Preparing psychology and psychologists for new health care markets.

Abstract Because our training models in Clinical Psychology have not kept pace with the rapid changes in the health care marketplace, we may be in danger of preparing psychologists for markets that no longer exist. The next generations of psychologists will require the skills of the entrepreneur and the leader in addition to a range of core clinical skills. At the same time, our profession's historic commitment to science as the best epistemic game in town may founder if we fail to pay better attention to knowledge translation (i.e., how to move scientific findings expeditiously from the laboratory into practice). Two recent incidents helped crystallize my thinking about the challenges to psychology and psychologists from continuing changes in the health care marketplace.1 In the first instance, I served as a member of a working group in the Calgary Health Region designing a new ambulatory rehabilitation program that is designed to move all outpatient rehabilitation care out of the acute care sites and into the community. When operational in 2007, three community centres will provide comprehensive rehabilitation care to a diverse population, including patients with musculoskeletal injuries, amputees, neurologically ill patients, and frail seniors. The funding model for the community ambulatory rehabilitation program provided for one psychologist to provide service to all three centres and all these populations. As part of the planning exercise, the day came when the group turned to me and asked: What model of psychological services is there for this kind of program and where can we find a psychologist trained to do this work? My answer was: There isn't any model of care. We don't train psychologists for this kind of work. This is a brand new market and whoever comes to it is essentially going to have to make it up as he or she goes along. In the second instance, the Calgary Health Region leaders have realized, perhaps belatedly, the serious impact of chronic illness on the populations we serve and decided to develop a comprehensive program of care to address the needs of these populations. The initial focus of the Chronic Disease Management Strategy is on patients with diabetes, hypertension, and chronic obstructive pulmonary disease. Much evidence converges on the conclusion that it makes sense to consider these and many other chronic illnesses to be behaviour disorders, because the kinds of things that lead to and maintain them have to do with how people act, think, and feel. Not surprisingly, Chronic Disease Management program development activities have focused heavily on habit change, lifestyle modification, and on enhancing readiness to change, all of the things that would appear to be right up psychology's professional alley. Although psychologists are involved in various aspects of these programs and in the program development activity itself, my more urgent question is: Why aren't we in charge of this? These two situations reflect the changing face of health care provision in Canada. They challenge psychology's traditional methods of preparing students for practice and the way psychology provides practitioners with the tools that they need for such practice. I propose, first, that although the health care marketplace has changed substantially, our training models and methods have not. The challenge for the next generation of psychologists and for those who train them is to prepare new graduates with the skills necessary to anticipate and adapt to entirely new markets. In addition to the clinical knowledge, skills, and judgment that we currently develop in our students and young psychologists, we need to equip them with two other critical skill sets: those of the entrepreneur and those of the leader. Second, I consider that the most critical issue for psychological training and practice in the future is no longer whether we are scientist-practitioners, scholar-practitioners, scientists, practitioners, or any other of the entities that have preoccupied us in training for the past 50 years. …

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