As the profession of psychology has matured, serious interest has surfaced over the past decade in obtaining prescription privileges within the practitioner community. Other nonphysician disciplines have exercised this clinical responsibility for years, significantly improving their ability to comprehensively serve current and new populations. Efforts are underway to develop appropriate and viable training modules. The primary objection expressed by medicine is once again that our practitioners will become "public health hazards." Not surprisingly, resistance to change exists within psychology's training programs. However, the power to prescribe represents the authority to ensure that psychotropic medications are appropriately utilized, if used at all, and will ensure that psychology's practitioners can address society's pressing needs.
Many psychologists are finding new opportunities for practice in primary care settings. These settings challenge many aspects of traditional practice and require adaptation and innovation. Psychologists must consider changes in their site of practice, treatment duration, type of intervention, and role as part of a health care team. This article describes the culture of primary care medicine and offers 10 practical tips for the adaptation of psychological practice to primary care.Primary care is now the linchpin of the new health care delivery system. This focus on primary care creates both threats to the conventional independent practice of psychology and new opportunities for collaboration and direct participation in the delivery of primary care services. In terms of threat, a psychologist whose solo or small-group practice has focused predominately on private, office-based psychological assessment and psychotherapy faces increasing economic pressures created by market-driven reforms, managed care, and other limits to traditional fee-for-service psychological services (Frank & Vandenfios, 1994). Managed care systems increasingly rely on primary care providers (including physicians in family medicine, general internal medicine, pediatrics, and sometimes obstetricsgynecology) to screen and triage patients with a wide range of medical and psychological problems. These physicians are the gatekeepers for referral to all specialists, including psychologists. In terms of opportunity, psychologists who shift their practices to work closely with these providers as part of an integrated delivery system are most likely to continue to deliver services to a wide variety of patients (Shortell, Gillies, & Anderson, 1994).Many patients who present in primary care settings have psy-
At present, nearly 70% of APA members are identified as health care providers. The PhD degree, a generic scholarly degree, is most commonly used to certify completion of doctoral studies in professional psychology. As a result, the consumer has difficulty determining which psychologist is qualified to provide health care. The Doctor of Psychology (PsyD) should identify those psychologists who provide doctoral-level health services. Licensed, qualified PhD psychologists could be awarded the PsyD retroactively on the basis of a credential review, as the JD degree was awarded to lawyers previously holding the LLB. Applicants for the PsyD would not relinquish their PhD degrees. Upon review and approval, they would identify themselves with both degrees: PsyD, PhD. Mechanisms for accomplishing the change are suggested.
Discusses factors that have affected and recently improved the tenuous and often hostile relationship between psychologists and unions, including an increase in published studies illustrating the applicability of psychological knowledge to labor concerns, activities within organized psychology, and increased interest in behavioral issues on the part of organized labor. In an effort to explore and ultimately improve the perception and utilization of psychologists by unionists, the authors present an overview of the literature on unionists and psychologists, offer contextual information to explain the relationship problems, and describe a number of projects conducted by an American Psychological Association task force on unions. Findings from a survey sent to 150 national, international, and independent unions that assessed current and past problems between psychologists and unions, unionist perceptions of psychologists, and the need for services that could be delivered by psychologists are presented. The need for further work, such as the identification of prolabor psychologists in the field and demonstrations to unions and their members of the efficacy of services provided by health care and organizational psychologists, is discussed. (68 ref)
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