Reassembling Psychology Proposed Modifications to the Training & Licensure of Psychologists in West Virginia

Transcription

1 Reassembling Psychology Proposed Modifications to the Training & Licensure of Psychologists in West Virginia William Brezinski, M.A. Licensed Psychologist Member of the West Virginia Board of Examiners of Psychologists Cell: (304) Office: (304) April 2014

2 2 PROPOSAL TO MODIFY THE TRAINING AND LICENSURE OF PSYCHOLOGISTS IN WEST VIRGINIA William Brezinski, MA April 2014 OUTLINE I feel compelled as a member of the West Virginia Board of Examiners to propose dramatic changes to the education and licensing of our psychological community to combat our deteriorating ability to meet the needs of West Virginians. This proposal calls for the transformation of West Virginia's psychological graduate education system in West Virginia and changes to the licensure process for psychologists. If enacted, this proposal will reverse the dangerous decline in service providers and end decades of dissention between Masters level and Doctoral level psychologists. Over a three to five year period, I propose that the Masters program at Marshall University be eliminated and that those faculty and resources be added to Marshall s existing Psychological Doctorate program (PsyD). West Virginia University has already abandoned their clinical Masters program. In the same timeframe, West Virginia University would transform their research based PhD program into to a practice based PsyD program. Both Marshall and WVU would be required to fill these programs with a significant majority of West Virginia applicants. An educational ladder for licensed Masters level psychologists would be created to allow advancement to Doctoral status through a new West Virginia Board of Regents PsyD degree. Eligible participants would be currently licensed Masters level psychologists as well as those in the existing Masters level licensure track. Requirements for this degree would include a valid license to practice psychology and 10 years worth of Continuing Education credits (100 CEUs) made available and supervised by the West Virginia Board of Examiners. After completing these requirements, individuals would be awarded a West Virginia Board of Regents PsyD degree. This proposal calls for the future elimination of Masters level licensure.

3 3 Important Questions Why are you bringing this up? Didn t the last PERD report document that adequate services were now being provided by Masters level psychologists? Access to psychological services to the citizens of WV is in a disturbing decline. Although presently underserved (WVBOE 2010 Report), the West Virginia Board of Examiners data demonstrates within 10 years, a crisis will be upon us. 46% of Doctoral level psychologists and 29% of Masters level psychologists in West Virginia are now 61 or older. About 10% of these individuals will be retiring each year for the next 10 years. This means 9 Masters level and 14 Doctoral level psychologists will retire each year. This decline will continue for the next decade as well. 58% of Masters level psychologists and 71% of Doctoral level psychologists are age 51 and older. Active Licensees by Age (2013) Number of Psychologists Under Age The graph below reflects changes in the number of licensed psychologists in West Virginia for each five-year period for the last 30 years Net Number of New Psychologists Per Year The number of psychologists has become static and soon will decline. With the aging of the profession, these numbers will quickly deteriorate, and West Virginia

4 4 will begin to lose providers at an estimated rate of 23 psychologists per year. New providers are not being produced at levels to replace those who retire. Where Our Universities Stand The PsyD program at Marshall University has produced an average of only 4 new Doctoral level psychologists a year. The PhD programs at West Virginia University produce almost no new psychologists who practice in West Virginia. Board of Examiners data shows that less than one WVU PhD graduate per year becomes a psychologist in West Virginia only eight in the last decade. West Virginia University produces no new Masters level graduates either, having abandoned this program altogether. Marshall University s Masters program fails to attract our best students, and students who graduate from Marshall s program have difficulty passing both the written and oral examinations required for licensure. Although they produce 43 Masters graduates per year, many never enter the licensure process and only an average of 8 per year (19%) of their graduates complete the licensure process. Ending the Masters/Doctoral Dispute This proposal will address decades of animosity within the psychological community. Our internal disputes regarding licensure have resulted in legislative fatigue, public chagrin, a diminished voice for the field of psychology, and estrangement between our most learned Doctoral level psychologists and the Masters level psychologists who provide the bulk of the services for our citizens, particularly in rural areas. In short, the status quo is not an option. If changes are not made, the availability of mental health services provided by trained, competent psychologists will drop dramatically. Without compromise on the licensure issue, psychologists will continue our dispute, weakening our profession and sapping our strength. What are the advantages to West Virginia? West Virginia's best and brightest psychology undergraduates will finally comprise our future psychological community. Currently, promising students feel compelled to apply to Doctoral programs at out-of-state universities or are limited to the poorly supported Masters program at Marshall University. Instead, these future clinicians will be able to earn a Doctoral degree designed to prepare them to serve their communities.

5 5 This is a simple solution, but will require modification of state code. However, the complicated federal guidelines regarding psychological services would not need to be rewritten, a significant cost savings when compared to the present proposal endorsed by the West Virginia Psychological Association. No new types of psychological providers would be created. The long-term dispute between Masters and Doctoral level psychologists will be resolved allowing our psychologists and legislators to focus on the most crucial issues: access, cost, and quality. All of these improvements and advancements come at no cost to West Virginia. What about internships? The universities already cite their absence as a major limiting factor in promoting their graduates to remain in WV. We can turn to our medical schools for guidance. Internship sites will be developed across West Virginia in a fashion similar to the model used by the West Virginia School of Osteopathic Medicine. This program has internships and residencies in 7 West Virginia hospitals from Beckley to Wheeling. They also rotate their students though medical settings in 48 of our 55 counties. West Virginia University has been known to have an excellent PhD program for decades. Why does your proposal affect it in such a substantial way? The West Virginia Board of Examiners of Psychologists 2010 Report clearly shows that almost all Doctoral level psychologists who are educated at WVU do not stay in West Virginia. The reason is clear; WVU does not admit many West Virginia applicants. In WVU s own words, they educate scientists, not clinicians for our state. This program has developed its identity by recruiting the very best undergraduate students from other states and involving them in its research based, academically oriented program. Our tax dollars train these students to work in a research/instructional capacity and the citizens of West Virginia export this money and talent out of state. WVU s graduates matriculate from other states, benefit from West Virginia s faculty, facilities, and tax dollars, and then promptly leave West Virginia when they graduate.

6 In-State vs. Out-of-State Graduates by University* School Program In State Graduates Out of State Graduates West Virginia University Counseling 1 1 West Virginia University Ph.D West Virginia University Total 1 16 Marshall University Total 4 0 *Most recent data available to the Board of Examiners In contrast, in 2012, West Virginia University Medical School admitted 63% of their new students from West Virginia applicants. Marshall University Medical School admitted 44% of their new students from West Virginia. On average, West Virginia University has produced 15 PhD psychology graduates per year for the last five years. By changing their focus to a practice oriented degree (PsyD versus PhD) and admitting a significant majority of their students from West Virginia applicants, most of these providers would be added to the ranks of our Doctoral clinicians. West Virginia University can refocus its research and grant efforts on topics relevant to providing mental health services in our state and relinquish the more esoteric research to the universities of other states who choose to fund those efforts. Our universities can have a beneficial presence in all of West Virginia s communities by helping to provide statewide psychological services. These benefits can be accrued without additional costs if service to the state is prioritized. The following is drawn from the Mission Statement of the West Virginia School of Osteopathic Medicine; The West Virginia School of Osteopathic Medicine is dedicated to serve, first and foremost, the state of West Virginia and the special health care needs of its residents, emphasizing primary care in rural areas. How would this affect Marshall University? The resources of the Masters program would be added to the resources of the existing PsyD program. In the last four years, Marshall University has graduated 17 Doctoral level providers (4.25 per year) and 172 Masters level graduates (43 per year). Most of their Masters graduates fail to become licensed after struggling to pass the required written and oral examinations. If the resources of these programs are combined and Marshall University produces the same number of

7 7 Doctoral graduates per faculty member as West Virginia University, Marshall will be producing 11 Doctoral level graduates each year. Combined, our University system will be producing 26 new Doctoral level psychologists each year and most graduates will stay in West Virginia. This exceeds the number expected to retire, and provides West Virginia a net gain in psychological care. Who would pay for the changes? The faculty positions are funded and the facilities have been paid for. (Based on their websites, West Virginia University presently has 25 psychology faculty positions. Marshall University has 19). The program at West Virginia University is located in the new 200,000 square foot Life Sciences Building. Marshall's facilities include campus buildings in both Huntington and Charleston. No additional space would be required. To elevate the existing Masters providers to Doctoral status, Continuing Education activities will be provided. This additional training for the ladder of advancement to Doctoral status would be paid for by the licensed Masters psychologists who participate. Graduate education is disproportionately expensive for psychologists if they pursue a Doctoral degree. Won t the cost prevent WV undergraduate students from being able to attend? What about student loans? If they borrow the money, won t this saddle them with unacceptable debt? Two funding sources could help. First, the University system depends upon graduate students who have Teaching Assistantships (TA) to instruct many of their undergraduate courses. A review of other PsyD programs shows that most offer support through TA programs. Secondly, after the first two years, PsyD graduate students can practice under supervision and provide billable services as Supervised Psychologists. This will allow funded practicum and internship experiences. If our Masters licensed providers receive a WV Board of Regents PsyD, won t many simply move out of state to increase their income? The West Virginia Board of Regents PsyD degree may not be accepted by licensing boards in other states because it will not be issued by a regionally accredited, APA certified training program. Holders of that degree will only benefit if they stay in West Virginia.

8 8 Would these new Doctoral graduates work in rural areas of our state? West Virginia has successfully dealt with this issue in its physician s community. 87% of Licensed Osteopathic Physicians practicing in West Virginia graduated from the WVSOM. Graduates who are from West Virginia are more than 10 times more likely to remain in our state as those from other states. These individuals are now providing services to 84% of our counties both in our smaller communities as well as in our cities. Their success stems from a clear orientation towards selecting and training physicians to work in the state of West Virginia with an emphasis on internship experiences across our state. Tailoring the admission process and training experiences for psychologists at West Virginia University and Marshall University would allow the same process to occur within the psychological community. How would you protect the individuals who are licensed with a Masters degree? If future Masters level licensure is eliminated, experience has shown that thirdparty payers will reduce reimbursement levels to Masters level providers who are currently licensed. This has already happened in the state of Pennsylvania. Creating the CEU based educational ladder will elevate participating Masters providers to Doctoral status and help protect them from income loss when the West Virginia Code is changed. This protection is important because psychologists who work in rural areas often treat low income West Virginians, which results in lower fees for the psychologist. In order for our Masters level providers to continue to function in these underserved areas, income protection is important. Would participation in this program be required for Masters level graduates who are already licensed in West Virginia? No. Participation would not be obligatory; they could continue to practice as they have been.

9 9 What about individuals already in the Masters program at Marshall University as well as the Supervised Psychologists who are now working towards licensure as a Masters provider? These individuals would be eligible for the West Virginia Board of Regents PsyD degree once they become licensed as Masters level psychologists and complete 100 hours of approved CEUs in a one-year period. What would happen if a Masters level psychologist who cannot be licensed in another state comes to our state only for the workshop experiences and the West Virginia Board of Regents PsyD degree? They would not be eligible to participate. Only licensed Masters level psychologists would be allowed to participate. West Virginia has a unique licensure law that has permitted licenses for these individuals. Other states do not license Masters level providers and therefore, they would not be eligible to participate. Would this degree program continue indefinitely? No. The West Virginia Board of Regents PsyD degree program would end automatically after those currently in the Masters program at Marshall progress though the new system. Wouldn t this proposal lower the number of providers in the future leading to higher costs for the state? No. The data suggests the opposite. Instead of fewer providers each year under the existing system, the supply of providers would be stabilized. A complete revision of the licensure law would have to take place. What if Marshall and WVU decide not to participate? Do you think that the changes you propose for their programs will be deleted, leaving only the elimination of future Masters level licensure as the major change in the law? Before this, or any, proposal to change the licensure law is seriously considered, another PERD study would be required by legislative procedure. The likely result of that study is that the Legislative Auditors staff will make strong comments about West Virginia University's current inability to serve the state's need for new providers. That data will speak for itself. The single most important factor in psychologist retention is a personal connection with our state.

10 10 Without transforming the University system into an organized training system to meet the needs of our state, terminating Masters level psychological licensure would diminish the number of providers, limit access, and increase costs for those who can afford it the least. Any legislation that incorporates these adverse effects will be defeated. Would the Board of Regents PsyD process lead to an increase in scope of practice without Board approval or without supervision in the new area(s)? No. Any increase in scope of practice requires both education and supervision. Some may use this educational ladder to become proficient in new areas but to provide services in a new area, supervision will be required. This process will be managed through an application to the Board to increase the scope of services. Why must all the educational requirements for the WV Board of Regents PsyD be earned in one year? The intent of the ladder of advancement is to provide a reasonable method for a licensed Masters level psychologist to increase their skill level and receive a West Virginia Board of Regents PsyD degree. It is my belief that the knowledge and skill level of the participants will increase substantially if educational experiences equivalent to ten years of Continuing Education experiences occur in a one year period. By conducting workshops on long weekends, Masters level psychologists can continue to practice in their home communities while participating. Subjects covered would include (but not be limited to) new information regarding evaluating and treating children and adults as well as legal and forensic issues. How much would a licensed Masters psychologist have to pay for the educational component of the proposal? My proposal calls for a fee of $2,500 to be paid through a mechanism approved by the state. If 150 licensed Masters psychologists participate, $375,000 will be available to defray costs. These funds would cover the cost of arranging, conducting, and supervising the Continuing Education Units necessary to obtain a West Virginia Board of Regents PsyD degree. My proposal calls for oversight to be provided by the West Virginia Board of Examiners and also includes sufficient funds to cover these costs.

11 11 Who would instruct these workshops? Instructors could be drawn from our universities, the ranks of experienced experts within West Virginia, or from outside sources. How would this affect the licensure of school psychologists? My proposal would not affect the licensure of school psychologists. This document has been prepared by William Brezinski, MA and should not be considered to be a product of the West Virginia Board of Examiners. No one member can speak for the Board. All data are from the records of the West Virginia Board of Examiners of Psychologists, the West Virginia Health Sciences and Rural Health Report Card, and the West Virginia School of Osteopathic Medicine.

12 12 Age Group Total Number of Licensees APPENDIX Active Licenses by Age & Education % of Total Number of Master's % of Total Number of Doctoral % of Total Unlisted % 0 0% % Under 85 14% 42 7% 43 7% % 90 15% 40 7% % 89 15% % % 82 13% % % 7 1% 25 4% % 1 0% 6 1% Totals % % % Number of Licensed Psychologists Active Licenses by Year 5 Year Increase by Number 5 Year Increase by Percentage Year % % % % % % % %