Professional Growth and Development:
A Survey of Tennessee Practitioners in Psychology
David C. Mathis, Ed.D.
September 4, 1997

A telephone survey of Licensed Psychologists and Licensed Psychological Examiners(1) was commissioned by the Tennessee Psychological Association's (TPA) Legislative Committee to gain insight into aspects of the practice and application of psychology in Tennessee. The survey was particularly aimed at assessing practitioner practices regarding ongoing professional growth and development. This was considered especially pertinent given the new continuing education requirements that were enacted into law during 1997. In addition, the survey allowed an opportunity to obtain information about practitioner characteristics, practice activities, practice locales, supervision practices and costs, and involvement with professional organizations. This information was also analyzed for differences between the masters and doctoral licensure levels, among other things. Results of this survey are being made available to committees of TPA and the State of Tennessee, Health Related Boards, Board of Examiners in Psychology.

Psychologists have on average spent over 7 years in graduate studies in preparation for providing health services to the public. While there is a foundation of knowledge that will remain relatively unchanged with the passage of time, ongoing research is contributing to the advancement of knowledge about human development and functioning as well as the application of psychologically based technologies in assisting individuals with a wide array of health problems. It is thus incumbent upon Psychologists to remain abreast of new knowledge. The American Psychological Association's (APA) Ethical Principles of Psychologists underscores the importance of being competent and maintaining competence to provide the services in which Psychologists are engaged. They are thus to participate in ongoing education in order to maintain the necessary degree of competence.

The leadership of TPA determined that promoting professional development could be enhanced through mandating continuing education units for Psychologists and Psychological Examiners. To achieve this end, TPA developed legislative language that was sponsored in the Tennessee legislature and eventually passed into law. This writer was not familiar with the procedures involved in formulating the guidelines governing the continuing education requirements. At the time of the survey, the continuing education requirements had not been implemented into law as the bill still awaited approval through the necessary governmental procedures. This survey sought to gain information about the practices and habits of Psychologists and Psychological Examiners related to continuing education even prior to the implementation of the new law. It was decided that a telephone survey would be the preferred method of soliciting information.

Method
Procedure
A telephone survey was conducted during the month of November, 1996. A copy of the survey can be reviewed in Appendix A. A database of practitioners was obtained from the Bureau of Manpower Statistics of the State of Tennessee. The database required updating so as to delete the names of individuals who were not yet licensed, i.e., those who had applied for licensure and were considered candidates but had not yet completed the process. Once the survey was underway it was discovered that there were inaccuracies in the database, particularly in regards to telephone numbers. Most likely, the inaccuracies were attributable to records that had not been updated since the last license renewal process. This resulted in the inability to contact many of the practitioners.

Names in the database were sorted by county and distributed to individuals who had volunteered as coordinators for a particular region. A region was composed of either a single county, multiple counties or a range of names within a county. Coordinators were responsible for recruiting assistants to conduct a telephone survey, receive and distribute survey forms, collect survey results and return the results to the project coordinator.

Coordinators were recruited for counties across Tennessee. Counties from west, middle and east sections of Tennessee were included. However, failure to recruit an adequate number of coordinators resulted in some regions not being represented in the survey. In addition, after the project commenced, some coordinators were unable to complete their portions and thus further regions were not included in the survey results. A listing of included and excluded counties can be seen in Appendix B.

Respondents
The database of practitioners indicated that there were 1043 Licensed Psychologists and 800 Licensed Psychological Examiners in Tennessee. The telephone survey resulted in 301 respondents (refer to Table 1 below). Thus, the survey results represent 16 percent of licensed practitioners. Thirty-eight individuals who were contacted (9 Psychologists, 19 Psychological Examiners) declined to participate. One Psychological Examiner's results were excluded due to what appeared to be spurious responses which would have skewed the results.

Table 1
Survey Respondents by Licensure Type
License
P,HSP
P,T
PE
PE,T
UL
Total
n
176
3
118
2
2
301
Abbreviation code: P,HSP=Psychologist, Health Service Provider; P,T=Psychologist, Temporary license; PE=Psychological Examiner; PE,T=Psychological Examiner, Temporary Licensed; UL=Unlicenced.

Results
Professional Development
Continuing Education
A review of continuing education activities from the past 12 months reveals that among the total sample there were two primary avenues for obtaining CEUs. Eighty-eight percent reported engaging in professional reading and 86% attended a professional workshop. The next highest area, presenting a guest lecture, was a distant third at 55%. Other areas of activity which may be recognized under the licensing requirements for CEUs are listed in Table 2. Ninety percent of Psychologists and 76% of Psychological Examiners had attended a professional workshop.

A comparison of Psychologists and Psychological Examiners reveals that a higher percentage of Psychologists participated in all areas of continuing education with the exception of enrollment in academic courses. Thirty-three percent of Psychological Examiners reported that they had been enrolled in an academic course over the past twelve months as compared to 6% of Psychologists. The results indicate that Psychologists are participating in a broader range of continuing education activities relative to Psychological Examiners.

Table 2
Continuing Education Activities of Previous 12 Months, By Percentage*
Activities
P,HSP
PE
P,T
PE,T
UL
TOTAL
Engaged in professional reading
94
76
67
100
100
88
Attended professional workshop
90
83
0
50
50
86
Presented a guest lecture
60
47
33
50
0
55
Presented at professional meeting
30
28
0
0
100
29
Participated in self-study course
22
16
67
0
50
20
Taught psychology course
22
14
0
0
100
19
Enrolled in academic course
6
33
0
100
50
18
Member of oral exam committee
28
1
0
0
50
17
Published research
10
7
0
50
100
10
Editorial board member
7
3
0
0
50
6
*Note: Percentage is calculated for each licensure level based on the number of survey respondents at that licensure level, see Table 1. The Total column represents the percentage of respondents based on the entire sample.

Respondents were asked to estimate the number of CEUs they had accumulated for 1995 and 1996. They were asked to estimate the CEUs based on the continuing education activities identified in the survey questionnaire (see Appendix A) as likely to be recognized in the licensure requirements. The totals for estimated CEUs were then divided by the number of respondents who had obtained CEUs during the years in question (the results are displayed in Table 3). The licensure requirement is to obtain 40 CEUs in a two year period.

The average number of CEU hours (credits) obtained by respondents during either 1995 or 1996 was more than half of the 40 hour requirement. However, in 1995, 14% of Psychologists and 26% of Psychological Examiners received less than 10 CEUs. In 1996, 26% of Psychologists and 38% of Psychological Examiners received less than 10 CEUs. There were 23 Psychologists and 25 Psychological Examiners that reported no CEUs during 1996. For 1995, there were 16 Psychologists and 19 Psychological Examiners who reported no CEUs.


Table 3
Average Estimated Continuing Education Hours
1995
1996
Total
25
22
Psychologists
24
22
Psychological Examiners
27
22
Note: Corrected for those reporting no CEUs.

Supervision
The respondents were asked about supervision practices. Thirty-seven percent of Psychologists reported providing supervision services for Psychological Examiners. Of those, 70% supervise fewer than 3, 15% supervise 3 to 4, and 6% supervise 5 or more Psychological Examiners. Of the supervising Psychologists in the survey, 14% reported that their supervisee was also an employee. Forty-six percent of supervising Psychologists reported that they had received formal training or supervision for being a supervisor.

Cost is an important issue in mandatory supervision. The survey did not ask whether the respondent was receiving supervision but rather what was the cost of his or her monthly supervision. Table 4 shows the results from this survey.

Table 4
Cost of Supervision by License and Amount
License
None
$50-$100
$101-$200
$201-$300
$301+
Psychologist, HSP
144
14
11
3
4
Psychologist, Temporary
3
0
0
0
0
Psychological Examiner
83
14
11
5
5
Psychological Examiner, Temp.
0
0
0
1
1
Unlicensed
2
0
0
0
0

It was interesting to find that 17% of Licensed Psychologists are paying for supervision even though supervision was not mandatory. There may be additional Psychologists who are participating in supervision but are not having to pay for the service. Of the License Psychological Examiners, 70% are not having to pay for supervision. Of those who pay for supervision themselves, 12% pay between $50 to $100 per month, 9% pay between $101 to $200, and 8% pay more than $200 per month for supervision. This data does not reflect the costs paid for supervision by third parties such as employers. Rather, the survey asked the respondents about supervision costs that they were having to pay.

Professional Association
Participation in the activities sponsored by a professional association or organization can be an important avenue for professional development. Respondents were asked if they had membership in professional associations. Of the survey respondents, it was found that 93 percent of Psychologists and 61 percent of Psychological Examiners had membership in professional associations. Furthermore, 75 percent of Psychologists reported membership in the American Psychological Association (APA) while 14 percent of Psychological Examiners reported APA membership. Fifty-four percent of Psychologists and 11 percent of Psychological Examiners in the survey had membership in the Tennessee Psychological Association (TPA). Fifteen percent of the survey Psychological Examiners had membership in the Tennessee Association of Psychological Examiners (TAPE) while no Psychologists had membership in TAPE. Thus, very similar percentages of Psychological Examiners were represented in TPA and TAPE. Since TPA is the organization for representing professional psychology in Tennessee, survey participants were asked to provide a grade for TPA's leadership. On a four point system, TPA received an average grade of 2.5. When considered by licensure level, Psychologists gave TPA an average grade of 2.69 while Psychological Examiners gave a lower average grade of 2.2. Thus, TPA received only a "C" grade irrespectively of level of licensure.

Practitioner Profile
Years of Professional Experience
Practitioners were asked about their years of professional experience. The largest number of Psychological Examiners in any five year range were those with 6 to 10 years of experience (31%). Two 5 year ranges were equally represented by Psychologists at 23%: 11 to 15 years and 16 to 20 years of experience (see Table 5). Overall, 59% of Psychologists reported having more than 10 years of professional experience compared to 37% of Psychological Examiners. Both levels of temporary licensure were represented in the 0 to 2 years of experience range. However, it is common for Psychologists to have experience as Psychological Examiners prior to becoming licensed at the doctoral level, i.e., Psychologists.

Table 5
Years of Experience by License, Expressed in Percentage
0-2
3-5
6-10
11-15
16-20
21-25
25-30
31+
P,HSP
7
19
15
23
23
10
2
1
PE
10
21
31
17
11
8
1

Practice Locales
There was interest in gaining information about where people practiced. A listing of Tennessee counties represented in this survey is found in Appendix B. It was found that fifty-six (32%) of the Psychologists and 39 (33%) of the Psychological Examiners reported that they provided psychological services in more than one county. Therefore, although licensure records with the State of Tennessee may list an office address or residence address, the actual practice locale(s) is often different. This is significant when addressing geographical regions that may appear to be under-served based on the data maintained by the Health Related Boards of the State of Tennessee.

Practice Settings
The survey results clearly indicate that more Psychologists are in private practice than Psychological Examiners. Fifty-three percent of Psychologists reported that they spend three-fourths or more of their time in private practice compared to 19% of Psychological Examiners. Psychological Examiners were most frequently represented in public agencies. Thirty-one percent of Psychological Examiners reported spending three-fourths or more of their time in a public agency, compared to 14% of Psychologists. Mental health centers, at least among survey respondents, appear to be becoming a less common place of employment for both Psychologists and Psychological Examiners. The survey results indicate that only 18% of Psychological Examiners and 7% of Psychologists spend one-half or more of their professional time with a mental health center. Table 6 records the results for the estimated amount of time that the survey respondents spend in the various practice settings.

Table 6
Practice Setting
Percent of Time
90% or more
75% or more
25% or less
Licensure
P,HSP
PE
P,HSP
PE
P,HSP
PE
Private Practice
48%
19%
53%
19%
43%
78%
Mental Health Center
5%
14%
7%
18%
91%
81%
Public Agency
12%
31%
14%
31%
84%
68%
Private Agency
7%
18%
10%
19%
89%
79%
University
9%
7%
10%
7%
88%
73%

Practice Activities
The survey yielded information regarding the types of professional services in which providers are engaged through their professional practice. The interviewer asked which activities were included in the respondent's professional practice. The actual time spent in a particular activity was not obtained. The desire was to inquire about the scope of professional activities being rendered.

Table 7 lists the type the activities which are listed by order of frequency for Psychologists. One can see from the results that Psychologists frequently provide a broader range of services than Psychological Examiners. The top three reported activities for each licensure group relate to the core activities in professional psychology: psychotherapy, psychological evaluations and counseling.

The activity that was most represented was "psychotherapy" with 88% of Psychologists and 75% of Psychological Examiners providing that service. "Administration" was more highly represented among Psychological Examiners than among Psychologists. Otherwise, a larger percentage of Psychologists are providing professional services in a broader range of activities.

Table 7
Professional Activities by Licensure
Activity
Psychologists
Psychological Examiners
Psychotherapy
155 (88%)
89 (75%)
Psychological Evaluations
146 (83%)
75 (64%)
Counseling
129 (73%)
89 (75%)
Administration
96 (55%)
43 (66%)
Hospital Consultation
81 (46%)
31 (26%)
EAP Assessments
81 (46%)
31 (26%)
Forensic Evaluations
53 (30%)
9 (0.7%)
Other
43 (24%)
34 (29%)
Research
41 (23%)
27 (23)
Neuropsychological Evaluations
27 (15%)
10 (8%)

The list of activities included in the survey was necessarily brief. Most respondents apparently felt that their services were adequately characterized in the available categories. The category of "Other" allowed for a collection of additional activities not covered by those listed in this survey (see Table 8). Consultation services (17) was the most often cited activity among the "other" activities. Thirteen reported that they participated in teaching activity but the type of teaching setting was not usually indicated.

Table 8
"Other" Services Rendered by Providers
Applied Behavior Analysis (3)
Financial Analysis
Behavioral Modification Programs (2)
Grant Writing
Biofeedback and Hypnosis
Marital/Group Therapy
Case Management (3)
Nursing Home Consultation
Chronic Pain Management
Outreach/Marketing (2)
Computer Work
Parent Training Classes (2)
Consulting (17)
Program Evaluation/Development (4)
Court Testimony/DHS Consultation (2)
Sleep Disorder Center
Crisis Intervention (2)
Supervision (7)
Disability Evaluations (4)
Teaching (13)
Divorce Mediation
Writing

Use of Online Services
With the proliferation of the Internet, it was thought appropriate to inquire about the use of online services. Online services already provide a host of avenues of professional interaction and professional development including online continuing education courses. The results indicated that 21% of Psychological Examiners and 20% of Psychologists make use of the Internet.

Other Professional License
Respondents were asked if they held an additional license of any kind. Thirty-seven percent of Psychologists and 30% of Psychological Examiners reported having additional licenses. Among Psychologists, 34 held licenses in another state, 7 were also Licensed or Certified School Psychologists, 5 were Licensed Professional Counselors, and 4 were Licensed Marriage and Family Therapists. Among Psychological Examiners, 11 were also Licensed Professional Counselors, 7 were Licensed or Certified School Psychologists and 3 were Licensed Marriage and Family Therapists.


Discussion
Continuing Education
To whatever degree this survey is representative of practitioners in Tennessee, it appears that the implementation of mandatory continuing education (CE) will help advance professional development within the profession. The survey results indicate that the majority of respondents estimated themselves to already be engaging in regular continuing education activities. There were those, however, that were not actively pursuing CEU's. Twenty three Psychologists and 25 Psychological Examiners reported no CEU's during 1996. In addition, 26% of Psychologists and 38% of Psychological Examiners had received less than 10 CEU's during 1996. Others were engaging in continuing education activities which may have only partially met the new requirements of the statutory code governing the profession. The CE requirements will provide guidelines for as well as shape the CE activities of practitioners. To that end, it would appear that the new requirements will promote professional development through continuing education.

The requirements will place heightened emphasis on the need to avail oneself of appropriate continuing education activities. The most common avenue for CEU's among survey participants was professional reading. The second most common activity was attendance at a professional workshop. Under the new requirements, professional reading, considered independent study, can only account for a maximum of 3 CEU's in a given year. Overall, of the 40 CEU's required in a two year period, 18 hours must be from a formal continuing education program as defined in the code.

The need for CEU's from formal programs would seem to provide an opportunity for TPA to offer leadership in this regard. There would not only be added value for attending the annual TPA convention, but TPA could sponsor additional workshops, seminars or training institutes. There should be a broader receptivity for such programs. Thus, TPA could have a greater influence on the profession by sponsoring workshops for dissemination of research findings, instruction in use of technologies in psychotherapy, and advanced training in assessment.

The survey results indicate that a majority of Psychologists (54%) but only 11% of Psychological Examiners are TPA members. It would appear that a significant number of practitioners do not believe that there is sufficient benefit to membership in their State association. An increased value of membership, due to reduced fees when attending TPA sponsored CE workshops, might be seen if TPA can offer accessible and pertinent workshops. The survey indicates that TPA is in a significantly stronger position to provide leadership in this regard than any other State or local association. The survey found only 11% of Psychological Examiners, and no Psychologists, hold membership in TAPE. As a caveat to association membership, TPA received a "C" grade among Psychologists and Psychological Examiners. TPA could consider seeking feedback from practitioners as to the factors associated with the apparent discontent.

There was also inquiry about supervision practices. Surprisingly, cost was not as pertinent as was expected since the majority of respondents reported no out-of-pocket costs for receiving supervision. Seventy percent of Psychological Examiners do not pay for supervision (assuming that all Psychological Examiners are participating in supervision as mandated by law). Not all Psychological Examiners would be required to participate in supervision if their practice or employment was limited to activities and services within their scope of independent practice as defined by T.C.A. 63-11-202. The survey results indicate that 17% of Psychologists were paying for supervision. There may have been additional Psychologists in supervision who were not having to pay for it. The results also indicate the interest of many in whether supervision could be or should be considered as a source for CEU's. The new requirements do not have any provision for supervision, even when it is voluntarily undertaken as an avenue for professional development.

Practitioners
The practitioners in the survey are providing a broad range of clinical services in a variety of practice settings. The majority regularly provide core services of psychotherapy, psychological evaluations, and counseling. Most practice or are employed in private or public agencies. Over one-third of the practitioners provided services in more than one Tennessee County. It was surprising that both Psychologists and Psychological Examiners are not spending significant amounts of time in Mental Health Centers. Ninety-one percent of Psychologists and 81% of Psychological Examiners spend less than 25% of their professional time in a community Mental Health Center. Apparently, mental health centers are largely being staffed by workers from other mental health fields than psychology. One third of practitioners reported themselves to have an additional license in a related field. Only one-fifth of the practitioners reported using online services and/or the Internet.

The practitioners in the survey shared many things in common when considering professional practice. Regardless of level of licensure, they provided very similar services (see Table 7). The areas of distinction between licensure levels are not as readily apparent as the great degree of similarity. It could thus be confusing to explain the differences relative to licensure level. Psychologists tended to have more years of experience, to be in a private practice setting, to provide a broader range of clinical services and to more frequently provide such services. Psychological Examiners were more likely to perform administrative duties as part of their clinical services and to work in a public agency. Psychologists were much more likely than Psychological Examiners to provide hospital consultation, EAP assessments, neurological evaluations and, in particular, forensic evaluations.

Appendix A
PROFESSIONAL DEVELOPMENT AND PRACTICE SURVEY
Final Version, 10-25-96
You may be aware that current law requires that each licensee receive 40 hours of continuing education units for each two year renewal period. This law is expected to go into affect in 1997.
Which of the following professional development activities have you participated in during the previous 12 months (check all that apply):
( ) professional workshop ( ) academic course ( ) professional reading ( ) self-study course
( ) serving on editorial board ( ) member on oral examination committee ( ) taught psychology course ( ) published research ( ) presented at professional meeting ( ) provided guest lecture
Estimate how many CEU's you accumulated during 1995? __________
Estimate how many CEU's you have accumulated so far this year? __________
Type of License: ( )PE ( )P, HSP ( )P, Temp. ( )PE, Temp. ( )Unlicensed (check one)
Years of Experience since license in psychology was obtained:
( ) 0-2 ( )3-5 ( ) 6-10 ( )10-15 ( ) 16-20 ( )21-25 ( ) 26-30 ( ) 31+
What is your usual monthly cost for supervision or consultation?
( ) $50 to $100 ( ) $101 to $200 ( ) $201 to $300 ( ) $301+ ( ) None
Do you believe that supervision and consultation should be considered for CEU credit? ( ) Yes ( ) No
(If Psychologist) Do you provide supervision for PE's ( )No ( )Yes
If so, how many? ( )1-2 ( )3-4 ( ) 5 or more. What is your usual charge for supervision?
Is the supervisee an employee of yours, i.e., receives a W-2 tax form? ( ) Yes ( ) No
Have you participated in formal training or supervision in preparation for being a supervisor?
What is your County of Primary Practice: __________________________ (zip code) _____________
Other counties where services are provided_______________________________________________
Estimate the percentage of your practice you spend in the following settings: ( ) Private Practice
( ) MHC ( ) Private Agency ( ) Public Agency ( ) University
Indicate which activities are included in your practice: ( ) EAP assessments ( ) counseling
( ) psychotherapy ( ) psychological evals ( ) neuropsychological evals ( ) forensic evals
( ) hospital consultations ( ) research ( ) administration ( ) other __________________
Do You Hold Any Additional State License or Certificate? ( )No ( )Yes, which?
Do You Hold Membership in any Professional Associations? ( )No ( )Yes, which?
What grade would you give TPA for leadership of psychology in TN? [A-F] ( )
If you are a member of another professional association, (identify which one - ___________________ )
how would you grade its performance? [A-F] ( )
Do you use the following? ( ) On-Line Service, e.g., America On-Line ( ) Internet

Appendix B
Tennessee Counties in Survey

Included in Results

East Region:
Carter
Greene
Hamblen
Hamilton
Hawkins
Johnson
Knox
Sullivan
Unicoi
Washington


Middle Region:
Cannon
Coffee
Davidson (partial)
DeKalb
Giles
Hickman
Lawrence
Lewis
Macon
Marshall
Maury
Overton
Putnam
Rutherford
Smith
Trousdale
Williamson

West Region:
Chester
Crockett
Decatur
Fayette
Hardeman
Hardin
Haywood
Henderson
Madison
McNairy
Perry
Wayne

Those Without Results:
Benton
Carroll
Cheatham
Dickson
Dyer
Gibson
Henry
Houston
Humphrey
Lake
Lauderdale
Montgomery
Obion
Robertson
Shelby
Steward
Sumner
Tipton
Weakley
Wilson
 1. "Psychologist" and "Psychological Examiner" will be used as synonymous with "Licensed Psychologist" and "Licensed Psychological Examiner," respectively.


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