Clinical Neuropsychology in North America: What the First Twenty Five Years Might Tell Us About the Future of the Specialty

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Clinical Neuropsychology in North AmericaWhat
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
• puente_at_uncw.edu

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Outline

• Introduction
• Brief Overview of Twenty Five Years
• Current Status
• Projections for the Future
• Challenges, Pitfalls and Opportunities

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History Organizational

• American Psychological Association
• Division of Clinical Neuropsychology (40)
• National Academy of Neuropsychology
• International Neuropsychological Society
• Other issues/groups
• APAs First Specialty (1996)
• Board Certification (e.g., ABPN)
• Licensure (e.g., Louisiana)
• Specialty Groups (e.g., Pediatrics)

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History Informational

• Publications
• Books
• Journals
• Online
• Trends
• Assessment
• Rehabilitation
• Forensic

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History Personnel

• Overall Trends
• Growth Patterns
• Demographic Patterns
• Academic Vs. Clinical
• Individuals
• Reitan
• Golden
• Kaplan
• Others

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History Clinical Activities

• Assessment
• Fixed Battery (Halstead-Reitan Vs.
  Luria-Nebraska)
• Flexible Approach
• Rehabilitation
• Cognitive Rehabilitation
• Forensic
• Disability
• Workers Compensation

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Current Status Review of the Surveys

• Brief History of Surveys
• Hartlage
• DeLuca Putnam
• Current Survey Methodology
• Sweet Peck
• Division 40 and NAN

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APA Membership
 
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APA Membership by Division

• Approximately 150,000 members
• Approximately 50 different divisions
• Top three divisions are
• Clinical Psychology
• Clinical Neuropsychology
• Independent Practice

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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

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Survey of Clinical Neuropsychology

• National Academy of Neuropsychology
• Division of Clinical Neuropsychology of the APA
• Surveyors Jerry Sweet Ted Peck
• Date 2001-2002

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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

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Organizational Membership(All Doctoral Licensed
Clinicians)
Percent
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Gender (All Doctoral Licensed Clinicians vs.
Younger Samples)
Percent

• Age
• Males 48.6 (n866)
• Females 45.5 (n524)
• Years Since Licensed
• Males 14.6 (n855) Females 10.1 (n508)
• ----------------------------------

Among licensed lt10 years (n525) Males
48.6 Females 51.4 Among licensed lt5
years (n216) Males 36.6 Females
63.4
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Type of Doctoral Degree (All Doctoral Licensed
Clinicians)
Percent
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Field of Doctoral Degree(All Doctoral Licensed
Clinicians)
Percent
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Work Status(All Doctoral Licensed Clinicians)
Percent
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Work Setting(All Doctoral Licensed Clinicians)
Percent
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Gender Within Work Setting(Doctoral Licensed
Clinicians)
Percent
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Board Certification Status(Doctoral Licensed
Clinicians)
Percent
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Weekly Professional Activities by Organization
Percent
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Weekly Professional Activities by Organization
Percent
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Percentages of Reimbursement Sources(For All
Doctoral Licensed Clinicians)
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Incomes by Organization(Doctoral Licensed
Clinicians Working Full Time or Full Time)

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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 ns between 775 and 1185
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Income by Years of Licensure
Stratification - Mean (Median)
Starting Salaries - Mean (Median)
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Income by Work Setting(Doctoral Licensed
Clinicians Working Full Time or Full Time)
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HOURS/Week Clinical Activity
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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.
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Time-Related Case Activities(All Doctoral
Licensed Clinicians)
Minutes
Hours billed Private11.1 (SD5.0)
Institution8.2 (SD3.3) Only scoring is not
significant between groups covarying amount
of forensic practice did not eradicate group
differences
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Use of Testing Assistants(All Doctoral Licensed
Clinicians)
Percent
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Use Of Testing Assistants By Work Setting
Percent Using Assistants
(n1349)
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CPT Codes Used For Neuropsych Assessment
Activities (Doctoral Level Clinicians)
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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

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• 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)

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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

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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

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What Trends Are Developing

• Organizational
• Informational
• Professional (versus Clinical)
• Financial
• Public Policy

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• 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

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Potential Overall Trends

• Catching up to Psychiatry
• Leaving Psychiatry
• Joining Medicine
• Leaving Medicine
• Legal
• Sports
• Governmental
• Industrial

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• Future Problems
• Empirical Data Base
• Limited Understanding of Culture
• Continued Professional Infighting
• Personnel Issues
• Value to Society (face vs criterion validity)

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Summary

• Continued Growth
• Especially in the Professional Domains
• Expansion Beyond Mental Health, to Health, to
  Other Areas
• Vibrant and Unpredictable yet Exciting

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• Defining the Future
• New Paradigm Change