Neuropsychologists - how many assessments do you do a week?

[thebalmofhurtminds]

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Especially looking for information for those who have multiple trainees working with you.

 

[PsyDr]

Sounds like the typical exploitative business model of "I'll get students to act as free labor, but that's not exploitation". It's a bad business plan. And it's unethical.

If you put a bunch of zeroes in the "testing by technician" line, you're negatively skewing the insurance data for reimbursement rates. In general, it's a bad idea to try to show insurance companies that they can pay you less. It's a particularly bad idea to lower costs through free labor, have your rates lowered, and then have to increase this practice until your business is in a death spiral.

If your business plan is based upon using trainee labor to maximize profits in the short term, you're planning for lower profits due to competition in the long run.

 

[thebalmofhurtminds]

I'm not a neuropsychologist, nor am I making a business plan. I'm looking at the workload in my own department and trying to see what a reasonable caseload generally is.

 

[WisNeuro]

It's a pretty wide number that is dependent on many factors. Having a psychometrist or doing your own testing? That's one of the biggest factors. Also, what kind of evals are you doing? General dementia evals? Sure, I can whip those out with 1.5 hours of testing generally. Doing pre-surgical epilepsy evals? Gonna be longer. Number of assessments really isn't the number to look for to determine reasonable load. You should really be looking at number of clinical hours. Many hospital sites will want you to be around 32 billable hours/week.

 

[thebalmofhurtminds]

It's a pretty wide number that is dependent on many factors. Having a psychometrist or doing your own testing? That's one of the biggest factors. Also, what kind of evals are you doing? General dementia evals? Sure, I can whip those out with 1.5 hours of testing generally. Doing pre-surgical epilepsy evals? Gonna be longer. Number of assessments really isn't the number to look for to determine reasonable load. You should really be looking at number of clinical hours. Many hospital sites will want you to be around 32 billable hours/week.

Thanks! That's really helpful. We do have psychometrists. Evals are a mix, we appear to take anything from dementia to TBI. I'll have to look a bit closer to see what that translates to in billable hours.

 

[PsyDr]

I'm not a neuropsychologist, nor am I making a business plan. I'm looking at the workload in my own department and trying to see what a reasonable caseload generally is.

Sorry, I didn't realize that is was a department that was relying upon trainees for free labor.

 

[thebalmofhurtminds]

Sorry, I didn't realize that is was a department that was relying upon trainees for free labor.

I never said a word about how many cases or hours are currently done, let alone how many interns and supervisors we have. I already said that we have psychometrists and are not relying on interns for testing. We only have interns and fellows, no graduate students.

I’m in my first year in the department and was looking for comparisons in terms of typical caseload. Not sure where your assumptions or aggression are coming from.

 

[Therapist4Chnge]

Sometimes PsyDr offers aggression for free, kinda like never ending bread sticks at the Olive Garden. They will come whether requested it not, but some find them helpful, others prefer other options.

Periodically we have ppl ask about exploitive setups, which ultimately hurt the profession, so that likely impacted responses in here. The asking and the actual doing out in the real world happens often enough, I understand the response, and wanted to explain it for ppl not familiar with the general context.

One of the things many depts underestimate about having neuro students/trainees is the amount of time they require to be trained well. There is a lot of writing, rewriting, and mentorship (including didactics and journal club) that should be happening in conjunction w. any clinical F2F. What can be used and by whom can be nuanced, but the gist is that the free labor is quite limited if done w. prioritizing training over using unpaid labor just as psychometricians.

 

[WisNeuro]

Generally speaking, interns and prac students are a time sink. They cost us a lot more time than they save. So you either get a time offset, or plan on working more to cover that time. Fellows can eventually be a time saver on the clinical side, but you usually spend more time on supervision and didactics there.

Some clinics use trainees in a very exploitative way. Using them as glorified psych techs and doing the bare minimum of didactic and supervision. But, in good training programs, supervising providers are generally spending a lot more time on extra activities (supervision, didactics, checking scoring, report editing) than they ever save with the trainees work product. Psychometricians are a different story, and variable depending on their skill, but also you region and insurers, as many people still have trouble with reimbursement codes, even with the 59 modifier.

 

[thebalmofhurtminds]

Sometimes PsyDr offers aggression for free, kinda like never ending bread sticks at the Olive Garden. They will come whether requested it not, but some find them helpful, others prefer other options.

Periodically we have ppl ask about exploitive setups, which ultimately hurt the profession, so that likely impacted responses in here. The asking and the actual doing out in the real world happens often enough, I understand the response, and wanted to explain it for ppl not familiar with the general context.

One of the things many depts underestimate about having neuro students/trainees is the amount of time they require to be trained well. There is a lot of writing, rewriting, and mentorship (including didactics and journal club) that should be happening in conjunction w. any clinical F2F. What can be used and by whom can be nuanced, but the gist is that the free labor is quite limited if done w. prioritizing training over using unpaid labor just as psychometricians.

Thanks for the explanation! And the breadstick analogy 😂 I generally agree with PsyDr, so was a bit taken aback by the assumptions when I didn’t think I provided any information suggesting exploitation.

Yes, I’ve certainly seen many instances of utilizing trainees in inappropriate ways throughout my own training and am aware of how much it hurts the profession. We all participate in training activities (didactics, journal clubs) and I know there’s a lot of time spent among all supervisors on rewriting etc. I just don’t have a lot of experience in non-VA caseloads, so was hoping to get some general sense of comparison.

 

[MCParent]

One of the things many depts underestimate about having neuro students/trainees is the amount of time they require to be trained well. There is a lot of writing, rewriting, and mentorship (including didactics and journal club) that should be happening in conjunction w. any clinical F2F. What can be used and by whom can be nuanced, but the gist is that the free labor is quite limited if done w. prioritizing training over using unpaid labor just as psychometricians.

+1
As a professor who runs an assessment clinic for the dept, yes. I’ve found it is a rare trainee who is able to do well even doing the same batteries over and over for a year. You have to go back and check all coding (eg missing scoring items below baseline), they struggle with writing (eg not understanding or internalizing what is wrong with a sentence like “during kindergarten, the patient reported that…”), and other errors (why would you send me a table where the t score for something is outside of the confidence intervals for t score???). Lots of effort.

 

[PsyDr]

I never said a word about how many cases or hours are currently done, let alone how many interns and supervisors we have. I already said that we have psychometrists and are not relying on interns for testing. We only have interns and fellows, no graduate students.

I’m in my first year in the department and was looking for comparisons in terms of typical caseload. Not sure where your assumptions or aggression are coming from.

1) It's exploitative and destructive. Trainees are there to train, not produce. BOL has pretty specific rules about internships, including the requirement that they solely benefit the intern. Productivity seems to indicate a non-training purpose. In the case of licensed fellows, such underpayments combined with productivity goals are exploitative. Look at what they are paid (i.e., $51k). Look at what insurance will pay for one unit of neuropsych (i.e., ~$100/hr. Someone is financially benefitting to the detriment of the trainee.

2) Underpaid labor lowers pay for EVERYONE. Insurances determine pay (partially) based upon local averages. Let's say your department and I are the only neuropsych games in town. I charge $1000/neuropsych, $100 of which is psychometrists' costs. Let's say your department uses underpaid labor in the form of 4 fellows. They pay them $45k/yr, require them to do all testing, and charge $750/neuropsych. Let's say your department does 4x more volume. Insurance does a survey, finds that the average price of a neuropsych is $800, and decides to only pay $800/neuropsych. Your department got a $50 raise per case, while I lost $200 per case. Not that the fellows see that money. What happens in the next few survey cycles? Or if your department expands their program? It becomes a volume game where the unit price goes down, so we are forced to bill more units. This is the Walmart model which has driven people out of business. This generally does not happen when labor is fairly paid.

 

[AcronymAllergy]

In a full-time, 100% clinical setup without trainees or psychometrists, I think a reasonable expectation for one adult neuropsychologist is 4 full outpatient evals/week at an average of 7-8 total hours per eval. Possibly include a couple brief inpatient evals or outpatient clinical intakes as well, and of course feedback appointments, especially if some of the outpatient evals semi-frequently end up being a bit shorter (e.g., very impaired patient or very straightforward dementia eval).

I do not change/adjust my workload when I have trainees, particularly if it's only one trainee on a full-time rotation or two trainees half-time. I suppose I might make slight adjustments if I had more than two full-time trainees simultaneously (e.g., one extra eval/week), but I would be hesitant to put myself in that situation. As has been said, trainees generally don't boost productivity for neuropsych, and I always approach the situation such that the trainees are not needed to keep my clinic running. I ensure I am able to cover all of the trainee's evals myself if they are out, or if something comes up while they're testing.

Edit to say: I 100% agree with WisNeuro that more important than number of evals is number of clinical hours/wRVUs. My 4 outpatient evals at 7-8 total hours each plus a few feedbacks and intakes, for example, puts one right around that 32 clinical billable hours/week.

I would say a psychometrist should be adding 4-5 evals/week, although the neuropsychologist may cut down their own workload to perhaps 2-3 evals/week to keep from drowning in feedback appointments and reports. But I don't have as much direct experience in this setting, as I've thus far done most or all of my own testing (which is absolutely not the most monetarily efficient way to go about practicing).

 

[debaura]

I'm not a neuropsychologist, nor am I making a business plan. I'm looking at the workload in my own department and trying to see what a reasonable caseload generally is.

I have not been in practice for quite a few years now, but my experience is aligned with what WisNeuro said. It depends on a variety of factors, depending on the setting and types of patients seen. When working at a rehabilitation hospital, we were expected to produce at least 75% billable hours. Also, in addition to evaluations, explaining results to the patient significant others, we carried out formal monitoring of progress for individuals who were not ready for testing. Participation in the meetings with the weekly interdisciplicary team was also required.

As I shifted into private practice, the length of testing again was flexible as to the referral question. I did at least two full evaluations per week, one or two shorter disability and/or dementia evaluations, and flexible batteries on consults at several rehabilitation hospitals. I also did child and family therapy to address issues related to neurological problems.

In both settings, the amount of time I spent on evaluations when there were post-doctoral trainees was increased by over 1/2, depending on the graduate curriculum pre-doctoral experiences of the trainee. Even with those who were well-trained, there seemed always to be issues related to diagnosis and determining the functional implications of the results.

 

[ClinicalABA]

I'd hardly call myself a neuropsychologist, but I pretty much bill only neuropsych codes. generally do 3-4 intakes and 3-4 evals per week, which easily let's me meet minimum billable requirements. I occasionally sneak in a 5th. Anything more than 4 is a stretch- generally it means I'll work less the following following week. Also, doing more than one per day is tough in that I have hundreds of little toys, pieces, etc to sanitize, and it's much easier to be able to soak in disinfectant and leave to dry overnight than to sanitize, dry off, and repack for another client (all young children) on same day.

I concur that practica students/ pre docs do not help the process, either time-wise or financially, and they can make the job much less enjoyable for me ( I want to do the testing, not watch others do it!).