Alternatives to the Psychologist Path

[jdawgg]

I am about to graduate with an MA in Counseling Psych and am starting to explore my future career options. I had initially planned on obtaining licensure as an LPC and then going on to a funded Counseling Psych PhD program with the intention of becoming a psychologist. After reading many, many messages on this forum and after interviewing some practicing psychologists in various settings, I am now MUCH more wary of taking this path.

It is becoming increasingly apparent to me that (un)professional schools and the APA have not protected the future of psychologists in the face of changes brought on by managed care. Therapy now seems to be conducted mostly by master’s level folks at low reimbursement rates, whereas the ethically problematic RxP movement (distance learning? really?) is progressing very slowly, leaving psychologists with an increasingly shrinking slice of the mental health pie. Creating value for the consumer with such a small slice seems like an exercise in frustration and it only seems to be getting worse as professional schools churn out more and more clinicians with questionable skills.

Beyond the above, I think a lot of the current trouble rests with the fact that mental health and physical health operate in largely separate arenas. One is stigmatized to some extent, the other isn’t. Even though mental and physical health are exceedingly interrelated on a patient level, I don’t know any PCP practices with dedicated mental health practitioners on staff. Of course this is largely due to financial concerns/reimbursement issues, though broad physician lack of understanding of the value in what we actually do also plays a part.

Ultimately, I think integrated behavioral health seems like it’s the future, though structural/financial/turf problems seem to keep this from happening any time soon. So, what to do?

I’m considering going back to school to a direct-entry MSN program with the intention of becoming a psychiatric nurse practitioner. Psych NPs have the ability to prescribe medications independently in my state. This would entail a great deal of money up front, but since psych NPs are reimbursed at 2/3rds the rate of psychiatrists for medication management, such debt could be more easily be paid back than, say, PsyD debt. I eventually envision starting a private practice consisting of medication management and self-pay therapy split 50/50… or perhaps opening a group practice.

I’m also considering ASU’s “Doctor of Behavioral Health” program, which seems to present a model of doctoral direct-service work that is actually tenable, though it’s clearly in its infancy. I don’t know much about this option, as I just learned about it.

Those of you who are currently on the psychologist path, would you do it again? Anyone have first-hand knowledge of ASU’s DBH program? Have any of you obtained licensure as a psych NP as an adjunct to your work as a psychologist?

Other thoughts?

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[positivepsych]

Become a Psychiatrist. It's a long hard road, but you'll be rewarded for it (unlike psychology, which is just as long, but you'll get 1/3 of the freedom/prestige/pay/flexibility).

I wouldn't try to combine the Psychologist + Psychiatric Nurse Practitioner role from the outset, it would be much better to just do the psychiatry route. I only think this is a feasible option if you're already a psychologist.

The Psychiatric Nurse Practitioner option is an interesting one, but I would really explore how widely they are used (in terms of job availability), what their role function is, salary, future of the profession, etc. At this point, it seems niche, and seems like you're really trained to be a nurse first in this role.

DO NOT do the Doctorate in Behavioral Health. That is a BS degree designed for MSWs, MFTs, and other non-doctorate mental health professionals to be able to call themselves "Dr." (that's not just my opinion, that's what their actual ads say in the back of Psychology Today/APA). You're buying a "Dr." title in 18 months for huge amounts of cash, that's it. What a shame how slimy these institutions have become.

Best of Luck.

 

[beaconshome]

I am about to graduate with an MA in Counseling Psych and am starting to explore my future career options. I had initially planned on obtaining licensure as an LPC and then going on to a funded Counseling Psych PhD program with the intention of becoming a psychologist. After reading many, many messages on this forum and after interviewing some practicing psychologists in various settings, I am now MUCH more wary of taking this path.

It is becoming increasingly apparent to me that (un)professional schools and the APA have not protected the future of psychologists in the face of changes brought on by managed care. Therapy now seems to be conducted mostly by master’s level folks at low reimbursement rates, whereas the ethically problematic RxP movement (distance learning? really?) is progressing very slowly, leaving psychologists with an increasingly shrinking slice of the mental health pie. Creating value for the consumer with such a small slice seems like an exercise in frustration and it only seems to be getting worse as professional schools churn out more and more clinicians with questionable skills.

Beyond the above, I think a lot of the current trouble rests with the fact that mental health and physical health operate in largely separate arenas. One is stigmatized to some extent, the other isn’t. Even though mental and physical health are exceedingly interrelated on a patient level, I don’t know any PCP practices with dedicated mental health practitioners on staff. Of course this is largely due to financial concerns/reimbursement issues, though broad physician lack of understanding of the value in what we actually do also plays a part.

Ultimately, I think integrated behavioral health seems like it’s the future, though structural/financial/turf problems seem to keep this from happening any time soon. So, what to do?

I’m considering going back to school to a direct-entry MSN program with the intention of becoming a psychiatric nurse practitioner. Psych NPs have the ability to prescribe medications independently in my state. This would entail a great deal of money up front, but since psych NPs are reimbursed at 2/3rds the rate of psychiatrists for medication management, such debt could be more easily be paid back than, say, PsyD debt. I eventually envision starting a private practice consisting of medication management and self-pay therapy split 50/50… or perhaps opening a group practice.

I’m also considering ASU’s “Doctor of Behavioral Health” program, which seems to present a model of doctoral direct-service work that is actually tenable, though it’s clearly in its infancy. I don’t know much about this option, as I just learned about it.

Those of you who are currently on the psychologist path, would you do it again? Anyone have first-hand knowledge of ASU’s DBH program? Have any of you obtained licensure as a psych NP as an adjunct to your work as a psychologist?

Other thoughts?

First off, if you don't mind me asking, what counseling psych MA program are you in? I am considering this or a MA in clinical psych. I am currently an undergrad with 1 semester of classes left before I graduate. I have been doing A LOT of thinking and I believe I want to go onto a master's program and then onto a doctorate.

With that said, I was in a similar situation as you just a few months ago. I do admit, I am still concerned about the salary I will be making as a psychologist, considering I will be graduating with about $40,000 in debt. However, I believe I am making the right decision on pursuing a doctorate degree in clinical/counseling psychology. You are correct in the fact that more and more master level clinicians are doing the actual therapy with the clients, but psychologists still do some therapy on occasion. I believe they perform more work with diagnostics and assessment compared to one-on-one therapy. In addition, there are many opportunities with a doctorate degree-private practice, group practice, forensics, public health, advertising, etc. I’m sure some of these may not float your boat (mine neither), but if you wanted a private practice or group practice that option is always available. Even at the master’s level in some states.

Regarding the psychiatric nursing (direct entry MSN), I was also faced with this dilemma. I really thought that was the option for me. I needed around 3-4 undergraduate courses in natural sciences to even apply for the programs, but I was almost dead set on doing that. I changed my mind because I thought I wouldn’t be a competitive candidate for the application process, and I thought I may have to do an accelerated BSN program before moving onto an MSN program. I have done a lot of research on these programs, and this too can also be very costly. I suggest if you would like some more information on these programs visit (allnurses.com). It is a great forum with a ton of information. I also had a change of heart, and really wanted to do therapy and assessment instead of just writing prescriptions with limited therapy and hardly any assessment. The money is definitely good ($100,000+ after a few years) and they are in demand as we speak.

The option I am considering for paying for my graduate schooling as a doctorate student (when I get there eventually) is joining the Armed Forces. As a psychologist or doctorate student, you can get a substantial amount of your loans paid off or your tuition paid if you guarantee to severe 3 years after school. If this seems of interest to you maybe you should check it out. Also there are CIA psychologist positions open now, and I only wish I were a psychologist at this moment!

I do not have any information regarding the ‘Doctorate in Behavioral Health’ but it sounds interesting. Sorry.

I hope I helped a tiny bit. Good luck with your decision!!

 

[docma]

The integrated primary care/behavioral health field seems likely to take off in the next decade and it remains to be seen which degrees will be the best path with upward momentum. At the moment, the psychiatric NP is probably the safest, most flexible and lucrative; they are definitely in demand.

The DPH path is definitely interesting but so new that it is too soon to tell and remains to be seen if it will take off beyond the scope of Nick Cummings mentorship at ASU. It is currently restricted to applicants who are already licensed at the master's level though so you need to select a licensure path with your MA/MS, which gives time to see what is unfolding.

 

[Psy01]

DO NOT do the Doctorate in Behavioral Health. That is a BS degree designed for MSWs, MFTs, and other non-doctorate mental health professionals to be able to call themselves "Dr." (that's not just my opinion, that's what their actual ads say in the back of Psychology Today/APA).
You're buying a "Dr." title in 18 months for huge amounts of cash, that's it. What a shame how slimy these institutions have become.

Somehow I doubt their ads read:

The Doctorate in Behavioral Health is a BS degree designed for MSWs, MFTs, and other non-doctorate mental health professionals to be able to call themselves 'Dr.'




Have you actually examined this program, the curriculum, coursework, etc.? Have you done so while keeping any preconceptions and assumptions at bay?

You don't have to bother responding (I'm not looking for your answers), I'm just throwing these out there.

 

[jdawgg]

First off, if you don't mind me asking, what counseling psych MA program are you in? I am considering this or a MA in clinical psych. I am currently an undergrad with 1 semester of classes left before I graduate. I have been doing A LOT of thinking and I believe I want to go onto a master's program and then onto a doctorate...

I'll PM you re: this.

 

[jdawgg]

Somehow I doubt their ads read:

The Doctorate in Behavioral Health is a BS degree designed for MSWs, MFTs, and other non-doctorate mental health professionals to be able to call themselves 'Dr.'




Have you actually examined this program, the curriculum, coursework, etc.? Have you done so while keeping any preconceptions and assumptions at bay?

You don't have to bother responding (I'm not looking for your answers), I'm just throwing these out there.

I second this. While I'm concerned about this particular program on numerous fronts, they make a good case for the integration of behavioral health with primary care. Whether the "DBH" is a good way to go about this is of course up for debate.

From their website...

Why DBH?
PCP’s lack the time or training to provide evidence‐based behavioral interventions.

Patients with underlying behavioral conditions are very common in primary care, but rarely offered behavioral interventions that are evidence‐based and the follow‐up needed to insure good outcome.

PCP’s report they have more time to spend on patients with medical conditions when they are able to handoff behavioral cases to the DBH clinician.

Patients with somatization or co-morbid medical and behavioral conditions have much higher costs than the average patient and focused behavioral interventions have demonstrated both improvement and significant cost savings for these patients.

Referrals to specialty behavioral care are a source of frustration with many PCP’s, and issues such as stigma and barriers to care result in many patients who are referred to specialty behavioral care not connecting, and for those who do no feedback to the PCP on treatment progress.

Patients prefer to receive behavioral treatment in their primary care office, with much better engagement compared to referral out.


Over 80% of primary care patients will accept a referral for behavioral care in the PCP office, while referrals to outside specialty behavioral result in as few as 10% accepting the referral 2,3,4.

 

[Therapist4Chnge]

Some hospitals already have a full-integrated primary care...using health psychologists. Treating patients while they are in for check-ups is a win/win. I am very much against the degree mentioned above.

I was reading an interview posted in another thread and came upon this:

Kaiser got interested in psychotherapy because they found out that 60 to 70 percent of their physician visits in primary care had psychological, not medical, conditions. So we decided to follow these people the year after they'd been in, the second year after, the third year, and see what their overutilization of health care was, because they would be running to the doctor when they actually had psychological problems. We found that we were reducing medical overutilization by 65 percent within five years after the initial contact, with no further therapy. And that's how the medical cost offset attracted the National Institute of Mental Health, the Veterans Administration, and so forth. We started a series of research.

http://www.psychotherapy.net/interview/Nick_Cummings

 

[jdawgg]

Some hospitals already have a full-integrated primary care...using health psychologists. Treating patients while they are in for check-ups is a win/win. I am very much against the degree mentioned above....

I'm concerned about Nick Cummings' involvement with this, but I'm wondering... why, specifically, are you against the program? The implication that 5 - 7 years of education is not required to do such work?

 

[ClinPsycMasters]

I am about to graduate with an MA in Counseling Psych and am starting to explore my future career options. I had initially planned on obtaining licensure as an LPC and then going on to a funded Counseling Psych PhD program with the intention of becoming a psychologist. After reading many, many messages on this forum and after interviewing some practicing psychologists in various settings, I am now MUCH more wary of taking this path.

It is becoming increasingly apparent to me that (un)professional schools and the APA have not protected the future of psychologists in the face of changes brought on by managed care. Therapy now seems to be conducted mostly by master's level folks at low reimbursement rates, whereas the ethically problematic RxP movement (distance learning? really?) is progressing very slowly, leaving psychologists with an increasingly shrinking slice of the mental health pie. Creating value for the consumer with such a small slice seems like an exercise in frustration and it only seems to be getting worse as professional schools churn out more and more clinicians with questionable skills.

Beyond the above, I think a lot of the current trouble rests with the fact that mental health and physical health operate in largely separate arenas. One is stigmatized to some extent, the other isn't. Even though mental and physical health are exceedingly interrelated on a patient level, I don't know any PCP practices with dedicated mental health practitioners on staff. Of course this is largely due to financial concerns/reimbursement issues, though broad physician lack of understanding of the value in what we actually do also plays a part.

Ultimately, I think integrated behavioral health seems like it's the future, though structural/financial/turf problems seem to keep this from happening any time soon. So, what to do?

I'm considering going back to school to a direct-entry MSN program with the intention of becoming a psychiatric nurse practitioner. Psych NPs have the ability to prescribe medications independently in my state. This would entail a great deal of money up front, but since psych NPs are reimbursed at 2/3rds the rate of psychiatrists for medication management, such debt could be more easily be paid back than, say, PsyD debt. I eventually envision starting a private practice consisting of medication management and self-pay therapy split 50/50… or perhaps opening a group practice.

I'm also considering ASU's "Doctor of Behavioral Health" program, which seems to present a model of doctoral direct-service work that is actually tenable, though it's clearly in its infancy. I don't know much about this option, as I just learned about it.

Those of you who are currently on the psychologist path, would you do it again? Anyone have first-hand knowledge of ASU's DBH program? Have any of you obtained licensure as a psych NP as an adjunct to your work as a psychologist?

Other thoughts?

Wow, I would never consider psychiatric nurse practitioner. It's one thing to open your private practice and see patients, and another to deal with psychiatric patients in a hospital setting. I couldn't handle it.

If I were to consider an alternate career path, it'd be human resources, specially if you specialize in development and training.

 

[Guelker]

Admittedly I know little about the DBH training model, requirements, or career path but I have to in general wonder why, as a field we are continuously adding new ways to do the same job? In any case, if there is a mental illness/adjustment/behavioral problem/whatever, it should be handled by someone trained in that area and those who are not comfortable (or capabale) with treating it (primary care docs, whomever) are ethically bound to recommend them to the appropriate people...no matter how inconvenient that may be. However if new schools/training models continue to develop with lower admission standards, less training, and minimal training time committments we are cheating those individuals who are getting their training in the way originally put forth. If, as a field we continue this path we are going to essentially allow ourselves to be bought out of existence.

I fully agree with the qualitative difference between a psychiatrist and a psychologist...to expect someone to be 100% competent in and always keep on top of all things medical/medicine and all available and developing ESTs is unrealistic and I believe there is a reason for both roles. If you want to split PhDs and PsyDs for research vs. practice reasons I can see it (don't like it, but with better integration it could be justified). However, you bring in more "therapists" with lower qualifications and less school and it makes everyone else obsolete...not to mention would be rediculous by the standards of other fields

Take the dental field...Dentists are specifically trained to do what they do with teeth How would it be accepted if I came in and said I'll start a training program for Dental Health Specialists that can do all the same things as dentists but are cheaper...and by the way, I accepted twice as many applicants as dental schools, had lower standards, and trained them in 1/3 the time. You want that person in your mouth? The reality is that our standards need to be consistent for the good of our patients and the sake of the field. All therapists should be trainined in the same way, with the same expectations and expected to maintain their competencies (stay on top of ESTs and use them..seperate issue)...isn't that the point of accredidation? But if that's not required then what are we doing anyway?

Granted, I'm just a lowly third year clinical PhD student and have officially been broken down to the point where I still have opinions but know I'm usually wrong, so I recognize this will likely anger some...sorry and not intentional. I just think we have a major field related problem that doesn't have a solution...but I'd rather see people be a part of the solution than add to the problem.

 

[LM02]

There are a lot of solid psychiatric nurse practitioners who work in the community where I live, and are very busy in their outpatient practices. I've seen them in the psychiatric day hospital, in psychiatry practices, and community mental health settings. Several of my outpatients actually have their meds managed by an NP, and by and large, they seem to be getting good care.

I think it may be a regional thing, because I would never describe their practice as "niche."

 

[Psy01]

Admittedly I know little about the DBH training model, requirements, or career path but I have to in general wonder why, as a field we are continuously adding new ways to do the same job?

...

However if new schools/training models continue to develop with lower admission standards, less training, and minimal training time committments we are cheating those individuals who are getting their training in the way originally put forth.

The DBH pipeline is about 55 credits post-master's. Which would mean total graduate coursework would be around 115, which is commensurate with other doctoral programs.

Also, I am not aware of how stringent their admission standards are, but don't just assume they're low/er. (I'm not sure if you actually are, but I'll just say that anyway.) Also keep in mind that different standards don't mean inferior.

Can you explain what you mean by this sentence a bit more?

we are cheating those individuals who are getting their training in the way originally put forth.

I'm not sure if I understand your precise angle.

 

[jdawgg]

Take the dental field...Dentists are specifically trained to do what they do with teeth How would it be accepted if I came in and said I'll start a training program for Dental Health Specialists that can do all the same things as dentists but are cheaper...and by the way, I accepted twice as many applicants as dental schools, had lower standards, and trained them in 1/3 the time. You want that person in your mouth? The reality is that our standards need to be consistent for the good of our patients and the sake of the field. All therapists should be trainined in the same way, with the same expectations and expected to maintain their competencies (stay on top of ESTs and use them..seperate issue)...isn't that the point of accredidation? But if that's not required then what are we doing anyway?

To continue this metaphor, I don't know about you, when I go to the dentist's office, I only spend about five minutes with the actual dentist unless I have a major problem. The rest of my time is spent with a dental hygenist. Going to a dentist rather than hygenist to get your teeth cleaned is overkill and so is going to a psychologist for most issues in therapy. Therapy isn't rocket science and no studies have proven psychologists have better therapeutic outcomes than social workers or MFTs. This isn't to say that psychologists don't have an important role in mental health (one that can't be effectively fufilled by master's level folks). This is a supply and demand issue... there are too many psychologists given their increasingly limited (though still clearly important) role... which is why i'm not interested in taking that path and am looking for specialized roles that are actually in demand.

 

[docma]

Outside of the primary care/behavioral health domain, you might also look at early childhood primary intervention (both assessment and family system/parenting intervention and education) and vocational/occupational/rehabilitation domains. With the changing economy and returning veterans there is going to be demand for skilled assessment and counseling focused on functional abilities/strengths. A counseling MS/MA gives you foundation skills here and you could talk to people doing the jobs above and find out what the credential paths are that employers seek. Gerontology-related jobs will also be growing.

 

[AnnoyedByFreud]

.

 

[justme08]

Sorry, I don't know about the DBH, but I do know about the PNP role. I too orginally planned to go this route; however, I didn't desire to take on the school debt, and there is no way to work in one of the accelerated programs. I was looking to go BSN to MS though.

I know there is demand, and the pay is . School will be costly though, and unless you have someone else to support you while in school you will need to take on additional debt for living expenses as well. If I did not have a family that needed me to bring in money I still might have gone this route. You will earn an RN on the way to your MSN, so you will be busy (in an accelerated or direct entry program).

But, yes, you need to be interested in med management if you are looking at this, as of course that is where the majority of the money and work is at. Also, I've been told by many that they did not feel as well trained in therapy aspects of the job.

I work at a place that hosts NP students on a rotation. So, I've met many students and NPs. It really is not a bad job, but if you are looking for a therapy oriented job it doesn't seem to be that (but, again, who knows this could change as well). And since you already have an MA this likely won't be an issue for you. There is another poster here, I think it's Medium Rare, or something close, that has a PhD and then went the NP route. They can probably provide you even more insight.

If you are thinking of going this route in the near future NPs will have to be at the PhD level and no longer masters (of course people will be grandfathered in).

 

[Therapist4Chnge]

I'm concerned about Nick Cummings' involvement with this, but I'm wondering... why, specifically, are you against the program? The implication that 5 - 7 years of education is not required to do such work?

I didn't mean to imply I support his views or his prior business/professional dealings...I was merely commenting on the benefits of integrating Behavioral Health services into a Primary Care setting.

As an earlier poster wrote, it makes little sense to keep inventing new degrees/positions when there are existing professions that can fill that role as well or better. I think of this degree like I do the DNP....it is a compromise of a number of different disciplines, doing none of them particularly well.

I have worked in a PC department as the BH person, and it is a great opportunity for folks who are able to thrive in a medical setting. It isn't the easiest place to work because there are a lot of "hurry up and wait" experiences, and you are often tasked with vague consults for complex cases. Most of my cases fell into one of three catagories: Suicide assessment, capacity/competency assessment, We have no idea...help!

My background training is neuro/rehab assessment, so I felt very comfortable handing the first two areas....though the third area was a challenge because I had to be strong across realms. While I'd like to think I could handle everything thrown at me, utilizing various team members to handle rule-outs is really the only way to competently handle those cases. This degree may argue that the professional can be a jack of all trades, but I think he'd more likely be a master of none. They have Primary Care fellowships for psychologists, with Michigan State having arguably the top one in the country (2 years). There is also a 1-yr PC fellowship out of Boston. Completing a fellowship in the area should produce a well-rounded clinician who could handle most any BH issue in the PC setting. The VA implemented a new position aimed at psychologists that looks at integrating BH into various medical dept.

 

[PHinisheD]

Jdawgg: Bravo on doing due diligence before investing 4-5 years on a clinical PhD. I wish I'd done the same. I'm bearish on the future of the profession, for many of the same reasons you are.

You said that you looked at this message board and talked to a lot of psychologists before arriving at that conclusion. Why not do similar research with psychiatrists and psych NP's? They'd probably be better to speak to the pros and cons of those other paths. Personally, I'd be really curious to know what their perspectives are and whether they are similarly pessimistic about their fields.

 

[edieb]

Being a newly-minted Ph.D. in clinical psychology, there is no doubt in my mind that the field is dying. therefore, I would RUN, not walk, from this field. However, don't just take my opinion, look at the facts:

1 - Salaries of doctoral level psychologist have precipitously dropped in the last 10 years (APA, 2010)

2 - There are fewer and fewer jobs available with more and more people being churned out of professional schools.

3 - The belief that health psychologist will be hired in primary care facilities is a joke. The only places that hire health psychologists are academic medical centers and the V.A. There will be an "integration" of behavioral health care and mental health; however, the hospitals will hire social workers/counselors, not Ph.D.s Why? Because psychologists cannot bill insurance at a much higher rate than master's level practitioners. Therefore, psychologists cannot generate enough revenue to justify a higher salary. Hospials are all about the bottom line. Therefore, why would they higher a Ph.D.?

4 - Now ASU is training master's levels to compete with psychologists. After 7 years of training, I still don't feel competent as a psychologist. Most psychologists whom I see aren't as competent as they could be, either. Research out of Yale shows that 99% of therapsists practicing CBT don't practice it with enough fidelity to the original model or vigorously enought to affect patient care.

Therefore, if PhDs aren't fully competent after all this training, how can a person with 1-2 extra years of training be good at what they do?

5 - People talk about how wonderful the V.A. is. However, here is my experience: you see 8+ patients/day and have an immense amount of paperwork and reminders to complete, not to mention all the meetnigs. I am lucky if I see the same patient 3 times in 6 months. The motto at my V.A. is 'case managment, not therapy." The psychiatrists here get better benefits (double the days off), a TON more pay (most are locum tenens). The $58K you get as a PhD looks a lot better before you get your first paycheck.

 

[PHinisheD]

3 - The belief that health psychologist will be hired in primary care facilities is a joke. The only places that hire health psychologists are academic medical centers and the V.A. There will be an "integration" of behavioral health care and mental health; however, the hospitals will hire social workers/counselors, not Ph.D.s Why? Because psychologists cannot bill insurance at a much higher rate than master's level practitioners. Therefore, psychologists cannot generate enough revenue to justify a higher salary. Hospials are all about the bottom line. Therefore, why would they higher a Ph.D.?

4 - Now ASU is training master's levels to compete with psychologists. After 7 years of training, I still don't feel competent as a psychologist. Most psychologists whom I see aren't as competent as they could be, either. Research out of Yale shows that 99% of therapsists practicing CBT don't practice it with enough fidelity to the original model or vigorously enought to affect patient care.

Therefore, if PhDs aren't fully competent after all this training, how can a person with 1-2 extra years of training be good at what they do?

5 - People talk about how wonderful the V.A. is. However, here is my experience: you see 8+ patients/day and have an immense amount of paperwork and reminders to complete, not to mention all the meetnigs. I am lucky if I see the same patient 3 times in 6 months. The motto at my V.A. is 'case managment, not therapy." The psychiatrists here get better benefits (double the days off), a TON more pay (most are locum tenens). The $58K you get as a PhD looks a lot better before you get your first paycheck.

I'd have to agree. I spend my last two years of grad school poring through internship brochures from VA's and medical centers that were promoting B Med internships, believing that B Med was this burgeoning field. I never really questioned who was writing those brochures, or why they might not be entirely truthful.

Having since met healthcare providers at other, non-academic medical settings, I've come to find out that psychologists are generally seen as interchangeable with other MH providers--or simply dispensable. Having a psychologist in a med clinic is seen as a luxury. Our services are very much appreciated, but if budgets are tight, we're the first to go.

Of course, some psychologists will have great success at convincing healthcare orgs of their value . But, personally, it's not how I want to build my career.

 

[ClinPsycMasters]

Being a newly-minted Ph.D. in clinical psychology, there is no doubt in my mind that the field is dying. therefore, I would RUN, not walk, from this field. However, don't just take my opinion, look at the facts:

1 - Salaries of doctoral level psychologist have precipitously dropped in the last 10 years (APA, 2010)

2 - There are fewer and fewer jobs available with more and more people being churned out of professional schools.

3 - The belief that health psychologist will be hired in primary care facilities is a joke. The only places that hire health psychologists are academic medical centers and the V.A. There will be an "integration" of behavioral health care and mental health; however, the hospitals will hire social workers/counselors, not Ph.D.s Why? Because psychologists cannot bill insurance at a much higher rate than master's level practitioners. Therefore, psychologists cannot generate enough revenue to justify a higher salary. Hospials are all about the bottom line. Therefore, why would they higher a Ph.D.?

4 - Now ASU is training master's levels to compete with psychologists. After 7 years of training, I still don't feel competent as a psychologist. Most psychologists whom I see aren't as competent as they could be, either. Research out of Yale shows that 99% of therapsists practicing CBT don't practice it with enough fidelity to the original model or vigorously enought to affect patient care.

Therefore, if PhDs aren't fully competent after all this training, how can a person with 1-2 extra years of training be good at what they do?

5 - People talk about how wonderful the V.A. is. However, here is my experience: you see 8+ patients/day and have an immense amount of paperwork and reminders to complete, not to mention all the meetnigs. I am lucky if I see the same patient 3 times in 6 months. The motto at my V.A. is 'case managment, not therapy." The psychiatrists here get better benefits (double the days off), a TON more pay (most are locum tenens). The $58K you get as a PhD looks a lot better before you get your first paycheck.

what would you recommend instead though? I have my master's and I already regret having chosen this path. I'm thinking of social work, human resources, etc, something meaningful but with decent pay and somewhat brighter future.

 

[psich]

Being a newly-minted Ph.D. in clinical psychology, there is no doubt in my mind that the field is dying. therefore, I would RUN, not walk, from this field. However, don't just take my opinion, look at the facts:

1 - Salaries of doctoral level psychologist have precipitously dropped in the last 10 years (APA, 2010)

2 - There are fewer and fewer jobs available with more and more people being churned out of professional schools.

3 - The belief that health psychologist will be hired in primary care facilities is a joke. The only places that hire health psychologists are academic medical centers and the V.A. There will be an "integration" of behavioral health care and mental health; however, the hospitals will hire social workers/counselors, not Ph.D.s Why? Because psychologists cannot bill insurance at a much higher rate than master's level practitioners. Therefore, psychologists cannot generate enough revenue to justify a higher salary. Hospials are all about the bottom line. Therefore, why would they higher a Ph.D.?

4 - Now ASU is training master's levels to compete with psychologists. After 7 years of training, I still don't feel competent as a psychologist. Most psychologists whom I see aren't as competent as they could be, either. Research out of Yale shows that 99% of therapsists practicing CBT don't practice it with enough fidelity to the original model or vigorously enought to affect patient care.

Therefore, if PhDs aren't fully competent after all this training, how can a person with 1-2 extra years of training be good at what they do?

5 - People talk about how wonderful the V.A. is. However, here is my experience: you see 8+ patients/day and have an immense amount of paperwork and reminders to complete, not to mention all the meetnigs. I am lucky if I see the same patient 3 times in 6 months. The motto at my V.A. is 'case managment, not therapy." The psychiatrists here get better benefits (double the days off), a TON more pay (most are locum tenens). The $58K you get as a PhD looks a lot better before you get your first paycheck.

It is indeed discouraging that these are the facts of the profession right now, but does it mean that a person should cross off a PhD in clinical psychology? Is there any way for the field to regain some strength and credibility within the next few years?

 

[Psy01]

Now ASU is training master's levels to compete with psychologists. After 7 years of training, I still don't feel competent as a psychologist. Most psychologists whom I see aren't as competent as they could be, either. Research out of Yale shows that 99% of therapsists practicing CBT don't practice it with enough fidelity to the original model or vigorously enought to affect patient care.

Therefore, if PhDs aren't fully competent after all this training, how can a person with 1-2 extra years of training be good at what they do?

Maybe there's something going on with the PhD-style of training. And maybe a different approach might be something good.

Research out of Yale shows that 99% of therapsists practicing CBT don't practice it with enough fidelity to the original model or vigorously enought to affect patient care.

You have a reference for this?

"Original" as in the Beckian-style approach?

 

[Psy01]

I have my master's and I already regret having chosen this path.

Why? And what does your job entail?

 

[Psy01]

For those who generally agree that the field is in huge trouble (or even dying), what would you recommend to people? I've seen a lot say that those who want to focus on therapy should just do a master's. Is this the consensus?

 

[psich]

I don’t know if I would say the field is dying, but it is definitely not in good shape right now. It’s a shame that external factors (such as insurance companies) are determining the standard of education in mental health. Since the market and overall outlook for doctoral level psychologists is not exactly bright right now, many people are moving towards master’s level positions that have a better outlook. And the main reason things look better for them is because many insurance companies prefer master’s level practitioners over psychologists because they are cheaper. Every profession has its place, but it’s disappointing that the future of clinical mental health is based on profits and not on quality of training.

 

[ClinPsycMasters]

Why? And what does your job entail?

I do neuropsych assessments (which take forever and are mind-numbing) right now and do a bit research on the side. Essentially I have no control over how often or when or how much I get paid. I want to open my own practice, to divide my time between therapy, research, and teaching, to be more in control of my future, have more job security, better pay, etc. I don't mind assessments either but not a six-hour neuropsych one...nothing longer than sixty minutes.

Can't do that with masters in clin psych.

 

[RNtoPharmD]

....

 

[PHinisheD]

For those who generally agree that the field is in huge trouble (or even dying), what would you recommend to people? I've seen a lot say that those who want to focus on therapy should just do a master's. Is this the consensus?

For a therapist, a doctoral degree can help, but it is not necessary or sufficient for success. And a dissertation is no picnic--especially when you have no interest in research. I think that if you are certain that you solely want to do therapy, then a master's in psych, or an MFT or LCSW, would be a preferable way to go. Requirements varies by state, so talk to some folks near you and find out who is able to practice independently.

 

[PHinisheD]

I don’t know if I would say the field is dying, but it is definitely not in good shape right now. It’s a shame that external factors (such as insurance companies) are determining the standard of education in mental health. Since the market and overall outlook for doctoral level psychologists is not exactly bright right now, many people are moving towards master’s level positions that have a better outlook. And the main reason things look better for them is because many insurance companies prefer master’s level practitioners over psychologists because they are cheaper. Every profession has its place, but it’s disappointing that the future of clinical mental health is based on profits and not on quality of training.

It is a shame that the outlook is not better. It reeeally sucks. But, given that we have a free market healthcare system (ok, well, that's debatable. but anyway...), the system is only going to pay for what it deems valuable. Healthcare and insurance administrators have no concern for our profession's place--nor should they. They care about outcomes and budgets, and they are rightly taking advantage of the glut of MH providers by offering lower salaries.

If we want to justify more training and more income for the doctoral degree, we need to demonstrate why our services are worth more than the master's level folks'. What did we learn in those extra years of school? What did the dissertation teach us? Can we demonstrate some competencies that master's level people lack? Do we have stringent testing standards with good content validity?

As long as we can't say yes to these questions, we can't advocate convincingly for the doctoral degree.

 

[Rivi]

2 - There are fewer and fewer jobs available with more and more people being churned out of professional schools.

Where is the evidence that psychologist positions are decreasing? I am not saying you are wrong or anything, I am just curious if there are any articles or if there is anything out there to support this idea.

 

[docma]

The historical and current economic perspective are both so important in this discussion. It is also critical to think on an individual level about what do you want to be doing in your daily work life and what do you need (in contrast to want) to be earning? Sorting out goals and options does take individual research (so if you are someone who doesn't like "research" you will need to overcome that.) I wish graduate programs were more proactive in helping students get that process started--but even when they are, the actual final goal setting and finding of work is up to each of us to meet individual needs. The topic does generate anxiety. The original poster is really doing the needed work and it is important to stay on that tack...and not get sidetracked into blame or regret.

Discussion boards in other professional tracks are also lamenting similar themes to these; there is no perfect profession. Psychology is a field with vast potential and the world is full of needs to be met. You have to find a path that works for you and path finding in these times can be tough but people do it. Part of the key is to stay open to options and the other is really know yourself, your limitations, and your skills

 

[Psy01]

I'm concerned about Nick Cummings' involvement with this

Why is that?

 

[PHinisheD]

Well, he did start the professional school nonsense, which suggests whatever he is currently peddling if probably some sort of sham.

To his credit, Cummings acknowledges that the professional school movement didn't turn out as planned. As he says in this interview, "It has failed."

http://www.psychotherapy.net/interview/Nick_Cummings

But I get your point. When it comes to new types of doctoral degrees, I wouldn't be an early adopter.

 

[Therapist4Chnge]

As a businessman, I don't begrudge his willingness to capitalize on opportunities and profit, however as a psychologist I take issue with anything that can harm the profession. Supporting anything that is direct competition to the profession, particularly something that attempts to undermine the profession by offering a "lesser" training, is a problem (in my opinion).

 

[Psy01]

To his credit, Cummings acknowledges that the professional school movement didn't turn out as planned. As he says in this interview, "It has failed."

This was something I was just thinking about. Is it that the pro schools were lousy in both conception and eventual outcome, or was the idea good and the outcome deviated from the original intentions?

 

[Psy01]

Supporting anything that is direct competition to the profession, particularly something that attempts to undermine the profession by offering a "lesser" training, is a problem (in my opinion).

Are you suggesting deliberate attempts to "undermine" clin psy, or are you just saying that it can undermine by providing competition. (I think you're suggesting the latter, but I just want to confirm.)

Further, why would you call it "lesser" training?

Note that the DBH program is within a university and not an independent, professional school setting. Perhaps it would be fairer to compare it to PsyD programs within universities (eg Rutgers or Baylor) than freestanding PsyD programs in professional schools.

 

[medium rare]

As someone who is both (clinical psychologist and psych NP), I can tell you firsthand the differences in the market between the two. The psych NP will give you MUCH more bang for your buck although you'll be better trained in many ways as a psychologist.

For example, in my city I could make a phone call to the Medical Director of any one of a number of CMHCs and command a starting salary of at least $125-$130K for full-time work as a psych NP. Psychologists in these places barely exist and most who are there are in administrative or supervisory roles. They would be happy to hire a psychologist to do therapy, but they would pay according to their pay scale for Master's level therapists who start at about $37,000K. So you do the math...

Private practice is harder for most psych NPs because many private insurers reimburse at the same rate as other Master's level providers (LCSW, LPC, LMFT, etc). In some states you have to bill Medicare and some Medicaid under a physician's number so getting reimbursed can be tricky if you're on your own. Most of the psych NPs here have told me that it doesn't make sense for them to do private practice because they can make more as a salaried employee and not have to deal with the stress of establishing and running a business. It's pretty much the other way around for psychologists; the only real place left to possibly make decent money is private practice.

The quagmire of the situation is that you will be much better trained in most aspects of behavior and mental health as a psychologist but you will not necessarily be appreciated for it nor will you likely be compensated accordingly. This has been frustrating for me at times. The psych NP opened many doors, but my NP training left a lot to be desired when it came to pretty much anything beyond the medical aspects of mental healthcare - e.g. prescribing, H&Ps, labs, pathophysiology, r/o of co-mordid medical conditions. DO NOT expect to do therapy as a psych NP; you will be utilized in largely the same capacity as a psychiatrist. And, don't expect to get good therapy training as a psych NP - many programs don't even touch on it. And psych assessment? Forget it.

And to the OP, you mention the low, questionable standards of current Rx training? Then by the same reasoning, stay far, far away from the DBH program at ASU. I know many of the folks involved in starting the program and it is basically a joke - with a considerable amount of on-line learning also included. The program most likely will not lead to psychology licensure (as was originally touted) and you're left with a glorified Master's degree with questionable standards. Buyer beware.

 

[Psy01]

I know many of the folks involved in starting the program and it is basically a joke

Could you please expound?

 

[Manicsleep]

I am about to graduate with an MA in Counseling Psych and am starting to explore my future career options. I had initially planned on obtaining licensure as an LPC and then going on to a funded Counseling Psych PhD program with the intention of becoming a psychologist. After reading many, many messages on this forum and after interviewing some practicing psychologists in various settings, I am now MUCH more wary of taking this path.

It is becoming increasingly apparent to me that (un)professional schools and the APA have not protected the future of psychologists in the face of changes brought on by managed care. Therapy now seems to be conducted mostly by master’s level folks at low reimbursement rates, whereas the ethically problematic RxP movement (distance learning? really?) is progressing very slowly, leaving psychologists with an increasingly shrinking slice of the mental health pie. Creating value for the consumer with such a small slice seems like an exercise in frustration and it only seems to be getting worse as professional schools churn out more and more clinicians with questionable skills.

Beyond the above, I think a lot of the current trouble rests with the fact that mental health and physical health operate in largely separate arenas. One is stigmatized to some extent, the other isn’t. Even though mental and physical health are exceedingly interrelated on a patient level, I don’t know any PCP practices with dedicated mental health practitioners on staff. Of course this is largely due to financial concerns/reimbursement issues, though broad physician lack of understanding of the value in what we actually do also plays a part.

Ultimately, I think integrated behavioral health seems like it’s the future, though structural/financial/turf problems seem to keep this from happening any time soon. So, what to do?

I’m considering going back to school to a direct-entry MSN program with the intention of becoming a psychiatric nurse practitioner. Psych NPs have the ability to prescribe medications independently in my state. This would entail a great deal of money up front, but since psych NPs are reimbursed at 2/3rds the rate of psychiatrists for medication management, such debt could be more easily be paid back than, say, PsyD debt. I eventually envision starting a private practice consisting of medication management and self-pay therapy split 50/50… or perhaps opening a group practice.

I’m also considering ASU’s “Doctor of Behavioral Health” program, which seems to present a model of doctoral direct-service work that is actually tenable, though it’s clearly in its infancy. I don’t know much about this option, as I just learned about it.

Those of you who are currently on the psychologist path, would you do it again? Anyone have first-hand knowledge of ASU’s DBH program? Have any of you obtained licensure as a psych NP as an adjunct to your work as a psychologist?

Other thoughts?

Our group currently employs 2 NPs with psychology backgrounds (masters not PhDs). They are VERY good and get paid more than our PhD psychologists who have extra fellowships and are boarded.

Baseline salary is only around 90k but productivity adds a lot and on call bonuses can more than double that amount. Both make more than the baseline salary offered at the local VA for a psychiatrist.

This is a very good way to go, you will be respected by psychiatrists, nurses and psychologists. The pay is good and you are in a good place to help patients.

 

[Molls]

I have talked to some friends in the health field and they all tell me to do nursing because of the huge demand. I have worked in a hospital (in HR) and have a economics background but want to change careers as it is going nowhere even though I graduated from an excellent school.

I took some very limited psychology classes and some basic science classes (and some AP classes in high school) in college. I am in my 30s now and think the medical school route is too much, I can work hard during the day but I need to sleep at least a few hours every day.

I have thought about nursing and psychology (and accounting but thats another story). Advice?

 

[Psy01]

If you are thinking of going this route in the near future NPs will have to be at the PhD level and no longer masters (of course people will be grandfathered in).

Not PhD, it will be Doctor of Nursing Practice (DNP), in 2015.

To be grandfathered, would one have to be fully licensed and practicing as an NP? What about about, say, people that are in the midst of the current NP programs come 2015?

 

[deleted176373]

Being a newly-minted Ph.D. in clinical psychology, there is no doubt in my mind that the field is dying. therefore, I would RUN, not walk, from this field. However, don't just take my opinion, look at the facts:

Wow, dismal.

It's not that bad. You just have to do it carefully, like any other profession.

...

You have to do it right. I know in other threads I have suggested that medical school is a better path (and I think, on average it is, for a few reasons) and that psychology is harmed by the existence of professional schools and pressures from midlevels (this is true). But, there are many professions that have much greater pressures and problems that are still considered to be good professions (e.g., law). Psychology is often ranked in top 25 lists for desirable professions.

For those who generally agree that the field is in huge trouble (or even dying), what would you recommend to people? I've seen a lot say that those who want to focus on therapy should just do a master's. Is this the consensus?

There is a lot of good information in the above posts, but what would I recommend, I would recommend along with Jon that you think very carefully about your career path and whether it makes sense. For a great many people it won't!

I don't think that in hindsight that I would go down this path today unless I was doing it with the advantages that I have from a fully funded government program that pays me a salary and guaranteed me not only a high paying internship opportunity but also a high paying job to follow. Yes, there are opportunities, but there are fewer and fewer places each year that offer great training and a substantial income to newly minted psychologists.

I know that once back in the private sector I will be facing the same problems in the field that I am currently insulated from. It is not a prospect that I am looking forward to.

Mark

 

[Manicsleep]

Have you considered an accelerated nursing program MSN/BSN to get you started?

This doesn't take that long, the payback is large and you can get a hands on feel for nursing. You can then decide if DNP/PA/PhD/MD or whatever is right for you.
Also, with your MH background, you would probably find that you have a much easier time with administrative work even if you decide not to go the DNP route. You may want to consider an MBA/MPH. The director of our program is a masters level therapist with a BSN and an MBA....very anecdotal but she seems to have a foot in each door and is very effective.