Don, from all I have read and understand there could be a positive impact provided psychological professionals recognize just how much impact we may have. The push to get more behavioral science components into primary care and hospitals can improve compliance and decrease utilization of services. If you talk to anyone who handles work in emergency departments in hospitals, people presenting with exacerbations of chroinc pain conditions is a major concern. Many of those cases have no health insurance at this point in time. Psychology's involvement at the primary care level can assist in helping those physicians recognize the legitimacy of pain complaints by most individuals and non-medication avenues available in addressing many issues. Perhaps more important is a re-entry of psychology into chronic pain mangement which has largely become a medical treatment only approach in most locations (i.e., non-academic settings). I was involved in the multi-disciplinary pain treatment programs in the 1980s to mid-1990 years. Unfortunately, I believe the programs failed to show long term efficacy in relation to medication usage and return to work, resulting in less insurance coverage. At that time my observation was that the anesthesiologists and physiatrists set up their offices to provide oral medications and injections often as the sole treatment without any input on a day-to-day basis from psychological professionals. I often received referrals in worker's compensation cases for chronic pain patients with there being no communication from the pain physician's office and certainly no interest in input on how pain was being managed. At this point, there is a gigantic rise in the use of spinal cord stimulators and I have not seen the inclusion of behavioral components following implant. I have recently used the example of medical treatments for smoking cessation and the need to recognize inclusion of behavioral components for success since that habit goes well beyond just the physiological addiction addressed by medical treatments. In chronic pain, one needs to be aware of the environmental control factors of pain behaviors Fordyce targeted, particulalry in non-assertive and socially anxious individuals. Increasing compiance with time based medication administration and psychological approaches to increasing exercise (particularly in the water) are just a couple of areas where we have the expertise. Anyway, suffice it to say that the impact largely depends on whether we psychological professionals see the future and get on board while everyone else is trying to figure out what to do and grieving the loss of the medical care as they will inevitably call "the good old days." Bob

Thanks, Bob. That's an excellent answer. I hadn't considered the implications of ACA on increasing the representation or access to mental health services in medical environments, but I am certainly inclined to agree with you about the benefits of this (and I agree that we are likely to see these services proliferate). I've also witnessed an increase in spinal cord stimulator implants both at the medical center where I am on faculty now and through the military.