The annual APA Practice Directorate State Leadership conferences (SLC) provide an exciting opportunity for practitioners to personally experience how the public policy process will directly affect their future. With the enactment of President Obama's landmark
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Psychologists must come to appreciate that it is essential to be personally involved in the public policy/political process if we want to maintain our professional identity and independence. The newly elected President of the American Medical Association (AMA), in response to questions regarding non-physician health care providers, has stated: "It's imperative that we collaborate. The patients need that. We think that care must be delivered in a physician-led team. There are appropriate roles for other health-care providers, like nurse practitioners [NPs] and physician assistants [PAs]. They all have the ability to function to their highest level within a physician-lead team. [Why 'physician-led team?'] The physician has the potential and capability to manage the unexpected, something that might not go as predicted. And that's why you need a team. The physician is the highest trained and the one who has to be in charge of the whole thing."
Perhaps not a surprising orientation. However, last summer the Centers for Medicare and Medicaid Services (CMS) issued proposed conditions of participation for community mental health centers (CMHCs) which seem to take the AMA's view to another level. "The comprehensive assessment would build from the initial evaluation and be completed by the physician-led interdisciplinary team in consultation with the patient's primary health care provider, if any…. The CMHC must designate a physician-led interdisciplinary treatment team that is responsible, with the client, for directing, coordinating, and managing the care and services furnished for each client." Interestingly, psychologists will be allowed to conduct psychiatric evaluations, if there is a "physician counter signature." This summer the Department of Veterans Affairs (VA) requested: "A nationwide blanket tier exception for Psychiatrists… in order to provide a broader and more competitive salary range to potential recruits and provide greater retention to existing staff." Hardly a vision of effectively utilizing the skills of non-physician providers by the current Administration.
President Obama recently issued an important Executive Order – Improving Access to Mental Health Services for Veterans, Service Members, and Military Families. He called for the Departments of Veterans Affairs and Defense to jointly develop and implement a national suicide prevention campaign focused on connecting veterans and service members to mental health services. An Interagency Task Force will be established to be co-chaired by the Secretaries of Defense, Veterans Affairs, and Health and Human Services, or their designees. The critical question for psychology, as well as for other non-physician health care providers: What will our role be? We would suggest that it would be extraordinarily naïve to assume that all those involved in establishing and implementing important national (and local) health care policies truly have "the best interest" of the client/patient in mind, rather than their own professional identity or "turf." As our visionary leader
