Today’s episode kicks off a three-episode series on international assessment. During the series, I’m going to be talking with folks from Australia, South Africa, and Russia. It’s been very interesting to talk with these folks and learn about what assessment looks like in different countries. I think that you will at least find this interesting.
I know that there’s been a lot of discussion in the Facebook group recently about practicing overseas, and my hope is that these episodes may give you some insight into what that looks like. My guest today is Debbie [00:01:00] Anderson.
Let me tell you a little bit about Debbie. She is a clinical neuropsychologist. She trained at the University of Melbourne and has practiced in Queensland, Australia since completing her course in 1989. She initially worked in public hospital settings before moving into full-time private practice work.
She evaluates clients both at the referral of treating physicians and she does a lot of independent expert work in what she calls medicolegal cases like personal injury matters and competency to stand trial and so forth. She enjoys the challenge of complex cases and has done quite a bit of testimony in legal proceedings.
Debbie has several publications and conference presentations related to this work. She’s very active in the Australian Psychological Society, and most recently chaired the College of [00:02:00] Clinical Neuropsychologists annual conference in 2018.
Debbie’s passionate about training the next generation of professionals and supervises new graduates which are called registrars and retains casual appointments at two universities in Brisbane where she lectures on clinical neuropsychology and assessment skills. Her most recent project combines self-care for clinicians and professional education, and organizing overseas retreats for neuropsychologists.
I was really fortunate, Debbie and I had our interview way back in February, 2019. And then I had the great privilege to meet her in person at the AACN conference later that summer. Debbie’s full of energy. She has a great personality and she’s clearly very knowledgeable about the assessment world. So I hope you enjoy this.
We [00:03:00] dig into the nuances of assessment in Australia and cover a wide range of topics; what assessment looks like, what private practice looks like, the healthcare system, those are just a few things that we touch on in this episode. So I hope you enjoy it.
Here’s my conversation with Debbie Anderson.
Hello all, welcome back to The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Today, I am speaking with Debbie Anderson. Debbie is a neuropsychologist in Australia and this is part of our international series of assessment podcasts. So I’m really excited to be talking with Debbie.
Debbie, welcome to the podcast.
[00:04:00] Debbie: Gooday from Down Under. I’m very glad to be here.Dr. Sharp: Oh, nice. I’m glad you led off with that. It’s funny, Debbie and I were rehearsing a little bit before we started recording, she came out that, and I had to ask, do people actually say that? Debbie, of course, your answer’s what.
Debbie: Not usually people that work in urban or professional areas, but ordinarily, more the people who live in rural areas might say that. It’s not a phrase I use every day. I’m sorry, everyone.
Dr. Sharp: That’s totally okay. I’m glad that we got the truth here from you. Welcome to the podcast. Like I said, I’m thankful that we were able to make this work. It is 7:00 AM, your time. You are up bright and early, which I appreciate. [00:05:00] I think we’re all set for a good conversation. So thanks.
Debbie: Thank you for inviting me.
Dr. Sharp: Of course. Let’s start out, I would love to hear and I think other folks would like to hear where you’re practicing in Australia and what your day-to-day looks like, a little bit about your training and how you got where you are.
Debbie: I’m in Brisbane in Queensland in Australia. Australia overall has a population of about 24 million. So it’s a very large place with not many people. Queensland itself has around 4.5 million, Brisbane, 2 million people.
I did a little bit of research to say, what parts of America our weather would be most similar to, and I think it would be Florida, possibly New Orleans. So that’s [00:06:00] subtropical area. We’re in the northern part of the country that, so there are other parts of Australia that are not like this.
I was not born in Queensland, but I love living here, and the weather is one of the reasons. It has a really relaxed holiday like atmosphere in some ways in either direction from Brisbane; both the Gold and Sunshine Coasts. So if you’ve seen tourism, you would have seen a lot about probably the Gold Coast which are beautiful beaches, that sort of thing but Brisbane is more of the commercial center, if you like, of Queensland.
I personally I am in private practice full-time. I do a little bit of very occasional lecturing at universities, but full-time private practice. I’ve been doing it for a large number of years that it gets embarrassing every time I say the number. [00:07:00] I try not to say it out loud on the public record too often, but more than 20 years.
I like the flexibility that private practice gives me and the opportunity to do the kinds of work that I like to do. I basically assess all day, every day apart from report writing days because that’s what I like. I don’t do any therapy. I’m not endorsed to do any true therapy in the clinical psychology way.
I very much was very excited when I found your podcast, because I was like, there’s someone else in the world that does what I do every day.
Dr. Sharp: Wow. Yeah. Is there, we’re jumping into it already, but I would think in a city of 2 million people, there might be a lot of folks doing testing. Is that not true?
Debbie: [00:08:00] I looked up the figures yesterday and the number, in Australia, we have the use of titles, so the name psychologist is heavily regulated by one national body. So we have rules about who can say they’re a psychologist and the specialist titles, like neuropsychology, you have to do additional training to be able to use that title.
So in Queensland overall, we have just over 100 neuropsychologists, so it’s not that many really. A lot of those work in the public system, so there’s not all that many in private practice.
Dr. Sharp: Okay.
Debbie: Other psychologists that would do testing would probably be very similar to a large number of people in your group. We call them educational and developmental psychologists. They tend to do more of [00:09:00] the academic testing and that type of thing, working more closely with the schools.
While some neuropsychologists specialized in pediatric neuropsychology, so they’re also doing the assessment of learning disorders and similar things, the educational and developmental group, they tend to work a little more closely with the schools, often are employed by schools.
Dr. Sharp: Okay. That’s fascinating. So you said that there are about 100 in all of Queensland.
Debbie: Yes, 100 neuropsychologists.
Dr. Sharp: 100 neuropsychologists. Sure.
Debbie: There are other kinds of psychologists. There are a lot of clinical psychologists; they can give a WAIS, it’s required that they’re able to do that and general psychologists, but not the true, it [00:10:00] won’t be endorsed neuropsychologists.
Dr. Sharp: Yeah, sure. Maybe we could talk through the different levels of meaning. We spoke briefly before we started recording about that. Walk us through where do you go schooling wise to what’s that look like to get to being an endorsed neuropsychologist in Australia.
Debbie: Sure. After school we go to university and we would do an undergraduate degree, a three-year degree usually with an emphasis on psychology and then an honours year, a fourth year in psychology. So that fourth year has a small thesis, so it’s an honours year. That is the very most basic amount of training before university years of psychology that are required to be a [00:11:00] psychologist.
Dr. Sharp: Oh wow.
Debbie: That’s the academic training. Some people branch off there. They do a program that we call the 4+2 program, which means they’ve done four years of university, and then they do two years of supervised experience. So they don’t do further academic training; they just get workplace supervision, if you like.
They do sit an exam. Part of the national requirements are that they have to demonstrate their knowledge and sit an exam and submit cases and the like. They become general psychologists so they don’t have any specialty area, they’re endorsed as a general psychologist.
If you want to be more specialized, however, you obviously go on to do further academic training. So the minimum requirement [00:12:00] for the specialist training is master’s level. So we can do master’s level training in neuropsychology, clinical psychology, some forensic educational and developmental and so on.
So the minimum is the two years, the master’s level. Some people do a side day; that additional third year. Some people do it as a PhD, but in Australia, PhDs tend to be more research than coursework, and so you have to have done the master’s level coursework somewhere, somehow, to be applying for registration to use the specialist title.
So then when you come out from that, you’ve got your academic qualification, there are a large number of people like me that have stopped at the end of the [00:13:00] masters level. And then you have to work then for another two years in a supervised environment, which is called the registrar program. Those people are referred to as registrars. At the end of that is when they then can say, I’m a clinical neuropsychologist or I’m a clinical psychologist. So it’s at the end of that registrar program.
Dr. Sharp: I appreciate you walking through that a little bit. I want to make sure that I’m following. It sounds like, that may be a difference here, maybe in terminology, where after folks do a bachelor’s degree, do you call it a bachelor’s?
Debbie: Yes.
Dr. Sharp: So that four-year university degree, they can call themselves a psychologist and go into practice as a general psychologist.
Debbie: [00:14:00] Okay.
Dr. Sharp: Is that right?
Debbie: Yes, they still have to do the two years of supervised work after, they can’t just open up their shop at the end of four years.
Dr. Sharp: Okay. Got you. Interesting. So that’s almost like an applied masters or something where you just do two extra years of. But for y’all, it’s almost like your master’s degree is like our doctoral degree. You do two years of course work, but then you have to have two additional years of supervision and work.
Debbie: Yes.
Dr. Sharp: Got you. I’m just getting it all straight trying to wrap my mind around all of this. That’s interesting. So people will go and get the masters and then is that where you choose after that, which specialty you want to go into? Like you could do neuropsychology or forensic or clinical or?
[00:15:00] Debbie: When you’re accepted into the masters, that’s the specialty you’re in. So the masters is specifically to do with that specialty or that area. So yes, you make a choice. You might apply to lots of them, but you might get accepted into one. So whatever is the name or the content of that training is the area for which you can obtain the endorsement.Dr. Sharp: Okay. That’s interesting to me. So when you applied, you knew ahead of time, I’m applying for neuropsychological programs. Was it totally focused on assessment then for the what ended up being four years or did you do therapy training or how does that work?
Debbie: I trained a few years ago and at that time, it was [00:16:00] very assessment focused, there was no therapy. I understand things have changed over time, that people do learn a little bit more about the interventions, but yes, when I did it, it was all assessment.
Dr. Sharp: Got you. I’m just thinking through, that for folks who, if you know what you want to do, that’s a cool way to do it. I can say there were many parts of graduate school that for me felt useless to be honest. Especially, they felt useless at the time, they feel incredibly useful now, but I’ve honed in on only doing testing with kids, it’s a niche.
So that’s interesting to me to think that you could choose that ahead of time and just know this is what I’m committing to, and that’s all my graduate education is going to be.
Debbie: Absolutely.
Dr. Sharp: That’s cool. So you have the specialist designation neuropsychologist and that you get to [00:17:00] practice that way.
Debbie: Exactly. Yes.
Dr. Sharp: Can you talk a little bit about how is a neuropsychologist different from a clinical psychologist and is there any overlap? Are neuropsychologists the only ones that can do assessment or not? All those things.
Debbie: There’s an added level of controversy around some of these things. I should clarify to say, I incorrectly used the word specialist, the word we’re meant to use to describe us is endorsed whatever title. We’re not supposed to imply to the public that we’re special but anyway that’s just the government.
The differences of these, and this has an impact on the funding, so I’ll come to the funding in a second. [00:18:00] Clinical psychologists primarily engage in treatment. They see people for one hour sessions and engaged in some kind of treatment program. As part of their training, the clinical psychologists and all psychologists are trained to administer at least the WAIS, WISC, and possibly the WMS and some personality measures.
If it is within their purview, if they decide that they would like to assess somebody, they’re allowed to do it. There’s no reason that they couldn’t. A lot of people are very glad to say goodbye to the WAIS the moment they leave university, and who are clinical psychologists, so they’re often happy to refer their cases along for assessment to someone who likes to actually do that.
[00:19:00] But then some of the other groups, so the forensic groups often do intellectual assessments. They, as I said, educational, developmental, they do quite a lot of assessment. They’re very practiced at it.The neuropsychologists tend to do a little more differential diagnosis in a much more medical setting; does this person have dementia? If so, what type? That kind of thing, or what is the impact of this brain injury on the ability to return to work? They are more the kinds of questions I would get asked rather than just what’s this person’s intellectual level? That sort of thing.
So I guess the idea is that the more complex assessments do tend to come to neuropsychologists, but all other psychologists are allowed to do assessments, but they often choose not to.
Dr. Sharp: Okay. It sounds like there’s less overlap than there is [00:20:00] here, maybe, or more distinction between clinical psychologist and neuropsychologist than there is here.
Debbie: Possibly, but that might just reflect the way that I work and who I associate with, because I know in the past, there has been a lot of angst around who should be doing assessments and who can be giving expert opinions to the court, that’s usually where it really fires up around and particularly around the assessment stuff.
There have been people in the past who are clinical psychologists who prepare essentially neuropsychological assessments for court, and then there’s a bit of debate around should they be doing that? So there is debate and there is definitely overlap [00:21:00] but the funding, in recent years, some of the things that changed with the funding have made it a little more divided, if you like.
Dr. Sharp: Okay, before we totally dive into that, can I ask one clarifying question around the different endorsements? As an endorsed neuropsychologist, could you do a forensic evaluation and have that be credible?
Debbie: I’m giving my best. I’m in court and thinking about my answer carefully.
Dr. Sharp: That’s was the thing. That’s exactly what it was.
Debbie: Consumers of our skills don’t really distinguish. If you do a good report, they’re happy it’s a good report. [00:22:00] It might be raised, I have certainly been in cases where the forensic people have said, oh no, it should be a forensic person giving this report. I say, I’m just reporting on this bit here that I know and understand, and if you want to put that in the forensic context, then good luck.
There is a little bit of that debate, but at the end of the day, the marketplace just worries about whether it’s a good report. So the consumers are more concerned with the quality of what they’re getting. Legally, as long as I’m not calling myself a forensic psychologist, I can do any kind of psychology work.
Dr. Sharp: I see. Okay. Good answer. Nice. I’ll let you off the stand now.
Debbie: Thank you.
Dr. Sharp: You were talking about the funding piece, which I’m guessing, does that mean insurance [00:23:00] versus private pay, that kind of thing?
Debbie: Yes. I’ll step back, Australia has quite a big difference in its philosophy around health funding than I understand America has, although I may have that wrong. We have universal health care in the public system, so if you fall over and break your leg, they take you to the local hospital, you get treated and that’s for free under your, everybody pays a little bit in their taxes to fund the health system and that’s free.
That then extends out into the public sphere, where if you want to just go and see your local GP for your antibiotics, there is some element of that is paid for by the Medicare system, and you might pay a little bit of additional fee on top of that to keep their practice running.
[00:24:00] Most neuropsychologists work in the public health system so they’re funded by the state government to work full-time in the hospitals. So then the biggest change in funding in Australia happened a few years ago, I failed to look up what year it was because it didn’t apply to me because what happened was we got funding for psychological treatment under the Medicare program.So that means that you can go and see your local psychologist and a portion of that fee will be paid by the public health system, even if they’re in private practice. Some or all of the fee, it depends on what they charge. They can charge an additional payment.
But there’s a distinction; so this whole business about endorsed and not endorsed is quite important now [00:25:00] because the people that have general registration get one kind of rebate, the people who have clinical psychology endorsement only get a much higher rebate per session. So that means they can either charge more or the patients pay less of a gap.
There is this enormous thing around if you’re a clinical psychologist and we have very large numbers of clinical psychologists, but the Medicare funding only covers treatment, so it doesn’t cover assessment. So we’re left out. We don’t get any Medicare funding.
And so that also becomes a driver in the marketplace though, because the clinical psychologists, if they can get funding per hour to be treating people, then it’s not really worth them spending their time on non-funded hours [00:26:00] where the person has to pay fully out of pocket to them for them to do assessment. So that kind of changed the marketplace a little bit in that respect.
Dr. Sharp: I can see that. Do you have any idea why assessment is not included in those public funds?
Debbie: Oh, I shall put away my cynicism and paranoia and say the following; the funding was essentially, it’s to do with funding buckets, the way that the government thinks of where the money comes from. The original funding was under mental health, and so cognitive assessment was not seen by the government as being part of mental health. They were thinking anxiety and depression, that sort of thing.
And so even though what people actually go to the psychologist for is much more than what was perhaps originally [00:27:00] intended, assessments still excluded. So that’s changed the landscape of the way that psychology has operated in the last few years.
Dr. Sharp: Oh yeah. So prior to that change, were all psychologists just private pay?
Debbie: Yes. Even though we’ve got the free public hospitals, we’re encouraged by the government to have some private health insurance as well so that if we wanted to have some elective surgery and go to a nice private hospital, that’s what that insurance pays for. It also pays a small amount for other types of things like your glasses and your physiotherapy and psychology.
[00:28:00] Some people were using their private health funding to get some rebate on their psychology sessions prior to Medicare coming in, but they also still do now because if they don’t want it on their records and those sorts of things, they might not go through the Medicare system.Dr. Sharp: Okay. I see. So zooming out a little bit and maybe to help me understand the whole haelthcare system; it sounds like over there everyone basically has what older adults have in the U.S. like Medicare plus maybe a supplementary policy if they want it.
Debbie: Pretty much, yes. So the supplementary policy, the government has been creating incentives or penalties if you don’t take it out by a certain age. So they’re trying to move people into that idea of having some private health insurance as [00:29:00] well, but it is not mandatory and you still can get treatment if you need it.
Dr. Sharp: Okay. I see what you mean. That’s interesting. So you then, I’m gathering, have never really dealt with insurance in your practice?
Debbie: Primarily not in the way that it sounds like you guys do. I’ve been reading all your posts about the changes and it sounds awful.
Dr. Sharp: Oh my gosh.
Debbie: No. With neuropsychologists, certain bodies will fund an assessment, so they are sometimes insurance companies but insurance companies where someone’s had an injury rather than a health insurance company. So it’s a little bit different here.
Dr. Sharp: Okay. This is what our brains do, we’re to [00:30:00] categorize and organize things according to existing heuristics. So is this like a worker’s compensation kind of thing where if they get injured on the job, then that would pay for their evaluation, that kind of insurance.
Debbie: That’s one very good example. Yes. Certainly, I provide for workers’ compensation, which is good because they will pay for the person’s, say someone has an injury, they get treated at the public hospital and then workers take over, so then they fund all of their rehabilitation; so their physiotherapy, their occupational therapy, and their neuropsychological assessment. If they need some psychological intervention, they will also fund that.
That’s quite comprehensive funding, because the goal is to get people back to work. They are usually generous in the beginning. So I do that. The other insurers are motor vehicle accident insurers. If you had a [00:31:00] car accident and the other person was at fault and the insurance company said, look, we accept that this driver was at fault so we’ll pay for your treatment.
Dr. Sharp: Yes.
Debbie: So again, thinking in the same way as the worker’s compensation, they do the same thing to get people back to work and so on. In one of our states, Victoria, they have a very large system where all the insurance for the motor vehicle accidents is all pulled together and they actually fund rehabilitation hospitals.
And so if you have a car accident, you go from your initial treatment into a rehabilitation hospital, which is multidisciplinary, does include neuropsychology, includes lots of other disciplines. The treatment is all managed there.
In the state that I work in, we don’t have [00:32:00] that. That’s why there’s opportunities for private practice because people have to get those treatments outside in the private sphere.
Dr. Sharp: Got you. That might be a nice segue to my next question, which is, where do your referrals come from? How do you get folks in your private practice?
Debbie: There are three main areas. The first one is medical referrals. So because I primarily work with adults, they may be seeing their urologist or a geriatrician, and there might be questions about cognitive function, MS query, dementia, that kind of thing. So the neurologist would send them.
Those people are 100% private pay. They have to pay that out of their own pocket unless the [00:33:00] health fund will give them money, but it will be a very small percentage. It will be like 10% of what the cost is. It’s not generous at all. That’s the first group. That’s classically what you would think of as neuropsychology and what we do.
The second group is the insurers. So the workers’ other insurance companies. Also we have a system for our veterans, so department of veterans’ affairs. So a little bit like your VA. They also, regardless of their age, it’s to do with their accepted level of compensation. If their doctor wants it, they can be sent for a neuropsychological assessment as well, fully funded. That’s the only public money we get.
And then the next group [00:34:00] as I’ve become more experienced I’ve moved into is the personal injuries cases; the legal cases. They are very exciting. In Queensland, if you have a motor vehicle accident, you can sue the other party who was responsible and their insurance company then answers that legal claim. And so the plaintiff will need to prove that they’ve been injured or damaged by the accident and how it’s affected them.
So the neuropsychology becomes quite important. I tend to be quite comprehensive looking at both the cognitive and the mood elements to that. So even though I don’t treat like a clinical psychologist, I certainly assess the issues that will be relevant to a clinical psychologist. So those are probably the top end of paying cases. [00:35:00] So I do those as well.
Dr. Sharp: Nice. Do those rates from the insurances and those different sources, are they comparable to your out-of-pocket rate? I know here, there’s a pretty big difference between what insurance reimburses and what our out-of-pocket rate typically is. Is that the case there as well?
Debbie: We set our out-of-pocket rate to be around about the same as the work cover rate so that they’re all about the same amount. It’s all worked on X number of hours at X rate, which is below the recommended rates.
Our provisional society says you should get this much per hour but the rates that the insurers are paying are lower than that. I personally set them at about the same because it’s just too [00:36:00] hard to deal with the differences otherwise, because sometimes people will ring up and say, what’s the fee and you tell them, and then they say, oh, but we’re on work cover, and the fact that it’s a different fee ends up being just problematic.
Dr. Sharp: Who’s that term that you used just a minute ago, your provisional society.
Debbie: Oh, our professional society.
Dr. Sharp: Professional society. Would that be like the APA for us?
Debbie: Yes.
Dr. Sharp: They put forth a recommended rate for you?
Debbie: They sure do.
Dr. Sharp: Okay. That’s interesting.
Debbie: It is interesting. It’s their way of helping us to argue our worth, if you like. When we say this person needs treatment, then they need 10 sessions at the APS rate and that’s far higher than the Medicare rate or the insurance rate.
[00:37:00] They’ve got some kind of algorithm that is to do with what it would cost to have an office, to work there 40 hours a week, and do all the things you’ve got to do. It’s based on more therapy work, though. It’s worked out in a therapy hours model.Dr. Sharp: Okay. I see. That’s fascinating. Without getting into specifics, you don’t have to go into detail with the numbers, but I know over here, being a psychologist, you can make a pretty good living. We could get into all sorts of arguments about that but if you charge a reasonable rate, that’s market rate, you can do pretty well. Is that the case over there too or is it upper, lower?
Debbie: Oh, look, it’s partly way about how you manage it and how much bulk billing work you do.
[00:38:00] If you’re the kind of psychologist that’s working in an area that people can’t pay extra, can’t pay out-of-pocket fees, then you’re not going to be making a lot of money because it’s a pretty basic sort of amount that Medicare would give you. So it would be like if you only took the insurance without a copay.In my case, because the personal injuries cases we charge more than double what the other ones are, we charge more than the recommended rate, that creates a good income. My observation is people who have that mix of cases in all different kinds of psychology do tend to be doing reasonably well.
Dr. Sharp: Sure. Is it feasible at all for a neuropsychologist there to only [00:39:00] do private pay where maybe they don’t have these work cover contracts or the personal injury stuff? I’m thinking maybe, if you can’t answer this, that’s totally fine, but maybe pediatric neuropsychologist where it’s not coming from a neurologist or an accident or something but people walking in off the street, so to speak.
Debbie: Oh, absolutely. Yes, I have several friends that are pediatric neuropsychologists who that’s all they do. And it’s pretty much private pay all the time.
Dr. Sharp: Oh, okay.
Debbie: It’s probably not an enormous income, but it’s certainly doable. So once people are in with the right guidance officers, the guidance officers tend to be at the schools and then they request this information. They can have quite a busy assessment practice [00:40:00] and as I understand it, they do reasonably well.
Dr. Sharp: Okay, that sounds good. Nice. Let’s talk about your practice. What does that look like? Is the evaluation structure similar or different? There’s a huge variation, maybe I’ll back up and just ask what do your evaluations look like? How many might you do a month? We’ll just go from there.
Debbie: Okay, of all the people in Australia, you’ve probably chosen one of the small number who have adopted what would probably be a very American model. There’ll probably be a lot of similarities in the sense that I like to come to the American conferences and read a lot of the American literature so I’m quite influenced by that.
The structure is that; it’s me, I have a psychometrician some days; a technician, [00:41:00] is the word you might use. I have some registrars, so I have two, but one does more work than the other, two are casual. So if we get extra cases that don’t need super specialty work done on them, the registrars do them and I supervise them so that counts as part of their training, they’re moving towards endorsement.
We try to have a mix of cases per week. We might have three assessment days in a week and two report writing days. The cases that take the most time and energy to write the reports are the medicolegal ones, because they’re very long and detailed.
Having listened to the podcast about time blocking and things, I’m trying to keep days free to work on those, to give [00:42:00] myself the psychological space to actually think about the problems. With the assessment days, they’re quite full. We do very full batteries, so full WAIS, WMS. I personally don’t like the D-KEFS so I use more of the Rey figures and RAVLT and what’s called the Halstead category test, those types of things.
Depending on people’s reading level, the PAI or the MMPI-2. We try to do a comprehensive, my philosophy is most of the basics and several effort measures, of course, most of the basics are the same for all assessments. So I choose to do a full WAIS, a full WMS every time, unless there’s something really outstanding about why the person can’t cooperate to do [00:43:00] that.
We are a very assessment-based practice. People are here anything from five hours to eight hours, depending on the complexity of the case and the history and so on. We do it as a one-off. So they come in one day. Ordinarily, we asked them to bring a partner or family member to interview. So I interviewed them and all of that happens on the one day. So everybody’s exhausted at the end of that day.
Dr. Sharp: Yeah, I’m sure. I worked for a clinical neuropsychologist in graduate school and that’s what they did as well.
Debbie: The advantage of this for me, because of where we are, is it means that it’s [00:44:00] only so people cities, Queensland’s very large and popular, the idea of getting it all into that one day is quite important so it’s a long assessment day and then we keep all the report writing and so on for the other days.
Dr. Sharp: I see. So then you said the medicolegal reports end up fairly lengthy, what does that mean when you say lengthy?
Debbie: Probably about 12 to 15 pages, which to you guys, I hear people talking on your podcast or in your group, and they seem to talk about that as an average report. An average report for me, so if I was reporting back to a doctor or an insurer, would be no more than [00:45:00] 4 or 5 pages.
Dr. Sharp: I see.
Debbie: There’s data in there, we do data tables, but only the summary indexes and focus on what the conclusion is; what does this data mean? Because we found that people just were, it was doubling up information. So all of that longer-term history, we just found it was doubling up and the referrers just didn’t want to read it all again. They already knew it and it was just pointless paying us to do it again.
I’d spoken directly to workers’ conference, for example, about that. They were like, oh, we just want the news. What’s the news? So that’s what we do. The legal ones; they are a bit longer. They could be up to 20 [00:46:00] pages because the lawyers have always gotten millions of questions.
Some people like to explain every test and stuff like that, I write it as if the person reading it knows what the tests are. I explain what they mean rather than what they are and that seems to go down reasonably well.
Dr. Sharp: Got you. You said that you’re maybe in the minority, that this is more of an American model. So what’s the typical Australian model?
Debbie: There are plenty of people that do quite a bit of assessment, but not quite as much as I do. There is also a history in Australia of a more, people would call it a hypothesis testing approach. So they would do a bit of this and a bit of that, Paired [00:47:00] Associates, but not the other things or similarities and Block Design and so not the full batteries of things.
When I trained many years ago, that was the prevailing model and over time, there has been increased influence of a much more psychometric model. So it probably is the case that the majority of people do use a more psychometric approach now. I was probably wrong in saying I was a minority, but there are certainly some people who do not do full batteries at all, particularly in the public space. They feel like that the pressure to see lots of people is such that it’s hard to justify the time that a full battery would take.
Dr. Sharp: Yes. That makes sense. Nice. You said you have technicians or psychometricians; [00:48:00] what level of training do folks have to have to be a technician over there?
Debbie: It’s not a full-time job, it’s a casual job. I ordinarily employ them whilst they’re studying their masters. So they are already done the four years. They’re provisionally registered, all they have to be is provisionally registered and I have to be their supervisor. That’s all they need.
Dr. Sharp: I see. Nice. I like that model as well; employing graduate students, that makes a lot of sense.
Debbie: Exactly.
Dr. Sharp: Do you have any idea how U.S. training might translate to Australia? So let’s just say I wanted to leave the U.S. and move to Australia, would I be able to find a job or open a practice [00:49:00] as an assessment psychologist or neuropsychologist or not?
Debbie: I couldn’t see why not because the APRA; the regulation body would, I’m quite sure, see the training as equivalent and that’s the first hurdle. So as long as you’re registered, you can do whatever you like. I don’t know a lot of people that have come from the U.S. to Australia. The main people I know people that have perhaps trained in the U.S. but had originally come from Australia and come back for more academic roles, lecturing and the like. I can’t say I know of any clinicians that have made the move, maybe there’s a place for you.
Dr. Sharp: Hey, I’m going to take that and run with it. Australia would be a great place. [00:50:00] It sounds fantastic, aside from that whole meme about millions of predatory creatures out to kill you everywhere you turn. I don’t know if I can get over that.
Debbie: Our houses are just like everybody’s houses. There’s no crocodiles.
Dr. Sharp: That’s good to hear. That gives me some hope. One thing that I did not really touch on was just the role of diagnosis. Do you all use the DSM? Do you use something else? Do you care about diagnosis? How does that work?
Debbie: In my view, diagnosis is really important and it’s a crucial part of what we do. I know in the pediatric area, there is a greater emphasis on the DSM diagnosis around some learning disorders and stuff like that.
It depends on what people are being assessed for. [00:51:00] With the more medical assessments, if it’s coming from a neurologist, they don’t care what the DSM says. So if I write back to them, this person’s got major neurocognitive disorder, they’re like, what are you talking about? So I don’t worry about that. But if I was writing to a psychiatrist, then that would be helpful to them because they would know what the DSM says.
From a statutory point of view, some of the medicolegal cases that we do, some of the ratings, when you do medicolegal case, you’ve often got to distill your results down to a rating; this person has X% impairment in relation to whatever.
Some of those are medically based on the medical diagnosis, so brain injury and its cognitive effects would fall under there but if you want to say, and they’ve got an adjustment [00:52:00] disorder or they’ve got PTSD, you have to show that meets the DSM requirements. To use that rating, you do need the DSM. We do use the DSM, but for the less neurological things.
Dr. Sharp: Yeah, I see what you mean, but it is the DSM, there’s no other manual.
Debbie: Oh, no. DSM, that’s it.
Dr. Sharp: Got you. That makes sense. You write for your audience.
Debbie: Yeah.
Dr. Sharp: Got you. Very cool. My gosh, I feel like I’ve learned a lot about practicing in Australia. What else is out there? What have I not asked about? Anything that is unique or interesting about practicing there that might be different from what we do or any other points of interest you might think of?
[00:53:00] Debbie: Two things; I wanted to say that I have enjoyed your stuff on technology and I’ve been an early adopter as well. So all good. It’s available in Australia. You’d be pleased to know.Dr. Sharp: Oh, great.
Debbie: Probably the thing that’s a little unique about the size of Australia is it makes the whole provision of healthcare to everybody very difficult because of the amount of travel and the outback and those sorts of things. The majority of us are localized in quite urban areas, particularly in New South Wales and Victoria. That’s where everybody is.
In some of the other states, one of my friends in Western Australia runs a clinic where they fly to another part of the state and run a clinic because they [00:54:00] don’t have access to neuropsychology or psychology otherwise. And so that kind of adds a dimension.
I have a forensic person in my office who every week flies to another part of our state and provides services because they can’t get the services locally. I get to fly around occasionally with my tests and people. I realized it’s a reflection of the size and shape of the land, but we do a little bit of travel sometimes which is interesting and fun.
Dr. Sharp: Yeah, that is really interesting. It sounds like there’s maybe more of a norm for that than there is here certainly where you have to. Oh, that’s great. It does sound exciting. It makes our job sound a little more exotic than just hanging out.
Debbie: That’s what I tell myself when I have to get up very early to catch the only plane [00:55:00] that’s going to that location that day.
Dr. Sharp: I bet. Whatever it takes, those cognitive tricks.
Debbie: Exactly.
Dr. Sharp: Wow. This has been informative, interesting and fun too. Like I said, I really appreciate that you were willing to make the time to talk with me about these things and listen to some of my dumb questions as we’re just figuring it out.
I know there are a lot of folks around the world who are listening to the podcast and practicing in different settings in other countries, I’m curious about all of that. So I appreciate what you’re willing to talk with us about.
Debbie: Thank you very much. I’ve certainly enjoyed it.
Dr. Sharp: Oh, good. If people have questions either about Australia or Queensland or Brisbane or neuropsychology or really anything down there, what’s the best way to get in [00:56:00] touch with you?
Debbie: Probably best to email me. I’m happy for you to put my email in the notes.
Dr. Sharp: Okay. Yeah, we can do that.
Debbie: Yeah.
Dr. Sharp: Great. Debbie, this has been great. I really appreciate it. I know our paths will cross in the Facebook group but until then, take care.
Debbie: Thank you. Bye bye.
Dr. Sharp: All right y’all, thanks as always for listening to this episode with Debbie Anderson, all about testing in Australia. I was struck by how similar the practice is. There’s certainly some differences in the healthcare system and some of the environmental factors, but sounds like the practice is largely similar.
I know for myself, I’m always at least a little bit in the back of my mind, thinking about practicing internationally and maybe moving our family, and this was a really cool conversation to have [00:57:00] to add some more information to that decision-making process.
We will continue with the international assessment series over the next two Mondays. Next time I will be talking with Michelle Ireland about assessment in South Africa and following that, I’ll be talking with Joseph Graybill about assessment at an international school in Russia. So both of those were just equally fascinating conversations. My hope is that you’ll stick around and tune into those as well.
If you have not subscribed to the podcast, now’s a great time to do it so that you don’t miss any episodes coming up. If you have a moment to do me a huge favor and rate the podcast, I love those 5-star ratings. It helps to spread the word and increase exposure for the podcast. And like I always say, if you are tempted at all to leave a less than 5-star rating, please shoot me an email [00:58:00] and let me know what could be better and what you’d like to see different here on the podcast, always open to feedback.
Okay, y’all, take care. We’ll catch you on Thursday with another business episode all about time blocking and streamlining your schedule to be most efficient with your time. All right, take care.