Master’s level clinicians and assessments

[quickpsych]

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I am not going to be surprised when the salaries offered to us are exactly 25 percent more than a midlevel. For context, when I started out my company was paying psychologists 50 percent more than midlevels with many openings. However, we were the only option for snf facilities at the time. Many folks mentioned companies were making little off of us but needed to offer the service and made money off the NPs. Increasingly solo private practice may be the only way to money.

You're not far off. The current growing company I work for is at about offering 30% more to psychologists than midlevels and in recent year or so has started shifting the model more where psychologists basically do the same work as midlevels (and insurance wise nearly the same as LMFTs). When I started like 5 years ago it was about 50% more. I expect within next 2-3 years they'll lower the starting salary for new hires and maybe offer 20% more if that to psychologists. They're really missing an opportunity (not just this company but all companies like them) to leverage the unique competencies and skillsets of psychologists instead of just "everyone from LPC to LCSW and LMFT to Psychologist just does the same work!" Ironically, it would probably, since for profit, boost profits but also increase insurance liability costs if they wade into actual evaluations on patients instead of basically glorified screeners and data collection for SNFs and Nursing Homes. It's an easy gig , generally flexible, less hours, as I recall you used to work in these places too.

But you're right, solo practices are probably going to wind up being where real money is (and I think where real skillsets and services we as psychologists are trained and competent to provide will be of most use). I fear that solo private therapy only practices are at risk of being competed further by bottom of barrel companies like Better Help and midlevels racing to the bottom to be a part of that while also charging less per session. Assessments, testing, accommodations evaluations, and such are probably where psychologists solo will still find the time/effort is relatively still worth the payoff.

 

[cara susanna]

I miss the Raven dissertation.

 

[Sanman]

I miss the Raven dissertation.

We should probably all wear robes and bird masks while initiates recite the findings of the raven dissertation in order to enter the old guard. Like a really dull version of Eyes Wide Shut. As a founding member of the old guard, I am of course grandfathered in (as is psychology and academic tradition).

 

[Fan_of_Meehl]

Initiates traditionally participate in sharing detailed life histories and recounting their sexual histories (known as "Connubial Bliss") to forge deep psychological bonds. Leaked accounts suggest rituals involve macabre imagery, lying in a coffin, kissing a skull, and dramatic reenactments designed to confront mortality and test loyalty. If it is good enough for the leaders of the free world, it is good enough for SDN.

Whatever you do, don't tell them about the 'Desire Chip' that is offered at the beginning and end of every meeting.

Shhhhh!

 

[WisNeuro]

1. Be old, in SDN years.
2. Know enough of the canon/lore of SDN like the Raven dissertation.
3. Be a bit crotchety and/or abrasive around certain topics.

I’m sure there are other things too.

You have to be accused of being mean/elitist/racist/etc more than 10+ simply because you counsel prospective students that 200k+ is a poor ROI.

 

[R. Matey]

Whatever you do, don't tell them about the 'Desire Chip' that is offered at the beginning and end of every meeting.

Shhhhh!

Wait! @Fan_of_Meehl is in the old guard?! My join date is like three months prior to theirs.

 

[Sanman]

Wait! @Fan_of_Meehl is in the old guard?! My join date is like three months prior to theirs.

Honorary membership due to years of service in the profession. Typically the old guard is 2010 and prior. Why 2010? That is the year the Raven dissertation was published.

 

[WisNeuro]

Honorary membership due to years of service in the profession. Typically the old guard is 2010 and prior. Why 2010? That is the year the Raven dissertation was published.

PRD and ARD are the eras, Pre and After-Raven Dissertation.

 

[PsyDr]

1) At this point, the next SDN phases are: retired guard and last guard standing.

2) I recently looked for more practice oriented message boards, and google directed me to SDN.

 

[Therapist4Chnge]

There clearly isn't enough EMDR, IFS, Brainspotting, and related "alternative" treatment talk on here to last as a practice oriented message board.

 

[Sanman]

1) At this point, the next SDN phases are: retired guard and last guard standing.

Retired guard sounds better and better.

2) I recently looked for more practice oriented message boards, and google directed me to SDN.

Reddit is the best alternative I have found. However, I am not as active of a contributor over there.

 

[The Cinnabon]

I can't resist asking, but what does eveyone think of the model other countries have for clinical psychology and its practice?

Specifically countries like the UK and Oz where the terminal practicing degree is master's level iirc. I know it's not a one to one comparison with our mid-levels, but assessment is firmly in the domain of master's level clinicians in other rich western nations (say for US and CAN).

 

[WisNeuro]

I can't resist asking, but what does eveyone think of the model other countries have for clinical psychology and its practice?

Specifically countries like the UK and Oz where the terminal practicing degree is master's level iirc. I know it's not a one to one comparison with our mid-levels, but assessment is firmly in the domain of master's level clinicians in other rich western nations (say for US and CAN).

Considering what I overwhelmingly see from assessments from masters folks, I am firmly against it. I have seen far more harm than benefit from a patient perspective. Waiting for an assessment is usually preferable to an assessment that misdiagnoses or causes iatrogenic damage.

 

[Sanman]

I can't resist asking, but what does eveyone think of the model other countries have for clinical psychology and its practice?

Specifically countries like the UK and Oz where the terminal practicing degree is master's level iirc. I know it's not a one to one comparison with our mid-levels, but assessment is firmly in the domain of master's level clinicians in other rich western nations (say for US and CAN).

UK has the DClinPsy professional doctorate.

 

[The Cinnabon]

UK has the DClinPsy professional doctorate.

Whoops, idk why I assumed they were master's being terminal.

 

[PsyDr]

It's probably inaccurate to make a direct comparison of our educational systems. Most commonwealth physicians have a bachelors degree of medicine/surgery, not a doctorate (i.e., MBBS). IIRC, commonwealth psychologists generally have a masters plus 3 years of supervised practice.

If someone is providing general psychotherapy to the worried well, then whatever. NY allows independently licesensed psychoanalysts.

If someone is providing services with higher stakes, then more education is better.

 

[oliversacks4thewin]

It's probably inaccurate to make a direct comparison of our educational systems. Most commonwealth physicians have a bachelors degree of medicine/surgery, not a doctorate (i.e., MBBS). IIRC, commonwealth psychologists generally have a masters plus 3 years of supervised practice.

If someone is providing general psychotherapy to the worried well, then whatever. NY allows independently licesensed psychoanalysts.

If someone is providing services with higher stakes, then more education is better.

At the risk of disparaging our own country here, it is wild to see the differences in higher education in other commonwealth countries. I lived in an international dormitory during undergrad and talking with the international student's really opened my eyes to how different our trajectories are just in getting to the undergrad college level.

As a direct example, certain other countries hold the title of doctorate in very high esteem, with absolute demonstration of expertise required, as demonstrated by formally requiring you to publish in international journals to graduate. Meanwhile, here in the US, we have a number of doctorates that don't even require the publication of a dissertation, such as DPT, PharmD, MD/DO, and some PsyD programs...

In essence, it's like comparing apples to Ferraris lol.

 

[PsyDr]

At the risk of disparaging our own country here, it is wild to see the differences in higher education in other commonwealth countries. I lived in an international dormitory during undergrad and talking with the international student's really opened my eyes to how different our trajectories are just in getting to the undergrad college level.

As a direct example, certain other countries hold the title of doctorate in very high esteem, with absolute demonstration of expertise required, as demonstrated by formally requiring you to publish in international journals to graduate. Meanwhile, here in the US, we have a number of doctorates that don't even require the publication of a dissertation, such as DPT, PharmD, MD/DO, and some PsyD programs...

In essence, it's like comparing apples to Ferraris lol.

You're slightly incorrect. It's not a PhD that is the demonstration of absolute demonstration of expertise, it's "habilitation" (i.e., Dr habil, DsC, etc). Jung, Bleuler, etc all completed their habilitations after their doctorates. In academic regalia, hood length goes: PhDs, followed by applied doctorates (e.g., JD, MD), followed by masters.

*I'm full of useless information

 

[futureapppsy2]

If someone is providing general psychotherapy to the worried well, then whatever. NY allows independently licesensed psychoanalysts.

If someone is providing services with higher stakes, then more education is better.

The danger here is, of course, not being able to correctly distinguish worried well patients from patients with higher risk/care needs.

 

[Sanman]

You're not far off. The current growing company I work for is at about offering 30% more to psychologists than midlevels and in recent year or so has started shifting the model more where psychologists basically do the same work as midlevels (and insurance wise nearly the same as LMFTs). When I started like 5 years ago it was about 50% more. I expect within next 2-3 years they'll lower the starting salary for new hires and maybe offer 20% more if that to psychologists. They're really missing an opportunity (not just this company but all companies like them) to leverage the unique competencies and skillsets of psychologists instead of just "everyone from LPC to LCSW and LMFT to Psychologist just does the same work!" Ironically, it would probably, since for profit, boost profits but also increase insurance liability costs if they wade into actual evaluations on patients instead of basically glorified screeners and data collection for SNFs and Nursing Homes. It's an easy gig , generally flexible, less hours, as I recall you used to work in these places too.

But you're right, solo practices are probably going to wind up being where real money is (and I think where real skillsets and services we as psychologists are trained and competent to provide will be of most use). I fear that solo private therapy only practices are at risk of being competed further by bottom of barrel companies like Better Help and midlevels racing to the bottom to be a part of that while also charging less per session. Assessments, testing, accommodations evaluations, and such are probably where psychologists solo will still find the time/effort is relatively still worth the payoff.

I am not surprised to hear about the salary decline in geriatrics, but saddened for younger folks. The really sad part is that plenty of older folks in positions of authority decided to eat their young and advocate for legislation that would increase competition and reduce salaries for folks in their own profession. APA did little to stop it as they are yoo busy squeezing money out of students. Compare that to what AMA does when we advocate for prescriptive authority. With the VA being less and less of a career option for many folks, private practice is seeming like the only viable path forward.

I'm not really concerned about Betterhelp. The pay at most of these companies is so poor that the game is volume over quality. Any provider offering quality niche psychotherapy will likely be alright. Think McDonalds vs gastropub for a burger. Not saying it won't affect the market to some degree, but there will still be a market. Assessment is a less crowded market currently. However, as you can tell by the topic at hand, it is not safe either and the investment can be higher.

 

[thebalmofhurtminds]

I was just referred a patient who tried BetterHelp before us and said that their therapist read (?) them their tarot cards in the first session.

 

[Sanman]

I was just referred a patient who tried BetterHelp before us and said that their therapist read (?) them their tarot cards in the first session.

That is the type of assessment that is better left to midlevels or folks with exotic accents and those beaded curtains in their doorway.

 

[R. Matey]

I was just referred a patient who tried BetterHelp before us and said that their therapist read (?) them their tarot cards in the first session.

The real question is whether they'll be able to cleanse the patients chakras virtually.

 

[Therapist4Chnge]

That is the type of assessment that is better left to midlevels or folks with exotic accents and those beaded curtains in their doorway.

Now I want to add beaded curtains in my office doorway. I think it'd really make statement.

 

[Sanman]

Now I want to add beaded curtains in my office doorway. I think it'd really make statement.

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