Rules Versus Guidelines Establishing Entry-Level Competence in Clinical Neuropsychology

U.S. doctoral students training to practice as clinical neuropsychologists can be forgiven for being confused about the level of competence required. A disconnect exists between entry-level guidelines developed from within the field by national, nongovernmental organizational entities versus legal rules of competent practice from state licensing boards. Neither has a consensus model. National, nongovernmental guidelines commonly promote generic training in a health service psychology specialty (e.g., clinical, counseling, or school) at the doctoral/predoctoral internship level with specialized clinical neuropsychological training within a 2-year postdoctoral residency. Passing academic-type and oral exams to achieve diplomate status is recommended. This model was not derived from scientific evidence but is an attempt to mimic medical specialties. In contrast, state licensing boards that issue generic licenses to practice psychology within a licensee's sphere of competence typically consider a minimum level of competence comes from 2 years of supervised experience, one each for pre- and postdoctoral placements. Few state licensing boards offer specialty certification. State psychology licensing board total adjudicated complaints above a reprimand against licensees for incompetent practice within all specialties constitutes only about 4% of all disciplinary actions confirming the adequacy of this level of training. Reconciliation of nongovernmental guidelines and state licensing board rules pertaining to entry-level competence to create a more egalitarian profession is a goal that would benefit clinical neuropsychological trainees and the public. Recommendations for making such a change involve dropping the medical model and reordering priorities at the doctoral, predoctoral, and postdoctoral training levels. Public Significance Statement Guidelines for establishing entry-level competence popularized by national, nongovernmental, clinical neuropsychological organizations set the bar higher than that legally required by state licensing boards. The continued maintenance of this difference, an attempt to mimic the medical model, may no longer be justified. The current health care climate calls for greater accessibility to neuropsychological services while balancing the protection of the public.