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Clinical Neuropsychology in North America:

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  • Responses below 1 st and above 99 th were excluded. Direct patient contact time for interview and test administration is about 48% of total time spent. Camara, Nathan, and Puente (2000) found that among administration, scoring, and interpretation as a total, the latter two represented 44% of the time. A grand average would be that 12.2 hours are spent and elsewhere in our data for the total sample, an average of 9.9 hours are billed. Clearly, when only reimbursed for face to face time, we are way undervalued and lose considerable money, without even considering the discounted rate .

Clinical Neuropsychology in North America: Presentation Transcript

  • 1. Clinical Neuropsychology in North America: What the First Twenty Five Years Might Tell Us About the Future of the Specialty Antonio E. Puente Department of Psychology University of North Carolina at Wilmington Wilmington, North Carolina 28403 www.uncw.edu/people/puente www.clinicalneuropsychology.us [email_address]
  • 2. Outline
    • Introduction
    • Brief Overview of Twenty Five Years
    • Current Status
    • Projections for the Future
    • Challenges, Pitfalls and Opportunities
  • 3. History: Organizational
    • American Psychological Association
    • Division of Clinical Neuropsychology (40)
    • National Academy of Neuropsychology
    • International Neuropsychological Society
    • Other issues/groups;
      • APA’s First Specialty (1996)
      • Board Certification (e.g., ABPN)
      • Licensure (e.g., Louisiana)
      • Specialty Groups (e.g., Pediatrics)
  • 4. History: Informational
    • Publications
      • Books
      • Journals
      • Online
    • Trends
      • Assessment
      • Rehabilitation
      • Forensic
  • 5. History: Personnel
    • Overall Trends
      • Growth Patterns
      • Demographic Patterns
      • Academic Vs. Clinical
    • Individuals
      • Reitan
      • Golden
      • Kaplan
      • Others
  • 6. History: Clinical Activities
    • Assessment
      • Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska)
      • Flexible Approach
    • Rehabilitation
      • Cognitive Rehabilitation
    • Forensic
      • Disability
      • Worker’s Compensation
  • 7. Current Status: Review of the Surveys
    • Brief History of Surveys
      • Hartlage
      • DeLuca & Putnam
    • Current Survey Methodology
      • Sweet & Peck
      • Division 40 and NAN
  • 8. APA Membership   Year Doctorate Masters Bachelors 1970 1505 457 2975 2183 19077 14602 1980 1921 1333 4096 5812 15440 26653 1990 1566 2245 3377 7353 15336 38616 2000 1405 2905 3552 10913 17402 56600
  • 9. APA Membership by Division
    • Approximately 150,000 members
    • Approximately 50 different divisions
    • Top three divisions are:
      • Clinical Psychology
      • Clinical Neuropsychology
      • Independent Practice
  • 10. What is Clinical Neuropsychology?
    • Study and practrice of the relationship between brain and behavior, especially in neurological patients
    • Approximately 4-5,000 (out of 150,000)
    • Doctorate with post-doctorate training is minimum requirement
    • Difficulties in agreement of definition
  • 11. Survey of Clinical Neuropsychology
    • National Academy of Neuropsychology
    • Division of Clinical Neuropsychology of the APA
    • Surveyors: Jerry Sweet & Ted Peck
    • Date: 2001-2002
  • 12. Survey Return Rates
    • Actual Return Rate
    • 1569 returns
    • 5791 mailed
    • 1569/5791 = 27.1 %
    • Adjusted Return Rate
    • Or returns, 1406 U.S., Doctoral, Licensed, Clinicians
    • Of mailed, 1590 excluded (duplicates, unintended, undelivered)
    • 1406/4201 = 33.5 %
  • 13. Organizational Membership (All Doctoral Licensed Clinicians) Percent
  • 14. Gender (All Doctoral Licensed Clinicians vs. Younger Samples)
    • Age:
    • Males = 48.6 (n=866)
    • Females = 45.5 (n=524)
    • Years Since Licensed:
    • Males = 14.6 (n=855); Females = 10.1 (n=508)
    • ----------------------------------
    Among licensed <10 years: (n=525) Males = 48.6% Females = 51.4% Among licensed <5 years: (n=216) Males = 36.6% Females = 63.4% Percent
  • 15. Type of Doctoral Degree (All Doctoral Licensed Clinicians) Percent
  • 16. Field of Doctoral Degree (All Doctoral Licensed Clinicians) Percent
  • 17. Work Status (All Doctoral Licensed Clinicians) Percent
  • 18. Work Setting (All Doctoral Licensed Clinicians) Percent
  • 19. Gender Within Work Setting (Doctoral Licensed Clinicians) Percent
  • 20. Board Certification Status (Doctoral Licensed Clinicians) Percent
  • 21. Weekly Professional Activities by Organization Percent
  • 22. Weekly Professional Activities by Organization Percent
  • 23. Percentages of Reimbursement Sources (For All Doctoral Licensed Clinicians)
  • 24. Incomes by Organization (Doctoral Licensed Clinicians Working Full Time or Full Time+) $
  • 25. Correlates of Income
    • Years licensed .27**
    • Work Setting -.25 **
    • % Forensic .24**
    • Gender -.21 **
    • % Self Pay .19**
    • Age .18**
    • Hrs billed/Eval .13**
    • % Public Aid -.12 **
    • % Medicare -.09 *
    • % Man. Care -.09 *
    • % Indemnity .07
    • % Indigent -.04
    *=.05 **=.01 Negative correlations in red. “ Work Setting” above limited to Private and Institution All n s between 775 and 1185
  • 26. Income by Years of Licensure Stratification - Mean (Median) ‘ Starting ’ Salaries - Mean (Median)
  • 27. Income by Work Setting (Doctoral Licensed Clinicians Working Full Time or Full Time+)
  • 28. HOURS/Week Clinical Activity
  • 29. Evaluation Time by Evaluation Goal (Except forensic, those using assistants test more hours (e.g., for determination of diagnosis, 6.6 hrs vs. 5.8 hrs, p =.017.) However, hours billed are similar .
  • 30. Time-Related Case Activities (All Doctoral Licensed Clinicians) Hours billed: Private=11.1 (SD=5.0); Institution=8.2 (SD=3.3) * Only scoring is not significant between groups; covarying amount of forensic practice did not eradicate group differences Minutes
  • 31. Use of Testing Assistants (All Doctoral Licensed Clinicians) Percent
  • 32. Use Of Testing Assistants By Work Setting Percent Using Assistants (n=1349)
  • 33. CPT Codes Used For Neuropsych Assessment Activities (Doctoral Level Clinicians) CPT Code for Activities Frequency Percent Intake Interview 90801 96117 96115 Other (16 codes) 231 106 40 21 16.5 7.6 2.9 1.5 Clinical interview/history 90801 96117 96115 Other (20 codes)   250 180 59 34   17.9 12.9 4.2 2.4 Test administration 96117 96100 96115 Other (12 codes)   498 37 9 21   35.7 2.7 0.6 1.5
  • 34. CPT: Applicable Codes
    • Total Possible Codes = 7,500
    • Possible Codes for Psychology = Approximately 40 to 60
    • Three Paradigms
      • Psychiatry/Mental Health
      • Neurology
      • Medicine
    • Sections = Five Separate Sections
      • Psychiatry
      • Biofeedback
      • Central Nervous Assessment
      • Physical Medicine & Rehabilitation
      • Health & Behavior Assessment & Management
  • 35.
    • CPT: Background
    • American Medical Association
      • Developed by Surgeons (& Physicians) in 1966 for Billing Purposes
      • 7,500 Discrete Codes
    • HCFA/CMS
      • AMA Under License with CMS
      • CMS Now Provides Active Input into CPT
    • Congress
      • Trent Lott (2001)
  • 36. Time for the Future
    • Is History the Best Predictor for Our Future?
    • What are APA Members Worried About?
    • My Own Personal Glimpse Into What Awaits Clinical Neuropsychology
  • 37. Initial Results of APA Policy & Planning Survey
    • Procedure
      • Five Year Review of Status of APA & Psychology
      • Random Survey of APA Membership, Staff, & Governance
    • Results
      • Public Image of Psychology
      • Protecting & Expanding Sources of Income
      • Membership Concerns
  • 38. What Trends Are Developing
    • Organizational
    • Informational
    • Professional (versus Clinical)
    • Financial
    • Public Policy
  • 39.
    • Immediate Predictions Income (depends on activity; if clinical)
      • Steadier (if economy does not further erode)
      • Probable incremental declines, up to 10-20%
      • “ Final” stabilization by 2005
    • Recognition
      • Physician Level
      • Mental vs. Physical Health
    • Paradigms
      • Industrial vs. Boutique
      • Health vs. Non-Health
  • 40. Potential Overall Trends
    • Catching up to Psychiatry
    • Leaving Psychiatry
    • Joining Medicine
    • Leaving Medicine
      • Legal
      • Sports
      • Governmental
      • Industrial
  • 41.
    • Future Problems
    • Empirical Data Base
    • Limited Understanding of Culture
    • Continued Professional Infighting
    • Personnel Issues
    • Value to Society (face vs criterion validity)
  • 42. Summary
    • Continued Growth
    • Especially in the Professional Domains
    • Expansion Beyond Mental Health, to Health, to Other Areas
    • Vibrant and Unpredictable yet Exciting
  • 43.
    • Defining the Future…
    • New Paradigm = Change