We have been contacted by several attendees at the inaugural advisory council meeting. Generalists received little focus in discussions, compared to ongoing and public comments repeatedly about ‘colleges’.
At the first Advisory Council meeting, the effects of the two-tier Medicare rebate introduction were referred to by Lyn Littlefield and Co as ‘Unintended Consequences’. These were the many university postgraduate courses shutting down, and the limited courses available (42 clinical post graduates, compared to single figures for all others, from 1 to a maximum of 8 for all others). Also, the limiting of services for non-clinicals.
The APS stated it was unaware of the consequences of the Medicare two-tier rebate introduction in 2006. Perhaps the analogy is ‘friendly fire’ or ‘innocent bystanders’ – non-clinical psychologists being injured? We do know that the APS only advocated for Clinical Psychologists to be admitted to the Medicare Register. We also know – read on – that once the two-tier system was introduced the APS advocated in favour of it.
The APS supposedly does understand now.
In relation to the claims by the APS of not being aware of the unintended consequences we would like to offer the following:
On 6th April 2006, i.e. over six months before the two-tier system was officially launched, Dr. Clive Jones wrote to Lyn Littlefield about the very ‘unintended consequences’ that she and the APS now claim they were unaware of. Dr. Jones received no reply to his communication.
On 11th October 2006 Dr. Clive Jones wrote to the then Federal Minister for Health, Tony Abbott again describing the now infamously termed ‘unintended consequences’ of the two-tier system. Dr. Jones received the standard reply, acknowledging receipt of the letter.
Dr Jones also wrote to InPsych and to the APS Board, APS Branch Committee members, and APS College Committee members in 2009 regarding an APS News Media release by Mr Bob Montgomery, then president of the APS, in which he states:
“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”
You can see the statement by Bob Montgomery in the Parliamentary record of the Senate Community Affairs completed enquiry into Commonwealth Funding of Mental Health (2010-2013). Follow this link and scroll down to Clause 6.29.
The APS stated in the Advisory Council Meeting that it is wanting to support ALL psychologists, all 23,000 members. This being the case it is reasonable to expect that the APS would send a submission to the MBS Review Task-force to actually support ALL of those psychologists. So what, if any, submission has been sent?
Are ALL members of the APS not entitled to know the APS is looking after their interests, and wanting to try to get some fairness back for non-clinicals?
ALL APS members must be requesting that the APS makes a submission. The submission must be placed on the APS website. Such an important submission surely needs to be available to ALL APS members.
The APS continues to want unity. Yet, the APS expects all non-clinicals to just accept what has gone (namely the two-tiers) for the good of the society. But it continues to ignore the increasingly reduced income, and reducing employment opportunities, as agencies (like Centrelink) limit non-clinical work.
In a somewhat enigmatic presentation of the Advisory Council meeting Andrew Chua posted the following:
Of course everyone agreed we are all psychologists first.
However, despite discussing the current competencies, there is no definite answer on how to take advantage of our current competencies. The only concrete answer is the stepped care model, and we know that is not working well for most generalists. How do we implement them, measure them, apply them and distribute the messages to all agencies, companies, etc?.
The diversity of psychology is crucial, necessary – but the table which showed 42 clinical courses, while all other courses had 1, 2 maybe 8 – but mostly 2 – highlights that competencies are not appreciated, and diversity will continue to be degraded if universities do not offer courses other than clinical.
The bottom line is an obvious one – the competencies are wonderful – but the two-tier model keeps reinforcing that clinicals will get a higher rebate. If agencies such as Centrelink, WorkCover, NDIS focus on work only by clinicals, and/or higher rebates, then competencies will not make any difference to the profession. The APS did not say how the competencies would be measured, and promoted to the wider community. They did not say if the APS would approach PsyBA to do this – or any other government agency. To say we are all one APS tier in the room is cute – but the reality still is two-tier, with clinicals always getting the higher rebate than all non-clinicals.
Perhaps we are missing something here but we believe the Medicare Rebate is for our clients not for practitioners. It is there so that people in need of services will be able to afford them. Instead it appears to continue to be a money grab based upon ‘academic qualifications’. Who is standing up for the rights of consumers. A more equitable and egalitarian model would be based upon consumer needs including socio-economic status. Rebates would be higher at the lower end of the socio-economic ladder so that practitioners could be adequately remunerated and clients in this group would have no out of pocket expenses. Rebates would decrease as the system moves up the socio-economic ladder where clients can afford gap fees and here free market forces would be factored into everyone’s decisions. We experience some feelings of shame when we look at what has been and is now escalating in our profession. It is indeed difficult to explain this system to our clients when they ask, and they challenge us with most valid questions. We can only shrug and say we are trying for you but no-one is really listening yet.
We urge all psychologists to make their own submissions to the MBS Review Task-force. We have written several for you if you want to use them instead. They can be sent with a single mouse click and filling in some personal details. You can access them here.