ABPP in Geropsychology draws accolades and aspersions
Paula E. Hartman-Stein, Ph.D.
The National Psychologist, Vol. 24, No. 1, p. 7
Members of geropsychology organizations congratulated each other profusely on an APA listserv following the announcement in early December that the American Board of Professional Psychology (ABPP) designated geropsychology as an area of expertise for specialty certification.
But the acclaim was not universal. Others saw ABPP recognition as a potential practice barrier or at best a meaningless vanity title.
According to Victor Molinari, Ph.D., president of the new ABGERO Board and professor in the School of Aging Studies, University of South Florida, ABPP’s acceptance of geropsychology bodes well for the future of the field.
“The main goal of board certification is to make sure there are competent geropsychologists that provide state-of-the-art services to our older clients,” he said. “The benefit of the credential to practitioners is that there are an increasing number of organizations that are requiring or at least giving preferential treatment in hiring and offering raises to board certified psychologists.”
One of the newly certified specialists, Sara Honn Qualls, Ph.D., Kraemer Family Professor of Aging Studies and professor of psychology, University of Colorado, Colorado Springs, said the main benefit for practitioners to seek this credential is to demonstrate their expert level of identity in the field.
“We want to distinguish the patients with high levels of complexity who require specialist involvement. ABPP is one mechanism to define and identify experts or specialists. In addition the ABPP process requires self-reflection about one’s knowledge and skill set at a level that can be very productive for practitioners, especially those who may have begun to work in a new area without knowing its full base of knowledge or the scope of practice needed to serve a population effectively,” said Qualls.
Peter Kanaris, Ph.D., APA council representative from New York, said that board certification will be a benefit to geropsychologists in the ever-developing age of integrated care. “This model stresses collaborative involvement with physicians. In order to hope to be perceived on the same plane with physicians in medical environments, board certification can serve as one step in that direction,” he said.
Kanaris is not currently planning to apply for the credential himself. “As a senior psychologist I have worked collaboratively and successfully in integrated care skilled nursing facilities for 15 years and held privileges and hospital appointment during the same time. I have not been hurt by not having board certification. I believe there is a simpler path available to the senior clinician. In truth it may be more for ego rather than practical value, but for early and mid- career folks the practical value is greater,” he said.
Kanaris said the downside to applying for the credential is adding more expense for psychologists who are already qualified, overburdened and underpaid. “Ultimately, however the potential benefit seems to justify the burden,” he said.
Barriers and benefits
Lamar Freed, Psy.D., a private practitioner in Philadelphia who has treated patients in long term care facilities for 20 years, disagrees. “I’m disgusted,” said Freed who has long been a vocal critic of board certification in psychology.
According to Freed, the only value for board certification in psychology is for academicians to help them reach full professor status. He is doubtful that the new credential will help practitioners devoted to treating older adults. “Because there are certified nurse specialists in geriatrics and in mental health, having a board certification available in geropsychology will make it more difficult for psychologists without certification to say they are more qualified to see patients in retirement homes and nursing units,” he said.
Freed predicts geropsychology board certification will result in more barriers than benefits to practice. “We are capped at charging what Medicare thinks we are worth, we have to compete to get into retirement communities with psychiatric groups that offer medication management along with the ‘psychotherapy’ and ‘behavior management’ provided by their nurses, and now we have another set of hoops to jump through in order to consider ourselves full- fledged geropsychologists.”
He foresees the consequences will not be particularly dire unless Medicare or other third party payers decide to use it as a way to reduce the number of practitioners and requires board certification for payment. “As the geriatric population grows and the mental health needs grow along with it, psychologists are being pushed out of geriatric mental health services from many directions. This is just another shove, but in this case it is self- inflicted,” said Freed. “The last thing we need is another barrier to providing care for seniors.”
As far as creating barriers to treating older adults, Qualls said, “I think it is too early to tell whether ABPP will become a barrier to access for services for older adults because we don’t know how the payers and other systems will use ABPP status.”
Leslie McClure, Psy.D., a 2005 graduate of a post-doctoral geropsychology fellowship and new owner of a moderate size private practice in Kent, Ohio, said, “There is a need for clinicians who specialize in geropsych, and the ABPP certification process is one way to verify expertise.”
“However, the cost/benefit ratio of applying for the credential is not good for me,” she said. “If I worked at a large institution that would subsidize me in time or money then I would be more likely to do it. In my current role the most important thing is doing good work, maintaining a good reputation, and continuing to stay current. It is unlikely that this credential would mean much to the referral sources. Taking the time away from clinical work to complete the certification process is a cost. Our time is money in private practice. I’ve seen ABPP as icing on the cake, not a fundamental to practice.”
McClure’s recent experience hiring psychologists brought to light that many of the early career people are in a difficult financial situation because of student loans. “It limits what jobs they can take and I would think it could limit their ability to apply for ABPP,” she said.
The cost to apply for the new certification is $825 plus $185 for annual renewal.
According to Molinari, of the 36 newly minted board certified specialists in geropsychology one or two are in private practice. Over half of the credentialed geropsychologists work for the Veterans Administration.
The composition of the 11-person board includes one independent provider, June Blum, Ph.D., a psychoanalyst from New York City, three are employed by the Veterans Administration and the others work full time in hospital settings or at universities. Molinari said no remuneration is received by board members, only travel expenses are covered. He said he is grateful to the University of South Florida for the time to devote to the application process that has taken three years.
Historical perspective of ABPP
Nicholas Cummings, Ph.D., former APA President, said, “For 60 years I have refused to join or support ABPP as it is a needless and stodgy organization that actually hampers bold advances in practice. It is the waving of the flag by many academic clinicians that do little actual hands-on treatment of patients.”
According to Cummings, in the 1950s the “Dirty Dozen” (14 psychologists who spearheaded the move toward psychology licensure) solicited the help of ABPP, but the group refused to help. “ABPP told us it was an academic credentialing organization that had nothing to do with practice. Eventually ABPP finally got around to practice issues and wanted to be the gatekeeper to psychology practice in the days when psychology licensing was not available in all states.
“This limpid and even tainted history has long ago been buried. I would challenge ABPP to demonstrate any real positive achievements on behalf of practice, as opposed to window dressing,” said Cummings.
Benefits for academic psychologists
According to Qualls, there are clear benefits for academic psychologists. She said, “In some settings, ABPP is viewed as a standard for trainers, a way of demonstrating achievement of expert status in the field.”
For more information on how to apply for the ABPP in Geropsychology go to http://agingstudies.cbcs.usf.edu/abppgero/index.html.
Paula E. Hartman-Stein, Ph.D., former president of the Society of Clinical Geropsychology, provides consultation and training on private practice issues including the Physician Quality Reporting System. She can be reached through her website, www.centerforhealthyaging.com.