Enraged psychologists fighting for an improved mental health system

Enraged psychologistI’ve never met so many enraged psychologists as I have in the last six months. We’re channelling our pent up fury by pounding keyboards, our battle cry is echoing loudly through social media and Members of Parliament (MP’s) are being accosted at every opportunity.

And that goes against everything I know about my usually sedate and contemplative colleagues.

Life of an enraged Psychologist 

Let me tell you a bit about the life of a psychologist. We work with vulnerable people in our community. You can find us in hospitals, schools, unemployment services, domestic violence agencies, substance abuse services, disability services, prisons, rehabilitation clinics, the armed forces, the police service and in private practice. We work with kids and adults.

Most of our days are spent being cool, calm and collected… and teaching others to do the same.

We are a female workforce, 80% of psychologists are female.   I have worked with very few male psychologists. Possibly men don’t join us because it’s a low paid, caring role and we need to change that. You’ll often find a disproportionate number of male psychologists in management, board and director roles. The mental health system is dominated by male psychiatrists. Yes, psychology is low paid. Many psychologists work part-time, juggling family care.

We spend hours exploring trauma, often perpetrated by the hands of others, that has led to the clients’ mental health problems. We sit beside those in debilitating emotional and physical pain. We hold space for gut-wrenching grief. We teach, support, advocate and listen.  It’s exhausting work.

We often don’t have much energy or patience left at the end of the day, but we go home and tend to our families. We are not usually enraged psychologists.

Blindsided Psychologists – Is this a feminist issue?

To our detriment, as female psychologists, we have been so focused on supporting our clients (and our families), that we have allowed our profession to be blindsided, and this has ultimately been detrimental to our clients. Most psychologists (and our clients), not just those who work in private practice, will continue to be disadvantaged unless the Medicare Benefits Schedule Taskforce Review into Mental Health currently underway makes significant changes. (If you are a psychologist who doesn’t work in private practice and you think this has no impact on you… keep reading!)

In 2006, in the dark ages, before we had harnessed the power of social media to build a collective of enraged psychologists, Medicare instigated a two-tier system to assist Australians to access psychological treatment.

I vaguely remember this happening, but I wasn’t working in private practice then, so didn’t pay much attention. I should have!  Behind this two-tier system is a story worthy of a tv drama of political intrigue and deceit. It includes powerful and stealthful lobbying by one group of psychologists and academics, unnoticed by another preoccupied group of psychologists who were focused on their clients (and family) and placed their faith, and money, in the Australian Psychological Society (APS) who vowed to represent them. In my opinion, the APS ruthlessly betrayed the majority of psychologists and the Australian public by failing to advocate for the bulk of their members and failing to advise on an appropriate mental health process for Australians.

The drama also includes the pervasive culture of fear that has been instilled in psychologists, through threats of retribution and ostracism if you are do not hold membership with the APS.  Fearful psychologists question “If I advocate for change will I be audited?”,  “Will I be blacklisted?”

I say viva la revolution!

Why are psychologists enraged? Meet the discriminatory Medicare two-tier system!

The Medicare two tiers are this.

  1. One tier provides access to Clinical Psychologists who are permitted to provide the evidence-based therapy which is best for the client. Clients receive a rebate of $124.50.
  2. The other tier provides access to Psychologists who are only permitted to provide Psychologically Focussed Therapy. This is a limited choice of therapies and may not be the best therapy for the client. Clients receive a rebate of $84.80.

Psychology sessions under the Medicare two-tier system are not free to clients!

Let us do away with that fallacy. Most psychologists can’t sustain a living by bulk billing clients. We have to charge a gap fee.  In general, psychologists providing Medicare services are self-employed, even if we work in a group practice. We must pay for room rental, insurance, professional development, and administration. We do not get paid holiday or sick leave. We are meant to finance our own superannuation, but many don’t make enough to do so. There is no fee for letters to doctors, the phone calls we make and the preparation that takes place before we see clients.  If a client doesn’t turn up, we often don’t get paid.

The Medicare two-tier system misleads clients!

Clients assume that the higher rebate for a clinical psychologist ensures they receive superior therapeutic treatment from a psychologist who is more skilled and experienced than those who are not eligible for the higher rebate.  This is false.

Consider a client with Complex Post Traumatic Stress Disorder as a result of child sexual abuse who requires psychological treatment.  Currently, the treatment options for a client through Medicare may hypothetically be:

  1. A clinical psychologist, with a Masters in Clinical Psychology, with two years’ experience whose previous employment was in a hospital renal ward.  This psychologist is at the start of their career and their professional development has been in pain management and weight loss strategies.
  2. A psychologist, with a Masters in Applied Psychology (Counselling), with 10 years’ experience working with trauma victims in domestic violence and sexual assault services. This psychologist has invested years of professional development in treating child sexual abuse.
  3. A psychologist who completed 4 + 2 pathway (four-year degree + two years’ probation completing a competency-based program under supervision) with 20 years’ experience in sexual assault services, a drug and alcohol community organisation and private practice. This psychologist has invested in years of professional development from leading trauma experts.

Under the current Medicare two-tier system, the clinical psychologist (A) can offer a broad range of therapeutic interventions.  However, psychologists B and C, while trained and experienced in the delivery of appropriate therapeutic interventions are limited to only providing Focussed Psychological Strategies while working under Medicare.  Although, they can provide alternative and more appropriate services to private clients.  Therefore, the two-tier Medicare system limits the client’s access to the most appropriate therapeutic intervention and their ability to choose the most experienced psychologist that would best meet their needs.

The situation becomes even more complex when a client needs to access a service where there is only one (non-clinical) psychologist available, such as in a remote area (most clinical psychologists are found in cities).  That psychologist is then limited, unethically and without evidence, by the Medicare rebate system, to the type of therapy they can provide the client. And, psychologists with clinical endorsement only make up 40% of the psychology workforce.

While I have proposed a hypothetical situation, it reflects my real-life experience of working within psychological services alongside clinical psychologists.  We all do the same work.  I have taken over caseloads when psychologists have resigned, with and without clinical endorsement, and there is no discernible difference between client complexity or treatment plans. All registered psychologists are trained in and can diagnose, assess and treat clients, regardless of whether they are clinically endorsed or not. The example provided demonstrates that depth and breadth of psychological expertise is developed post-university.

This great video by One Psychology  Australia explains it even better.

All psychologists do great work with their clients.

Psychologists working in both Medicare tiers obtain great outcomes with their clients.  There is no outcome difference between psychologists with or without clinical endorsement. Behind the closed doors of the counselling room, we all do the same work.  We all provide the therapeutic treatment that is the best for the client. To not do so, despite the Medicare restrictions, would be unethical.  See Research into Outcomes in Psychology Practice Under Medicare Better Access.

The Medicare two-tier system perpetuates a false hierarchy

The Medicare two-tier rebate system has imposed a false hierarchy within the profession of psychology which is now negatively impacting psychologists’ roles in systems outside of Medicare such as hospitals, schools, Centrelink and the NDIS.  A clinical psychologist is now, falsely, seen to represent a psychologist with more expertise than that of other psychologists. Psychologists, who do not have a clinical endorsement, have been stopped from providing assessments and reports in these systems, despite years of experience and appropriate expertise.  Imagine what its like if you are a parent of a child with autism, who has been diagnosed and treated by a psychologist, with years of experience and training in the field,… but their report is rejected.  However, a newly qualified psychologist with a clinical endorsement, with limited experience, can sign the report. No wonder we are enraged psychologists!

Private practices are recruiting clinical psychologists over other, possibly more experienced and qualified psychologists, simply because they attract a greater Medicare rebate and therefore higher fees can be charged.

In popular usage, the term clinical psychologist refers to a psychologist who works in a clinic. The term is often misunderstood by community members and those that work in the health profession.

The term clinical psychologist represents an area of endorsement with the Australian Health Practitioner Agency (APHRA).  There is an increased number of jobs advertising for clinical psychologists, despite there being other psychologists (who may hold other endorsements with APHRA) who would meet the skills and experience required for the position.

The Medicare two-tier system limits client access to a competent and diverse range of psychologists.

The consequences of this false hierarchy, which is seeping through the profession, is that there are now fewer university courses in Applied, Counselling, Health, Organisational, Education and Developmental psychology.  This narrowing of the psychological field is not a benefit to the mental health and wellbeing of our community. The continuation of the Medicare two-tier model would further support and promote this false hierarchy.

I am a psychologist in a busy Brisbane inner-city practice and our administration team now consists of four psychology students.  They have all discussed the pressure they are under to complete a Masters of Clinical Psychology, despite valuing the diversity of our team, and preferring to take an alternative pathway to become a Psychologist.  They worry that if they do not take the clinical psychology pathway their future employment opportunities will be limited.  They contemplate leaving the profession before they have even entered it.

One Tier – One Rebate

The MBS Taskforce Review into Mental Health initial draft document for public consultation has now been released. The report recommends some improvements including much needed additional sessions for clients with the greatest need, being able to see parents without the child being present and more flexibility to deliver group program.  Unfortunately, the two-tier model remains!

We need One tier – One rebate.  This system will allow the client to access the therapy they need from the most appropriate psychologist… or mental health social worker, or mental health occupational therapist.

Psychologists, let’s continue the rage!  The Australian Psychological Society has now proposed a complex three-tier model!

Psychologists we need to maintain the rage like we never have done before!  On 24 March 2019, The Australian Psychological Society (APS) had a second go at formulating a proposal for the Medicare Benefits Schedule Taskforce Review into Mental Health. The APS  originally proposed a three-tier system to the Taskforce Review (see my earlier response to that here!) after months of deliberation, and a dubious member consultation process, they have maintained the three-tier model and increased the complexity of administering the model!  The details are in their so-called Green Paper.  All the worthwhile improvements they suggest to the Medicare system were already identified in the MBS Taskforce Review into Mental Health initial draft document for public consultation.  If vulnerable clients had to navigate through the APS three-tier system they would be placed in situations where they would have to change psychologists, for no good reason.   I thank the APS for publishing the Green Paper as it has fuelled my fire. We must stop this model from being implemented as it will have devastating effects on clients.
Enraged psychologists it is now time to speak boldly with fury, the public debate is urgently required. Do not listen to those that label you a trouble maker, be the instigators of change. Do not be “good” and quiet girls, be strong and powerful women.
We must take time out from client and family care, and stand up for ourselves, and for our clients. We need to become political beasts, meeting with MP’s, writing missives of rebellion to the Australian Psychological Society.  Consider whether you want to spend your time and money supporting the APS when it does not support you as a psychologist. Consider joining the Australian Association of Psychologists and Reform APS who provide an alternative viewpoint to the Australian Psychological Society. The profession of psychology cannot be united unless the injustices are addressed.

Keep up the activism, so we have significant input into the final report of the MBS Taskforce Review into Mental Health.

We need consumers and providers of the Australian mental health services to understand the ramifications of maintaining the Medicare two-tier system and act to change it.

One tier – one rebate.

Enraged Psychologists, you can take action.

  • Has the APS represented you as a psychologist? Has it looked after your best interests? Has it looked provided a workable suggestion for mental health clients? Is it in your benefit to remain a member?
  • Join the Australian Association of Psychologists www.aapoz.com
  • Go to www.reformaps.org
  • Make your views know to:
  • Join the Australian Psychologists Facebook page. This is a closed group of enraged psychologists with a huge passion, great debate, and inspiration. They are an amazing brains trust.  Make sure you answer the questions required to join the group.
  • Share this post on social media.

Mental health advocates and consumers, you can take action

34 thoughts on “Enraged psychologists fighting for an improved mental health system

  1. Guust 17/02/2019 / 11:49 am

    Well done, Anne, you put it in a nutshell.
    I am not a psychologist, but I know a few and know some of them very well.

    One observation I would like to make, is the terminology used regarding “Clinical” psychologists. By using the term without highlighting that in most circumstances “Clinical” is merely a label applied as result of a false assumption, is akin to saying that psychologists not endorsed with the particular label may not be clinical psychologists.
    Plenty of people worked for years as clinical psychologists, and ARE clinical psychologists, until APS hijacked the term. Until the 2-tier system, clinical psychologists were just that.
    It may be wise to clarify when using the term “Clinical psychologists”, that you are not necessarily talking about clinical psychologists, but may only be talking about psychologists that have been labelled differently somehow, maybe by putting clinical between quotation marks, or dare I suggest, using the term “so-called clinical” psychologists.

    While I am on a roll, I don’t think this is a gender issue. Some people are just better suited to some jobs than others, and that is OK. Discrimination is never OK.

    Thank you

  2. Naoise Caomhánach 17/02/2019 / 9:37 pm

    I have tried to get the gender breakdown between non-endorsed and endorsed Psychologists from AHPRA as I suspect there is a significant difference between the two with what I suspect to be a higher female percentage in non-endorsed and higher male percentage in endorsed (therefore males being more likely to benefit from the higher rebate for doing exactly the same job and skill level if my suspicions are true) but they are not forthcoming. It would be very interesting to have a look at those figures.

  3. Anonymous 18/02/2019 / 4:42 pm

    The entire Medicare system seems to work on a two tier system. If you have money you get the best care. If you don’t, you join queues and fight for the limited resources. It needs to change

    • Anne 15/04/2019 / 4:54 pm

      Thank you for your thoughts. Yes the Medicare system indeed needs to change.

    • Dr Lee 08/05/2019 / 8:01 pm

      I asked Ms Phillips for the breakdown of those who were grandfathered in to the clinical AoPE and those who were not. She was not able to provide these figures for me 🤷‍♀️

      • Anne 09/05/2019 / 8:18 am

        Unable or unwilling? I would love to see those figures.

  4. Dr M E (Mel) Henderson 25/02/2019 / 2:23 pm

    Anne: I love your analysis. Spot on & fearless.

    Surely whoever reads this will see the utter foolishness of the two tier system.

    As far as I am aware the APS Review are suggesting three in their tentative (?) Green paper. I have yet to decide if I agree and wait for the final white paper.

    I worked as a psychologist in Canberra for over a decade.

    Medicare, the APS. Reviews. Bureaucratic and Systems inertia. ”Situation very normal.’

    How much pressure is there on Frances (APS new CEO) to conform to the quote, ‘powerful clinical psychology putsch’ within the APS and now within the Review Bureaucracy?

    Ah, well. I am 74. 42 years APS Member. Very interesting career in this remarkable Vocation. A Vocation (like so many others) almost taken over by ‘the Bureaucracy’ and vested interests withing the profession itself.

    Professor David Smail is one (deceased) UK Professor you might take a look at. His final book.

    (2005). Power, Interest and Psychology: Elements of a social materialist understanding of distress. PCCS Books.

    This one is my ”bible’ for honourable and ethical practice whatever one’s ”Endorsement’ by PsychBA. Not (actually) necessary if you have had the right training, qualifications, supervision, and verified experience.

    I acknowledge the public’s right to government protection from charlatan practitioners of course.

    However, is the ‘tail wagging the dog’ now?

    Thank you for the Blog.

    Best regards.

    Mel H

    Dr M E (Mel) Henderson
    BSc (Hons, MA, PhD
    MAPS/CHP/Registered-Endorsed Health Psychologist.

    • Anne 25/02/2019 / 5:41 pm

      Thank you Mel. I appreciate your words of wisdom, particularly the reference to the book which I will order. If you ever want to be a guest writer on my blog I would be happy to have you!

  5. William 08/05/2019 / 1:04 pm

    Hi Anne,

    You have identified an issue that is causing possibly irreparable harm to the profession of Psychology, and may have damaging consequences for those experiencing mental health difficulties – our clients.

    Rage is out of control anger, and we are seeing behaviours by psychologists (AAPI/RAPS) in the public arena that display poor emotion regulation, lack of awareness, hatred for others within the profession, bullying, inability to consider alternate points of view, and profound all or nothing thinking. There is no actual debate. This behaviour brings our profession into serious disrepute with decision makers, and damages the public’s trust in us.

    The demand of the AAPI/RAPS group is that the top tier of Medicare rebate be removed for clients who work with Psychologists who have achieved the qualification of Clinical endorsement. Just because you are enraged because you feel you are missing out by not having completed the education and training to become a Clinical Psychologist, do you really support financially punishing the thousands of clients working with clinical psychologists? Do you really support the opportunistic vilification of your clinical colleagues and the APS by the AAPI/RAPS group? Do you really support the public dishonesty by this group?

    There is a real risk that the public displays of dysregulated anger, misinformation, dishonesty, vilification, and bullying by the AAPi/RAPS group will work against the real interests of generally registered psychologists, as decision makers and actual experts see it, and can see through it. What if they thought AAPI/RAPS actually represented general registered Psychologists? Would they see value in providing funding to support people who behaved in this way?

    Being enraged is destructive to yourself, your clinical colleagues, the profession of psychology and our clients – people who are struggling with mental health issues. Please encourage others to demonstrate emotion regulation, ethical behaviour, and compassion. We might just be able to solve our problems.

    • Guust 08/05/2019 / 2:08 pm

      There is no actual debate from the APS because there is no evidence for the position they are taking. This behaviour brings the profession into serious disrepute with decision makers, and damages the public’s trust in psychologists. Name any other industry body that proposes changes without any evidence that discriminates against those it purportedly represents.

      The demand of the AAPI/RAPS group is that the top tier of Medicare rebate be extended for clients who work with registered psychologists who clearly have been seen to be fit to provide psychology services by the government regulator.

      Until a valid case can be made that treatment provided by those who have achieved the Clinical endorsement, is somehow better than the treatment provided by other registered psychologists, any demarcation is simply not warranted and purely artificial.

      Do you really support financially punishing the thousands of clients working with psychologists other than those officially labelled “Clinical”? Do you really support the opportunistic vilification of your colleagues and the AAPI/RAPS group by people like yourself just because you think you are somehow superior? Do you really support the public dishonesty by the APS?

      Insinuating that registered psychologists are not “actual experts” really diminishes any argument you want to make.

      There is a real risk that the public displays of misinformation and dishonesty by the APS will work against the real interests of all registered psychologists, as decision makers see it, and can see through it. What if they knew that the APS does not really represent general registered psychologists? Would they see value in providing funding to support people who behaved in this way?

    • Amanda Jones 08/05/2019 / 5:20 pm

      Wow William. How is it you have turned the victims of bullying and degredation of our training and skills into the perpetrators of abuse.

      It would be good if you were able to put yourself in our shoes – which is a skill all psychologists should have. How would you feel if it was decided in a few years that your qualifications were inadequate, that you were not a real psychologist, that in fact you needed to have completed a doctorate in psychology, or a Masters degree different from clinical psychology to be considered appropriately qualified. Remember you have already been deemed a fully registered psychologist to practice without restriction. How would you feel if you were also told that you were not adequately trained to diagnose or write reports even though your entire training was to ensure you were competent to do these. And that your clients were no longer able to receive a rebate for your services or that their rebate was significantly lower than people who were seeing a psychologist with a doctorate or the masters now deemed superior to yours.

      I think you would be devestated, enraged and determined to protect your qualifications and registration and the rights of your clients to equal rebates.

      If you are unable to see this from our point of view and from the point of view of our clients, I would wonder if you really understand the rigour of the training all psychologists receive and the high standards we are all expected to achieve. Or that you do not have the ability to empathise with your colleagues.

      It is the organisations who have not advocated for all their members or all branches of psychology that are causing the division in our ranks. They are the ones that have brought our profession into disrepute.

      • Anne 09/05/2019 / 9:15 am

        The most perplexing part of this debate for me is that not even all qualifications are considered equal. I’m working aside two young pscyhs, both have a masters, one in clin pscyh the other in counselling…. I can’t even remember who has what. They are both enthusiastic, learning, caring women who seem to have very similar skill sets… and yet one will be worth more pay than the other, and have more opportunity… crazy stuff.

      • William 09/05/2019 / 5:26 pm

        Hi Amanda,
        I was a generally registered psychologist before gaining endorsement. I was an expert in my area, and was unhappy that I was sometimes paid at a lower rate by insurance companies. I could still charge the same fee in private practice as any other psychologist, and my clients received a lower rebate. I didn’t have a problem with that. I didn’t have a clinical endorsement. The lower fee from some third parties and issues with reports led me to complete my Clinical Masters. I now teach in Masters programs, and am a supervisor at 4+2 and registrar levels. I am well aware of the elements of the different training pathways – past and present. Again, my issue is not with many of the arguments, but with the behaviours of those such as RAPS/AAPI that work against the interests of all psychologists.

    • Johanna 08/05/2019 / 7:44 pm

      The issue with this is that the majority of psychologists holding clinical endorsement do not meet the current requirements and were grandfathered in. Many of them have completed a 4+2, and back in the days when the 4+2 was significantly less onerous than it is currently and where many of the assessments were ticked off by the psychologists supervisor where standards were not so tightly regulated. So many generalist psychologists today have undergone far more extensive study and training.

      • William 09/05/2019 / 3:09 pm

        This is not true.

        When national registration came in, psychologists who were already well on track towards endorsement were able to apply to have their training and experience assessed. Those who were very close were able to complete training to satisfy endorsement. There are supreme court transcripts online describing this process.

        AHPRA does not automatically update academic qualifications when endorsement is achieved, so there are many clinical psychologists who are endorsed whose Masters is not listed. I know because I am one of them. AAPI are aware of this, but sent out misleading info to GPs anyway….

    • Dr Lee 08/05/2019 / 8:00 pm

      Wow William. Gaslighting at its finest! All I can say is here here GUUST. William you obviously are not a very empathetic psychologist. Thankfully myself and my clients don’t know you as I would hate to have them end up with a psychologist with your type of attitude.

    • Anam Cara 09/05/2019 / 7:17 am

      The word used was enraged= very angry/furious. If you had any training in mindfulness or ACT you might understand it is possible to hold the space within for large and intense emotions without being dysregulated, and then to use considered actions to deal with the behaviours from others that have so overstepped ones boundaries. But then you sound like a textbook.

      • Anam Cara 09/05/2019 / 7:19 am

        My last was addressed to William

        • Anne 09/05/2019 / 9:10 am

          Thanks.. I hoped it was addressed to William. Love ACT and love being enraged!

          • William 10/05/2019 / 7:58 am

            Hi Anam and Anne,

            I respectfully and profoundly disagree with your interpretation of ACT and the underlying mindfulness concepts. The fundamental understanding in mindfulness is the concept of impermanence.

            Destructive emotions are to be acknowledged and observed, to allow for the experiential understanding that they are impermanent – not actively held on to or encouraged. Actions and behaviours should not be guided by or through destructive emotions. They should be guided by equanimity and compassion, particularly when required to take right action.

            In other terms, acting from fight or flight can cause harm to the self and others, while using our frontal functions allows us to consider a greater range of information and actions, with greater access to wise mind. Sorry to mix so many metaphors haha. I apologise if you think I sound like a text book – I take these constructs seriously 🙂

            This gets to the heart of why I posted here in the first place. I am of course disappointed that so many here have attempted to justify bad behaviour by AAPI/RAPS by claiming “it’s not bullying if they deserve it” (my paraphrasing). Bullying is bullying, vilification is vilification, dishonesty is dishonesty – however you justify it. I am still hopeful some here will work towards a reduction in the divisive toxicity of the AAPI/RAPS approach.

            There are many of us who have ideas and can work towards resolving problems, but not in such a toxic environment. Please be aware that there are many of us who are willing to think, talk and help work out solutions. Unfortunately, I think things have gone too far and we will have to wait and see what all this rage will produce, and the dust settles. I hope not too much damage occurs to our profession and my non-clinical and clinical colleagues. Then hopefully we can get back to work on positive solutions.

            Thanks again Anne for allowing me to post here, as there is no where else these issues can be debated. I will take my leave though, as I have clients to see, a training workshop to prepare, and a family to be with. I wish you all well.

    • Anne 09/05/2019 / 8:16 am

      Hi William, thanks for your comments. I love my rage, it’s not out of control anger, its passion and energy to fight against the injustices perpetrated by the APS. It is the APS them who has created the division, we are trying to heal it. We should be debating this division between psychologists because it’s based on a false dichotomy, that clinically endorsed psychologists are better than non clinicals. In the last three years, I took a maternity leave position while the clinical psychologist was on leave. She was a fabulous psychologist who I regret not having the opportunity to work alongside, however, she was no better or worse than the other non clinically endorsed psychologists I worked alongside. Clients in the organisation were not allocated according to endorsement rather as to who would be the best fit for the client. She returned to work and was paid more than me… same job, same clients. After this, I worked in private practice with a mixture of clinical and non clinical psychologists. When the clinical psychologist managing the practice left, guess who got her caseload! The clients received less rebate while seeing me, I was paid less and the clients got good treatment from both psychologists. Seems unfair to me. When I have worked with teams of psychologists I have been unable to tell the difference between clinical and non clinical psychs because we are all doing the same work. Unless the topic of endorsement comes up, I would have no idea who was endorsed and who wasn’t.

      I do not think that clinical psychologists should have their livelihoods reduced, it’s hard to make a good living in this profession. I think we should all receive the same higher rebate. This would provide more opportunity to bulk bill and for clients to access psychologists. One tier is about unity.

      I too am concerned that this debate is now in the public arena, and share your concern for our clients, however, how could it not be in the public arena? This is not a new issue, psychs have been debating this with the APS for years… but it’s fallen on deaf ears, the only way that non clinically endorsed psychs have been able to come together has been through the use of social media, RAPS and AAPI.

      Being enraged is a healthy and powerful call to action, it enables me to fight against the unethical behaviour of the APS and to advocate for clients. This goes well beyond the Medicare rebate.


  6. Caroline Dowling 08/05/2019 / 4:59 pm

    So well said Guust!

  7. Mich 08/05/2019 / 8:47 pm

    Fantastic synopsis of the huge issues our clients and our profession are facing with the two or three tiered Medicare systems!

  8. William 09/05/2019 / 7:14 am

    Thanks Guust,

    I’ll take that as a no.

  9. Anonymous 09/05/2019 / 9:14 am

    I wonder what William suggests Psychologists who are not endorsed should do. Put up and shut up?

    • Anne 09/05/2019 / 12:24 pm

      I think that we have done that for long enough! No more of that. Sometimes you need to fight hard for your values.

      • Yolla 09/05/2019 / 1:09 pm

        Yes of course sometimes you do need the rage and to fight. It’s a rage against injustice. Nothing wrong with that in my opinion. No need to ‘keep it quiet for the sake of the family’.

  10. William 09/05/2019 / 1:46 pm

    Thanks for the responses. And thanks Anne for your considered response. I only posted on your blog because 1. You had not vilified your clinical colleagues, and 2. Because I wanted to see if you would allow a post that presented a different view. RAPS simply don’t allow posts of this nature – that’s what I meant by “no debate”. RAPS will allow hate speech aimed at clinical colleagues – I have counted no less than four times the phrase “kill the clinical parasite” has been allowed through. The RAPS website is full of nasty attacks on clinical psychologists (selfish, greedy etc).

    My post related to behaviours. While we may agree to disagree on semantics (I think the words we use are important), it is the behaviours I am identifying as problematic. The bullying of anyone who may have a different view has already occurred here, with several posters attacking me personally. We as psychologists should be modelling emotion regulation, regardless of our beliefs or concerns. Feeling you have experienced injustice does not justify bullying and vilification.

    I also have issues with the misrepresentation of information from the AAPi/RAPS group. Even the video reproduced on this site is misleading. It paints Clinical training as simply paying money for an academic degree, rather than what it is – intensive clinical training.

    I am a little confused that some here are now saying the aim is to extend the medicare rebate to all psychologists, when the AAPi?RAPS line has been to disparage clinical qualifications to remove the top tier. If the aim was to more psychologists onto the top tier, there are options to be discussed. When the black and white aim is to remove the top tier and create hardship for clients – options are limited.

    The top tier is to recognise a qualification. This is the norm across professions. Formal qualifications are more highly regarded. If we want to move more psychologists on to the top tier – how can they obtain or demonstrate competencies to allow for this? If we move away from vilifying clinical psychology as an all or nothing – there may be options. Most of us are well aware of problems facing psychologists, such as provision of reports, but the focus on attacking clinical psychologists themselves and focussing only on medicare, where qualification is the issue is unhelpful.

    The two tier system is not actually bullying or vilification of generalist psychologists – it is based on level of qualification. Feeling disenfranchised and angry does not justify vilification, bullying and dishonesty.

    My concerns are not even with the arguments put forward by some here, but the behaviours also demonstrated here by some. My concern is that the awful behaviours by some and by AAPI/RAPS are damaging the profession and damaging the prospects of resolution. My fear is that generalist psychologists are the ones who will be damaged the most, and I don’t want that for my non-clinical colleagues.

    Finally, thank you Anne, for allowing me to post here. I know some will continue to bully me, but at least you allow a dissenting view. Maybe this is actually debate?

    • Josie 09/05/2019 / 6:09 pm


      The 2 tier system is not based on level of qualification. If this was the rationale, then clients of psychologists with AoPE’s in areas other than clinical psychology would receive a rebate, as would those of registered psychologists with a PhD or Masters qualification without any endorsement. Then there are clinical psychologists who have not completed a Masters level of training whose clients receive a higher rebate because they have been endorsed as clinical. I personally know some of those people. It is not merely an error of omission from the AHPRA website, although that may be the case for you. The 2 tier system awards a higher rebate to psychologists with one endorsement only. And this is the issue, because nobody, including you, has put forward evidence to suggest that psychologists with this endorsement provide a superior service. This, despite multiple requests for that evidence.

      It is noteworthy that other Medicare Review groups made recommendations for rebate to be based on service provided, not practitioner qualification. That is, a procedure performed by a GP will attract the same rebate as the same service provided by a specialist. Why should psychology be different?

      I have to say that I find your OP highly ironic. You think it constitutes ‘punishment’ for clients of clinical psychologists to receive the same rebate as clients of other psychologists? Can you explain the logic behind this? Is there a rationale for them receiving a higher rebate? Are they more deserving than clients of other psychologists? The false premise that clinical psychologists have a higher qualification than other psychologists notwithstanding; the rebate belongs to the client, not the practitioner.

      If you want to discuss bullying, dishonesty and villification, perhaps we can address some of the following:

      * A public statement by an APS board member that psychologists with general registration have lower ethical standards and are more likely to be the subject of ethical complaints (without any substantiating evidence)
      * Professional forums where psychologists with general registration have been referred to as ‘cockroaches’ (I could continue to list the charming statements I have heard)
      * APS representatives advocating to Centrelink and NDIS that only clinical psychologists are sufficiently qualified to diagnose or complete reports for clients

      If the APS were actually willing to openly discuss the issues in our profession, then I personally would be more than happy to sit at the table. That won’t happen, because the majority of seats at the table have been allocated, disproportionately, to clinical psychologists. Attempts at dialogue have been shut down, sometimes with threats. If the APS will not listen and will not discuss these issues, then they force members and former members to take it elsewhere.

      Does it actually surprise you that people will stand up and fight when their livelihood is threatened? Do you understand that is the reality for many psychologists? Lets talk about that ironic OP and those people who are unable to consider an alternate point of view…….

  11. William 10/05/2019 / 7:36 am

    Hi Josie,

    I am unaware of any claims of lower ethical standards or disproportionate complaints to AHPRA. AHPRA do provide breakdowns of complaints etc, and I have not seen this specific information.

    I have not seen or heard of any psychologists being called “cockroaches”, and if this was a statement in a closed forum, I cannot comment on the context. Does one alleged comment by an individual in a closed forum equal an entire publicly accessible website dedicated to vilifying clinical psychologists? Does it justify multiple uses of the phrase “kill the clinical parasite” on a public forum? The public face of psychology is being damaged by such behaviours. There can be acrimonious exchanges within professions unfortunately, but they are usually and appropriately not made in public.

    The provision of reports is a valid concern, and likely more complex than may be evident. It is likely that poor reports have been prepared in the past (and I have seen many), so how do we ensure that the psychologist is appropriate to provide this service? I personally think this is an issue that needs to be resolved. The current divisive approach of AAPI/RAPS is way too toxic to allow open discussion of ideas.

    I used the term “punishment” because clients currently able to claim the higher rebate would have to be told they will have their rebate reduced and be further out of pocket. Removing the top tier would make thousands of clients worse off then they are now. We should be working on ways to allow more psychologists to provide services where clients can claim the higher rebate – not punishing those who already do – it is not their fault.

    AOPE should be relevant to the application. I think (and the APS Medicare submission) recommends more areas of endorsement should be eligible, and even includes that psychologists who can demonstrate equivalency should be. AAPI?RAPS approach of total opposition and misleading conduct ignores this – only pursuing the denigrating of higher level initial education and training (qualification) in an all or nothing push to remove the top tier.

    Once again, thank you Anne for allowing posts such as this, even if you disagree with what I say.

    • Josie 10/05/2019 / 5:42 pm


      The fact that you are not aware of these things suggests to me that you may not be fully informed as to past events. Perhaps you should be looking into this further?

      The first refers to submissions made on behalf of the APS and the APS Clinical College. There are references to research being undertaken by ACPA which is yet to see the light of day.

      The second comment is not an isolated one. It has been made many times, including verbally at CPD events. It’s only one of many statements made that denigrate registered psychologists.

      Regarding the third, psychological assessment and report writing is a skill required for completion of the 4 + 2 program and competency is set and assessed by AHPRA, not the APS. If the APS have an issue with the competency of registered psychologists in this area then they should be addressing that issue internally and with AHPRA, not via formal recommendations, apparently based on anecdotal evidence, to government agencies.

      I don’t condone vilification of anyone, nor do I support demonstrations (vs. expressions) of anger, but this is far from a one sided issue. It is not AAPi and RAPS who have damaged the public face of psychology, it is the APS and ACPA, via public statements and submissions, and incidents like those above. Registered psychologists are being forced to deal with commentary made about them to the public and to state and federal governments. They are being forced to defend their skills and qualifications on a regular basis. They didn’t create that situation, nor did they ask for it. So how is it that you attribute the issues in the profession to the actions they are taking in response to being professionally and publicly demeaned?

      Your defense of the word ‘punishment’ makes no sense. If that is your issue then you should be okay with future clients of clinical psychologists receiving the same rebate as clients of all other psychologists. Although that begs the question: How would you explain to them that they are entitled to less than other clients? Non-clinical psychologists have to field this question on a regular basis. Less than 50% of episodes of service per year are provided by clinical psychologists. Currently, it is the clients of non-clinical psychologists who receive a lower rebate and are more out of pocket. Sometimes this may be because they live in a rural area where there is no clinical psychologist. Is that their fault? Are they being punished because their chosen psychologist didn’t complete the ‘right’ pathway? They are aware that they receive less.

      The APS Green paper does not address the issue of tiers, it simply creates more of them. Under their proposal, clients of psychologists with demonstrated skills but no AOPE will still receive a lower rebate. Clients classed as mod-severe, solely on the basis of diagnosis, will not be able to claim a rebate at all if they see a non-endorsed psychologist in a metropolitan area. There is no recognition that some psychologists may have advanced training and experience in specific areas without ever completing a formal AoPE. So some clients of registered psychologists, who are currently receiving rebates, will no longer receive a rebate at all unless they change psychologist. Doesn’t that meet your definition of punishment?

      The Green Paper also highlights my point regarding the disproportionate number of seats at the table allocated to clinical psychologists – did you see the constitution of the ‘expert committee’? Why, when clinical psychologists make up less than 30% of the profession, were the majority of members of the committee clinically endorsed psychologists? How does that represent the whole profession?

      I understand that you might be upset by comments made about clinical psychologists. I understand because I’ve been upset by comments, including official ones, made about registered psychologists. Apparently those have flown under your radar, which is also understandable since they didn’t relate to you. If you are genuinely trying to see the ‘other side’ of the issue, then you need to honestly investigate the history of what is happening here, rather than pointing fingers from a position of hurt.

      • Anne 11/05/2019 / 4:11 pm

        Hi Jose thank you for responding so eloquently and knowledgeably to William. I have seen so many examples of non endorsed psychs being seen as not good enough that for me the actions against us of the APS are now irrefutable. William I suspect that the AAPI and RAPS have had to be loud and noisy in order to capture attention. Years ago someone told me about RAPS and I thought it was a lot of fuss about nothing, I wish I’d been wiser then.

        Re the reports. I was working with unemployed job seekers providing reports to Centrelink when this change was made. We were a team of about 20 psychs across QLD and VIC. All our reports were peer reviewed before sending. We were supervised by a psych with a Phd and a particular interest in assessment. At no time was the quality of our reports questioned. I saw no information regarding it, the information was just passed on. Now I ask, why did the APS not fight for us at this time, why did they not question the decision? If there was more complex information regarding the quality of reports why did they not address this. The impact on clients was extraordinary as we reduced the WAIS testing. Long term unemployed often have learning or cognitive difficulties which are undetected. They are left to rattle around in a heartless system, not designed to support them. So much good work that could not be done.

        My goal, is a united, diverse and equal cohort of psychologists to serve the Australian public. That is worth being enraged for!

Hi, I'd love to hear what you have to say.