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Discussion in 'Psychology [Psy.D. / Ph.D.]' started by imaginarysonicscape, Jan 3, 2018.
adults? children? Both?
Do you have any special interest areas? AD/HD, Autism, presurgical psychological evaluations (which may or may not include a good deal of testing depending)?
Psychoed evals might be another area to consider. Separate path from neuropsych, albeit with some of overlap. There is certainly some market for it with adolescents and young adults/college students.
Is there anyway that a portion of your/dissertation can be neuro-related? Possibly getting that neuro faculty as an part-time advisor? If you could do that, and do a fairly heavy neuro internship, a fellowship could still be in the cards. Additionally, I'd be looking for as many neuro didactics as I could (e.g., Marquette Neuro dissection course).
To what degree would one's research sufficiently need to be neuro-related to be competitive for neuro internships and post-docs? Would research on cognitive dysfunction of medical conditions (e.g., neurological disease, CVD, pain, etc.), at the very least for one's thesis and dissertation, make them competitive?
As for posters and pubs, because it's interdisciplinary research, would presenting at the big neuro conferences and publishing in neuro-specific journals be strictly necessary or is it sufficient to publish this research in other, related journals (e.g., Annals of Behavioral Medicine for CVD research or Pain for pain research)?
Those research topics would definitely count for neuro-related, which helps. It's a bonus if the research has an obvious neuro focus. As for presentations, they'd want to present at INS/AACN/NAN for sure. There are plenty of poster sessions that focus on the neuro interactions with medical comorbidities and such. As for publishing, at that stage, get it in where you can, may be harder to get in a neuro specific journal unless there is a special issue. But quality pubs are quality pubs as long as they are in a reputable peer-reviewed journal. Caveat being, if you are going to a neuro fellowship with a strong research component, you need more rigorous involvement and focus on neuro research.
Employee selection: Executive candidate screening. Police candidate screening, nuclear power plant employee screenings, FAA, etc.
Religious: If you're religious, most formal religions require psychological testing for individuals going into the clergy or monastic orders. The Catholics are notoriously insular here, because they can train their own.
SSDI: I wouldn't touch SSDI crap. If you are worried about security, this is not for you. This is a desperate population.
You could also pursue training in Gero or Rehab. I beleive @smalltownpsych sees a fair amount of gero and @Therapist4Chnge is a well respected rehah person.
Pre-surg eval is a great area with varying degrees of assessment v. intervention work. Eval for a spinal cord stimulator is different than a transplant eval or a lap band eval...but they have enough crossover that with the right mentor you can learn them.
Pre-employment can be a decent niche too. @PSYDR covered most of the areas i’d consider.
Avoid SSDI eval like the plague. Reimbursement stinks, high no-show rate, and it offers the same level of clinical interest as watching paint dry while someone gets angry at you.
Thanks, this is very helpful.
I've heard that there's a lot of money in bariatric evals, is this accurate in your experience?
If you are truly comfortable with adolescents and live in a place where this is possible, you can create a private practice centered around psychoed evals. This of course comes with putting a lot of money in up front, but with the right connections you can easily make that back. I am in the process of starting my own PP and will likely be doing about 50/50 testing/therapy. The nature of my training allowed me to make connections with local professionals and schools (private). So to answer your question- yes it is possible without going a neuro/forensic route (although I had 2 full year neuro practicums during training that definitely helped with all this).
The $ is likely made in seeing patients in volume, which is common in the field. I’ve never been a fan of that approach, but it can be good money. I don’t take commercial or gov’t insurance anymore, but here is what i’d bill if I did:
90791...psych intake. I would rec psych testing most of the time, though some referrals were clearly a bad fit and the consult w. recommendations was all I did. Billing was 1 unit, as it is an untimed code.
96101...a couple hours for psych testing, and prob an hour to write up....so 3 units. Some clinicians may just do this code and combine the intake/testing/report all in one. I didn’t like that approach bc not everyone should be tested and 90791 for the initial consult is pretty standard for the info collected.
96153...for feedback. These are 15min codes, so it’d typically be 3-4 units. Some clinicians use a straight therapy code (90834/90837). Insurance carriers often prefer if you used psych CPT Codes already, then they’d approve 90834/37 bc that is “psych” too. The 151 is an H&B Code.
If the CPT Codes are not familiar, it’s how we quantify our services. Each insurance provider assigns $ amounts to each one. Tony Puente has a great website (domain is down?) and slide decks that cover more than most ever need to know about CPT Codes/Billing.
This. And overtesting.
I would be cautious about investing in testing in private practice route unless you have connections that will for sure give you referrals. Psychoed testing is provided free in schools when there's a learning issue, done by school psychologists, so you need to do some serious research to determine demand in your community, and folks have to be willling to pay the high testing fees out of pocket (or else the psychologist will end up fighting insurance companies for a much lower rate of reimbursement). I haven't invested in intelligence/cognitive testing yet in my private practice because my community is solidly middle class, and parents can't typically afford the high fees for testing out of pocket, per a local colleague who used to offer assessments.
Really depends on demographics, location, and connections. Starting an assessment practice from scratch without connections is a formidable undertaking.
Thought of another one: transplant assessments. Dunno much about it. There used to be a poster who did this, but he/she went back to med school.
Yep, pre-transplant assessments can be a big one, depending on area. I've also seen/done pre-(kidney) donor assessments, which are somewhat related in scope and approach. I've seen them from both neuropsych and more general psych perspectives, depending on the case. Where I've been, it's almost universally the bmed folks who handle this, so getting some additional bmed training could help set you up. In part because few of them did these assessments full-time (they also often participated in things like weight loss, diabetes management, smoking cessation, and pain management).
One of the neuropsych practicum sites for my program does pre-transplant assessments, but, as you said, it's far from a full-time gig.
There's a neuropsych person in town here who does transplant evals full time (kidney, heart, liver) but they are associated with a large university and hospital, and it's pretty much the only place to get it done in the state.
You are absolutely correct about knowing your community, the need for providing such assessments, and the community's ability to pay out of pocket before investing the thousands of dollars needed to have the bare minimum of testing equipment. I will say, and this may differ from place to place, that the quality of report given at the schools, particularly at public schools, is often pretty far below what a doctoral level psychologist in private practice will give. The public schools where I am will do IQ/achievement and maybe a Vineland or BASQ, which IMO is not always adequate.
Public schools K-12 are required to provide psychoed assessments for free for Special Ed placement BUT the same is NOT true of public universities, so psychoed is still a profitable route for you if you're able to build connections with local universities/colleges/CCs. Additionally, some university Disabled Students programs will accept students' former IEPs and assessments from K-12 for learning disability designation and subsequent accommodations, but a lot actually will NOT and will require students to go out and get a private assessment. IMO it's really horrible but it does mean there is a market for some private psychs to provide psychoed assessments so college kids can get the services they need... There are also the private school students who may be denied by the assigned public school psych for their free child find psychoed assessment and thus be seeking a private psych assessment to get their SAT, ACT, whatever accommodations. I love assessment but it truly can be a racket...
[EDIT:] You may want to look at Therapeutic Assessment for use of assessment as a clinical intervention - it may marry your interests! Lastly, a lot of community mental health and hospital settings conduct psych assessments and you could always carve out a staff psych position for yourself that emphasizes this assessor and assessment training role. No need to narrow yourself to neuropsych IMO.