Managed Care and the Independent Practice of Psychology.

Abstract

Heritage Professional AssociatesHow has managed care impacted the independent practice of psychology? The present article reports on data from 2 national surveys (from 1996 and 2001) that address this question. Both surveys indicated that managed care was a source of stress, with external constraints, paperwork, and managed care reimbursement being the most highly rated stresses. These stresses had not increased in the 5 years between surveys, and the most recent survey suggested that, overall, psychologists did not report high levels of burnout. However, in contrast to respondents with low managed care involvement, respondents with high managed care caseloads worked longer hours, had more client contact, received less supervision, reported more negative client behaviors, experienced more stress, were less satisfied with their incomes, and scored higher on emotional exhaustion. Implications for burnout are discussed. PATRICIA A. RUPERT received her PhD in clinical psychology from the University of Kansas and is currently an associate professor of psychology at Loyola University of Chicago. Her research interests include professional ethics and factors related to burnout among professional psychologists. KEITH A. BAIRD received his PhD in clinical psychology from Loyola University of Chicago and is currently in private practice at Heritage Professional Associates in Chicago and the surrounding suburbs. His research interests include professional ethics and clinical decision making.

Using Clinical Trials to Benchmark Effects Produced in Clinical Practice

“…Third, there is great variability among clinical settings, and therefore, results obtained from benchmarking one type of clinical settings (e.g., managed care) may not be generalizable to other clinical settings (e.g., university and college counseling centers). Last but not least, the variability among therapists in based on differences in their work condition, including selection, training, workload and stress, and supervision need to be taken into account (e.g., Rounsaville et al, 1988;Rupert and Baird, 2004). Therefore, the possible qualitative differences between the effect sizes obtained from the clinical settings data and the clinical trials benchmarks negate a simple conclusion based solely on numerical differences in effect sizes; unless complete qualitative equivalence regarding the above factors could be established between the clinical settings and clinical trials, it would be a gross misuse of the benchmarking strategy if definitive conclusions were drawn regarding differences in effectiveness and efficacy by its use.…”

Work practices and the provision of mental-health care on the verge of reform: a national survey of Israeli psychiatrists and psychologists

“…Indeed, the selection and number of tests, and the time devoted to them, have decreased in frameworks of managed care [15]. …”

Results of a statewide evaluation of “paperwork burden” in addiction treatment

“…For example, a study of professional psychologists found that increased administrative and paperwork hours were associated with greater emotional exhaustion and burnout (Rupert & Morgan, 2005). Other studies have found that paperwork was among the greatest stressors (Rupert & Baird, 2004) and challenges (Kantorowski, 1992) reported among professionals in the mental health field.…”