|
Recoome posted:I think the tiered system we see in psychology is something which is related to, but a bit distinct from the issues around the removal of the extra 10 sessions from BAS. The line from the ALP is that the extra sessions are just clogging up the system and people aren't able to see psychs because people have 20 sessions and not 10. The ALP commissioned their report with a political end in mind and the idea that the 20 sessions was causing backlog among the psychologists currently privately practicing was the explanation they settled on. They've been signaling for over a year that the 20-session plan was on the chopping block and I'm frankly surprised it has persisted as long as it did. As you pointed out, the review did not recommend the sessions be cut; the review actually recommended that people who maximize their sessions may not be appropriate for "merely" psychology because service usage of that level suggests more chronic concerns than perhaps privately practicing psychologists are equipped to deal with. The recommended model of care for anyone with a condition complex enough that it doesn't resolve in 20 sessions is referral to some sort of complex care multi-disciplinary team which might have contributions from a psychiatrist, a psychologist, perhaps a social worker or speech therapist, etc... however the report acknowledges that this sort of complex care model doesn't actually exist and, in the absence of that service being available, psychologists are better than nothing. The thing that gets me is the rationale they use, that 20-session patients are clogging up waiting lists and denying services to new patients who can't get on the books is a tacit acknowledgement that there is a cohort of people utilizing this service (and utilizing it too much, apparently). If you acknowledge this point, it begs the question: where does the ALP imagine they'll go since they're now being forcibly exited from this system. The ALP's own statement on the matter is that they envision people this affects will find their way into referrals with more intensive services in the community. I actually work in these sorts of teams and I can confirm you have to be very unwell to qualify for this model of care (think, chronic schizophrenia or major treatment refractory conditions) and even with stringent acceptance criteria, they are already underfunded and stretched thin... there is no capacity to absorb a cohort of people who were otherwise being kept contained in the private psychology system. The reason why this particular rationale is interesting is because it's the inverse of the argument they used many years ago to reduce the number of allowable sessions from 26 to 10... I'm probably revealing my age here but back in 2008 or so the ALP commissioned a study on the then-26 session cap which had been in place for several years and they concluded that something like 90% of patients exited the system within 6 sessions and an aggregate 96-98% ended their therapeutic relationship by session 10... so capping at 10 sessions wasn't foreseen to affect very much. If they were interested in improving availability of psychologists, they could fix the deep flaws in the training system, like you pointed out. But I would also highlight that the medicare rebate for psychology has been frozen since 2012 and psychologists have been either charging increasingly ridiculous gap fees or leaving the profession altogether. There is a whole cohort of psychologists/clinical psychologists who want to do private practice but don't do so because it's not financially viable. The report the ALP commissioned also recommended this but raising the medicare rebate doesn't even seem to be on the radar for the ALP. I hate the Liberal party as much as anyone but I'm forced to acknowledge that the creation of the bulk-billing system for psychology was a Howard policy, sessions were reduced under Rudd, medicare rebate was frozen under Gillard, and then sessions were expanded again under Morrison... now ALP is back in charge and sessions are being reduced again. I don't know why the ALP hates psychology as much as it does but it's not a subtle thing nor a bipartisan thing.
|
#
¿
Dec 13, 2022 11:50
|
|
|
|
| # ¿ May 10, 2024 08:59 |
|
|
Recoome posted:This was an excellent post by the way, I wasn't as aware of the pre-2010 poo poo but it definitely contextualises a lot of the poo poo we see today. I appreciate that, I don't post often because most of what I have to say is on very narrow topics that don't come up that much quote:...in addition to a lot of the splits we seem to have within the profession. I remember at the time the CEO stated that we really need to consider how to we unfuck the internal dynamics so we can better advocate for ourselves but as stated earlier that CEO left under some pretty tight-lipped circumstances but there's been very little change since. I'm going to grossly over-simplify the problem but the profession of "psychology" comprises, as you pointed out, 4+2/5+1 psychologists and masters/clinical psychologists. When the better access scheme was introduced, there was an inherent inequality introduced into the system that seems so perfectly targeted to make the profession cannibalize it's own that it must have been intentional. From day 1, clinical psychologists could charge more for the same 1-hour of private practice work than non-clinical psychologists and clinical psychology as a title is available only to people who have completed a clinical psychology masters or PhD degree. You've already summarised the pros and cons from this approach however, ever since then, there has been an active and ongoing debate within the field of psychology as to whether we should be tightening up the rigor and academic discipline and do away with the apprenticeship scheme altogether (as North America and the UK have done) or broaden the apprenticeship scheme and attempt to seek parity within the field, either improving access to the clinical psychologist title for non-masters/PhD graduates or doing away with the two tiers of rebates. I am not exaggerating when I say that resolving this debate has represented the highest priority for the accreditation bodies which has lead to splits (the Australian Association of Psychologists spun off from the Australian Psychology Society specifically to advocate for 4+2/5+1 graduates) and a revolving door of APS leadership as one faction of this debate finds enough votes to become leader and then gets white-anted by the other faction until they resign. With each new president of the APS, we seem to get a new direction/policy as to whether we should be focusing on making the profession more academically rigorous vs focusing on expanding services and doing away with the different tiers of practice. One year we're adding a mandatory academic exam that all 4+2's must pass to graduate with their letters, then we have a change in leadership, and next year we're talking about introducing a bridging qualification to allow 4+2 trained psychologists to enter the clinical college. There's no "right" answer to the question of how much academic rigor we should require before someone can be a psychologist but resolving this debate only works when the leadership takes a position and then sticks with that position over years. So when the leadership talks about unfucking the internal dynamics, they might be referring to a number of issues but this is the issue that brings out the strongest emotions and sucks up a lot of oxygen within the political advocacy arms of both the APS and the AAPi. The following is my own personal opinion but I strongly feel that this 10-year civil war is reducing the capacity of psychology governing bodies to advocate for themselves. I've been to conferences where panel discussions are hosted for public debate, debates about the number of sessions allowed under the better access scheme might take 5 minutes and be quite civil and then you get to the agenda item of talking about doing away with clinical-psychology specific medicare billing numbers and suddenly people are shouting at each other, walking out, throwing tables, and nothing else gets discussed. And while the profession of psychology tries to reconcile this debate, policy changes like the medicare freeze and reduction in better-access sessions gets reduced without any real challenge. Sorry to put so many words to a narrow aspect of the profession but this has been going on for years and there appears to be no sign it might be resolving
|
|
#
¿
Dec 14, 2022 06:00
|
|
|
Sorry to keep this conversation going, people make posts that I feel I can reply to but if the conversation is too industry-specific and narrow, I'm happy to drop it... because this is my field, it's interesting to me and I have a lot of opinions but I always imagine this stuff would be boring to outsidersElectric Wrigglies posted:I see a similar thing in my old alma matter, the old Mr X or Ms Y no longer lecturing their specialty subject matter expertise because PhD being a minimum requirement to be a Uni lecturer so now the same subjects are instead presented by PhD havers with no specialist or deep understanding of the subject matter other than what is required in general in the industry. Not to say that lesser education is better, just that it is not strictly better to add additional years of pure education. I really think the crossover from pure education to practical exposure + updating training is late then it needs to be as a means to gate keep (also, I did it this way, so shall the young). I don't take a strong position on the central debate about how much "psychology" should be an academic discipline but I would point out that Australia is very unique in the world to allow the practice of psychology with a 4-year degree. I'm Canadian and in Canada and America, being a psychologist means having a PhD (or a PsyD which is also a doctoral qualification). Psychologists are rare and I would argue more highly esteemed than in Australia; people holding that title see only the most severe pathologies and tend to only live in major cities. In Australia, psychologists take on the role that would normally be done by a range of professions in other countries, counsellors, mental health nurses, social workers etc... Like I said in my previous posts, there is a constant debate in Australian psychology professional groups about whether to make psychology more academically rigorous and previous presidents of the APS have been pretty transparent that they resent the lessor status of psychology in Australia compared to other countries and want to bring the minimum standard of qualification up to the level of Europe (where a minimum of a masters qualification is required to practice) if not the level of North America. There is an acknowledgement that this will choke off availability of psychology however the answer from people who want to follow this path is to upskill other mental health professionals to see the "less severe" pathologies and reserve the worst cases for clinical psychologists. The philosophy in North America, that psychology should require a PhD, is an outflow from the Boulder Model, also known as the Scientist-Practitioner model of graduate programs. I won't get into the history too much but after WWII there was an understanding developed that the field of psychology, then, was not well-grounded in the sciences and there should be better training in the scientific method and the application of scientific study to the practice of applied psychology. There are arguments for and against the Boulder model but, in other countries, it's generally accepted that the level of scientific instruction required to meaningfully apply empirical principles to practice requires graduate level instruction with a masters+ level thesis. quote:Here is my idea, 20 sessions of non-clinically registered psych made available, or 10 sessions of clinically registered. Once the associations sort themselves out and get a sensible proposal to unify the registration without adding years of retraining, then we can talk about methodical systems to ensure the number of sessions is unlimited where required but inherently targets discontinuing sessions where a reasonable expectation of efficacy is not there. You're sort of stumbling on the solutions being proposed by some advocates in the college; rather than have one basket of sessions of psychology that can be redeemed by either a psychologist or a clinical psychologist, one solution has been to task GPs with assigning a severity to a person's pathology and referring them to one or the other. This is the answer used in North America and Europe. quote:as someone who is studying psych part time to change careers, this has been an extremely enlightening and somewhat disheartening conversation to read. is there anywhere online where this stuff is discussed that you recommend? Most of these conversations happen online or at various conferences and I don't think this stuff gets published in areas easily publicly accessable. The liveliest discussions happen on the state and national psychology and clinical psychology facebook pages but I think you need to already be a psychologist to join them (also things posted on facebook tend to be not vetted and garbage). The AAPi runs a number of online communities and facebook groups; they lean into the debate but they have staked out a very strong position that the two-tiers of psychology should be abolished altogether and that university trained psychologists should be on completely equal footing, in titles, college access, and medicare rebates, with apprentice-trained psychologists so I wouldn't count on them to honor both sides of the debate. Don't be disheartened, though! I would highlight that even paying for 10 sessions through the public medicare system is still 10 more sessions than virtually every other country in the world pays for and in most countries, psychology is a luxury paid for entirely out of pocket. Even with these cuts, even with the rebate freeze, and even with the constant noise in the facebook groups, this is the best country in the world to practice as a psychologist (and I say this as a person who has practiced in Australia, Canada, the United States, and England).
|
|
#
¿
Dec 15, 2022 11:57
|
|
|
Bucky Fullminster posted:There hasn’t been any milquetoast critique or even any response to why it’s not feasible, beyond “you might need to put a third line in”. 1. Putting in a new rail line, even a short one, is incredibly expensive, drawn out, and unpopular. People who own the land on which the rail line will protest, the people who are <not> serviced by the rail line will also protest, and this is all before you’ve even broken ground. Someone asked you who lives in the red circled area and you sort of brushed off the question but it’s a fundamental question to be answered and might be a reason why such a project is a non starter 2. Not putting in a rail line means leaving things as is. You might have an argument that you find trucks incredibly disruptive, they’re noisy, pollute, kill 50 people per year etc but the people in this area might have decided this is simply the cost of business and are happy with this. The advantage of trucks over rail is that it can be scaled easier, need to move more or less goods, put more or less trucks on the road. One road closed for construction or maintenance, re-route your trucks for the day/week/month. Also trucks go right to your door, any rail depot would need some system for transporting goods from the train to the respective warehouse so you haven’t eliminated all trucks, just the trucks through the middle bit of point a and point b 3. Similar to point 2, the scalability of trucks means you can appropriately wind up or wind down freight as the needs of community or society change. You need to be assured that the transportation needs between these two points will be the same in 50 years as they are now. If they reduce over those 50 years, it’s not worth the time/cost investment. If they <increase> it’s actually really hard to scale rail infrastructure <up> and you end up with a situation where you’re now running a train <and> convoys of trucks to keep up with demand I’m not a civil engineer so someone with a PhD could probably come up with other reasons. My experience comes from living on the Gold Coast when they built a light rail from one end of the city to the other in time for the commonwealth games a few years ago. It was a major issue throughout its 10 year construction and every prediction in terms of money, time, and problems it caused came out to be worse than predicted on paper and this was in spite of being designed by teams of civil engineers, some, presumably, with phd’s
|
|
#
¿
May 15, 2023 02:43
|
|
|
Animal Friend posted:In my case they basically split the payments accross the financial years I was claiming benefits and decided that my declared income that year was too high for the payments I received. In medical school, you graduate in December and you're hired by a respective health service to start working full time as a medical intern the following January. This creates an effective situation where you (usually) have 0 income for the first 6 months of that tax year and then the full income of a junior doctor for the second 6 months. Virtually everyone in my graduating cohort (and the cohorts above and below) were pinged by robodebt at virtually the same time approximately two years after graduation. Proving income was easy at least because in health services payslips are retained on an online system and easy to download but it was obvious from the timing and the manner in which debt notices were generated what the error was (even though at the time the government was being cagey about how these debts were being calculated). It's underappreciated how much the government at the time was gaslighting people and obfuscating the actual methodology about how these debts were being generated...
|
|
#
¿
Jul 13, 2023 01:11
|
|
|
The Lord Bude posted:The Gold Coast is pretty much the worst place in the country. Not just in terms of politics or demographics but to visit as well. I live on the Gold Coast and in the Fadden electorate. Can confirm. It’s actually getting <more> conservative over time
|
|
#
¿
Jul 16, 2023 08:02
|
|
|
birdstrike posted:dictator dan refugees The fadden electorate is in the north of the GC, anti vaxxers tend to be in the south of the city. This area is more economic liberals, old rich people who want to gently caress the poor but who have high vaccination rates and were generally okay with lockdowns and public health measures In a humble defense of the city in general, it’s a great place for expats and I like it here as a Canadian more than I liked Perth and Sydney. I get and don’t disagree with the criticism, though
|
|
#
¿
Jul 16, 2023 08:16
|
|
|
Eediot Jedi posted:Is there not some mechanism to oppose potential parole or appeal an insufficient NPP? Yes, but the judges overseeing the application of any order or considering the arguments from the DPP are bound by existing jurisprudence and sentencing guidelines. By taking the power away from the court and vesting it in the parole board, you can be more certain of the outcome and also more certain that the outcome won't be influenced by the established processes of the courtroom. The implementation of Dangerous Offender (including Dangerous Sexual Offender) laws did the same thing; took away power from the courts and judges and assigned more power to the DPP (who reports respective state governments and are not an independent body). In the case of Dangerous Offender laws, the law already allowed for indefinite sentences for sexual offenders but judges have historically been really hesitant to apply these sorts of sentences. This sort of nibbling around the boundaries between state governments and the criminal court is really worrying; all philosophies around the purpose and role of criminal sanctions are predicated around the court being an independent body. But the people who are affected by these new laws tends to be populations who don't elicit a lot of sympathy, sex offenders, serial killers, etc...
|
|
#
¿
Oct 31, 2023 10:24
|
|
|
|
| # ¿ May 10, 2024 08:59 |
|
|
Spookydonut posted:stage 3 kicks in bigly end of this current fy right? Stage 3 kicks in July 1, 2024, you’ll be paying less payg from that date. Approximately covers what I’m paying extra on my mortgage after my fixed rate expires in March. You win some, you lose some.
|
|
#
¿
Nov 18, 2023 05:25
|
|