Have I waited too long to get licensed?

[psychstudent5]

I haven't done clinical work since 2012, which was when I was on internship (APA accredited). I had a research postdoc, but opted out of the clinical component. I really thought I didn't need to do accrue more clinical training because I planned to have a research only career (plus, I was really burned out). However, now, I'm realizing the limitations of not having a license. Also, I kinda miss the clinical work. So, have I waited too long to get the license?

I'm also trying to decide between doing a formal postdoc or an informal postdoc. I'm leaning towards doing an informal postdoc (hopefully at a hospital) since the salary will likely be higher than a postdoc.

Also, my clinical and research focus has been in health psychology. I don't recall many of supervisors being boarded. I remember there being debates on the benefits of being board certified in clinical psych. I understand that board certification is necessary for neuropsych and to some extent, forensics. But is it necessary to be boarded in health psych? What are the benefits of it for health psych?

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[AcronymAllergy]

1) Depends on the state. Some have a limit on how long post-graduation you're able to earn the hours, and others don't. Check your local regulations.

2) In your case, I'd say take whichever you're able to find nearby. The advantages to the formal postdoc are it can be easier to track your supervisors/paperwork down later if you need to, there's a formal grievance process, and your amounts of clinical and supervision hours should be set ahead of time (definitely also do this with an informal postdoc).

3) It's not necessary, no. Folks seem to be gradually moving in that direction, but it doesn't seem to be nearly as commonly-pursued as in neuro or forensics.

 

[PsyDr]

1) depends on state. You could always do a round robin and apply to a state with no statute of limitations that has reciprocity with your state. Sorta stupid, but it could work. You'll need to read the hell of out reciprocity because many of them are not as easy as you'd think. For example, my most recent license in state E has reciprocity with my license in C state. But the license in C has to be active for 5 years before E will look at it.

2) I know someone in your shoes that did an abcn formal post doc. Iirc they thought more highly of the age and research than the younger applicants.

3) honestly, I don't really understand the added benefit of health psychology. Seems like it's a combo of psych, nutrition, and exercise. If so, they are trying to wrap psych, nutritionists, and physical therapy into one job; which would reduce billing for the treatment team. If they could ever brand themselves in a value added manner better, boarding would increase.

 

[deleted343839]

But is it necessary to be boarded in health psych? What are the benefits of it for health psych?

3) honestly, I don't really understand the added benefit of health psychology. Seems like it's a combo of psych, nutrition, and exercise. If so, they are trying to wrap psych, nutritionists, and physical therapy into one job; which would reduce billing for the treatment team. If they could ever brand themselves in a value added manner better, boarding would increase.

Clinical health psychologists also help manage behavioral issues that interfere with medical treatment and help people with serious or chronic diseases cope with symptoms, treatment side effects, functional changes, caregiver/family problems, end-of-life issues, etc. There can be some overlap with other professions, but a lot of health psychologists (like me) don't focus primarily on diet and exercise interventions. There's a push to quantify our outcomes in terms of health care utilization and costs, which is where we have the most potential to show our external value, assuming we get that far.

Board certification is not a common expectation in clinical health unlike neuropsychology. Part of the problem with the field is fragmentation (we tend to subspecialize like our physician colleagues in areas like pain, sleep, cancer, cardiac, GI/bariatrics, transplant, etc.). There are also other professions, like PSYDR mentioned, who have interests in behavioral management of medical patients, nursing being a big one.

 

[Ollie123]

Have never heard of anyone not being able to obtain licensure for that reason if they needed to do so, its just a matter of how many hoops you have to jump through.

We have a strong neuro presence on SDN, which is why you see boarding talked about so often. Outside neuro and forensics, you almost never see it. I can count on one hand the number of boarded folks I've met with other specialties and I tend to work in the sorts of settings that would emphasize it.

That said, obviously things can change at any time.

 

[futureapppsy2]

Have never heard of anyone not being able to obtain licensure for that reason if they needed to do so, its just a matter of how many hoops you have to jump through.

We have a strong neuro presence on SDN, which is why you see boarding talked about so often. Outside neuro and forensics, you almost never see it. I can count on one hand the number of boarded folks I've met with other specialties and I tend to work in the sorts of settings that would emphasize it.

That said, obviously things can change at any time.

It's extremely common in rehabilitation psychology, too. I'm surprised it's not more common in health psych, as one of the reasons I think it's common in rehab is how "medical" the specialty is, same as neuro.

 

[Sanman]

It's extremely common in rehabilitation psychology, too. I'm surprised it's not more common in health psych, as one of the reasons I think it's common in rehab is how "medical" the specialty is, same as neuro.

Depends on where you are doing rehab psych. I see people that want rehab training often want neuropsych training as well in acute rehabs and hospitals. In sub-acute rehabs and nursing homes, rarely any requirement for specialized training. I am one of few people with extensive training in neuro and rehab, though with no formal post-doc. It also tends to cross paths with geriatric psych usually.

 

[DrMikeP]

3) honestly, I don't really understand the added benefit of health psychology. Seems like it's a combo of psych, nutrition, and exercise. If so, they are trying to wrap psych, nutritionists, and physical therapy into one job; which would reduce billing for the treatment team. If they could ever brand themselves in a value added manner better, boarding would increase.

Health psych varies depending on the school but can be so much more than nutrition and exercise. Medical Psychology knowledge can be invaluable, as it takes specialized training to do presurgical clearances like organ transplant, IVF, barriatrics, etc. Also, many clinical programs don't train students in reading labs, doing physical neuro exams, etc and such can be invaluable if working in a medical environment. The place one gets such is often in a health/medical psych rotation, internship, residency and occasionally a class.

Is it Alzheimer's or is is hepatic encephalopathy? You get called into see a psych pt in the bh unit and the patient is 65 and confused, so you have to figure out which through hx and then order appropriate psych and sometimes blood testing (yes psychologists can order such if properly trained). The psychiatrist may not be available and sometimes says call psychology first and I'll see the pt tomorrow. A delay in figuring out the cause can lead to patient death.

Also, in transplant your decision can/will directly mean a patient dies! With the shortage of organs if you give a clearance to a chronic substance abuser who is currently abusing then you've likely wasted the organ on someone who will destroy it AND killed someone who might have taken care of it. So ignorance has killed 2 people. However, if you know how to assess properly you can give better guidance on who should and who should not be cleared.

 

[PsyDr]

Health psych varies depending on the school but can be so much more than nutrition and exercise. Medical Psychology knowledge can be invaluable, as it takes specialized training to do presurgical clearances like organ transplant, IVF, barriatrics, etc. Also, many clinical programs don't train students in reading labs, doing physical neuro exams, etc and such can be invaluable if working in a medical environment. The place one gets such is often in a health/medical psych rotation, internship, residency and occasionally a class.

Is it Alzheimer's or is is hepatic encephalopathy? You get called into see a psych pt in the bh unit and the patient is 65 and confused, so you have to figure out which through hx and then order appropriate psych and sometimes blood testing (yes psychologists can order such if properly trained). The psychiatrist may not be available and sometimes says call psychology first and I'll see the pt tomorrow. A delay in figuring out the cause can lead to patient death.

Also, in transplant your decision can/will directly mean a patient dies! With the shortage of organs if you give a clearance to a chronic substance abuser who is currently abusing then you've likely wasted the organ on someone who will destroy it AND killed someone who might have taken care of it. So ignorance has killed 2 people. However, if you know how to assess properly you can give better guidance on who should and who should not be cleared.

A few things:

1) Alz vs. Hep seems like a neuropsych consult.
2) One should be very very careful about writing orders. The legality of ordering labs is HIGHLY dependent on the state in which one practices. Ordering psych tests would be a nightmare for billing due to CMS regulations.
3) transplant stuff sounds interesting.

 

[WisNeuro]

Is it Alzheimer's or is is hepatic encephalopathy? You get called into see a psych pt in the bh unit and the patient is 65 and confused, so you have to figure out which through hx and then order appropriate psych and sometimes blood testing (yes psychologists can order such if properly trained). The psychiatrist may not be available and sometimes says call psychology first and I'll see the pt tomorrow. A delay in figuring out the cause can lead to patient death.
.

Yeah, if a confusional pt hasn't been given a blood workup and they are waiting on a psychologist to order the labs, there is a systemic problem in that healthcare setting, grossly so. We should be testing for the subsequent effects of hepatic encephalopathy vs Alzheimer's, not the acute diagnosis of the former.

 

[deleted343839]

Is it Alzheimer's or is is hepatic encephalopathy? You get called into see a psych pt in the bh unit and the patient is 65 and confused, so you have to figure out which through hx and then order appropriate psych and sometimes blood testing (yes psychologists can order such if properly trained). The psychiatrist may not be available and sometimes says call psychology first and I'll see the pt tomorrow. A delay in figuring out the cause can lead to patient death.

This particular example brings up an important distinction between "medical psychology" and "health psychology." Health psychologists collaborate with physicians but are not physician extenders. If you were to become board certified in clinical health psychology, you would not be asked questions about ordering labs, performing a physical examination, or performing other functions that would imply the practice of medicine. But you might be asked about how you would collaborate with the medical team to improve the quality of triage/risk assessment of new admits, etc.

IMO if acute medical (not behavioral) decision making is ever placed in the hands of a psychologist, that is terrifying both from medico-legal and patient safety perspectives.

 

[DrMikeP]

This particular example brings up an important distinction between "medical psychology" and "health psychology." Health psychologists collaborate with physicians but are not physician extenders. If you were to become board certified in clinical health psychology, you would not be asked questions about ordering labs, performing a physical examination, or performing other functions that would imply the practice of medicine. But you might be asked about how you would collaborate with the medical team to improve the quality of triage/risk assessment of new admits, etc.

IMO if acute medical (not behavioral) decision making is ever placed in the hands of a psychologist, that is terrifying both from medico-legal and patient safety perspectives.

At my university we had a health psych specialty but one could take courses in med psych and practicum/internship with strong med psych focus so those things were learned at least to a level of understanding then students were encouraged to follow a psychopharmacology prog and board cert in med psych on graduation if such was appropriate for them. Some students loved it and some didn't. There is a component of responsibility but nothing done was out of scope for a med psychologist.



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[psychstudent5]

Thanks for the help and information everyone. I've applied to a few clinical positions. It's kinda difficult since I don't have the license yet, but I'm willing to temporarily work at the master's (pay) level to get reacquainted with clinical work until I get the license. I'm glad to hear board certification in health psychology is not necessary. This eases my mind a lot.

Thankfully, the state I live in does not require postdoctoral hours and has no time limit on when you can obtain the license after obtaining the degree. If your pre-internship and internship hours meet the minimum number of hours, you're eligible to sit for the test. My only concern is having trouble in another state that requires postdoctoral work if I move in the next couple of years. I really wish our field could have national reciprocity.

I've been studying for the EPPP the last week or so, and I cannot believe how much I remember as well as how much I forgot.