What's happening to clinical neuropsychology?

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I am really set on going into the field of clinical neuropsychology. I loved my neuropsych internship at a hospital and neuropsych research is most interesting to me. However, I have been hearing things on SDN and other places that it's going south. But I've also heard that's its one of the hottest fields in psychology. So my question is, can someone tell me what exactly is happening with clinical neuropsychology? Will it continue to become less profitable and eventually fade out? Will it be profitable in only certain areas (forensics)? Does it still have a bright future and is just being hit by tough economic times? Can anyone truly answer these questions?

Thanks!

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if thingsd continue: decrease of 15%/YR, while inflation increaes, NP is screwed.


i'm getting out of the entire mentla health field in 3-5 years.
 
In terms of actual practice, reimbursements is the biggest problem right now. Its getting even lower and arguing with insurance companies to get reibursment is increasingly common thse days. Those working for the VA or in thriving practrices that do alot of IMEs or forensic work are still ok. However, as reimbursement contrinmues to go down, i think it will trickle down to them and affect their salaries and new jobs opps in the future as well. The field is pretty factionalized and has had enormous problems uniting to defend itself and its econmiic livelihood.
 
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I'm going to do it for probably 4-5 years out, while I build up my outside business. Once I get that funded, I'm done with clinical work, and I'll just handle pass-through and consulting gigs...I'd rather take a % a bunch, than 100% of a little.
 
if thingsd continue: decrease of 15%/YR, while inflation increaes, NP is screwed.


i'm getting out of the entire mentla health field in 3-5 years.

If you don't mind my asking, what are you going to do? I probably should follow your lead,lol!
 
This post brings up a good question: What is going to happen to clinical psychology? I really enjoy the work but there are very few jobs out there. It seems that psychiatry is burgeoning while psychology is dying a fast death, especially neuropsychology which was once the shining star in clincial!
 
This is very saddening and discouraging to me as I am currently applying to doctoral programs and came back to pursue Psychology because of NP. I primarily want to do sports concussion research and be a concussion specialist for professional athletes. Hopefully this won't be affected as well...:scared::(
 
So what would you guys recommend for undergraduates pursuing clinical psychology or neuropsychology? Is there anything we can do to help us succeed in this field? Neuropsychology is the field I really want to get into and I don't want to compromise my goals too much. If I had to specialize in forensics or something too keep doing neuropsych that would be fine.
 
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Here is the latest...BTW all salary surveys are still up...but please go into some other specialty if you are that depressed about it.

This came from NAN this week...

Thank you for contacting your house representatives to pass H.R. 3961, which will prevent the 21.2% cut to Medicare to take effect in 2010. Your efforts were successful and the bill passed!!

Now we need to take action again as the senate may vote on this bill as early as tomorrow. Please take 5 minutes and contact your senators with the same message - to pass H.R. 3961. Please use the link from APA to find your senators: http://capwiz.com/apapolicy/home/. After you click on this link, enter your zip code to search for your senators. Your senators will be shown at the bottom of the next page; click on the email link provided and choose the option to "compose your own letter." Cut and paste the letter below or craft your own using the subject line, "Stop the SGR Medicare Cut!" Then, if you have time, call your senator and explain how your ability to see their constituents will be affected by this proposed cut. Your senators' phone numbers can be found using the same APA link under "info."

Dear Senator X:

I am writing as a constituent and neuropsychologist to urge you to pass H.R. 3961, the Medicare Physician Payment Reform Act of 2009.

Congress must take action to prevent the 21.2% cut to provider payments scheduled for 2010 and should permanently replace the Sustainable Growth Rate (SGR) formula. If congress does not take action to prevent the 21.2% cut to provider payments, I may be forced to opt out of Medicare.

If individual practitioners opt out of Medicare, access to care can be adversely impacted for your Medicare constituents. Delays in treatment, denials of treatment, and decreased quality of providers may all be direct consequences attributable to the proposed 21.2% Medicare provider cut. Neuropsychological and rehabilitative services become increasingly important for older adults as the frequency of neurodegenerative disorders (e.g., Alzheimer's and other dementias, movement disorders) and strokes increases. Proposed cuts and yearly battles to postpone the cuts is an untenable situation. It is time for you to be proactive and support a solution which will benefit your professional constituents and the patients we serve who are also your constituents. Medicare beneficiaries, your constituents, who have paid into the program for years, must maintain access to high quality behavioral health services such as neuropsychology. Please pass H.R. 3961.
 
Here is the latest...BTW all salary surveys are still up...but please go into some other specialty if you are that depressed about it.

This came from NAN this week...

Thank you for contacting your house representatives to pass H.R. 3961, which will prevent the 21.2% cut to Medicare to take effect in 2010. Your efforts were successful and the bill passed!!

Now we need to take action again as the senate may vote on this bill as early as tomorrow. Please take 5 minutes and contact your senators with the same message - to pass H.R. 3961. Please use the link from APA to find your senators: http://capwiz.com/apapolicy/home/. After you click on this link, enter your zip code to search for your senators. Your senators will be shown at the bottom of the next page; click on the email link provided and choose the option to "compose your own letter." Cut and paste the letter below or craft your own using the subject line, "Stop the SGR Medicare Cut!" Then, if you have time, call your senator and explain how your ability to see their constituents will be affected by this proposed cut. Your senators' phone numbers can be found using the same APA link under "info."

Dear Senator X:

I am writing as a constituent and neuropsychologist to urge you to pass H.R. 3961, the Medicare Physician Payment Reform Act of 2009.

Congress must take action to prevent the 21.2% cut to provider payments scheduled for 2010 and should permanently replace the Sustainable Growth Rate (SGR) formula. If congress does not take action to prevent the 21.2% cut to provider payments, I may be forced to opt out of Medicare.

If individual practitioners opt out of Medicare, access to care can be adversely impacted for your Medicare constituents. Delays in treatment, denials of treatment, and decreased quality of providers may all be direct consequences attributable to the proposed 21.2% Medicare provider cut. Neuropsychological and rehabilitative services become increasingly important for older adults as the frequency of neurodegenerative disorders (e.g., Alzheimer's and other dementias, movement disorders) and strokes increases. Proposed cuts and yearly battles to postpone the cuts is an untenable situation. It is time for you to be proactive and support a solution which will benefit your professional constituents and the patients we serve who are also your constituents. Medicare beneficiaries, your constituents, who have paid into the program for years, must maintain access to high quality behavioral health services such as neuropsychology. Please pass H.R. 3961.
 
I would have to say don't worry, look its not like psychology is the only field hurting, medicine, dentistry, pharmacy, pretty much ANY medically-related field is hurting, but the fact remains job security will always be there/ Truthfully, many of us might end up doing things we never thought we would want to do, but if money is what is important than maybe suck it up? I am currently at the NIH, and well frankly clinical neuropsychologists make a ton and there are tons of post-doc fellowships, staff positions, etc available. NIMH and NINDS both have huge budgets for funding. Also, ever think of working over-seas? There are plenty of opportunities, especially if you are ok with doing a little research here and there.

Ultimately (or even idealistically) the recession will turn around, more money will be made and all will be fine. don't let panic-stricken members scare you from doing what you want to do, in fact if there is any psych field that has security (aside from I-O psych) its neuro...

Of course if you would like evidence, please PM me and I would be happy to provide it, Im just not going to spam it here in the chat area

Cheers everyone!

Justin
 
I really think your missing the point here. The problems neuropsych is facing, (and im talking clinical practice issues here, those working within NIH dont have to worry about keeping a referal base and the economic realities of PP settings and hospital billing) have little to do with the current recession. Its a problem of reibursement cuts, (which alll insurance providers will quickly follow suite, since they see medicare as setting the bar) and a professional division that prevents us from moving forward at an acceptable pace. If you dont see this, then you are either in an insulated position (ie., NIH) that has little in common with the practice settings most npsych work in, or you're just not paying attention.

Within a non-academic medical center setting (the vast majority of hospitals) npsych is a financial drain on the hospital. You might be turning some profit for them, but its not much. Therefore, its an expendable specialty in many hospitals and clinics. Trust me, i have heard this from more than one than hospital adminstrator. Job security doent mean alot when you cant find one to begin with.

Lastly, we have done a poor job at marketing ourselves and our services, both to the public and to our referal sources. "Weekend warriors" pull down our reps whuch makes PP neurologists less likley to refer. However, where we have been the worst as a profession is actually demostrating that what we do is cost efficient for anyone involved! Across all aspects of health care (of which our little neighborhood is a teensy-weensy part), payors are asking for outcomes data (e.g., cost savings, differences in clinical outcome) with increasing frequency. This is true whether you are discussing surgical procedures, medical procedures, or which medications they will include on their formularies (or the extent to which these medications will be covered for given therapeutic conditions).

Note that "outcomes data" is a completely different animal from "how well does this procedure clarify the diagnosis?" An expensive procedure may well help clarify a muddy diagnostic picture but have minimal impact on either the patient's clinical outcome or the cost of managing the patient. In my experience, if you can demonstrate a very compelling difference in clinical outcome as a result of a procedure, the managed care company will be hard pressed not to cover it unless the cost is just nightmarishly insane (unless you are in Europe, in which case the cost has only to be a little wacky to get denied).

Simply put, we don't have these data. We have data that we can clarify diagnostic thinking, we have position statements from medical societies agreeing with this, and we even have some data that our results can predict some clinically important phenomena (e.g., disruptive behavior on nursing home units, legal competencies). But these are not outcomes data. In the very near future, we are going to need data that demonstrates that patients end up in nursing homes later, live longer, require less in the way of other treatment modalities, etc., if we are going to continue to be paid.

If I am the insurer, I'll be asking questions like "OK, given that most patients diagnosed with dementia never see a neuropsychologist, can you demonstrate the quantifiable clinical or cost benefits of having seen one?" Payment for our services will slowly continue to get uglier until we can answer this question affirmatively.
 
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I really think your missing the point here. The problems neuropsych is facing, (and im talking clinical practice issues here, those working within NIH dont have to worry about keeping a referal base and the economic realities of PP settings and hospital billing) have little to do with the current recession. Its a problem of reibursement cuts, (which alll insurance providers will quickly follow suite, since they see medicare as setting the bar) and a professional division that prevents us from moving forward at an acceptable pace. If you dont see this, then you are either in an insulated position (ie., NIH) that has little in common with the practice settings most npsych work in, or you're just not paying attention.

Im not sure what world you're in, but npsych within a non-academic medical center setting (the vast majority of hospitals) is a financial drain on the hospital. You might be turning some profit for them, but its not much. Therefore, its an expendable specialty in most hospitals and clinics. Trust me, i have heard this from way more than one than hospital adminstrator. Job security doent mean alot when you cant find one to begin with.

Lastly, we have done a poor job at marketing ourselves and our services, both to the public and to our referal sources. "Weekend warriors" pull down our reps whuch makes PP neurologists less likley to refer. However, where we have been the worst as a profession is actually demostrating that what we do is cost efficient for anyone involved! Across all aspects of health care (of which our little neighborhood is a teensy-weensy part), payors are asking for outcomes data (e.g., cost savings, differences in clinical outcome) with increasing frequency. This is true whether you are discussing surgical procedures, medical procedures, or which medications they will include on their formularies (or the extent to which these medications will be covered for given therapeutic conditions).

Note that "outcomes data" is a completely different animal from "how well does this procedure clarify the diagnosis?" An expensive procedure may well help clarify a muddy diagnostic picture but have minimal impact on either the patient's clinical outcome or the cost of managing the patient. In my experience, if you can demonstrate a very compelling difference in clinical outcome as a result of a procedure, the managed care company will be hard pressed not to cover it unless the cost is just nightmarishly insane (unless you are in Europe, in which case the cost has only to be a little wacky to get denied).

Simply put, we don't have these data. We have data that we can clarify diagnostic thinking, we have position statements from medical societies agreeing with this, and we even have some data that our results can predict some clinically important phenomena (e.g., disruptive behavior on nursing home units, legal competencies). But these are not outcomes data. In the very near future, we are going to need data that demonstrates that patients end up in nursing homes later, live longer, require less in the way of other treatment modalities, etc., if we are going to continue to be paid.

If I am the insurer, I'll be asking questions like "OK, given that most patients diagnosed with dementia never see a neuropsychologist, can you demonstrate the quantifiable clinical or cost benefits of having seen one?" Payment for our services will slowly continue to get uglier until we can answer this question affirmatively.

Check out Prigatano's "Clinical Neuropsychology and Cost Outcome Research: A Beginning." This text appears to address your concerns. I have not read the book though so I can't verify the accuracy.

If the book is compelling though I would wonder why the evidence is not better marketed. Presumably it would be favorable to neuropsychology because it is written by a neuropsychologist. But then again, psychology is one of the only fields where current professionals will occasionally argue against the best interest of the field.
 
The way I figure (personally at least), I've got 5-7 years to spend in graduate school working towards my PhD. If clinical neuropsychology does not improve I'm hoping Wisconsin passes RxP. If that doesn't work, and I can't find something else in psychology I like, then I've got some thinking to do. I've thought about Physician Assistant a bit, or I could just do research at a University.

I think part of being successful is being the best psychologist you can and going into your career with a business plan. If you don't go in prepared, you're going to have a bad time (like anything).

Neuropsyance
 
The way I figure (personally at least), I've got 5-7 years to spend in graduate school working towards my PhD. If clinical neuropsychology does not improve I'm hoping Wisconsin passes RxP. If that doesn't work, and I can't find something else in psychology I like, then I've got some thinking to do. I've thought about Physician Assistant a bit, or I could just do research at a University.

I think part of being successful is being the best psychologist you can and going into your career with a business plan. If you don't go in prepared, you're going to have a bad time (like anything).

Neuropsyance

I like your earnest enthusiasm and I believe you should have a straightforward opinion. If you honestly believe that neuropsychology is the ONLY thing you were set on this earth to complete then by all means please pursue the field. We need good people who are dedicated to the craft and advancing the purpose of neuropsychology as a science of equal stature to other doctoral-level healthcare fields. We don't need to have more people who got into the field pal around with cliques at NAN and INS, drinking the free booze with self-satisfied knowledge that they will retire long before the field's reputation and value to the public is bankrupted. The old "I've got mine, screw the next generation" mentality is in full hyperdrive mode with the leadership of today's neuropsychologists.

I have hope for our generation to refocus our field's priorities however. I think the inequities bequeathed on today's generation with leave an indelible impression on the perspective of what the best interests are for neuropsychology and how to convey our strengths to the public.

That being said, let me give you blunt advice and I mean this absolute solemnity: Do not go in this field. JUST DO NOT DO IT.

The amount of work you will do to be successful, the resistance you will face if you are creative, and the low compensation and relative respect you will receive far outweigh any considerations that could charitably attributed to a personal philosophy of altruism. If that statement will offend some folks, I really did not intend that to be the case. Also I do not speak for everyone.

But it sounds like the OP can live with thriving in other jobs and if that is the case than certainly there are other pathways that have more value than clinical psychology.
 
I like your earnest enthusiasm and I believe you should have a straightforward opinion. If you honestly believe that neuropsychology is the ONLY thing you were set on this earth to complete then by all means please pursue the field. We need good people who are dedicated to the craft and advancing the purpose of neuropsychology as a science of equal stature to other doctoral-level healthcare fields. We don't need to have more people who got into the field pal around with cliques at NAN and INS, drinking the free booze with self-satisfied knowledge that they will retire long before the field's reputation and value to the public is bankrupted. The old "I've got mine, screw the next generation" mentality is in full hyperdrive mode with the leadership of today's neuropsychologists.

I have hope for our generation to refocus our field's priorities however. I think the inequities bequeathed on today's generation with leave an indelible impression on the perspective of what the best interests are for neuropsychology and how to convey our strengths to the public.

That being said, let me give you blunt advice and I mean this absolute solemnity: Do not go in this field. JUST DO NOT DO IT.

The amount of work you will do to be successful, the resistance you will face if you are creative, and the low compensation and relative respect you will receive far outweigh any considerations that could charitably attributed to a personal philosophy of altruism. If that statement will offend some folks, I really did not intend that to be the case. Also I do not speak for everyone.

But it sounds like the OP can live with thriving in other jobs and if that is the case than certainly there are other pathways that have more value than clinical psychology.

I do appreciate your viewpoint even though it is somewhat disheartening. With neuropsychology, I have perhaps too much optimism that I would be able to change the way things are going now and change the downward spiral it is heading in. I definitely want to work with the brain's relationship to behavior in some context. Neuropsychology seems the best fit for this and as of now I've been setting myself up for the best chance to be able to be in that field. However, I am learning more and more about the negative aspects of neuropsych. Though it seems this is just about clinical psych in general. So my question is to your last part of your post. What other pathways of similar interests are there that have more value than clinical psychology?
 
I really think your missing the point here. The problems neuropsych is facing, (and im talking clinical practice issues here, those working within NIH dont have to worry about keeping a referal base and the economic realities of PP settings and hospital billing) have little to do with the current recession. Its a problem of reibursement cuts, (which alll insurance providers will quickly follow suite, since they see medicare as setting the bar) and a professional division that prevents us from moving forward at an acceptable pace. If you dont see this, then you are either in an insulated position (ie., NIH) that has little in common with the practice settings most npsych work in, or you're just not paying attention.

Actually I was not missing the point, I was simply pointing out that 1) this isnt the first time something like this has happened in the US economy, 2) its not just happening to neuropsych and 3) there will always be other things that neuropsychologists can do, and if you have not been to the NIH or worked at the NIH then dont banter, there are clearly clinically related positions here that also include research, but there are also positions that have less to do with research (if any research basis, the clinical center here alone has plenty).

Now while I agree that PP in general, not just for neuro, must show why they are important, I dont think perscription privilages is the answer either. I am however saying that inevitably things will turn around, you are also correct to say that the evidence needs to be there for insurers, I would agree most certainly, but that TOO will come.

Suggesting to people to NOT go into the field is ridiculous, just down right absurd, and clearly would not help the situation at all.
 
I truely belive we are a valuable profession, but i really cant prove that with empirical data when asked by the insurance executive. Do you not find that seriously disturbing!? Like I said, can we demonstrate the quantifiable cost benefits of having seen a neuropsychologist?" I mean really, can you? I'm curious to hear your answer to this.This is how we have to start thinking about ourselves and our services! Anecdotal stories and your faith that your making a economic difference dont mean squat to the people who set the CPT code pay scales. Payment for our services will slowly continue to get uglier until we can answer this question affirmatively.
 
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ooops. it looks like the cuts might stay at 20-30%.


ever seen a cpt code go up in value? me either.


i wonder if starbucks is hiring. at least there i won't have to put up with people yelling at me.
 
The amount of work you will do to be successful, the resistance you will face if you are creative, and the low compensation and relative respect you will receive far outweigh any considerations that could charitably attributed to a personal philosophy of altruism. If that statement will offend some folks, I really did not intend that to be the case. Also I do not speak for everyone.

It is good to see a forum where so many diverse opinions can be voiced. I don't know of any appropriately trained neuropsychologist who would agree with the above post. Neuropsychology has the same struggles as every other modern healthcare discipline. However, opportunities for neuropsychologists are better than they have ever been. Concussion guidelines increasingly require neuropsychological testing, the aging population is increasingly concerned about and vulnerable to cogntive disorders, head injuries are the unfortunate hallmark injury of the modern military, objective cognitive measures are a growing industry in the pharmaceutical industry, and the acceptance of neuropsychology as a valid neurodiagnostic procedure has opened tremendous medical-legal opportunities. And, that's only adult neuropsychology. Pediatric neuropsychology seems to be similarly growing and for totally different reasons (increased awareness of autism spectrum conditions, increasingly challenging standards to obtain academic accommodations). As for respect and compensation, both are largely a function of the individual clinician. There are far too many examples of both to argue that either is a problem within the field. The poster is correct that it takes a lot of work to be successful, but I don't know a single neuropsychologist who has left the field because of dissatisfaction with available opportunities or the rewards of the profession.
 
As for respect and compensation, both are largely a function of the individual clinician. There are far too many examples of both to argue that either is a problem within the field.

I think as long as the field isn't dead (like mailing via carrier pigeon), success is largely up to the individual. It may not be as easy to step into a 6-figure job like some of our medical, legal, and business colleagues....we definitely can still do it. A few of my former supervisors do neuro work, and none were hurting for work, and often were turning away work because they didn't want to work 60+ hrs a week.
 
Just to be clear, I dont want to dissuade anyone and I dont think that npsych will be hurting for business/patients in the future either. But the more one ventures outside the academic setting, the more pronouced and severe the practice issues (reibursement, weekend warriors, and neurologists doing neurotrax) seem to be.

To shift the issue slightly, one of my biggest concerns is in regard to our reports and report writing styles. Its so disheartening to see docs flip through the first 5-6 pages of our reports and simply read the summary. I have docs consitently tell me/us "this is all I want/need." After training in a very process oriented clinic, I have come the conclusion that the majority of neurologists and PCPs (especially outside academic settings) simply dont care about all the process issues and observations we write and interpret in our reports. To me, the 10 page process approach reports I had to write last year felt like intellectual masterbation that was only appreciated by the other neuropsychologists in our department. I loved the learning but always wondered if this huge time investment really help the patient more in the end. I really wish there was more a of focus on writing shorter reports that focus more on discussing and extrapolating the functioning of the patient rather than simply differntial diagnosis. Although we do this to some extent of course, I don't think we do very good job of writing about it and expounding on it in our reports. As much as I love the info i can get from full WAISs, full WMSs, and and full DKEFS, etc. I wish there was more a of push to maximize senstivity and specificity with shorter batteries rather than simply clinging to the grueling 7-8 hour batteries. While they offer us more info, I revert back to asking whether this is truley cost efficient/effective for anyone involved. We are having to fight tooth and nail with insurance companies to get reimbursed for that much testing these days and what exactly are the patients getting? As a i said before, "outcomes data" is completely different from "how well does this procedure clarify the diagnosis?" An expensive procedure may help clarify a muddy diagnostic picture but have minimal impact on either the patient's clinical outcome or the cost of managing the patient. I think what we are doing has relatively minimal impact on patients outcome or lowering the cost of the patient's care from that point forward. This is what we need to work on as a profession. If we do not, I think reibursement will continue to get lower and we vey possibly could fall by the wayside in clincal care as 3rd party insurers realize that we are not a cost efficent service.
 
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My report writing style is a bit different than what you described, as there is a big focus on writing a "functional" report. Usually my reports are around 3 pages single spaced, with the focus really being on answering the referral question(s) and providing functional recommendations.

We are limited in our testing time (usually 1.5-2.0 hours), so we have to pick and choose assessments, and try and get as much info up front to inform our choices (having everything electronic is really helpful for grabbing remote data). It isn't ideal, as there is always more I wish I could give to tease out a few more things, but it helps with the turnaround time and I think provides a bit more "value".
 
May I ask why your time is so restricted? I realize that sometimes your alloted time can be limited by other factors outside of your control, especially when working within an interdiciplinary team/clinic such as a WRIISC or polytrauma. But still, 1.5-2 hours? I would be very vocal to your referal sources that this gives time for a good screen, but not a full diagnostic neuropsych eval, especially if TBI is in question. If you are in a full neuropsychology service clinic, who is putting these caps on your time? Isn't it up to you (or your supervisor i suppose) how long the evals take?

My VA practicum was very, very process-oriented and had very long batteries (with exception of our inpatient consult evals), so the short stuff is kinda new for me.
 
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It is good to see a forum where so many diverse opinions can be voiced. I don't know of any appropriately trained neuropsychologist who would agree with the above post. Neuropsychology has the same struggles as every other modern healthcare discipline. However, opportunities for neuropsychologists are better than they have ever been. Concussion guidelines increasingly require neuropsychological testing, the aging population is increasingly concerned about and vulnerable to cogntive disorders, head injuries are the unfortunate hallmark injury of the modern military, objective cognitive measures are a growing industry in the pharmaceutical industry, and the acceptance of neuropsychology as a valid neurodiagnostic procedure has opened tremendous medical-legal opportunities. And, that's only adult neuropsychology. Pediatric neuropsychology seems to be similarly growing and for totally different reasons (increased awareness of autism spectrum conditions, increasingly challenging standards to obtain academic accommodations). As for respect and compensation, both are largely a function of the individual clinician. There are far too many examples of both to argue that either is a problem within the field. The poster is correct that it takes a lot of work to be successful, but I don't know a single neuropsychologist who has left the field because of dissatisfaction with available opportunities or the rewards of the profession.

NeuroPhD, you have outlined areas that neuropsychologists can certainly make an impact and have historically made significant progress. However you make some blanket statements that do not hold up to scrutiny.

Yes we agree that neuropsychologists can make contributions to issues of aging and head trauma. No one disputes these claim. However I made the assertion that the compensation that neuropsychologists receive is small compared to the number of years of schooling in this field and in other professions. Beyond the standard bachelors degree, a neuropsychologist can expect an extra 10 years of schooling (6-7 years graduate school including internship, 2-3 years of post-doc). With the diminished reimbursement from medicare just enacted this should give pause. The statement that compensation is "largely a function of the individual clinician" is a truism. However this does not prevent us from discussing general trends of the field. Those trends are that costs of neuropsychological practice are not keeping pace with inflation.

Moreover you point to the importance of neuropsychological practice with the elderly. Sir, it is with great regret (for both of us) that I must inform you that a recent Institute of Medicine report entitled "Retooling for an Aging America: Building the Health Care Workforce" discussed in the January 2009 issue of the APA Monitor failed to indicate a role for neuropsychologists in the healthcare workforce dealing with the emerging problem of healthcare delivery to the elderly population. This does not bode well for our field.

On the issue of delivery of services to the military I agree there are a number of roles that neuropsychologists can fill. However the field has experienced encroachment of practice by other healthcare fields such as from speech therapists, Occupational therapists, social workers, nurse practitioners, and many other areas. This trend will also likely continue into the military as cost savings remain an important impetus for allocating roles.

I cannot speak to forensics. That is not my area of expertise.

You also have not addressed one of the biggest problems facing psychology in general right now: The internship match imbalance. Sir, a full 25% of psychologists are not matching right now. That is the equivalent of the unemployment rate during the height of the Great Depression. Some of the most qualified and creative individuals are not matching because of a numbers game whereby 75 people may be vying for one of five slots. It is beyond human capacity to adequately assure that the "best man" is selected. That is the basis for my claim that creative individuals may face significant resistance including exclusion by way of not matching.

Essentially, I know you have espoused a view of optimism. But my view is optimistic as well. I believe neuropsychology will eventually gain a more stable foothold in the changing healthcare landscape. But it will only be when neuropsychologists have provided significant proof that their contributions are substantial enough to warrant the extant training and education necessary to obtain a doctorate. The significant medicare cuts and the diminished public perception of need do not strongly support your broad claims. The "appropriately trained neuropsychologist(s) who" disagree with my statements would do well to put their ear to the ground. The field is not doing well. We need to stop the dismissive optimism and face the problems with a realistic perspective.
 
The significant medicare cuts and the diminished public perception of need do not strongly support your broad claims. The "appropriately trained neuropsychologist(s) who" disagree with my statements would do well to put their ear to the ground. The field is not doing well. We need to stop the dismissive optimism and face the problems with a realistic perspective.

There are challenges in neuropsychology, but to say the field is not doing well is just not a common opinion. I would encourage anyone who is interested in neuropsychology to contact several neuropsychologists and ask for a few minutes to talk about the profession. Even better, get involved with your state psych or neuropsych association. This would probably be good advice for the poster above as well. There are senior psychologists who often are willing to spend time helping less experienced psychologists grow a succesful practice.
 
There are challenges in neuropsychology, but to say the field is not doing well is just not a common opinion. I would encourage anyone who is interested in neuropsychology to contact several neuropsychologists and ask for a few minutes to talk about the profession. Even better, get involved with your state psych or neuropsych association. This would probably be good advice for the poster above as well. There are senior psychologists who often are willing to spend time helping less experienced psychologists grow a succesful practice.


Actually, from the vantage poing of members of my spa's listserv, neuropsych is foundering quite a bit. Granted, only 2 neuropsychologists post on there, so I could be wrong.

However, I am curious how you can say neuropsychology is prospering when it just suffered a huge paycut from Medicare, even when compared to the cuts suffered by other medical professions. This cut is especially troubling because a decrease in Medicare funding is known to adversely affect reimbursement from private insurance.
 
Actually, from the vantage poing of members of my spa's listserv, neuropsych is foundering quite a bit. Granted, only 2 neuropsychologists post on there, so I could be wrong.

However, I am curious how you can say neuropsychology is prospering when it just suffered a huge paycut from Medicare, even when compared to the cuts suffered by other medical professions. This cut is especially troubling because a decrease in Medicare funding is known to adversely affect reimbursement from private insurance.

Very true. Your last sentence is the most troubling part. However, look at the most recent salary survey and check out the average hourly rate collected. Medicare rates have always been too low to make up anything more than a small proportion of a private practice. An organized clinician can bill 25-35 hours/week without difficulty. Do the math. Then compare the cost of operating a neuropsychology practice to a dental, podiatric, chiropractic or optometric practice.

It is hard for me to imagine an established, board certified neuropsychologist struggling to do well in a practice.There are just far too many well-paying referral sources that need the objective information provided by neuropsychology.
 
Very true. Your last sentence is the most troubling part. However, look at the most recent salary survey and check out the average hourly rate collected. Medicare rates have always been too low to make up anything more than a small proportion of a private practice. An organized clinician can bill 25-35 hours/week without difficulty. Do the math. Then compare the cost of operating a neuropsychology practice to a dental, podiatric, chiropractic or optometric practice.

It is hard for me to imagine an established, board certified neuropsychologist struggling to do well in a practice.There are just far too many well-paying referral sources that need the objective information provided by neuropsychology.

Out of curiosity, do private practice neuropsychologists typically do their own testing or do they hire others? I just think it would be maddening to administer those tests day in and day out
 
Im sure there is article somewhere regarding how many neuropsychs use psychmetrists. I was one for 2 years at a neuropsych service in an academic medical center before grad school. The biggest advantage to uing techs is being able to utilize your time for reports writing and other odds and ends. Unless you have a thriving practice with a heavy pt flow, I think it would be cost prohibtive in a single practioner PP. Lots of psychometrists are employed at academic med centers and other hospital based services.
 
Out of curiosity, do private practice neuropsychologists typically do their own testing or do they hire others? I just think it would be maddening to administer those tests day in and day out

That information is in the salary survey as well. In most states, neuropsychologists have the option of hiring psychometrists.
 
May I ask why your time is so restricted? I realize that sometimes your alloted time can be limited by other factors outside of your control, especially when working within an interdiciplinary team/clinic such as a WRIISC or polytrauma. But still, 1.5-2 hours? I would be very vocal to your referal sources that this gives time for a good screen, but not a full diagnostic neuropsych eval, especially if TBI is in question. If you are in a full neuropsychology service clinic, who is putting these caps on your time? Isn't it up to you (or your supervisor i suppose) how long the evals take?

Some of it is just an over-abundance of consults/referrals, while other times the people being tested are transitioning somewhere else. It also depends on the referral questions. We try and keep the questions manageable and functional. I prefer the quick turn around, as it keeps things moving, however there have been times I wish I had more assessment hours.
 
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