That article showcases the issue but maybe you're skimming over the fact it provides pointers on how to charge these fees without breaking the law.
Just a few examples of what I mean-
"This tends to be more relevant to physicians who might refer their patients to a practice or clinic that has imaging or diagnostic equipment where the physician is an owner. This kind of scenario does not typically apply to psychologists."
It lists the states where accepting these fees is a violation of law-
"Nearly half of U.S. states have enacted statutory or regulatory policies barring psychologists from receiving any kind of “remuneration for referral of a client for professional services.” In other words, a psychologist should not accept any kind of compensation from another provider, nor offer any compensation to another provider, for simply making a patient referral. States with such a policy include Alabama, California, Colorado, Florida, Hawaii, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Texas, Virginia and Wisconsin."
It then lists the ways to get past these restrictions in nearly any state as long as you structure your practice in a certain way.
"This prohibition does not affect employment arrangements where the health care provider is an employee or independent contractor and paid for providing licensed health care services, or where the provider is a partner or corporate shareholder for a practice that provides health care services consistent with state law."
Then for those states where the practice is totally legal, the practice simply needs to make sure to put a disclaimer on the form they have you fill out when you register for your appointment.
"Some states may not have an explicit prohibition but may caution psychologists to fully disclose in advance to patients any compensation made or received for patient referrals."
This is from the actual Ethics code.
6.07 Referrals and fees
When psychologists pay, receive payment from, or divide fees with another professional, other than in an employer-employee relationship, the payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself. (See also Standard 3.09, Cooperation with Other Professionals.)
In other words, there are psychologists who employ therapists as part of their practice or as independent contractors (paying them $5000 or more a year, as an example) and then pay them the referral fees as part of their employment compensation practices and it's perfectly "ethical."
Next, we'll check 3.09-
3.09 Cooperation with Other Professionals
When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately.
(See also Standard 4.05, Disclosures.)
In other words, psychologists can cooperate with therapists when "indicated and professionally appropriate" and it's not an ethics violation.
6.04 Disclosures
(a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law.
(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which
instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements.)
Nothing out of the ordinary there, and 6.04e basically states a provider needs to inform the patient who isn't paying their bills before referring them to a collection agency.
6.04e
(e) If the recipient of services does not pay for services as agreed, and if psychologists intend to use collection agencies or legal measures to collect the fees, psychologists first inform the person that such measures will be taken and
provide that person an opportunity to make prompt payment.
So don't be fooled into believing there aren't both psychologists and physicians legally paying referral fee to therapists as outlined above. It's a common practice. They typically put the therapists on their payroll as independent contractors to ensure they're the only provider getting said referrals, or, if their practices are big enough, they hire therapists directly and handle all the referrals in house.
I think you and I may be assuming different tones in understanding what the article is describing. The article is not suggesting ways around running afoul of the referral payments, its describing how some people choose to enter into these types of transactional relationships in a way that is difficult to legally combat. I don't see it as an endorsement of the behavior.
The APA has enforceable standards that are independent of the law. Someone can lose their license for behavior that is 100% legal and unable to be combatted in court. And that's what they're describing here: situations where therapists have avoided legal problems, but still create ethical conundrums for the APA, which has made its stance pretty clear.
So if I am a therapist in an office FOR a psychiatrist, and I say, "Hey, I think the office psychiatrist should try prescribing you Zoloft" to my patient, and then they go get Zoloft, and then the psychiatrist pays me my salary as his employee, that's not necessarily an ethics violation. That's me getting a salary.
If I tell a patient to go to the in-office psychiatrist for meds, and then I get EXTRA money because the psychiatrist prescribed my patient meds, then now I'm in an ethically problematic area, and I can be complained about.
It is not a problem for a therapist to say that someone should try meds. It's a problem for a therapist to receive kickbacks specifically for referring someone for meds. I can be a therapist who gets a consultation fee for working with a psychiatrist, but I can't be a therapist who gets a fee for getting my patient on medication. I am not certain I agree with the interpretation of these statutes that kickbacks are considered by the APA to be ethically okay.
That being said, you can absolutely be suspicious of your therapist and ask them these kinds of questions. You can absolutely say no to psychiatric medication and your therapist ethically needs to be okay with that. If they can't be, then file a complaint.
Who cares whether the behavior is endorsed or not? It's a common practice and I broke down exactly how it happens legally.
It's an unfortunate fact many people are prescribed antidepressants just so their therapists can increase their take home pay. You act like there's a difference between a "consultation fee" and a "kickback", when the end result is a patient getting meds and the therapist making extra money.
Also, SSRIs cause people to either commit suicide or react violently in many cases. I've yet to see a school shooter who hasn't had a history of being prescribed SSRIs at some point.
As I said, what is legal is not necessarily protectable.
The APA can revoke your therapy license for unethical but legal behavior. You can be legally protected and still lose your ability to practice.
The APA is not a law-based organization. What is legal or illegal doesn’t have a direct correlation to what the APA is permitted to address and act upon.
For instance, APA psychologists can’t be involved in torture interrogations. Torture may be legal if the government says so, but the APA will take your license to practice if you accept a job where you interrogate water boarded detainees.
Which is why I’m pointing out that the APA writing an article like this should be more comforting than alarming. Because they’re telling you that they see the problem you are worried about and are not okay with it, and are willing to take action on their own even if local laws don’t specifically prohibit this behavior. It’s not being endorsed or protected by the people who matter here.
That article showcases the issue but maybe you're skimming over the fact it provides pointers on how to charge these fees without breaking the law.
Just a few examples of what I mean-
"This tends to be more relevant to physicians who might refer their patients to a practice or clinic that has imaging or diagnostic equipment where the physician is an owner. This kind of scenario does not typically apply to psychologists."
It lists the states where accepting these fees is a violation of law-
"Nearly half of U.S. states have enacted statutory or regulatory policies barring psychologists from receiving any kind of “remuneration for referral of a client for professional services.” In other words, a psychologist should not accept any kind of compensation from another provider, nor offer any compensation to another provider, for simply making a patient referral. States with such a policy include Alabama, California, Colorado, Florida, Hawaii, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Texas, Virginia and Wisconsin."
It then lists the ways to get past these restrictions in nearly any state as long as you structure your practice in a certain way.
"This prohibition does not affect employment arrangements where the health care provider is an employee or independent contractor and paid for providing licensed health care services, or where the provider is a partner or corporate shareholder for a practice that provides health care services consistent with state law."
Then for those states where the practice is totally legal, the practice simply needs to make sure to put a disclaimer on the form they have you fill out when you register for your appointment.
"Some states may not have an explicit prohibition but may caution psychologists to fully disclose in advance to patients any compensation made or received for patient referrals."
This is from the actual Ethics code.
6.07 Referrals and fees
When psychologists pay, receive payment from, or divide fees with another professional, other than in an employer-employee relationship, the payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself. (See also Standard 3.09, Cooperation with Other Professionals.)
In other words, there are psychologists who employ therapists as part of their practice or as independent contractors (paying them $5000 or more a year, as an example) and then pay them the referral fees as part of their employment compensation practices and it's perfectly "ethical."
Next, we'll check 3.09-
3.09 Cooperation with Other Professionals
When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately.
(See also Standard 4.05, Disclosures.)
In other words, psychologists can cooperate with therapists when "indicated and professionally appropriate" and it's not an ethics violation.
6.04 Disclosures
(a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law.
(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which
instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements.)
Nothing out of the ordinary there, and 6.04e basically states a provider needs to inform the patient who isn't paying their bills before referring them to a collection agency.
6.04e
(e) If the recipient of services does not pay for services as agreed, and if psychologists intend to use collection agencies or legal measures to collect the fees, psychologists first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment.
So don't be fooled into believing there aren't both psychologists and physicians legally paying referral fee to therapists as outlined above. It's a common practice. They typically put the therapists on their payroll as independent contractors to ensure they're the only provider getting said referrals, or, if their practices are big enough, they hire therapists directly and handle all the referrals in house.
I think you and I may be assuming different tones in understanding what the article is describing. The article is not suggesting ways around running afoul of the referral payments, its describing how some people choose to enter into these types of transactional relationships in a way that is difficult to legally combat. I don't see it as an endorsement of the behavior.
The APA has enforceable standards that are independent of the law. Someone can lose their license for behavior that is 100% legal and unable to be combatted in court. And that's what they're describing here: situations where therapists have avoided legal problems, but still create ethical conundrums for the APA, which has made its stance pretty clear.
So if I am a therapist in an office FOR a psychiatrist, and I say, "Hey, I think the office psychiatrist should try prescribing you Zoloft" to my patient, and then they go get Zoloft, and then the psychiatrist pays me my salary as his employee, that's not necessarily an ethics violation. That's me getting a salary.
If I tell a patient to go to the in-office psychiatrist for meds, and then I get EXTRA money because the psychiatrist prescribed my patient meds, then now I'm in an ethically problematic area, and I can be complained about.
It is not a problem for a therapist to say that someone should try meds. It's a problem for a therapist to receive kickbacks specifically for referring someone for meds. I can be a therapist who gets a consultation fee for working with a psychiatrist, but I can't be a therapist who gets a fee for getting my patient on medication. I am not certain I agree with the interpretation of these statutes that kickbacks are considered by the APA to be ethically okay.
That being said, you can absolutely be suspicious of your therapist and ask them these kinds of questions. You can absolutely say no to psychiatric medication and your therapist ethically needs to be okay with that. If they can't be, then file a complaint.
Who cares whether the behavior is endorsed or not? It's a common practice and I broke down exactly how it happens legally.
It's an unfortunate fact many people are prescribed antidepressants just so their therapists can increase their take home pay. You act like there's a difference between a "consultation fee" and a "kickback", when the end result is a patient getting meds and the therapist making extra money.
Also, SSRIs cause people to either commit suicide or react violently in many cases. I've yet to see a school shooter who hasn't had a history of being prescribed SSRIs at some point.
As I said, what is legal is not necessarily protectable.
The APA can revoke your therapy license for unethical but legal behavior. You can be legally protected and still lose your ability to practice.
The APA is not a law-based organization. What is legal or illegal doesn’t have a direct correlation to what the APA is permitted to address and act upon.
For instance, APA psychologists can’t be involved in torture interrogations. Torture may be legal if the government says so, but the APA will take your license to practice if you accept a job where you interrogate water boarded detainees.
Which is why I’m pointing out that the APA writing an article like this should be more comforting than alarming. Because they’re telling you that they see the problem you are worried about and are not okay with it, and are willing to take action on their own even if local laws don’t specifically prohibit this behavior. It’s not being endorsed or protected by the people who matter here.
There are thousands of therapists who receive commissions for patient referrals. That's the point.
Anything else you say after that is simply semantics.
SSRIs are bad news and are over-prescribed. There's a clear profit motive for that.