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Because the Veterans Health Administration (VHA) is the nation's largest health care system and employer and trainer of psychologists, changes in VHA psychology have implications for the rest of the profession. A national survey of 127 VHA psychology leaders (91% response rate) documented that many psychologists now are managed by a psychiatrist, deliver more outpatient services, and do less personality testing. In the context of a 10% reduction in psychology staffing, morale is rated lower than 2 years earlier. Diversified professional roles are associated with higher status of psychology and management support for mental health programs. Psychologists need to understand and respond adaptively to the organizational and economic forces affecting their practice.Motivated by a commitment to making quality health care more patient-centered and cost-efficient (Kizer, Fonseca, & Long, 1997), the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs has been undergoing a major reorganization since 1995 that has had major impacts on VHA psychologists and VHA psychology training programs. This report summarizes the results of a national survey of VHA psychology leaders that was conducted in 1999 to assess the effects of this reorganization on VHA psychology. Specifically, the survey asked about changes in the administrative structure within which psychological services are delivered, staffing levels, practice patterns, administrative and training effort, the morale of psychologists, the status of the profession of psychology, and management support for mental health programs.The size and historical importance of the psychology program in VHA make changes in VHA psychology significant for psychol-DALE S. CANNON received his PhD in clinical psychology from the University of Utah in 1970. He is chief, Informatics Section, Mental Health Strategic Health Care Group, Veterans Affairs (VA) Headquarters.

The relationship between organized psychology and labor takes on renewed interest in the context of marketplace changes leading some health care providers to unionize. Although they were once distant, organized psychology and labor have moved closer together in recent years in collaborations around mutual interests. Labor unions have been able to offer psychology effective models of grass roots organization, some ability to engage in collective bargaining, and legislative and legal advocacy to curb marketplace abuses and to protect scope of practice. Psychologists have been able to offer labor unions clinical and consulting services to help union members deal with workplace stressors and injuries, pro bono services for striking or furloughed workers, and innovative programs to promote workplace safety. Increased collaboration between psychology and labor helps the American workforce, including psychologists.The American workforce has been undergoing fundamental changes in recent years as corporate downsizing has threatened the job security of millions of white-collar professional workers. Whereas previous generations of blue-collar workers could turn to labor unions for help and protection in times of economic dislocation, many contemporary workers have no such resource. Psychologists are no exception. Like other health care providers, psychologists have been buffeted by the transformation of the health care delivery system into a system of managed care. However, as a white-collar profession traditionally more allied with management than with labor, psychologists have generally not considered collective bargaining as an option for themselves in dealing with managed care organizations (MCOs).

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