What neuropsychology has to do to survive...

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PublicHealth

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The field of clinical neuropsychology needs more of this type of research and integration of this type of research into practice in order to survive in behavioral healthcare. Neuropsychology surely has more to offer than assessment. The fact that social workers are doing this type of research should be worrying for clinical neuropsychologists.

http://pn.psychiatryonline.org/cgi/content/full/39/20/22
 
Since when do MSW's qualify as professors of psychiatry?
 
Sanman said:
Since when do MSW's qualify as professors of psychiatry?
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Two hypotheses:
(1) Since they've been able to generate NIH funding.
(2) Since department heads of psychiatry began to realize that MSWs are clinically equivalent to PhDs in psychology.

Apparently, there are two Professors of Psychiatry with MSW degrees in the Department of Psychiatry at the University of Pittsburgh School of Medicine:

http://www.wpic.pitt.edu/faculty/facultypage.aspx?I=17338

http://www.wpic.pitt.edu/faculty/facultypage.aspx?I=17339
 
That's scary...... *sighs and returns to the dissertation proposal*
 
lazure said:
That's scary...... *sighs and returns to the dissertation proposal*
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It sure is scary. I often wonder what the future holds for clinical psychology and clinical neuropsychology. There hasn't been much discussion about this in this forum. If RxP doesn't work out for psychologists, what role will they play in the ever-perplexing world of behavioral healthcare? I think the APA's active efforts in trying to get RxP for psychologists speaks to their awareness of clinical psychology's questionable future.

I personally elected to pursue medicine/psychiatry because I felt that clinical psychology and neuropsychology don't have much to offer in the way of treatment. I also feel that most clinical psychology training programs are antiquated. The face of behavioral healthcare has changed. There is no such thing as a scientist-practitioner who can do both science and practice well. Parallel in medicine is the MD/PhD. It's really tough to balance the two. MD/PhDs often have a tough time getting their research funded because there are so many PhDs with longer publication records competing for funding. Some medical schools are developing tracks for physicians -- clinical, research, or teaching.

I'm curious to know what people see as the future of clinical psychology and neuropsychology. Where is the field headed? Are the financial rewards of this career worth the duration of training? Why are interns and post-docs paid a measly $18K/year and $25K/year, respectively? What kind of financial security does a clinical psychologist and neuropsychologist have today?
 
Well, I think that the reason that the pay for interns and post-docs is so low, is that their previous education is funded and so they can get away with it. Thats why I refuse to attend an unfunded program. I think that the future of clinical psychology is in jeopardy from msw' s in the healthcare arena. In educational and other arenas I think they are better off. The clinical specialties are safer (health, forensics,neuro,peds) since they have more specialized training. I think that as a whole, psychologists need to start working in more administrative roles in the industry and get into a position where the msw's are in a kind of pa position. That is my plan anyway.
 
MSWs teaching at a University level? yikes.....that's a little scary
Like Sanman I won't accept admittance from an unfunded program either....
I also work with alot of clinical psychologists (some specialized and others are just fresh out of internships and doing post docs now) and I am not hearing anything negative. It may be that the field that they're in (working with autism, frafile X, etc.) is being given alot of grant monies right now so the money is there to pay them good salaries.

If I were having some type of mental crisis I would not be going to the MSW...no offense but I personally believe 4 yrs of education beats 2 yrs. Same reason why I won't see the PA at my doctors office for something that is not routine care. I trust the guy with 4 yrs + residency over the PA. Sorry...that might sound rude but just my opinion.
Maybe if the public was more informed about differences between PhD and MSW it might be different. An MSW can call themselves a therapist, and most people with knowledge of the field see no difference between psychologist and therapist (some use the two words interchangeably).

Personally I'm not freaking out about it...I'm gearing myself more towards academia than practice..precisely for the reason of not having to compete for a job with someone with less education than me.

Just an FYI...friend of mine has an MA and is a school psychologist in central CA making 90K a year (is retiring this year)......I probably won't make that in academia for a long long long time ...if ever lol 🙂

Public....If I liked the science (chemistry, calculus, etc.) I would have happily gone the med school route....but I could not stand it! Plus age of myself and husband and financial burden of med school was too much.
Isn't there worries though that there are not enough MDs in mental health and that once PhDs get the prescription rights that these worries may hold true for you as well?
 
twiggers said:
Isn't there worries though that there are not enough MDs in mental health and that once PhDs get the prescription rights that these worries may hold true for you as well?
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Psychologists have obtained RxP in TWO states. While psychologists and the American Psychological Association are fiercely lobbying for RxP in other states, their efforts are almost always quashed by the American Medical Association and American Psychiatric Association. This will make for a long battle, especially in states that are well-represented by physicians and psychiatrists. In fact, psychologists have been trying to gain RxP for the past 40+ years! To make matters worse, liability insurance will be a nightmare for psychologists with RxP. Medical malpractice lawyers are all over psychologists with RxP. Just read some of their journals. They're hungry for fresh blood.

Psychiatry is now moving toward a psychosomatic orientation, which increases the role of psychiatrists in the medical and surgical arena (see recent issues of Psychiatric Times). Psychosomatic psychiatry is now an full-fledged subspecialty of psychiatry. Many of said that this is the future of psychiatry. Moreover, there is increased interest in exploring endocrinologic and related treatments of psychiatric disorders. Psychologists, even with RxP, will be ill-prepared to meet the demands of such practice.
 
I think psychologists could contribute more to psychosocial factors and stressors. There are many mental health issues that do require psychological treatment more so than pharmacological treatment. I can't see the development of pills for marital distress, development of social skills, adolescent search for identity etc. I am now in a placement in pediatric oncology - these families have extensive behavioural and psychological issues that would not be addressed well by pharmacology and a strictly behavioural focus.

Regarding MSWs, I feel that many are excellent psychotherapists and may have a better grasp of issues like poverty than psychologists do. But they lack training in assessment and diagnosis which are essential to valid treatment.

*sighs and returns to grant proposal*
 
lazure said:
I think psychologists could contribute more to psychosocial factors and stressors. There are many mental health issues that do require psychological treatment more so than pharmacological treatment. I can't see the development of pills for marital distress, development of social skills, adolescent search for identity etc. I am now in a placement in pediatric oncology - these families have extensive behavioural and psychological issues that would not be addressed well by pharmacology and a strictly behavioural focus.
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Good point.

lazure said:
Regarding MSWs, I feel that many are excellent psychotherapists and may have a better grasp of issues like poverty than psychologists do. But they lack training in assessment and diagnosis which are essential to valid treatment.
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And they're quickly gaining these skills. Assessment courses are regularly offered at most schools of social work. Therapy courses are also taught. While these are mostly manualized therapies, insurance companies don't have any problem with it. In fact, they prefer it because it's cheaper and quicker! MSWs are also more likely than psychologists to be part of the treatment team in a psychiatric unit. Most psychologists have taken on research careers because managed care has pushed them out of clinics due to decreasing reimbursements. If testing is all that clinical psychology has left that is unique to the profession, the field is doomed.

lazure said:
*sighs and returns to grant proposal*
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I'm sorry for your pain.
 
While these are mostly manualized therapies, insurance companies don't have any problem with it. In fact, they prefer it because it's cheaper and quicker!

The problem with manualized treatments is that there is great empirical evidence for them that is based on highly controlled studies conducted by the academia. Way too little work is done on how these manualized treatment fare in applied settings. Manuals are a great guide but they overlook the needs and quirks of individual families and clients. In the longterm, I suspect that the one-size-fits-all therapies may prove more costly given that the client is still impaired after 10 sessions of CBT....

PH,
thanks for your empathy 🙂
 
lazure said:
The problem with manualized treatments is that there is great empirical evidence for them that is based on highly controlled studies conducted by the academia. Way too little work is done on how these manualized treatment fare in applied settings. Manuals are a great guide but they overlook the needs and quirks of individual families and clients. In the longterm, I suspect that the one-size-fits-all therapies may prove more costly given that the client is still impaired after 10 sessions of CBT....
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Good point. Isn't there some kind of controversy surrounding the efficacy vs. effectiveness of manualized psychotherapies that spurred the development of an APA task force that devised some classification scheme that identifies "well established" and "probably efficacious" psychotherapies? What is the status of this debate?
 
well, I don't think insurance companies are going to care about the efficacy of different treatment modalities if it means spending more money. Then again who knows what will change in the future.I don't think that RxP will be the future. I think that integrating psychological knowledge into different fields, such as I/O and health psychology do now, is much more promising. I also don't worry too much about the practice market because while msw's may penetrate, the best jobs and highest pay will still go to those with the best education. I don't see someone paying out of pocket going to a msw. I do worry that unfunded PsyD and PhD recipients with large debt will be squeezed badly compared to those with less debt. Where do you guys see the PsyD degrees going?
 
If you google Gerald Hogarty -- one of the much-maligned MSWs at U of Pittsburgh -- you will see that he has had quite a long illustrious career and has developed his own treatment method for working with patients with schizophrenia and their families. Personally, I think it is GRAND that the Psychiatric Dept. employs someone like that (someone who has actually DONE quite a lot, and who recognizes the role of psychosocial factors) rather than a lower achiever with a PhD. Just because someone has a PhD doesn't necessarily mean they've ever had an original idea in their life! My point is that we need to stop being so darn snobby and naive about credentials (MDs v. PhDs v. PsyDs v. MSWs and on and on it goes). I understand that the basic problem is that the job desciptions are no longer clearly defined --but does that mean that we need to turn on those lower than us in the hierarchy? Those who do the good, original work deserve the plum positions, in my opinion, and the name of their credentials just isn't that important.

Hope I haven't come across as too negative, guys.
 
Well, I am not bashing the man. I simply want to know what is his education qualifies the man to teach in the psychiatry department at upitt. Schizophrenia has very little to do with social work.
 
Hey, Sanman. Why do you say social work has little to do with schizophrenia? The way family members interact with people with schizophrenia has been shown to have a big impact on how well they recover/ live with it. Check out the research on the relationship between relatives with high levels of expressed emotion (i.e., highly critical, high emotional investment) and relapse rates. You might wanna check work by Penn & Mueser, Vaughan, etc. If someone with schizophrenia is living at home, the whole family is affected. Social workers tend to have family systems training, as well as training in other common therapies for schizophrenia, such as building social and work skills, etc. There's more to it that just dishing out the drugs, as I'm sure you know...

My point about old Gerald was that he has done extensive work on schizophrenia treatments. Probably this is why he is considered qualified for the job! The department appears to be more interested in the quality of the work than the name of the degree... I think that's good, and I would hope that a psychiatry department would not limit itself to teaching biological treatments, but would include staff members whose expertise is in other relevant areas.
 
Hey, Sanman. Why do you say social work has little to do with schizophrenia? The way family members interact with people with schizophrenia has been shown to have a big impact on how well they recover/ live with it. Check out the research on the relationship between relatives with high levels of expressed emotion (i.e., highly critical, high emotional investment) and relapse rates. You might wanna check work by Penn & Mueser, Vaughan, etc. If someone with schizophrenia is living at home, the whole family is affected. Social workers tend to have family systems training, as well as training in other common therapies for schizophrenia, such as building social and work skills, etc. There's more to it that just dishing out the drugs, as I'm sure you know...
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I certainly agree that if he was only assessing it from a family systems perspective then it would be alright. However, it seems that he has done work on treatment modalities of therapy and med combinations and relapse rates for individual patients and not family systems. While it is admirable work, I don't see what in his educational background qualifies him to do this. Traditionally this falls well within the research spectrum of clinical or clinical health psychologists. It is good that he is accomplished and that they aren't hiring based on degree, I am just wondering how he got into a field that is somewhat of a stretch with an msw degree. Granted I am not incredibly familiar with all the training in social work programs, but I don't believe they are well informed when it comes to schizophrenia. This man may be extremely intelligent and knowledgable, but he seems to be jumping fields.
 
Hey, Sanman. I guess I don't share your sense of alarm. Clinical social workers have always worked with psychiatric patients, as well as their families. And social workers can be trained in empirical research. Just because he compares different treatment modalities doesn't mean he has to prescribe the meds! As you pointed out, clinical psychologists routinely do the same thing. I don't think it's necessary to have full mastery of the biological mechanisms of schizophrenia to develop helpful psychotherapies (and a lucky thing, too, since nobody can yet claim anything like it).
 
I don't mean to be cruel, Winnie, but it is attitudes like yours (i.e., We need to stop looking at credentials; who cares if other specialties take our jobs, et cetera) that are causing psychology to plunge into crisis. MSW programs are a breeze to gain entrance into (in Louisiana they're begging for people) and the training is not rigorous as PhD clinical programs. PhDs deserve job security.

RxP is spreading like wildfire. The American Psychiatric Association is already worried about it passing in Florida and Georgia in Spring 05. New Mexico starts prescribing in <30 days. In addition, it seems like the poster PublicHealth is either misinformed about RxP's ramifications on insurance premiums. To shed light on this issue, here is a fact sheet link:
http://www.apa.org/apags/profdev/prespriv.html
 
I don't mean to be cruel, either, but I believe you have distorted my argument. 🙁

Like I said before, the basic problem is that there is not a clear distinction between CSWs, PsyDs, PhDs, etc. When boundaries are shaky and the job market is tight, we are bound to step on each other's toes. I think we are in agreement there.

I can't agree that a PhD automatically "deserves" a position over someone else who is more qualified.
 
well the issue is what is qualified. The whole point of PhD's having those positions is that they are more qualified and go through more rigorous training. Should we let any MD get a job over a supremely qualified PA or should we start replacing docs? If the system works that way, there will be no incentive to earn the extra level of education.
 
Well said Sanman.
At one time a high school degree was enough, then the BA was needed for more money, then it became a MA was necessary, and now the logical progression has been to a PhD or a professional degree to make any type of "good" money.
IMHO those who are better qualified (and i personally believe a good qualification entails both experience and education) should be paid higher and should be offered the positions. Unfortunately the real world doesn't work this way.
 
I am a little confused why a university would hire a MSW to do psych. research. (Most) PhD-level research positions already have very low starting salaries when compared to PhD-level positions in the private sector. Thus, do research institutions and universities pay MSWs even less than PhDs? How much money could they possibly save and wouldn't this small amount of savings be washed out when the institution considers that MSWs would be less able to pull in federal grant money, would need more support from other faculty (in things like research design, etc.) than Ph.D.s, etc.??? Very confusing...
 
Hi all,

I was browsing through this thread and was a little surprised at the strength of some of the responses. I am a MSW student. I think it is great to see that sort of collaboration with regards to schizophrenia. Many fields have professors with initially different orientations; for example, vision science draws from engineers, mathematicians and psychologists. Of course MSW training includes information on schizophrenia (!), and there are field placements and jobs where if you want to work entirely with that population you can.

Anyhow, if you have any questions about the LCSW credentialing process (licensed clinical social worker), or are just curious on how social workers are trained, please let me know. I am in California so it would be from that perspective. I think interdisciplinary collaboration is important and I welcome learning about your training as well.

Take care
 
Kimya said:
I think interdisciplinary collaboration is important and I welcome learning about your training as well.

Take care
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Collaboration and attempts to replace are clearly two different things.

Replacement of doctoral-level psychologists with social workers or other mental health workers at the master's level is the issue here. I get the sense that people see psychology as not being a big deal. This case seems very unusual, though. Research and academia, as far as I know, still place value in doctoral degrees and the level of education conferred with them.
 
I thought long and hard about posting this, because it is so negative. But maybe it needs to be said.

Look, I know that most of you are students and have so much invested in the process. I remember what that's like and that's why I'm reluctant to be negative. I'm post licensure 5 years, am a lecturer, director of a psychology department and am a supervisor of a practicum program. I have a (*&(* of student loans that I am still paying. In fact, I couldn't even pay them until I got married.

We are completely, 100% to blame for our predicament. We cannot unify, we backstab each other, we dicker about stupid things like PhDs and PsyDs, when the average person on the street can't tell the difference between MSWs and PhDs. I just saw a job for an LCSW OR psychologist on an APA division website job board. That is a failure of our political advocacy. And now we are reaping the rewards of being bitchy and myopic. Hence, you have MSWs qualifying as academics in a psychiatry department.

On a lesser, microcosmic level, I blame a lot of the women I know who are willing to settle for a job with absolutely no benefits because their husband works. What that does, especially in an urban area like Chicago, is drive down our salary and makes it so that employers don't have to offer enough money to live on. Now, before you jump on me for internalized oppression of women, I'll tell you that one prospective employer said this to me directly: "It's expensive to live in the Bay Area. Most women we interview have a partner who can take care of them." I said, "I expect equal pay for equal work." I got the job but I had to think long and hard about taking it. And BTW, I got paid quite a bit.

Sometimes people ask me, and send their kids to ask me, whether a career in psychology is them. I try to gently dissuade them unless they are interested in hard-core research.

I'm on this forum because I like to keep abreast of issues related to students and help if I can. I still love the field but I am very saddened by the state of it. Ladies and gents, we are on the downswing and if we want to survive, we need to take steps. I just don't see it happening. We just are not very good at defining our territory and protecting it.

I'm sorry if this is a downer. One of my students said that one of his profs just came out and said that they were wasting their time getting a doctorate. This particular school admitted 90 doctoral students last year. Where are the jobs for these people?
 
well Janusdog,
I can't say I disagree with you. There are a lot of problems in psychology today. I feel that there are definite problems here and if I weren't interested in neuropsychology, and the economic benefits associated with it, I wouldn't even consider a clinical psychology PhD. Even then I refuse to go to a program that won't properly fund me because I don't see how one can pay off the debt. It is bad enough that psychologists are being replaced in practice, but I don't see how a medical school could justify doing so. You have PhD's teaching the undergrads and MSW's teaching the med. students? Doesn't make sense to me.
 
I think it's hard to defend our territory because, unless you can prescribe pills, you're looked at as an also-ran. That's why RxP is SO important to psychology. Once we have prescriptive authority, we will be looked upon as real doctors. Although we don't have to prescribe, just having the power to do so helps...

For some reason psychologists are really apathetic regarding involvement in the legislative process. Anybody have any ideas why?
 
we will be looked upon as real doctors. Although we don't have to prescribe, just having the power to do so helps...

?! I think that we should spend more energy on educating the general public about what we do and what our extensive training allows us to do. The average jo on the street thinks we just have a BA....

And Janusdog, please hang around in this forum. I like your blunt wake up calls. When one discusses things with grad students only, it feels like we're stuck in our ivory towers....
 
edieb said:
...Once we have prescriptive authority, we will be looked upon as real doctors.
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How incredibly sad and misguided....both for how you view your own profession, and for what you perceive to be the main knowledge base of physicians.
 
Anasazi23 said:
How incredibly sad and misguided....both for how you view your own profession, and for what you perceive to be the main knowledge base of physicians.
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Welcome back, Anasazi. We need more of you around here!

How's your residency going? Any time for moonlighting?
 
I didn't say anything about how we are not real doctors; rather, I said the public doesn't view us as real doctors. As a previous poster said, the general public thinks we have a BA. Why don't you spew your venom somewhere else?


Anasazi23 said:
How incredibly sad and misguided....both for how you view your own profession, and for what you perceive to be the main knowledge base of physicians.
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The fact that you even think that the public will finally give you the respect that you feel you're lacking when a few psychologists prescribe some medications is testament to the essential dilemna of your own profession's future, as Janus alluded to earlier. I think I would give the public's perception of psychology a little more credit than assuming that you folks have nothing but bachelor's degrees. Assuming you're correct, however, how would that change your OWN view of the profession? Would you feel more like a "real doctor" if you had a prescription pad yourself? I assure you, there is much more to being a "real doctor" than that. I suggest some introspection.



Hi Public...

I'm busy in psychiatry residency....certainly no time for moonlighting. Anyway, you're normally not allowed to moonlight until at LEAST the 3rd year, if it's allowed at all (most places seem to allow it though). Something about passing Step III, and the Bell Comission.

Saw a relatively young patient in the ER today with new onset panic disorder. He had a funny, sort of extra-organic look to him. I'm ruling out a pheo and some other stuff just in case. Would hate to get caught with your pants down throwing Paxil and Risperdal at a pheo. Interesting cases, we have here. How's good 'ol NYCOM? 🙄 :luck:
 
PublicHealth said:
Welcome back, Anasazi. We need more of you around here!

How's your residency going? Any time for moonlighting?
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It's interesting how you've come out against clinical psych, PublicHealth. I guess I've been gone too long, but I didn't think it was that long. I can understand why you feel the way you do, but what happened? If I recall you were even in favor of RxP, something which I think many psychologists can do competently if well trained (but I will not be pursuing this personally as I'm going toward academia/research... if I did RxP for psychopharmacology training it would be for that purpose, the increased knowledge base). What changed your mind exactly, the pay for clinical psychologists? The competition from less-educated subdoctorals, both, more?
 
PsychMode said:
It's interesting how you've come out against clinical psych, PublicHealth. I guess I've been gone too long, but I didn't think it was that long. I can understand why you feel the way you do, but what happened? If I recall you were even in favor of RxP, something which I think many psychologists can do competently if well trained (but I will not be pursuing this personally as I'm going toward academia/research... if I did RxP for psychopharmacology training it would be for that purpose, the increased knowledge base). What changed your mind exactly, the pay for clinical psychologists? The competition from less-educated subdoctorals, both, more?
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Also, you're in medical school, and psychiatry is moving toward psychosomatic psychiatry as you've stated... but I don't think the fact that you may be going into psychiatry is the only reason why you seem to have negative sentiment for clin psych. Just interested to know what changed your mind on the topic
 
PsychMode said:
It's interesting how you've come out against clinical psych, PublicHealth. I guess I've been gone too long, but I didn't think it was that long. I can understand why you feel the way you do, but what happened? If I recall you were even in favor of RxP, something which I think many psychologists can do competently if well trained (but I will not be pursuing this personally as I'm going toward academia/research... if I did RxP for psychopharmacology training it would be for that purpose, the increased knowledge base). What changed your mind exactly, the pay for clinical psychologists? The competition from less-educated subdoctorals, both, more?
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If my posts suggests that I have come out against clinical psychology, it's likely due to my trying to justify my own decision to pursue medical training. I am still in favor of psychologists getting RxP given appropriate training, but I often wonder if the profession's seeking RxP speaks more to their lack of identity in the healthcare field than it does to their wanting to serve their patients better.

My decision was based on my need for a more biologically oriented approach to studying, diagnosing, and treating psychiatric disorders. I have limited interest in psychotherapy, so I did not want to train solely in these treatment modalities for 5+ years. Moreover, I noticed how disillusioned many of the psychologists and neuropsychologists with whom I have talked were with their careers. Pay is also decreasing for psychologists. Starting salaries in academic posts range from $40-60K. In psychiatry, they're $100-150K. More in private practice.

As a psychiatrist, I will be able to offer my patients comprehensive medical and psychiatric care. While clinical psychologists are an important component of the treatment process, they are increasingly being replaced by LCSWs and other mid-level practitioners. Medical doctors, on the other hand, tend to have more of a clearly defined position in behavioral healthcare.

I've also published a bit and plan to continue conducting research in whichever specialty I choose. At the moment I am leaning toward psychiatry with specialization in psychosomatic psychiatry. But that could change. I'm also interested in neurology, anesthesiology, and preventive medicine.

In sum, I want to understand the human condition from the inside out with an emphasis on biology. I also seek career stability and do not want to feel limited in terms of the services that I could provide my patients.
 
Thanks to everyone who had nice things to say about my posting, and/or my presence. 😀

My point of view related to RxP is...why? I mean, really. There are very definite trends that focus on behavioral and lifestyle change for chronic health problems that would benefit from the focus of psychologists. Also infant mental health. Forensics, and behavioral health in primary care (health psych).

I have an ex-boyfriend who specializes in juvenile sexual offenders. I think that's really gross, but it's a niche, and an important one.

I've read the arguments for RxP, but ultimately I remain unconvinced. I think we'll someday figure out that things like obesity need to be managed with education, advocacy, and lifestyle management. If we would get off our dupas we could convince the public at large to see that. Who are the best qualified people to do the work?

We just don't need RxP, IMHO.
 
I am not sure that the public wants to go throw the road that does not include instant gratifications e.g. medications, to help them gain tx for their depression, schizophrenia, etc. Western culture has become an instant gratification society that no longer want to become educated on proper and healthy life style or better coping skills, they prefer just to take a pill or go to a cosmetic surgent to make them more desirable.

I have worked in a community mental health center and I have come across individuals suffering from various mental illness. Psychologists and other non-medical mental health professionals spend numerous hours with patients providing counseling, assessment, psycho social eval., etc, and after all that time shared with the pt. they are easily referred to the psychiatrist for a 15 minutes medication management. After several years of psychological services, the center has decided to shut down the non-medical department (psychological) and make room for the new and improved psychiatrists and their SSRI medications that carry significantly less side effects and less time spent with the pt. and more money for the center. Meanwhile the psychologists and mental health professionals are out of jobs.

In my opinion, RxP can help keep the psychologist in business and allow them to provide more holistic tx that will include psychological, counseling and psychopharmacological services to their patients who are in urgent need of more comprehensive tx then just 15 min. of pill pushing.
 
I'm in favor of RxP overall, but my concern is that even if RxP works out, everyone else will want it too. We may find ourselves making the same argument as psychiatrists, because people often forget or ignore the fact that clinical psychology programs are extremely competitive. With some of these master's programs teaching counseling, therapy, and assessment, including a lot of MSW programs, it's almost like you can just kind stroll right on in off the streets. I wonder who in the hell actually gets rejected? This is coming from someone who is in one of the many master's programs for psychology. I'm not even in a doctoral program yet. Even if I don't get into clinical psychology, I will tell you the same thing. I've seen the curricula of MSW programs. In terms of mental health education and training, they are not any better than master's programs in counseling or psychology. Ironically many MSWs feel superior to them.

Also, another concern of mine is the fact that psychologists may be pushed to become pill pushers if they are not careful or in control of how psychologists are redefined. Managed care may end up sending clients to a physician for a medical work up and then to a psychologist to diagnose and write a prescription. I like the idea of holistic mental health tx, but the question is whether that is what ends up happening.

And I don't think there should be any fly-in programs to prepare for RxP. Sure, they might be challenging, but I'm uncomfortable with them. A lot of proponents of RxP would disagree with me, but unfortunately I sense that fly-in programs are more for the benefit of clinical psychologists currently in practice than for the clients.

Janus, reading your comments on the state of psychology I have to agree that a lot of this is our own fault. We didn't advocate enough, we didn't define ourselves & claim our identities enough, and too many psychologists were willing to take reduced pay/hours or no benefits. It's sad when an intelligent woman who climbed the PhD mountain settles for that. I'm glad you didn't.

And about jobs on APA site asking for clinical social workers or psychologists, I can't cheer enough when you point to lack of political advocacy. I do think there is quite a bit of advocacy for RxP, perhaps at our own expense... 😕
 
I am surprised that I find myself on the other side of the fence on a lot of issues as compared to where I was in graduate school.

In undergrad I thought RxP was a good idea, mostly because I am somewhat of a physician in psychologist's clothing. Honestly, some of what prevented me from going to med school in the first place was 1) a poor math education resulting in intense math anxiety and 2) the fact that I have to sleep. I don't function well on little sleep and I was afraid I would kill someone.

I also was in love with the academic thought related to psychoanalysis and psychodynamic treatment. I went to a psychodynamic program and was convinced I would only be doing psychodynamic therapy.

I'm now a behaviorist who is perpetually irritated at my analytically-oriented student trying to do analysis on a community health population. Methinks that instead of trying to do what physicians do, we should try and change the parts of society we don't like (the instant gratification factor), as opposed to adapting to it and feeding into it right off the bat. :scared:

How did that happen? :laugh:
 
I'm now a behaviorist who is perpetually irritated at my analytically-oriented student trying to do analysis on a community health population. Methinks that instead of trying to do what physicians do, we should try and change the parts of society we don't like (the instant gratification factor), as opposed to adapting to it and feeding into it right off the bat.

Do you mean to try and educate those parents that bring you a screaming child and tell you to fix him/her? And then you start explaining the principles of behaviour management and how they have to be consistent in the way they react to the child's behaviour..... but they roll their eyeballs..... In addition to pushing RxP rights, the APA could do more on educating the public that change in behaviour takes time and effort.....
 
PublicHealth said:
If my posts suggests that I have come out against clinical psychology, it's likely due to my trying to justify my own decision to pursue medical training. I am still in favor of psychologists getting RxP given appropriate training, but I often wonder if the profession's seeking RxP speaks more to their lack of identity in the healthcare field than it does to their wanting to serve their patients better.

My decision was based on my need for a more biologically oriented approach to studying, diagnosing, and treating psychiatric disorders. I have limited interest in psychotherapy, so I did not want to train solely in these treatment modalities for 5+ years. Moreover, I noticed how disillusioned many of the psychologists and neuropsychologists with whom I have talked were with their careers. Pay is also decreasing for psychologists. Starting salaries in academic posts range from $40-60K. In psychiatry, they're $100-150K. More in private practice.

As a psychiatrist, I will be able to offer my patients comprehensive medical and psychiatric care. While clinical psychologists are an important component of the treatment process, they are increasingly being replaced by LCSWs and other mid-level practitioners. Medical doctors, on the other hand, tend to have more of a clearly defined position in behavioral healthcare.

I've also published a bit and plan to continue conducting research in whichever specialty I choose. At the moment I am leaning toward psychiatry with specialization in psychosomatic psychiatry. But that could change. I'm also interested in neurology, anesthesiology, and preventive medicine.

In sum, I want to understand the human condition from the inside out with an emphasis on biology. I also seek career stability and do not want to feel limited in terms of the services that I could provide my patients.
Click to expand...

Hi PH, I wholeheartedly agree with this post.
Hi everyone, very interesting discussion here on psychology's identity.

As a recently licensed psychologist currently completing pre-med requisites in preparation for one day being a psychiatrist, I thought I would add some of my thoughts on this issue which I have struggled with for the last couple of years.

When I entered psych school I naively believed that psych PhD/PsyD were held in similar regard to psych MD/DO, i.e., similar professional status, pay, privileges and comparable scope of practice-both could do psychotherapy, PhD/PsyD could do testing and MD/DO could do medicating.
As I began to discover during my psych residency, there's no comparison between the two professions in either medical schools, medical centers, or in the managed healthcare system.
In my experience, PhD/PsyD are often seen by MD/DO as being helpful in one of two ways, as statisticians that can be of critical assistance to their research and as therapists that can be ordered to treat the patients that they are/aren't medicating-kind of like physical therapists are to physicians.
Additionally, psychiatrists make 2-3x more than psychologists-I was recently offered a job at 50k/40 hrs while I know just licensed psychiatrists who are making 100k/20 hrs-and while psychologists are facing a monumental struggle to obtain RxP, psychiatrists (and master level mental health providers) are increasingly asserting and exercising testing privileges.
In other words, psychology is caught between not being as high as psychiatry and being threatened with no longer being higher than social work, counseling, etc.
Why is this the case? In my IMHO, I believe it is because psychology still struggles between being a social science profession and a healthcare profession. That is why current PhD/PsyD curriculum is an amalgamation of statistics, research design, social psychology, psychopathology, physiological psychology, psychopharmacology, etc. This model often leaves the psych student uncertain as to the identity of his/her future profession: is the training for one to become a research scientist or to become a healthcare provider?
Supposedly, APA has been increasingly committed to cl psych being a healthcare profession thus the advocacy for RxP but in my opinion this commitment has not been strong enough. Current psych residencies put interns at a disadvantage from the beginning when they are in med ctrs, i.e., unlike med interns psych interns are not yet doctors. I believe it would be better for psych to have a two year (or more) post-doc residency but no pre-doc internship. I also believe that psychology needs to have RxP if it is going to be regarded in any way as comparable to psychiatry-control of a desired comodity provides authority and power. If only med has RxP than they will inevitably have the most authority/power. Furthermore, I believe that if cl psych is going to really be a healthcare profession than psychopharmacotherapy training needs to be part of the doctoral curriculum and not of a post-doc MS program in psychopharmacology-this is something tha APA has still not endorsed, preferring to see med psych as a sub-specialty of cl psych rather than RxP as a front-line tool of all cl psychs.

BTW, I'm personally very happy to have gone through psych school and to now be a psychologist but unfortunately, I'm very professionally dissapointed and would find it very difficult to encourage others to pursue psychology instead of psychiatry. Anyway, enough rambling. I will ultimately be a psychiatrist and I support psychologists having RxP but I just wanted to add my two cents in case there are some here in this forum that I may help to avoid this professional identity problem.
 
sasevan said:
Hi PH, I wholeheartedly agree with this post.
Hi everyone, very interesting discussion here on psychology's identity.

As a recently licensed psychologist currently completing pre-med requisites in preparation for one day being a psychiatrist, I thought I would add some of my thoughts on this issue which I have struggled with for the last couple of years.

When I entered psych school I naively believed that psych PhD/PsyD were held in similar regard to psych MD/DO, i.e., similar professional status, pay, privileges and comparable scope of practice-both could do psychotherapy, PhD/PsyD could do testing and MD/DO could do medicating.
As I began to discover during my psych residency, there's no comparison between the two professions in either medical schools, medical centers, or in the managed healthcare system.
In my experience, PhD/PsyD are often seen by MD/DO as being helpful in one of two ways, as statisticians that can be of critical assistance to their research and as therapists that can be ordered to treat the patients that they are/aren't medicating-kind of like physical therapists are to physicians.
Additionally, psychiatrists make 2-3x more than psychologists-I was recently offered a job at 50k/40 hrs while I know just licensed psychiatrists who are making 100k/20 hrs-and while psychologists are facing a monumental struggle to obtain RxP, psychiatrists (and master level mental health providers) are increasingly asserting and exercising testing privileges.
In other words, psychology is caught between not being as high as psychiatry and being threatened with no longer being higher than social work, counseling, etc.
Why is this the case? In my IMHO, I believe it is because psychology still struggles between being a social science profession and a healthcare profession. That is why current PhD/PsyD curriculum is an amalgamation of statistics, research design, social psychology, psychopathology, physiological psychology, psychopharmacology, etc. This model often leaves the psych student uncertain as to the identity of his/her future profession: is the training for one to become a research scientist or to become a healthcare provider?
Supposedly, APA has been increasingly committed to cl psych being a healthcare profession thus the advocacy for RxP but in my opinion this commitment has not been strong enough. Current psych residencies put interns at a disadvantage from the beginning when they are in med ctrs, i.e., unlike med interns psych interns are not yet doctors. I believe it would be better for psych to have a two year (or more) post-doc residency but no pre-doc internship. I also believe that psychology needs to have RxP if it is going to be regarded in any way as comparable to psychiatry-control of a desired comodity provides authority and power. If only med has RxP than they will inevitably have the most authority/power. Furthermore, I believe that if cl psych is going to really be a healthcare profession than psychopharmacotherapy training needs to be part of the doctoral curriculum and not of a post-doc MS program in psychopharmacology-this is something tha APA has still not endorsed, preferring to see med psych as a sub-specialty of cl psych rather than RxP as a front-line tool of all cl psychs.

BTW, I'm personally very happy to have gone through psych school and to now be a psychologist but unfortunately, I'm very professionally dissapointed and would find it very difficult to encourage others to pursue psychology instead of psychiatry. Anyway, enough rambling. I will ultimately be a psychiatrist and I support psychologists having RxP but I just wanted to add my two cents in case there are some here in this forum that I may help to avoid this professional identity problem.
Click to expand...

Well put, sasevan. You make a good point about clinical psychology lacking a professional identity. I often wonder why clinical psychology programs still insist on following an antiquated training model designed to produce scientist-practitioners. There is simply too much "fluff" in clinical psychology programs and too little training in practical and relevant psychotherapies. Most of the clinical psychologists and neuropsychologists that I know told me to avoid clinical psychology like the plague unless I was interested in a research career. Even then, they said, the competition for grants is stiff, and you'll likely start out making less than most research assistants. I've heard as low as $35K.

Sasevan, I enthusiastically applaud your efforts to become a psychiatrist. While the training is long, the payoff in the end is much greater. The opportunity to understand the biology and psychology of the human organism, to be able to utilize the full range of treatment options, to be able to grasp the complex relations between the various bodily systems and how they relate to psychiatric disorders is, in my mind, an unparalleled training experience and a privilege.

Keep us posted on your progress. I have no doubt that you will be successful.
 
Well I think that the reason for still using the scientist-practitioner model has to do with the fact that they are PhD degrees that allows one to be a professor. Otherwise it would be even less differentiated than the other mental health degrees. It is what the PsyD programs are trying to do, but I think that the lack of good paying jobs and educational debt make it somewhat of a failure. On the testing aspect, I don't think that the psychiatrists will take it because it would require more training and doesn't pay as well. Also, It gets too far from mid-level training, so if they fight it will still take a long time to get it. Psychotherapy on the other hand is a mess and is going to continue being dictated by mid-level practictioners, who can afford to do it cheaply.
 
Sometimes in all these arguments we may forget that their are people who don't want to practice...that want to go fulltime into academia/research.....is that really such a rarity nowadays?
After researching private practice I ran away scared......no thanks...all the overhead, stress, hours, paperwork, dealing with HMOs, etc. Sorry not worth it for an extra 20K a year.
But then again I guess some people just can't stand the research aspect 🙂
 
PublicHealth said:
Well put, sasevan. You make a good point about clinical psychology lacking a professional identity. I often wonder why clinical psychology programs still insist on following an antiquated training model designed to produce scientist-practitioners. There is simply too much "fluff" in clinical psychology programs and too little training in practical and relevant psychotherapies. Most of the clinical psychologists and neuropsychologists that I know told me to avoid clinical psychology like the plague unless I was interested in a research career. Even then, they said, the competition for grants is stiff, and you'll likely start out making less than most research assistants. I've heard as low as $35K.

Sasevan, I enthusiastically applaud your efforts to become a psychiatrist. While the training is long, the payoff in the end is much greater. The opportunity to understand the biology and psychology of the human organism, to be able to utilize the full range of treatment options, to be able to grasp the complex relations between the various bodily systems and how they relate to psychiatric disorders is, in my mind, an unparalleled training experience and a privilege.

Keep us posted on your progress. I have no doubt that you will be successful.
Click to expand...

Hi all,

PH: Thank you and congrats to you for getting into med school: what's your schedule like at NYCOM? I'm sure that whatever specialty you ultimately pursue you'll be successful but of course with your background in psychology I hope that you choose psychiatry and/or neurology.

Sanman: I just completed a forensic examiner training (multi disciplinary) and it was discussed there how other mental health practitioners are doing psychological testing (e.g., MMPI, WAIS). While its true that most psychiatrists would not usually do testing because (among other things) is not cost effective, in forensic cases they are doing them because in these they are cost effective. The point, though is not that psychiatrists are choosing or not choosing to do them but that they have the option, in contrast to psychologists who don't have the option with medication.

I definitely see the value in holding on to the psych PhD but I believe that the practitioner standard should be the PsyD and then those psychologists who want to enter into academia could obtain the PhD; kind of like the standard MD and the MD, PhD.

BTW, congrats to you too for getting into psych school. I do believe that the outlook for neuropsych (along with forensic, school, and child psych) is better than for non-sub-specialized cl psych.

Jwtaylor: I know of several cl psychs (all PsyD) in private practice who are all making over 100k/year (e.g., forensic neuropsych 150k; forensic 120k). However, both of these have been in practice for 10 years or so and they certainly put in more than just 40 hours a week. So, IMHO, its possible to have a financially rewarding private practice but improbable for starting out PsyDs. For one thing, many of the insurance panels are now closed to new psychologists.

Gzaky: I don't know if your comments regarding those who have jumped from psychology to psychiatry were intended for me or not. Regardless, I would like to clarify my last post since I do not want to give anyone the impression that I'm trying to persuade psychology majors to choose psychiatry over psychology.

My intention was, and is, to try to inform psychology majors of some of the realities in mental health practice so that they then may knowingly choose which discipline best fits their interests, aptitudes, and requirements. I know that when I entered psych school 6 years ago I did not know much of the realty; had I known I might have made a different choice, maybe.

I say "maybe" because like you I love psychology. On a personal level, I'm very happy with the education that I received since it has helped me to be much more open minded, compassionate, accepting of diversity, and valuing of the uniqueness of each human person. The humanistic principles that underlined my psych ed will remain with me forever. I'm not sure, in fact, I doubt, that I would be the person that I am today if 6 years ago I would have entered med school instead of psych school. Thus, I will always be proud of being a psychologist and intend to remain so even after I become a psychiatrist.

However, on a professional level, I'm dissapointed in the ongoing identity struggle in psych and the resulting mix bag psych curriculum, internship, psychopharm training, etc.

Like you, I support psychologists gaining RxP and I believe that eventually we will but I also believe that it will take decades before it is a nationwide reality and even then med psych will not be on a par with psychiatrists. Even to this day, for example, most insurance companies reimburse psychiatrists at a higher level than psychologists for psychotherapy! Once legislatures are persuaded to enact RxP legislation, training programs will have to be worked out between psych and med (no easy thing as the 2 plus years of this process in NM demonstrates) and then insurance companies will have to be persuaded to reimburse PhD/PsyD for med mgm.

I totally support psychology becoming a bona fide healthcare profession and mental health having two doctoral level disciplines that can provide effective and efficient patient care but, unfortunately, I believe that psychology will always be playing catch up to psychiatry in the current managed healthcare industry. I didn't realize it was that way when I entered psychology and now that I do I have to choose between limiting myself to the second tier discipline or going for the top of the line; despite the cost in time, money, etc of going to med school/residency I have so chosen because I believe that in the end the sacrifices will be well worth it.

That's just my choice and I'm not encouraging anyone else to so choose; just to consider the reality of mental health practice.

BTW, a psychiatrist can do everything that a psychologist can do (even if he/she shouldn't such as the case with psych testing), including doing psychotherapy full time instead of med mgm. And yes, it takes 8 long years to become a psychiatrist but it takes about 6-7 years on average to become a psychologist (3-4 didactics, 1 dissertation, 1 internship, and 1 fellowship) and this is without the 2 year post-doc MS in psychopharm! Additionally, during the 4 year residency MD/DO make more money than starting out post-licensure PhD/PsyD! Just some food for thought.

Also BTW, I agree with you that it's not about $$$$. But I do believe it's about quality of life; as a PhD/PsyD I would have to be engaged in highly intensive therapy/testing to make 55k/40 hrs while as a MD/DO I could be doing med mgm for 75k/20 hrs. I can easily live on 50k (an upgrade from student life style...LOL) but I would like to have the time to enjoy that.

PS, since we're both in Miami feel free to PM me; maybe we can talk more about all of this.

Janusdog: I respect your experience and choices; I was wondering if you'd consider supporting psychologists gaining RxP for those who want to have the freedom to make that choice even if you yourself have no interest in such a pursuit?

Peace all! 🙂
 
Sasevan, thanks for the congrats, but it's a little premature. I 'm applying this year. Hopefully the congrats will be true in a few months.

A couple of points, You say that testing could be used by psychiatrists in a forensic setting, but without proper training they would be ripped apart by the opposing counsel and I don't believe that there is any accreditation at present.

As far as training, you forget that psychiatrists are more likely pigeon-holed into what they like to do. Psychologists have more access to administrative, teaching, and reserach positions. They can also more easily balance many of these things simultaneuosly. It depends on what you enjoy. Also, it isn't as easy to work those 20hrs a week as you suggest because of med school debt. Also I have a friend, who's an internal med. doc and had that plan, but he just couldn't find such a job in his area. Maybe psychiatry is different.


PS: That is the most colorful post I've seen in a while.
 
Sanman said:
Sasevan, thanks for the congrats, but it's a little premature. I 'm applying this year. Hopefully the congrats will be true in a few months.

A couple of points, You say that testing could be used by psychiatrists in a forensic setting, but without proper training they would be ripped apart by the opposing counsel and I don't believe that there is any accreditation at present.

As far as training, you forget that psychiatrists are more likely pigeon-holed into what they like to do. Psychologists have more access to administrative, teaching, and reserach positions. They can also more easily balance many of these things simultaneuosly. It depends on what you enjoy. Also, it isn't as easy to work those 20hrs a week as you suggest because of med school debt. Also I have a friend, who's an internal med. doc and had that plan, but he just couldn't find such a job in his area. Maybe psychiatry is different.


PS: That is the most colorful post I've seen in a while.
Click to expand...

Hi Sanman,

Sorry about my jumping the gun on your school admission but I'm sure its only a matter of time; good luck and please keep us posted.

I agree with you on psychiatrists being ripped apart by opposing counsel if they do psych testing WITHOUT training but many do get training (there are plenty of weekend workshops all over the country that provide training in test administration/interpretation-not to mention all the automated report writing programs and services). My point is that psychiatrists CAN do psych testing with minimal training while psychologists cannot do medicating. I make that point in order to illustrate how my preconceptions about the limited scope of practice of these two mental health doctoral level disciplines was very wrong.

I don't agree with you on psychiatrists being more pigeon-holed professionally than psychologists. In my experience-admittedly limited-I've see psych MD/DO doing administrative, teaching, and research work as well as clinical. I don't see any limitation to what psychiatrists can do in the mental health field-maybe this is different in the industrial/organizational field but then again, I'm interested in MH work not I/O. I hope that if I'm mistaken others may illustrate with examples, especially any psych MD/DO out there.

What would be easier to pay off: (1) 135k student debt on 55k annual salary (psychology), or (2) 200k on 135k (psychiatrist)? I know a recently lic psychiatrist who has two 100k per 20 hrs hospital jobs plus a private practice. I know another just recently lic psychiatrist who was offered 80k for 20 hrs-she turned it down because it wasn't enough! I know several recently lic psychologists; the best compensated is getting 49k/40 hrs-most are getting paid $26 an hour for contract work without any benefits!!! I mean 100k/20 hrs may not be enough for some because of student debt AND the life style they may want to enjoy but for me that would be plenty.

Again, best of luck on the application/interviewing process; I certainly see you as someone who is very well informed on all of the psychology/psychiatry issues-professional and otherwise-and I believe that you will be very content with your choice to pursue a career in neuropsych.

PS: Here's a little more bit of color. 🙂
 
sasevan said:
Janusdog: I respect your experience and choices; I was wondering if you'd consider supporting psychologists gaining RxP for those who want to have the freedom to make that choice even if you yourself have no interest in such a pursuit?
Click to expand...

No, because I think it arises out of flailing about for professional identity with little foresight.

You have the right to do whatever you want. I'm not personally outlawing RxP. I'm just not going to give the APA my money to help you get privileges.
🙂

Yours would be a decent argument if I didn't see RxP as destructive to the profession, but I do.
 
Hey Sasevan,
I know about the weekend workshops and such, but without an accreditation board that ensures the training I still think that they would we compared to neuropsych's with a 2 year fellowship. I believe that would cause a problem. However, I could understand them administering the simpler tests that general clinical psychs use routinely.
As far as the debt is concerned, I agree with you in your scenario. That is why I refuse to go to an unfunded program. Many of the grad studens at my university are walking out with 50k or less debt, some with none. In that case I believe walking out with a starting salary of 55-60k and little debt makes it a bit of a wash. This is why I am not a fan of PsyD programs and only tell people to pursue a PhD if they are interested in neuropsych, forensics, school, or pediatric psych. Though that is just my opinion.
What I meant by pigeon-holed is that psychiatrists can do all of those things, but not as easily. It is much easier for a PhD to find an adjunct teaching position to supplement a clinical career or vice versa. In psychiatry, it is more of a choice of academic or private practice.
Also, consider the region you are living in. In the Northeast, many careers including psychologists get paid more for cost of living, but psychiatrsts are paid less because of saturation. In that case, the fiscal difference lessens even more. In the end, its all about getting a good job and that is up to the individual. There are careers that have us all beat. I had a PhD clinical psych teaching intro psych classes in my old high school for 95k a year and summers off. Haven't seen a job offer beat that yet. You don't want to know how much the administration made.
 
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