Practicing clinical social work in the field of psychiatry for 40 years has been most challenging. The constant changes in the medical profession and its absorption of psychiatry into a new approach of integrated medicine, has created new advancement in medication and a clinical revolution. I have a distinct concern about Licensed Practical Counselors who wish to be included in the Medicare reimbursement formula. First, unlike clinical social work they cannot practice in the medical field, as that would require the LPC to advance one more degree being required to obtain a Ph.D. in clinical psychology. The key distinction between the LPC and advanced "clinical" degrees is the level of knowledge and knowledge based collaboration that exists among practitioners and is expected by patients. LPC at present are not schooled and are not representative of a "clinical" professional at the masters degree level and until this changes LPC should not receive Medicare reimbursement. Medicare should provide clinical services only. The LPC has and always will be (for the future) the degree needed to prepare one for the Ph.D. clinical level but the LPC is not quite "there" in terms of clinical expertise. If LPC advocates are serious about their clinical pursuit let's see university medical schools and hospitals offer combined LPC/Ph.D. clinical psychology degrees. I wish the LPC luck as they integrate their programs with medically affiliated academic programs but a waiting time is needed as they catch up the current Medicare clinical program.