Facilitating mobility for psychologists: Comparisons with and lessons from other health care professions.

Abstract

Psychology and other health care professions are giving increasing attention to facilitating the movement of practitioners across jurisdictions. One of the greatest deterrents to mobility is the variability in licensing requirements among states and provinces. We review the status of mobility systems for licensed members of the professions of psychology, optometry, dentistry, medicine, nursing, and pharmacy. Each profession has, at a minimum, addressed the issue of mobility and licensure. With the exception of medicine, each profession currently has in place a version of licensure by endorsement and/or by reciprocity, although the professions differ in breadth of use and user-friendliness. Implications for enhancing mobility for psychologists are discussed. Many psychologists and other health care professionals today are able to practice in venues that were once difficult to access. With the increasing use of technology, a growing number of health professionals are able to easily cross geographical borders. This may be done through implementation of telehealth practices such as triaging by telephone with a patient in another state, videoconferencing with patients in other states, and online Internet-based services (Wakefield, 1999). Health care professionals may also work for integrated delivery systems that operate in different states (Ventura, 1999). Geographically relocating between jurisdictions during a professional’s career is not unusual. Peterson and Weiher reported in 1993 that in Nevada alone, 86% of the state’s psychologists were originally from other states. Although it makes sense to facilitate the mobility process for psychologists and other health care professionals, issues of quality of care, competency of practitioners, and standards of practice are of great concern for state regulatory boards that are ultimately responsible for licensing these individuals and protecting the welfare of consumers. Before implementing a system that facilitates the mobility process, licensing boards may consider several factors. Among the most important issues is the matter of requirements for initial licensure. That is, a jurisdiction may not be willing to accept a professional’s application for licensure based solely on the fact that the person already holds a license from another state. For example, the type of educational degree, accreditation status of the educational institution, type and amount of supervised experience, passing scores on national examinations, additional state or regional competency examinations, jurisprudence and ethic exams, years of experience, and disciplinary actions are all additional factors that may be considered. Not surprisingly, the process of implementing a system for easing mobility of health care professionals is often slow and arduous. Psychology has begun to implement systems that facilitate mobility. In February of 2001, the Committee for the Advancement of Professional Practice (CAPP) was given formal approval by the American Psychological Association (APA) Council of Representatives to continue with plans for the development of professional mobility mechanisms (Levant, 2001). Before this, CAPP was engaged in delivering various programs, discussions, and conferences to create an environment in which existing mobility mechanisms could be further enhanced. At this time, CAPP’s plans included informing members about the various mobility mechanisms that were already in existence; differentiating between endorsement and reciprocity processes, with endorsement being the more widely accepted mobility mechanism; and noting that individual state and provincial boards were responsible for making decisions about licensure and mobility. To understand how useful, effective, or cumbersome mobility systems will be, it is helpful to see what other health care professions are doing similarly or differently to address the issue. In this article, we review the factors that may ease or impede mobility of health care professionals within the United States and illustrate the systems that have been designed to address the mobility issue within the fields of psychology, optometry, dentistry, medicine, nursing, and pharmacy. Although our focus in this article is on mobility and licensure issues that are present in the United States, the issues are also applicable to professionals in Canada, and in some professions a common organization or advisory group applies to jurisdictions in both the United States and Canada. We note in our discussion when policies apply to both states and provinces. Canadian prov