What’s the pay? Psychologists, Pathways, Medicare… and you!

First published in The Psych Analyst, Winter 2021, by the Macquarie University Psychology Society (MacqPsych). Written by Devin Lam. Edited by Christine Wu.

If you’re looking to become a psychologist, there’s quite a bit to learn about the road ahead!

Once you can go out and practice as a psychologist, you might be concerned with another bit of bureaucracy, the Medicare Benefits Schedule (MBS). The MBS, connected to the Medicare card you might have in your pocket, is a list of medical services and how much providers are paid for them (Department of Health, 2021c).

One of the factors influencing your pay as a provider is what you’ve studied, which – if you’re reading this – is most likely psychology, as well as any Area of Practice Endorsements (AoPE) you have obtained through your education.

The basic requirements of an AoPE for psychologists in Australia are completing a “postgraduate qualification and supervised training” in an area of practice, along with general registration (Psychology Board, 2019). The areas of practice for psychology are: clinical, clinical neuropsychology, community, counselling, educational and developmental, forensic, health, organisational, and sport and exercise (Psychology Board, 2019). More information about the pathway to endorsement for psychology is available from the Psychology Board.

The mental health element of the MBS is the “Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule” initiative, commonly referred to as the Better Access initiative (Department of Health, 2021c). The majority of psychologists (88.1%) identified themselves as clinicians, and most commonly worked in solo (18.8%) and group (17.1%) private practice, as well as in schools (10.8%) (Australian Institute of Health and Welfare, 2021). In private practice, you can set fees for services at your own discretion, but the Australian Psychological Society suggests $260 for a 60 minute session in its “National Schedule of Recommended Fees” (Australian Psychological Society, 2020).

MBS subsidised mental health services are widely used: 96.2 services per 1,000 people in Australia are delivered by clinical psychologists, and 120.4 services per 1,000 people are delivered by other psychologists (Australian Institute of Health and Welfare, 2021). Pirkis et al.’s (2011) evaluation of the Better Access initiative was generally positive and indicated its importance, though there may be issues regarding disparities in accessibility (Meadows et al., 2015).

So, what can you be paid for under MBS? Clinical psychologists can provide psychological therapy services, listed in table 1 (Department of Health, 2021c).

Psychologists, listed in table 2, as well as occupational therapists and social workers, listed in table 3, can provide focussed psychological strategies (FPS) (Department of Health, 2021c). The MBS schedule fee is what is regarded as “being reasonable on average for that service” and the benefit is the amount payable through the MBS (Department of Health, 2021c). When comparing clinical psychologists to other psychologists, the differences in fees between item numbers 80000 and 80100 is $29.95, 80010 and 80110 is $48.42, and for 80020 and 80120 is $12.21.

Table 1
MBS Group M6 Psychological therapy services

Item number	Duration	Location	Fee	Benefit (85%)
80000	more than 30 minutes but less than 50 minutes	Consulting rooms	$102.85	$87.45
80001	more than 30 minutes but less than 50 minutes	Video conference/telehealth	$102.85	$87.45
80005	Refer to 80000	Other than consulting rooms	$128.55	$109.30
80010	at least 50 minutes	Consulting rooms	$151.05	$128.40
80011	at least 50 minutes	Video conference/telehealth	$151.05	$128.40
80015	Refer to 80010	Other than consulting rooms	$176.70	$150.20
80020	at least 60 minutes	Group therapy with 6 to 10 patients	$38.35 per patient	$32.60 per patient
80021	at least 60 minutes	and video conference/telehealth	$38.35 per patient	$32.60 per patient

(Department of Health, 2021c)

Table 2
MBS Group M7 Focussed Psychological Strategies (Allied Mental Health; Psychologist)

Item number	Duration	Location	Fee	Benefit (85%)
80100	more than 20 minutes, but not more than 50	Consulting rooms	$72.90	$62.00
80101	more than 20 minutes, but not more than 50	Video conference/telehealth	$72.90	$62.00
80105	more than 20 minutes, but not more than 50	Other than consulting rooms	$99.15	$84.30
80110	more than 50 minutes	Consulting rooms	$102.85	$87.45
80111	more than 50 minutes	Video conference/telehealth	$102.85	$87.45
80115	more than 50 minutes	Other than consulting rooms	$129.20	$109.85
80120	at least 60 minutes	Group therapy with 6 to 10 patients	$26.25 per patient	$22.35 per patient
80121	at least 60 minutes	Group therapy with 6 to 10 patients and video conference/telehealth	$26.25 per patient	$22.35 per patient

(Department of Health, 2021c)

Table 3
MBS Group M7 Focussed Psychological Strategies (Allied Mental Health; Occupational therapist/Social worker)

Item number	Duration	Location	Fee	Benefit (85%)
80125/80150	more than 20 minutes, but not more than 50	Consulting rooms	$64.20	$54.60
80126/80151	more than 20 minutes, but not more than 50	Video conference/telehealth	$64.20	$54.60
80130/80155	more than 20 minutes, but not more than 50	Other than consulting rooms	$90.45	$76.90
80135/80160	more than 50 minutes	Consulting rooms	$90.70	$77.10
80136/80161	more than 50 minutes	Video conference/telehealth	$90.70	$77.10
80140/80165	more than 50 minutes	Other than consulting rooms	$116.90	$99.40
80145/80170	at least 60 minutes	Group therapy with 6 to 10 patients	$23.05 per patient	$19.60 per patient
80146/80171	at least 60 minutes	Group therapy with 6 to 10 patients and video conference/telehealth	$23.05 per patient	$19.60 per patient

(Department of Health, 2021c)

Patients accessing services require a referral from a professional such as a general practitioner, psychiatrist, or a paediatrician (Department of Health, 2021b). Patients can access 10 individual and 10 group services every year (Department of Health, 2021b). For eating disorders, patients can access 40 psychological services every year (Medicare Benefits Schedule Review Taskforce, 2020). In response to the COVID-19 pandemic, access to psychological therapy was expanded by 10 sessions and includes telehealth services (Department of Health, 2020a, 2020b, 2021a).

There are a few professional organisations representing psychologists in Australia, and they have different perspectives on the MBS. The Australian Psychological Society (APS) suggested three groups of mental health services: “advanced psychological therapy” for clinical psychologists, “psychological therapy” for psychologists, and “supportive therapy” for other allied health professionals (Australian Psychological Society, 2019). The Australian Association of Psychologists Inc. (AAPi) guiding principles support one group of mental health services for all psychologists, and oppose a distinction between psychological therapy and FPS (Australian Association of Psychologists Inc, n.d.).

On the other hand, the Australian Clinical Psychology Association (ACPA) advocates for the value of clinical psychology and has published a media release where Dr Judy Hyde, its former president, supports the distinction between psychological therapy and FPS (Australian Clinical Psychology Association, n.d., 2019).

It might seem curious to differentiate psychologists who offer psychological therapy from those that offer FPS, which suggests that some psychologists don’t provide psychological therapy. One argument for the distinction is that clinical psychologists have specialised training at the postgraduate level, which takes more time (King et al., 2010). One would expect this to hold true for general psychologists; however, other endorsed psychologists can’t provide the psychological therapy items. Another argument is the matter of equity, that is, providing the same service should earn you the same pay. The Mental Health Reference Group (2018) disagreed on how to resolve the issue of provider training, registration, and fees, and noted it as “an outstanding debate”.

This was a glimpse into your professional future as a psychologist, and the role of the MBS: what it is, what patients get, and what you are paid. There are ongoing disputes occurring at the intersection of bureaucracy, professional identity, and psychology. A resolution certainly won’t be determined by one person, but what are your perspectives on these issues?

References

Australian Association of Psychologists Inc. (n.d.). Our Guiding Principles. https://www.aapi.org.au/Web/About- AAPi/Guiding-Principles/Web/About-AAPi/Guiding-Principles.aspx

Australian Clinical Psychology Association. (2019, June 28). Psychologists Raise the Standard for Mental Health. https://acpa.org.au/psychologists-raise-the-standard-for-mental-health/

Australian Clinical Psychology Association. (n.d.). Objectives. https://acpa.org.au/objectives/

Australian Institute of Health and Welfare. (2021). Mental health services in Australia. https://www.aihw.gov.au/reports/mental-health- services/mental-health-services-in-australia

Australian Psychological Society. (2019). The Future of Psychology in Australia [Whitepaper]. https://www.psychology.org.au/Campaign/blueprint

Australian Psychological Society. (2020). National Schedule of Recommended Fees.

belozersky. (2019). Paper checklist isolated. Stack of paperwork icon. Pile of documents. Exam form. Stack of white papers. Vector illustration in flat design. [Illustration]. Depositphotos. https://depositphotos.com/240112966/stock-illustration-paper-checklist-isolated-stack-paperwork.html

Department of Health. (2020a, November 30). Looking after your mental health during coronavirus (COVID-19) restrictions. https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/ongoing-support-during-coronavirus-covid-19/looking-after-your-mental-health-during-coronavirus-covid-19-restrictions

Department of Health. (2020b, October 6). Prioritising Mental Health – Doubling Better Access Initiative sessions. https://www.health.gov.au/resources/publications /budget-2020-21-prioritising-mental-health-doubling-better-access-initiative-sessions

Department of Health. (2021a, April 29). Accessing health services during coronavirus (COVID-19) restrictions. https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/ongoing-support-during-coronavirus-covid-19/accessing-health-services-during-coronavirus-covid-19-restrictions

Department of Health. (2021b, March 17). Better Access initiative. https://www.health.gov.au/initiatives-and- programs/better-access-initiative

Department of Health. (2021c). Medicare Benefits Schedule online. http://www9.health.gov.au/mbs/createPublication.cfm

King, D., Tan, Y., Wainer, J., Smith, L., Fitzpatrick, D., Sun, L., & Owada, K. (2010). Evaluation of the Better Access Initiative Component C: Analysis of the Allied Mental Health Workforce Supply and Distribution. Department of Health. https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-ba-eval-c-toc

McCauley, D. (2019, Janurary 9). Medicare review of psychologists derailed by professional
stoush. Sydney Morning Herald. https://www.smh.com.au/politics/federal/medicare-review-of-psychologists-derailed-by-professional-stoush-20190108-p50qbx.html

Meadows, G. N., Enticott, J. C., Inder, B., Russell, G. M., & Gurr, R. (2015). Better access to mental health care and the failure of the Medicare principle of universality. Medical Journal of Australia, 202(4), 190-194. https://doi.org/10.5694/mja14.00330

Medicare Benefits Schedule Review Taskforce. (2020). An MBS for the 21st Century Recommendations, Learnings and Ideas for the Future. https://www.health.gov.au/resources/publications/medicare-benefits-schedule-review-taskforce-final-report

Mental Health Reference Group. (2018). Report from the Mental Health Reference Group. https://www1.health.gov.au/internet/main/publishing.nsf/Content/MBSR-closed-consult

Pirkis, J., Ftanou, M., Williamson, M., Machlin, A., Spittal, M. J., Bassilios, B., & Harris, M. (2011). Australia’s Better Access initiative: an evaluation. Australian and New Zealand Journal of Psychiatry, 45, 726-739. https://doi.org/10.3109/00048674.2011.594948

Psychology Board. (2019, December 2). Endorsement. https://www.psychologyboard.gov.au/Endorsement.aspx