Psychologists seek changes to pilot project aimed at trimming backlog of ADHD, autism testing
Letters raise concerns about pay inequity, fears about pilot causing retention issues
A number of Nova Scotia psychologists and psychiatrists are sounding the alarm over a provincial program meant to help address the growing waitlist for autism and ADHD testing, saying the pilot could drive badly-needed public health professionals into the private sector.
In September, the provincial government announced it would pay some private practice psychologists to perform autism spectrum disorder and ADHD assessments for preschool and school-aged children using health service codes as family doctors do — a first for mental health and addictions care in the province.
Glen Berry, a clinical psychologist who recently retired after 30 years working in the public sector in the Annapolis Valley, said while the public-private partnership has potential, he's concerned the program in its current form could have unintended consequences.
Berry said the pilot heightens the pay disparity between public and private psychologists and creates inconsistencies in the scope of assessments being offered to the roughly 1,600 people on the years-long waitlist for autism testing and the 400 people on the waitlist for ADHD testing.
He and nine Nova Scotia Health psychologists have penned a letter to the Office of Addictions and Mental Health outlining their concerns, while 11 rural child and adolescent psychiatrists from across the province have sent a separate letter echoing similar issues with the pilot.
"The way that this is being implemented is giving me and my former colleagues a lot of concern," Berry said in a recent interview. "I know of some psychologists who have left our system to go privately and a number in the last five years. One or two I know of is specifically related to this."
Berry noted there is a gap between what the province pays out for autism assessments conducted by a public psychologist, which is about $750, and what private psychologists are paid, which is up to $4,000.
He said he realizes those amounts could never be equal due to the various costs incurred in private practice, but "the amounts that we're talking about here are way far apart."
As well, there is a disparity between the scope of the assessments offered by public and private psychologists, Berry said.
For example, he said those conducting testing in the public sector have been told they can't complete psychoeducational assessments — which help identify an individual's learning style and needs — as part of ADHD assessments, as it falls outside Nova Scotia Health's mandate. But private psychologists taking part in the program have professional discretion to decide what components are needed for an assessment.
"This is a serious issue that needs to be addressed as it is unfair and unethical to provide a more comprehensive assessment to some clients when both are being paid for by the government," one of the letters read.
"When families become aware of this discrepancy in service, those who are assigned to service-as-usual from [Nova Scotia Health] will likely have justifiable concerns about their children receiving less comprehensive assessments."
Berry said this could be resolved by setting limits on what kind of assessment private psychologists can offer as part of the program, or by allowing public psychologists to use their professional discretion to determine what assessments are needed.
He doesn't want clients placed with a public psychologist to think they will not receive a quality assessment. Clinicians are highly specialized, are required to follow industry standards and all psychologists — public and private — are accountable to a regulatory body called the Nova Scotia Board of Examiners in Psychology.
Data provided by Nova Scotia Health shows the number of psychologists working for Nova Scotia Health has fluctuated over the past five years. There were 105 in 2019. Currently, the health authority has 96, with 31 vacancies.
Since the program was announced on Sept. 11, eight private psychologists have signed on and have performed 31 diagnostic autism assessments.
Brian Comer, the minister responsible for the Office of Addictions and Mental Health, said he takes the concerns of front-line health professionals seriously.
"It's really about increasing access and with any pilot, you certainly learn and evaluate as you go along," Comer said in a recent interview.
He wouldn't comment on the apparent pay disparity, noting public psychologists are unionized and compensation is negotiated as part of collective bargaining.
His office disputed the psychologists' claims that there is a disparity in the scope of the assessments.
"I want to be very clear that we place no restrictions on registered psychologists — private or public sector — when it comes to diagnostic assessment for autism," spokesperson Sarah Levy MacLeod said in an email statement.
"The length of an assessment and which tools are used as part of it are at the discretion of the clinician based on the needs of the child. Where clinically indicated, psychoeducational assessments can and will be provided whether the child and family are with a public sector psychologist in a hospital or a private sector psychologist at their offices as part of this pilot."
Waitlist continues to balloon
When asked what the province is doing to retain its public psychologists, Comer said where someone practices is a personal choice.
"There's a lot of different reasons for that. In my previous life, I worked with folks who have done both, worked in the public and the private. Some prefer one for a variety of reasons," said Comer, who is a registered nurse.
"There's a lot to unpack there, but we'll certainly do what we can on our end."
MacLeod said the province is making record investments in the health-care system, including hiring more clinicians to support diagnostic autism assessments.
While the program was touted as a way to address the growing waitlist, the list for autism assessments has grown by 300 names in the last six months, according to figures provided by the province. The number of children on the list for ADHD assessment has remained unchanged.
Cynthia Carroll, executive director of Autism Nova Scotia, said her non-profit organization commends the government's efforts to be more innovative in how it provides health care, but the pilot does little to address the years-long wait for an assessment.
"This is a very small pilot. I think we have to be realistic about that," said Carroll, noting that as the province's population booms, so too does the need for services.
"Are we happy about the partnership? Yes. Is it going to support new people coming into the system? Not really, because we have 1,600 people still waiting for those assessments."
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