TO: Members of the North Carolina Psychological Association (NCPA)
Members of the North Carolina Association of Professional Psychologists (NCAPP)
FROM: Pamela Corbett, MA, Member, NCAPP
Elaine Crummett, MA, Secretary, NCAPP
Lisa Mehaffey, MA, President, NCAPP
Jennifer Snyder, Ph.D., Immediate Past President, NCPA
Richard Tedeschi, Ph.D., President, NCPA
David Wiesner, Ph.D., Chair, Legislative Committee, NCPA
Erica H. Wise, Ph.D., President-Elect, NCPA
RE: Report of the joint NCAPP NCPA work group on psychology practice in North Carolina
DATE: 1/12/12
The above named officers of NCAPP and NCPA have been in communication for the past few months and have met on three occasions to discuss possible changes to the Psychology Practice Act in North Carolina. We are sending this letter jointly to the members of both organizations to make you aware of our meetings and some of the possibilities we have been discussing. We have had cordial and constructive conversations and wish to continue to work together to find mutually acceptable arrangements to resolve broad areas of concern to LPA's and LP's in our state. We hope that you will take time to carefully consider our proposed resolution, to share your thoughts, to raise questions and to offer suggestions to us.
Historical perspective
In North Carolina, we have a long history of dual-level licensure, providing opportunities for masters-degreed psychologists to practice under supervision. This arrangement dates back to 1967. In 1997 rules were adopted by the North Carolina Psychology Board that created a path to reduce supervision to once a month. Attempts to improve the environment for Masters-degreed psychologists led to their inclusion as providers in the NC State Employees Health Plan and under Medicaid.
Issues of Concern
Implications of the current licensure system for LPA's
We are all concerned about the disadvantaged position that Licensed Psychological Associates (LPAs) face in this state in relation to other Masters-degreed mental health professionals. LPAs are bound by the Practice Act to work under perpetual supervision of Licensed Psychologists (LPs) who have doctoral degrees. This requirement leads to a number of constraints not experienced by other Masters-level mental health providers. LPAs are not eligible for third party reimbursement from most insurance companies including Medicare and Tricare. LPAs requirement for ongoing supervision presents obstacles in working or volunteering with the Red Cross, other federal agencies and NPOs/NGOs. LPAs must arrange appropriate supervision, at their expense or their employers' expense. LPAs provide psychological testing which historically gave them some advantage among their professional peers. Recently, however, LPCs have begun to do testing.
Implications of the current licensure system for LP's
There are concerns related to LP practice as well. The American Psychological Association (APA) has for many years advocated for a doctoral-degree practice model nationally, restricting the use of the title "psychologist". A recent trend has been for states to discontinue master's level licensure and to only offer new licenses at the doctoral level. Currently 38 states offer doctoral-only licensure in the field of psychology. North Carolina varies from the APA national model in two ways: the title "psychologist" can be used by both masters and doctoral trained professionals and master's degree professionals are licensed to practice in the state.
Possible Resolution
Our work group has been considering various approaches to the apparently competing concerns embodied in the two perspectives outlined above. We have reviewed how various states have addressed these issues. Based on this review and careful consideration of the unique circumstances in our state, we have developed a possible resolution for your consideration:
- Providing a pathway to independent practice (i.e. without a supervision requirement) for Masters -degreed professionals trained in psychology. This pathway would involve some combination of requirements. Those not meeting these requirements or choosing not to apply for independent practice could continue to work as LPAs under supervision. LPA's who are licensed for independent practice would carry a distinctive title with the use of the title "psychologist" being reserved for those with doctoral degrees.
- Ending the granting of new licenses to those with master's degrees in psychology at some point in the future, while allowing sufficient time for those who are in training to become licensed. Those who are already licensed would be able to renew their licenses indefinitely at the level of supervised or independent practice (dependent on meeting the to-be-determined requirements). This would have the effect of creating a doctoral level profession for psychology in North Carolina as MA licensed psychologists retire or otherwise cease practice in our state.
We recognize that there are many details to be worked out in this proposed resolution. There are possible implications related to the number of psychologists licensed in the state in the future, access to psychological care, viability of master's training programs at North Carolina universities, or other unforeseen consequences. The implementation of this proposal would likely lead towards a shift in training models to the doctoral degree in North Carolina as is already occurring at East Carolina University and UNC Charlotte. East Carolina University ended their MA degree training for clinicians in favor of a Ph.D. program, and UNC Charlotte reduced their MA degree program by half as they began to award the Ph.D. It is uncertain how the proposals by UNC Wilmington and Appalachian State to initiate doctoral programs will affect their master's degree training programs.
Moving Forward
Developing a resolution to a problem that has on occasion divided psychology as a profession in North Carolina would bring significant benefits to all of us. Our group recognizes that in order to achieve this outcome, we will need to seek common ground and compromise. We invite you to send your comments on our proposed resolution to ncpsychologymovingforward@gmail.com by February 17, 2012. All of us on the joint work group will have access to this account and your comments will be carefully considered as we continue the deliberation and resolution process. We will report to members of NCAPP and NCPA again after all comments have been carefully reviewed and considered.
