PhD/PsyD Assessment side hustle for generalist psychologists

[psypipe]

Hi All,

I am an early career psychologist in a major metro area seeking information on how to incorporate assessment into my practice. Throughout my graduate career, I did mostly psychotherapy and intakes at various externship/internship/postdoc at hospital, counseling center, and community mental health settings. I did only about 7 integrated batteries throughout my entire training. I went to a very decent program, but I feel I have basic competency in assessment at best, as my program only required 4-6 full batteries and my various externships/internship did not have students do assessments. My APA-accredited internship required two integrated batteries at most, as the pandemic limited student opportunity. At the time I was a student, I could not care less, as assessments at my program clinic were 30 plus page reports that took enormous amounts of time, and my goal was simply to get a job at a hospital doing non-testing related things such as psychotherapy, intake, and supervision.

I now find myself with the hospital job and a part time psychotherapy private practice, but I do not feel like a full-fledged psychologist, as I feel I am missing the testing part. Therefore, I am interested in integrating testing into my part-time private practice, but I do not even know where to begin. When I was a student most of my integrated batteries were psychoeducational/ADHD evals.

My questions is: would you know what psych testing area a generalist clinical psychologist could ethically and competently do with some re-training and supervision in private practice? It must be lucrative and in somewhat demand, as I would be sacrificing private practice psychotherapy patients to integrate assessments into my practice. Another questions related to this : is there an insurance that pays fairly for psych testing or is it sadly low like with psychotherapy?

Thanks,
Dr.Psypipe

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[AcronymAllergy]

I'd recommend joining your state psych association listserv if you haven't already. You'll likely start to see emails coming through requesting evaluations (or referrals for evaluations) for all sorts of stuff, from child custody to ADHD to ASD to general psychoeducational to immigration and asylum to fitness for duty to who knows what else. Those requests may start to give you an idea to the types of evals that are in-demand in your area. I wouldn't recommend it yet given your comfort level and experience, but forensically, non-neuropsych/non-child custody MH assessment for both criminal and civil work is also a pretty big market. Some of it pays well and some of it may not, with portions of that being dependent on your state (e.g., for state-mandated evals).

You could also reach out to other PP folks nearby or elsewhere in the state, take them out to lunch, and ask them questions about what they see as need(s) in the area.

 

[psypipe]

I'd recommend joining your state psych association listserv if you haven't already. You'll likely start to see emails coming through requesting evaluations (or referrals for evaluations) for all sorts of stuff, from child custody to ADHD to ASD to general psychoeducational to immigration and asylum to fitness for duty to who knows what else. Those requests may start to give you an idea to the types of evals that are in-demand in your area. I wouldn't recommend it yet given your comfort level and experience, but forensically, non-neuropsych/non-child custody MH assessment for both criminal and civil work is also a pretty big market. Some of it pays well and some of it may not, with portions of that being dependent on your state (e.g., for state-mandated evals).

You could also reach out to other PP folks nearby or elsewhere in the state, take them out to lunch, and ask them questions about what they see as need(s) in the area.

Thanks! I hadn't thought about this: I'd recommend joining your state psych association listserv if you haven't already
Il join to get a better idea of the market.

 

[PsyDr]

1) Why have you not looked this up yourself? Go to CMS’ fee schedule lookup tool. Learn it. If you need to learn the CPT codes, spend an hour learning those. You should be tracking these numbers everyday, as part of your hospital job, and as part of your PP. Those number let you know if you should ask for a raise, how to negotiate with insurance companies, if your business is profitable by the hour and overall, if you need to fire an insurance panel, if a test purchase is a good idea, and how to effectively do your job. Adding another thing to your practice without this foundation is a horrible idea.

2) If you won’t exert that effort, do not go into business for yourself. Seriously.

3) You know the APA ethic standard is supervision in this scenario. Under no circumstance would anyone believe that 7 assessments is even close to competent. Find a supervisor, get supervision, stick to your area of competence in testing.

4) You could probably make more money by altering your psychotherapy billing practices.

5) Do not include supervision as a career goal. It’s a short sighted, academic goal that has a pyramid structure. What happens when you supervise people, and they stay in your area? They become your competitor. Any emotional or short term financial gains from this will be lost long term.

6) this might sound harsh, but it’s less harsh than telling you to do whatever, and letting you fail.

 

[psypipe]

1) Why have you not looked this up yourself? Go to CMS’ fee schedule lookup tool. Learn it. If you need to learn the CPT codes, spend an hour learning those. You should be tracking these numbers everyday, as part of your hospital job, and as part of your PP. Those number let you know if you should ask for a raise, how to negotiate with insurance companies, if your business is profitable by the hour and overall, if you need to fire an insurance panel, if a test purchase is a good idea, and how to effectively do your job. Adding another thing to your practice without this foundation is a horrible idea.

2) If you won’t exert that effort, do not go into business for yourself. Seriously.

3) You know the APA ethic standard is supervision in this scenario. Under no circumstance would anyone believe that 7 assessments is even close to competent. Find a supervisor, get supervision, stick to your area of competence in testing.

4) You could probably make more money by altering your psychotherapy billing practices.

5) Do not include supervision as a career goal. It’s a short sighted, academic goal that has a pyramid structure. What happens when you supervise people, and they stay in your area? They become your competitor. Any emotional or short term financial gains from this will be lost long term.

6) this might sound harsh, but it’s less harsh than telling you to do whatever, and letting you fail.

I appreciate this advice 100%. I will certainly not be doing assessments without supervision. Regarding the CMS fee schedule, I must say I am late to the game. My workplaces (postdoc and beyond) usually emphasize the number of visits, rather than searching your fee. Now, knowing exactly how much you make via insurance for your employer is certainly golden advice. I will be looking into that. The private practice thing I have going is mostly cash only for now, but I am looking to incorporate insurance once I learn a bit more of the insurance contracts work and I figure out the assessment part.

 

[PsyDr]

I appreciate this advice 100%. I will certainly not be doing assessments without supervision. Regarding the CMS fee schedule, I must say I am late to the game. My workplaces (postdoc and beyond) usually emphasize the number of visits, rather than searching your fee. Now, knowing exactly how much you make via insurance for your employer is certainly golden advice. I will be looking into that. The private practice thing I have going is mostly cash only for now, but I am looking to incorporate insurance once I learn a bit more of the insurance contracts work and I figure out the assessment part.

Determine which CPT codes you use. Find out how much those are reimbursed. Take a sheet of paper, fold it in thirds vertically. Track your patient load on the left side, assign the CPT code in the middle, and the reimbursement fee on the left. After a few weeks, you’ll have a really good idea of what you bring in.

 

[psychma]

I would not take competency lightly. Neither would your state’s board.

 

[Therapist4Chnge]

You really want to make sure you secure formal supervision for your assessment work, especially if you move from clinical to more forensic-based work. There are plenty of hacks out there who stumble their way through for awhile, but eventually they get outed, and you don’t want to be that person.

You will be best served to work in a specific area (e.g. substance abuse, bariatric surgery, etc) and learn the area really well. Learn the research, learn what are the main components of such an assessment, etc. Is it lucrative, it really depends on reimbursement rates and knowing the various CPT Codes and avg # of hrs that are typically charged.

What you don’t want is to run into someone like me, Wise, PsyDr, or similar on a case that ends up in court and you don’t have an identified supervisor and the necessary background to conduct the assessment. Someone doing forensic work will have hundreds/thousands of assessments of experience. On internship I did ~3-4 full battery (e.g. pre-surg bariatric, pre-surg SCS, DBS, neuro, sub abuse, etc) evals per week, then two years of evals on fellowship, all of the didactics, published, etc. I’m not saying this to brag, but I’m doing it to point out that 4-6 batteries is a week or two of training worth. Focusing on one specific area can help you develop competency and give yourself a shot to build upon.

 

[psypipe]

You really want to make sure you secure formal supervision for your assessment work, especially if you move from clinical to more forensic-based work. There are plenty of hacks out there who stumble their way through for awhile, but eventually they get outed, and you don’t want to be that person.

You will be best served to work in a specific area (e.g. substance abuse, bariatric surgery, etc) and learn the area really well. Learn the research, learn what are the main components of such an assessment, etc. Is it lucrative, it really depends on reimbursement rates and knowing the various CPT Codes and avg # of hrs that are typically charged.

What you don’t want is to run into someone like me, Wise, PsyDr, or similar on a case that ends up in court and you don’t have an identified supervisor and the necessary background to conduct the assessment. Someone doing forensic work will have hundreds/thousands of assessments of experience. On internship I did ~3-4 full battery (e.g. pre-surg bariatric, pre-surg SCS, DBS, neuro, sub abuse, etc) evals per week, then two years of evals on fellowship, all of the didactics, published, etc. I’m not saying this to brag, but I’m doing it to point out that 4-6 batteries is a week or two of training worth. Focusing on one specific area can help you develop competency and give yourself a shot to build upon.

I appreciate the advice. I certainly won't move on this till I know what I am doing and have good supervision. I tend to be risk averse so the forensic line might be more into the future, as I feel more competent and stack experience. I do genuinely want to incorporate testing into my practice portfolio, as it is a unique skill only psych's have, but I don' want to take too much of a financial hit or risk in the process. The hope is to start slowly and competently and develop a niche that will pay dividends in the future.

 

[PsyDr]

I appreciate the advice. I certainly won't move on this till I know what I am doing and have good supervision. I tend to be risk averse so the forensic line might be more into the future, as I feel more competent and stack experience. I do genuinely want to incorporate testing into my practice portfolio, as it is a unique skill only psych's have, but I don' want to take too much of a financial hit or risk in the process. The hope is to start slowly and competently and develop a niche that will pay dividends in the future.

He's not referring to you doing forensic evaluations. It is VERY common for people to request testing for a clinical reason, and after they get the report, they reveal forensic involvement (e.g., "They need this report for my lawsuit/disability claim/criminal case/divorce/custody dispute"). When that happens, opposing counsel hires a forensically trained psychologist to tear you apart. Not having a formal supervision agreement would be an easy way to tear you down.

 

[psypipe]

He's not referring to you doing forensic evaluations. It is VERY common for people to request testing for a clinical reason, and after they get the report, they reveal forensic involvement (e.g., "They need this report for my lawsuit/disability claim/criminal case/divorce/custody dispute"). When that happens, opposing counsel hires a forensically trained psychologist to tear you apart. Not having a formal supervision agreement would be an easy way to tear you down.

I see. Thus, it makes sense to stress the formality of the supervision component regardless of whether a formal forensic assessment is involved. I appreciate this information.

 

[R. Matey]

He's not referring to you doing forensic evaluations. It is VERY common for people to request testing for a clinical reason, and after they get the report, they reveal forensic involvement (e.g., "They need this report for my lawsuit/disability claim/criminal case/divorce/custody dispute"). When that happens, opposing counsel hires a forensically trained psychologist to tear you apart. Not having a formal supervision agreement would be an easy way to tear you down.

YMMV, but this may not be as scary as it sounds. Someone reviewed my notes for an 'I'ME back during my residency, but had a very difficult time finding flaws so they just kept insisting that the C-SSRS was a made up instrument. My client won the dispute with their insurance company.

 

[WisNeuro]

YMMV, but this may not be as scary as it sounds. Someone reviewed my notes for an 'I'ME back during my residency, but had a very difficult time finding flaws so they just kept insisting that the C-SSRS was a made up instrument. My client won the dispute with their insurance company.

In general, no. But if you really screw up, those IME can find ethical violations. I'm currently waiting for a case to finalize I have to address such an issue with a provider.