Is there a threat of a blockade of neurology services? National consultant responds to the issue of psychologists.

• Are there so few neuropsychologists in Poland that their shortage could block access to neurology services? I cannot agree with this statement, says Prof. Bernadetta Izydorczyk, national consultant in clinical psychology.
• There are currently approximately 5,000 psychologists working in healthcare in Poland. There are approximately 3,000 clinical psychology specialists (neuropsychology is a subspecialty), and each year, another 40-60 people pass the specialization exam.
• The blocking of services has a different reason. It's related to the fact that the obligation to employ a psychologist in neurological departments is not universally required, he explains.
• The exception are stroke units, where there is a requirement to employ not even a specialist neuropsychologist, but a part-time psychologist - he points out.

Psychologists play an important role in neurology departments, not only in supporting patients and their families, but primarily in diagnostics. As Professor Bartosz Karaszewski, national consultant in neurology, pointed out in the Sejm (lower house of parliament), the descriptions of services reimbursed by the National Health Fund (NFZ) specify the competencies required for those providing them. National consultants in specific fields, when revising some of these services, will be required to specify them more precisely. This also applies to neurology, where either a psychologist or a clinical psychology specialist will be listed under the service.

"If many universities educate psychologists at the undergraduate level who are prepared to work with patients, there will be no need to include the term clinical psychologist in the definition of services. Otherwise, the provision of services may be blocked due to insufficient numbers of these specialists," the expert emphasized.

Are there so few neuropsychologists in Poland that their deficit may block access to neurology services?

- It cannot be unequivocally stated that the number of neuropsychologists in Poland is sufficient, but I also cannot agree with the statement that their shortage may block access to neurology services - says Prof. Bernadetta Izydorczyk from the Institute of Psychology of the Jagiellonian University, national consultant in the field of clinical psychology.

The expert points out that neuropsychologist is a title reserved exclusively for psychology graduates who have completed specialization training in clinical psychology and passed the State Specialization Examination in Clinical Psychology at the Medical Examination Center in Łódź (title of clinical psychology specialist with completed internal subspecialization: clinical neuropsychology).

- Due to their long-term and highly specialized training, there are actually significantly fewer neuropsychologists than other clinical psychologists working in healthcare for patients with diseases of the nervous system - admits Prof. Izydorczyk.

At the same time, it addresses the issue of whether the smaller number of these specialists translates into the availability and quality of psychological services for neurological patients .

"The root of the problem lies elsewhere. The point is that, according to current healthcare regulations, the obligation to employ a psychologist in neurological departments is not universally required, " emphasizes the national consultant.

He adds that stroke units are an exception, as they are required to employ a part-time psychologist, not even a neuropsychologist. However, there is still no requirement to employ psychologists in neurology and neurological rehabilitation departments.

"This is precisely what is meant by blocking the provision of healthcare services to patients in neurological wards. Patients hospitalized in these facilities for the diagnosis of neurodegenerative conditions, such as Parkinson's disease, Alzheimer's disease, frontotemporal dementia, and others, require rapid neuropsychological assessment and the establishment of neuropsychological interventions, while there is no requirement to employ a psychologist in such a ward," emphasizes Professor Izydorczyk.

- Therefore, we should consider regulations defining the requirement to employ a significantly larger number of psychologists, adjusted to the number of patients in neurological departments - argues the expert.

Clinical psychologists as supervisory staff

How many clinical psychology specialists with a neuropsychology subspecialization do we have?

"Data indicates that approximately 5,000 psychologists currently work in healthcare in Poland. For many reasons, we do not have a complete list of clinical psychologists in Poland, but we do have a breakdown of the number of healthcare services provided to the National Health Fund (NFZ). We also know that from 2009 to the spring of 2025, nearly 3,000 clinical psychology specialist diplomas were issued, with an additional 40-60 (some sessions more) passing the specialization exam each year. Comparing this group to, for example, child psychiatry shows that it is not so small," says the national consultant.

- Therefore, we do not have full knowledge of the number of clinical psychologists employed in the health care sector, but the Act on the Psychologist Profession could make a significant difference and make the existing lists of psychologists, including clinical psychologists, more credible, as is the case in other European Union countries - he adds.

However, as Professor Izydorczyk points out, it is not true that the shortage of clinical psychologists will block patients' access to health services .

"First and foremost, they need to be employed. Currently, there are too few positions available to provide patients with neurological disorders with access to basic neuropsychological diagnostics and therapy. Calls for the employment of more psychologists have been repeated in annual reports for years," he emphasizes.

" Clinical psychologists would be responsible for supervising and monitoring the quality of healthcare services provided to patients, including neurological patients . These specialists don't have to be available in every neurological department, but it would be very beneficial if they were present, for example, in a hospital, so they could provide supervision services and teach junior psychological staff specialized psychological diagnostics," explains the national consultant.

"A psychologist employed in a neurology department doesn't necessarily need to specialize in clinical psychology. They can work under the supervision of a more experienced psychologist in the facility while simultaneously pursuing postgraduate training. Therefore, clinical psychologists don't have to be specialists in healthcare—some psychologists working there can study and gain experience under the supervision of highly specialized staff," he explains.

"In Poland, there is no obligation to provide continuing education for psychologists in health care"

The national consultant reminds us that in most European countries, psychologists who want to work in healthcare must complete regular postgraduate training after graduation . Only then will they be included on the list of healthcare professionals, as only specialized postgraduate education, supervised by specific institutions in a given country, allows them to work with patients in accordance with scientific standards (EBM).

"The need to meet postgraduate training standards is therefore mandated and described in legal regulations in neighboring countries. Postgraduate training in clinical psychology is standard, but it doesn't always mean only training requiring a clinical psychology specialist title. It can also mean a psychologist working in healthcare and deepening their professional competences through courses and training specific to their profession," says Professor Izydorczyk.

As he notes, unlike many other EU countries, Poland has no established legal regulations requiring continuing education for psychologists working in healthcare. Psychologists pursue education because they want to, but it's not mandatory.

"Meanwhile, further education after a master's degree in psychology is necessary. A psychologist with a master's degree certainly possesses a certain knowledge base that allows them to work in the profession, but before entering the healthcare field, a psychologist must develop this knowledge base to work based on scientific evidence. This is essential in today's world," argues Professor Izydorczyk.

He also explains that psychology programs at various universities offer various specializations that develop basic skills, but neuropsychologists—in accordance with international standards—receive postgraduate education and obtain professional licenses. In Poland, this occurs through a specialization program conducted at an accredited center, listed by the Ministry of Health. This four-year specialization program culminates in a State Specialization Examination and the possibility of obtaining the title of clinical psychology specialist.

"A neuropsychologist cannot be educated at a basic level"

"A neuropsychologist can't be trained at a basic, academic level alone. This way, we can develop someone with certain skills and predispositions that give them the ability to deepen their neuropsychological path through postgraduate education," says the national consultant.

He adds that in Poland, there is also a path for recognizing clinical experience based on clinical practice acquired by psychologists working in healthcare. If they gain experience that is consistent with their specialization program, they can apply for recognition of their professional and/or academic achievements and take the specialization exam to obtain the title of clinical psychology specialist.

- Clinical psychology, which also trains neuropsychologists, is a specialization that has been functioning for a long time, and in 2023 its program was adapted to EU standards - reminds the national consultant.

As he explains, the specialization encompasses 4,176 hours of theoretical and practical training in the form of clinical internships . The first two years of training are intended for all psychology master's degree holders and include seven clinical internships , each lasting two months of daily work at a selected facility, in each of the primary medical disciplines (departments of neurology, psychiatry, pediatrics, and internal medicine).

After two years, psychologists choose a subspecialization. One of these paths is clinical neuropsychology . As part of this path, psychologists complete seven theoretical and clinical courses ( 832 hours ) and additionally complete 720 hours of clinical internships in neurology departments and other facilities, where they apply their knowledge of neuropsychology, neurosurgery, and neuropsychological rehabilitation.

- This clearly shows that clinical psychology as a discipline in health care requires first obtaining basic psychological education (scientific foundations of methodology, basic sciences in psychology, including specialization in the area of clinical and health psychology) and then specialized education, because people entering this specialization learn what is not available in other psychological subdisciplines .

Therefore, a clinical psychologist, through the medical knowledge he or she acquires and applies in his or her practice, is a practitioner of the medical profession , says Professor Izydorczyk.