Practicing members of the American Psychological Association ( APA) were surveyed regarding their work settings, activities, and greatest professional concerns in the managed care era. Results from 15,918 licensed psychologists indicated that half were full-time independent practitioners engaged principally in psychotherapy and assessment and another third were in part-time private practice.Four out of five reported a negative impact of managed care on their practices. Concerns about changes to practice and ethical dilemmas as a result of managed care policies were common to all settings. Relatively few differences were apparent between earlier and more recent generations.
The authors conclude that the PDP successfully achieved a primary objective for which it was established by demonstrating that licensed psychologists can be trained to provide safe, high-quality pharmacological care. As such, the project serves as a foundation for efforts to include prescription authority in state licensing laws and for the further development of a psychological model for prescribing. The Department of Defense (DoD) Psychopharmacology Demonstration Project (PDP) has been one of the most intensively studied and widely scrutinized experiments in the training of non-physicians for prescriptive authority. The result of Congressional action in 1988, the PDP training program was initiated in 1991 by the DoD as a demonstration project to train already
How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.
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