Warren Buffet has been quoted as saying, “Everyone has a circle of competence. The important thing is not how big the circle is. The important thing is staying inside the circle.” All health care professionals are legally and ethically obligated to practice within the scope of their knowledge, skill and experience. Given this obligation, is there a need for board certification to establish a psychologist’s expertise in a specialty area(s)? If board certification is desirable, why are fewer than five percent of psychologists board certified?
The American Board of Professional Psychology (ABPP) offers board certification in 17 specialty areas. The ABPP website lists multiple reasons that psychologists should become board certified as part of the larger goal of serving the public and promoting quality. These include: the ability to demonstrate expertise, potential opportunities for career growth, and facilitation of license mobility.
The application fee is $125 and the fees for the evaluation of the practice sample, oral exam, and written exam total approximately $1,000, though there are opportunities for scholarships from the ABPP Foundation. There is also an annual fee to maintain certification.
Psychologists with appropriate training may pursue board certification in multiple specialty areas including, Addiction Psychology, Behavioral and Cognitive Psychology, Clinical Child & Adolescent, Clinical Health, Clinical Neuropsychology, Clinical Psychology, Counseling, Couple & Family, Forensic Psychology, Geropsychology, Group Psychology, Organizational & Business, Police & Public Safety, Psychoanalysis, Rehabilitation, School Psychology, and Serious Mental Illness.
To gain some perspective from a board-certified psychologist, I reached out to Dr. Jennifer Ferrand, a clinical health psychologist and director of wellbeing at Hartford Healthcare in Connecticut.
She noted, “I became board certified to verify for myself, my peers, and the public that I’m a specialist in clinical health psychology, and because I hoped it would bring visibility to the important work of psychologists in my healthcare system.”
I wondered whether board certification might be more important for some subspecialties compared to others, as appears to be the case in clinical neuropsychology.
Ferrand replied, “For my specialty and in my health system, board certification was not required, but I can think of a few examples where board certification might be particularly helpful. If you interface with the legal system in your work, board certification in forensic psychology could be very important, as it is recognized by some jurisdictions as the standard of professional competence in this area.”
Psychologists who have done the work to become board certified are to be commended and clearly care about elevating the field. But why is there so little buy-in from psychologists regarding board certification?
The perceived costs are high, relative to the direct benefits, particularly for self-employed practitioners. There is also a case to be made that the field is has not reached a point where there is sufficient consensus about the model to establish post-license psychologist competence. Indeed, the taxonomy of specialties is perplexing.
I was surprised to see that a specialty in Psychoanalysis is offered, given the lack of consensus on the effectiveness of this treatment approach. The taxonomic categories cover heterogeneous domains including, populations (e.g. child/adolescent), types of problems (e.g. addiction), types of intervention (e.g. behavioral and cognitive) and modalities (e.g. couples/families). The model is not hierarchical nor designed to establish post-licensure competence at different levels.
The “minimal standard” of psychology licensure is not a trivial effort. Doctoral level psychologists must receive a passing score on the Examination for Professional Practice in Psychology (EPPP).
The EPPP is overseen by Association of State and Provincial Psychology Boards. Typically, licensure requires four years of college, four or more years of graduate school, completion of pre-doctoral practicum, internship and a year or more of post-doctoral work experience.
It takes additional years of experience and continuing education to achieve competence in any given domain. For example, though I am competent to provide psychotherapy to people with cardiac illness, I work only with adults, having had no experience with children and adolescents (other than my own).
Though I worked for many years with cardiac patients, the field advances rapidly. Knowledge that was considered on the cutting edge a decade ago, becomes obsolete unless I continue to read relevant journals or work in an environment where I’m exposed to new treatments and methods.
I suspect that board certification has not caught on, partly because the framework is not yet coherent and has been developed without sufficient engagement of the intended audience. Why did the practice of telehealth proliferate during the pandemic? The culture must be ready for the movement to gain traction.
As workforce trends change, a gradual shift toward more positive attitudes regarding board certification may take place. A 2015 survey indicated that approximately 45 percent of psychologists are employed in private practice, 24 percent are employed in health care settings and 19 percent are employed in higher education.
By 2030, the largest projected demand for psychologists will be in hospitals and other healthcare settings, followed by schools and higher education settings, according to an independent workforce analysis commissioned by American Psychological Association (APA) in 2018.
Presumably, employment in these settings might require board certification as the field matures.
Current attitudes of psychologists toward board certification appear indifferent or neutral, rather than resistant. Expansion of telehealth services has led to a great deal of unmet demand for psychological services, according to the 2022 Covid Impact Practitioner Survey conducted by APA.
Practitioners who feel beleaguered by the inability to keep up with the demand of clients seeking treatment would likely struggle to find the time and resources to become board-certified, should the process become mandated rather than voluntarily sought.
The movement to encourage psychologists who are more recently graduated to pursue board certification has been successful, with a greater number of more recently graduated psychologists becoming board certified compared to those with more years of experience.
Board certification is the norm, not the exception, for our medical brethren, with 40 specialties and 88 subspecialities. But the notion that psychologists should derive a post-license competency framework from medicine is debatable. If post-licensure certification is the future, then the majority of psychologists need to become engaged in this potential policy change.