Integrated Primary Care vs Neuropsychology

[pcpsych]

Hi everyone,

I'm currently a graduate student in a clinical psychology doctoral program and am torn between the subspecialties of integrated primary care psychology and clinical neuropsychology. I have a genuine interest in both fields. Could anyone give me the pros/cons of working in each setting? Expected salary info for each would especially be appreciated, as it's difficult to parse IPC salaries by setting (e.g., physicians' offices, private hospitals, etc.). By no means is salary the biggest consideration in this decision, but I do believe it is important to choose a career with eyes open nonetheless.

I've perused the past SDN threads and was unable to find a similar thread, but feel free to correct me if I missed something similar. Thanks in advance.

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[WisNeuro]

What do you mean by subspecialty, exactly? Is this something you want to focus your career on, or do as a adjunct to other things?

 

[pcpsych]

What do you mean by subspecialty, exactly? Is this something you want to focus your career on, or do as a adjunct to other things?

Sorry for the lack of clarity in my original post; it would be my career focus, ideally.

 

[WisNeuro]

Still need a little more detail, when you think about what you want to do on a day to day basis once you're done with training, what do you envision? Each is a much different career path, with very different day to day responsibilities.

 

[pcpsych]

Still need a little more detail, when you think about what you want to do on a day to day basis once you're done with training, what do you envision? Each is a much different career path, with very different day to day responsibilities.

Thanks for the reply! My problem is that I think I could see myself doing either path when I'm finished with training. If you don't mind my asking, what made you choose neuropsych over other career paths?

 

[WisNeuro]

Well, one path is somewhat longer than the other (internship, 2 year fellowship, board certification for Neuro).

As for me, I have always been a neuro person. I worked in a neuropsych as well as an fMRI lab throughout undergrad and grad. I enjoy the neuro research I do/have done and the rigor of the clinical work. I never really chose, just what I was always on the path for, really.

 

[erg923]

One is almost all (psychometric) assessment and little treatment, at least in most setting. The other has pretty much no psychometric assessment and is all about treatment/intervention. Pretty different.

 

[pcpsych]

Thanks! Personally, I enjoy assessment and intervention equally. Hence, my dilemma.

Unless there's a path that can combine the two that I am unaware of?

 

[erg923]

Thanks! Personally, I enjoy assessment and intervention equally. Hence, my dilemma.

Unless there's a path that can combine the two that I am unaware of?

look at APA division 22

 

[Therapist4Chnge]

Div 22, Rehabilitation Psychology. They are some of the nicest people in APA.

 

[pcpsych]

look at APA division 22

Yup, I've been looking into rehab psych. I will continue to look into the field.

Erg, am I correct in that you are in primary care in the VA? What drew you in that direction compared to other career paths?

 

[erg923]

Yup, I've been looking into rehab psych. I will continue to look into the field.

Erg, am I correct in that you are in primary care in the VA? What drew you in that direction compared to other career paths?

stability, money, I don't like doing long-term treatment.

 

[deleted343839]

Thanks! Personally, I enjoy assessment and intervention equally. Hence, my dilemma.

Unless there's a path that can combine the two that I am unaware of?

You can also put both integrated care and neuropsych skills to use in geropsychology practice, or possibly pediatrics.

Salary is probably more determined by geography and institution than by specialty. Within the VA (a big employer for both IPC and neuro) I'm not sure there is a much of a distinction in pay scale, if any. You get a small salary bump for ABPP certification but that doesn't just apply to neuro.

 

[pcpsych]

stability, money, I don't like doing long-term treatment.

Good to know. Would you have gone into primary care outside of the VA for similar reasons?

 

[erg923]

stability was in reference to the VA. but yes, probably.

 

[pcpsych]

You can also put both integrated care and neuropsych skills to use in geropsychology practice, or possibly pediatrics.

Thanks! I was unaware of this! How would that work in a practical sense? (In other words, what would the breakdown in hours look like, what are the names of the job positions, setting, etc.?)

 

[pcpsych]

My other concern with primary care psych is that there is a lot of talk about positions being open to LCSWs and masters' level practitioners (no offense intended to any of users who may be out there!). Is this a real trend and, if so, should I avoid getting into primary care as monetary compensation may be lower?

 

[pcpsych]

Div 22, Rehabilitation Psychology. They are some of the nicest people in APA.

Whoops, missed this one earlier! Thank you for the reply!

 

[deleted343839]

My other concern with primary care psych is that there is a lot of talk about positions being open to LCSWs and masters' level practitioners (no offense intended to any of users who may be out there!). Is this a real trend and, if so, should I avoid getting into primary care as monetary compensation may be lower?

It's definitely a trend. I've seen IPC positions advertised that make no distinction between master's and doctoral level candidates. However, the psychologists who work in academic family medicine departments often do some IPC, and these are generally pretty good jobs.

Thanks! I was unaware of this! How would that work in a practical sense? (In other words, what would the breakdown in hours look like, what are the names of the job positions, setting, etc.?)

Some more info on geropsychology can be found here: http://www.apa.org/ed/graduate/specialize/gero.aspx
and here: http://gerocentral.org

 

[pcpsych]

It's definitely a trend. I've seen IPC positions advertised that make no distinction between master's and doctoral level candidates. However, the psychologists who work in academic family medicine departments often do some IPC, and these are generally pretty good jobs.

Some more info on geropsychology can be found here: http://www.apa.org/ed/graduate/specialize/gero.aspx
and here: http://gerocentral.org

Thank you! I'll look into these, too.

 

[smalltownpsych]

I work in a hospital and get an opportunity to do all of the above to an extent. Gero, primary care, inpatient, assessment, treatment. I also am involved in oversight committees for the pain management program and the addiction program (if they ever get that up and running). Rural communities necessitate a more generalist practice and approach. The pay is well above average and from the stats I see, private hospitals do tend to pay psychologists very well. Neuro does tend to pay more than average too and they are often the ones working at some of these hospitals. At any rate, as a psychologist, it will be up to you to generate the revenue and income regardless of specialty to a certain extent.

 

[pcpsych]

I work in a hospital and get an opportunity to do all of the above to an extent. Gero, primary care, inpatient, assessment, treatment. I also am involved in oversight committees for the pain management program and the addiction program (if they ever get that up and running). Rural communities necessitate a more generalist practice and approach. The pay is well above average and from the stats I see, private hospitals do tend to pay psychologists very well. Neuro does tend to pay more than average too and they are often the ones working at some of these hospitals. At any rate, as a psychologist, it will be up to you to generate the revenue and income regardless of specialty to a certain extent.

Thanks! My program is in a rural community, and I'm certainly seeing that generalist approach. Do you know if private hospitals pay well in more urban/large metropolitan areas too?

 

[AcronymAllergy]

My experience re: IPC and masters-level vs. doctoral-level providers is that hospitals/clinics that haven't really had much of either won't have a preference, while those that have previously had (competent) psychologists filling those positions tend to prefer psychologists. At least to some extent. Perhaps via having one or two psychologists and a larger number of masters-level folks. But if you're the one initially blazing that trail, you may have to "prove your worth" relative to, say, an LCSW.

In the VA, there's no salary difference; it's all just based on years in the system. Outside the VA, the neuro spots I looked at tended to be higher (e.g., circa-$100k straight out of fellowship, give or take).

And I'd second the rec for rehab neuropsych. It's a needed area of service, and there are plenty of folks who go neuro but without a heavy dose of treatment/rehab experience or interest (and vice-versa: lots of folks do straight rehab psych without much neuropsych/assessment experience).

 

[pcpsych]

My experience re: IPC and masters-level vs. doctoral-level providers is that hospitals/clinics that haven't really had much of either won't have a preference, while those that have previously had (competent) psychologists filling those positions tend to prefer psychologists. At least to some extent. Perhaps via having one or two psychologists and a larger number of masters-level folks. But if you're the one initially blazing that trail, you may have to "prove your worth" relative to, say, an LCSW.

In the VA, there's no salary difference; it's all just based on years in the system. Outside the VA, the neuro spots I looked at tended to be higher (e.g., circa-$100k straight out of fellowship, give or take).

And I'd second the rec for rehab neuropsych. It's a needed area of service, and there are plenty of folks who go neuro but without a heavy dose of treatment/rehab experience or interest (and vice-versa: lots of folks do straight rehab psych without much neuropsych/assessment experience).

Thanks for the advice! I'm seriously considering rehab neuropsych now. I only knew of people who did rehab psych alone, and I didn't realize that it was possible to combine the two areas.

 

[pcpsych]

Are there any rehab neuropsych-oriented internships/fellowships that anyone particularly recommends looking at?

 

[Therapist4Chnge]

Are there any rehab neuropsych-oriented internships/fellowships that anyone particularly recommends looking at?

Johns Hopkins PM&R…Bill Stiers is there, he's one of the best in the rehab psych field. Great guy too.
University of Michigan PM&R…didactics are split between Peds & Adult and Neuro & Rehab..so a ton of training and mentoring is provided. Intense and a ton of research options here. Model Systems (longitudinal research project) site for spinal cord injury.
The Ohio State PM&R…very good clinical training. Up to 50% research training offered. A ton of research options here. Model systems site for Traumatic Brain Injury.
University of Missouri Health Sciences (I believe they are in PM&R)..Renee Stucky should still be the Director, she's very good.
Michigan State offers a Primary Care Fellowship w. some neuropsych and rehab components. It is a great program run by Kirk Stucky, who is a brilliant neuro & rehab psychologist. It's been a number of years since I reviewed the program, so I'm not sure how they split up different rotation options.
Baylor…they are a match neuro site that offers a lot of rehab exposure. Corwin Boake is the Director, brilliant guy.

Other top rehab hospitals that *should* have fellowship programs: Craig Hospital in Colorado, Sheppard in Atlanta, and U of Washington.

Be aware that rehab psych sites vary in how much neuro they offer, and most of the above are explicit that they are REHAB sites first, and NEURO training is secondary. Baylor is the exception on that list, they are neuro first.

 

[Pragma]

Rehab is a great compliment to neuropsych and vice versa. However, while it may be unusual, just know that in some places you may be able to split your time between two different specialties - I've seen weirder combinations at the VA before. Like I said, unusual and kind of tough - it might make more sense to be doing rehab and neuro in some kind of combo clinically, but it wouldn't be out of the question.

That said, outside of the VA it might be a tougher sell given the emphasis on specializing these days, and the strange combinations have more to do with clinical need when they can maybe justify half a position in one area and half in another.

 

[pcpsych]

Johns Hopkins PM&R…Bill Stiers is there, he's one of the best in the rehab psych field. Great guy too.
University of Michigan PM&R…didactics are split between Peds & Adult and Neuro & Rehab..so a ton of training and mentoring is provided. Intense and a ton of research options here. Model Systems (longitudinal research project) site for spinal cord injury.
The Ohio State PM&R…very good clinical training. Up to 50% research training offered. A ton of research options here. Model systems site for Traumatic Brain Injury.
University of Missouri Health Sciences (I believe they are in PM&R)..Renee Stucky should still be the Director, she's very good.
Michigan State offers a Primary Care Fellowship w. some neuropsych and rehab components. It is a great program run by Kirk Stucky, who is a brilliant neuro & rehab psychologist. It's been a number of years since I reviewed the program, so I'm not sure how they split up different rotation options.
Baylor…they are a match neuro site that offers a lot of rehab exposure. Corwin Boake is the Director, brilliant guy.

Other top rehab hospitals that *should* have fellowship programs: Craig Hospital in Colorado, Sheppard in Atlanta, and U of Washington.

Be aware that rehab psych sites vary in how much neuro they offer, and most of the above are explicit that they are REHAB sites first, and NEURO training is secondary. Baylor is the exception on that list, they are neuro first.

Thank you! These all look great!

Rehab is a great compliment to neuropsych and vice versa. However, while it may be unusual, just know that in some places you may be able to split your time between two different specialties - I've seen weirder combinations at the VA before. Like I said, unusual and kind of tough - it might make more sense to be doing rehab and neuro in some kind of combo clinically, but it wouldn't be out of the question.

That said, outside of the VA it might be a tougher sell given the emphasis on specializing these days, and the strange combinations have more to do with clinical need when they can maybe justify half a position in one area and half in another.

It's good to know that it is possible to do both, at least in the VA environment.

 

[AcronymAllergy]

Johns Hopkins PM&R…Bill Stiers is there, he's one of the best in the rehab psych field. Great guy too.
University of Michigan PM&R…didactics are split between Peds & Adult and Neuro & Rehab..so a ton of training and mentoring is provided. Intense and a ton of research options here. Model Systems (longitudinal research project) site for spinal cord injury.
The Ohio State PM&R…very good clinical training. Up to 50% research training offered. A ton of research options here. Model systems site for Traumatic Brain Injury.
University of Missouri Health Sciences (I believe they are in PM&R)..Renee Stucky should still be the Director, she's very good.
Michigan State offers a Primary Care Fellowship w. some neuropsych and rehab components. It is a great program run by Kirk Stucky, who is a brilliant neuro & rehab psychologist. It's been a number of years since I reviewed the program, so I'm not sure how they split up different rotation options.
Baylor…they are a match neuro site that offers a lot of rehab exposure. Corwin Boake is the Director, brilliant guy.

Other top rehab hospitals that *should* have fellowship programs: Craig Hospital in Colorado, Sheppard in Atlanta, and U of Washington.

Be aware that rehab psych sites vary in how much neuro they offer, and most of the above are explicit that they are REHAB sites first, and NEURO training is secondary. Baylor is the exception on that list, they are neuro first.

All great recommendations.

Sheppard may have a separate rehab postdoc as well, but I know they offer a straight neuropsych fellowship, and I'm fairly certain it entails significant rehab experience.

Emory's neuro postdoc took a slight hiatus back when I was looking around, but may be back up and running now. I don't know what the full-on rehab experiences looks like, but I know they offer experiences in cognitive remediation/rehabilitation (Anthony Stringer is there and at least used to head the fellowship, and has done a lot of work in that area).

Mentis Neurorehab and TIRR in Houston are both rehab-oriented hospitals/clinics that offer neuro fellowships, and TIRR has significant research opportunities. The Houston VA is also great and offers multiple neuropsych fellowships, with one year spent in polytrauma (although not a "traditional" rehabilitation unit in the sense of TIRR, Mentis, or Spain Rehab as mentioned below); they also have a spinal cord injury unit there.

UAB (Birmingham) has a neuro fellowship as well. It's, I believe, through Neurology (with Dan Marson et al.) and housed primarily in the memory disorders clinic, but Spain Rehabilitation is literally right down the street. Tom Novack works there and is a pretty darn big name. It's also a Model Systems TBI site, although is more acute/post-acute as opposed to long-term neurorehab such as is offered through TIRR and Mentis.

 

[Therapist4Chnge]

All solid recs.

 

[RedWingedBluebird]

Johns Hopkins PM&R…Bill Stiers is there, he's one of the best in the rehab psych field. Great guy too.
University of Michigan PM&R…didactics are split between Peds & Adult and Neuro & Rehab..so a ton of training and mentoring is provided. Intense and a ton of research options here. Model Systems (longitudinal research project) site for spinal cord injury.
The Ohio State PM&R…very good clinical training. Up to 50% research training offered. A ton of research options here. Model systems site for Traumatic Brain Injury.
University of Missouri Health Sciences (I believe they are in PM&R)..Renee Stucky should still be the Director, she's very good.
Michigan State offers a Primary Care Fellowship w. some neuropsych and rehab components. It is a great program run by Kirk Stucky, who is a brilliant neuro & rehab psychologist. It's been a number of years since I reviewed the program, so I'm not sure how they split up different rotation options.
Baylor…they are a match neuro site that offers a lot of rehab exposure. Corwin Boake is the Director, brilliant guy.

Other top rehab hospitals that *should* have fellowship programs: Craig Hospital in Colorado, Sheppard in Atlanta, and U of Washington.

Be aware that rehab psych sites vary in how much neuro they offer, and most of the above are explicit that they are REHAB sites first, and NEURO training is secondary. Baylor is the exception on that list, they are neuro first.

I've heard some weird stuff about the MSU fellowship. One of my intern-mates said someone in her program go there and had a lot of problems. Not an issue for me since I'm going into neuro, but thought I'd pass it along.