APA reports salaries of psychologists drop from 2001-09

[docma]

Cultural competence is about, among many things, being attuned to the sociocultural environment and I agree that you might present your role differently in a medical setting than a counseling center--because you might in fact have a different range of both responsiblity and authority. But I don't think the essential attitude of interdisciplinary respect is any less valuable or effective.

Market forces are a huge and important factor that students are often not well educated in before they get into the work environment and when resentment about salary differentials is blamed on other professions (rather than shortcomings/short-sightedness in our own) it is heard in the work world as "entitlement" even if that is not how you intend it to come across. It doesn't help when a psychology intern says in a haughty tone, "I don't do case management" or "he's only a nurse". Obviously, many students do NOT take this stance; but it is these kinds of attitudes that contribute to views that psychologists consider themselves "better than" not because of an obvious skill set but simply because the degree takes longer. As a profession we need to have a much clearer definition of what a newly graduated psychologist does that makes a unique contribution to a clinical team. Every new graduate needs to be able to say what it is about them and their training that would make them worth hiring.

---

Members don't see this ad.

 

[docma]

Some do. Many don't. But yes, I have witnessed these kinds of comments. And we don't hire this kind of attitude.

I do think that some in the profession perpetuate (and even encourage in students) a kind of arrogance that does effect hiring decisions, which in turn affects employment which in turn affects salary.

My intended main point is that our attitude as a profession in how we work on this problem is important and so when discussions like this become adversarial (towards other professions or each other) they become self-defeating.

 

[phillydave]

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.

x3


I agree that a person doesn't have to be rich to be happy, but economic martyrdom shouldn't be our motto. Advocating for better compensation and more favorable employment conditions for psychologists is not arrogance. And arrogance isn't the problem anyway, as JS noted above. Not wanting to share job titles and quality of service expectations with mid-levels is not arrogant, it's absolutely necessary for the credibility of the field, which diminishes further and further the more blurry the lines between mid-level services and doctoral level services becomes.

 

[edieb]

x3


I agree that a person doesn't have to be rich to be happy, but economic martyrdom shouldn't be our motto. Advocating for better compensation and more favorable employment conditions for psychologists is not arrogance. And arrogance isn't the problem anyway, as JS noted above. Not wanting to share job titles and quality of service expectations with mid-levels is not arrogant, it's absolutely necessary for the credibility of the field, which diminishes further and further the more blurry the lines between mid-level services and doctoral level services becomes.

I am wondering what Docma would think about an M.D. saying, "I don't do case management." Would their refusal be deemed arrogant?

Personally, I think it's great that persons in the field of psychology tell docma that they refuse to do case management, especially interns. Interns are paid slave labor salaries and expect training in PSYCHOLOGY for this low wage. It is an outright abuse of the internship process to recruit interns and then the internship staff ask them to do more than a few minutes of case management. It is kind of like an opportunity cost: time spent making your interns do case management is time that could be spent providing them actual training in psychology.

 

[Therapist4Chnge]

Edieb makes a good point. Case management is the traditional role of social work (not psychotherapy or diagnosing mental illness) in a counseling setting (home visits, keeping track of referrals, who is involved in the treatment team, paperwork, public aid, etc. . .). Psychologists don't do that. It is a testament to just how much social work has eroded the profession (because of our lack of assertiveness in defending it) that now you find it arrogant that a psychology intern refuses to do case management. I certainly wouldn't do it; that's not arrogance, I didn't get a degree in social work, I'm not trained to do case management. But, then again, no where I've been would think to request that.

Scope of practice is definitely a concern in the area of case management. I wouldn't feel comfortable doing it, and I'd take exception if I was asked to do case management instead of work in my training area(s).

 

[phillydave]

I am wondering what Docma would think about an M.D. saying, "I don't do case management." Would their refusal be deemed arrogant?

Personally, I think it's great that persons in the field of psychology tell docma that they refuse to do case management, especially interns. Interns are paid slave labor salaries and expect training in PSYCHOLOGY for this low wage. It is an outright abuse of the internship process to recruit interns and then the internship staff ask them to do more than a few minutes of case management. It is kind of like an opportunity cost: time spent making your interns do case management is time that could be spent providing them actual training in psychology.

Not only does it not make sense to use the resources of a person who doesn't have training in case management, it's offensive to actual case managers who do have the training. The implication is that "anyone can do your job." Isn't it equally as arrogant to assume that just because you have a doctorate that you can perform the duties of a job with a different description than the one you were trained for?

 

[docma]

My point was not really about "case management" but about the "I don't do.." when it is delivered with a rigid or narrow idea of what psychologists may/can do in some settings. In community practice there are definitely things that psychiatrists and psychologists do that are within their scope of practice and might also be viewed as "case management" To reject the idea of doing something other than giving tests and doing one-to-one in the consulting room long term psychotherapy is one of the ways psychologists have restricted their range of opportunities for employment (and effectiveness in outcomes at times). I am just wanting early career (especially pre-licensed psychologists) to stay open-minded, especially if they want to serve the underserved in community settings where we have to be creative about getting resources. I do not think that helping a depressed client figure out how to get teeth so that their nutrition will be better and their depression will decrease is outside scope of practice. A psychology intern should not be accompanying a student to the dentist (unless maybe they are doing exposure therapy?)--but Problem Solving Therapy and actually helping the client make a call during a session so that they get their teeth is a way of practicing and generalizing skills..... But in fact we are way off the topic of salaries and onto issues of organizational cultures I guess. My main point is that when you are looking for work, being open to a broader definition of what is "psychological" can lead to some interesting job options.

 

[phillydave]

I understand the sentiment, I just don't believe that blurry scope boundaries are actually beneficial for the profession. In fact, just the opposite seems to be what will help bolster the idea that a psychologist's work is not a blurry mess of job descriptions, but a more focused and clear set of work expectations, separate from other mental health professionals such as mid-level counselors and social workers. This isn't to say that a psychologist is "above" the work of a social worker. But the field of clinical psychology, as talked about ad nauseam, has been adversely affected by the merging of scopes between levels of practitioners and it has certainly affected job markets and salaries. I agree that we shouldn't refuse to be open to "problem solving therapy" given the situation, but I generally am not a proponent of going outside the resources of the office or clinic, which is really as far as my training has taken me.

 

[Therapist4Chnge]

I'm with phillydave, we need to get back to our core areas of competency. I am open to the idea of psychologists exploring other avenues of practice, but as a profession...we need to first protect our core areas. Being a jack of all trades and master of none is what has contributed to our most recent marginalization. Frankly we have the best training to provide our core areas, why are people so ready to walk away from them?

I really hope/wish we could leverage the SCIENCE part of our training to come up with better ways to differentiate our profession. More and more research is supporting what WE do as clinicians, yet we continue to slide backwards in pay. We need MORE people to be active scientist-practitioners and make contributions to highlight the unique skillset we bring to hospitals, CMHCs, counseling centers, etc.

A general question for everyone out there....what are you doing to help our profession?

 

[docma]

Science is the key. We are social scientists, not social workers. But the curriculum required (or chosen) by many students often does not include work on social policy (which social workers do learn) or program evaluation or social systems.

The ability to organize and/or evaluate outcome studies and implement evidence based practices is where psychology can and should be differentiating itself. But this would require some basic changes at the graduate school level.

 

[Neuropsych2be]

I'm with phillydave, we need to get back to our core areas of competency. I am open to the idea of psychologists exploring other avenues of practice, but as a profession...we need to first protect our core areas. Being a jack of all trades and master of none is what has contributed to our most recent marginalization. Frankly we have the best training to provide our core areas, why are people so ready to walk away from them?

I really hope/wish we could leverage the SCIENCE part of our training to come up with better ways to differentiate our profession. More and more research is supporting what WE do as clinicians, yet we continue to slide backwards in pay. We need MORE people to be active scientist-practitioners and make contributions to highlight the unique skillset we bring to hospitals, CMHCs, counseling centers, etc.

A general question for everyone out there....what are you doing to help our profession?

The problem is that it is the market that decides what our pay is. We can differentiate ourselves all we want but the market has decided that psychotherapy is worth X, whomever delivers that therapy will be payed X. In an era where cost containment is the watchword of the day, why should insurers reimburse a psychologist doing therapy more than a LCSW? How can professional differentiation translate into higher reimbursement rates?? As nice as the idea is in theory, in practice it seem like spitting into the wind.

 

[phillydave]

The problem is that it is the market that decides what our pay is. We can differentiate ourselves all we want but the market has decided that psychotherapy is worth X, whomever delivers that therapy will be payed X. In an era where cost containment is the watchword of the day, why should insurers reimburse a psychologist doing therapy more than a LCSW? How can professional differentiation translate into higher reimbursement rates?? As nice as the idea is in theory, in practice it seem like spitting into the wind.

Because the quality and scope of practice needs to be differentiated. The problem is that people look at both the services that an LCSW and psychologist provide as X, when in reality it should be looked at as X and Y. Differentiation of services ought to be a priority in convincing the market that psychologists actually do provide a different service than LCSWs and LPCs. And yes, assessment is certainly one of those major differentiations.

 

[Therapist4Chnge]

The problem is that it is the market that decides what our pay is. We can differentiate ourselves all we want but the market has decided that psychotherapy is worth X, whomever delivers that therapy will be payed X. In an era where cost containment is the watchword of the day, why should insurers reimburse a psychologist doing therapy more than a LCSW? How can professional differentiation translate into higher reimbursement rates?? As nice as the idea is in theory, in practice it seem like spitting into the wind.

The market is the result of a number of different factor (complementary and supplmentary services, insurance reimbursement, supply/demand, legal/ethical scope limitations of providers, etc). Differentiation is a step in the process to influence and possibly change many of these factors. At the present time, most of the money and representation is directed towards reducing services and cost.

Therapy is one of our core areas that we failed to protect, and many argue that it is already the primary domain of mid-level providers. Insurance reimbursements are such that it is often not fiscally responsible for doctoral providers to be on insurance panels. Many still participate, while others have removed themselves and attempt to scratch out a living using a sliding scale and/or flat rate service. It is a harder sell in the "generalist" world, though being able to differentiate expertise can make a difference.

*added*

Mid-level providers and doctoral level providers have some crossover, but it is to the detriment of the doctoral level providers to not work to differentiate WHY and HOW your training is superior. Boarding, academic appointments, publishing, and holding positions of influence in the community are a few ways to do this. I know some providers who took the extra steps to do these things and they stand out. It isn't the answer for the profession, but it can be the answer for some individuals. I must sound like a broken record about ABPP, but being boarding can matter. Holding academic appointments can matter. Publishing journal articles, chapters, and books can matter. Obviously not all of these areas are things private practitioners want to do, but they can help. Admittedly this can also provide a tiered hierachy within the profession, but I don't think that is such a bad thing. Those who take the extra steps can reap the rewards, and those who don't will have to fight it out with everyone else.

One of the biggest gripes I've seen on the listservs are the declining rates and limited access to insurance panels (over-saturation). Unfortunately when providers fight to get onto panels that have sub-par reimbursement rates, it works against every provider that is fighting to get more $. I don't fault providers for getting on panels, but there is a direct effect on the profession when they essentially support some of the lowest rates out there. Will boarding get you a higher rate....no. Will it give you more clout as a provider...yes.

It can be a pretty bleak outlook for those who want to primarily provide talk therapy services and be on insurance panels. The assessment side doesn't look that much better. I recently attended a presentation of SSI evaluations, and I was shocked by the low reimbursement rates per case. The presenters were selling on volume and templating, which I guess is making the best of a poor situation.

The Healthcare bill may or may not be a good thing for psychology, it is too early to tell. If the APA (and related organizations) were smart, they would take every dollar they have and get their voices heard before it is too late.

I have decided to look outside of the traditional areas of psychology to make money, though that isn't a workable solution for most. It saddens me that the profession let it get this bad, but there is still hope if we can get proper representation where it counts. I'd encourage every professional (and pre-professional) to let our representative organizations know where you want your membership fees spent.