2023 Current state of Psychology in NL

In February 2022, the Association of Psychology Newfoundland and Labrador (APNL) surveyed its members to better understand their concerns as well as to assess stress levels as they relate to both COVID and uncertainty/changes in their current Psychology roles.  Key questions from this survey were repeated again in February 2023.   We received 111 responses proportionally spread across all stages of training and employment.

There are currently 210 Registered Psychologists in NL, and approximately 18,000 Psychologists in Canada.

According to the Newfoundland and Labrador Psychology Board (NLPB), in 2023, 57% of Psychologists listed the public sector as their primary place of employment, while 39% report working primarily in private practice.  This is in contrast to 2017 in which 72% of Psychologists were primarily employed in the public sector and 21% primarily engaged in private practice.

In recent years there has been a significant exodus of Psychologists working in the Public Health Sector (Education, Health, Post-Secondary) with many areas currently experiencing vacancies of >50%.

At the same time, likely related to lengthier waiting times or lack of available services in the public system, Psychologists working in Private Practice have seen an unprecedented demand on their services resulting in lengthy waiting lists or lack of availability, even for those with the means (or insurance) to pay.

“While we have seen some positive initiatives from the Department of Health, clearly more is needed in health, at the post-secondary level, as well as to address a looming staffing crisis in the K-12 Education System” says Dr. Janine Hubbard, Co-President of APNL.

“As Psychologists, we believe that access to timely, evidence-based, appropriate, publically funded psychological services should be a right, not a privilege” says Dr. Hubbard.  “Many of our members have expressed ambivalence about moving to private services, but have reported that working conditions in the public sector were taking a toll on themselves personally, and on the services they were able to provide their clients”.

Key Findings:

• Psychologists continue to enjoy and feel very passionate about the work they do with their clients.
• While the previous survey inquired about burnout specifically related to COVID, the current survey asked more generally about professional burnout.  Almost half (48.5%) of respondents reported experiencing Moderate to Severe levels of professional burnout.  Almost half (47%) reported feelings of burnout had increased somewhat (33%) or significantly (13.5%) over the past year.
• Top reasons for remaining employed as a Psychologist in the public sector continue to include: benefits, pension, job security, and types of clients
• 48% of current public sector Psychologists indicated “yes” they have recently considered leaving their job, with 24% responding “maybe”.  Only 29% indicated they were not considering leaving their current position – 72% have recently considered leaving public sector Psychologist positions.  When asked to reflect on their feelings from one year ago, 39% indicated they felt less likely they would stay in their current employment, and 37.5% reported feeling ambivalent.
• Similar to last year, in order to stay, public sector Psychologists indicated the need for:(listed in order of most common responses)

1. Better understanding of the role, education, and/or skills of Psychologists
2. Increased respect
3. Increased autonomy
4. Increased salary
5. Increased opportunities to use Psychology skills
6. Better understanding of the scope of practice of all mental health clinicians
7. Increased financial support for education/training opportunities

• The majority indicated they would leave the public sector and enter full time (40.5%) or part-time (15%) private practice, move out of province (13%), or retire (5%)
• Similar to the2022 survey, Psychologists who left the public sector listed the following concerns(listed in order of most common response)

1. Lack of understanding about the role, education and/or skills of Psychologists
2. Lack of Autonomy
3. Lack of respect
4. Workload level
5. Salary
6. Lack of understanding of the scope of practice of all mental health clinicians

• Psychologists in full time private practice indicated the following reasons for working in private practice (listen in order of most common response)
  –          Flexibility
  –          Autonomy
  –          Ability to meet client needs
  –          Respect
  –          Ability to practice to scope
  –          Types of clients
  –          Salary

Psychologists who responded to the survey were provided an opportunity to expand on their responses. Below are some quotes representatives of those responses

What do you enjoy about your work as a Psychologist

• “Helping clients improve their quality of life, learning about new evidence-based practices and incorporating them ethically, consultation with other psychologists, collaborative work with other MH professionals with different roles (SW, OT, etc), supervision/mentorship in Psychology, program development/evaluation”
• “Ability to work with amazing clients, see them make changes and improvements in their lives.  Consultation with peers, supervision of trainees”
• “Being able to build deep relationships with clients and hold their struggles, opportunities for constant learning and personal growth, and sense of purpose from my career”

Burnout and General Concerns:

• “ There is a complete lack of support from working within the public health system that compromises my ability to feel good about my work. My patients are regularly being harmed by the system and the moral injury associated with this is immense. While I thoroughly enjoy the work I do directly with patients, navigating the challenges associated with the bureaucracy and feeling that things won’t change because those with power are unwilling to address large scale issues makes it so that I am often dreading coming to work”.
• “The situation only worsens as the numbers of Psychologists working in healthcare decreases.  It feels demoralizing and defeating.  Meanwhile I am still not allowed to make evidence based decisions on prioritizing care or declining to continue working with someone who is not benefiting from treatment.  It’s very frustrating.”
• “ I work in education, and the lack of respect and acknowledgement we have received in recent years pertaining to our roles and competencies has impacted my decision to leave. In addition, the stories I have heard from other psychologists who work within health (about feeling unsupported and dismissed) has impacted my decision to call it quits. Psychologists are first responders for mental health and need support from their employers and government in order to continue to provide the care they are “called” to do.”
• “My professional burn out often presents as a feeling of stress that I’m not doing enough in my public sector job, knowing the level of waitlists and intense need for the service I work in. As an early career psychologist, it can be hard to balance professional boundaries and self care (to hopefully sustain a long term career in the public sector), and feelings of guilt that I’m not doing enough”
• “Following the pandemic, there has been (and will continue to be) ongoing increase in demands for services. Despite this, psychologists are continually being asked to do more and more with less and less. Not to mention the fact that we, as professionals and humans, are also dealing with the effects of COVID while attending to these increasing demands for our skills and services”.
• “The lack of autonomy, ability to practice fully within my scope of practice, and employer lack of flexibility (Irony: we advocate for clients but are not afforded the same luxury) are key issues. I would caution new grads about working within the public sector. It is demoralizing person when your position comes down to dollars and cents and you are treated as a cog in the wheel not as a human being. The toxic environment lends itself to breed disrespect, discontent and resentment.”
• “For all the government’s talk about prioritizing mental health – with the glaring need to do so- there’s a ridiculous level of total disregard for the expertise of psychologists. The lumping together of ‘mental health clinicians’ ‘MH Professionals’ such that a entry level MH Counsellor is not differentiated from a psychiatrist or a psychologist is misleading…. In some cases it’s akin to implying all medical clinicians are the same -a PCA is no different than a brain surgeon”

What would help?

• “Valuing the work the psychologists do, respect for the profession, inclusion in larger teams and a seat at the decision making table”
• “Increased awareness of our roles, and autonomy to practice in them”
• “Respect, autonomy, more understanding of our education, skills, ethical code. Providing psychologists with more leadership opportunities. More flexibility both in treatment choice (rather than one sanctioned manualized treatment) and in how a role is set up logistically (hours of work for example).”
• “Recognition that Psychology is a specialized and unique service that can work together with other professions to provide holistic care. Respect and autonomy within the workplace. Have Psychologists sit at the tables where decisions are being discussed and made. And realizing that psychologists predicted the exodus of psychologists well before it happened; ongoing consultation and collaboration could have helped retain our highly skilled and passionate psychologists. Also focusing on both retention and recruitment (rather than just recruitment)”