THIS IS A PERSONAL STATEMENT BY ACADEMY FELLOW MARTIN KENIGSBERG
Martin I. Kenigsberg, Ph.D., FAACP, ABPP
When I was a boy about ten years old I visited my physician father's office, just south of Central Park in New York City. While waiting for him, I had the opportunity to look over his many diplomas and certificates on the wall. I was curious about what they stood for, and asked my father as soon as he was available. He patiently explained what each one meant. " Four years in college for this one, another four years of medical school for that, and so many years of internship and residency." And finally he explained the ones he was most proud of, those for board certification in internal medicine and Fellowship in the American College of Physicians. " And how many years for the last two certificates?" Actually, no extra years in school, he told me. He had received them after establishing eligibility just by passing an exam! His response surprised me, and I wondered why he was so proud of these two achievements, which apparently did not require the same time spent in school. Why is board certification important to health practitioners? What does it mean to be board certified, and what benefits do you get when you are boarded? How is this different from state licensure? These are the issues I will attempt to address in this column.
As it happens, after completing my doctorate in clinical psychology at Penn State, an APA- approved internship at the VA, and a postdoctoral fellowship at Stanford, I went on to take my boards in clinical psychology from the American Board of Professional Psychology (ABPP). I have served for many years as an ABPP examiner, and I served two terms on the board of directors of the American Academy of Clinical Psychology, the membership organization of board certified clinical psychologists. The American Academy of Clinical Psychology is one of the psychology organizations that are analogous to the various Colleges of Physicians. We use the signature designation of "FAACP" whereas my father's colleagues use "FACP."
My father told me an interesting story. Prior to World War II, most physicians were general practitioners, or "family doctors." Specialists were in the minority. As the field of medicine advanced, physicians could no longer master the diversity of skills and techniques that evolved. Many chose to pursue additional training in order to specialize in one area of medicine. In one generation or so, the majority of physicians were practicing as specialists rather than generalists. How could someone tell which physicians had what training? By their board certification, of course, and fellowship in one of the Colleges of Physicians.
In psychology, as in medicine, most states award a generic license to health practitioners in a particular discipline after the practitioner has established a minimal level of competence. The interest of the state is primarily to protect the public. Licensure or certification does not identify specialty. In many states health care providers can obtain a license with minimal clinical training. Board certification, however, demonstrates to the public and professional community that the practitioner has established an advanced level of competency in a particular psychology specialty.
In 1947 when ABPP was first organized, there were very few identified specialties in Psychology. First there were Clinical and Counseling Psychology, then School Psychology. Psychologists had not yet developed specialized tools and techniques to a degree that would justify more specialties. The postdoctoral experience required by most states now was not typically part of psychologists' training. Today, ABPP examines candidates in the following specialty areas in psychology:
Behavioral
Clinical Neuropsychology
Clinical Psychology
Counseling Psychology
Family Psychology
Forensic Psychology
Group Psychology
Health Psychology
Psychoanalysis in Psychology
Rehabilitation Psychology
School Psychology.
More specialties are on the way. The American Psychological Association has several committees devoted to the identification and accreditation of specialty training programs in psychology. There is also an interagency organization, the Council of Specialties in Professional Psychology, which deals with specialty issues in Psychology. Specialty training is probably one of the most important issues in professional psychology today. For example, the most important legislative priority of the California Psychological Association is prescriptive privilege. For current practitioners, the new skills in psychopharmacology that this would require lead to the issue of additional training and certification. APA policy states that specialty training should occur at the postdoctoral level. In medicine there is one organization, the American Board of Medical Specialties, that oversees the board certification activities of each of the individual specialties. In psychology, the American Board of Professional Psychology serves this function. Consider that only about 16% of eligible specialists in psychology are board certified, as compared to about 58% of eligible specialists in medicine.
If a family member or friend needed to see a specialist in psychology, and you did not know of a local specialist, what information would you want to review to insure that he or she is referred to a qualified practitioner? You might begin by asking the following questions: Where did the psychologist do his/her doctoral training and internship? Was the training approved by the APA? What were the nature and content of the psychologist's graduate and postdoctoral training? What sort of pre- and postdoctoral evaluations did he or she receive? What did colleagues in the same specialty think about his/her practice? What was the exact status of his or her license or certification? Were there any prior disciplinary actions, or pending actions? To be really thorough and comprehensive, you might want to be able to review a professional work sample, such as a psychological report. Wouldn't it be informative to be able to listen to an actual therapy session? In the best of all possible worlds, if you had the opportunity to watch the psychologist examine an actual patient, spend time discussing the case, and ask any questions about the other information you had collected, wouldn't that assure you that you were making the right referral?
When a psychologist is assessed by ABPP in clinical psychology, this is essentially the evaluation that they go through. Paper credentials and recommendations are carefully reviewed prior to entering candidacy, and then the psychologist is examined by three qualified peers in the same field. Board certification by ABPP saves you and any other member of the public the exhaustive and expensive evaluation that I have just described. While there is a significant cost to complete this certification (current fees for the clinical psychology examination are $700 total - consisting of a $100 application fee with $50 discount for Division 12 APA members, $200 work sample review fee, and $400 examination fee), these fees are often much less than the cost of attending a convention out of state. The costs are usually tax- deductible, and the certification is something that you carry with you for your entire professional career.
Additionally, there are other advantages to being board certified. Many prospective employers and third party payers look favorably upon board certification. Psychologists employed by the Department of Defense receive extra incentive pay for being board certified. The Congress has passed legislation allowing incentive pay for VA psychologists. Many other agencies provide extra pay for board certification. Some insurance companies allow significant discounts on their malpractice insurance for ABPP certified psychologists. Approximately two-thirds of the states recognize ABPP board certification when psychologists apply for reciprocity. When credentials are carefully scrutinized in a judicial setting, board certification provides a significant advantage in professional credibility. In terms of a peer review of competence, the ABPP diploma provides a much more reliable measure of competence than merely a state license or National Register listing.
This article was adapted from an original article published in The California Psychologist, October, 1998 and reprinted in The Clinical Psychologist, Fall 1998.
