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THE MATURATION OF THE PROFESSION OF PSYCHOLOGY As we enter the 21st Century there is every indication that psychology is the key to our nation's health care system. Under President Carter, our nation's health policy leadership formally acknowledged the importance of the behavioral sciences. Healthy People, for example, proclaimed that: "(O)f the 10 leading causes of death in the United States, at least seven could be substantially reduced if persons at risk improved just five habits: diet, smoking, lack of exercise, alcohol abuse, and use of antihypertensive medication." Approximately five years earlier, Marc Lalonde, the then-Minister of National Health and Welfare of Canada, had similarly noted: "When the full impact of environment and lifestyle has been assessed... there can be no doubt that the traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate. Marvellous though health care services are in Canada in comparison with many other countries, there is little doubt that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology." More recently the Institute of Medicine (IOM), in a report co-edited by former APA Congressional Science Fellow Brian Smedley, concurred: "By itself, however, biomedical research cannot address the most significant challenges to improving the public's health in the new century. Approximately half of all causes of mortality in the United States are linked to social and behavioral factors.... Yet less than 5% of the approximately $1 trillion spent annually on health care in the United States is devoted to reducing risks posed by these preventable conditions. Behavioral and social interventions therefore offer great promise to reduce disease morbidity and mortality, but as yet their potential to improve the public's health has been relatively poorly tapped." The report went on to also highlight the critical importance of education and family economics on the health status of our nation's citizens (i.e., the "socioeconomic gradient"). Effectively and proactively addressing these aspects of health care is (or should be) the province of psychology, far more than any other discipline. What we need is proactive vision. There is no question from a public policy frame of reference that 21st Century will be an era of the Educated Consumer. It will be a time when individuals will be able to ensure that the quality of health care they and their loved ones receive is nothing less than outstanding. The rapid advances occurring daily within the communications and technology fields will have a direct impact upon the delivery of health care services. It will be a time when the educated consumer (as vocal patients) will have ready access to timely and objective information in order to verify any concerns they may have (e.g., increasing knowledge of best practice protocols, provider comparisons, and virtual consultation services). Today from 70-100 million Americans already use the Internet to retrieve health-related information. And, whereas four out of every ten U.S. households had Internet access as of August 2000, it is predicted that 90 percent will have access by 2010 or before. Large increases in Internet access have occurred among most groups of Americans, regardless of income, education, race or ethnicity, location, age, or gender. Anyone who lives with teenage children can personally attest to the extent to which the next generation will be computer literate. This access and the evolving appreciation for the critical importance of ensuring data-based decision making goes directly to psychology's strength and represents an entirely new frontier for organized medicine and health care. These are definitely changing times. The 21th Century health care system as envisioned by the IOM would provide care that is evidence-based, patient-centered, and systems-oriented. This implies new roles and responsibilities for patients and their families, who must become more aware, more participative, and more demanding in a care system that should be meeting their needs. At the same time, the IOM has also noted that the time lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of about 15 to 20 years and even then, many medical technologies are being used inappropriately. Between 30 and 40 cents of every dollar spent on health care is spent on the costs of poor quality. This is an extraordinary number representing slightly more than about a half trillion dollars a year. During the Presidency of Norine Johnson organized psychology finally and enthusiastically embraced its potential role within our nation's health care arena. Under her leadership the APA bylaws were amended to formally include the word "health" in the Association's mission statement. The Practice Directorate was successful in having six new Medicare reimbursement (CPT) codes adopted, thereby allowing reimbursement for health and behavioral assessment and intervention services to apply to behavioral, social, and psychophysiological procedures for the prevention, treatment or management of physical health problems. Prior to this development, almost all intervention codes utilized by psychologists involved psychotherapy and required a mental health diagnosis. We have always known that psychological services are truly "medically necessary". Now our practitioners can finally be reimbursed for their expertise. These are monumental changes in the status quo. They offer professional psychology a tremendous opportunity and challenge. The selection by the APA Council of Representatives of renown health psychologist Norm Anderson as the new CEO speaks very well for the future. In our judgment, one of the most important "next steps" facing our profession is to ensure that our current state-based psychology licensure system provides the type of mobility the 21st Century will require. Whether one contemplates moving to a neighboring state as we become more senior, or whether one is intrigued by the opportunities inherent in telehealth and virtual consultation services, as a maturing profession we can no longer afford to have our practitioners limited by geographical determinations and the unexplainable nuances of local licensure board politics. That may have been the "good ole days", but those times have long passed. Educated consumers will demand access to the highest quality health care providers. They deserve no less. Aloha.Pat DeLeon, Former APA President � National Register � August, 2002tom
 
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