Would you have made the same decision...

[Therapist4Chnge]

I would do it again in a heartbeat. I loved graduate school and I love my career (assistant professor in a psychology department). I have a lot of flexibility with my time, I really enjoy research and teaching, the latter of which includes clinical supervision and mentoring (OK, research includes mentoring too). Academia is kind of like grad school part 2, but with far more power (I no longer have to wait for my graduate advisor to return my emails before I can submit a paper, which inherently makes me more productive) and more ownership of my time. Even the tenure track hasn't been bad thusfar, though I thrive on being busy.

Kiss of death right there….

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[psych844]

I still very much enjoy what I do, although there are days where I feel like I'm barely keeping my head above water in terms of staying up to date on everything folks expect me to know.

This statement seems a bit contrary to what PSYDR said. If you specialize in a specific area, and you've been at it awhile, what stuff is there to always know?

 

[psych844]

What you guys describe about specializing in one thing (ie dementia), is what scares me. To spend 5-7yrs on something and then specialize in one area basically..it's obv not surprising that it would get boring. I could spend 2yrs doing a Masters in School Psych and be at the same place. (specialize in an area) You guys aren't saying it directly, but I assume you guys still love your jobs (despite boredom quite often) because you get to relay this knowledge always to DIFFERENT people, and I'm sure that is what keeps it exciting at the end of the day.

 

[ClinicalABA]

Testing: To keep yourself interested you can vary the tests you give and keep up with the literature about the various psychometric properties of said tests. Every now and again, there are reports about a very specific subtest that has XYZ properties which can be interesting. Or learn the history of some old tests.

Long story short: It can get boring. You can find some ways to mitigate boredom.

I do testing 2 days a week, with a very specific population (children under 3 suspected of autism spectrum disorder). There's not a lot of variation in the population diagnostically speaking (generally ASD or Speech Delay; occasional global developmental delay) as the kiddos are referred by trained developmental specialists, and it's pretty much the same protocol over and over (ADOS-2 Toddler Module; Bayley-III cognitive, occasional direct language measure). I was really concerned about it becoming repetitive and boring, but it sooooooo hasn't. I blow bubbles, play with balloons, and give the baby doll a bath over and over, and the kids' reactions and performance, though often topographically similar, continues to be just as much fun every time. Writing the reports is a whole different story. While each presentation is unique, there are a lot of similarities, and the recommendations, particularly for a a child with an ASD diagnosis, are pretty standard. After awhile, the reports all start to look the same.

All that said, variability in the type of work can be a nice perk of this field. As you advance in your career and pick up new skills (and even credentials), the type of work you can do will expand, giving you more options and flexibility. I test two days per week, consult in homes and schools on other days, do parent training, etc. I am able to do this because of the doctoral training and licensure (picking up the BCBA along the way hasn't hurt in terms of flexibility). I don't think I wouldv'e imagined the level of variation and flexibility I have now when I was in grad-school, where things can get pretty repetitive and there's not as much autonomy.

 

[AcronymAllergy]

This statement seems a bit contrary to what PSYDR said. If you specialize in a specific area, and you've been at it awhile, what stuff is there to always know?

Not necessarily, if the statement by PSYDR you're referring to is this one: " If you are competent, you learn everything you can about those diagnoses, treatments, legal ramifications (even if you are not forensic), prognosis, etc."

If you are a competent practitioner, then yes, you certainly do learn everything you can about the diagnoses you typically see. This makes good sense and is an ethical obligation. However, even "just" in something like dementia or TBI, there can be a lot to learn and stay up with. And when, like me, you work in more of a generalist role, it can spread you a bit thin at times (e.g., jack of all trades but master of none).

Even with all that, as PSYDR mentioned, you'll generally get a feel for a variety of conditions based on qualitative observation and information gathered via interview. Still, no two people are alike, so even the "cookie cutter" cases can be interesting as you come up with tailored recommendations and the like. Plus, to be honest, it's nice to have some fairly straightforward and less-complex cases now and again.

There's always something more to know. Maybe not always earth-shattering, but research is continually coming out. And when you see a case that involves things you don't often see, it can lead you in all sorts of new directions RE: intellectual curiosity.

 

[PsyDr]

What you guys describe about specializing in one thing (ie dementia), is what scares me. To spend 5-7yrs on something and then specialize in one area basically..it's obv not surprising that it would get boring. I could spend 2yrs doing a Masters in School Psych and be at the same place. (specialize in an area) You guys aren't saying it directly, but I assume you guys still love your jobs (despite boredom quite often) because you get to relay this knowledge always to DIFFERENT people, and I'm sure that is what keeps it exciting at the end of the day.

IME: A lot of times, subspecialization happens by accident. Referral sources, who generally specialize, are looking for a person who can give NP testing. Do a good job, they send you more. Sometimes they tell their colleagues. One day, you realize you are seeing a ton of XYZ diagnoses. There are those who seek out a subspeciality, but for many it happens by accident.

This statement seems a bit contrary to what PSYDR said. If you specialize in a specific area, and you've been at it awhile, what stuff is there to always know?

Say you have learned everything you could possibly learn about the neuropathology, genetics, lab values, test characteristics, patterns of performance on said tests, medications, treatment options, treatment outcomes, prognosis, longevity, etc about Parkinsons' disease. And you somehow kept current on key developments in this field. You'd still need to learn about the legal implications, (e.g., power of atty, driver's licensing laws, potential liability with driving, gun possession, healthcare/longterm care insurance, divorce, etc), how comorbid physical ailments affect medication and cognitive status (e.g., renal function impairment), etc. AND ALL OF THIS IS CONSTANTLY UPDATING. New legal cases, new treatments, new sens/spec data, new genetic studies, new imaging studies, new FDA trials, etc. Then you are going to get a family who asks a very interesting question, which will undoubtedly provoke you to learn about the subject in this subspeciality.

 

[smalltownpsych]

What you guys describe about specializing in one thing (ie dementia), is what scares me. To spend 5-7yrs on something and then specialize in one area basically..it's obv not surprising that it would get boring. I could spend 2yrs doing a Masters in School Psych and be at the same place. (specialize in an area) You guys aren't saying it directly, but I assume you guys still love your jobs (despite boredom quite often) because you get to relay this knowledge always to DIFFERENT people, and I'm sure that is what keeps it exciting at the end of the day.

Did someone say bored? That is pretty far from my experience as a psychologist. Stressful, challenging, difficult, rewarding, emotionally draining, all of these, but never boring. The main reason I chose psychology was the fact that I would not get bored because our knowledge base is so small compared to the scope of the questions. Just about every week, I have a referral that has me looking up something in the research and usually what I find just leads me to ask more questions. As a psychologist, I am sometimes like the four year old question factory trying to find out about the world when every answer just leads to more questions.

 

[psych844]

Did someone say bored? That is pretty far from my experience as a psychologist. Stressful, challenging, difficult, rewarding, emotionally draining, all of these, but never boring. The main reason I chose psychology was the fact that I would not get bored because our knowledge base is so small compared to the scope of the questions. Just about every week, I have a referral that has me looking up something in the research and usually what I find just leads me to ask more questions. As a psychologist, I am sometimes like the four year old question factory trying to find out about the world when every answer just leads to more questions.

PSYDR said:

"Long story short: It can get boring. You can find some ways to mitigate boredom."

But I see what he was trying to say now.

And I was specifically referring to neuropsych, or a situation where a person has specialized a lot (ie only handle dementia cases as a neuropsych). Obv if you are a clinical psychologist that is a generalist, there is so much that we don't know, and how you would approach therapy with one person may be vastly different to how you approach it with someone else.

 

[AcronymAllergy]

There aren't many psychologists coming along nowadays who are full-on generalists, at least in my experience. More and more folks are choosing a few (often related) areas of specialty, like trauma, health psych, substance abuse, eating disorders, etc.

But looking at neuropsych again, as I mentioned (and as PSYDR discussed above)--even with just dementia, there's a LOT to know. And it's almost never just dementia (again, as PSYDR discussed RE: complication medical and medication factors, impact of psychological and general psychosocial distress, etc.).

Same could be said about any of the non-neuropsych specialties.

 

[smalltownpsych]

PSYDR said:

"Long story short: It can get boring. You can find some ways to mitigate boredom."

But I see what he was trying to say now.

And I was specifically referring to neuropsych, or a situation where a person has specialized a lot (ie only handle dementia cases as a neuropsych). Obv if you are a clinical psychologist that is a generalist, there is so much that we don't know, and how you would approach therapy with one person may be vastly different to how you approach it with someone else.

Yeah, I would probably get bored if I was a neuropsychologist although I do love neuroscience.

There aren't many psychologists coming along nowadays who are full-on generalists, at least in my experience. More and more folks are choosing a few (often related) areas of specialty, like trauma, health psych, substance abuse, eating disorders, etc.

But looking at neuropsych again, as I mentioned (and as PSYDR discussed above)--even with just dementia, there's a LOT to know. And it's almost never just dementia (again, as PSYDR discussed RE: complication medical and medication factors, impact of psychological and general psychosocial distress, etc.).

Same could be said about any of the non-neuropsych specialties.

In the rural settings, we almost have no choice but to be generalists. Damn city slickers think that there is no world outside of the urban environment.

 

[Therapist4Chnge]

It's worth noting that providers that do mostly/exclusively assessment work (neuro, forensic, psych) are very much in the minority. The vast majority of psychologists provide therapy/interventions and similar services….so anyone reading this needs to take many of these comments w. a grain of salt. I know many clinicians who love providing therapy and find assessment boring, and vice versa.

 

[Ollie123]

IME: A lot of times, subspecialization happens by accident.

Fits with my experiences so far.

I seem to be developing a "niche" in treating MDD in folks with seizure disorders. There is no earthly explanation for how that could have happened besides cosmic accident and snowball referrals from our neurology dept.

I think just about any job can get boring. A lot also depends on your personality. Every patient is unique and somehow simultaneously every patient is exactly the same as all the other patients. I know that sounds contradictory, but I'm sure anyone here with a substantial record seeing patients knows what I mean. Just as an example from a traditional CBT perspective - the content of the distortions varies tremendously across patients, the nature of those distortions is usually quite circumscribed. Someone who loves diving into the content will be more focused on uniqueness, someone diving more into the distortion process will be more focused on the "sameness." Just one of many examples. Different individuals will have different takes on the above and I imagine for most folks it will waffle between those two depending on the day.

 

[erg923]

Fits with my experiences so far.

I seem to be developing a "niche" in treating MDD in folks with seizure disorders. There is no earthly explanation for how that could have happened besides cosmic accident and snowball referrals from our neurology dept.

I think just about any job can get boring. A lot also depends on your personality. Every patient is unique and somehow simultaneously every patient is exactly the same as all the other patients. I know that sounds contradictory, but I'm sure anyone here with a substantial record seeing patients knows what I mean. Just as an example from a traditional CBT perspective - the content of the distortions varies tremendously across patients, the nature of those distortions is usually quite circumscribed. Someone who loves diving into the content will be more focused on uniqueness, someone diving more into the distortion process will be more focused on the "sameness." Just one of many examples. Different individuals will have different takes on the above and I imagine for most folks it will waffle between those two depending on the day.

VA patients are often groundhog day in terms of symptoms and their causes, even if all have their own unique experiences.

 

[mlwg1]

I'm on internship at a VA, and my quality life has gone up compared to previous years in grad school. I would choose this career again, but I would approach grad school differently.

-I entered right of grad school right out of undergrad. I'm fortunate to have entered a fully funded, academically rigorous PhD program. My attitude towards graduate school wasn't serious enough during my first year or two. I think that I would have been more focused had I taken a year off before jumping in.
-I might have spent less time looking into grants and other options for external funding. I did it just to pad my CV, but looking back I should have put that energy into doing my quals/dissertation and getting out of there. Especially considering that I was in a funded program. I think my research interests just aren't a good fit with the type of grants I was applying to, so it was mostly a waste of time.
-I would have taken on fewer projects in general. I think until quite recently I've had the tendency to spread myself way too thin.

Now that I'm in inching closer to the other side, I'm pretty optimistic about my future. I have some debt because I'm in a high cost-of-living area, but it should be paid off within two years after graduating. I used to go back and forth about whether I should have pursued a medical degree, but I know that I wouldn't be happy in that role. Working side by side with physicians at the VA has pretty much confirmed that for me. I think folks who have MD envy should consider lurking med school forums here on SDN. The grass is always greener on the other side, my friends.

So, to answer the OP's question, yes, I would choose to be a psychologist again. It' the journey/getting there piece that I would change.

 

[WisNeuro]

. I used to go back and forth about whether I should have pursued a medical degree, but I know that I wouldn't be happy in that role. Working side by side with physicians at the VA has pretty much confirmed that for me. I think folks who have MD envy should consider lurking med school forums here on SDN. The grass is always greener on the other side, my friends.

Heck, my fiancee is an MD, so I see/hear about it every day at work and at home. That question has already been answered for me, the salary bump would not be worth not enjoying what I like plus some of the other BS. Plenty of other things I can do if I simply wanted to make more money.

 

[psych844]

I honestly think that some people romanticize certain professions way too much, when in the end every job has good/bad. I also think that it's often a red flag if a person often says things like "what fascinates me are the many possibilities/options". Medicine is huge, and so is Psychology, and yes that makes it interesting..but spots are competitive, and you will eventually most likely have to specialize...so that appeal may go away. Ie How many premeds dream of becoming a dermatologist and have their dreams crushed when they realize it's way too competitive? But aside from competitiveness, you will have to eventually specialize, and if for whatever reason that thing you specialized in isn't necessarily your #1 choice, i think you will always have doubts.

I've also heard people say "I really found it interesting to learn neurology..found it fascinating" then went into residency and found it mindlessly boring. So liking theory of something doesn't necessarily translate into fun clinical work. I worry about that part as that isn't necessarily something you can figure out without doing it yourself..but forums like this help, and that is why I try to ask many questions.

 

[psych844]

Also, comparing the psych specialties..what's the specialty that society really couldn't do without? I feel that one problem with psych (at least generalist) practice, many people think it's a luxury to have such services but not necessarily a necessity..but is there any that are vital (that if you didn't have them), we just couldn't do without them (ie as in medicine, don't think you could really afford to not have any specialty)

 

[PsyDr]

Also, comparing the psych specialties..what's the specialty that society really couldn't do without?

For clinical specialities, it's stuff that people would spend money on like kids, marriages, some neuro, rxp, hospitalist, etc. Emphases on marriage due to the cost of divorce and kids educational stuff because inherent drive. Caveat: there's s lot of unpleasantness that can come out of this.

 

[psych844]

btw, do neuropsychiatrists exist..and what the heck would be the difference between them and neuropsychologists?

 

[Pragma]

Google that one.

 

[AcronymAllergy]

btw, do neuropsychiatrists exist..and what the heck would be the difference between them and neuropsychologists?

Yes, they exist, and I believe there are fellowships that focus on this area. There's a good bit of overlap between neuropsychology, neuropsychiatry, and behavioral neurology.

 

[psych844]

Yes, they exist, and I believe there are fellowships that focus on this area. There's a good bit of overlap between neuropsychology, neuropsychiatry, and behavioral neurology.

i've been around premed forums a lot in the past I don't ever remember anyone talking about specializing in neuropsychiatry. Maybe it's just me but neuropsychology seems a lot more common/popular.

 

[Pragma]

There are entire organizations dedicated to the subspecialty of neuropsychiatry. I don't think it is about popularity - both neuropsychology and neuropsychiatry are competitive fields to get into in their own right.

 

[psych844]

There are entire organizations dedicated to the subspecialty of neuropsychiatry. I don't think it is about popularity - both neuropsychology and neuropsychiatry are competitive fields to get into in their own right.

Right. But I was reading about the difference between neuropsychology and neuropsychiatry and honestly it doesn't explain well what they are. why would someone see one over the other?

 

[smalltownpsych]

Also, comparing the psych specialties..what's the specialty that society really couldn't do without? I feel that one problem with psych (at least generalist) practice, many people think it's a luxury to have such services but not necessarily a necessity..but is there any that are vital (that if you didn't have them), we just couldn't do without them (ie as in medicine, don't think you could really afford to not have any specialty)

My practice is always full and the patients I prefer are the ones who really need my services. Some of them desperately so. I don't think you realize how severe mental illness is and how effective and essential our interventions can be. Lots of people think they can be as effective as a highly trained psychologist right up until the person starts talking about suicide. Psychiatrists and psychologists are not going anywhere. Sure there is midlevel encroachment, but when they get nervous they refer to us. Maybe half of my patients have been to midlevels and they come to me now for many reasons. Also, psychology is getting more specialized and that is a good thing IMO, but we will probably never be equivalent to medicine in that respect.

 

[AcronymAllergy]

i've been around premed forums a lot in the past I don't ever remember anyone talking about specializing in neuropsychiatry. Maybe it's just me but neuropsychology seems a lot more common/popular.

As an example, I believe splik in the Psychiatry forums is a neuropsychiatrist, or at least has a very strong interest in the area. I've seen a few threads pop up on the topic in the Psychiatry forums as well.

 

[Pragma]

btw, do neuropsychiatrists exist..and what the heck would be the difference between them and neuropsychologists?

Right. But I was reading about the difference between neuropsychology and neuropsychiatry and honestly it doesn't explain well what they are. why would someone see one over the other?

It's kind of like the difference between psychology and psychiatry, but within a specialty focused on patients with neurological conditions.

 

[Pragma]

http://forums.studentdoctor.net/threads/neuropsychology-vs-psychiatry.963563/

 

[IT514]

To answer the original question, yep I would do it again. I have tons of freedom and flexibility, I see the patients I want to see (for the most part), in a setting I love, with lots of opportunity to make extra money with PP on the side. The path to get here was incredibly difficult and my priorities changed mid-way, but I made it out of my neuro post-doc right about the time I was ready to walk away. I was offered a hospital position with a high salary and bonuses, but I'm glad I turned it down and took a VA position that offers a great mix of clinical and academic opportunities without having to answer to the RVU gods, at least not yet. Plus, I now have time to work on my sea kayaking, skiing, and eventually living semi off-grid.

 

[WisNeuro]

Neuropsychiatry as I've seen it has been much too Freudian to be of much practical use. I do like the more holistic view of the patient, but but everyone I've had contact with who has called themself one of these has been depressingly psychoanalytic. Very small n of experience though, so I would hope there are some somewhere who have updated their DSM's since 1952.

 

[JedMosley]

To answer the original question, yep I would do it again. I have tons of freedom and flexibility, I see the patients I want to see (for the most part), in a setting I love, with lots of opportunity to make extra money with PP on the side. The path to get here was incredibly difficult and my priorities changed mid-way, but I made it out of my neuro post-doc right about the time I was ready to walk away. I was offered a hospital position with a high salary and bonuses, but I'm glad I turned it down and took a VA position that offers a great mix of clinical and academic opportunities without having to answer to the RVU gods, at least not yet. Plus, I now have time to work on my sea kayaking, skiing, and eventually living semi off-grid.

Did you leave the neuro post-doc? I'm on a neuro track (applying to internship now) but trying to decide if I would prefer to do more health psych focused work in the end..

 

[Therapist4Chnge]

If you are between neuro and health…have you considered Rehabilitation Psychology? Division 22 with APA if you want more info.

 

[IT514]

Did you leave the neuro post-doc? I'm on a neuro track (applying to internship now) but trying to decide if I would prefer to do more health psych focused work in the end..

No, I finished it. I wouldn't do anything else in the field. Maybe geropsych. Agree with above that maybe rehab psych or neuropsych with cog rehab would interest you.