An analysis of the roles and attitudes of medical school psychologists with respect to administrative autonomy

The history of psychology in medical education was reviewed emphasizing the period of formal proposals beginning in 1910, and the rapid growth after World War II. The number of psychologists has grown from a few dozen to 2336 in 1976. Several philosophical, economic, and political barriers between medicine and psychology were outlined. The importance of administrative autonomy for psychology's effectiveness and even survival has been pointed out by many and close to 90% of the chief psychologists in 1972 favored some form of an independent department. Several administrative models exist for psychologists in medical schools including 1) a division of psychology with psychiatry, 2) individual appoint ment, 3) department of psychology, 4) department of behavioral science, and the most recent, 5) single faculty model in which the department of psychology of the university provides training to all the colleges including medicine. The last three models have been assumed to provide greater autonomy and job satisfaction than the two more traditional models The purpose of the present investigation was to test the assumption regarding autonomy and to document the development of the single faculty model. A national survey of 41% of the psychologists in schools of medicine was conducted. The questionnaire was fashioned after earlier surveys (Matarazzo & Daniel, 1957; Wagner & Stegeman, 1964). A total of 962 psychologists were randomly selected, surveyed, and followed-up. The overall response rate was 48%. Fifty-four percent were members in divisions, 30% were individually appointed, 9% were in departments of behavioral science, 6% in departments of psychology, and less than 2% in a single faculty model. Only one chief designated his school as single faculty. Comparing themselves to psychologists in other settings, those surveyed rated their freedoms as significantly greater, but there were no significant differences between psychologists in different models. While there was a significant relationship between model and academic rank, it suggested that individual power was enhanced within interdisciplinary models rather than autonomous ones. Thus, autonomous administrative structures do not insure greater freedom or power. In addition, the administratively autonomous models demonstrated the greatest variability in actual operational practices and seem, therefore, to be the least organizationally meaningful models. Unexpectedly, psychologists in departments of psychology choose to do more diagnosis and report underutilizing their therapy skills more than others. Those in divisions do the most supervision. Respondents indicated that their experiences in medical schools has significantly increased their personal satisfaction, career commitment, and vocational interest, but their model of organization was unrelated to the increases. No other variable studied was significantly related to organizational model. Nevertheless, close to 80% of the psychologists favored a model other than the one which exists at their medical school. The rarity of the single faculty model was considered in relationship to maxims in organization psychology and was conceptualized as a transitional administrative structure. The concept of "stature" (Bucher, 1970) provided a way of understanding the greater power reported by psychologists in multidisciplinary models of organization. The unexpected differences in functions psychologists choose to perform under different models, particularly the greater diagnostic work of psychologists in departments of psychology, may serve as necessary means of entree and interprofessional linkage for more isolated psychologists. Given the high job satisfaction and the strong tendency to favor a model other than the one they are under, it was concluded that the grass is, in fact, green, and that the concern with administrative models may be a function of the grass appearing greener on the other side.