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Here's some information about clinical neuropsychology that JRB was so kind to share with us in this forum:
(1) What made you decide to pursue a career in clinical neuropsychology? What is your background/undergrad major?
I'm fascinated by the brain and it's relationship to behavior. To observe a person or test a person, and conceptualize their behavior, personality, affect, etc. as the output of their brain is infinitely interesting. The most interesting and bizarre things can be seen... for example, a case of reduplicative paramnesia whereby the patient believed that his wife was replaced by an identical imposter.
Neuropsychology appeals to my need for challenge; I am typically called upon to assist in determination of the diagnosis, so I tend to get difficult cases. It also satisfies my need for precision and justification. Evaluations require that you keep up with the scientific literature and advances in the field, and the approach to the evaluation and diagnosis is based on standardized methodology and statistical inference.
(2) What is a typical day like for you? Do you enjoy being a clinical neuropsychologist?
I work in a Medical School, so I see patients, teach, and perform research. With regard to my clinic, I see patients for therapy as well as for NP evaluations. On clinic days, I arrive around 8 - 8:30, begin seeing patients at 9, and end around 5 - 6. I usually work a little in the evenings, and I get up around 5am to work before I come to the office. (I'm writing a book on neurotoxicity).
Yes, I enjoy being a neuropsychologist. I am transitioning my practice toward forensic work... more challenging and better income for the effort.
(3) Given the problems associated with managed care, is it better to become a psychiatrist or neurologist instead of a clinical neuropsychologist?
I would never want to be a psychiatrist. I would be burned out within a year. For a while, about 80% of my therapy practice was psyc patients with personality disorders and I was ready to quit.
I never went to grad school with the intention of working with psyc patients. I wanted to work with medical patients. I don't want to be a physician, and I still don't. It would be sooooo unsatisfying to me. They are limited by managed care where they are unable to have the time they need to connect with their patients. Move em in and move em out.
Neurology would be more interesting, but only if I also had training in neuropsychology. Or at least, heavy training in behavioral neurology.
The choice depends on how you see yourself working with people. In what way do you want to impact their lives? Where do you get your satisfaction?
I work with physicians. I don't want to work with people the way they do. And soooo many of them are dissatisfied and burned out themselves. I also teach in a medical residency training program.. the residents are already burned out.
(4) What is the typical salary for a clinical neuropsychologist in a salaried position? Private practice? Is this level of income worth the 7+ years of training to become a clinical neuropsychologist?
I'd say that a starting salary may be in the 60 - 80 range. Private practice... maybe 100 to 150, but I can't be sure about that.
There's very good money to be had, you just have to know where to get it. Not many in our field know how to do that.
(5) Some people have complained that clinical neuropsychologists are nothing more than "glorified proctors" and that neuropsychological testing will one day be done completely by computers. I have also heard that Master's level psychologists (and yes, even occupational therapists!) will increasingly begin doing cognitive testing in rehabilitation hospitals. Granted, time will tell what will really happen, but in your experience, do you think there is any truth to this speculation?
With regard to "glorified proctors" I'd say that the person or people who are saying this are being defensive for some reason, because that is an opinion that is not based on any reality. Maybe they feel threatened somehow, or need to justify why they are rejecting the field by demeaning it.
The neuropsychological evaluation (done properly) involves much more than just testing. Some neuropsychologists use Master's level employees as testing technicians. There is controversy regarding this practice, because the good doctor will insure that he/she personally works with the patient in order to develop their own clinical impression. The whole is more than the sum of it's parts... the quantitative data is not sufficient to answer most npsyc referral questions. I do use doctoral health psyc students in training to administer a limited number of tests to my patients, but I never conduct an evaluation without having worked with the patient myself.
Some tests are computerized, but they won't be all computerized any time soon. You simply can't measure the range of human output yet through computerization, and technology isn't to the point that it can make the subjective determinations that are made by the doctor.
All the technical information (test data) has to be integrated with the patient's history of the presenting problem, the medical history, laboratory and brain scans if done, current medications, psyc history, family history, psychosocial history, and behavioral observations. This is what any doctor does. A technician or mid level provider simply cannot do this without the supervision of a doctor who has the proper training and educational background.
It is fine that OTs and SPs might be administering some (limited) neuropsyc tests; but these are done and will continue to be done under the supervision of an attending neuropsychologist. This doctor is responsible (and liable) for insuring appropriate administration, interpretation, diagnosis/conclusions, and treatment recommendations. In most facilities of this sort, the neuropsychologist and a physician are co-directors.
In order to be a properly trained health psychologist, you must have a strong foundation in medicine AND psychology. In order to be a properly trained neuropsychologist, you must have additional foundation in neurology, neurobiology, structural neuroanatomy, and functional neuroanatomy. There is wide variability in how neuropsychologists are trained. The "Houston Conference" was an attempt to define neuropsychology and set guidelines. These guidelines are still a source of controversy in the field, as is the issue of Board Certification.
The ethical and responsible doctor will take it upon him or herself to make sure that he or she is properly trained. Take extra classes, buy books, shadow a neuropsychologist, do an extra clinical rotation in grad school....
(6) In forensic neuropsychology, is the fact that clinical neuropsychologists, as opposed to medical doctors/psychiatrists, are evaluating a patient ever called into question?
In the forensic area, the question is always brought up... by the opposing attorney as a red herring. It's an anticipated question and is very easily handled. As experts we are equivalent, as long as we stick to our area of expertise.
We are doctors that are evaluating medical (neurological) syndromes. (In fact, our procedure codes are billed under medical, not psyc, and I give a medical diagnosis). Our expertise is highly valued by our referral sources. But, you have to be good at what you do to achieve this level of respect, and that takes work. Too many psychologists don't want to put in the effort.
(1) What made you decide to pursue a career in clinical neuropsychology? What is your background/undergrad major?
I'm fascinated by the brain and it's relationship to behavior. To observe a person or test a person, and conceptualize their behavior, personality, affect, etc. as the output of their brain is infinitely interesting. The most interesting and bizarre things can be seen... for example, a case of reduplicative paramnesia whereby the patient believed that his wife was replaced by an identical imposter.
Neuropsychology appeals to my need for challenge; I am typically called upon to assist in determination of the diagnosis, so I tend to get difficult cases. It also satisfies my need for precision and justification. Evaluations require that you keep up with the scientific literature and advances in the field, and the approach to the evaluation and diagnosis is based on standardized methodology and statistical inference.
(2) What is a typical day like for you? Do you enjoy being a clinical neuropsychologist?
I work in a Medical School, so I see patients, teach, and perform research. With regard to my clinic, I see patients for therapy as well as for NP evaluations. On clinic days, I arrive around 8 - 8:30, begin seeing patients at 9, and end around 5 - 6. I usually work a little in the evenings, and I get up around 5am to work before I come to the office. (I'm writing a book on neurotoxicity).
Yes, I enjoy being a neuropsychologist. I am transitioning my practice toward forensic work... more challenging and better income for the effort.
(3) Given the problems associated with managed care, is it better to become a psychiatrist or neurologist instead of a clinical neuropsychologist?
I would never want to be a psychiatrist. I would be burned out within a year. For a while, about 80% of my therapy practice was psyc patients with personality disorders and I was ready to quit.
I never went to grad school with the intention of working with psyc patients. I wanted to work with medical patients. I don't want to be a physician, and I still don't. It would be sooooo unsatisfying to me. They are limited by managed care where they are unable to have the time they need to connect with their patients. Move em in and move em out.
Neurology would be more interesting, but only if I also had training in neuropsychology. Or at least, heavy training in behavioral neurology.
The choice depends on how you see yourself working with people. In what way do you want to impact their lives? Where do you get your satisfaction?
I work with physicians. I don't want to work with people the way they do. And soooo many of them are dissatisfied and burned out themselves. I also teach in a medical residency training program.. the residents are already burned out.
(4) What is the typical salary for a clinical neuropsychologist in a salaried position? Private practice? Is this level of income worth the 7+ years of training to become a clinical neuropsychologist?
I'd say that a starting salary may be in the 60 - 80 range. Private practice... maybe 100 to 150, but I can't be sure about that.
There's very good money to be had, you just have to know where to get it. Not many in our field know how to do that.
(5) Some people have complained that clinical neuropsychologists are nothing more than "glorified proctors" and that neuropsychological testing will one day be done completely by computers. I have also heard that Master's level psychologists (and yes, even occupational therapists!) will increasingly begin doing cognitive testing in rehabilitation hospitals. Granted, time will tell what will really happen, but in your experience, do you think there is any truth to this speculation?
With regard to "glorified proctors" I'd say that the person or people who are saying this are being defensive for some reason, because that is an opinion that is not based on any reality. Maybe they feel threatened somehow, or need to justify why they are rejecting the field by demeaning it.
The neuropsychological evaluation (done properly) involves much more than just testing. Some neuropsychologists use Master's level employees as testing technicians. There is controversy regarding this practice, because the good doctor will insure that he/she personally works with the patient in order to develop their own clinical impression. The whole is more than the sum of it's parts... the quantitative data is not sufficient to answer most npsyc referral questions. I do use doctoral health psyc students in training to administer a limited number of tests to my patients, but I never conduct an evaluation without having worked with the patient myself.
Some tests are computerized, but they won't be all computerized any time soon. You simply can't measure the range of human output yet through computerization, and technology isn't to the point that it can make the subjective determinations that are made by the doctor.
All the technical information (test data) has to be integrated with the patient's history of the presenting problem, the medical history, laboratory and brain scans if done, current medications, psyc history, family history, psychosocial history, and behavioral observations. This is what any doctor does. A technician or mid level provider simply cannot do this without the supervision of a doctor who has the proper training and educational background.
It is fine that OTs and SPs might be administering some (limited) neuropsyc tests; but these are done and will continue to be done under the supervision of an attending neuropsychologist. This doctor is responsible (and liable) for insuring appropriate administration, interpretation, diagnosis/conclusions, and treatment recommendations. In most facilities of this sort, the neuropsychologist and a physician are co-directors.
In order to be a properly trained health psychologist, you must have a strong foundation in medicine AND psychology. In order to be a properly trained neuropsychologist, you must have additional foundation in neurology, neurobiology, structural neuroanatomy, and functional neuroanatomy. There is wide variability in how neuropsychologists are trained. The "Houston Conference" was an attempt to define neuropsychology and set guidelines. These guidelines are still a source of controversy in the field, as is the issue of Board Certification.
The ethical and responsible doctor will take it upon him or herself to make sure that he or she is properly trained. Take extra classes, buy books, shadow a neuropsychologist, do an extra clinical rotation in grad school....
(6) In forensic neuropsychology, is the fact that clinical neuropsychologists, as opposed to medical doctors/psychiatrists, are evaluating a patient ever called into question?
In the forensic area, the question is always brought up... by the opposing attorney as a red herring. It's an anticipated question and is very easily handled. As experts we are equivalent, as long as we stick to our area of expertise.
We are doctors that are evaluating medical (neurological) syndromes. (In fact, our procedure codes are billed under medical, not psyc, and I give a medical diagnosis). Our expertise is highly valued by our referral sources. But, you have to be good at what you do to achieve this level of respect, and that takes work. Too many psychologists don't want to put in the effort.
I'd like to call him and ask for his current position in regard to his procedures used during WADA.
