APA reports salaries of psychologists drop from 2001-09

[JockNerd]

Since when does forensic testing not pay well?

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[edieb]

Forensic testing isn't compensated by insurance and most psychologists don't conduct it. I am talking about testing, in general (IQ, memory, personality)

 

[FadedC]

You are confusing how much testing is being done with how much testing pays.... There can be tons of testing conducted but if insurance doesn't pay enough to make it profitable, it doesn;'t matter

Well when it comes to educational testing, it's the sort of thing where it has to be done or the school will get sued. As a result it's not so much of an insurance issue, schools have little choice but to hire people to do it, because they'd pay a lot more if they didn't. This is the realm of the school psychologist rather then the clinical psychologist in most cases though.

 

[docma]

Maybe someone could post typical ranges so students would be more aware of the different categories of testing and range of reimbursement that is typical?

 

[manko7]

That's incorrect.

A mechanism is, by definition, a mediator. A mediator, by definition, is something that is affected by one variable, and, in turn, affects another variable. In the case of treatment, the intervention (psychotherapy, drug treatment) affects functional/structural physiological changes, which affect behavioral output. The physiological changes are,then, the mechanism.

I have never heard that mechanism is synonymous with mediator. I do not typically do moderator/mediator analyses so I was just curious. Do you have a citation for this assertion? Please feel to PM me so as not to disrupt the flow of this thread.

 

[cara susanna]

T4C: I am a HUGE fan of the PAI. I like the MCMI too, but not entirely because it needs to be interpreted within Millon's theory.

 

[JatPenn]

I have never heard that mechanism is synonymous with mediator. I do not typically do moderator/mediator analyses so I was just curious. Do you have a citation for this assertion? Please feel to PM me so as not to disrupt the flow of this thread.

Baron & Kenny's seminal 1986 JPSP paper makes this assertion, but for a more recent example, try Kraemer, Wilson, Fairburn, & Agras (2002) in Archives of General Psychiatry.

 

[Therapist4Chnge]

Since when does forensic testing not pay well?

It can still vary. Contract and per diem work is more lucrative, as staff positions don't pay that much higher than assessment work in other settings. Some clinicians who specialize in forensic work have been able to maximize their fees by securing out-of-state contracts and cranking through assessments/reports for a week or two at a time. Networking can make a huge difference in this area, though I'd strongly recommend not taking on any forensic work without prior supervision and mentorship.

Well when it comes to educational testing, it's the sort of thing where it has to be done or the school will get sued. As a result it's not so much of an insurance issue, schools have little choice but to hire people to do it, because they'd pay a lot more if they didn't. This is the realm of the school psychologist rather then the clinical psychologist in most cases though.

It really depends on the district, their resources, and the type of assessment. Some districts may structure it so their school psychologists are the only ones doing the assessments, though it can be dicey if they have a true neuro case and they try and get by with a non-nuero person. ADD/ADHD assessment is what first comes to mind, as a proper assessment requires more expertise, in addition to a physical and neurology assessment. ADD/ADHD assessment is a pet peeve of mine because most of the assessments out there aren't really sufficient, mostly due to poor reimbursement and/or limited resources.

Some states allow for a clinical/counseling psychologist to work as a school psychologist with additional training/requirements, so it may be worth looking into if you are in a district with a need. Other states are much more particular about the training and will only work with a clinical/counseling psychologist for therapy/assessment outside of the school.

There are still shortages in some states/districts for school psychologists, while other districts have simply cut back on hiring and have changed the day to day work of their school psychologists to include covering multiple schools within the district. Unfortunately some school psychologist duties have been out-sourced to para-professionals, which has changed their scope of practice for day to day work. Working as a school psychologist is more complex than just giving assessments, and proper supervision and mentorship is strongly recommended….even if the district doesn't require it. Students that attend combined school/clinical programs are well positioned to take advantage of the school psychologist shortage. Of course, I think there are maybe 6 true combined programs, and almost all of them are in the Northeast.

Maybe someone could post typical ranges so students would be more aware of the different categories of testing and range of reimbursement that is typical?

I don't have the 2009 or 2010 rates in front of me, but Medicare/Medicaid (I always get them confused) rates are usually what people reference most. Private insurance carriers can provide better/worse rates, it usually varies by region. I've been pretty shocked at some of the low rates offered by some insurance companies in satured markets. Shocked.

T4C: I am a HUGE fan of the PAI. I like the MCMI too, but not entirely because it needs to be interpreted within Millon's theory.

I usually lean towards the MCMI-III because of the administration time and relative ease of interpretation. I learned the PAI in graduate school, though I haven't used it much until recently. I really like the MMPI-2 as an instrument, but it takes too long and the norms leave a lot to be desired…I know, beating a dead horse.

Have you tried the California Personality Inventory? One of my supervisors likes it (I'm not sure if he uses the 260-item or the 434-item), though I haven't tried it yet. Honestly I'm not big on personality assessment, but I like to have a number of options in each area.

Baron & Kenny's seminal 1986 JPSP paper makes this assertion, but for a more recent example, try Kraemer, Wilson, Fairburn, & Agras (2002) in Archives of General Psychiatry.

Thanks for the references! I always appreciate when people post interesting articles to look up. I actually tried to get a journal discussion thread started on here a year or two ago, though I think it died out pretty quickly. If you'd like, I can split out the posts about this to a new thread.

 

[FadedC]

It really depends on the district, their resources, and the type of assessment. Some districts may structure it so their school psychologists are the only ones doing the assessments, though it can be dicey if they have a true neuro case and they try and get by with a non-nuero person. ADD/ADHD assessment is what first comes to mind, as a proper assessment requires more expertise, in addition to a physical and neurology assessment. ADD/ADHD assessment is a pet peeve of mine because most of the assessments out there aren't really sufficient, mostly due to poor reimbursement and/or limited resources.

Hmm yeah my understanding as a school psychology student is that we don't tend to do clinical diagnosis while working as a school psychologist. Many of us may be trained to do so, but it's still outside the scope of our practice while working at the school. Of course we still need to deal with the disorders, it's not our place to put a label on them (other then labels that might be relevent for special education placement).

 

[cara susanna]

I haven't tried the California Personality Assessment! I love personality assessment, probably because personality is a research interest of mine

 

[manko7]

Baron & Kenny's seminal 1986 JPSP paper makes this assertion, but for a more recent example, try Kraemer, Wilson, Fairburn, & Agras (2002) in Archives of General Psychiatry.

Thank you!

 

[TreeOfSouls]

I'm not sure an historical perspective is in any way helpful--but do keep in mind that for most of the last century psychology was a scientific/academic profession, not a professional services profession. It was the effort to become more "like" physicians and lawyers and the related economic gains, that led to the business of professional schools. However, the field is far behind business and law in its evolution on that track--and there is still a large division of values (eg APS and APA controversy reflects this). All of these factors are part of the equation and it is hard to see them when you first enter into the training process. (I think history and systems of psychology should be a first year course personally) The professional school movement is helping us prepare many more psychologists to meet the needs to the population--but it is also a business and there are huge economic forces at work, especially in the current economy. Overall, psychology still has a long way to go in professional "maturation" and so there are a lot of adolescent-like dynamics in the works and we all are caught up in them now.

 

[TreeOfSouls]

In my experience, school psychologists usually do most educational testing... then, if they don't get the results they want, parents seek out private practice psychologists to re-do the testing to get those "better" results (e.g. qualify for academic accomodations/services or testing into honors/gifted).

Well when it comes to educational testing, it's the sort of thing where it has to be done or the school will get sued. As a result it's not so much of an insurance issue, schools have little choice but to hire people to do it, because they'd pay a lot more if they didn't. This is the realm of the school psychologist rather then the clinical psychologist in most cases though.

 

[TreeOfSouls]

Med school pre-reqs are 2 years unless you did 1 year of majors level bio and 2 years of chem and a year of physics in undergrad (some med schools also require biochemistry and calculus). Chem has to be completed sequentially, which can slow down the post-bacc process.

Also, residency is 4 years for most specializations, including psychiatry, plus another year or two for a fellowship if you want to further specialize (e.g. child/adolescent psychiatry, pain management, sleep, etc.).

Regarding medical MiJac, it's a different lifestyle I think you just have to ask yourself if that's the lifestyle you want. Plus, there are lots of changes afloat. You could probably do pre-reqs in a year, med school is four years, residency one or two. But, unless you are really interested in other areas of medicine than psychiatric, it seems like med school would be a long haul.

Edited to add: Also, med school debt is very high compared to a funded PhD.

 

[justme08]

Yep, I understated the time, MiJac, it's a long time There are some 2 year IM residencies in the Appalachian area, at least that's what a premed I was taking classes with last year told me, they might be wrong. But, yeah, psychiatry will take longer. And, if a person is starting science classes from scratch as Galen2010 said, it would take longer than a year to get the chem sequence (prereqs) done.

 

[MiJac]

Yep, I understated the time, MiJac, it's a long time There are some 2 year IM residencies in the Appalachian area, at least that's what a premed I was taking classes with last year told me, they might be wrong. But, yeah, psychiatry will take longer. And, if a person is starting science classes from scratch as Galen2010 said, it would take longer than a year to get the chem sequence (prereqs) done.

I was a biochem major in the beginning of my undergraduate career so I have most of the foundation courses in chem, bio, physics, and I finished the calculus sequence. I just don't have any of the upper level elective courses. Thats kinda why I want a more neuropsych related career because I still have a huge interest in the biochemical aspect of the mind/brain. I can't really see myself counseling but you never know.

 

[purplebutterfly]

wow why am I barely hearing about this now? Would this seriously be an alternative to earning a PhD in clinical psych to essential do the same duties?

Not exactly.... it's as hard (if not harder) to get into nursing school these days as it is to get into clinical PhD/PsyD programs. See: http://www.npr.org/templates/story/story.php?storyId=125594201

Note that this story is about getting into nursing school at a community college. I'd imagine getting into a doctoral nursing program would be much harder. Plus, a lot of these students are going to end up in much worse debt than those graduating from a clinical psych program (if they do the private school route) for a lower starting pay than a psychologist.
We are in the midst of a healthcare crisis in this country and things will change (hopefully for the better). My opinion is that I'll make things work somehow as long as I'm following my dream. Naive? Maybe, but consider this:

I graduated with a master's degree in a social science field more than 15 years ago. At that point, my dream was to work on international development issues for an NGO. I was the biggest "do-gooder" out there. I moved to a major metropolitan area with no job (nail biting, to say the least), worked as a temp for a temp agency for a year and then got my "dream job" as a research assistant at a top notch think tank in my field, earning a salary of.... $27K. I had no experience in the field, it was the middle of a recession (not as bad as this one), so I eagerly took the very low pay and was over-the-moon happy that I'd managed to get my foot in the door. And, yes, I did have student loans from grad school (pretty minor, but significant given my non-existent income).

After 15 years, I was an expert in the field, but only making $80K when I was laid off last year. I'm no longer excited by the field and my interests have changed, which is why I will be getting a PsyD. However, I made things work in spite of the low pay, lived what I thought was a relatively comfortable lifestyle in a major metropolitan area. I did things everyone else thought were next to impossible (getting into a highly competitive field and moving to a place without any job).

I'm luckier than most because I am freelancing now (pulling in well over what I made when I was employed), and I can probably do some of this work while in grad school to help defray costs. I'm also willing to take in a renter in my 2 BR condo to help with the mortgage even if it means sharing a bath & my kitchen/living areas.

My point in all this rambling is that for me, it makes less sense to get all anxious about how I'm going to make things work just b/c the stats seem to point to a difficult battle ahead. Statistically speaking, I took huge risks to get where I am today.

However, this is all a matter of preference and some just aren't willing to take the risks I took. To each his own!

 

[Resham]

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[docma]

This is an important observation. Another relevant factor may be sociological changes in how long individuals stay in jobs. The frequency of job changes within career course has increased in recent decades, across occupations, I believe and this changes the trajectory of earnings. The APA study that started this thread is also a very small n relative to the population of psychologists.

 

[Therapist4Chnge]

Has anyone considered the effect that gender may have on the salary issue? We were discussing this in my class last week, and my professor pointed out that as the field has shifted from being male dominated to female dominated, salaries have gone down. The same thing happened in other professions, such as education. Thoughts?

There is literature in business that support this, though people in our field seem squeamish to talk about it. There is definitely an impact, though the gap is shrinking in some sectors, though I can't speak to psych. The more female dominated professions often trade flexibility for compensation, but that deflates the overall salaries. It astounds me when people accept the first offer for any (non training) job.

 

[phillydave]

*bump. bump-bump it up*

 

[docma]

I think many practicing psychologists are fine with their salaries. Much of the distress I hear and see is related to debt load students acquire and it is way our of proportion relative to the domains where many early career jobs are. We'd be much better served figuring out how to fund students and decrease training costs I think. Most people do not earn "six figures" in any profession. Those who have the ambition can figure out how to do it. The rest of those entering the profession should be able to do it without crushing debt. That is the locus of the problem from my perspective.

 

[phillydave]

I think many practicing psychologists are fine with their salaries. Much of the distress I hear and see is related to debt load students acquire and it is way our of proportion relative to the domains where many early career jobs are. We'd be much better served figuring out how to fund students and decrease training costs I think. Most people do not earn "six figures" in any profession. Those who have the ambition can figure out how to do it. The rest of those entering the profession should be able to do it without crushing debt. That is the locus of the problem from my perspective.

Agree on finding better ways to fund students, and I'd add better loan repayment options. But I think that there are probably many more practicing psychologists who would like to earn more money and aren't just okay with their current pay. It's true that most people do not earn six figures in their professions, but most people also don't pursue educations that take 6-8 years to finish. The ones who do, in the helping professions (MDs) make well beyond just six figures. That's, of course, not to compare grad school to med school, but the length of time to finish is comparable.

 

[edieb]

Agree on finding better ways to fund students, and I'd add better loan repayment options. But I think that there are probably many more practicing psychologists who would like to earn more money and aren't just okay with their current pay. It's true that most people do not earn six figures in their professions, but most people also don't pursue educations that take 6-8 years to finish. The ones who do, in the helping professions (MDs) make well beyond just six figures. That's, of course, not to compare grad school to med school, but the length of time to finish is comparable.

As the main point of the thread is that psychologist salaries are on a significant downward trend, it is myopic to think that just lowering the student loan burden is an adequate solution. If that is all we do, then salaries will continue their downward path and no amount of student loan relief will help.

I think psychologists forget that they are doctors and should be compensated for their doctoral status and the amount of help they provide to others. I find it absolutely insane that we go through an arduous process to get in to these programs, get an internship, get our degree, get a post-doc and then get licensed, and then get paid less than a plumber. Then people like Dr Carlatt compare us to social workers and refers to psychologists lower in the mental health "hierarchy" than psychiatrists. Don't all of you think that his referring to us as lower than psychiatry is an attempt to further marginalize psychology and imply that there is NO difference between our field and that of social work??? Where is the outrage?

As long as we continue to avoid the issue of gaining parity with M.D.s, or at least allied health professionals, and try to solve the problem indirectly with things such as student loan reduction, our status will continue to decline. We must GIVE money to the APA Practice Division, get active in our state psychological associations (or at the least JOIN them so they have money to lobby for interests of psychologists [stopping mid level encroachment, letting us call ourselves"doctor", RxP]) and stop defending our step child status, things will continue to decline.

 

[phillydave]

As the main point of the thread is that psychologist salaries are on a significant downward trend, it is myopic to think that just lowering the student loan burden is an adequate solution. If that is all we do, then salaries will continue their downward path and no amount of student loan relief will help.

I think psychologists forget that they are doctors and should be compensated for their doctoral status and the amount of help they provide to others. I find it absolutely insane that we go through an arduous process to get in to these programs, get an internship, get our degree, get a post-doc and then get licensed, and then get paid less than a plumber. Then people like Dr Carlatt compare us to social workers and refers to psychologists lower in the mental health "hierarchy" than psychiatrists. Don't all of you think that his referring to us as lower than psychiatry is an attempt to further marginalize psychology and imply that there is NO difference between our field and that of social work??? Where is the outrage?

As long as we continue to avoid the issue of gaining parity with M.D.s, or at least allied health professionals, and try to solve the problem indirectly with things such as student loan reduction, our status will continue to decline. We must GIVE money to the APA Practice Division, get active in our state psychological associations (or at the least JOIN them so they have money to lobby for interests of psychologists [stopping mid level encroachment, letting us call ourselves"doctor", RxP]) and stop defending our step child status, things will continue to decline.

Agreed, on all points, especially the lack of outrage, which I believe is linked to the aforementioned economic martyrdom psychologists feel.

My original statement above about loan repayment and funding wasn't supposed to be read as a solution to the problem, more an additional consideration for making beginning psychologists' finances less painful.

 

[Therapist4Chnge]

Not exactly.... it's as hard (if not harder) to get into nursing school these days as it is to get into clinical PhD/PsyD programs. See: http://www.npr.org/templates/story/story.php?storyId=125594201

This is more of an attribution error than anything else; it is still far harder to get into a clinical PhD/PsyD program. The demand is for some of the more traditional areas of nursing, and while there are plenty of nurses out there, most do not want the types of positions that are open. I'd argue that both need to have higher standards and a market correction has been delayed because of extenders and marginalization within each field. Now that I've gone completely off topic...back to our reguarly scheduled thread topic.

Agreed, on all points, especially the lack of outrage, which I believe is linked to the aforementioned economic martyrdom psychologists feel.

My original statement above about loan repayment and funding wasn't supposed to be read as a solution to the problem, more an additional consideration for making beginning psychologists' finances less painful.

Loan repayment and funding should be a separate discussion from pay because it really is a different animal in regard to long-term professional compensation.

Psychiatry is under siege from all angles, which Dr. Carlat has been very vocal out, though he definitely took some uncalled for swipes at psychology.

 

[kpx85]

I would like to give another perspective on this debate. I might be slightly out of place here but I am an undergrad right now preparing for graduate school.

I started a double major in Anthropology last year (emphasis on physical anthropology) There may be an income disparity between clinical psychologists and medical practitioner's but not necessarily between other ph.d's. Within the social sciences and humanities (anthropology - sub fields, philosophy, sociology, literature, etc.). When I speak to anthropology majors who aren't going into medicine they would be thrilled to get a 60k a year job in their field and usually only do if they land a university position. Even biology, chemistry, and physics dont pay much higher than psych and if they do its only when comparing a psychology prof to a physics prof.

Its hard to take out loans and It makes me sick to do it right now but I cant imagine just working a 9-5 for a larger income. I know I could go into business but I'm not working towards getting my education for money alone, it is for purpose, reward, and accomplishment. Money is transitory and happiness both fleeting and difficult to come by. Theres a balance you have to strike between doing what you enjoy and what you can "survive" doing. Then again I may just be very naive, thats always possible!

 

[docjohng]

I cringe whenever I see psychologists-to-be or psychologists say their salary "should" be something. It "should" be whatever the market is willing to compensate for the skills of the profession. Hopefully those skillsets have differentiated themselves significantly enough from other professions -- through not only lobbying of their impotent professional associations, but also through empirical research -- to justify what the market will bear.

What we see is a market saying, "Sorry, your skillset isn't worth what you think it is." This isn't going to change with magical thinking about "shoulds." Market forces are at work here and a few courses in economics or business will teach us much about why our salaries are on a downward trajectory. Sadly, few psychologists will ever take an economics or business course in their entire 10 year higher education career.

At this point, there's little that can be done. Some organizations are trying to shoot the profession in the foot even further (APS) by suggesting psychologists' training isn't elite enough. That's not going to help insurance companies or Medicare raise their reimbursement rates.

I'm not sure what would at this point. I think that's the real incentive behind the drive for prescription privileges. You can make double the salary by focusing on prescribing over psychotherapy. And until something completely turns the economics of that around, that seems to be the direction -- albeit slow direction -- the profession may be heading.

John

 

[JockNerd]

I cringe whenever I see psychologists-to-be or psychologists say their salary "should" be something. It "should" be whatever the market is willing to compensate for the skills of the profession. Hopefully those skillsets have differentiated themselves significantly enough from other professions -- through not only lobbying of their impotent professional associations, but also through empirical research -- to justify what the market will bear.

What we see is a market saying, "Sorry, your skillset isn't worth what you think it is." This isn't going to change with magical thinking about "shoulds." Market forces are at work here and a few courses in economics or business will teach us much about why our salaries are on a downward trajectory. Sadly, few psychologists will ever take an economics or business course in their entire 10 year higher education career.

This is a rather myopic economical analysis. It is true that psych folks need more business training if they want to do well in PP. The other clear problem is that there is too much supply, and much of the supply has large loans that they're stretching to pay back--thus, dropping their rates to get a larger client base.

At this point, there's little that can be done. Some organizations are trying to shoot the profession in the foot even further (APS) by suggesting psychologists' training isn't elite enough. That's not going to help insurance companies or Medicare raise their reimbursement rates.

This argument makes no sense--there's some other assumption there that you're not saying. You appear to be saying that calls to make the practices of the profession more empirically-based are going to lead to lower reimbursement. Not sure how you're drawing that from the above.

I'm not sure what would at this point. I think that's the real incentive behind the drive for prescription privileges. You can make double the salary by focusing on prescribing over psychotherapy. And until something completely turns the economics of that around, that seems to be the direction -- albeit slow direction -- the profession may be heading.

Reimbursement-driven RxP is silly. The inevitable result is blindingly obvious--professional schools will transform instantly into RxPer factories (recognizing their own market dynamics), there will be a massive oversupply, psychiatry will drown and pay rates for psychologist prescribes will drop like a rock as RxP experiences the same oversupply of supply that psychology has now.

 

[docjohng]

Myopic or not, it is what it is. The market has spoken. You can either listen or bury your head in the sand. Too much supply is because another market -- psychology grad programs -- are meeting a demand. The problem is the demand doesn't translate into actual real demand in the marketplace of psychology professionals. This isn't a unique situation to grad schools, however. A community college just made the news for introducing a midnight intro to psych class because of overwhelming demand for such courses. Students are disconnected with the reality of the real-world marketplace.

I said what I meant; if I wanted to say something else, I would've said something else. Really, how much more clear can a person be? Elitism in professional training has NO CORRELATION to empirical outcomes in psychotherapy. When the science catches up with politics and professional association's own agendas, let me know.

Reimbursement-driven RxP may be "silly," as you say, but it continues to gain momentum. While Oregon failed, that won't stop the movement. I think it's a short-sighted movement, but my opinion doesn't matter a wit in this.

John

 

[phillydave]

I cringe whenever I see psychologists-to-be or psychologists say their salary "should" be something. It "should" be whatever the market is willing to compensate for the skills of the profession.

I don't think desiring better compensation is cringe-worthy for any line of work. Sure, I roll my eyes when professional athletes hold out and pout until they receive their multi-million dollar contracts, but I understand why they do. No one here has said "as a psychologist I should make x amount," we've discussed market influences and factors beyond our immediate control that weigh down our salary potential. And yeah, I don't think that is a discussion that we should be shying away from because you think we should feel some shame about wanting better compensation. If you're happy with your salary being the CEO of PsychCentral.com, then that's great; the rest of us would like to earn our full potential.

This isn't about vanity or greed, it's about security. I believe it's okay to long for a market that is inclined to differentiate between mid-level practitioner and doctoral level.

 

[PHinisheD]

Theres a balance you have to strike between doing what you enjoy and what you can "survive" doing. Then again I may just be very naive, thats always possible!

Yeah, that's what I thought, too, when I decided to go into this field. If I can give you some advice from the end of the PhD road, it's this: As you get older, priorities change and expenses increase. When I decided to enter grad school at 23, I was living in a college town and had very low expenses. $70K sounded like a princely sum. Now that I've got aspirations to someday buy a house, pay off loans, etc., it sounds shockingly low. The goalposts have moved. Career change is an option, but it's much more difficult to take (and even get) an entry level job after you have a PhD than before.

A clinical psych degree has many components, and few of those components are unique to the field (testing being the exception). You like doing psychosocial therapies? Get an MSW. You like treating SME or medical patients? Get an MD. You like mental health administration? Get an MPH. You like research? Really? Honestly? You sure? Okay, well, go get a PhD, or, better yet, get an MD and do a research fellowship, where they'll be thrilled to have you. If you figure out which particular activities you're really interested in, chances are you can find a better, more direct route to doing those. And, by all means, talk to people in those fields about their career and salary prospects. It will be important.

 

[PHinisheD]

How do you know? It hasn't been measured.

By that logic, I'm a surgeon right now. There is no correlation with empirical outcomes and psychologists performing surgery any worse than a general surgeon. What we do have is plenty of empirical evidence about the efficacy of various approaches/methodologies and illnesses.

As much I hate to admit it, I'm afraid docjohng has a point. Of course there are heaps of evidence in favor of certain treatment packages, and it is also true that S-P psychologists (by definition) are more likely to practice those EBPs. But, there isn't much (any?) evidence that experience or credential predict treatment efficacy. Social workers or MA psychologists are perfectly capable of learning to competently deliver EBPs, in a relatively short period of time. It's much more realistic to think that we will meet the market's needs by training up mid-level folks to do these things on a mass scale than by hiring more psychologists.

If that's the case, then we end up providing value primarily as researchers and administrators. Obviously, we've got the research angle covered. But regarding administration, I think that most of us are woefully undertrained. I didn't know anyone in grad school who took classes in healthcare administration, business, policy, org psych, or any of the other subject areas that would come in handy if we want to work in mental health administration--which many of us will.

 

[Therapist4Chnge]

As much I hate to admit it, I'm afraid docjohng has a point. Of course there are heaps of evidence in favor of certain treatment packages, and it is also true that S-P psychologists (by definition) are more likely to practice those EBPs. But, there isn't much (any?) evidence that experience or credential predict treatment efficacy. Social workers or MA psychologists are perfectly capable of learning to competently deliver EBPs, in a relatively short period of time. It's much more realistic to think that we will meet the market's needs by training up mid-level folks to do these things on a mass scale than by hiring more psychologists.

Learning how to deliver a manualized treatment and learning when/why are two very different things. JS made reference to the importantance of research, and how it plays a distinct role in treatment decisions and delivery. Not all manualized treatments for a particular Dx are appropriate for each individual, though how does a provider differentiate between good candidates and poor candidates for treatment?

Here is my favorite analogy to explain the difference: A mechanic can look at a car and understand the various aspects of the car, and how they are related. The technician that work in his/her shop are very good at conducting repairs based on the mechanic's direction, though s/he is less capable of making differentials between similar problems. Consulting a technical manual on a car can provide more data, but it offers little to the technician who isn't equipped to deal with that data effectively. The technician is limited by the tools in his/her toolbox, so s/he grabs the one he is most comfortable, which may or may not be the correct tool for the car in question. Not all mechanics can fix every car, but they know enough when they need to refer the car out to a speciality car place. I have strong doubts that the technician has the same level of expertise in regard to differential diagnosing, as well as the training to interpret all of the available data and make an informed decision.

If that's the case, then we end up providing value primarily as researchers and administrators. Obviously, we've got the research angle covered. But regarding administration, I think that most of us are woefully undertrained. I didn't know anyone in grad school who took classes in healthcare administration, business, policy, org psych, or any of the other subject areas that would come in handy if we want to work in mental health administration--which many of us will.

While I agree that some will work towards those positions, I'm not supportive of changing the clinical psychology curriculum to add these courses, because that means either extending the training even further, or dropping classes. IMHO, there are already deficits in neuropsychology and pharmacology training, and any additions to curriculums should start there and not add on MBA/MPH-Lite. If a psychologist wants to move into an administration position, they are better off going back for a specific degree, instead of piece-mealing the training.

I think it's in the best interest of development of the field and of patients to keep medicine and psychology as doctoral level professions. Another issue is autonomy. It's one thing to hand out pills that a physician tells someone to (e.g., a CNA); it's quite another to choose which pills to give. Midlevels are not, in my opinion, adequately trained to distinguish between scientific and non-scientific approaches to mental health. This is a huge problem with respect to allowing autonomy (along with not being able to diagnose anything).

I agree with your sentiments, but the horse is out of the barn in regard to diagnosing. It would be nearly impossible to take that away now, even though I've seen some woefully underprepared mid-level clinicans out there who diagnose. I've lectured in MA/MS/MSW classrooms, and the entire approach to Dx'ing is much more cookbook and less scientist. The DSM-IV-TR is already flawed, and that is with understanding all of the statistical anomolies and limitations. The entire nosologic approach is something that is understood at a much different level with non-doctorally trained clinicians. I've seen similar issues with RNs/NPs/PAs, etc.

 

[Therapist4Chnge]

It's just plain irresponsible to allow midlevels to diagnose/assess/choose treatment approaches, regardless of whether or not it's legal.

This irresponsibility also falls on the shoulders of those professionals that refer to midlevels for this purpose (e.g., a general practitioner who diags depression and refers to a midlevel for treatment. . . that patient has never been seen by anyone that knows what they're doing).

Not only are they diagnosing/assessing/treating...but they are doing so independantly. This is almost a direct result of the degredation of our scope and poor representation/protection of our profession and the rise in political activism by mid-levels. According to most state laws, anyone with some amorphis training in a helpful profession and a copy of the DSM-IV-TR is able to assess/diagnose/treat a person with a mental disorder. I still scratch my head that some of these Dx's can be made without formal psych/neuro testing. Anyone else come across ADHD dx's with no documentation? How about PTSD, BPD, etc? Btw, I pick on PTSD because it is given far too much to people who express ANY traumatic event or related symptoms. I mentioned ADHD because I previously worked with children and it was all over the place, when it really only applied in a handful of cases.

I think one of the biggest weaknesses in training for mid-level providers (counseling, social work, nurses, physician assistants, etc) is the lack of true diagnostic and differential training. Since mid-levels cannot conduct formal psychological assessments, how can they adequate rule out the various Dx's that masquarade together? How does an MD Dx someone with a quick H&P? The answer is they don't...they slap a popular Dx, make a referral, and/or toss in some pills to "treat" the problem. A few years later a psychologist stumbles across the case and scratches their head at the Dx's....

 

[edieb]

Psychotherapy is not some skill that can be based solely on a manual. Manual based treatments are tested on groups of patients that are pure for one disorder. These pure presentations rarely ever occur in real life and there are many choice points in therapy that need the expertise of someone with a PhD/PsyD. In addition, ever conducting the correct treatment is largely dependent on correct diagnosis, which is something that should be left up to a psychologist.

The bigger question is: Is psychology ever going to fight back or are we just going to sit back and debate all this while the profession die and are degrees are made worthless. Even in the V.A., psychologists are increasingly threatened by master's level practitioners. In fact, at a V.A.-AAS conference I just attended, a cost-cutting initiative was noted in which the V.A. would shift priority recruitment AWAY from psychologists and TOWARDS addiction therapists, MSWs and psychiatrists

Not only are they diagnosing/assessing/treating...but they are doing so independantly. This is almost a direct result of the degredation of our scope and poor representation/protection of our profession and the rise in political activism by mid-levels. According to most state laws, anyone with some amorphis training in a helpful profession and a copy of the DSM-IV-TR is able to assess/diagnose/treat a person with a mental disorder. I still scratch my head that some of these Dx's can be made without formal psych/neuro testing. Anyone else come across ADHD dx's with no documentation? How about PTSD, BPD, etc? Btw, I pick on PTSD because it is given far too much to people who express ANY traumatic event or related symptoms. I mentioned ADHD because I previously worked with children and it was all over the place, when it really only applied in a handful of cases.

I think one of the biggest weaknesses in training for mid-level providers (counseling, social work, nurses, physician assistants, etc) is the lack of true diagnostic and differential training. Since mid-levels cannot conduct formal psychological assessments, how can they adequate rule out the various Dx's that masquarade together? How does an MD Dx someone with a quick H&P? The answer is they don't...they slap a popular Dx, make a referral, and/or toss in some pills to "treat" the problem. A few years later a psychologist stumbles across the case and scratches their head at the Dx's....

 

[erg923]

Does anyone else notice a disconnect between our insights and rhetoric here and those directing and leading our training programs, particularly academic doctoral programs? I sure do. I think some of them might have just as skewed a view of salaries and job opps as some naive under grads and brand new grad students. I swear if one more newbie grad student or supervisor says "Um well..its not about the money...." Um....well..actually....IT IS! That has kinda been the whole basis and reason for formalized employment since the dawn of civilized man..to make money for you and your family..I mean WTF!

 

[PHinisheD]

Psychotherapy is not some skill that can be based solely on a manual. Manual based treatments are tested on groups of patients that are pure for one disorder. These pure presentations rarely ever occur in real life and there are many choice points in therapy that need the expertise of someone with a PhD/PsyD. In addition, ever conducting the correct treatment is largely dependent on correct diagnosis, which is something that should be left up to a psychologist.

While psychotherapy (in the broad sense) is a complex skill, particular treatment packages can be competently delivered by master's level practitioners. That's assuming, of course, that a client has been diagnosed and assigned to treatment on the basis of a competent assessment (our job). Large mental health systems tend to think that it makes sense to assign the bulk of treatment cases to mid-level providers. I reluctantly agree with them, unless you can show the administrative decision-makers some evidence that experience or credentials lead to improved treatment outcomes.

We need to demonstrate unique value if we expect to be paid well. If assessment is our unique selling point, then we need to focus our efforts on defending that piece of turf. It seems like the best we've got right now.

 

[Ollie123]

I mentioned ADHD because I previously worked with children and it was all over the place, when it really only applied in a handful of cases.

You mean the primary diagnostic criteria for ADHD is not how loud the parents complain about their child not having a 4.0 GPA?

I say that somewhat tongue-in-cheek, but it really isn't that far removed from what seems to be taking place.

 

[Therapist4Chnge]

You mean the primary diagnostic criteria for ADHD is not how loud the parents complain about their child not having a 4.0 GPA?

I say that somewhat tongue-in-cheek, but it really isn't that far removed from what seems to be taking place.

I almost added something to my post about a hidden Criteria involving the parents. I'm glad I'm not the only one that sees this as a problem.

 

[docma]

I think it is tempting to focus on assessment as a key in differentiation and that it may be self-limiting and misleading to students. While all psychologists should be competent in basic test-based assessment, the practical reality of many, many service settings is that tests are not the primary or most reliable path to diagnosis. They take too long, cost too much, have limited reliability for important populations--and clinicians (yes, including masters-level clinicians) with a good range of experience will be just as effective in reaching an initial dx for many, many circumstances.

Where I think the range of doctoral level psychology training can be a key differentiating factor is at the policy level. Unfortunately, that is almost never given formal attention in clinical doctoral curricula. In fact, social work students get a better introduction to policy. But this is the domain where psychologists do make a serious, long term difference and it is very relevant to the administrative positions where higher level incomes happen. While I often don't agree with David Brooks, his op-ed in today's NYT is right on about where I think psychology should be putting its focus. Here is the Social Science Research Council report that prompted his story: http://www.measureofamerica.org/acenturyapart/

I work with highly skilled NPs and LCSWs who are excellent diagnosticians; certainly as skilled or more skilled 5 years into the field than many PhD/Psyds I meet. Testing has its place, but good observational and interpersonal skills can be developed in all kinds of training and it the clinical practice settings that make the difference

Those who want six-figure incomes might want to look more at the ways research and developmental effects over time are the domain where clinical psychology can lay claim to greater levels of compensation

 

[ClinMixie]

http://apa.org/monitor/2010/04/salaries.aspx

Clarification question: are these salaries not for psychologists in general, rather than clinical psychologists specifically (i.e. when they talk about professors is this not across all areas of psychology)?

Not that I am debating how abysmal these numbers are...I'm just wondering if there's a chance they aren't quite as depressing as they look for those going into clinical...

(Sorry if someone already asked this, I've only been through the first half of the thread)

 

[Therapist4Chnge]

Accurate salary data can be hard to find because of a number of factors (regional differences, part-time/per diem work, etc). I'd recommend looking at jobs in the market you want to practice, and talking to clinicians in those areas.

 

[Therapist4Chnge]

I think it is tempting to focus on assessment as a key in differentiation and that it may be self-limiting and misleading to students. While all psychologists should be competent in basic test-based assessment, the practical reality of many, many service settings is that tests are not the primary or most reliable path to diagnosis. They take too long, cost too much, have limited reliability for important populations--and clinicians (yes, including masters-level clinicians) with a good range of experience will be just as effective in reaching an initial dx for many, many circumstances.

I admittedly have a strong bias towards assessment, partially because of my background and partially because of the lack of good assessment most places, though I agree that there are limitations.

Where I think the range of doctoral level psychology training can be a key differentiating factor is at the policy level. Unfortunately, that is almost never given formal attention in clinical doctoral curricula. In fact, social work students get a better introduction to policy. But this is the domain where psychologists do make a serious, long term difference and it is very relevant to the administrative positions where higher level incomes happen. While I often don't agree with David Brooks, his op-ed in today's NYT is right on about where I think psychology should be putting its focus. Here is the Social Science Research Council report that prompted his story: http://www.measureofamerica.org/acenturyapart/

Public policy is definitely where we need more support and action. "Hello APA...we are talking to you." Unfortunately your average psychologist is not well informed about public policy, nor do they have the training to step in without guidance. All of those lovely political action committees know what they are doing, the trick is forming and directing one that meets your needs.

I work with highly skilled NPs and LCSWs who are excellent diagnosticians; certainly as skilled or more skilled 5 years into the field than many PhD/Psyds I meet. Testing has its place, but good observational and interpersonal skills can be developed in all kinds of training and it the clinical practice settings that make the difference

I too have worked with them, though it goes back to curricula. Most/All of the mid-levels I know went above and beyond their training to develop those skills. I have some issues with the current doctoral requirements by the APA, though that will be a long and hard battle to change their requirements. There are already too many areas that need to be covered. I believe we NEED post-doctoral training, particularly in speciality areas, but the economic limitations make that training much less paletable.

Those who want six-figure incomes might want to look more at the ways research and developmental effects over time are the domain where clinical psychology can lay claim to greater levels of compensation

Psychologists can make serious money doing research in marketing, public policy, etc...though that requires very specific knowledge 98% of psychologists do not possess just from their training. We need multiple things to happen to raise salaries:

1. PRO-active participation in the legislative process, and develop legislation to aid psychology as a field.
2. Actively fight scope creep by mid-levels.
3. Acitively fight against insurance cuts.

(notice the first 3 are all about activism and legislation....we sorely lack in these areas).

4. Change acred. policies to address the supply side issues in clinical/counseling psychology. Additionally, re-examine the requirements of training to better prepare students for professional work.
5. Change when the doctorate is granted (pre-internship not post), then fight for legislation to have insurance cover psychology interns, which will then allow sites to pay interns more.
6. More public/professional education about the role of psychology*.
7. Put people in the right positions to influence the right people. It sounds vague, but it is amazing what a few well placed people can do**.

*I'll never forget having to explain to a state representative the difference between a psychologist and a psychiatrist. S/he had no idea what we did, and why we are important. The discussion was the impetus to follow-up questions and the avenue into his/her office as an "expert" for any mental health related issues. I was a lowly graduate student at the time, but the more senior people there were able to "get on the short list" for that representative. Briefs/position papers about topics were then an option. Being seen as an informational resource and the "go-to" person in politics is more valuable than 10,000+ e-mails/letters from random people.

**In my previous career I was part of a number of very successful elections, and it is amazing how many more things go your way when you help get people into office, and then they help you.

Btw, when I run for a office in my state and/or for a position in a psych association, I'm going to let ya'll know so you can vote for me. Consider this fair warning.

 

[poch]

I think some people touched on this earlier in the thread, but I'm gonna point this out again. The finding from positive psychology is that income has serious diminishing returns when it comes to happiness, i.e. as long as you aren't poor income isn't correlated with happiness. I don't even necessarily need to conceptualize it in terms of sacrificing money for my principles or the common good, because that 15-20k different just doesn't matter that much in the end.

On the other hand, I don't know if anyone has studied the moderating effect of indignant forum posting on the relationship between income and happiness

 

[JockNerd]

I think some people touched on this earlier in the thread, but I'm gonna point this out again. The finding from positive psychology is that income has serious diminishing returns when it comes to happiness, i.e. as long as you aren't poor income isn't correlated with happiness. I don't even necessarily need to conceptualize it in terms of sacrificing money for my principles or the common good, because that 15-20k different just doesn't matter that much in the end.

Trying to pay $150k in loans from grad school, plus maybe $10k-$50k from undergrad, plus your house payment, plus paying for food and clothing, plus starting a family, while on the starting salary for a practicing clinical psychologist would easily qualify as poor to me. Seeing yourself making less money than less qualified and less trained people in the same organization probably has a direct impact on happiness too. Probably so does seeing the quality of graduates of your profession slide.

It would be fantastic if we could all run through a meadow collecting butterflies and rainbows together. But, that kind of pollyannaism isn't going to serve the profession, nor will this "money doesn't matter to happiness" stuff. If money doesn't matter to you, awesome--it shouldn't be hard to understand why I'd ask you to please stay away from my profession, though.

 

[edieb]

Trying to pay $150k in loans from grad school, plus maybe $10k-$50k from undergrad, plus your house payment, plus paying for food and clothing, plus starting a family, while on the starting salary for a practicing clinical psychologist would easily qualify as poor to me. Seeing yourself making less money than less qualified and less trained people in the same organization probably has a direct impact on happiness too. Probably so does seeing the quality of graduates of your profession slide.

It would be fantastic if we could all run through a meadow collecting butterflies and rainbows together. But, that kind of pollyannaism isn't going to serve the profession, nor will this "money doesn't matter to happiness" stuff. If money doesn't matter to you, awesome--it shouldn't be hard to understand why I'd ask you to please stay away from my profession, though.

x2

 

[docma]

I'm not sure that it serves the profession to denigrate alternative voices by consigning them to the "pollyanna, butterflies, and rainbows" category though. We are not going to thrive as a profession if we fall into the Fox News outlook on social problems--and the debt load relative to salary potential problem in the profession is a huge social problem we need to solve TOGETHER. Fueling entitlement and resentment in students does not help them get creative about where to find work with their skill sets. Being derogatory about other professional categories doesn't foster the kind of interdisciplinary cooperation that will lead to new work settings for psychologists. The biggest domain for new work/salaries for psychologists is in primary care and hiring committees in those settings will detect attitudes of "superiority" relative to RNs, LCSWs, that will doom candidates...Teamwork is what we need I think......even in relation to your colleagues who care less about the total income category.

 

[Neuropsych2be]

I'm not sure that it serves the profession to denigrate alternative voices by consigning them to the "pollyanna, butterflies, and rainbows" category though. We are not going to thrive as a profession if we fall into the Fox News outlook on social problems--and the debt load relative to salary potential problem in the profession is a huge social problem we need to solve TOGETHER. Fueling entitlement and resentment in students does not help them get creative about where to find work with their skill sets. Being derogatory about other professional categories doesn't foster the kind of interdisciplinary cooperation that will lead to new work settings for psychologists. The biggest domain for new work/salaries for psychologists is in primary care and hiring committees in those settings will detect attitudes of "superiority" relative to RNs, LCSWs, that will doom candidates...Teamwork is what we need I think......even in relation to your colleagues who care less about the total income category.

I agree wholeheartedly with you. Psychology will thrive if we break out of the current paradigm and develop new roles for ourselves. We can continue to fight over the dribs and rabs that insurance companies reimburse or develop new revenue streams and professional roles. My feelings are that the psychologists should do the following:

1) Create new roles for ourselves and the profession. Look beyond academe and the role of a healthcare provider. Other social scientists find very rewarding careers in this way. Cultural anthropologists have developed the field of applied anthropology and are continuously creating new applications for their discipline. There are even Ph.D. programs in anthro that are explicitly applied. The University of South Florida has just such a program. Psychology should look to the other social sciences to see what they have done to create roles for their Ph.D.'s outside academe. This means that psychology must be less elitist and admit that the sociologists and anthropologists actually know things we don't. And they do!

2) Ditch the elitism and sense of entitlement. No one owes you anything in terms of income. While physicians make a certain income, other persons holding doctoral degrees make less than psychologists. Many of them are unemployed or employed outside their area of study. What does the average liberal arts Ph.D. make when they are not employed as a waiter, cab driver or receptionist?? If you want your work to generate income, develop those opportunities.

3) Ditch the elitism and entitlement part 2. Treat other professions with respect. Purge the word "midlevel" from your vocabulary. Calling LCSW's and LPC's by the term "midlevel" is insulting, demeaning, elitist and inaccurate. A "midlevel" is a health care provider who functions under the supervision by a doctoral level person. It is not synonymous with master's level training. LCSW's and LPC's function autonomously within the bounds of their licensure. Some even have doctoral level training. Social workers actually have some skills that psychologists *don't* have. No matter what your level of training, there will always be master's level clinicians who are better therapists than you and who ahve skills you don't possess. Never demean yourself by calling anyone a "midlevel."

4) Understand that psychotherapy is not the purview of psychologists. Even though psychologists have the highest level of training among the various professions, we don't own the practice any more than psychiatry did when it claimed that psychologists were not able to provide those services back in the 1940's and 1950's.

5) Gets some training in economics and business. Learn how the system works. All your kindness and compassion or your ability to design and run experiments or read the literature will not help your income unless you have a firm grasp of business principles and the ability to market yourself. Many people in psychology graduate from college at 22, go to straight to grad school and leave at 27 or 28 and have limited "real world" business experience. Get involved in one of the mentorship programs with persons who have a business background.

6) Find an unfilled niche and fill it.

7) Market yourself relentlessy, repeat as necessary. However, understand that it is always necessary. Even if you are in academe or a salaried position, market yourself and network. Opportunities will present themselve to you only if you are in the right place at the right time.

8) If you work in a medical setting, revere every single nurse you meet. They have skills that you as a psychologist don't have and never will.

9) You get from the universe what you put out into the universe. Treat every professional you meet with respect and you will receive respect *and referrals* to the degree you do this. Other people can smell entitlement and the scent is foul indeed. Many people in their 20's still have a developmental holdover from adolescence. I call it the "unearned arrogance of youth" that often bleeds over into the personalities of young professionals, especially those who have been in academe for most of their 20's. Remember that you are never as important as you think you are.

 

[PHinisheD]

Jon Snow, great points. Of course we need to be respectful, but an undeserved sense of entitlement has been the least of our problems.

The organizational culture of a medical center is a world apart from, say, a counseling center. In counseling centers, we downplay status differences between themselves, other professionals, and patients. But med centers are hierarchical; status is important. From what I’ve seen, the most successful psychologists are those who “act like doctors.” They speak with authority. They use medical jargon. They don’t get intimidated. In a counseling center, they would come off as a bit narcissistic. But a measure of narcissism can be adaptive.


Maybe our salary woes are all a matter of market forces. I don’t know. But I think that our emphasis on humility can do us a disservice, when assertiveness is what’s called for. If we don’t see ourselves as doctors who are worthy of doctoral level compensation, then who will?