Paper Presented at the Meeting of The American Psychological Association

San Francisco, California August 17 – August 20, 2007 
 

Clinical Practice Strategies Outside The Realm Of Managed Care: An Update 

Jane K. Le, Georgia State University 

and Steven Walfish, Independent Practice, Atlanta

(psychpubs@aol.com) 

      Several volumes have outlined strategies for psychologists in independent practice to earn a living that does not involve participating in managed care (Ackley, 1997; Kolt, 1999; Haber, Rodino & Lipner, 2001; Kase, 2005). A previous study (Walfish, 2001) of Division 42 members identified 180 specific activities were identified that were rationally grouped into ten separate categories.  The purpose of the present investigation is to replicate and extend the work of Walfish (2001) by utilizing a: (a) larger sample, and (b) contemporary sample as practice patterns and market opportunities may have changed over the six years when the initial survey was completed.

Methods

      The participants for this study were 141 members of Division 42 (24% return-rate).  Participants were asked to name three specific activities in their own current clinical practice that did not fall under the purview of a managed care company.  They were asked to be as specific as possible in identifying these activities.  Once the surveys were returned, the authors reviewed and synthesized the responses into individual practice activities.  The aim was to eliminate duplication and overlap, and to include only practice strategies that were specific in nature.

Results

      The psychologists in our sample were able to identify a total of 158 separate practice strategies that fell outside the purview of managed care in which they received income for their efforts.  These strategies have been rationally grouped and alphabetically presented under nine general headings and include: (a) Services to Organizations; (b) Forensic Psychology; (c) Services to Government; (d) Psychoeducational Service; (e) Business Psychology; (f) Teaching and Supervision; (g) Health Psychology; (h) Fee-for-Service and (i) Other Services. There is some overlap among the general headings for specific practice activities. 

Discussion

      For clinicians who want to practice outside the restrictions managed care may place on them the results of the current practice survey suggest there are a number of income-generating practice opportunities available in which they are able to utilize their consultation and therapy skills. The results of the present study suggest that with creativity, skill development, and an entrepreneurial spirit, psychologists in independent practice can practice, at least partially (and possibly fully), outside the purview of managed care. However, this will take a sense of being willing to be open and flexible on the part of psychologists to think in nontraditional ways. It is also important to understand that while the present survey identified a wide variety of clinical activities independent practitioners may pursue in their practice the ethical imperative is to be skilled at the service being provided.  Therefore, psychologists are urged to obtain appropriate training and ongoing supervision when pursuing new practice opportunities.  

References 
 

Ackley, D. (1997). Breaking free of managed care. New York: Guilford Press. 

Haber, S., Rodino, E. & Lipner, (2001). Saying good-bye to managed care: Building an  

      independent psychotherapy practice. New York: Springer.  

Kolt, L. (1999). How to build a thriving fee-for-service practice. San Diego, CA:  

      Academic Press. 

Walfish, S. (2001) Clinical practice strategies outside the realm of managed care. Paper  

      presented at APA Convention. San Francisco, California, August, 2001 
 
 

Organizations 

 
 

Forensics 

 

Government 

 

Psychoeducational 

 

Business 

 
 

Teaching and Supervision 

 

Health 

 

Fee for Service 

 

Other