Cost Containment

Master’s-level psychologists, depending on their training, can provide the same services as PhD-level psychologists in North Carolina.

Fees and salaries paid to LPAs are typically lower than fees and salaries paid to PhD-level psychologists, but the costs of supervision reduce the savings that can be passed along to insurers, taxpayers and consumers paying privately for services.

As the law now stands, an LPA providing psychological services in North Carolina requires at least one to four hours of supervision per month, depending on the number of years in practice, the number of hours per month engaging in activities requiring supervision and the number of settings where the psychologist works.

Specific requirements:

  • At Level 1, 1 to 4 hours of supervision per month for an LPA with fewer than 3 calendar years consisting of at least 4,500 hours of post-licensure supervised practice
  • At Level 2, 1 to 2 hours of supervision per month for an LPA with at least 3 calendar years of 4,500 or more hours of post-licensure supervised practice during years 4 and 5
  • At Level 3, after at least 5 calendar years consisting of at least 7,500 hours of post-licensure supervised practice, at least 1 hour per month of individual supervision

It’s difficult, if not impossible, for an LPA providing services requiring supervision part-time to accumulate the hours needed to advance to a higher level of supervision.

A practitioner providing services in more than one work setting must meet the minimum requirements in each setting separately.

For example, for an LPA who works part-time for an agency and also maintains an independent counseling practice, the supervision requirements are applied to each work setting, independent of the other, even if the services provided are similar or identical.

This stipulation effectively doubles costs in time and money for supervising an LPA working two part-time jobs. Should the LPA work as little as an hour a month in a third work setting, the supervisory requirements would be tripled.

Over a 40-year career, that amounts to 480 to 612 hours of supervision for each work setting in which the LPA serves clients.

Supervisors are typically paid $75 to $150 per session, boosting overhead expenses for each practitioner from $36,00 to as much as $91,800 per work setting over the course of a 40-year career.

For private practitioners, these fees represent an added cost of doing business that must be recovered from insurers or directly from private-pay clients. For psychologists working in publicly-funded agencies, the costs of supervision are covered by taxpayers.

Additional costs of supervision include the lost productivity from travel time to and from the supervisor’s office and the out-of-pocket travel expense. (The tax-deductible rate for business travel is currently $.55 a mile.)

LPAs in urban areas may find a supervisor nearby, since 78% of PhD-level psychologists live in urban counties, but LPAs serving clients in rural areas may drive an hour or more each way to meet with the supervisor, losing a full morning or afternoon to every session.

For every hour of one-on-one supervision, two hours of two psychologists’ availability to serve clients are forever lost.

NCAPP maintains the hours the LPA and the supervisor spend discussing psychological services could be much more productively spent delivering psychological services to the citizens of North Carolina who need them.

Amending North Carolina’s Psychology Practice Act to eliminate career-long supervision of LPAs by PhD-level psychologists will effectively reduce and contain the costs of mental health care services provided by psychologists to the citizens of North Carolina.