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Australian Psychological Society Medicare review submission betrays members and clients

The Australian Psychological Society’s (APS) submission to the Commonwealth Government’s Medicare Benefit Schedule (MBS) review is an astonishing attempt to restrict access to psychology services for the most vulnerable of Australians. The submission, which was only made available to APS members on Friday, 17 August 2018, represents a kick in the guts to over 60% of Australian psychologists, who may have their ability to provide affordable and accessible services to clients with complex mental health needs significantly reduced.

The submission preferences psychologists who have been “endorsed” by the APS above all other psychologists, for treating clients with “Severe and Chronic/Unremitting Disorders” and “Moderate – Severe Disorders and more Complex Disorders”. This includes disorders ranging from bipolar, autism and ADHD, to obsessive compulsive disorders, trauma disorders, eating disorders or anything else a referring practitioner thinks is “moderate/severe”.

The APS explicitly excludes four “Area of Practice Endorsements” (AoPE) categories from providing MBS rebated services for “Severe and Chronic/Unremitting Disorders”, recommending, and thus inferring, that only practitioners holding endorsements for Clinical, Counselling, Forensic, Health or Education and Development Psychology are competent to treat clients with complex health issues. These endorsed psychologists make up less than 34% of all registered psychologists in Australia.

Additionally, the proposal excludes over 66% of registered psychologists from providing MBS rebated services to clients presenting with “Moderate – Severe Disorders and more Complex Disorders”. It states that these clients should be treated only by AoPE practitioners, or “psychologists who can demonstrate equivalent competence”. While on the face of it, the addition of demonstrated equivalent competence implies that other experienced practitioners will be able to access the MBS for clients with moderate/severe disorders, sources have revealed that the APS requires onerous and unrealistic requirements to be met to demonstrate experience and competence (eg, failing to recognise relevant qualifications which were obtained prior to a psychology degree), which will effectively exclude the vast majority of experienced practitioners from treating clients with a broad range of moderate disorders.

All psychologists are registered with the Psychology Board of Australia. They are required to have a minimum of 4 years of university training and two years of supervised experience, and engage in yearly professional development to keep up to date with knowledge, and supplement  their skills, experience and training.

Less than 38% of registered psychologists are “endorsed” by the Psychology Board of Australia across nine separate areas of practice. However “endorsement” does not equate to better clinical skills or greater practical experience. It is not a confirmation of demonstrated and practical expertise. It simply means that the practitioner may have attended university for an additional two years. This study does not necessarily provide the AoPE practitioners with further people and practice skills required to form and build relationship with clients. The endorsement purely recognises an academic achievement which over time becomes less relevant compared with decades of actual practical experience in a specialist field.

To fully appreciate the offensiveness of this proposal, its estimated that up to 50% of “endorsed” psychologists do not hold the higher qualifications now required for AoPE. Historically, what preceded the “endorsement” was simply paid membership of an “interest group” or “College”. When the APS changed to a qualification based endorsement system, paid members of Colleges were grandfathered into the AoPE. The “grandfathered” practitioners may only hold undergraduate qualifications, yet are now preferenced by the APS above psychologists who did not pay membership to an interest group, but hold requisite qualifications.

The proposal is a brazen attempt by the APS to monopolise the market in favour of a select few endorsed psychologists. If accepted by Minister for Health, Greg Hunt MP, it may see registered psychologists with decades of experience and expertise in specialist areas lose their livelihoods. Vast swathes of the population, including the most disadvantaged in the community, may lose access to crucial services, particularly as many AoPE practitioners do not bulk-bill.

Under the proposal, a client with autism, ADHD or or schizophrenia would potentially be restricted to seeking services from less than 33.4% of registered practitioners. A client with a trauma disorder would be restricted to accessing less than 40% of registered practitioners. The remaining 60% of practitioners would have their client base severely curtailed, almost certainly resulting in the closure of many rural and regional practices, where dedicated professionals have formed and built relationships to ensure the best possible services are provided.

Psychologists have slammed the proposal, which they claim is unethical and potentially exposes them to claims of professional negligence, with the APS inferring that general practitioners lack the experience, skills and qualifications to treat complex health issues.

The APS strong inference that a practitioner who was formerly a paid member of a special interest College, or a recent university graduate, is capable of providing better service than a general practitioner who has diligently gained experience by working with clients in the community while maintaining professional development requirements, is plainly offensive.

Australians should be able to choose a medical specialist based on their skills and experience and expertise. If the APS proposal is accepted, clients with complex issues will not be able to access Medicare benefits for their preferred practitioner.

Each year in Australia, approximately one in five people will experience a mental illness. However a recent national survey showed that only 35% of people with a mental disorder had accessed a health service within the 12 months before the survey.

Research by Meadows et al (2015) of MBS items claimed under the nationally funded mental health program, Better Access, shows unequal distribution across the Australian population for psychiatry and clinical psychology services, compared with the equal distribution of general practitioner and non-clinical psychology services. This suggests that distribution of practitioners in the community has an impact on the accessibility of services. It is evident that the APS proposal to reduce number of practitioners able to access Medicare benefits for clients with complex mental health needs will significantly impact on levels of care and outcomes.

If accepted by Minister Hunt, the APS proposal will have the effect of funneling vital health funding to psychologists preferenced because of their privilege/access to higher education, rather than to those with proven and demonstrated skills at treating clients with complex mental health issues. It will result in reduced access to health services and consequently lead to poorer outcomes for Australians who require mental health services. It will restrict access to necessary and vital services for the most vulnerable of Australians. It will unfairly impact on Indigenous Australians, the homeless, those disadvantaged through circumstance, trauma or financial status, those in lower socioeconomic groups and rural and regional areas – in fact, the APS proposal will impact unfairly on exactly those people the Better Access program is intended to support.


100 comments

  1. Natasha Kavanagh

    Thank you for this well written article.
    I am a Masters Qualified Psychologist with 15 years for practice experience where I have successfully worked with thousands of clients. I have extensive training and experience in multiple trauma presentations and treatments.
    I work in a low socio-economic area where the hallowed few, the clinical psychologists, don’t seem to want to work as workforce data shows they congregate around more centralised, richer areas, leaving General Psychologists to do the hard work in more remote and lower socioeconomic areas.
    Should the APS proposal pass, I and many of my colleagues, will no longer be able to practice and this area will be all but un-serviced by the psychology profession. This isn’t a small town, there is a population of 150000 and desperately in need of Psychology service.
    In my opinion, this proposal serves the interest of the privileged few and betrays the majority of fee paying members. Yes, we actually pay these people a lot of money per year to serve our interests (ha!), $680/year to be precise worth of food out of my children’s mouths for little but a knife in the back.
    I am currently reeling from this information and the words dissapointed, and disgusted don’t begin to describe how I am feeling right now.
    The impact on my career will be catastrophic if it passes, but the impact on the community is my greatest concern. Basically there will be very few, if any, Psychologists in the area. If by some miracle a clinical psychologist does stay in the area they will have months-years long waiting lists, can charge what they like and are highly unlikely to offer bulk-billing when needed as myself and my colleagues currently do to to a complete (and cleverly engineered) lack of competition.
    Thank you again for helping our voice.

  2. lawrence winder

    Hmm… another small but significant step to privatizing medibank.

  3. Melissa Turner

    Excellent article. Thank you Thank you Thank you

  4. Amanda Wood

    Thank for writing this article that presents the truth. Well researched and understood. As one of the endorsed psychologists I am disgusted by the APS. im even more disgusted that they have actively tried to hide from the membership what they have been doing. Thank you and all we can hope is that the minister sees this for what it is.

  5. Rochelle James

    Incorrect information: the last several years endorsement is through AHPRA and not the APS. Now to become an endorsed psychologist practitioners need to go through 6 monthly reviews and fortnightly supervision over a 2 year period on top of 6 years of study or training. ‘Grandfathering’ has not occurred for a long time. #FactCheck

    Maybe add this information to the article so that the public receive accurate information.

  6. Daniel Renehan

    Hello, could you please reference this article?
    Seems fake.

  7. Stephanie Walton

    The wait list for a psychologist in my area is between 3-6 months. It’s already next to impossible for people to see an endorsed psychologist who routinely charge gap fees. This proposal will result in even longer wait lists and the very clients who this medicare scheme was meant to help will miss out again due to high gaps fees. Get ready for a US style system where only the wealthy can afford care.

  8. Katrina Sheraton-Yu

    Thank you for sharing this important information in an insightful way, accurately reflecting the concern the majority of Psychologists have as a result of APS taking a stand against the majority of its members and in advocating for a system that would have a negative impact on those requiring mental health treatment. As a registered Psychologist with over ten years experience and working with many of the diagnoses outlined in the “top two tiers” of the APS submission, I feel the APS are out of touch with (or without care for) the diverse and extensive experience and expertise among the General Psychologists who have undergone extensive professional development, supervision and training that exceeds that covered in the 2 years Masters degrees and two years supervision required for Endorsement. All Psychologists are bound by the ethical code and registration requirements of the Australian Psychology Board and therefore, those practicing in mental health are well equipped and well qualified to treat a broad range of disorders and clients with diverse needs. Creating division and elitism among Psychologists with different training backgrounds and specialisations is not helpful for clients or the Psychologist workforce as a whole and can only be seen as politically motivated and without consideration of the purpose of the Medicare schemes, which is to enable access to Mental Health treatment for those most vulnerable in our society.

  9. Johnathan Locke

    A very large percentage of general psychologists who took the 4+2 route are complete fuckups who have failed their way through University and can’t get a place in Masters. These people who can barely string a sentence then get supervised by other psychologists and sent out to see clients barely knowing what they are doing. After 2 years they get to call themselves psychologists. Endorsed psychologists, on the other hand, have at least 8 years training ( 4 years undergrad 2 years Masters 2 years Supervision ) at the minimum and at the level of competitiveness getting into masters is now, you can be sure they are of a very different caliber than their peers who insist they are just as good despite half the training. Also keep in mind the international standard ( US, UK, CANADA, Most of EU ) is the endorsed pathway. Australia is the only joke that allows people with Bachelor degrees to be psychologists.

  10. Sharon

    Thank you Eva!
    Journalism at its best.

    Yes Daniel Renehan- it’s an incredulous position taken by the APS against the majority of its membership- I understand that you are concerned that’s it’s fake news- but unfortunately it’s not!

    Check out
    https://reformaps.org/petition-for-the-aps-submissions-to-the-mbs-review/

    Also some psychs want STOP all Medicare benefits for other psychs
    https://acpa.org.au/wp-content/uploads/2017/09/Submission-to-Medicare-Review-2017.pdf

    You may be interested in signing this petition
    https://www.communityrun.org/petitions/australian-psychological-society-your-membe

    I cannot post the link to the APS submissions – as it’s not open source and a friend shared it with me- but it’s real and the implications are vast for mental health consumers in our community- as well as the livelihoods of all Psychologists who appear to be targeted and now unjustly deemed unskilled.

    This article is excellent in summarising most of the facts very clearly.

    If these changes are going to impact you or a loved one- please sign online petitions, write to your MP and express your personal concerns.
    If you are a psychologist – there are a number of Facebook groups you can join to keep up to date with updates…

    All the best!

  11. Scott McDonald

    Rochelle James. The article says grandfathering was done; not that it is ongoing. It literally says “historically”.

    If you can find an actual error, by all means point it out, but the contents of the article appear to be accurate.

  12. megan jane

    Good article and i sympathise with the sentimrntd but note your information about how one obtains endorsement currently is not correct – there is a registrar program via AHPRA that takes minimum two years to complete, requiring 80 hours of supervision amongst other requirements. Not easy or inexpensive to achieve (especially if you pay for supervision and personsl development out of own pocket).

  13. Mandy Curry

    The psychologists who run the Facebook group who pushed this story are now complaining that asking for the missing evidence to support the claims in this article is “trolling”. It seems they feel that their claims should be accepted without proof. That goes a long way to explain why the same psychologists with decades of experience spend their time desperately spamming Facebook groups for high school and University students with these claims, but are too terrified to do the same to any of the numerous Facebook groups for registered psychologists.

  14. Philip Sewell

    Finally some truth about the deception, this is only the tip of the ice-berg, people will now start to feel safe and the full story that stretches back to the early 2000’s will unfold. This will need a some kind of inquiry to unravel

  15. Sharon Snowdon

    Thanks for writing this well researched and accurate article. I am a psychologist with clinical endorsement. The APS has for too long not appreciated and respected the wealth of experience and expertise of all its members. It is a very sad situation that a Society that is meant to advocate for all its members has produced this submission. As another Sharon has posted above, more information and a petition can be found at these links

    https://reformaps.org

    https://www.communityrun.org/petitions/australian-psychological-society-your-membe

  16. Emma Clarris

    I am a counselling psychologist appalled at the treatment by the APS of its members. For years it has discriminated against most of its members with the exception of the clinicals creating division and disunity in the profession. The requirement for endorsement is an interesting one as it mimics in many ways the 2+4 and 5+1 in the requirement for supervision and direct client hours. Why one results in endorsement and greater recognition and the other results in being looked down upon as lesser is baffling.

  17. Sharon Snowdon

    I think the big question here is “Where is the scientific evidence to support the APS submission?” It is a question that all psychologists have been trained to ask.

  18. Kristina Challands

    Thank you for this well written article. As a recently registered psychologist I am stunned at the betrayal of its members by the APS. I encourage everyone to take action, educate yourself on what’s happening and advocate for your clients and yourself.

  19. Pamela M

    Having read many govt reviews and submissions over the years, it seems very strange that the APS submission to the MBS Review is not public. Why is that?

    Once I made the mistake of choosing a relatively inexperienced dentist and paid the price. Experience matters.
    Perhaps the restrictions to service might not effect the likes of Mr #Reefgate-Tophat, but for the rest of us this is more of the same from the LNP, the boa-constrictor of public good.

  20. Kat Johansen

    I predicted this would happen two years ago when I started lobbying with Senators. Members wouldn’t believe me but here is the proof. I feel saddened that we have been lied to but this response from the APS is clear. I have sent this article to those senators and will follow up. The APS should be held responsible for misrepresentation of its members. Is anyone interested in taking action? If I am elected I will not hold back! It is disgraceful!

  21. Rebecca

    This crap has been going on for about 10 years now. Despite it being mentally exhausting, I love my job. I don’t like the industry. This is why I actively tell people not to become a psychologist. Do counselling or social work instead. Can we blame the public for not wanting to pay for our services when our own industry undermines our qualifications?!!

  22. Cherie Dorotich

    This is a total injustice for the people of Australia that are already experiencing a mental health crisis in terms of access to services. Purely to play elitist politics, the APS’s actions have simply intensified our countries crisis. To restrict access to 70% of Australia’s available Psychologists with no evidence or valid reason for the action, is purely hostile to the Australian public and to the thousands of passionate Psychologists who want to be there for the public when and as needed. Disband the APS.

  23. John

    I am as frustrated as most you your readers here commenting are. But lets stop and think, realistically. The APS is to be congratulated in moving to transparency with the new CEO. YES, thats what I believe! At last, we see emerging signs for hope for fairness and equity. Finally there is an opportunity where we can move to robust arguments to work things out. But we can expect pain, more pain asa we clean up the mess. We need to be careful we do not allow self-interest and the emotions that come with pain many of us have experienced to cloud clearly reasonable fair and equitable outcomes. There has been a lot of misinformation and vilification if not demonisation. Sadly Eva, you have fallen into that trap. You need to do some better fact checking and not give in to the temptation to stoke the fires of discontent. Express our anger, but then grasp the window of opportunity for constructive collaborative solutions for moving forward. Eva, this is not investigative journalism at its forensic best, very far from it: it is more akin to the popular press. It is divisive and in the end destructive of the profession and the qualitative services Australians deserve. It bespeaks the sort off view I would expect from some far side political groups.
    As a psychologist I want to encourage my colleagues reading this to be ethically respectful of one another, no matter how differing our views. Self-interest and hubris are our enemies. A house divided falls. Lets put down our swords and fashion them into plough shears to join together, unite to ensure a fair and equitable resourcing of our profession. Unless we do, and do so quickly, we are doomed. We have no alternative. Let us as psychologists demonstrate that we understand our emotions, our frustrations and anger, and that in the end we garage the means and strength to have voice of reason drive our profession.

  24. John Quinlan

    Thanks
    This would be a horrible change – the medicare payment is still under review – and anyone can make submissions – my experience is that submissions DO get read and listened to and are worth the time – I think at least this article and the comments should be submitted to the the Department of Health website – following is copied from their website/web address follows

    Two Tier Medicare Rebate System for Psychological Therapy Services:The review of mental health MBS items commenced in June 2018. The Mental Health Review Group has been formed and includes representatives of each profession eligible to deliver services under the Better Access initiative including both registered and clinical psychologists, as well as related professions such as mental health nurses. Further information on the MBS review including a full list of the membership of the Mental Health Review Group, is available on the Department of Health website.

    Public submissions to the MBS review are welcome at any time by emailing mbsreviews@health.gov.au.
    http://www.health.gov.au/internet/main/publishing.nsf/Content/MC18-004045-TwoTierMedicareRebateSystemforPsychologicalTherapyServices

    John Quinlan FAFRM (Consultant in Rehabilitation Medicine)

  25. Emma Clarris

    I agree with John. We need to act as a unified profession that respects all of its members and recognises the diverse skills of all. I just saw a comment that was seriously disturbing in its denigration of those who have chosen the 4+2 and the 5+1 pathways. My understanding of the current situation is that it is very hard to get into Masters courses now because of the loss of university courses. The 4+2 and 5+1 provide another options for those who are passionate about wanting to be psychologists. They should be supported not judged as inferior. If we cannot be respectful of difference and recognise that strengths come in all shapes and sizes what is it we are modelling for our clients?

  26. Justin C

    I’m glad to see a wider audience is being reached with these criticisms of the two- and three-tier systems. The current and newly proposed models are convoluted, unsupported by empirical evidence, and detrimental to clients and the Psychology profession overall.

  27. Josie

    Thank you for this article. As a psychologist practicing in a rural area, the implications of this proposal are extremely concerning. 90% of the referrals I currently receive would need to be referred on, as would those of the other 3 generalists in private practice here. I already have a wait list of up to 3 months, as does our one clinical psychologist. So my clients would either need to see me without accessing a government rebate, endure a ridiculous wait time to see the clinical psych (who specialises in chronic pain management, not mental health) or travel over 100km at their own expense to see an endorsed psychologist elsewhere. If 90% of referrals are funnelled to 32% of psychologists (those numbers are from Inpsych (Littlefield, 2017), and from AHPRA, respectively), the system is going to break at some point.

    For those who claim that clinical psychology is superior to other endorsements, that endorsed psychologists produce better outcomes or that a masters/doctorate is superior to a 4+2/5+1 pathway, please show us your evidence. As pointed out, other countries do require that level of training, so it should be relatively simple for you to show that they achieve better outcomes with clients than we do. Except no such evidence exists. These claims of superiority by a minority group are what is dividing our profession and it is being supported by the APS, with it’s board of 80% clinical psychologists. Unfortunately, it’s consumers who will pay the price.

  28. Sharon

    The integral Psych Organisations response to this- just released today.

    NB The APS submission is not open source was initially accessed by a member who has shared it.
    There’s no transparency- which is how the APS has managed to maintain membership numbers by NOT advising members of what they are doing and apparently actively saying one thing to members and then voting differently behind closed doors…
    We need an inquiry into their behaviour and how they have used our membership numbers and funds to create this load of unscientifically tested, factually unsupported, negligent and against the wellbeing of psychologists, their clients and the families of their clients.

    Please sign and share the petitions

    https://reformaps.org/raps-responds-to-the-aps-mbs-review-submission/

  29. Ane

    Thank you for bringing this complex issue to the attention of the public. I am a generalist experience with over 20 years experience in a range of settings. It is galling to have my years of experience and expertise deintegrated by the APS. If the APS recommendation comes to pass then most of the more complex work will be done by less experienced clinical psychs.

  30. Amanda

    Thanks for your article. It reflects my concerns. I for one would have to shut my doors if the APS submission was implemented. I do not agree that we should be unified as some have suggested. The fact is we are not unified thanks to some very divisive actions carried out by the APS. Hopefully the exposure of their behaviour will encourage psychologists to unite and insist the submission be thrown out and that the APS Board start to represent the interest of all their members.

  31. Kaz

    Thank you for this article. I am an APS member and have read the full submission. It has some strengths in that it includes a proposal for clients who need more sessions to receive them. Unfortunately, the very sensible idea of providing care to address people’s needs is completely overshadowed by the shortsighted and non evidence based suggestion to limit who the public can access for psychological care based on arbitrary categories of practitioners, instead of who as an individual is best placed to provide a service. This is particularly concerning as the skills to treat many of the tier 2 and 3 diagnosis are very specific and not taught in masters programs in any comprehensive way. Those skills are developed via ongoing professional development that psychologists frequently undertake regardless whether or not they have an endorsement.

    So, a generalist may have extensive knowledge and training in managing a particular condition, whilst a clinical psychologist who hasn’t done extensive professional development in the same area because they may not share the same clinical interest will have a much lesser understanding. Yet, the APS suggests that a person seeking treatment for that condition can access rebates for seeing the clinical psychologist with little interest or more than basic skills in managing the condition, whilst they cannot go to a generalist who has devoted their entire career to working with people with the condition and has much more training in doing so, for all that the training isn’t in the form of a masters degree.

    My view is that in proposing this arbitrary split, the APS is suggesting that its generalist members are unethical. After all, ethical psychologists already know their scope of practice and work within it.

    By suggesting that clinical psychologists are able to service all tier 3 clients, the APS is suggesting that clinical psychologists are able to be trusted to work within their scope of practice, whilst generalist psychologists are not. We all have areas we tend focus on in our practice, and areas where we may only have basic knowledge and refer on. That is the case for generalists and people in every endorsement area. It’s ludicrous to suggest that endorsed psychologists are the only ones capable of recognizing and not accepting referrals that fall outside their scope of practice.

    The APS is also suggesting that a minimum of 6 years of full time study/ placement qualifies us to essentially do the same thing as a chat bot. No other profession would stand for its peak body being so utterly disrespectful to the professional skills of half of its membership.

    But the biggest problem with the submission that that in the end, if it is accepted, the public will miss out. People in rural areas will not have the same opportunity for care as people in cities where most endorsed psychologists practice. That alone is sufficient for this submission to be poor policy. Better access is about improving access to mental health care, not limiting it.

  32. Amanda White

    As a registered psychologist I am deeply concerned about what this review would mean in terms of reduced access to services for complex mental health clients. The APS submission did advocate for increased sessions and more approved evidence based interventions – both of which are desperately needed – but allocating psychological services in the three tier stepped care model simply won’t work given distribution of endorsed psychologists across Australia. I am writing to the APS, which I am a member of, to present my concerns and will also be communicating with both my local MP and Minister Hunt. Whether you are an industry professional or someone in the community who cares about mental health in Australia, please take the time to read the APS Medicare review submission and provide feedback to the APS as well as the government on what you feel this means for everyday Australians.

  33. Jon Chesterson

    I disagree with the suppositions and assumptions in this article, remembering we are predominantly talking about MBS access for clients with ‘complex mental health’ needs.

    Unless a psychologist has postgraduate qualifications in mental health; substantive experience working in mental health; substantive training and supervised practice in providing evidence based interventions and/or psychological/counselling therapies; or preferably all of these I’d argue they are very probably providing treatment and care beyond their scope of practice and competence.

    A 4 year psychology degree does not address any of the above credentials and nor does any other postgraduate training or experience per se unless it is specifically concerned with mental health, relevant therapies and acquisition of skills and capacities to treat people with mental disorders. So why should they be paid by the government to provide these specialist services to clients with ‘complex mental health’ needs?

    Would you endorse a Registered Nurse to provide specialist nursing care to clients with ‘complex mental health’ needs, other than under the supervision of appropriately qualified and experienced mental health professionals and/or multidisciplinary team within a public hospital? I wouldn’t and certainly not to practice individually or privately under the MBS, but I would expect that a credentialed mental health nurse might and should have access to MBS but they don’t. If we are talking about providing basic and/or general nursing care that is a different matter.

    Would you expect such treatment and access to MBS by any undergraduate trained doctor? No you wouldn’t, you would expect a suitably qualified GP or psychiatrist. So why should we be making exceptions for psychologists?

    Frankly there are many practicing mental health nurses, especially credentialed, who would have the appropriate knowledge, skills and capacities to provide mental health care under MBS than a majority of psychologists in Australia, who have never worked in a mental care setting, treated people with a mental illness and/or have no particular postgraduate training in mental health or suitable exposure to relevant therapies. It is certainly not in the undergraduate psychology degree, it is a mistake to assume psychology = mental health or therapy for people with mental illness. Psychology is the study of human development and behaviour, ‘normal’ behaviour and that does not necessarily include competency training for any number of appropriate therapies and therapeutic approaches, and there are many. The study of abnormal psychology is basic in an undergraduate degree and even abnormal psychology is not psychology nor is necessarily mental disorder per se, and it is not mental health by definition. But if they want to treat people who don’t have a mental disorder or provide general psychology and counselling services to a person with a mental disorder, no problem. But not specific or specialist treatment for people with ‘complex mental health’ needs.

    It is incomprehensible that all psychologists should be eligible to treat people with ‘complex mental health’ needs under MBS when to date credentialed mental health nurses cannot, other than the more basic and less autonomous and appropriately remunerated MHNIP program.

    So sorry Eva I cannot agree with you or your arguments as put, which are emotive, inconsistent and conceptually misfounded. And as for what politicians think, legislate, regulate, policy and fund on this subject, they are merely political. They not only haven’t got a clue but they don’t even listen to expert and professional advice of those who do have some idea what they talking about, rather they look for confirmation of their political world view and are easily persuaded by political lobby groups who have their own vested interests. The age of reason, integrity and sensibility is gone.

  34. Jan

    Thank you for the fabulous article and taking the time to put together truths in this horrible situation that has affected the majority of psychologists in Australia and the majority of consumers. As you can see by some of the comments above, we have faced denigration not only of our skills and knowledge, but dedication to our vocation and helping others, for 15years. Anytime we have tried to have a voice it has been met with threats and fear of repercussion. There is no evidence to support this submission. But it is evidence of more betrayal and lies, with very real consequences to the Australian public.

  35. Tracey Angel

    Thank you for a very well-written and well-researched article on a very confronting topic. The Australian Psychological Society is meant to represent ALL Australian Psychologists. I have faithfully paid my annual renewal for so many years only to find my money is being used to deny me my livelihood.
    I am a psychologist and have been for over twenty years. I worked for a decade for Wld Health on an Adult Mental Health Community Team. I worked as a senior psychologist. I provided supervision. I was employed as a Clinical Psychologist. Since, I have run a very successful private practice – working with all clients, with all presentations. My clients, their families, and my referrers – including: GPs, psychiatrists, paediatricians, solicitors – trust me, respect me, and continue to enjoy irk eith me for now over a decade. I have maintained my professional registration and all of my required Professional Developmemt.
    The APS continues to try to have me, and my colleagues, removed from practising in this way. Shame on an organisation that mouths support for all psychologists. Shame!

  36. melissa turner

    With respect Jon Chesterson herein lies the issue. I would not want to be treated by someone who cannot and does not have experience to treat complex issues BUT psychologists like myself with over twenty years experience in treating complex clients, supervision experience, experience in complex trauma and mental health will not under this system be able to treat clients i have been treating successfully for years – because i trained in the old system where all training pathways were recognised and accepted. A new graduate with two years experience that i have supervised will be able to see these clients. I know i would rather an old nurse who trained on the job and kept up her knowledge through continuing education than a new graduate who has only university theory and little experience.

  37. lisa johnson

    thank you for sharing with the public what is happening to our psychology profession. it has caused so much divide amongst our mental health professionals and the implications of loss of funding for generalist has extensive damage for both our clients as well as our general psychologist. I myself have completed masters level of psychology but no in the clinical program, so am still classes as a generalist.. so after 6 yrs of full time study which took me 9 years while raising a young family and trying to work part time to survive, it is pretty scary to be faced with such a situation…

  38. ObviousFuckUp

    Johnathan Locke, that’s hilarious. Please tell us which Australian universities have such low standards that they accept people into 4th year with a failing GPA. You could probably sell that information. Doing so would not be ethical, but then neither is degrading your fellow psychologists (assuming you are one).

    Mindboggling that you seem to think the key reason someone might not pursue masters for registration is academic ineptitude.

    It’s kind of sad that with all your extra qualifications, the outcomes you achieve (as a group) have not been shown to be any different from a bunch of ‘fuck ups.’ They’re good outcomes, but that must rankle, after spending all that time and money to help you feel superior. Narcissistic wounds are just the worst.

    Finally, your maths is wrong. Generalists have 4 or 5 years at university, plus 1 or 2 years of supervision (which by the way, involves double the supervision hours per hour of practice compared to supervision for endorsement). That’s 6 years training total. Endorsed psychologists undertake 6 years of university and 2 years of supervision to receive endorsement. That’s 8 years of training total.
    It does not bode bode well if you can’t calculate that 6/8 is not 1/2. It’s just a simple fraction. Can’t even get that right, what else are you wrong about?

  39. Amanda Abel

    Thank you for this article. Although I feel utterly betrayed by the APS, I worry more about the future of mental health in the community if ridiculous changes like those proposed are put in place. For so many reasons already outlined in the article and comments, this submission is just plain wrong and should not be given any airtime.

  40. Vikki

    This is so sad. Such a wonderful profession, such dedicated practitioners and yet the sheer number of responses to this article and the passion behind them are indicative of the painful rupture that is going on in our industry.

    If only it were as simple as: we’ve all done the training, regardless of route, we all continue to learn in our areas of interest via annual Professional Development requirements, we all want what is best for our clients. Perhaps therefore, we should all receive just one rebate amount. Then there simply can not be any arguments regarding unfairness – unless it is a minority suggesting they are worth more. And if they want to do that, that’s fine, but first show us the evidence, because that is what psychologists of any type are supposedly trained to do.

    Thank you so much Eva Cripps for this wonderful article and providing a voice for so many of us who are feeling intimidated and concerned about possible repercussions of speaking out against the APS . I hope you have not let a clear minority of our profession put down your fine journalistic skills, as they are doing to the skills of 60% of their own members.

    And just for the record Johnathan Locke, I completed my entire 4 years at University with nothing lower than a Distinction. I received First Class Honours and I was on a Scholarship to complete my Doctorate in Psychology. Due to life circumstance I was forced to leave studies and focus on my family. But with a burning desire to work in the profession, the Supervision route was the option that best supported my needs. You are an imbecile and if you are a psychologist, you shouldn’t be.

    Has anyone notified local and Federal MPs to this discussion?

  41. Oh so grateful

    Magnificently written piece Eva….thanks so very much for lending your voice to this reprehensible situation. Yet again, APS seeks forgiveness not permission post MBS submission….more of the same.

  42. David

    Notice most comments in opposition are from generalists. Generalist wages and access to lower rebates and less sessions reflects less education at a University level. In any other similar profession, the more rigorous training is more difficult to access (I.e. the argument about Masters being harder to get into). To use a clunky analogy, if you exited a undergraduate medical degree at fourth year, you would have a bachelor of medical sciences. No amount of ‘on the job training’ and experience will get you recognised as a Medical Doctor…

    I do think that more respect should be given to other areas of endorsement for their speciality activities.

    Frankly, this type of opinion piece is frustrating. Perhaps we should have better advocacy overall for peoples ability to access mental health services? Generalists with less formal education can still provide help and absolutley should be given opportunity, but to gouge those who studied harder and frankly achieved to a higher degree is facile and I would suggest not very helpful for those who need to access psychology services.

  43. Michelle Allsop

    Thank you for this article. I am completely shattered and disheartened by the APS’ proposal. As a provisional Psychologist I have put my life on hold for the last 6 years to achieve my life long goal to become a qualified psychologist. I have completed an Undergraduate degree, a graduate diploma and am about to finish my second masters degree. Once completed I will be in debt $100,000. To now be told that I will be restricted in the kinds of clients I can and cannot see makes me feel as if the APS believes I am incompetent and not worthy. I want a refund of my membership fees until the APS acts on behalf of ALL Psychologists. Not happy!

  44. Anrieoverit

    Dear Eva,
    Thank you. It has been a long time that I have tried in various settings to raise the issues you write about directly with leadership groups and also with colleagues. I have been targeted by certain bullies who cannot abide the arguments against their unscientific premises.
    To the person who wrote so disparagingly about people who did not complete masters levels or doctorates I say you have no idea what you are talking about or the calibre of such people. Some of us have completed other professions rather than waste our time and money on so called higher degrees. The reason for that in my case is my absolute disgust with the leadership of this profession.
    By the way I was accepted into and completed the first year of the Masters Clinical but due to lack of access to supervision (rural area) and family tragedy I did not complete. The year was enough for me to see I was learning nothing at all that was new to me after already having 10 years in practice. A complete waste of time and money.
    How dare you!
    I sat at a National meeting recently whereby those at the table with me laughed about the inrrelevance of their higher degrees to their current practices. All were endorsed and at least half endorsed clinical.

  45. Clive

    For the few people here posting vitriol against other registered psychologists while claiming to be psychologists themselves, I direct your attention to the APS code of ethics:

    https://www.psychology.org.au/About-Us/What-we-do/ethics-and-practice-standards/APS-Code-of-Ethics

    In particular:

    “A.2.3. When psychologists have cause to disagree with a colleague in psychology or another profession on professional issues they refrain from making intemperate criticism.”

    “A.2.4. When psychologists in the course of their professional activities are required to review or comment on the qualifications, competencies or work of a colleague in psychology or another profession, they do this in an objective and respectful manner.”

    I am concerned that these qualified, superior professionals appear to be unaware of their ethical obligations.

  46. Tilly

    As much as I am enjoying reading the comments here- the occasional whine of white male priviledge, here again is quite palpable.

    The majority of Psychologists have been lied to and systematically deceived by the APS Executive, most of whom have now moved into other positions in “ivory towers with a view” ie out of touch with the actual Mental Health needs of the Australian population. They have failed in their feduciary duties to all psychologists, from whom they have taken both vast amounts of money from over the years, as well as quoting membership numbers to lever themselves into positions of influence and allowed key positions on governmental policy decision making panels, and on various committees.

    Boys you’ve had over 10 years to gather data to support the extra Medicare rebates- but you’ve got nothing, zilch, nada.
    This suggested that you cannot find any difference between the clinical outcomes of your work and that of any other psychologist, or you may all be just clinically lazy- who knows.

    You don’t present a rational & logical argument – your just emote unnecessary highly charged and unethical attacks on your own colleagues.

    So back to basic research principles 101
    You need to develop a rational and logical argument (position) and support your position with rigorously tested, empirically vapid, reliable and statistically significantly data.
    The Australian population deserve to know how their good tax dollars are being spent.
    I suggest that as academically gifted as you all proport to being (but who knows) this little task shouldn’t be outside of your skillset?

    Put up or shut up!

  47. Wendy Arnold

    I wish to provide a quote from InPsych 2017, vol 39, Feb, Issue 1 by Professor Lyn Littlefield “…the APS undertook a client satisfaction survey of more than 2000 clients. Client reports indicated 91 per cent of clients, psychological treatment resulted in significant or very significant improvement, and that 96 per cent of clients who received services could not afford psychological treatment without a Medicare rebate. APS surveys found that 72 per cent of clients presenting under Better Access received a diagnosis of depression, 68 per cent anxiety, and 46 per cent comorbid anxiety and depression. Fourteen per cent of clients had received a diagnosis of post-traumatic stress disorder (PTSD), nine per cent adjustment disorder, and five per cent drug and alcohol use disorder (APS, 2008; 2011)…” when this article was written, Prof Littlefield was concerned that the exlcusion of FPS services for Generalist psychology medicare item numbers would limit access to “a much broader range of psychologists who can provide effective services to consumers with complex mental health needs.”

    As you may notice, there was no arbitrary line between therapists and client outcomes in this description. It reflects how the two tier model with Medicare has obviously devalued generalist psychologists overtime and is resonated by some of the aforementioned comments above. Kudos to the inclusion of some other endorsements other than clinical psychology, however this should not serve as a reason to further denigrate generalist psychologists.

    On this point, some comments very disrespectfully commented about the ineptitude of generalist psychologist: To those individuals, if you found peers to be violating clients rights or lacking in skills then report them to AHPRA as they are the governing body who monitor harm caused by psychologists to clients.

    We must all continue PD. I received more practical skills by PD obtained after leaving university. Uni gave me background, theoretical knowledge and fundamental skills. However, experienced and professional supervisors and world renowned practitioners honed my skills. Clients are the beneficiaries of what I’ve learned. Medicare rebates have not increased since 2010 for psychologists despite the costs of building hire and electricity, etc always increase. It would be a shame for clients and my own love of my career if I am forced out of my profession and will no longer be able to utilise all ive learned for the last 17 years over Medicare rebates.

  48. Jenny

    There is currently a lack of fairness to Australians suffering psychologically based mental illness as a consequence of the two tiered Medicare rebate system. The arbitrary, unfair and highly discriminatory distinction in the Medicare rebate system, Better Access Scheme, between clinical psychologists and all other psychologists. This distinction between equally trained psychologists is unrelated to their skill, level of qualification, (all requiring at least 6 years of university training and 2 years of supervision) or professional competence and, regrettably, Australia is the only country to make it.

    Clinical psychologists are not the only psychologists equipped to deal with serious mental illness and there is no empirical evidence or theoretical basis to support the view that Clinical psychologists may be “best equipped” to do so.
    The Australian public would be better severed if the arbitrary and highly discriminatory distinction between clinical psychologists and all other psychologists in the top tier for Medicare rebates was removed. The current discrimination limits access to high-quality psychology care and is particularly restrictive in rural and outer metropolitan areas, and for patients who cannot afford to pay the larger ‘gap’ payment.

  49. Ethan Jones

    it makes me laugh as a new clin masters graduate to hear all the boohooing from all the experienced and dedicated non-clinical psychologists about to lose their careers. we clinical graduates know we have superior training – why else would we get paid $140 an hour by medicare to work with rich bored housewives as soon as we graduate our clin masters while you generalists get paid a pittance to work with socially disadvantaged members of the public in poorer areas? even though all the research shows no difference in outcomes between clinical psychologists and non-endorsed psychologist (Pirkis, 2011) the fact is we are considered better then all of you after finishing a few lectures and 40 hours of observational placements. you may have think you have won a victory by getting a few genuine and hardworking representatives of the psychological community, including Dr James Alexander and Dr Clive Jones, to represent you on the MBS review board. however we clinicals have many more tricks we will use to make sure our supremacy goes unchallenged, no matter how many of you donate your time and effort to the Australian Association of Psychologists inc or join the Australian Psychologists facebook group. Don’t worry though. once we guarantee only holders of clin masters can work as psychologists, we know how even more desperate all your daughters will be to get a clin masters place and we will be waiting to take full advantage.

  50. Mark Andersen

    I am a clinical psychologist, and I benefit from the two-tier system, being able to make more money from my clients than my generalist colleagues. I am not a better psychologist than they are. My generalist colleagues are, for the most part, exemplary psychologists. There seems to be some sort of collective narcissism (for some clinical psychologists) operating that promotes a narrative that clinical psychologists are better practitioners than other psychologists. That narrative has no evidence base. The evidence from the limited research in Australia is that there are really no differences in psychotherapy outcomes between clinical and generalist psychologists. If one wants evidence for a difference to have a rationale for the Medicare rebate two-tier system, then there is a problem. There currently is no evidence. I would like to talk to other clinical psychologists who think this system is flawed and based on prejudice and undeserved privilege.

  51. Sharon Snowdon

    I am also a clinical psychologist. I agree with Mark Andersen.

  52. John

    While we squabble internally, and even bring gender conflicts into this, we are completely oblivious to the threats to our profession from the outside. Look around you: non-psych counselling courses are pumping out thousands of graduates around the country each year, universities are making a fortune from unregulated full fee paying master of counselling courses : yes do your homework on that! Psych nurses and social workers in private practice are proliferating exponentially.
    Yes, we have some problems to solve: but let’s pull together and stop the unprofessional unethical paranoid demonising. It is costing us dearly. We need to pull together to solve our problems. Yes, as generalists we need to be properly recognised, but continued divisive sniping and a victim mentality will only block us getting real progress. It is not a productive tac, shooting ourselves in the foot. We have had our gripe here, let off steam- now get a rational handle on things : PLEASE OH PLEASE STOP THE FIGHTING! Promote that for the sake of the wellbeing of Australians we need outstanding generalists – we have outstanding generalists- we are outstanding generalists, the majority of psychologists are generalists- stand tall and stop the self defeating whinging! We have a serious job to get on with.

  53. Peter Faulkner

    When the history of RAPS is written it should be called –

    “Madness, misinformation, and misfits: How RAPS destroyed psychology in Australia”

    While thise with postgrad degrees and endorsements should be at the higher tier, the 4+2’s should be thankful they receive any medicare. There was no quality control in the 4+2 process, friends and work mates signing off other friends and work mates with no true assessment of skills – i saw this done first hand. Would you think this was ok if this was how medical practitioners were trained?

    As for this ‘article’ – clearly written from a RAPS information sheet, very poor.
    The colleges were not interest groups, you had to have a masters to be a member….

  54. Oh so grateful

    ‘The Guardian’ may well be interested in shining a light on this situation as well ?

  55. Roz Ramplin

    Those Clin Psychs spewing venom towards Gen psychs need to review the APS code of ethics. Seriously and be warned by them.
    They also need to be aware that many gen psychs have Ma degrees and PhDs, which counter the venomous remarks that gen psychs are unintelligent.
    I also add that Clin Ma is a choice, not a directive. The same institutions that trained clin psychs are the same instructions that trained gen psychs, so I’d be careful about suggesting people are unintelligent.
    It’s worrying that such venom and narcissism exists in those who should be able to articulate a grammatical and well considered argument while maintaining moral and ethical standards.

  56. J.Stein

    What is not well conveyed about Psychology is that it is a life long learning profession. The extra 2 years at University to do a Masters in Clinical mean nothing if you do not continue to regularly update your skills, the same as if you did a 4+2 and do not update your skills. Do they teach you to treat complex trauma during a Masters of Clinical Psych? – no, well they didn’t when I went through. Do they teach DBT? No. Do they teach the management of chronic pain? Well if you take the line of CBT for everything then I guess you can say you are qualified however these are all specialist areas of treatment and usually those that are interested in treating them have done far more extensive training then is offered in any Masters or +2 supervision pathway.
    The argument for who can treat complex disorders should not be based on who has a Masters Degree in a broad area such as clinical but rather who has done more specialised training in these areas – and from my experience after completing a 4+2 then going back to “upgrade” through a Clinical Masters there was nothing extra added by this degree to my treatments which only showed it is a useful pathway if you have had no exposure to sitting in front of clients previously. The psychology profession has been derailed by academics who do not have any real idea for what is actually occurring in treatment rooms every day throughout this country. A tiered model takes away an important aspect of Psychological therapy – it reduces the clients choice as to who they feel most comfortable with in exploring some of the most traumatic experiences in their life.
    Have one tier for all, fund it at a lower level, and increase the number of sessions available to all – this is in the best interests of the public, and the profession.

  57. Maree Boyce

    Thank you so much for this well researched and accurate article – I would call upon the Minister, the Government and the review board to reject the current APS’s obvious, self-interested attempt to hijack funds and power from what mental health initiatives and medicare are designed for – to allow people with mental health issues especially those already marginalised, access to adequate care and experienced practitioners. Working psychologists since 2006 have been unable to stop a small group of self-interested people who sought APS leadership positions (often academics) distort the whole Australian profession but members have tried, both individually and through uniting. The current leadership and board have acted unethically (and some could also argue illegally) many times and have used members own funds against them with lawyers etc. Record numbers of psychologists have walked away from membership as there is no benefit – I fear bankrupting the current APS will not stop them if they successfully fool the government before that happens. It needs to be added that many psychologists practising in remote and rural areas have ‘general’ registration and this means where services are already thin on the ground they will cease or become rarer at least. Both the Australian population and many skilled practitioners will, in one foul swoop, both be hit – the first won’t be able to access services and the second won’t be able to practice. An analogy perhaps might be – consider a group of people in medicine setting themselves up as ‘specialists’ although they have no different skills to other practitioners and then challenging the ability of other practitioners (like GP’s) to see sick people – all sick people must see one of these ‘specialists’ with long waiting lists and higher fees. These new ‘specialists’ are likely to be people skilled in theoretical perspectives but some will possess much less practical experience and often less life experience as all these new requirements added are historically recent developments.

  58. Greg Kasabian

    Roz, I agree with your argument – does it go both ways though? You seem only to hold the ‘dastardly clin psychs’ to your ethics and set of standards while the ‘Gen psychs’ are allowed to make derogatory comments about training and skills of the ‘other side’….

    Clearly some of the posts on here are trolls and some simply bizarre (eg – Ethan Jones – clearly a badly written RAPS piece)
    There are two issues here that are being conflated –

    1) How to manage Medicare for current psychologists
    2) What should the training of psychologists be in the future

    Re: 1) – there is no doubt that all endorsed psychs should be at the higher tier. Rather than blunt ‘grandfathering’, all others should have o go through an assessment process. The issue that no gen psychs seem to want to address is that the 4+2 process was highly variable in terms of quality and outcome – no doubt there are some good psychologists from this process, however there are many poor psychologists and the reality is – who knows what they are doing in their private practice rooms? They might provide good support – but is this treatment?? I think not….and this is not the intent of Medicare.

    I attended a peer review group of 7 psychologists (I’m a counselling psychologist), and was appalled at the level of skill and competence in simply presenting a case and a cohesive formulation and treatment plan. The majority presented rambling, unstructured and poorly thought through cases with no clear theoretical underpinning. I attended 4 peer groups and then stopped due to the lack of insight and willingness to work reflectively and consider sills deficits.

    Now, I’m not saying this is all ‘4+2’s’,, of curse not, but how do we know what people can and are doing??? Who knows what training 4+2’s have received. Again, some received good training, but clearly some received very poor training and probably shouldn’t be registered or receiving Medicare.

    Regarding 2) – psychology has been modernising training over the past 20 years – it needs to be a masters minimum and clearly the 4+2 is outdated and of questionable reliability and quality in some cases – that is not good enough. We do need to look at what is happening overseas and what will prepare our psychologists to be the best they can be.

  59. Sharon Snowdon

    To Peter Faulkner above. Would he like to comment on the fact that many of the endorsed psychologists are in fact 4+2 psychologists, who were grandfathered into endorsement through belonging to an interest group or College?

  60. Philip Armstrong

    If what I have read in all the above comments plus the APS submission (I think they are up to version 3 now) is reflective of a regulated industry John, then I am even more proud to belong to an industry that is so well self-regulated as registered counselling under ARCAP. Let’s remember the much-discussed non-existent research in regards to who gets better outcomes also relates to registered counsellors. There is no research that reflects psychologists clinical or otherwise get better outcomes as a whole. I will make one caveat, counsellors should not in the main be working in isolation with clients who have a severe mental illness as opposed to a mental health issue. That would be working beyond most counsellors skill base which would be unethical.

  61. Joanna Redfort

    i have a superb experienced GP. She is an older GP who once used to do quite a bit of surgery at our local country hospital. In the last couple of years she has helped me through two medical crises. First, I was having a heart attack I didn’t know about when I went to her for an enduring headache. She ran an EEG and shunted me straight off to a heart surgeon for a stint. Then shortly after that I experienced a face cancer on my lip. She sent me to an outstanding plastic surgeon. Now, I wonder as to why she didn’t do the treatment herself. After all she has a medical bachelor and bachelor of surgery degrees ( MBBS), a number of diplomas, upkeep’s her PD, and has dollops of experience. I have every confidence in her because she seems to know what she doesn’t know or wasn’t trained for.

  62. Don

    In my view the article and many of the comments, overlook the implications for our profession of our professional body (APS) lobbying government around an tiered model of specialty unsubstantiated by outcomes data. The issue for today may be the public funding for treatment of ‘complex mental health concerns’, but what about tomorrow?

    Let’s think about the NDIS, the Courts and Child Protection systems and myriad of other touch points our clients have with government or insurance bureaucracy. Should the federal government accept this lobbying, how soon will it be before the only psychologists allowed to deal with government funded clients are those who are ‘endorsed’ in the way described by the APS in their submission?

    How long before the dynamism and the potential of our future of other specialties in our profession are threatened further by Universities narrowing their offerings further?

    Some of my best friends are Clinical Psychologists. I admire their work, I admire their dedication to their training and ongoing professional development. But I do not subscribe to their clinical model of care. When I did my initial training, choosing to study Clinical Psychology was as much about choosing a philosophy as it was about the use of particular treatment strategies. In the Court I was considered an expert witness in another model of psychological care. It saddens me that organisation to whom I’ve paid membership dues for 25 years does not credit my professionalism.

  63. Robin the Hood

    Thank you very much your article Eva. bringing together some very important points on the treatment, hopefully ongoing treatment for the Australian community at large. One can only wonder WHY the Peak body has gone down this path. Indeed the AMA decided to restrict the number of ‘foreign GP’s’ obtaining their accreditation, recognition of their overseas qualifications, in the name of ‘whats good for Australia’ Seem to be the catch cry of the rabid right, before their time. Is the APS becoming precious or trying to hose down potential litigation?

  64. Jon Chesterson

    PETTY TURF WARS – Oh dear John and a few others, it would seem you should do your home work too, “Psych nurses and social workers in private practice are proliferating exponentially” as if you suggest they are a threat to psychologists, what rot! Do you think by stating a territorial opinion that this is fact? Where is your evidence and please please do not cite the MHNIP program which has been capped for a long time by this government and in no way compares to the proliferation of psychologists into mental health on MBS. We need many more social workers in our system than we presently have and we need to adopt more sociological and systems orientated approaches. Individual client centred approaches have become somewhat of a myth we all fall behind to justify our existence and I question their worth, a far cry from their original exponents who might be turning in their graves right now.

    On reading many of the comments here and seeing the polarised arguments within the psychology profession, this canvases many of the same issues facing other professions, particularly nursing and social work, psychology is far from alone or unique. I am so tired of psychologists cutting up their territory thinking they can ignore nurses and social workers or indeed think they are some how special and have more ambient claim on mental health, spilling their specialist generic divide into attacks on other professions. The reality is psychology has legitimate issues which need to be sorted and get its own house in order just as any other profession does. Members of the public are not owned by any health care professional and we all have a responsibility to listen to the voice of public need, choice and advocacy.

    Mental health is a complex domain and frankly I find the discipline of psychology territorial and wanting when it comes to meeting the needs of people with mental illness. Part of this is also to do with orientation, since the causes of mental disorder, the factors that bring it into play and maintain disorder are as much social, institutional, economic and political. There is a rampant social and existential pathology and aetiology that cannot be effectively treated by focusing on the individual or individual pathology, whether genetic and developmental prerequisites are present or not. Many of our social, economic, corporate and political institutions are toxic, including our public health system and industrial relations. No amount of CBT, DBT, RET, TA and psychology services are going to repair the damage when we throw people back into the mud or conveniently ignore the social determinants, the society we live in, or throw our hands up and say I have done what I can for you, because it is not enough. We need social workers, mental nurses, psychiatrists, occupational therapists, alternative therapists, counsellors as much as psychologists and casting dispersion as some do here on these groups is counterproductive and dysfunctional. The question of formal education, life long education, supervision, regulation and ethical practice are matters for all our professions or disciplines to address, and medicine and psychology have done hugely well politically and economically with their inferred status and political lobby and yet I hear so much grumbling from the upper table.

    Perhaps if we all constructively participated in addressing the internal conflicts instead of projecting and blaming, attended to a constructive, reasoned and equitable approach to resolving these issues, combined our expertise across disciplines to fight the real enemy which is corporate and political greed, excessive human self interest and selfishness, bad government, individual egos and our toxic corporate, public and private institutions, to name a few, we might become a little more relevant to the needs of the people we assume to be good for or indeed the society they live in. There is an elephant in the room, a moral question here.

    Time to tune up our moral development and ethical practices across the sector and time to look at how we might treat, repair and nurture our public and social institutions instead of seeing people with mental illness as a psychological farm to put food on the table or thinking we have done a god job when we send them back into the trenches half repaired and still wounded.

  65. James Hands

    The two-tiered Medicare rebate scheme has caused many problems for the field of psychology, especially an ironing out of diversity of expertise across the profession and bias towards clinical streams.

    This latest proposal will compound the divisions within our profession, marginalise its relevance to the broader community and eventually make the whole field redundant.

    As stated above, we are all registered with AHPRA and members of our peak professional body. While allowing for special interests and expertise, all psychologists who meet the above criteria should be treated with equal value and respect.

  66. Jon Chesterson

    James, just wondering what the above criteria are? Would this be AHPRA? Because if nursing for instance relied just on AHPRA nursing registration to determine who would be eligible to provide services under MBS or MHNIP for people with complex mental disorders we would all be in a right pickle. AHPRA’s nursing registration does not regulate or define the practice of a specialty such as mental health nursing and if this were the benchmark we would have the majority of the nursing profession eligible to practice well outside its scope and depth of practice and specialisation. To practice in the primary health care system a nurse must be an RN with AHPRA and a Credentialed Mental Health Nurse with the ACMHN and a social worker I understand a member and Approved Mental Health Social Worker with AASW, a similar or equivalent recognition for the field, and I believe that would be the AASW position. Is this not equitable to the APS position?

  67. Michael H

    Unfortunately Jon, for psychologists The Psychology Board in AHPRA is the one that recognises specialities, as endorsements noted in the registration register – not the APS Colleges. The APS can only lobby. We are in a right pickle because only those endorsed as clinical can claim a higher medicare tier, and now Centrelink is only accepting their assessments as valid for NDIS. With developmental disorders for example, developmental psychologists cannot now sign off – it has to be a clinical.

  68. Dr

    A well-written and apt article. I am a ‘generalist’ psychologist with a PhD in my area of interest and research reliability in the diagnostic tools related to this area. I have been working in the area for almost 20 years, yet I will not be recognised under this proposal. I am disgusted with the APS and it’s past and current deceptions. Perhaps they should be known as the ‘ACPS’ (Australian Clinical Psychology Society) as they seem to only serve the interests of the minority of their members. I respect my friends and colleagues with clinical endorsement , however there is no evidence that Clinical endorsement creates better outcomes for clients. Somehow this myth continues. A Clinical Masters is simply another pathway to increasing knowledge and experience.

  69. Dr. Vitorrio

    There seems to be a lot of misunderstand regarding generalists psychologists and there level of higher education.

    Many psychologists have studied four years at university – an undergraduate degree and a graduate diploma in psychology and then did their supervision in the community. These psychologists now despite their level of experience are relegated to generalist titles.

    Then there are psychologists who have six years at university with a masters degree in psychology and even a clinical masters degree and still not be endorsed as a clinical psychologist and will be endorsed as a generalist.

    It’s important for psychologists making criticisms against generalists to understanding this.

  70. Phil Hunt

    There seems to be a divide between psychologists, some who hold generalist training, post graduate training and those who are members of the APS and those who are not.
    The APS submission seems to quote, quite rightly, that there is a two tier Medicare rebate pathway for clinical psychology rebates and generalist psychology services rebates.

    Is the APS therefore not happy with the current provision and wanting to legitimise their claim for gaining access to increased per calendar sessions with clients (currently 10 per year)? Surely, this doesn’t need to be at the expense of psychologists who have entered the profession via different routes and whom provide essential services to many in the population in need. Would it not be more prudent to argue on the evidence for the number of treatments required for each disorder which in fact is in the public domain right now. I’m sure most of my colleagues see people who don’t fit into simplistic diagnostic groupings with the level of complexities experienced by people often being chronic and across diagnostic boundaries. I wonder if the Clinical college of the APS believe their chances of obtaining more sessions for their clients would improve if they could argue the additional costs could come from a realignment of existing service provision?

    I agree that further formal training is essential with many studies identifiying better outcomes relate to concordance with therapy models, however this training can be obtained in many different ways ( in service training, further degrees, supervision) indeed, a point needs to be raised in respect of practitioners being concordant with therapy models such as CBT or schema therapy or CPT to ensure that clients have the best opportunity for recovery and that the collaborative therapy they receive is evidence based. Ensuring this is the case requires practitioner openness and ongoing training/supevision which isn’t actually guaranteed with the APS model.

    As a foot note, I am a generalist registered psychologist who has both social work and psychology undergrad degrees, post grad in Social work and completed the 18/12 Post Grad Diploma in CBT in the UK. The latter post grad being a prerequisite in the UK for clin psychs and psychiatrists to attend if they wish to utilise CBT in the uk. interestingly, this does not equate to any formal qualification in Australia and as such would prohibit me from providing Medicare services if the proposal by the APS was taken up by the Dept of Health.

    Shame on the APS and clinical college for essentially rubishing the good work of others to further their own self interest on the basis of nothing more than elitism.

  71. Greg Gardiner

    MISREPRESTATION: I ask the APS and staff to stay away from Australian Government Ministers and stop pretending to represent Australian Psychologists. You do not and have not represented me for a long time. The APS has a track record of being self-serving making decisions that are harmful to the Australian community.

  72. John D'Alessandro

    Hi
    I am a rural psychologist who holds general registration. I am about to ask the APS is the information in your story correct. If it is I will resign and save the 700 dollars I am paying to support a group that is apparently not supporting my interests.
    I find it extremely puzzling that a society such as the APS who purports to use evidence does not seem to accept the vast amount of research that does not support this elitist and poorly thought out position.

  73. Matthew Hemsworth

    Found this on a website, thought I’d post out of interest – quite shocking!

    David Attenborough’s observations on the matter –

    The “RAPSidious 4+2” is a strange and magical beast, prone to subscribing to misinformation and so called “alternate truths”. After completing four years of university with no applied skills, many were trained by psychologists who themselves went through the 4+2 process, a process of questionable merit and at times varying and unknowable content. Idiosyncratic and largely unstandardised in nature, the 4+2 process sees the “senior” training the “junior”, passing on questionable skills and knowledge from one generation to the next and so forth, creating generation after generation of variably and unreliably trained psychologists. Often without any substantial evidence or formal objective assessment, the “senior” signs off that the “junior” is ready to practice independently, a magical process largely, and one difficult to quantify and shrouded in mystery.

    Knowing full well for almost 30 years that masters degrees would be required and was the future direction of psychology, the 4+2 instead largely seems to have chosen to stay locked away in the “private practice” office, with little exposure to sunlight or the regulatory eyes of registration boards or peers, doing….. well, we are not quite sure; it is an unknowable and enigmatic space. With claims of ‘alternate degrees’ imbuing the 4+2 with skills which they claim allows them to function at a level the “same” as or “higher” than those with psychology postgraduate degrees, they continue this pattern, year in, year out, refusing to undergo any form of objective competency assessment.

    And on the horizon we see the ‘alpha’, the masters trained psychologist who has undergone additional structured and objectively assessed advanced training. In other colonies internationally we see higher level training pathways at the doctoral level. But the 4+2, tied down by history, remains steadfastly against this, focused solely on the ‘lowest common denominator’ training level.

    They group together, often on social media platforms, sprouting alternate facts about APS colleges and memberships, conspiracy theories, evil alternate psychology organisations, and make emotive calls demanding equivalence – if you listen carefully you can hear them at night ….”We want what you have, but we are not going to do any additional training for it … it is our experience”. It is a strange call that is unable to be verified in any way, and often perpetuated by self-reinforcing alternate facts and odd claims such as the recently developed “horses for courses” theory of training (“The 4+2 pathway is for more mature and self-driven / self-directive people, while a masters is for those that require structure and more guidance in their learning”).

    Training pathways are often re-named by the RAPSidious 4+2, such as masters programs re-labelled as “book learning” and the 4+2 pathway as “clinically based” or “based in a clinic” in an attempt to legitimise clinical skills. The perceptions of reality held by the 4+2 are oddly skewed – 1000 hour placements in masters programs are re-defined as “40 hour observational placements” in an effort to undermine “alternate postgraduate training pathways”. Despite logical challenges and corrective information, the 4+2’s ideology remains fixed, clouded by in-group justifications, rationalisations, and blatant denial of reality.

    Ultimately, it is the species of ‘psychologist’ that suffers. In the changing landscape and territory within which the psychologist finds itself, and within which there are increasing demands for psychology input, the 4+2’s RAPSidious head remains firmly planted in the sand, refusing to acknowledge the change in climate, and staying firmly embedded in a historical training architecture seriously found wanting. These ‘climate change deniers’ refuse to engage in rational debate and frequently block dissenting comments from their social media platforms.

    Ultimately, the profession as a whole is weighed down by history rather than looking towards a bright and fulfilling future where psychologists can specialise, and in response to spending additional years studying and developing further expertise, be recognised and rewarded. The RAPSidious group remains lurking in the valleys, the shadows, prepared to take down it’s prey … at any cost, …. even at their own.

  74. Michelle Carroll-Walden

    Wonderful article. Clear with the issues facing the psychological community and the broader community.

  75. Joelle

    I’m an endorsed organisational psychologist. I don’t provide services through Medicare and have no vested interest in this issue (other than a general concern that people are able to access affordable, evidence-based treatment from competent professionals). I’m not interested in defending the APS nor making comment on the relative value of different pathways to registration.

    What I did note in this article is either a misunderstanding or misrepresentation of the role of the APS and the role of AHPRA in determining area of practice endorsements, and of the history of endorsements prior to the creation of AHPRA, when this was the responsibility of State Psychology Boards. The training requirements for obtaining area of practice endorsement described in the article are also inaccurate.

    This leads me to question the accuracy of how the APS submission has been represented through this article. The above misrepresentations seriously damage the credibility of the arguments put forward in the article.

  76. Maria Polymeneas

    What disgraceful comments Johnathan Locke (if that’s your real name). With that type of disrespect I hope you are not seeing real people and are in fact only in research!

    Registered psychologist are the backbone of psychology. I specialise in pain management and will often get people coming to see me for help after having seen an endorsed clinical psychologist and getting very little assistance at much higher rates that I charge (because they get a higher rebate).

    There is nothing wrong with changing the 4+2 system long term but people need to be given an opportunity to train up (no places) and the clinical psychs need to think outside their square and understand that there way is not the only way – down that path goes destruction and limited beliefs systems.

    I tell clients to study social work as psychology is going to the dogs!

  77. Charles Lucas

    Eva Cripps – I applaud you – in my forty-two years as a psychologist and with over thirty years of continuous membership of he APS working within governmental, organisational, academic and now private practice in city, rural and relatively remote areas, I don’t think I’ve ever read a more informed and insightful piece about our profession. Thank you so much for your advocacy and giving voice to the concerns of the current state of the profession in Australia. The absurdity of the proposed Level Services model, which as well as being discriminatory of registered psychologists in Australia and arguably unethical (C.2.3.), creates perceptions of differing qualities of service delivery amongst not only our referring professionals, but within the client community itself. This, of course, has consequences for service outcome as the expectation may be created by the consumer that they are much more likely to get a good treatment outcome with an “endorsed”psychologist, than they would with a “non-endorsed” psychologist. Rather, we all know that therapeutic “fit” is the fundamental determiner of treatment outcome. The APS recently released the review of evidence based interventions in the treatment of mental disorders (https://www.psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/Evidence-based-psych-interventions.pdf) and try as I did I just can’t see where any of the interventions are restricted exclusively to “endorsed” psychologists with regard to skills acquisition and the development of competence. Therefore, of course, if these interventions are evidence based and have a place in the treatment of “severe and complex” disorders (Level 1 endorsed psychologists only) then under the model there could be potentially many “non-endorsed” psychologists who have the requisite treatment skills for the “severe’ disorders who will be discriminated against having dire implications for our client community in view of the case that the majority of registered psychologists are not “endorsed”. Basically then, we are all psychologists first and foremost – we have a Code of Ethics – we are regulated by a requirement that we maintain and enhance our skills and competencies through professional development which includes of course unrestricted entry to workshops and training venues providing evidence based treatment frameworks to treat our client populations whose difficulties range across the intensity spectrum, including, Axis 11. I’d prefer to move away from the concept of “endorsed” and “non-endorsed” (members of the DGPP and the majority of the membership) back to the concept of the registered psychologist under the governance and regulation of the Psychology Board of Australia and AHPRA who is committed to maintaining a professional standard of evidence based treatment delivery across the spectrum of mental disorders. Within the broad population of registered psychologists, as in any profession, there will be those with special interest areas and preferences for certain interventions where continued practice could lead to expertise in the area, but any expertise is not, of course, the exclusive domain of either the “endorsed” or the “non-endorsed” psychologist, but may be found right across the community of psychologists.

  78. James Ising

    Yes unfair if true but…Psychologists cannot rely on Medicare for the sole source of their income. Government programs change all of the time. before Gov’t funding psychologists did just fine. Develop other sources of referrals and income. e.g. counsellors charge $100 plus for a session with no client rebate. Run courses in relationship education or anger management. Do EAP work. Many ways to skin a cat people, don’t rely too much on one source.

    Even if this did happen it is up to psychologists to be creative. By developing relationships with referring Doctors/practices they can adjust to any rules changes to still get you the clients they, and you, need to see. e.g. if a client does have complex trauma and also happens to have depression, refer for the depression-if you happen to treat the trauma as part of depression treatment so be it-the referrer, referee, and Gov’t are all happy.

    Psychology needs to teach more lateral thinking and basic business skills. Remember, YOU are the product-market it well!

  79. caroline ooi

    Thank you for taking the time to write this very important article. As a registered psychologist what is going on in the industry is very upsetting on a professional and personal level. Thank you for raising awareness of the issues.

  80. Peter Goodluck

    How about those that complain make the effort and commitment to being better psychologists by doing a masters course and undertaking a registrar program. You’ll notice I didn’t say clinical, but any postgrad psych masters. If you want a higher rebate then be better and offer better. The 4+2 ‘psychologist’ is a misnomer, who knows what they can / cannot do. Masters guarantees a certain level of training and capacity to function.

  81. Paul

    Yes Peter Goodluck
    The logic is sound and you are also not alone in the conclusions you have formed, as like the population of Australia you have apparently been mislead.
    Let me clarify some facts for you

    62% of Generalist Psychologists are Masters in Psychology (MA or MSc) or have a Doctorate in Psychology (PhD)

    Of those highly qualified Psychologists who CURRENTLY have Clinical College Endorsement
    43% of then Do not have a Higher degree
    Some have a degree in Psychology
    Some have an Honours degree in Psychology

    So I appreciate your endorsement of Generalist Psychologists gaining parity – because by your argument 62% of us are “guaranteed to a certain level of training and capacity to function”

    Of the other 38% they have followed and paid for extensive training and. Supervision (Sadly some have HECS Debt of $100K and now are unable to flourish in this profession)
    The Australian Psychological Societies has defined clear directives and now understandably these people feel a little bit cheated out of a future.
    Their own professional body has apparently misled them, the Universities have apparently mislead them and they are tragically left with limited options after 6 + years of committed study.

    But bedsides all that we have a crisis of mental health and suicide rates which the media are unable to report on because of the frequency.

    We have a profession which is ranked internationally as effective, if not more, in establishing the same high treatment outcomes- whatever rank or degree we are paid at.
    We are very proud of all the excellent work ALL Psychologists do in supporting the vulnerable, traumatised, distressed in our communities. I am impressed by the work of our profession and this false division is both illegitimate, unwarranted and unwanted by most.

    Many Clinical Psychologists are supportive of the #OneTierMedicareRebate
    Some have expressed embarrassment about the disparity about the higher ($40/ hour rebate) their clients can claim.
    Others- as we have met in this thread are very proud of the disparity and smuggly suggest that “they are superior” and therefore deserve it.
    But do they?
    Let’s look at the research….
    Pirkis, J et al (2011) found almost identical effectiveness in outcomes regardless of the levels of training undertaken and academic pathway followed.
    Surprising isn’t it- that in a highly scientific community that our “leaders” and I use the term very losely-
    Have NO EVIDENCE to back up their submission & their peacocking of some people- above others.
    Sounds like the ol divide and rule politics scenario….

    In real monetary terms…
    Cost of 10 sessions with a Gen Psych- Medicare will rebate the client $848.00
    The rebate to the client of a Clinically endorsed Psych for 10 sessions is $1,245,00
    That’s a whopping Medicare saving of $397/ client – and sadly another burden passed onto the client.

    Also bear in mind that Generalist Psychs can charge whatever gap fee they choose so the real people loosing out are the consumers- the Australian public – as they get lower rebates from Medicare- higher charges.

    Currently Generalist Psychs are seeing more clients and undertakings 2/3 rds of the work.
    This inequity is apparently working both for the government and against the people who fund Medicare, and access these essential services.
    You will understand that when a client need to see a Psychologist- they have serious challenges in their life- they are not coming to discuss the carpet or have a pleasant chat- they want solutions and safety, and support and reassurance and a whole range of tools- we Psychologists are excellent at managing these crises- it’s not a job for everyone and it’s not a job most people understand either- unless they have experienced the process.

    It’s quite sticky when you start looking at it and I encourage you as a consumer/ possible consumer/ family member of someone with mental health needs to do so.

    In concluding Peter thanks for your support
    We continue to lobby for #Unity and #OneTierMedicareRebate
    There are a number of petitions online you could sign.

    This one is particularly effective in highlighting the inaccuracies and explains finer details

    https://www.communityrun.org/petitions/enough-is-enough-all-consumers-and-psychologists-in-australia-deserve-equal-access-to-medicare?source=facebook-share-button&time=1534994462

    But do let me know if there’s any other fact checking you’d like me to clarify for you.

    Regards

  82. Teresa Slaviero

    Maybe it’s the negotiation with the government and APS to lower the amount they spend on mental health. Not every pain in life is physical. Imagine going to a GP who only specialises in coughs and colds and not any serious diseases/infections. Some of us would be dead now.

  83. Peter G

    Hello Paul,

    Thank you for your response. While some of what you say is true, you also put forward misinformation and unproven information under the guise of ‘facts’. I’m more than happy to be corrected if there facts to dispute what I am saying. I have questions below which I would appreciate you responding to which will certainly correct any errors at my end.

    62% of Generalist Psychologists are Masters in Psychology (MA or MSc) or have a Doctorate in Psychology (PhD)
    So I appreciate your endorsement of Generalist Psychologists gaining parity – because by your argument 62% of us are “guaranteed to a certain level of training and capacity to function”

    Where do you get data this from?
    In referring to masters degrees are you referring specifically to ‘psychology’ masters or a mixture of psychology and non-psychology masters degrees? There is a difference here. I have an additional masters in an area of ‘mental health’, but we are talking about accredited formal psychology masters degrees for the purposes of registration.
    Australian PhD’s are very important, however they are not a psychology registration training degree. While having one is fantastic and displays huge commitment, it has nothing to do with registration as a psychologist and the base skill level across the population of psychologists. (American PhD’s and UK DPsych’s are of course different).

    And yes – compared to the 4+2, there is a certain level of skill that psychologists come out of the course with. This is not the case with 4+2 and never has been no matter how you want to argue the point.

    Of those highly qualified Psychologists who CURRENTLY have Clinical College Endorsement
    43% of then Do not have a Higher degree
    Some have a degree in Psychology
    Some have an Honours degree in Psychology

    Yes, I agree with you – this is highly problematic and should not have occurred. What should have occurred is –
    Endorsement in clinical, neuro, health, forensic, and counselling got higher tier, + those with ‘X’ years experience could undertake assessment to demonstrate competency. But how to assess ‘experience’? Is is competency based or just number of years based?
    Org and Sports and Exercise – no, these are different areas of practice and not in the clinical realm.
    Community – ?? who knows. Rather than community there should be a ‘public health’ group who operate at the system level.

    Of the other 38% they have followed and paid for extensive training and. Supervision (Sadly some have HECS Debt of $100K and now are unable to flourish in this profession)

    Sorry but undergrad psychology degrees do not cost $100K – even now. As for supervision, yes this can be stupidly expensive – and who knows what training and supervision they are being provided with? Sometimes good, sometimes not, and a lot in between. And I’m talking about the last 40 years of this – this is nothing new. I have seen people be signed off on competencies they were not competent at. Is this what we as a profession would accept? I ceased doing 4+2 supervision years ago after supervising two and realising the system was highly flawed – how could I teach them everything or be ale to assess that they are fit to practice across all areas? No other profession has this. And let’s not forget – this has all been coming for 40 years. People have had ‘years’ to update qualifications and address this. And still today we have people requesting 4+2 pathway supervision – and even worse, psychologists recommending the 4+2 pathway. I’m amazed at this. Granted, students don’t get much information during undergrad about the realities of the profession, however to still be pursuing the 4+2 (and being told to do so) with so much out there regarding it’s flaws and challenges is not a good indicator of suitability to work as a psychologist nor of doing due diligence- which anyone entering a profession should of course be doing. I would argue it is also inappropriate and bordering on unethical for a psychologist to be recommending (or to have over recent years) that a student pursue the 4+2 pathway.

    Part 2 below

  84. Peter G

    Continued

    The Australian Psychological Societies has defined clear directives and now understandably these people feel a little bit cheated out of a future.

    The APS is trying to advocate for changes for the betterment of the profession, but at the same time is also tasked with trying to advocate for all psychologists. They haven’t done a great job, no doubt, but if you think back to 2000 the APS membership was changed then to masters minimum – the writing was on the wall. They should not have introduced Assoc membership, and the 4+2 should have been closed down in 2000, if not earlier.

    I think we would both agree – there has been a failure of leadership in psychology over the past 30 years.
    Did you know that psychology in the 1970’s was offered Medicare? 40 years ago…..and we couldn’t decide then how to manage ourselves. Stupid.

    Their own professional body has apparently misled them, the Universities have apparently mislead them and they are tragically left with limited options after 6 + years of committed study.

    Maybe – but shouldn’t people be doing research about the career they want to pursue and what the realities are? It’s pretty clear that any older / mature age student undertaking a new law degree will struggle to find employment. I agree that the 4+2 pathway leaves people with very few options hence my comment above regarding advice from psychologists already working.

    We have a profession which is ranked internationally as effective, if not more, in establishing the same high treatment outcomes- whatever rank or degree we are paid at.

    Ok – Pirkis, J et al (2011). This is the one study thrown out repeatedly as evidence to justify the one tier. The fact that this is repeatedly used as evidence by RAPS etc is testament to the poor training and understanding of research methods of this group of psychologists. There are so many flaws in it that any epidemiologist would consider it interesting, but not valid. Cases were self selected, there was no control for patient complexity, etc etc etc – this has been discussed at length on other sites.
    This is not evidence. It is a small part of wider complex picture. There is no doubt that ‘certain’ psychologists are better than other psychologists at ‘certain’ things – I do think this should point us to areas of specialty that should be remunerated at a higher level – I’m not saying ‘clinical’ here, I’m saying areas of specialty where higher levels of training, supervision, and competence are required.

    Having started the 4+2 myself for one year, then moving to a masters program I know the difference in what i was receiving.

    4+2 – weekly meetings with a supervisor ‘X’, attending some PD, reading, seeing some clients.
    Masters – 12+ subjects with multiple assessment, 1000+ placements with multiple supervisors and exposures, thesis, etc, + registrar program.

    There’s a difference here.

    We are very proud of all the excellent work ALL Psychologists do in supporting the vulnerable, traumatised, distressed in our communities. I am impressed by the work of our profession and this false division is both illegitimate, unwarranted and unwanted by most.

    I too am proud, but we need to be clear about what psychology is and what it isn’t. Things are changing, there are specialties – we are not all the same – we are diverse and have different specialist skill sets based on our initial masters training. Psychology is gaining momentum and we need to jump on this and have psychology better recognised and appreciated. Psychiatry is questionable with ongoing failure to meet the claims it makes.

    I certainly support change in the profession. I suspect this won;t go away for many years unfortunately.

    Regards
    Peter

  85. Josie

    I find it interesting Peter, and somewhat hypocritical, that you criticise the Pirkis et al. study whilst offering no reliable evidence in support of your own argument.

    There is no doubt that the research by Pirkis et al. was never designed to answer the question ‘Is there a difference in the skills of endorsed vs. non-endorsed practitioners of psychology?’ and it doesn’t do so. But neither do the anecdotes, individual, uncontrolled, single case studies and personal opinions you have offered here. If you are making a claim of superiority of one method over another, then the onus is on you to provide satisfactory evidence in support of those claims.

    Personally, I make no claims of superiority or specialty. I work within areas in which I have training and experience. According to the APS submission, I am not skilled enough to do so, despite the fact that my training has been approved by AHPRA. It’s not unreasonable to ask them for evidence to support this assertion which will potentially affect my livelihood, my employability and my clients’ ability to access services of any kind.

    I do accept that the 4 + 2 pathway will be retired. I don’t accept that this means I am no longer capable of providing services I have provided and trained in for some 20 years.

  86. Mark Andersen

    Dear Josie, thank you for your comment. It does seem quite facile to take the only piece of research on client outcomes of clinical and generalist psychologists in Australia and then dismiss it as “flawed.” Almost all research has flaws, and researchers, statisticians, and epidemiologists can argue (often from their own biases) about the merits and deficiencies of any piece of research. But then to criticise people, who refer to such research, as “obviously” under-educated about research methods, smacks of a kind of ad hominem argument against practitioners citing a study that was funded by the Australia Government Department of Health and Ageing and conducted by a professor at the Centre for Health Policy, Programs and Economics, Melbourne School of Population Health at the University of Melbourne. That sounds like a research group that might have some respect from the academic (and governmental) community. Sure, there could have been better controls, and more data could have been collected on the complexity of client cases, but one works with what information is available. The DASS and the K-10 are almost universally used as measures of metal health and metrics for changes in mental health. When many of us receive referrals from GPs, there is often a DASS, or a K-10, or both. When we work with clients on workers’ compensation or through insurance companies, we are often asked to provide K-10 or DASS scores as evidence of client improvement or deterioration. The Pirkis et al. study used the metrics we all use in Australia. The almost identical effect sizes in the Pirkis et al. study between clinical and generalist psychologists for improvements in client outcome is actually quite astounding. When I calculated them, I was quite surprised that the differences were all trivial and within the margins of measurement error. I expected some differences, but there were essentially none. To blow my own horn, I have published 12 refereed articles on statistics, effect sizes, arbitrary metrics, and the flaws of null-hypothesis significance testing (e.g., Ivarsson, A., Andersen, M. B., Johnson, U., Stenling, A., & Lindwall, M. [2015]. Things we still haven’t learned (so far). Journal of Sport & Exercise Psychology, 37, 449-46.), so I have based my observations on the data available, not on unsupported opinion. So I guess the question is, if one is going to discount the only data we have as flawed (but “interesting”), then how is that an argument that clinical psychologists offer more valuable service? Government policy should be based on evidence. So I think the onus is on clinical psychologists, who think their services are worthy of higher rebates, to supply the research evidence that they have the data to prove that assertion. Until they do that, they really have no basis to claim that they are worth more than the generalists. I am a clinical psychologist, and I benefit from the two-tier system, but I think it is divisive, alienating, wrong, and just bollocks. I have never agreed with it. I am arguing against my own privilege and a pay cut. Split the difference and all psychologists get $104.50 rebate on medicare, or better yet give every client of a psychologist a $124.50 rebate. This debate has generated at lot of nastiness and narcissistic posturing on both sides. Generalists have been engaged in “poor me” victimisation diatribes. Clinical psychologists have expressed narcissistic “I am special” tendencies. It has been interesting how willing some of us are to display our pathologies in public ways. Hell, this post exposes my narcissism, something I have been in therapy for (with a generalist psychologist, who was fabulous). Please, let’s all get over ourselves.

  87. Nicholas Petrie

    It’s a shame that better training and skills, and a desire to see the psychology workforce aiming for higher level base training and recognition is viewed as ‘narcissism’. While individual differences are present across psychologists it is the base training we are talking about.

  88. Josie

    Nicholas Petrie can you provide some evidence of the better skills of endorsed vs. non-endorsed psychologists please? I’ve asked 3 times and nothing has been put forward, aside from this repeated claim of being ‘better’. Surely there is some research out there to support this opinion that you seem to share with so many others who also believe they are ‘better’. Surely this ‘better’ training produces ‘better’ client outcomes?

    Are we an evidence based profession or not?

  89. Larry Desmond

    Johnathan Locke seems representative of those who support graded psychological servcies. Who are you Jonnathan, and what – evidence do you have, beyond youir abuse, to support your opinion? I am a psychologist.

  90. Nicholas Petrie

    Josie and Mark, it seems equally as facile to accept one piece of flawed research as evidence. You seem to be missing the point. This is about the minimum standard – currently a client can go to a psychologist and who knows what they will get or what the level of training and expertise is? You seem ok with this. No other profession would tolerate or accept this (maybe social work is the only other profession accepting of this). When i see a professional for a particular service i want to make sure they are effective and can deliver.
    You seem more focussed on naive egalitarian principles at the expense of the profession and clients accessing care by well trained psychologists.

  91. Josie

    Nicholas, you seem to be suggesting that there is no minimum standard for a psychologist. That is incorrect.

    According to AHPRA, if a client goes to a psychologist currently, this is what they can expect to receive:

    General registration is available to individuals who meet the eligibility requirements under section 52 of the National Law. General registration as a psychologist enables an individual to work in any area of psychology that is within their scope of competence and use the title ‘Psychologist’. All psychologists with general registration meet a minimum standard of education and training and have been assessed as a suitable person to hold general registration in the profession.

    According to the APS:

    Psychologists with general registration have a minimum of six years of university training and supervised experience, and build on that every year with ongoing education to keep their skills and knowledge up to date. They are often experts with supplementary skills, experience and training in other areas applying their skills in psychology within a broad range of professional settings.

    That seems to be a minimum standard to me. Of course, many generalists exceed that standard, which is commendable.

    On the other hand, if client goes to a clinical psychologist, they may see someone who meets current endorsement standards for AoPE, or they may see someone who was ‘grandfathered’ into the role. (According to ACPA, that number is well over 40%) That is, many clinical psychologists have less academic training than many generalist psychologists.

    Either way, you are deflecting. Where is your evidence that endorsed psychologists produce better outcomes or have better skills than generalist psychologists? I’m not relying on one study. International research shows exactly the same outcome. On the other hand, you have no evidence whatsoever. I am firmly an evidence based practitioner. I’m awaiting your evidence. When you show that, I will happily concede.

  92. Paul

    Hello everyone. I did the 4+2 and qualified in 2016 January. I am an older student. I spent 20 years working in behavioural settings and privately with adolescents and their families. I also studied at night and completed a Masters in Counselling and later a Masters in Special Education. Both courses I pursued to enrich my understanding and knowledge of the profession. However, the best training and learning was in the field with other professionals. I joined the APS feeling confident it was a decent body to represent Psychologists like myself. After reading about the proposal submission I feel betrayed and let down. And to think, we pay a membership fee to have this occur. Shame. An alternative professional body might be the answer now.

  93. Melissa Jones

    Hi Paul

    Join the AAPi. Spread the word. More people more power.

  94. Nicholas Petrie

    Hello Paul, this is an interesting case in point. You have masters degrees but they are not postgrad psychology masters. While they no doubt add to your capacity as a psychologist they are not specific to being a psychologist.
    So, to reverse the AAPi and RAPS argument – why should you get the same as me when i have psychology masters and doctorate and you have non-psychology masters and 4+2?
    Clearly you have good experience and training, but should you get the same as someone specialising in Edu/Dev psych with a masters in that?

  95. Anita

    Nicholas, it’s the client that gets the rebate. Not every client would benefit from the skills that you have. People in Australia, like psychologists are diverse. Of course, you can charge as much as you feel you are worth – but at the end of the day, if a client can’t choose a psychologist that meets their need because of unequal rebates, it’s the client missing out.

  96. Dr. Vitorrio

    Nicholas, if you read the above posts you will see that having a masters degree in psychology, even clinical psychology doesn’t guarantee you are a clinical psychologist and therefore deserving of higher rebates.

    Endorsement of a psychologist’s registration is a legal mechanism under the National Law to identify practitioners who have an additional qualification and advanced supervised practice recognised by the Board.

    The standard pathway to obtaining a psychology area of practice endorsement in Australia is completion of an accredited higher degree (or equivalent overseas qualification) in one of the approved areas of practice, followed by a Board approved registrar program.

    The registrar program consists of three components:

    1.psychological practice
    2.supervision with a Board approved supervisor
    3.active continuing professional development

    It’s one of the greatest myths going around the profession that a masters in psychology, particularly clinical psychology gives you automatic endorsement, it doesn’t. Your still considered a generalist.

  97. Josie

    Dr Vitorrio

    I think it’s been mentioned frequently here that endorsement as a ‘clinical psychologist’ and ‘higher rates’ doesn’t guarantee an advanced qualification and advanced supervised practise in clinical psychology. In 2016 42% of ‘clinical psychologists’ did NOT have additional training in clinical psychology, courtesy of the grandfathering process.

    The standard pathways that you refer to are relatively recent. I’m open to any evidence to suggest these pathways are superior. In fact, I’ve asked for it multiple times.

    The issue being raised here is that psychologists who have been practising for many years are now facing restrictions to their practice, regardless of any specialised training they have completed, if it isn’t a university based ‘clinical’ course of study. Again, if evidence exists to show that a university based clinical masters course is superior, I’m happy to accept it. Please cite it so that we can move on.

  98. Gary

    Josie, what is the source of your claim that “ In 2016 42% of ‘clinical psychologists’ did NOT have additional training in clinical psychology, courtesy of the grandfathering process“? I note that when DGPP rep Andrew Chua requested the source of this often repeated claim by the AAPi, AAPi president Michael Pointer claimed that the AAPi has conducted a study that supported this claim but then was completely unable to provide the source of the data or the methodology used for this study despite multiple requests to do so.

  99. Sharon

    Hi Gary

    There is so much misinformation around in the market place, which seems to be restricting trade practices for Generalist Psychologists. I am happy to clarify any facts and refer you to the online open source information to answer your questions, as there is a team of us currently collating this infomation for various reasons. You’d be welcome to join us if you are interested in contributing and getting up to speed on the facts for yourself.

    It’s actually more than 50% of clinically endorsed psychologists who do NOT hold a degree higher than general psych 3 years or hons degrees- who were grandfathered into the college- according to Dr J Hyde, president ACPA, who made a submission to the Federal Dept of Industry 2016.
    There would be serious implications for her no doubt if she is found have mislead or indeed lied to a government department in her presentation of the data- given that she is the President of the ACPA and also holds an academic post with a University and is deemed to have an understanding of how to interpret data and represent this to government departments.
    This is the link to her submission: https://reformaps.org/wp-content/uploads/2018/06/acpa.pdf

    Research undertaken by Scobie et al (2016) indicates that of the Psychologists registered in the
    ‘Generalist’ category 66% of Psychologists hold either a Masters of Psychology or are Doctors of Psychology.
    The argument pertaining to academic expertise equaling superiority does not hold up to a basic level of scrutiny.

    Michael Pointer has never been the President of AAPI.

    The current President of AAPI is Paul Stevenson, awarded the OAM, ethical Psychologists who blew the whistle on the situation in Nauru and Manus island, to some degree of personal risk.

    Here’s his abc interview

    https://www.abc.net.au/radio/programs/conversations/conversations-paul-stevenson/7999406

    http://catholicleader.com.au/people/paul-stevenson-the-australian-psychologist-who-blew-whistle-on-nauru-its-worse-than-prison

    AAPI offer free membership for all provisional Psychologists and Student Psychologists

    AAPI website upgrade in process also 😊

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