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This week, I had the opportunity to work with a journalist on an article discussing the impact of the two-tier system. Not only does the two-tier system cost clients of psychologists approximately $150 million a year due to lower rebates, but it has had profound impacts on the diversity of areas of practice and funnelled future psychologists into increasingly narrow course options.
The significantly pressing and systemic issue that must be addressed is the preferencing of psychologists with clinical endorsement above psychologists with either endorsement in one of eight other endorsement areas, and general registration. This is referred to as the two-tier system. The introduction of Better Access brought into effect a two-tiered rebate system whereby the clients of psychologists with clinical endorsement were afforded a 40% higher rebate than clients of all ‘other’ psychologists. This two-tier system has permeated many separate funding schemes and the public sector. It has profoundly and negatively impacted psychology in Australia and is attributed to promoting the false assumption that psychologists without clinical endorsement have lower qualifications, competencies and scope of practice.
Community Psychology, a vital area, has been a casualty of the two-tier system. The last course in Australia is now listed as teach-out only, with only a couple of students still enrolled, and other students who were undertaking a community psychology pathway changing streams. This loss is a stark reminder of the system's detrimental effects on the diversity of psychology practice.
There are 124 APAC-accredited level 3 and 4 post-grad courses currently available (noting that some of these are combined Masters and Doctorate programs). Only 36 of these are non-clinical psychology. There are 9 Areas of Practice Endorsement, of which clinical psychology is only one. Forensic, health, sport and exercise and counselling psychology have only a couple of options for the next generation of psychologists to battle it out for a place.
Clinical psychology is undoubtedly an important area of practice, but so are all areas of practice and interest.
The Government is further exacerbating the reduction in diversity. A recent $55 million grant to incentivise higher education providers to grow the profession excluded Master of Professional Practice and 4 of the 9 AoPE (ed and dev, forensic, org, and sport and exercise).
This is all the more galling when reviewing the Federal Government Select Committee into Mental Health and Suicide Preventions recommendations:
Recommendation 17
The Committee recommends that the Australian Government support the growth and diversity of psychology specialties by:
- funding ongoing Australian research to compare outcomes across the nine areas of practice endorsement in the psychology profession, and using this research to inform future policy and funding decisions
- increasing university master's level programs to improve distribution across the nine areas of endorsement, with at least one educational and developmental psychology program in every state and territory
- dedicating a percentage of Commonwealth-funded scholarships to psychology specialisations outside of the primary clinical psychology pathway
- providing funding or tax incentives to registered psychologists to increase their capacity to offer placements to psychologists in training and ongoing clinical supervision and for continuing professional development.
Recommendation 30
The Committee recommends that the Australian Government’s evaluation of Better Access, and reform of the system, focus specifically on:
- the viability of bulk-billing incentives available to general practitioners (GPs) being similarly made available to mental health practitioners for the treatment of mental illness, where there are patient affordability constraints
- the two-tier system impacts on treatment access, appropriateness and affordability of psychological care
- including psychologists with other areas of endorsement (non-clinical endorsement) on the higher rebate tier, noting that this will increase access to specialists, address non-clinical endorsement disincentives and support the diversity of the psychological workforce
- the value of extending the annual cap on psychologist sessions, to ensure evidence-based delivery of care for complex presentations to increase affordability for people experiencing serious and/or complex mental illness.
Through Senate Estimates last week, AAPi has again asked for a Government response and action plan for the above. We have also asked why the MPP and other endorsement area courses have been excluded from Federal grant funding. Our question is on notice for a Government response.
Earlier in the week, I attended a consultation for the Health Workforce Scope of Practice Review Phase 3. The consultation covered four key areas:
- National Skills and Capability Framework Matrix
- Legislation and regulation
- Workforce design, development and planning
- Funding and payments
The Scope of Practice Review has the potential to fix the two-tier system. With current recommendations to address the fee discrepancy and ensure all psychologists are enabled to work to the top of their scope of practice.
Other key AAPi activities this week included:
- Disability Framework Reference Group meeting.
- Allied Health Professions rural and remote working group.
- The NDIA mental health sector reference group.
- Allied Health Professions Australia Member Forum Meeting.
- Meetings with Occupational Therapy Australia and the Australian Association of Social Workers to further our advocacy work in the NDIS.
- Supportive work for the National Autism Strategy.
AAPi is dedicated to addressing the two-tier system. Promoting a one-tier profession means ALL psychologists are valued and respected. We are the only psychology association that holds this position. We ask all psychologists to unite through AAPi for a diverse, fairer, stronger psychology profession. We are stronger together!