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Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
Clinical Neuropsychology in North America:
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Clinical Neuropsychology in North America:

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  • Responses below 1st and above 99th 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.
  • Transcript

    • 1. Clinical Neuropsychology inClinical Neuropsychology in North America:North America: What the First Twenty Five Years Might Tell UsWhat the First Twenty Five Years Might Tell Us About the Future of the SpecialtyAbout the Future of the Specialty Antonio E. PuenteAntonio E. Puente Department of PsychologyDepartment of Psychology University of North Carolina at WilmingtonUniversity of North Carolina at Wilmington Wilmington, North Carolina 28403Wilmington, North Carolina 28403 www.uncw.edu/people/puentewww.uncw.edu/people/puente www.clinicalneuropsychology.uswww.clinicalneuropsychology.us puente@uncw.edupuente@uncw.edu
    • 2. OutlineOutline  IntroductionIntroduction  Brief Overview of Twenty Five YearsBrief Overview of Twenty Five Years  Current StatusCurrent Status  Projections for the FutureProjections for the Future  Challenges, Pitfalls and OpportunitiesChallenges, Pitfalls and Opportunities
    • 3. History: OrganizationalHistory: Organizational  American Psychological AssociationAmerican Psychological Association  Division of Clinical Neuropsychology (40)Division of Clinical Neuropsychology (40)  National Academy of NeuropsychologyNational Academy of Neuropsychology  International Neuropsychological SocietyInternational Neuropsychological Society  Other issues/groups;Other issues/groups;  APA’s First Specialty (1996)APA’s First Specialty (1996)  Board Certification (e.g., ABPN)Board Certification (e.g., ABPN)  Licensure (e.g., Louisiana)Licensure (e.g., Louisiana)  Specialty Groups (e.g., Pediatrics)Specialty Groups (e.g., Pediatrics)
    • 4. History: InformationalHistory: Informational  PublicationsPublications  BooksBooks  JournalsJournals  OnlineOnline  TrendsTrends  AssessmentAssessment  RehabilitationRehabilitation  ForensicForensic
    • 5. History: PersonnelHistory: Personnel  Overall TrendsOverall Trends  Growth PatternsGrowth Patterns  Demographic PatternsDemographic Patterns  Academic Vs. ClinicalAcademic Vs. Clinical  IndividualsIndividuals  ReitanReitan  GoldenGolden  KaplanKaplan  OthersOthers
    • 6. History: Clinical ActivitiesHistory: Clinical Activities  AssessmentAssessment  Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska)Fixed Battery (Halstead-Reitan Vs. Luria-Nebraska)  Flexible ApproachFlexible Approach  RehabilitationRehabilitation  Cognitive RehabilitationCognitive Rehabilitation  ForensicForensic  DisabilityDisability  Worker’s CompensationWorker’s Compensation
    • 7. Current Status: Review of theCurrent Status: Review of the SurveysSurveys  Brief History of SurveysBrief History of Surveys  HartlageHartlage  DeLuca & PutnamDeLuca & Putnam  Current Survey MethodologyCurrent Survey Methodology  Sweet & PeckSweet & Peck  Division 40 and NANDivision 40 and NAN
    • 8. APA MembershipAPA 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 DivisionAPA Membership by Division  Approximately 150,000 membersApproximately 150,000 members  Approximately 50 different divisionsApproximately 50 different divisions  Top three divisions are:Top three divisions are:  Clinical PsychologyClinical Psychology  Clinical NeuropsychologyClinical Neuropsychology  Independent PracticeIndependent Practice
    • 10. What is ClinicalWhat is Clinical Neuropsychology?Neuropsychology?  Study and practrice of the relationshipStudy and practrice of the relationship between brain and behavior, especially inbetween brain and behavior, especially in neurological patientsneurological patients  Approximately 4-5,000 (out of 150,000)Approximately 4-5,000 (out of 150,000)  Doctorate with post-doctorate training isDoctorate with post-doctorate training is minimum requirementminimum requirement  Difficulties in agreement of definitionDifficulties in agreement of definition
    • 11. Survey of ClinicalSurvey of Clinical NeuropsychologyNeuropsychology  National Academy of NeuropsychologyNational Academy of Neuropsychology  Division of Clinical Neuropsychology of theDivision of Clinical Neuropsychology of the APAAPA  Surveyors: Jerry Sweet & Ted PeckSurveyors: Jerry Sweet & Ted Peck  Date: 2001-2002Date: 2001-2002
    • 12. Survey Return RatesSurvey Return Rates ActualActual Return RateReturn Rate  1569 returns1569 returns  5791 mailed5791 mailed 1569/5791 =1569/5791 = 27.127.1%% AdjustedAdjusted Return RateReturn Rate  Or returns, 1406 U.S.,Or returns, 1406 U.S., Doctoral, Licensed,Doctoral, Licensed, CliniciansClinicians  Of mailed, 1590Of mailed, 1590 excludedexcluded (duplicates,(duplicates, unintended, undelivered)unintended, undelivered) 1406/4201 =1406/4201 = 33.533.5%%
    • 13. Organizational MembershipOrganizational Membership (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 0 5 10 15 20 25 30 35 40 45 50 NAN only (n= 156) D40 only (n= 276) Both (n= 670) Unknow n (n= 304) Percent
    • 14. GenderGender (All Doctoral Licensed Clinicians vs. Younger(All Doctoral Licensed Clinicians vs. Younger Samples)Samples) 62.3 37.7 0 10 20 30 40 50 60 70 Male (n=871) Female (n= 528) Age:Age: Males = 48.6Males = 48.6 (n=866)(n=866) Females = 45.5Females = 45.5 (n=524)(n=524) Years Since Licensed:Years Since Licensed: Males = 14.6Males = 14.6 (n=855);(n=855); Females = 10.1Females = 10.1 (n=508)(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 DegreeType of Doctoral Degree (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 0 10 20 30 40 50 60 70 80 90 PhD (n= 1225) PsyD (n= 143) EdD (n= 24) Percent
    • 16. Field of Doctoral DegreeField of Doctoral Degree (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 0 10 20 30 40 50 60 70 Clinical Couns. Neuro. School Ed. Psy. Comb. Percent
    • 17. Work StatusWork Status (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 0 10 20 30 40 50 60 70 80 Full Time Part Time Full + Part Not Working Percent
    • 18. Work SettingWork Setting (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 0 5 10 15 20 25 30 35 40 Private Practice I nstitution Comb. Other Percent
    • 19. Gender Within Work SettingGender Within Work Setting (Doctoral Licensed Clinicians)(Doctoral Licensed Clinicians) 0 10 20 30 40 50 60 70 Private I nstitution Comb. Other Male Female Percent
    • 20. Board Certification StatusBoard Certification Status (Doctoral Licensed Clinicians)(Doctoral Licensed Clinicians) 0 10 20 30 40 50 60 70 80 Board Certified (n= 271) Not Board Certified (n= 1053) Percent
    • 21. Weekly Professional Activities byWeekly Professional Activities by OrganizationOrganization 0 10 20 30 40 50 60 70 80 Clinical Pract. Teach. Research ($) Res. (No $) Non-Clin Admin. NAN D40 Both Unknow n Percent
    • 22. Weekly Professional Activities byWeekly Professional Activities by OrganizationOrganization 0 10 20 30 40 50 60 70 80 Supervision Forensic NAN D40 Both Unknow n Percent
    • 23. Percentages of ReimbursementPercentages of Reimbursement SourcesSources (For All Doctoral Licensed Clinicians)(For All Doctoral Licensed Clinicians) 0 5 10 15 20 25 30 Managed Care Medi- care I ndemnit y I nsur Self Pay CHAMPUS Public Aid I ndigent Forensic
    • 24. Incomes by OrganizationIncomes by Organization (Doctoral Licensed Clinicians Working Full(Doctoral Licensed Clinicians Working Full Time or Full Time+)Time or Full Time+) 78,228 99,296 107,856 108,794 103,336 0 20,000 40,000 60,000 80,000 100,000 120,000 NAN n= 125 D40 n= 223 Both n= 581 Unkn. n= 259 Overall n= 1188 Mean Median $
    • 25. Correlates of IncomeCorrelates of Income  Years licensed .27**Years licensed .27**  Work SettingWork Setting -.25-.25****  % Forensic .24**% Forensic .24**  GenderGender -.21-.21****  % Self Pay .19**% Self Pay .19**  Age .18**Age .18**  Hrs billed/Eval .13**Hrs billed/Eval .13**  % Public Aid% Public Aid -.12-.12****  % Medicare% Medicare -.09-.09**  % Man. Care% Man. Care -.09-.09**  % Indemnity .07% Indemnity .07  % Indigent% Indigent -.04-.04 *=.05 **=.01*=.05 **=.01 Negative correlations in red.Negative correlations in red. ““Work Setting” above limited to Private and InstitutionWork Setting” above limited to Private and Institution AllAll nns between 775 and 1185s between 775 and 1185
    • 26. Income by Years ofIncome by Years of LicensureLicensure 0 Yrs $44,763 (47K) 1-5 73,567 (63K) 6-10 93,172 (77K) 11-15 109,457 (88K) 16-20 118,776 (93K) 21-25 126,979 (102K) 26-30 152,359 (120K) 0 Yrs $44,763 1 66,810 (56K) 2 61,512 (61K) 3 69,061 (60K) 4 94,800 4 (minus outlier) 78,641 (70K) 5 73,596 (65K) Stratification - Mean (Median) ‘Starting’ Salaries - Mean (Median)
    • 27. Income by Work SettingIncome by Work Setting (Doctoral Licensed Clinicians Working Full Time or(Doctoral Licensed Clinicians Working Full Time or Full Time+)Full Time+) 127318 105000 76463 70000 105149 87750 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 Private (n= 424) I nstitution (n= 378) Comb. (n= 358) Mean Median
    • 28. HOURS/Week Clinical ActivityHOURS/Week Clinical Activity 3.3 2.1 13.7 3.7 2.1 2.5 4.9 0.6 2.2 2.1 0 5 10 15 DX I nterv Nbeh Ex Npsy Test Psy Test F/ Up Ass. TX (BD) TX (No BD) CogReh Tx plan Superv
    • 29. Evaluation Time by Evaluation GoalEvaluation Time by Evaluation Goal 6.3 4.4 4.2 4.8 9.3 0 2 4 6 8 10 Determ DX (n= 1022) (1-16) TX Plan (n= 914) (.5-12) Pre/ Post (n= 566) (1-10) Baseline (n= 784) (1-10) Forensic (n= 790) (1-20) (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 ActivitiesTime-Related Case Activities (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 319 260 0 50 100 150 200 250 300 350 I ntake I nterview Rec Rev Test Admin Scoring * I nterp/ Rep Feedback Cons Ref So Privat e I nst it ut ion 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 AssistantsUse of Testing Assistants (All Doctoral Licensed Clinicians)(All Doctoral Licensed Clinicians) 51.2 48.8 0 10 20 30 40 50 60 Yes (n= 692) No (n= 660) Percent
    • 32. Use Of Testing Assistants By WorkUse Of Testing Assistants By Work SettingSetting 72 48 46 51 39 0 20 40 60 80 Private Practice Institution Combination Other Total Percent Using Assistants (n=1349)
    • 33. 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 CPT Codes Used For Neuropsych Assessment Activities (Doctoral Level Clinicians)
    • 34. CPT: Applicable CodesCPT: Applicable Codes  Total Possible Codes = 7,500Total Possible Codes = 7,500  Possible Codes for Psychology = Approximately 40 to 60Possible Codes for Psychology = Approximately 40 to 60  Three ParadigmsThree Paradigms  Psychiatry/Mental HealthPsychiatry/Mental Health  NeurologyNeurology  MedicineMedicine  Sections = Five Separate SectionsSections = Five Separate Sections  PsychiatryPsychiatry  BiofeedbackBiofeedback  Central Nervous AssessmentCentral Nervous Assessment  Physical Medicine & RehabilitationPhysical Medicine & Rehabilitation  Health & Behavior Assessment & ManagementHealth & Behavior Assessment & Management
    • 35. CPT: BackgroundCPT: 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 FutureTime for the Future  Is History the Best Predictor for OurIs History the Best Predictor for Our Future?Future?  What are APA Members Worried About?What are APA Members Worried About?  My Own Personal Glimpse Into WhatMy Own Personal Glimpse Into What Awaits Clinical NeuropsychologyAwaits Clinical Neuropsychology
    • 37. Initial Results of APA Policy &Initial Results of APA Policy & Planning SurveyPlanning Survey  ProcedureProcedure  Five Year Review of Status of APA & PsychologyFive Year Review of Status of APA & Psychology  Random Survey of APA Membership, Staff, &Random Survey of APA Membership, Staff, & GovernanceGovernance  ResultsResults  Public Image of PsychologyPublic Image of Psychology  Protecting & Expanding Sources of IncomeProtecting & Expanding Sources of Income  Membership ConcernsMembership Concerns
    • 38. What Trends Are DevelopingWhat Trends Are Developing  OrganizationalOrganizational  InformationalInformational  Professional (versus Clinical)Professional (versus Clinical)  FinancialFinancial  Public PolicyPublic Policy
    • 39. Immediate PredictionsImmediate 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 TrendsPotential Overall Trends  Catching up to PsychiatryCatching up to Psychiatry  Leaving PsychiatryLeaving Psychiatry  Joining MedicineJoining Medicine  Leaving MedicineLeaving Medicine  LegalLegal  SportsSports  GovernmentalGovernmental  IndustrialIndustrial
    • 41. Future ProblemsFuture Problems Empirical Data Base Limited Understanding of Culture Continued Professional Infighting Personnel Issues Value to Society (face vs criterion validity)
    • 42. SummarySummary  Continued GrowthContinued Growth  Especially in the Professional DomainsEspecially in the Professional Domains  Expansion Beyond Mental Health, toExpansion Beyond Mental Health, to Health, to Other AreasHealth, to Other Areas  Vibrant and Unpredictable yet ExcitingVibrant and Unpredictable yet Exciting
    • 43. Defining theDefining the Future…Future… New Paradigm = Change

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