It is difficult to believe that four decades ago, I embarked upon what would become a most fascinating journey, on the very first day of the infamous Watergate hearings. I retired from the U.S. Senate staff with wonderful memories and a deep feeling of accomplishment. Our nation's Capital is an unforgettable place; rich in history and tradition, and for those who decide to become engaged in the public policy/political process, providing a once in a lifetime opportunity to "make a real difference" in the lives of our nation's citizens. It is simply an awesome experience that I would recommend to every colleague; an opportunity to truly "give psychology away" in the finest sense. When I arrived in Washington, DC, professional psychology was, in retrospect, in its infancy – especially in becoming involved in the public policy/political arena. Practice legends Ted Blau, Nick Cummings, Max Siegal, Logan Wright, and Ray Fowler had not yet begun thinking about running for APA President. What today we might consider specialized professional divisions (e.g., Divisions 38, 41, 42, 55, etc.) simply did not exist. In the mid-1970s, we were collectively just beginning to appreciate our potential role as generic health care providers, beyond being "merely" mental health specialists in small private practices and community mental health centers.
In the early 1970s, the profession was fortunate to have committed visionaries at both the state and national level. In New Jersey, Gene Shapiro, Bob Weitz, Marv Metsky, and Stan Moldawsky were paving the way for psychology's ultimate recognition as a licensed independent profession. Those seeking to advance our professional agenda had little expectation that APA, which was historically heavily influenced by academic psychology, would be the appropriate vehicle for guiding professional psychology's (r)evolution. Consequently, much of the creative energy over the next several decades would be strategically expended outside of APA as California's Nick Cummings and the late Rogers Wright, along with their "dirty dozen" colleagues, pressed for (dare we say "lobbied for") psychology's statutory recognition. Future APA President Jack Wiggins (envisioning and naming the National Register), Gene, and Carl Zimet worked with the APA Board of Directors and the American Board of Professional Psychology to establish this vibrant entity, chaired by Carl, outside of APA's governance. The professional school movement and specialized post-doctoral educational initiatives (e.g., rehabilitation psychology and psychology and the law) would come. Reflecting, I expect that it is probably impossible for today's early career psychologists to truly appreciate yesterday's seemingly turbulent and yet vibrant environment. So many really do owe so much to so few.
In the midst of what must be considered a period of extraordinarily exciting professional growth, our esteemed colleague Alfred M. Wellner strived to operationalize what he, a gifted visionary, could readily see needed to be accomplished. He was clearly an individual who was ahead of his time. He appreciated that if the profession of psychology were ever to fulfill its clinical potential, it would have to position itself for those who established federal (and state) health policy standards in a logical and transparent manner. He understood that psychology would have to address the vexing questions: "Who are we?" and "How can we assure the public (and those who ultimately pay for our services) that we are who we say we are?" At the time, Gene and Jack were focusing upon independent recognition under the Department of Defense CHAMPUS program, where these fundamental questions had to be answered for non-psychologist administrators. Al soon came to experience that as a discipline, psychologists are wonderfully talented in developing rationales for why something cannot be done or exploring ad infinitum why what has been proposed must be modified. In spite of these seemingly insurmountable challenges Al persisted and even invited me to participate in reviewing resumes for potential inclusion in his envisioned National Register of Health Care Providers in Psychology. Several states had not yet passed licensing laws so the Register served as the resource for insurance carriers and others to identify qualified psychologists eligible for reimbursement. Should those with PhD's be differentiated from those with EdD's? Was a doctorate in clinical substantially different than one in counseling or educational psychology? What about licensed masters level psychologists? There were no simple answers; yet Al pressed on – proclaiming decisions had to be made and always in an open and judicious manner. The Register was serving a critical need of the time providing an objective listing of those who should be deemed "psychologists" for the purpose of receiving reimbursement for their clinical services. And, its Psychologists' Legal Consultation Plan brought to life the crucial interface of psychology and the law for many practitioners. Alfred M. Wellner was a visionary who was decades ahead of his time. Mahalo.
With the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA), our nation has finally taken the position that all Americans will have access to timely healthcare, particularly patient-centered, gold standard (i.e., data driven) primary care. Putting this in perspective, this has been a policy agenda for nearly every President since Franklin D. Roosevelt, regardless of political affiliation. By 2014, almost all of the provisions of ACA will have been implemented and the healthcare environment for psychology's practitioners and training institutions will have undergone unprecedented change. The extraordinary advances occurring today within the computer and communications fields call out for some form of national licensure and national scope of practice for each of the health professions. There is increasing evidence that the quality of telehealth services are comparable to, and often significantly more cost-effective, than traditional face-to-face provider relationships based upon geographical availability, especially with the younger technology-savvy generation. Under the leadership of Al's successor, Judy Hall, the Register has been proactively positioning itself to address this professional and societal need, working closely with the leadership of the various state licensing boards and now being recognized, or in the process of being recognized, in 46 jurisdictions in the U.S. and Canada as a vehicle for licensure mobility. Similarly, the Register's leadership has been highly cognizant of the unique and pressing needs of our early career psychologists for obtaining quality and relevant continuing education experiences.
The Register was established at a time when psychology was just beginning to seek federal statutory and regulatory recognition. Over the years, we successfully obtained inclusion under CHAMPUS (now TRICARE), the Federal Employees' Health Benefit Program, the Federal Workers Compensation Act, the Federal Criminal Code, various provisions of Medicare; and such training initiatives as the Indian Education Act Fellowship program, the National Health Service Corps Scholarship Program, and the Individual Federal Insured Loan Program. Recognition was obtained under various provisions of the Social Security Disability Benefits Act, not to mention eligibility for the U.S. Public Health Service Regular Corps which is the sole requirement for being appointed U.S. Public Health Service Surgeon General. This was also the era when Nick and his colleagues participated in the Colorado Medicare study Senate Finance Committee hearings, exploring to what extent psychological services were "safe, effective, and appropriate" pursuant to the U.S. Office of Technology Assessment finding that only 10 to 20 percent of all medical procedures had been shown by controlled tests to be beneficial. Today there are of course many new legislative challenges; for example, obtaining inclusion under the Medicare Graduate Medical Education (GME) program, Medicaid (which is the foundation for the ACA's beneficiary expansion efforts), and express recognition under the Accountable Care Organization and Medical Home provisions of ACA.
At this year's 2013 outstanding APA State Leadership conference, Practice Directorate ED Katherine Nordal reflected upon the radically changing healthcare environment: "At this time last year, the future of the Affordable Care Act (ACA) seemed uncertain. The ACA has survived, and implementation of the largest expansion of the health care safety net will proceed. We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us. The details of ACA implementation vary from state to state, and so do the key players. I see professional psychology facing challenges on three levels: First, there are challenges on the federal level. Beyond the federal level, there are challenges for the states. A principle example is expansion of Medicaid as ACA is fully implemented. And, there are challenges for individual practitioners regardless of practice setting. Our practitioners increasingly will need to promote the value and quality they can contribute to emerging models of care. I believe that if we are not valued as a health profession, it will detract from our value in other practice arenas as well. So regardless of how we feel about the current state of our health care system, psychology must take its seat at the table and contribute to the solutions needed to fix our ailing system.
"No one else is fighting the battles for psychology… and don't expect them to. Health care reform is a marathon – we're in it for the long haul. New models of care and changes in health care financing won't take shape overnight. We can't afford to be left out of health care again [i.e., Medicare] and then have to spend decades playing catch-up. We can't hope to finish the marathon called health care reform if we're not at the starting line. Fortunately, many psychology leaders have embraced our call to action." We need another "dirty dozen" to fight for the role of tomorrow's providers. Aloha,
Pat DeLeon, former APA President – National Register – April, 2013
