PhD/PsyD How much are PsyD salaries?

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I saw posts saying that the average is 88,000 and can get up to 110,000 a year. Is that correct? So many people complain of psychologists complaining of low salaries so it seems strange that they would be making that much.

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Check out the APA Salary survey. They break these numbers down in a variety of different ways. I believe in the last survey the median for PsyD was 75k after a median 8 years and for PhDs it was 85k after 8. Obviously there are ranges of salary, and different debt loads, which will bring your net earnings down. I believe the issue is that the debt load is much too high considering the salary. You shouldn't be taking on med school level debt for a salary that is 1/3 or less than a med school earning.
 
I saw posts saying that the average is 88,000 and can get up to 110,000 a year. Is that correct? So many people complain of psychologists complaining of low salaries so it seems strange that they would be making that much.

What the SD, though?

Salaries can get up to close to 200, but that would be for high level executive and administration type jobs and likely in high cost of living areas.

The state prison system in my state starts psychologist at 46. Why anyone would take a job that pays like that is beyond me. The turnover rate in my states prison system is absurd.
 
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Prison jobs are difficult to fill despite salary range. Psychologist jobs in Corrections in the three State where I am licensed range from 45,000 to 85,000 and they seem to run continuous advertising year around. Private Practice with multiple contract may get income in the 150,000 to 200,000 range.
 
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When you're in school, 80k-100k sounds like an unfathomable amount of money. When you start making that, you realize the take home is much smaller. 80k is around 5400/month without state taxes. Then deduct the maximum for your 401k, because you are starting later than everyone else, and your take home is around 4000. Now you'll probably want a mortgage, so following the 30% rule you can afford about 260k worth of house with property taxes. Now you have 2800/month for food, cars, childcare, savings, insurance, student loan debt, and saving for your child's education. Say 500:month in car paymentsx2, groceries $500, 250 for college fund which won't pay for your kids education at all when inflation is accounted for, $400 for leisure+ eating out+ vacation fund, $200 for cable and Internet and phone.... You're not even thriving.


As you interact with the general population, you run into plumbers and cops who are making 100k. Then you run into physicians pulling in 300-400k. Friends who have married and were careful with their money are well ahead due to compounding.
 
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In more competitive areas PsyD salaries could be as low as the 40s due to saturation. But typically I see 50-80 starting, increasing over time.

There are tons of factors to consider. In PP the salaries might be inflated relative to others without retirement and healthcare benefits. As Wis mentioned, debtload impacts earnings. Some people work more than one job and some can't. For instance, a local AMC near me hires both PhD and PsyD folks after formal postdoc at 85-90 but there is a noncompete clause and they can't really do much else, nor have time to. In contrast, the VA starting salaries are comparable after postdoc, but they don't restrict outside activities so you can earn more. With specialty training like neuro it might be 90-100 starting, but it's more time to get there and still competitive.

In academia and clinical work you could be looking at 150k plus with some more experience or admin roles, but those would be outliers compared to the average psychologist.

I'd also say that the starting salaries I mentioned are for competitive positions. There are plenty that start lower. Your modal PsyD student doesn't come from the few solid PsyD programs out there, so chances are on average they are taking the lower paying jobs compared to candidates from stronger programs. Of course there are exceptions- I know some. But the FSPS programs are flooding the market with students and by virtue of their large class sizes are simultaneously hurting job prospects for those students.
 
When you're in school, 80k-100k sounds like an unfathomable amount of money. When you start making that, you realize the take home is much smaller. 80k is around 5400/month without state taxes. Then deduct the maximum for your 401k, because you are starting later than everyone else, and your take home is around 4000. Now you'll probably want a mortgage, so following the 30% rule you can afford about 260k worth of house with property taxes. Now you have 2800/month for food, cars, childcare, savings, insurance, student loan debt, and saving for your child's education. Say 500:month in car paymentsx2, groceries $500, 250 for college fund which won't pay for your kids education at all when inflation is accounted for, $400 for leisure+ eating out+ vacation fund, $200 for cable and Internet and phone.... You're not even thriving.


As you interact with the general population, you run into plumbers and cops who are making 100k. Then you run into physicians pulling in 300-400k. Friends who have married and were careful with their money are well ahead due to compounding.
Yep. All things to consider when it comes to partner income, cost of living by location, kids, etc. debt and opportunity cost are major factors but not usually what students think about when they are signing up for a program.
 
In academia and clinical work you could be looking at 150k plus with some more experience or admin roles, but those would be outliers compared to the average psychologist.
True, but these are *very* competitive positions. Many/most students incorrectly assume they will be the outlier, but most aren't.
 
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When you're in school, 80k-100k sounds like an unfathomable amount of money. When you start making that, you realize the take home is much smaller. 80k is around 5400/month without state taxes. Then deduct the maximum for your 401k, because you are starting later than everyone else, and your take home is around 4000. Now you'll probably want a mortgage, so following the 30% rule you can afford about 260k worth of house with property taxes. Now you have 2800/month for food, cars, childcare, savings, insurance, student loan debt, and saving for your child's education. Say 500:month in car paymentsx2, groceries $500, 250 for college fund which won't pay for your kids education at all when inflation is accounted for, $400 for leisure+ eating out+ vacation fund, $200 for cable and Internet and phone.... You're not even thriving.


As you interact with the general population, you run into plumbers and cops who are making 100k. Then you run into physicians pulling in 300-400k. Friends who have married and were careful with their money are well ahead due to compounding.

No its certainly not rich but if you're like myself and don't plan to have a family, and are a home body and don't really go out and spend money, it's at least comfortable.
 
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It seems that the question would be "How much are Psychologist Salaries" rather than "How much are PsyD Salaries." Would responses be any different if you had titled the thread "How much are PhD Salaries?"
 
It seems that the question would be "How much are Psychologist Salaries" rather than "How much are PsyD Salaries." Would responses be any different if you had titled the thread "How much are PhD Salaries?"

Well, there is a quantifiable difference when we look at a large number of respondents. Additionally, there is a large difference in debt load between the degrees. You will get a different answer depending on which question you ask, so yes, you would get a different answer if you asked about PhD salaries.
 
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No its certainly not rich but if you're like myself and don't plan to have a family, and are a home body and don't really go out and spend money, it's at least comfortable.

"Plans" change. Life is funny that way.
 
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In two of the States where I am licensed there are many more PhD trained psychologist but in one of the States where I am licensed there are many more PsyD as it is a State that had a Well Known PsyD training program. So, in that State there are a larger number of PsyD than PhD and many of the Psychologist on the Licensing Board have a PsyD. Seems that the principle of supply and demand factor in as when you have a surplus of Psychologist, either PsyD or PhD, the demand and salary goes down. Interesting, the PsyD program closed this year but due to the surplus of Psychologist in this State it will take some time for the supply/demand principal to factor in to jobs and salaries. Whereas, the two States I work in with a minority of PsyD psychologist there are many jobs that do not go filled or MS level licensed professionals fill the positions. When I applied for jobs in that State, most doctoral level psychologist where paid at the lower wage common for MS level licensed professionals, and I was informed that the salary would not be comparable to the other two States I was employed. Some of these positions started at 40,000 or below.
 
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I saw posts saying that the average is 88,000 and can get up to 110,000 a year. Is that correct? So many people complain of psychologists complaining of low salaries so it seems strange that they would be making that much.
88k is pretty low when you consider the years of schooling and training that takes to get to that point. Also factor in the difficulty of our job and the cognitive abilities required coupled with the responsibility that we have to our patients and I would say that it is a very low number. There has been ten to fifteen years of stagnant wages for psychologist and as I am trying to pay off my loans, save for retirement, and provide for my family, I take this issue very seriously.
 
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When you're in school, 80k-100k sounds like an unfathomable amount of money. When you start making that, you realize the take home is much smaller. 80k is around 5400/month without state taxes. Then deduct the maximum for your 401k, because you are starting later than everyone else, and your take home is around 4000. Now you'll probably want a mortgage, so following the 30% rule you can afford about 260k worth of house with property taxes. Now you have 2800/month for food, cars, childcare, savings, insurance, student loan debt, and saving for your child's education. Say 500:month in car paymentsx2, groceries $500, 250 for college fund which won't pay for your kids education at all when inflation is accounted for, $400 for leisure+ eating out+ vacation fund, $200 for cable and Internet and phone.... You're not even thriving.


As you interact with the general population, you run into plumbers and cops who are making 100k. Then you run into physicians pulling in 300-400k. Friends who have married and were careful with their money are well ahead due to compounding.

I saw two important take-homes from this:
1) Notably absent from the list of items was student loan debt. For many, that would eat up a sizable chunk of that remaining $2800. Now imagine that rather than an 80-100k/year job, you are planning to work in a college counseling center (not an uncommon goal we see stated here, often from folks pursuing the professional school route). In many places, that will literally mean 50% of that salary. My graduate university had licensed psychologists in the CC that were earning less than I make as a post-doc (43k). If the loans are the same...that is starting to look VERY difficult to manage or even impossible.
2) Psychology is very rarely a path to the upper class. This is especially true for someone planning on a single-income household. Two folks earning around 80k with zero loans? Now those numbers start to look a little better (if memory serves, we're talking around 70th percentile vs. 90th percentile for household income). Still not wall street pay...but not bad. Folks always need to make their own decisions, but I think its important to walk into those fully informed. I think its a great career, one that can provide a comfortable living for folks who follow the right path and have the appropriate expectations. I have no regrets. Its important to know what you're getting though.
 
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I have no regrets. Its important to know what you're getting though.

I'm curious how many of us thought hard about our starting salary expectations when we applied to graduate school. Clearly some people think about this before they apply, which is the smart thing to do. I will admit that my expectations were rather vague (as in, x dollars give or take 20K) until well into my training. The only dollar figures my advisor ever discussed with me were the ones in grant budgets, and I'm afraid that if we'd ever had a conversation about salary expectations I might have been set up to be lowballed. A postdoc mentor set me straight about what kind of salary to expect, and I got it.

My sense is that a lot of psychology trainees don't really think this out. This seems rare among students in many other highly trained professions (medicine, law, etc.). As a group I fear we have more in common with the underemployed glut of PhDs in other academic fields when it comes to finances.
 
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I'm curious how many of us thought hard about our starting salary expectations when we applied to graduate school. Clearly some people think about this before they apply, which is the smart thing to do. I will admit that my expectations were rather vague (as in, x dollars give or take 20K) until well into my training. The only dollar figures my advisor ever discussed with me were the ones in grant budgets, and I'm afraid that if we'd ever had a conversation about salary expectations I might have been set up to be lowballed. A postdoc mentor set me straight about what kind of salary to expect, and I got it.

My sense is that a lot of psychology trainees don't really think this out. This seems rare among students in many other highly trained professions (medicine, law, etc.). As a group I fear we have more in common with the underemployed glut of PhDs in other academic fields when it comes to finances.
Compared to these other professions, many in psychology seem to act as though we shouldn't ask for more money. There was a thread awhile back where many were intimating that anything more than 80k was being greedy. I was frankly quite astounded by this thinking. Meanwhile when I am reading on the psychiatrists thread, they talk about how to maximize their earnings all day long with no reservations whatsoever. I know that mindfulness is popular in our field these days and we have good evidence to support it's efficacy, but that doesn't mean we have to become monks.
 
Compared to these other professions, many in psychology seem to act as though we shouldn't ask for more money. There was a thread awhile back where many were intimating that anything more than 80k was being greedy.

Wow. Words fail me.
 
I think as a field, we need to become better about not only requesting what we feel is adequate compensation and subsequently demonstrating our worth (free marketplace, after all), but then drawing attention to those demonstrations when they occur. I don't see much wrong with helping people and indicating when you've earned or saved your employer money.
 
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I thought about it quite a bit. Especially as a neuro person who did 2 years of postdoc, by the time I was done, I wasn't touching anything below 80k. And that's with $0 in loans outstanding. I'm with AA, look at your RVU output compared to your salary to get a rough estimate of what you're bringing in. You'll probably be surprised.
 
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I think as a field, we need to become better about not only requesting what we feel is adequate compensation and subsequently demonstrating our worth (free marketplace, after all), but then drawing attention to those demonstrations when they occur. I don't see much wrong with helping people and indicating when you've earned or saved your employer money.
Fear makes us make many mistakes, including stuff like this imo. You see a really good opportunity, so you tell yourself that if you demand anything you'd lose the opportunity, so you just take what you get.
 
Fear makes us make many mistakes, including stuff like this imo. You see a really good opportunity, so you tell yourself that if you demand anything you'd lose the opportunity, so you just take what you get.

Very true. Which is why mentors need to be honest and proactive about these conversations. Expecting new graduates to figure this out on their own, and acting as though talk of money is uncouth, is bad for the profession.


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There was a thread awhile back where many were intimating that anything more than 80k was being greedy.

Ironically enough, that could actually have been me you are referring to. I remember several disputes like that over the years. My stance has sometimes been mischaracterized as saying we should "settle" for 80k (no idea if that was you or not). We had one regular from some time ago (who I now haven't seen in awhile) who routinely implied the financial sky was falling and made innumerable gross exaggerations and was never easy to pin down. I maintain that writing a senator and saying that 80k is not enough to feed a family (which was being advocated for at one point) would simply get us laughed at and told to go find an accountant. Said person also allegedly had 30+ publications as a graduate student, but couldn't find a job for more than 35k in a high COL area after graduate school, etc. etc.

I do think its important to keep a realistic perspective. Are we undercompensated given the time and training we invest? Absolutely. Is someone who goes to a solid program, works hard in graduate school and plans appropriately going to be unable to feed themselves? I haven't seen it happen. This is pretty much what I tell students. People still imagine us having the life of a stereotype psychoanalyst from 50-100 years ago. That is silly. If money is the main goal, psychology is a very very stupid choice for achieving that goal. It offers numerous other benefits beyond that and for many (myself included) the tradeoff seems to be worth it - at least right now. If you think money isn't important, think hard about that because its probably more important than you realize. Its nonetheless important to recognize the vast grey area between "Stay away or you'll be starving in the streets" and "Psychology will provide you wealth beyond your wildest dreams!"

Part of this is easy for me to say since I've apparently had fantastic mentors throughout and even as a lowly post-bac had a very real "what kind of salary are we talking about" conversation with a professor who gave me a very realistic picture of what I could expect. I continued to have those conversations throughout graduate school. This has always come from the academic side so strategies for maximizing earnings looked very different than I imagine they do with purely clinical folks, but they were happening. These conversations are incredibly critical and I will never understand why we leave so much to mystery.
 
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My mentor discussed salary with me but it won't usually come up if you don't ask. In my own supervisory capacity I try to be transparent about expectations, negotiations, and options. But normally I'd imagine a student needs to be proactive to get those answers.
 
imo: psychologists' low salaries are due to a combination of:

1) poor work ethic- there are many psychologists who put minimal billable hours per day. While that is each persons choice, there are few professions which would compensate well for what is essentially part time productivity.

2) a lack of understanding of what they are bringing in- billing, grant income, and figuring out overhead/cost per day sucks. But each psychologist should know the mean daily income per month. And the value of the total compensation package. It's difficukt to negotiate against hard numbers. Likewise, it's *****ic to think that putting in 4 billable hrs because you need to "process" should be paid anything other than part time wages. See edieb's discussion in rvus.

3) an emphasis on passive modes of communication in training which spills over in negotiation- while this is probably well and good in therapy, saying bs like "I'd be more comfortable with 90k" is just going to get you run over in negotiations.

4) being scared- it's true that there is a paucity of jobs. But rule 1 in negotiations is being willing to walk away.
 
Very true. Which is why mentors need to be honest and proactive about these conversations. Expecting new graduates to figure this out on their own, and acting as though talk of money is uncouth, is bad for the profession.


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Problem is mentors often have academic affiliations as their primary source of income, and may not have the best sense of salaries and pay structures in applied settings. I was fortunate to have a practicum supervisor who initiated conversations on the topic of salary.

Early career I always had a goal of doubling my age in thousands for a salary. It worked well for me and kept me at or above median levels. As I get older, I've adjusted my expectations for that figure to represent a base salary from a primary job, with opportunities for bonuses and outside opportunities of an additional 20-25% of base.

While I've become less concerned about offending employers with outrageous salary demands, my worst experience was when a previous employer actually met a rather ridiculous demand (along the lines of a 30% salary increase, plus going from 3 to 6 weeks paid vacation). It was a deal to keep me there, but the end result was that I was vastly overpayed relative to other employees and my ability to generate revenue.n I enjoyed the money, but not the job, and was constantly waitng for the axe to fall. In the end, it wasn't worth it and I jumped ship. I now make a fair salary, with good personal and agency incentive bonuses, and am much happier, despite lower weekly take home.
 
My mentor discussed salary with me but it won't usually come up if you don't ask. In my own supervisory capacity I try to be transparent about expectations, negotiations, and options. But normally I'd imagine a student needs to be proactive to get those answers.
Agreed.

I speak w. my fellows about this during our professional development time. They need to understand the real world part of the job too. We also use the time to discuss how insurance panels work, how to negotiate rates, etc.
 
Ironically enough, that could actually have been me you are referring to. I remember several disputes like that over the years. My stance has sometimes been mischaracterized as saying we should "settle" for 80k (no idea if that was you or not). We had one regular from some time ago (who I now haven't seen in awhile) who routinely implied the financial sky was falling and made innumerable gross exaggerations and was never easy to pin down. I maintain that writing a senator and saying that 80k is not enough to feed a family (which was being advocated for at one point) would simply get us laughed at and told to go find an accountant. Said person also allegedly had 30+ publications as a graduate student, but couldn't find a job for more than 35k in a high COL area after graduate school, etc. etc.

I do think its important to keep a realistic perspective. Are we undercompensated given the time and training we invest? Absolutely. Is someone who goes to a solid program, works hard in graduate school and plans appropriately going to be unable to feed themselves? I haven't seen it happen. This is pretty much what I tell students. People still imagine us having the life of a stereotype psychoanalyst from 50-100 years ago. That is silly. If money is the main goal, psychology is a very very stupid choice for achieving that goal. It offers numerous other benefits beyond that and for many (myself included) the tradeoff seems to be worth it - at least right now. If you think money isn't important, think hard about that because its probably more important than you realize. Its nonetheless important to recognize the vast grey area between "Stay away or you'll be starving in the streets" and "Psychology will provide you wealth beyond your wildest dreams!"

Part of this is easy for me to say since I've apparently had fantastic mentors throughout and even as a lowly post-bac had a very real "what kind of salary are we talking about" conversation with a professor who gave me a very realistic picture of what I could expect. I continued to have those conversations throughout graduate school. This has always come from the academic side so strategies for maximizing earnings looked very different than I imagine they do with purely clinical folks, but they were happening. These conversations are incredibly critical and I will never understand why we leave so much to mystery.
I would never say that you would starve on 80k so I am sure that wasn't me. I think of 80k as the place to start as a psychologist and it is what I accepted for my first job as a licensed psychologist.

When I say we should always ask for more, it is not because we "need" it, it has more to do with promoting our value and negotiating. In other words, if we don't ask for and expect more, we will get less. That is how the business world works. I see admin and business type people continually trying to devalue and undermine the practice of clinical psychology.

It is worse than other aspects of healthcare because everyone seems to think they can do our job. When I am in a meeting with the orthopedic surgeon, admin doesn't say too much because they don't know jack about his procedures and equipment. When it comes to our department admin knows all about addiction, depression, talk therapy or at least so they think mainly because the words are familiar.
 
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i would never say that you would starve on 80k so I am sure that wasn't me. I think of 80k as the place to start as a psychologist and it is what I accepted for my first job as a licensed psychologist.

When I say we should always ask for more, it is not because we "need" it, it has more to do with promoting our value and negotiating. In other words, if we don't ask for and expect more, we will get less. That is how the business world works. I see admin and business type people continually trying to devalue and undermine the practice of clinical psychology.

It is worse than other aspects of healthcare because everyone seems to think they can do our job. When I am in a meeting with the orthopedic surgeon, admin doesn't say too much because they don't know jack about his procedures and equipment. When it comes to our department admin knows all about addiction, depression, talk therapy or at least so they think mainly because the words are familiar.

Exactly. If we don't advocate for our value, there will always be plenty of folks willing to advocate against it (e.g., via lower reimbursement rates).

This is one reason I was happy to hear Puente won the recent APA vote. He's worked pretty tirelessly to get psychologists a seat at the political Medicare table.
 
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This is one reason I was happy to hear Puente won the recent APA vote. He's worked pretty tirelessly to get psychologists a seat at the political Medicare table.

This. I doubt most psychologists understand what a huge freaking deal it is to hold a seat on the CPT panel. I'm not sure what he will be able to accomplish in the span of one year, but if anyone can do it I have more confidence in Puente than in most others.
 
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This. I doubt most psychologists understand what a huge freaking deal it is to hold a seat on the CPT panel. I'm not sure what he will be able to accomplish in the span of one year, but if anyone can do it I have more confidence in Puente than in most others.
My thoughts exactly. Tony is s great guy who has dedicated decades of effort to helping our profession.
 
Early career I always had a goal of doubling my age in thousands for a salary. It worked well for me and kept me at or above median levels.

Geez, did you start internship at age nine?? :p
 
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I would never say that you would starve on 80k so I am sure that wasn't me. I think of 80k as the place to start as a psychologist and it is what I accepted for my first job as a licensed psychologist.

When I say we should always ask for more, it is not because we "need" it, it has more to do with promoting our value and negotiating. In other words, if we don't ask for and expect more, we will get less. That is how the business world works. I see admin and business type people continually trying to devalue and undermine the practice of clinical psychology.

It is worse than other aspects of healthcare because everyone seems to think they can do our job. When I am in a meeting with the orthopedic surgeon, admin doesn't say too much because they don't know jack about his procedures and equipment. When it comes to our department admin knows all about addiction, depression, talk therapy or at least so they think mainly because the words are familiar.

Oh, I was sure you weren't the one talking about "starving" - I just wasn't sure if I was one of the ones you thought was arguing we shouldn't be asking for more! I agree with everything else in your post. Its a very real problem. We absolutely need more discussion about these issues in training. I feel like I have a solid understanding of salary expectations (at least for the path I'm on), but I still don't know jack about billing and paneling. Some of that is probably because I'm trying desperately to avoid ever being in a situation when more than 20% of my salary comes from clinical billing anyways, so I've had other things to prioritize. That said - trying to learn, but its not easy. Its not even the sort of thing there are good books or websites about (at least that I've found), which doesn't make it easy to get the foundation. Billing is mostly an invisible process in the settings I've worked - which I guess is great in the sense that it has probably spared me from a lot of headaches, but obviously comes at a cost.

I will add another way I think we can be our own worst enemy in this regard. We still have an enormous portion of the field who believes in moonbeam therapy, thinks tracking outcomes is silly, will go to war over the very idea that an established treatment with demonstrated efficacy should be the first line treatment, etc.. I think that reflects badly on us. And frankly, I'm not convinced many of those administrators WOULD do any worse as therapists than a fair number of psychologists out there. That's not to say there isn't room for going off-manual, trying other treatments, etc. and it is a fine line to walk since I think there are plenty of times were patient care is hurt by physicians who want to "keep their numbers up" so-to-speak. However, I maintain that it is VERY hard to simultaneously argue that we are experts who are worthy of high salaries and that we can just do whatever we want regardless of whether or not there is evidence to support it and shouldn't be expected to demonstrate clinical efficacy. It doesn't get talked about in this way very often...but I think it plays a bigger role in people's perceptions of us, our role and our reimbursement than many realize (or at least are willing to acknowledge).
 
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Oh, I was sure you weren't the one talking about "starving" - I just wasn't sure if I was one of the ones you thought was arguing we shouldn't be asking for more! I agree with everything else in your post. Its a very real problem. We absolutely need more discussion about these issues in training. I feel like I have a solid understanding of salary expectations (at least for the path I'm on), but I still don't know jack about billing and paneling. Some of that is probably because I'm trying desperately to avoid ever being in a situation when more than 20% of my salary comes from clinical billing anyways, so I've had other things to prioritize. That said - trying to learn, but its not easy. Its not even the sort of thing there are good books or websites about (at least that I've found), which doesn't make it easy to get the foundation. Billing is mostly an invisible process in the settings I've worked - which I guess is great in the sense that it has probably spared me from a lot of headaches, but obviously comes at a cost.

I will add another way I think we can be our own worst enemy in this regard. We still have an enormous portion of the field who believes in moonbeam therapy, thinks tracking outcomes is silly, will go to war over the very idea that an established treatment with demonstrated efficacy should be the first line treatment, etc.. I think that reflects badly on us. And frankly, I'm not convinced many of those administrators WOULD do any worse as therapists than a fair number of psychologists out there. That's not to say there isn't room for going off-manual, trying other treatments, etc. and it is a fine line to walk since I think there are plenty of times were patient care is hurt by physicians who want to "keep their numbers up" so-to-speak. However, I maintain that it is VERY hard to simultaneously argue that we are experts who are worthy of high salaries and that we can just do whatever we want regardless of whether or not there is evidence to support it and shouldn't be expected to demonstrate clinical efficacy. It doesn't get talked about in this way very often...but I think it plays a bigger role in people's perceptions of us, our role and our reimbursement than many realize (or at least are willing to acknowledge).
Completely agree. A good psychologist should always be looking at and talking about outcome measures. We should be bringing that concept to the organizations where we work and spearheading the implementation of the measures. I also think that a combination of quantitative and qualitative measures are helpful. The fact is we did this more when I was working in sales than we do in most mental health settings that I have worked. Granted, a lot of this was because psychologists tended to be in peripheral roles at many places. I have been surprised at how little our talents seem to be used outside of the VA system and in academia to be quite honest.
 
most postdocs probably wouldn't work out either...
I hit my number about 1 year after graduation. I didn't do a formal post-doc, but rather took a position that didn't require licensure but still gave me supervision for licensure. I realized quickly that I was underpaid (due in large part to my cluelessness in giving my salary needs when I was initially hired). I renegotiated after about 10 months. It was my first real salary negotiation, and it felt strange leading up to it. I was worried about seeming ungrateful. When I asked for an objectively fair and competitive salary, my boss said "of course- that's fair and what your worth, and we want to keep you." I had done research, interviewed elsewhere, and had a place to go if it didn't work out. I was careful to not present it as an ultimatum ("pay me more or I'm gone!"), but was ready to leave she couldn't come close.

Having had some years of admin experience since and been on the other side of things, I can say that it's likely that employers know the worth of a good clinician. If you're good, they'll pay what you're worth. If they don't, you're either not as good as you think or they're not interested in a good clinician, but rather a body with a pulse and a license.
 
And frankly, I'm not convinced many of those administrators WOULD do any worse as therapists than a fair number of psychologists out there. That's not to say there isn't room for going off-manual, trying other treatments, etc. and it is a fine line to walk since I think there are plenty of times were patient care is hurt by physicians who want to "keep their numbers up" so-to-speak.

Isn't a good question to ask..why are people going off-manual or trying other treatments? why don't they care about tracking outcomes? How much is it psychologists as a whole not believing in their own treatments (ie talk therapy as a whole)?
You just wouldn't see something like that in medicine. Nobody would doubt their training on how to deal with a broken leg, or what drugs to give for disease x, etc..they believe in it because they've seen it work. So clearly it does go back to outcomes..but still interesting to understand, what does it say if we aren't really tracking outcomes..is it no faith in talk therapy as a whole?
 
Some of this stems from historical factors. During the entire Rogers v Skinner debate timeframe, the dsm was a vastly different beast. Skinner proposed psychiatric illnesses were maladjusted behaviors. Rogers' reaction to this was to propose that there were no psychiatric disorders, just people who could grow out of anything given assorted factors. The result was psychologists saying that professional psychology wasn't healthcare, but something that helped people grow, ala self improvement. When the hmo stuff started, this conceptualization meant psychologists were out in the cold for reimbursement. The field quickly changed course, but some of it was too late. There remain people who ascribe to the growth model, and teach it. The idea of outcome measures is antithetical to this concept.
 
You just wouldn't see something like that in medicine. Nobody would doubt their training on how to deal with a broken leg, or what drugs to give for disease x, etc..they believe in it because they've seen it work.

I understand where you are coming from, but in many areas of medicine this is not true.

Psychiatry- using 3-4 anti-psychotics when there is zero support that it is more effective.

Physiatry- management of severe head injury. There are zero FDA approved meds, so all sorts of things are tried.

Neurology- managing a treatment resistant patient w seizures. I've seen crazy high dosing of meds bc "nothing else has worked."

PCP- Bogus "eye movement retraining" for a post-concussive syndrome case.

IM- Chronic pain patient is maxed out on opiates, so now stuff like reiki and other bogus treatments are recommended.

Etc.

These are all exampkes of cases I've seen, just in the past year.
 
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Some of this stems from historical factors. During the entire Rogers v Skinner debate timeframe, the dsm was a vastly different beast. Skinner proposed psychiatric illnesses were maladjusted behaviors. Rogers' reaction to this was to propose that there were no psychiatric disorders, just people who could grow out of anything given assorted factors. The result was psychologists saying that professional psychology wasn't healthcare, but something that helped people grow, ala self improvement. When the hmo stuff started, this conceptualization meant psychologists were out in the cold for reimbursement. The field quickly changed course, but some of it was too late. There remain people who ascribe to the growth model, and teach it. The idea of outcome measures is antithetical to this concept.
I agree with most of what you say but I think that it does point to a problem in our thinking of the field as being either one or the other. I see no problem with both models and I don't see how an outcome measure is antithetical to the concept of client centered therapy. If I remember correctly, Rogers did conduct studies of his treatments using some types of outcome measures. Some of his constructs are difficult to measure but a lot of work on relational factors continues. I actually think the problem has more to do with certain clinicians from the "I hate research" crowd whose clients aren't getting better hiding behind the "I'm using a client centered approach so it doesn't matter if my client is not improving their functioning in any measurable way". I hear this about using the client centered approach from most of the online masters level folk who don't know what they are doing either. To be honest, I don't see it as much in psychologists but when I do, it does make my blood boil.
 
I think the, "therapy is art, not science" mindset may contribute as well. Heck, I see it in some of the folks with whom I work. I agree there are significant interpersonal components involved, and there's a good bit to be said for the clinical intuition and "feel" you develop as you work with more and more folks. But as you've said, smalltown, none of that is mutually exclusive with using evidence-based treatments, psychometrically-sound assessments, and outcome tracking measures.

You know what's great about all that intuition and feel you develop over the years? You can then use it to organically implement evidence-based interventions. Fancy that.

And if the response is: "well, we just don't have any good measures for tracking outcomes with my patients." Hey, you're a scientist, come up with one (I know it's not that easy, but the point stands).
 
Of course, I too practice evidence-based treatments in my clinical work. But I'll also say that in my experience the loudest voices trumpeting evidence-based interventions are frequently those who don't do full-time clinical work, don't enjoy clinical work, or are neuropsychologists.
 
When I recommend therapy to people it often is received with eye-rolls. A lot of times people say they went to therapists who didn't ever really structure things much and just seemed to chit chat all the time. For how often that comes up for me, I think it is an enormous problem. Every client should be explained what their treatment options are, what goes into each option, who can provide those options, and then be allowed to make an informed decision. The good therapists I know do this and refer out if appropriate. The bad ones are strapped for cash and want to maintain their client load and use some BS theoretical explanation to justify the fact that they aren't actually doing anything evidence-based. They also don't make it clear to clients what their other options are. Just my two cents.
 
Isn't a good question to ask..why are people going off-manual or trying other treatments? why don't they care about tracking outcomes?

To a great extent I think it boils down to tremendous variability in standards for training.

Well trained psychologists appreciate the limitations of structured therapies but should always have a strong theoretical basis for their interventions. If your outcomes are flatlining with CBT but you're seeing some change after switching to interpersonal therapy, then you stick with what is working. But in doing so you also refine your clinical hypotheses along the way and continue to test them.

As Pragma refers to, it is also a matter of misaligned incentives. We get paid regardless of whether the patient is improving. Some therapies string out this way for years. This is such an ethical gray area that few therapists really get called out on it.

How much is it psychologists as a whole not believing in their own treatments (ie talk therapy as a whole)?

One of the questions we always have to ask ourselves is whether the patient is a good candidate for the treatment we have to offer. Sometimes the answer is no. Someone who takes on everything and everyone could very well get the feeling that their treatments aren't working. It's probably true though not for the reasons they might think.
 
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