Psychologists have been attempting to gain a greater voice in the actions and policies of the Joint Commission on Accreditation of Hospitals (JCAH)for more than 10 years. This article outlines the formal and informal attempts that have been made during that period to remove barriers to the hospital practice of psychology. Included are discussions of direct interactions with the Joint Commission itself, state legislative efforts, the Ohio Attorney General's antitrust suit against the JCAH, and the Federal Trade Commissions proposed investigation. Attempts to make the JCAH responsive to psychology's concerns are chronicled. The gradual changes in JCAH policies, and suggestions of future changes, are presented.
Considered from the perspective of licensed psychologists in fee-for-service practice, the extent of medical staff membership and clinical privileges are tabulated and described. The hospital practice of psychology, although still proportionally quite limited, is viewed in the context of interpnofessional competition and current trends. One fifth of fee-for-service licensed psychologists report membership on the medical staff of a hospital (one fourth if those with affiliate status are added). One fifth of fee-for-service licensed psychologists have formal privileges, whereas almost one third report some type of clinical privilege based on formal agreement or informal arrangement. These data on hospital practice were derived from a direct questionnaire survey of all licensed psychologists in 10 states.
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