Will anyone actually discuss salary? Let's see...

[erg923]

Most clients' insurances give me closer to $70 than $85.

Yea. So, it even worse than I thought. I am not currently doing any clinical practice/work other than supervision.

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[Therapist4Chnge]

JS...I think that'd be a wise move. A clinician who can bring a research approach to clinical work will not hurt for jobs or compensation. I'm not sure how strict the VA is w. non-compete agreements, but you can probably pad your income through clinical work and not stress about making sure the soft-money is there 2-3 yrs down the road.

 

[PHD12]

I'm a bit concerned about possible drops in the future. I'm mostly soft money both in my VA and university positions. My income is good, but it is not guaranteed in the future. I am actively wondering if I should drop the tenure track academic/research VA track and just shift to clinical VA. I wouldn't have a problem getting a clinical VA position right now. I am fairly well connected and I already do clinical work in the VA system. It would cost me a chunk of money in the short-term as my income level is 30K or so higher than the VA pay rate, but I could come up with alternative revenue streams for that. Within two years, you get locked in security of federal employment. I would no longer have to worry about begging for money (grants), publishing rates, etc. .. I could work 40 hours a week and not stress at all. For me, clinical work, while interesting, is very easy. My clinic days feel like a day off, in a sense.

How is the clinical work low stress at the VA? The VA patients are on the severe end of the spectrum for most diagnoses. Lots of emergencies, behavioral problems, suicidal and homicidal ideation. Plus, the caseloads are enormous and you can't see patients weekly anymore at most VA's. Psychologists are the ones who are "on call" to take walk-in emergencies at the VA where I trained (not the psychiatrists). For clinical work, I have not seen any decent work env. for psychologists (ridiculous caseloads, seeing patients once every 4 weeks, tons of paperwork, and long hours are the norm).

 

[PHD12]

It wouldn't sting half as much if I didn't feel like I continue to make a lot of sacrifices for my career (long hours, typically not getting home until 8pm or later, going in on weekends to catch up on reports or paperwork). If I made 44K at a 9-5 job that would be more palatable.

Dr. E

That is pretty awful pay for hours worked. You can make 40K as an RA (that's what I was making many years ago). In the future if you want to build your own practice, at least you would be able to take the full $70 from insurance companies. Rents are not so high unless you are in places like NYC or LA. You would probably net 75-80K if you saw 30 patients per week at $70 after paying your rent. Have you looked into how much it costs to rent a small office in your location (I've heard of psychologists who pay only $500 per month)? It may not be very risky if you can get a month to month or sublet from someone short-term. I think it would be unlikely that you would make any less than you are right now.

 

[Doctor Eliza]

That is pretty awful pay for hours worked. In the future if you want to build your own practice, at least you would be able to take the full $70 from insurance companies. Rents are not so high unless you are in places like NYC or LA. You would probably net 75-80K if you saw 30 patients per week at $70 after paying your rent. Have you looked into how much it costs to rent a small office in your location (I've heard of psychologists who pay only $500 per month)? It may not be very risky if you can get a month to month or sublet from someone short-term. I think it would be unlikely that you would make any less than you are right now.

Yeah, office space around here isn't bad. $500 or less sounds about right. I do plan to make the leap to solo practice, but have hesitated thus far. One is the fear of being able to maintain a steady stream of clients. The PP I'm affiliated with now could give me 50 people a week if I wanted. They pay me horribly, but at least I get paid something. A second issue is a complete lack of savings or safety net. Although I went to a funded program, it is nearly impossible to save while going to school or in the 1st few years of practice. When you branch out on your own, you need to be prepared for lean weeks at the beginning. (I have heard it takes 2 yrs to get a PP truly up and running). It also takes $ to buy a couch and a computer and other stuff like that. A more minor issue is that I worry about doing insurance paperwork on my own. I guess I'd figure it out eventually.

Although all that is on hold for a while because life has interfered and I will need to be out of work 3-4 months due to medical issues. The good thing about being with this PP is that they will be able to build my caseload back up when I am able to get back to work. It's a trade off.

I know I post a lot, but I think it is really important, because I think a lot of people get into this field thinking that PP is the dream job. In fact, if you want to do clinical work, you are much better off if you can position yourself to find employment with the gov't or maybe a hospital.

Dr. E

 

[JeyRo]

How is the clinical work low stress at the VA? The VA patients are on the severe end of the spectrum for most diagnoses. Lots of emergencies, behavioral problems, suicidal and homicidal ideation. Plus, the caseloads are enormous and you can't see patients weekly anymore at most VA's. Psychologists are the ones who are "on call" to take walk-in emergencies at the VA where I trained (not the psychiatrists). For clinical work, I have not seen any decent work env. for psychologists (ridiculous caseloads, seeing patients once every 4 weeks, tons of paperwork, and long hours are the norm).

Au contraire. My job (with some exceptions) is very easy. I don't have to clear consults, track my time, or make appointments (except the ones I make myself). My schedule is also hugely flexible. Maybe I'm in a minority but I've found working for the VA to be pretty darn low stress.

 

[ResearchGirlie]

How is the clinical work low stress at the VA? The VA patients are on the severe end of the spectrum for most diagnoses. Lots of emergencies, behavioral problems, suicidal and homicidal ideation. Plus, the caseloads are enormous and you can't see patients weekly anymore at most VA's. Psychologists are the ones who are "on call" to take walk-in emergencies at the VA where I trained (not the psychiatrists). For clinical work, I have not seen any decent work env. for psychologists (ridiculous caseloads, seeing patients once every 4 weeks, tons of paperwork, and long hours are the norm).

This must be VA site specific because I know of a number of psychologists in the VA that see their patients weekly and work 40-45 hour weeks, suggesting they don't have an enormous caseload or more paperwork than could be reasonably done in a very doable work week.

 

[Therapist4Chnge]

For clinical work, I have not seen any decent work env. for psychologists (ridiculous caseloads, seeing patients once every 4 weeks, tons of paperwork, and long hours are the norm).

The Devil is definitely in the details. I think a lot of it depends on your specific hospital and the VISN associated with the hospital. I can see how doing mostly/all therapy could be a recipe for disaster, but carving out a more balanced position could be a completely different experience. I know people who have been able to divide their "clinical" duties among a few different areas: Covering Primary Care, securing a day for research/admin work, seeing individual patients for therapy, and taking on a full day of C&P evals. That much therapy would make my head explode, but it sure beats spending 5x/wk seeing individual pts back to back.

Is the VA favoring more short-term individual therapy or groups now? When I was in the system it was Individual > Group...but there was a noticeable shift towards more groups and making individual therapy directly connected to a time-limited VA-approved intervention: CPT, Prolonged Exposure Therapy, etc. I think it was the right move, but I'm not sure if that was a hospital, VISN, or system-wide change.

I considered a VA neuropsych position last year, and it sounded like a very manageable schedule (40hr wks). They had reasonable expectations for brief and full evals done, and they was a focus on the amount of flexibility I would have in the position: the opportunity to teach at the local uni, conduct research, volunteer for additional C&P work for extra $, etc. I think if clinicians can avoid the "grind-like" positions, the VA is still a great place to be a clinician. This was all at the GS-13 level, so decent money too.

 

[PHD12]

I think it varies a lot depending on your specialty and VISN. If you are in PTSD, patients are seen weekly for short-term interventions because you can't space out PE/CPT sessions, but most go through several psychoeducational PTSD groups because there usually are not enough providers to see them individually (depending on the patient/VA). Substance abuse is primarily group treatment. I interviewed at many VA hospitals, and some have you running groups all day and others focus on individual treatment. I know there are some VA hospitals where psychologists see patients weekly, but I don't think this is the norm anymore (especially if you are in a heavily populated location). You may see a portion of your patients weekly and then space out the rest.

 

[Pragma]

How is the clinical work low stress at the VA? The VA patients are on the severe end of the spectrum for most diagnoses. Lots of emergencies, behavioral problems, suicidal and homicidal ideation. Plus, the caseloads are enormous and you can't see patients weekly anymore at most VA's. Psychologists are the ones who are "on call" to take walk-in emergencies at the VA where I trained (not the psychiatrists). For clinical work, I have not seen any decent work env. for psychologists (ridiculous caseloads, seeing patients once every 4 weeks, tons of paperwork, and long hours are the norm).

FWIW I know people at 3 VAs and they all consider it a cakewalk.

 

[PHD12]

Yeah, office space around here isn't bad. $500 or less sounds about right. I do plan to make the leap to solo practice, but have hesitated thus far. One is the fear of being able to maintain a steady stream of clients. The PP I'm affiliated with now could give me 50 people a week if I wanted. They pay me horribly, but at least I get paid something. A second issue is a complete lack of savings or safety net. Although I went to a funded program, it is nearly impossible to save while going to school or in the 1st few years of practice. When you branch out on your own, you need to be prepared for lean weeks at the beginning. (I have heard it takes 2 yrs to get a PP truly up and running). It also takes $ to buy a couch and a computer and other stuff like that. A more minor issue is that I worry about doing insurance paperwork on my own. I guess I'd figure it out eventually.

Although all that is on hold for a while because life has interfered and I will need to be out of work 3-4 months due to medical issues. The good thing about being with this PP is that they will be able to build my caseload back up when I am able to get back to work. It's a trade off.

I know I post a lot, but I think it is really important, because I think a lot of people get into this field thinking that PP is the dream job. In fact, if you want to do clinical work, you are much better off if you can position yourself to find employment with the gov't or maybe a hospital.

Dr. E

Obviously its not the right time to start a PP, especially due to the medical issues. I'm curious about one thing. I thought it was relatively easy to get patients if you take insurance. I think building a cash practice is what takes 2 years. All the psychologists I know don't want to take insurance and many pass around patients on the listserve who want to use their insurance. If you willing to use several insurance plans, I don't know why it would be such a hassle to get patients, particularly if you see children, adolescents, and adults. There is a huge demand for psychotherapy, but nobody can pay out of pocket.

 

[Doctor Eliza]

Obviously its not the right time to start a PP, especially due to the medical issues. I'm curious about one thing. I thought it was relatively easy to get patients if you take insurance. I think building a cash practice is what takes 2 years. All the psychologists I know don't want to take insurance and many pass around patients on the listserve who want to use their insurance. If you willing to use several insurance plans, I don't know why it would be such a hassle to get patients, particularly if you see children, adolescents, and adults. There is a huge demand for psychotherapy, but nobody can pay out of pocket.

I think that can be location dependent. In my area (and I am no longer willing/able to relocate), only a number of psychiatrists don't accept insurance. Almost all psychologists do (plus all the MSW and LPC's). While I wouldn't say we are saturated, we are certainly not hurting for therapists. That said, people who have left our PP seem to be managing okay after a year or so.

A bit part of building a practice is keeping patients (in an ethical and appropriate manner!) I remember learning that the modal number of therapy sessions is 1. So every client you get is not going to stick around for months and months of therapy, particularly if you see a relatively healthy client population. You constantly need to be getting more and more patients.

You definitely need a hook or something that will set you apart. Seeing kids will help, but of course that will mean needing to be available most evenings (when I would like to spend time with my own kid).

Dr. E

 

[JeyRo]

I think it varies a lot depending on your specialty and VISN. If you are in PTSD, patients are seen weekly for short-term interventions because you can't space out PE/CPT sessions, but most go through several psychoeducational PTSD groups because there usually are not enough providers to see them individually (depending on the patient/VA). Substance abuse is primarily group treatment. I interviewed at many VA hospitals, and some have you running groups all day and others focus on individual treatment. I know there are some VA hospitals where psychologists see patients weekly, but I don't think this is the norm anymore (especially if you are in a heavily populated location). You may see a portion of your patients weekly and then space out the rest.

It's both system and position specific, potentially. Like I mentioned, I have a pretty cushy deal and have for years. However, I know a colleague in a neighboring VISN with an identical position who has it exactly the opposite that I do. She has to track her time in three different places, is required to have a consult system, and has several other bureaucratic paperwork requirements that in my case have always been assumed by nursing staff. She tells me she regularly stays late at the office and clocks in 50+ hour workweeks.

Of course, her service chief is Psychiatry (mine is Psychology), which might make some difference.

 

[JeyRo]

FWIW I know people at 3 VAs and they all consider it a cakewalk.

My sense is generally if you work in the outpatient mental health line at VAs (or, horrors - C&P) you're more likely to find yourself in psychologist-sweatshop territory, overburdened with caseloads and bureaucratic nonsense.

The trick is to get yourself a position where you're assigned to a medical service (like extended care or spinal cord) and you're more able to independently create your own job description as you see fit. Besides, integrated healthcare is much more fun and interesting anyways.

 

[PHD12]

My sense is generally if you work in the outpatient mental health line at VAs (or, horrors - C&P) you're more likely to find yourself in psychologist-sweatshop territory, overburdened with caseloads and bureaucratic nonsense.

The trick is to get yourself a position where you're assigned to a medical service (like extended care or spinal cord) and you're more able to independently create your own job description as you see fit. Besides, integrated healthcare is much more fun and interesting anyways.

How long after graduating did you land your VA job? The problem with the VA system is that if you are looking in a particularly specialty area and in a particular geographic location, you can wait 10 years before there is an opening. I agree that there are better VA positions and "sweatshop" positions.

 

[JeyRo]

[double post - deleted]

 

[JeyRo]

How long after graduating did you land your VA job? The problem with the VA system is that if you are looking in a particularly specialty area and in a particular geographic location, you can wait 10 years before there is an opening. I agree that there are better VA positions and "sweatshop" positions.

Three years. Everyone who knows my situation (including myself) agrees that I was extremely lucky - preparation meeting opportunity, that kind of thing.

I will say that in the three years prior to my VA position I was making barely 20K per year, and I was living in an extremely high cost of living area (even higher than I am now), working a patchwork of consulting gigs. This is much, much superior in terms of lifestyle, hands down.

 

[PHD12]

Three years. Everyone who knows my situation (including myself) agrees that I was extremely lucky - preparation meeting opportunity, that kind of thing.

I will say that in the three years prior to my VA position I was making barely 20K per year, and I was living in an extremely high cost of living area (even higher than I am now), working a patchwork of consulting gigs. This is much, much superior in terms of lifestyle, hands down.

Thanks. I think this needs to be advertised more. I also know some early career folks who are barely getting by (not 80K but more like 30K). People are skeptical when they hear that early career psychologists do earn poverty wages sometimes. Do you have some advice for people so that they do not fall into a 20K type of situation?

Sounds like you have a dream job now!

 

[JeyRo]

Thanks. I think this needs to be advertised more. I also know some early career folks who are barely getting by (not 80K but more like 30K). People are skeptical when they hear that early career psychologists do earn poverty wages sometimes. Do you have some advice for people so that they do not fall into a 20K type of situation?

Sounds like you have a dream job now!

Just avoid things like CAPIC (always keep your doors open). Also, for me, ultra-specialization has worked - when the position at the VA opened up (in geriatrics), I was one of probably only 2-3 applicants who fit the bill. I'm sure there were probably 30-40 applicants, but only a tiny handful of us were competitive, and I got the nod.

I'm not sure how I could have avoided the 3 years of poverty wages. I had to study for about 6 months for licensure (so I wasn't working much at all), and since there were no full time psychology salaried positions available, and since I had no business plan in place at all, I just pieced things together (poorly) to make money. In the end, though, I found out later that the particular consulting work I did actually reflected well on my VA app, so that worked too.

Beyond that, if salaried positions aren't your thing and you want to do entrepreneurship / private practice - take business courses and / or read about what it takes to strike out on your own. Network with other businesspeople. Be unafraid to fail a few times. All the stuff Psychiavelli has recommended sounds like gold.

 

[PHD12]

I'm not sure how I could have avoided the 3 years of poverty wages. I had to study for about 6 months for licensure (so I wasn't working much at all), and since there were no full time psychology salaried positions available, and since I had no business plan in place at all, I just pieced things together (poorly) to make money. In the end, though, I found out later that the particular consulting work I did actually reflected well on my VA app, so that worked too.

Makes sense. What i'm finding while interviewing for post-docs right now is that the vast majority of the post-doc fellows have not been able to find time to study for the EPPP (they are 6 months into post-doc at this point) due to being exhausted from long clinical hours and also having to do a job search at the same time. Unfortunately, what ends up happening is that they are not licensed by the end of post-doc year and end up having to be unemployed/working PT in some lower wage position while studying for the EPPP for a few months. I also know some people with kids who were unable to study while working FT. When you are out of the workforce, it is tougher to get back into it. This is why I think we need to support legislation that allows students to take the EPPP at the end of graduate school or eliminate the post-doc year entirely. We are putting early career folks through an additional year or two of poverty. This seems so unfair to me.

 

[Pragma]

Makes sense. What i'm finding while interviewing for post-docs right now is that the vast majority of the post-doc fellows have not been able to find time to study for the EPPP (they are 6 months into post-doc at this point) due to being exhausted from long clinical hours and also having to do a job search at the same time. Unfortunately, what ends up happening is that they are not licensed by the end of post-doc year and end up having to be unemployed/working PT in some lower wage position while studying for the EPPP for a few months. I also know some people with kids who were unable to study while working FT. When you are out of the workforce, it is tougher to get back into it. This is why I think we need to support legislation that allows students to take the EPPP at the end of graduate school or eliminate the post-doc year entirely. We are putting early career folks through an additional year or two of poverty. This seems so unfair to me.

Well making time to study is one's own decision. There are lots of ways to do it. I was working around 80 hours a week between postdoc and adjuncting, but I managed to make it happen. It is just a fact of life/rite of passage/whatever you want to think of it. It just has to happen.

What is more troubling to me is that a lot of states don't let you sit for the exam until the hours are completed, and then it can take some time to process your application to sit for the exam. So let's say I was finishing a 1 year postdoc in June - I might not be able to actually sit for the exam until August or even September if they are slow. Some jobs are okay with you coming in unlicensed for a brief time, but some aren't. Some jobs also keep you at a low pay grade if you still require supervision.

So I'd like to see states let people take the exam earlier such that they could be licensed immediately upon completing their hours. I saw some friends in limbo, even when they got hired on for great jobs, because it took X weeks/months to get licensed, and then after that X months to get credentialed, etc...so they had to stay at postdoc salary until that process was complete.

 

[AcronymAllergy]

Makes sense. What i'm finding while interviewing for post-docs right now is that the vast majority of the post-doc fellows have not been able to find time to study for the EPPP (they are 6 months into post-doc at this point) due to being exhausted from long clinical hours and also having to do a job search at the same time. Unfortunately, what ends up happening is that they are not licensed by the end of post-doc year and end up having to be unemployed/working PT in some lower wage position while studying for the EPPP for a few months. I also know some people with kids who were unable to study while working FT. When you are out of the workforce, it is tougher to get back into it. This is why I think we need to support legislation that allows students to take the EPPP at the end of graduate school or eliminate the post-doc year entirely. We are putting early career folks through an additional year or two of poverty. This seems so unfair to me.

I personally would be fine with an elimination of the licensure-required post-doc year. I'd think this could also actually help the market for post-doc training, as such positions would then be able to bill more easily for your services.

As for the EPPP, there's time to study, but it can be tough, and much of it happens on weekends. I liken it to having to work on my dissertation while on internship. It wasn't at all fun, and it required more than one near-all-nighter (with work the next morning), but it was possible. It probably doesn't need to be said, but I'll mention it anyway--I'd highly, highly prioritize sitting for the EPPP and being licensed or as license-eligible as possible prior to completing post-doc. For you interns out there, this could include identifying the state in which you'd like to be licensed and at least getting an idea of what they're going to require from you prior to even beginning post-doc.

Edit: And I agree with Pragma--states that require you to complete your postdoc hours before even allowing you to sit for the exam need to change that ASAP.

(For what it's worth, none of the post-docs here have been unable to find the time to study; the motivation, on the other hand...)

 

[Pragma]

For you interns out there, this could include identifying the state in which you'd like to be licensed and at least getting an idea of what they're going to require from you prior to even beginning post-doc.

Another thing you can do is get licensed in a state that lets you take the exam earlier just for the purpose of taking the exam. I had some friends do that and take the exam right after internship. Then they transferred their scores upon completion of the postdoc hours. There are ways to take it when you want to, but they can be irritating.

 

[AcronymAllergy]

Another thing you can do is get licensed in a state that lets you take the exam earlier just for the purpose of taking the exam. I had some friends do that and take the exam right after internship. Then they transferred their scores upon completion of the postdoc hours. There are ways to take it when you want to, but they can be irritating.

I actually was going to suggest something similar, and definitely agree with you that it could certainly be a worthwhile solution.

You can do the same (i.e., pursue licensure in one of the lower-requirement states, such as Alabama or Kansas, and then transfer later) if you aren't sure where you might end up for work.

 

[Sanman]

Just avoid things like CAPIC (always keep your doors open). Also, for me, ultra-specialization has worked - when the position at the VA opened up (in geriatrics), I was one of probably only 2-3 applicants who fit the bill. I'm sure there were probably 30-40 applicants, but only a tiny handful of us were competitive, and I got the nod.

I'm not sure how I could have avoided the 3 years of poverty wages. I had to study for about 6 months for licensure (so I wasn't working much at all), and since there were no full time psychology salaried positions available, and since I had no business plan in place at all, I just pieced things together (poorly) to make money. In the end, though, I found out later that the particular consulting work I did actually reflected well on my VA app, so that worked too. .

Agreed for the most part. Being specialized, for me, was a bit of a mixed bag. There was a while where my clearly apparent specialty choices meant that I would not be considered for a number of convenient positions (mostly in substance abuse), but when things in my specialty area did open up I was a readily hired. The one good thing about a job vs post-doc is that I can stay in my position until I am licensed and have an offer waiting once licensed.

Moving is another issue that concerns me. I am contemplating moving as I plan to get engaged at the end of this year/early next year and am likely moving to her state. I'm trying to figure out the quickest/best way to do this.

 

[Rivi]

For those in PP, can group therapy help boost your income at all?

Hypothetically speaking, 6-8 clients x 40$ a session = 240-320 per hour, or per 90 minute session, depending on how you do it.

I know, I know. The challenge is finding a steady stream of clients, etc. I just wonder if integrating this approach into your practice might be more efficient and helpful in the future, as I see very few people in PP doing therapy groups.

OR

Maybe creating an intensive outpatient program, etc. You could run three groups per day, five days a week, and the insurance reimbursement rate may be much higher for IOP days.

Am I way off the mark here? Or is there some validity to this?

 

[Doctor Eliza]

For those in PP, can group therapy help boost your income at all?

Hypothetically speaking, 6-8 clients x 40$ a session = 240-320 per hour, or per 90 minute session, depending on how you do it.

I know, I know. The challenge is finding a steady stream of clients, etc. I just wonder if integrating this approach into your practice might be more efficient and helpful in the future, as I see very few people in PP doing therapy groups.

OR

Maybe creating an intensive outpatient program, etc. You could run three groups per day, five days a week, and the insurance reimbursement rate may be much higher for IOP days.

Am I way off the mark here? Or is there some validity to this?

It makes sense to me, but I suspect there are logistical issues with group therapy because it is very rarely done in a PP context. You'd need people to pay out of pocket because insurance rarely reimburses for groups. I will also say that the man who owns my PP is a business genius and has a good set up for groups but has never had them as part of the practice in spite of many therapists wanting to do them. As he makes all decisions based on finances rather than clinical care, I suspect groups are not profitable. That said, I have a friend who is a substance specialist in PP who runs a group. She's the only one I know, though.

With IOP I would think client severity would be the issue. You'd want to be affiliated with a hospital or something.

Dr. E

 

[deleted176373]

While I doubt compensation is going to drop at all for military psychologists, I can't help but wonder if if any changes are on the horizon for folks at the VAs.

With all the cost-cutting, I'd see either mid-level encroachment or (not sure about this one) perhaps pay grade adjustments? I just can't help but wonder if VA hiring is a "bubble" for our field given the oversaturation and our healthcare/budget issues.

I see it that way too. They can't take away rank and it's a small community with a valued impact. If all we did was see patients, I would be concerned, but in the past few years, specialty pays, board pays, and retention bonuses have been added. They could axe those, but, that's not a factor yet in my salary.

 

[VAneurodoc]

I see it that way too. They can't take away rank and it's a small community with a valued impact. If all we did was see patients, I would be concerned, but in the past few years, specialty pays, board pays, and retention bonuses have been added. They could axe those, but, that's not a factor yet in my salary.

The only potential changes are a freeze on step increases, although this is unlikely to happen. So far there has been the freeze on cost of living raises (past few years), but this is all federal employees and it is a very small increase. The step increase is the important thing.

At my VA they went through a period of considering replacing psychologists with social workers when one of us would leave (the formula being 1 psychologist = 2 social workers), but that was short lived. Personally, I am not worried at all. I do think the hiring will slow, but that always has up swings and down swings.

 

[JeyRo]

Agreed for the most part. Being specialized, for me, was a bit of a mixed bag. There was a while where my clearly apparent specialty choices meant that I would not be considered for a number of convenient positions (mostly in substance abuse), but when things in my specialty area did open up I was a readily hired. The one good thing about a job vs post-doc is that I can stay in my position until I am licensed and have an offer waiting once licensed.

Specialization is a gamble, particularly as you're more specialized and depending on how much of a niche area your specialty occupies. The alternative is to be a generalist and that makes you as distinguished as generic vanilla ice cream. Everyone wants vanilla ice cream for dessert every once in a while but there's tons of it out there and no one is ever particularly enthusiastic about it.

 

[erg923]

But here's the thing, on almost all PP websites Ive seen the person seems to promote that they do nearly everything under the sun...

 

[JeyRo]

But here's the thing, on almost all PP websites Ive seen the person seems to promote that they do nearly everything under the sun...

I have no choice but to take the completely opposite approach when I start this PP experiment of mine. Obviously, first, because I'm hopelessly specialized in terms of the experience I've amassed over the past 10 years. Second, too many of the services I could potentially offer would just be too labor-intensive for far too little reward (geriatrics tends to be a thankless area, thank you Medicare).

And of course, I just think as a sales pitch for PP it makes you completely unremarkable compared to everyone else. Just about everyone knows the saying - "jack of all trades, master of none."

 

[psychRA]

FWIW I know people at 3 VAs and they all consider it a cakewalk.

I've worked in 3 different VISNs, and in my opinion, it's the best setting to pursue if you want to do clinical work. Minimal (if any) dealings with insurance companies, set hours (unless you're in an emergency setting), and a decent salary and benefits. In every VA setting I've worked in, patients are seen weekly, unless a lower intensity is clinically warranted. We have patients that have been in the system for years and years, and there's no push to get them out the door. Granted, that's a double-edged sword - I sometimes think that some of my patients would be fine without regular therapy, but I'm not constantly having to justify the need for services to an insurance panel.

 

[Sanman]

I would have to agree with the consensus that in doing clinical work, the VA is one of the best job opportunities out there. Having worked in a couple of different VAMCs including on internship, I can tell you that other than a few really out there personalities on the staff at some places, it is a pretty enjoyable job. Interestingly, I checked out a few articles on physician job problems and came up with this:

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?source=cn

http://www.forbes.com/sites/rickungar/2012/01/06/if-american-doctors-are-going-broke-who-is-really-responsible/

I think the most interesting stat is that in recent years the percentage of doctors in private practice went from ~75% to ~50% and it is suggested it will be dropping to ~33% soon. Most are taking hospital jobs instead. It sounds very similar to a lot what we are discussing regarding private practice. I think other than the smaller percentage that have cadillac insurance or pay out of pocket, we will see a lot of privately own small businesses in healthcare close. I am already seeing this in the geriatric side of things, where large groups with hundreds of mental health providers are popping up in every region.

 

[PHD12]

Its a myth that VA hospitals are overall good places to work. You really have to do your homework because they vary dramatically. I know several psychologists at different VA hospitals who have some of the most stressful jobs i've seen out there (in part because of the management). They have enormous case loads, no control over their schedules, are micromanaged, and are required to keep certain slots full. They have to keep on call hours/take walk-ins (instead of psychiatrists). I also know some psychologists on inpatient units at the VA and those settings can be really high-risk and overwhelming. I have a friend who recently turned down a VA position because she found out that she would be seeing patients monthly and i believe her case load would have easily been over 150. This person is trying to get out of her VA job because the management is really incompetent and she is micromanaged. I also worked in different VA settings and they were dramatically different from each other.

 

[PHD12]

I think the most interesting stat is that in recent years the percentage of doctors in private practice went from ~75% to ~50% and it is suggested it will be dropping to ~33% soon. Most are taking hospital jobs instead. It sounds very similar to a lot what we are discussing regarding private practice. I think other than the smaller percentage that have cadillac insurance or pay out of pocket, we will see a lot of privately own small businesses in healthcare close. I am already seeing this in the geriatric side of things, where large groups with hundreds of mental health providers are popping up in every region.[/QUOTE]

Kaiser has dominated mental health care in some parts of the country already. They have over 6 million members. Its obv. tough for private practitioners to compete when there is a kaiser location within 3-5 miles that offers free services once you are a member (although they aren't comprehensive).

 

[AcronymAllergy]

Each VISN (and even each individual medical center/hospital) certainly does have its own overall culture, to be sure. In general, the VA seems to be a solid employment option for the time being. However, I'd definitely suggest getting in contact (if possible) with multiple providers at any VA at which you're applying to get an idea of the overall attitude towards mental health (and psychology).

 

[Pragma]

Yeah PHD, your example sure sounds like the exception and not the rule. I'd be curious if other VAs had similar problems. Because the people I know at VAs in multiple states absolutely love it.

 

[PHD12]

Yeah PHD, your example sure sounds like the exception and not the rule. I'd be curious if other VAs had similar problems. Because the people I know at VAs in multiple states absolutely love it.

Aren't most of you in the mid-west and south? I don't know if that makes a difference. Also, some of them like their jobs overall but will describe it as very high stress. I can't imagine the VA as a low stress job, but apparently this set up exists.

 

[Pragma]

Aren't most of you in the mid-west and south? I don't know if that makes a difference. Also, some of them like their jobs overall but will describe it as very high stress. I can't imagine the VA as a low stress job, but apparently this set up exists.

I know people at VAs in the Midwest and the west coast. Admittedly I don't know anyone at a VA on the east coast or in the south.

It is intriguing to me that you have such a reaction about VAs (and the one you are talking about does sound bad), but I hope that you can see how low stress it could be. In the VAs I am familiar with, psychology is well-regarded and psychologists seem to have some measure of power. The trainees and the staff psychologists didn't ever seem to have complaints about workload. The only complaint I ever heard was that sometimes they had to do briefer assessments than they wanted to, because there was a high caseload. But never was the caseload described as unmanageable or so high that they couldn't see clients for a month in between appointments. The only other complaint is the perceived lack of prestige at VAs that are not affiliated with an AMC.

My postdoc was affiliated with a VA but I didn't work on the VA side. Boy, those psychologists over there had it made and never seemed to eclipse 45 hours in a week. Just sayin' - the AMC life seems much more stressful overall in my experience.

 

[JeyRo]

I know people at VAs in the Midwest and the west coast. Admittedly I don't know anyone at a VA on the east coast or in the south.

It is intriguing to me that you have such a reaction about VAs (and the one you are talking about does sound bad), but I hope that you can see how low stress it could be. In the VAs I am familiar with, psychology is well-regarded and psychologists seem to have some measure of power. The trainees and the staff psychologists didn't ever seem to have complaints about workload. The only complaint I ever heard was that sometimes they had to do briefer assessments than they wanted to, because there was a high caseload. But never was the caseload described as unmanageable or so high that they couldn't see clients for a month in between appointments. The only other complaint is the perceived lack of prestige at VAs that are not affiliated with an AMC.

My postdoc was affiliated with a VA but I didn't work on the VA side. Boy, those psychologists over there had it made and never seemed to eclipse 45 hours in a week. Just sayin' - the AMC life seems much more stressful overall in my experience.

I imagine it's really hard to identify all of the objective variables that might make a VA position "high stress" or "low stress" - but I'm convinced I'm not the only VA guy with an easy detail.

 

[Pragma]

I imagine it's really hard to identify all of the objective variables that might make a VA position "high stress" or "low stress" - but I'm convinced I'm not the only VA guy with an easy detail.

Well aside from this example PHD is brining up, I have never met anyone who didn't have an easy VA detail.

Note: 'Easy" meaning overall workload. Obviously what makes a job stressful or not stressful can vary from person to person. For example, I loved doing inpatient work severe, violent dual-diagnosis cases. Other people might find that stressful whereas for me it didn't seem too bad because it is so interesting. I am sure that VA psychologists have their share of stress - but generally stress because of the number of hours worked/overall expectations is probably not very comparable to people who work at AMCs (with some exceptions, I gather).

 

[PHD12]

Well aside from this example PHD is brining up, I have never met anyone who didn't have an easy VA detail.

Note: 'Easy" meaning overall workload. Obviously what makes a job stressful or not stressful can vary from person to person. For example, I loved doing inpatient work severe, violent dual-diagnosis cases. Other people might find that stressful whereas for me it didn't seem too bad because it is so interesting. I am sure that VA psychologists have their share of stress - but generally stress because of the number of hours worked/overall expectations is probably not very comparable to people who work at AMCs (with some exceptions, I gather).

Just to clarify, the stressful aspects of the VA system that i've seen are unrelated to the number of hours worked (most people are pulling in 45 hours), but have to do with management, lack of autonomy, high case loads at some VAs. There are also some VA locations that are in lower SES/higher crime areas where they have a high proportion of patients with behavioral problems (including attacks on staff) and that require hospitalization.

I don't see how inpatient work with violent patients is not stressful considering there are attacks on staff in these locations and that some of these patients commit suicide after discharge (although they are rare overall). Its easy to say that maybe now that you are in academia...don't know.

 

[Pragma]

Just to clarify, the stressful aspects of the VA system that i've seen are unrelated to the number of hours worked (most people are pulling in 45 hours), but have to do with management, lack of autonomy, high case loads at some VAs. There are also some VA locations that are in lower SES/higher crime areas where they have a high proportion of patients with behavioral problems (including attacks on staff) and that require hospitalization.

I don't see how inpatient work with violent patients is not stressful considering there are attacks on staff in these locations and that some of these patients commit suicide after discharge (although they are rare overall). Its easy to say that maybe now that you are in academia...don't know.

Some people really like inpatient work. I loved it. If I were not a neuropsychologist, I would absolutely want to work on an inpatient unit (and actually prefer inpatient neuropsychs). To each their own I guess. Before I came to graduate school, I worked on an inpatient unit where there were attacks on staff. I guess I just viewed it as a part of the job, and if the unit is any good, you have very clear protocols for how to handle such situations. In fact, part of why I enjoyed the work was because I thought I was pretty good at preventing situations from escalating.

Regarding the VA, there is a reason that those positions are so coveted. Personally, I view number of hours worked vs. compensation to be a hugely significant when it comes to stress levels. The VA pays a lot of money for less work compared to many settings for psychologists. I am not sure I'd characterize the nature of the work to be of greater stress than for people in other settings. Heck, I thought CMHC work was the most stressful of all of my training experiences. Plus, those folks work longer hours for less money.

A lot of things might be easy to say now that I am in academia. But dealing with patients dying/suicide attempts/etc were all things I encountered (all in settings outside of the VA). I'd be interested in some data about the proportion of those things happening in the VA versus other settings. If I were to quit my job, I'd absolutely work for a VA if I could. The costs/benefits ratio is awesome compared to other gigs out there.

 

[Doctor Eliza]

Re: VA jobs. I can't speak to the quality of life working at one, but I would like to make it clear to folks still in grad school that not just any old psychologist can apply to a VA job and get it. It is a very hard system to break into unless you have a foot in the door. From what I have heard, it is pretty imperative to do your internship at a VA if you ever want to be hired there. You also need a specialty that fits with their needs (e.g., substance abuse, PTSD, neuropsych).

Dr. E

 

[AcronymAllergy]

Like Pragma, I actually have found CMHC settings to be much more frustrating and stressful than VA work...although it's also going to depend on what is stress-inducing for you. I've personally never felt threatened or as though I were in danger anywhere I've worked, which has included indigent-care hospitals and forensic facilities in very low-SES/high-crime areas. Although I also realize that being male likely significantly influenced my experiences in those settings.

The VA obviously isn't perfect, of course, and it has its own set of stressors (of which overarching bureaucratic issues can be one, depending on the hospital).

The more nerve-wracking situations tend to be those cases for which there's an increased likelihood of a lawsuit/legal involvement when that wasn't the referral source/reason.

 

[edieb]

I completed my internship at a medical school and landed a V.A. job 6 months later, so landing a V.A. job without a V.A. internship is possible. Overall it was an ok place to work but it lends itself to the type of personality who is very laid back. Other than step raises, you don't receive additional money and, if the V.A. isn't academically connected, it isn't the most intellectually stimulating environment. Also, the amount of dependence and malingering is truly outstanding.

 

[JeyRo]

Well aside from this example PHD is brining up, I have never met anyone who didn't have an easy VA detail.

Note: 'Easy" meaning overall workload. Obviously what makes a job stressful or not stressful can vary from person to person. For example, I loved doing inpatient work severe, violent dual-diagnosis cases. Other people might find that stressful whereas for me it didn't seem too bad because it is so interesting. I am sure that VA psychologists have their share of stress - but generally stress because of the number of hours worked/overall expectations is probably not very comparable to people who work at AMCs (with some exceptions, I gather).

"Easy" for me means overall workload is tolerable, generally busy, but not overwhelming (I should note that when it's not busy and I'm twiddling my thumbs is also when it's not "easy" - but I've taken care of that by taking on various 'research' (QM) projects, mildly interesting administrative duties, and supervising students over the years). Also the almost complete lack of bureaucratic nonsense paperwork stuff (which makes me somewhat unusual in my VA) also helps. Finally, people seem to respect me. And the patients I get are generally all ones that I understand (lots of dementia and geriatrics stuff) - so I don't typically feel out of my element, but at the same time I'm intellectually challenged because each case is a little bit different.

 

[JeyRo]

Re: VA jobs. I can't speak to the quality of life working at one, but I would like to make it clear to folks still in grad school that not just any old psychologist can apply to a VA job and get it. It is a very hard system to break into unless you have a foot in the door. From what I have heard, it is pretty imperative to do your internship at a VA if you ever want to be hired there. You also need a specialty that fits with their needs (e.g., substance abuse, PTSD, neuropsych).

Dr. E

Interestingly, I was told by one of the psychologists on my hiring committee that the fact I had done my internship and postdoc outside of the VA was one factor that made me more attractive to him..... something about getting experience in the "real world" that appealed to him.

 

[Doctor Eliza]

Interestingly, I was told by one of the psychologists on my hiring committee that the fact I had done my internship and postdoc outside of the VA was one factor that made me more attractive to him..... something about getting experience in the "real world" that appealed to him.

Interesting. Did you have another sort of foot in the door?