The claim by a Canberra academic that higher Medicare rebates are not justified for the provision of clinical psychological services compared to general psychological services is totally unfounded according to the Australian Psychological Society (APS).
‘The statement that there is no evidence showing a difference in outcomes of treatment by clinical psychologists compared with general psychologists is accurate at this time, but only due to the fact that no study has been done comparing the two, therefore there is no evidence,' said Professor Bob Montgomery, APS President.
‘However, there is equally no evidence that general psychologists are having similar outcomes to clinical psychologists, because there has not yet been any outcome research. Psychologists at the University of Canberra have put together a proposal to undertake such research, but this has not yet been conducted. The paper written by this group is just that, a research proposal, not a research report, as it has been described in some media.'
General psychologists require a minimum of four years university training followed by two years of professional development and supervised practice. Under Medicare, their patients are entitled to rebates when they are treated with Focussed Psychological Strategies, a small number of well-established, basic psychological treatments. It is expected that these will be sufficient for successful treatment of common, uncomplicated psychological problems.
Clinical psychologists require six years of university training, with the last two years usually being a Master's degree specialising in clinical psychology, followed by a year of supervised practice. They have a far greater level of training in clinical psychology and are expected to be able to treat more complex cases, particularly those where the patient has more than one problem.
‘Given their differences in training, it is reasonable to expect that general and clinical psychologists will often be treating cases of different complexity. It is this and their more extensive, specialised training that justifies the higher Medicare rebates for their patients, just as similar factors justify higher rebates for medical specialists,' said Professor Montgomery.
‘It is quite reasonable to suggest this justification should be tested by research,' said Professor Montgomery, ‘but quite misleading to publish conclusions before the research has been done. In fact, the APS is contributing to the first outcome study to be done on the Medicare psychology items and there is no evidence available yet.'
‘The two other proposals from this group are in complete agreement with our policy. When the Medicare psychology rebates were being developed, we argued that there would be some complex cases that needed more than 12 consultations to be treated successfully. And there is already evidence that the compulsory preparation of a diagnosis and mental health care plan by the patient's GP before they can see a psychologist is not working as intended and needs to be reviewed. We would welcome such a review,' concludes Professor Montgomery.
The media release above was written, as media releases sometimes are, in a hurry to counter a very misleading statement that was appearing in the public media. Normally media releases on behalf of the APS are vetted and approved by both the President and the Executive Director, or their respective deputies. Due to personal, family circumstances the Executive Director was unable to do so on this occasion so the release was written and approved by me alone and I take full responsibility for it. With the wisdom of hindsight, there was an ambiguous sentence in it and that ambiguity has caused some members some anguish, for which I apologise. Rather than continue to cause this distress to some members, the original media release has been amended above to remove the ambiguity by inserting the words, ‘a minimum of', into the fourth paragraph. The main thrust of the media release remains as intended.
– Bob Montgomery
The APS is the largest professional association for psychologists in Australia, representing more than 16,500 members. The APS is committed to advancing psychology as a discipline and profession. It spreads the message that psychologists make a difference to peoples' lives, through improving psychological knowledge and community wellbeing.
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