Best Clinical Focuses for the Future

[PsySeeker]

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As a beginning doctoral student I've examined and reexamined these boards more times than I can count. There is much debate about the future of clinical psychology, and about its various focuses. Many of the threads I see are limited to a specific focus in clinical psychology, and are a tug of war between positive and negative posters. What I am interested in hearing about in this thread is what do you think the best clinical focus is/will be going forward? Let's focus on what is working and what one expects will continue to be in demand in the future.

To clarify I'm asking what type of clinical psychologists (eg. clinical pediatric neuropsychology, clinical geropsychology, health psychology, autism ect.) is most in demand and whose future prospects look brightest.

Of course I have my interests, but I have a lot of flexibility at this stage and I'm interested in your opinions, plus I think this thread could be valuable for plenty of other new and future students.

Lastly, while I am interested in bot pros and cons, let's try to keep this thread as positive as possible!👍 I think most of us our painfully aware of the challenges facing the discipline.

 

[Therapist4Chnge]

1a. Become a nurse practitioner, lol.

1. Get boarded, get established, and do Forensic assessment.
2. Take some biz courses to learn how to run a practice, open a PP, and get others to work for you.
3. Do what you love, do it well, and do it often. Research shows higher satisfaction w this approach.

 

[JeyRo]

As a beginning doctoral student I've examined and reexamined these boards more times than I can count. There is much debate about the future of clinical psychology, and about its various focuses. Many of the threads I see are limited to a specific focus in clinical psychology, and are a tug of war between positive and negative posters. What I am interested in hearing about in this thread is what do you think the best clinical focus is/will be going forward? Let's focus on what is working and what one expects will continue to be in demand in the future.

To clarify I'm asking what type of clinical psychologists (eg. clinical pediatric neuropsychology, clinical geropsychology, health psychology, autism ect.) is most in demand and whose future prospects look brightest.

Of course I have my interests, but I have a lot of flexibility at this stage and I'm interested in your opinions, plus I think this thread could be valuable for plenty of other new and future students.

Lastly, while I am interested in bot pros and cons, let's try to keep this thread as positive as possible!👍 I think most of us our painfully aware of the challenges facing the discipline.

I would cautiously recommend geropsychology. On the one hand, the field has a huge upside potential due obviously to the fact that the US (like the rest of the industrialized world) is rapidly aging and the increasing shortages of geriatrician specialists (which will only get more pronounced) is well-documented. However, I say "cautiously" because our field is being hurt badly by the way Medicare has nickel-and-dimed (and otherwise warped to our detriment) reimbursement mechanisms for geropsychologists (and geriatricians in general).

 

[PsySeeker]

1a. Become a nurse practitioner, lol.

1. Get boarded, get established, and do Forensic assessment.
2. Take some biz courses to learn how to run a practice, open a PP, and get others to work for you.
3. Do what you love, do it well, and do it often. Research shows higher satisfaction w this approach.

1a. Is not an option! lol

Interestingly my background is in business!

 

[PsySeeker]

I would cautiously recommend geropsychology. On the one hand, the field has a huge upside potential due obviously to the fact that the US (like the rest of the industrialized world) is rapidly aging and the increasing shortages of geriatrician specialists (which will only get more pronounced) is well-documented. However, I say "cautiously" because our field is being hurt badly by the way Medicare has nickel-and-dimed (and otherwise warped to our detriment) reimbursement mechanisms for geropsychologists (and geriatricians in general).

So the demand for the geropsychologists will be there, but the earning potential is unknown. Excuse my ignorance of the focus, but geropsychologists in PP do well as of now? Is this a boarded specialization (require a specific post doc?) or does one become one by making that the focus of their practicum/internship?

 

[cara susanna]

I would say forensic psych, particularly forensic assessment and custody evals (although the latter tends to be VERY high risk for lawsuits etc)

 

[graduatingsoon]

Honestly, it's pretty tough, if not impossible, to predict what is going to be in demand and generate a nice income in the next 5-10 years. Our field has been going downhill, especially in the past 5-10 years (we didn't have the internship crisis before). You should def. stay clear of being a generalist and only providing psychotherapy. Therapy jobs and therapy only practices are probably one of the lowest paying jobs for psychologists and will likely continue to be even lower in the future. The VA continues to be one of the highest paying clinical jobs for psychologists, but it's pretty competitive to land a spot. You would have to specialize to get into the VA system (health psychology, substance abuse, neuropsychology, geropsych). The VA is hiring now, but I don't believe that this trend will continue with all the federal and military cuts. I still think it's one of the better clinical jobs, especially if you can manage the bureaucratic bs and are interested in a pretty complex and severe population.

Oh and I will add that with the huge professional school movement, there are now at least two tiers of clinical jobs in psychology. People who don't complete accredited internships are usually not competitive for the any of the higher paying jobs in psychology and I believe will also have difficulty establishing a solid forensic/neuropsychology practice. I don't even know if you can get board certified? Anyhow, my main recommendation for increasing your income potential in this field is to attend at solid program, APA internship, good post-doc fellowship, and NETWORK.

 

[ResearchGirlie]

When I was on internship interviews it seemed like lots of places were really big on behavioral med / health psych.

 

[Therapist4Chnge]

Anyhow, my main recommendation for increasing your income potential in this field is to attend at solid program, APA internship, good post-doc fellowship, and NETWORK.

Good advice. I'd add that the person should also pursue board certification. Almost all of the better paying jobs will strongly prefer/require this both now and in the future. I know it is the standard for neuropsychology and it is quickly becoming a standard for rehabilitation psychology. I'm sure other areas would like to also push this, it just depends if they can get enough people to pursue boarding in other areas.

Primary Care/Behav. Health is probably one of the best places to be if you are strictly a clinician, though I'd expect top competition for those jobs because there are some good fellowships out there in these areas.

 

[JeyRo]

So the demand for the geropsychologists will be there, but the earning potential is unknown. Excuse my ignorance of the focus, but geropsychologists in PP do well as of now? Is this a boarded specialization (require a specific post doc?) or does one become one by making that the focus of their practicum/internship?

In theory, the demand should be overwhelming for geropsychologists over the coming years, but medical services for older adults isn't exactly a market that plays by the typical rules of supply and demand (e.g., due to Medicare and the highly regulated nature of long term care).

I wouldn't say geropsychologists generally do well in private practice right now, no, although some do - keep in mind that Medicare essentially monopolizes the insurance market for over-65s in the US, and over the past 5 years or so psychologists have seen roughly double-digit declines in real dollars for covered services. There are ways to get around the Medicare monster (such as opting-out, or providing for services not covered under Medicare, or otherwise being creatively entrepreneurial), but they aren't easy.

Boarding is an interesting question. I'm actually angling to be one of the first in the country to get my ABPP in geropsychology - first exams will be taking place in November (I'm not sure I'll get a spot). If anyone wants details they can PM me. Otherwise, you specialize in geropsychology by getting specialized training - there are more than a few gero-focused internships and postdocs out there (Palo Alto VA has a great geropsych program).

 

[graduatingsoon]

My impression from going through the post-doc/job market is that geropsychology positions may actually be less competitive than other specialty areas as well (like health psychology, PTSD) since very few people are actually trained in this area or want to work exclusively with this population. This is not my area though.

The psychologists that I know who are making the most money are actually not doing any traditional clinical psychology work. Many are doing forensic type of assessments and organizational consulting/management consulting. You really have to go outside of clinical psychology and into the business world if you want a higher salary. For example, I live in a saturated location, and pretty much all the psychologists who survive in PP are doing organizational consulting work. I don't know how you get into this area exactly, but it seems to involve additional management coursework, certification etc. Even after 7 years of training, you may have to take additional coursework/supervision in order to keep up with economic/market changes.

 

[JeyRo]

My impression from going through the post-doc/job market is that geropsychology positions may actually be less competitive than other specialty areas as well (like health psychology, PTSD) since very few people are actually trained in this area or want to work exclusively with this population. This is not my area though.

You're probably right, and economics probably plays a part to this (e.g., reimbursement rates being so poor for LTC work, Medicare cuts, etc).

Also, work with older adults may not be exactly inherently appealing, like working with children, or sexy like neuropsychology or forensics. I have actually heard more than a few times from people (although not from psychologists typically), "oh, you work with old people? that's *so* depressing!" I always find that so curious - as if working with mentally disturbed, abused, disabled children isn't depressing? Or working with criminal populations isn't depressing? Working with brain injured patients isn't depressing?

 

[Therapist4Chnge]

I really enjoy working with an older population, though it is a minority of my practice. Octogenarians and Nonagenerians are the new Forty. 😀

 

[ResearchGirlie]

You're probably right, and economics probably plays a part to this (e.g., reimbursement rates being so poor for LTC work, Medicare cuts, etc).

Also, work with older adults may not be exactly inherently appealing, like working with children, or sexy like neuropsychology or forensics. I have actually heard more than a few times from people (although not from psychologists typically), "oh, you work with old people? that's *so* depressing!" I always find that so curious - as if working with mentally disturbed, abused, disabled children isn't depressing? Or working with criminal populations isn't depressing? Working with brain injured patients isn't depressing?

Sounds similar to comments related to SMI populations. Yeah, it can be depressing at times but it's sorely needed and can be an incredibly rewarding.

I've never heard of neuropsych as sexy

 

[Therapist4Chnge]

I've never heard of neuropsych as sexy

I cannot lie...it's kind of "a thing" now.

Mostly it involves people arguing over a handful of topics, though the actual cases can be quite interesting. People want to flock to neuropsych because it seems fun/sexy...but it is *a ton* of work to do it right, and then once you start practicing it can be a grind. I practice in a rehabilitation setting (doing in-pt, out-pt, consultation, and research) because I don't want to burn out just looking at data. Being a neuropsychologist (or rehabilitation psychologist) is far from sexy, but I happen to think the work can be pretty interesting.

 

[futurecatlady]

I would cautiously recommend geropsychology. On the one hand, the field has a huge upside potential due obviously to the fact that the US (like the rest of the industrialized world) is rapidly aging and the increasing shortages of geriatrician specialists (which will only get more pronounced) is well-documented. However, I say "cautiously" because our field is being hurt badly by the way Medicare has nickel-and-dimed (and otherwise warped to our detriment) reimbursement mechanisms for geropsychologists (and geriatricians in general).

Beat me to it...

 

[PHD12]

Let's focus on what is working and what one expects will continue to be in demand in the future.

To clarify I'm asking what type of clinical psychologists (eg. clinical pediatric neuropsychology, clinical geropsychology, health psychology, autism ect.) is most in demand and whose future prospects look brightest.

Of course I have my interests, but I have a lot of flexibility at this stage and I'm interested in your opinions, plus I think this thread could be valuable for plenty of other new and future students.

Lastly, while I am interested in bot pros and cons, let's try to keep this thread as positive as possible!👍 I think most of us our painfully aware of the challenges facing the discipline.

I also think it's nearly impossible to predict what areas are going to be in demand in the future once you graduate and get licensed in 6-7 years from now (You said you were just starting). The healthcare field is changing rapidly and there is a ton of technological innovation that keeps changing the marketplace.

I think your "surest bet" is to minimize loans, try to land a diverse set of high-quality practicum placements (e.g., VA hospital, medical center, counseling center, substance abuse facility), attend an APA internship and network. I had about 5 quality practicum sites and strong letters, and this really helped me in the internship and post-doc process (I don't think you need this many). I think if you are versatile and have solid credentials you are in the best position for the job market (you can always specialize on fellowship year, but it's crucial to also have a solid foundation as a general clinical psychologist).

I know several psychologists who were highly specialized with excellent credentials, but had a tough time with the job market because they were confined to one state (usually people are since most are married/partnered by the time graduation hits). In the end, the ones that fared the best were able to market other skill sets (such as program evaluation, management, research, statistics) that ultimately led them to get jobs in their preferred location.

 

[pretzels]

I also think it's nearly impossible to predict what areas are going to be in demand in the future once you graduate and get licensed in 6-7 years from now (You said you were just starting). The healthcare field is changing rapidly and there is a ton of technological innovation that keeps changing the marketplace.

I think your "surest bet" is to minimize loans, try to land a diverse set of high-quality practicum placements (e.g., VA hospital, medical center, counseling center, substance abuse facility), attend an APA internship and network. I had about 5 quality practicum sites and strong letters, and this really helped me in the internship and post-doc process (I don't think you need this many). I think if you are versatile and have solid credentials you are in the best position for the job market (you can always specialize on fellowship year, but it's crucial to also have a solid foundation as a general clinical psychologist).

This sounds contrary to a lot of what i've read on here: that generalists do not fair well compared to more focused students. Wouldn't it make sense that the student that spent all their practicum in prison / with forensic populations be more likely to land the internship at a BOP site compared to the generalist?

 

[PHD12]

This sounds contrary to a lot of what i've read on here: that generalists do not fair well compared to more focused students. Wouldn't it make sense that the student that spent all their practicum in prison / with forensic populations be more likely to land the internship at a BOP site compared to the generalist?

I wasn't suggesting that you be a generalist, just that you obtain a solid foundation during graduate school and a diverse set of practicum experiences. You want to strike a balance between having some specialized training and also being versatile. I would NOT recommend doing all your practicum placements in a forensic hospital if that is where you want to end up for internship. It may actually be more helpful to have 1 or 2 years in a forensic setting, 1 year psychiatric inpatient, another placement working at a VA or with substance abuse population etc.

 

[PsySeeker]

I also think it's nearly impossible to predict what areas are going to be in demand in the future once you graduate and get licensed in 6-7 years from now (You said you were just starting). The healthcare field is changing rapidly and there is a ton of technological innovation that keeps changing the marketplace.

I think your "surest bet" is to minimize loans, try to land a diverse set of high-quality practicum placements (e.g., VA hospital, medical center, counseling center, substance abuse facility), attend an APA internship and network. I had about 5 quality practicum sites and strong letters, and this really helped me in the internship and post-doc process (I don't think you need this many). I think if you are versatile and have solid credentials you are in the best position for the job market (you can always specialize on fellowship year, but it's crucial to also have a solid foundation as a general clinical psychologist).

I know several psychologists who were highly specialized with excellent credentials, but had a tough time with the job market because they were confined to one state (usually people are since most are married/partnered by the time graduation hits). In the end, the ones that fared the best were able to market other skill sets (such as program evaluation, management, research, statistics) that ultimately led them to get jobs in their preferred location.

I second what Pretzals said about this seeming contrary to what I've been interpreting, and is one of the reasons I started this thread. Next year will be my first year, and I thought one needed to start paving the way to specialization right away due to competitiveness of the fellowships. For instance I've heard that neuro fellowships are exceeding hard to obtain.

The part about being geo-restricted really hits home for me as well, as I already am for the reasons you stated above . I can relocate for my APA internship, I'm willing to go to my best match for a year, but I certainly can't swing two years away after that (though I'm in the Pittsburgh metro and there seems to be a lot of opportunities here)! You think my best bet is to become and excellent generalist so that I can obtain a position and eventually build a PP in the area I live in? (whatever branch I take I intend to eventually do PP).

Basically I want to best position myself to take advantage of where the demand will be. I appreciate all the thoughts posted so far 👍

 

[Sanman]

This sounds contrary to a lot of what i've read on here: that generalists do not fair well compared to more focused students. Wouldn't it make sense that the student that spent all their practicum in prison / with forensic populations be more likely to land the internship at a BOP site compared to the generalist?

Really, it is a crapshoot. Being generalized gives you the best shot at a variety of good jobs while being specialized is more likely to get you more sought after jobs that are fewer in number. For example, there were a number of decent substance abuse positions that I got turned down for because it was obvious that my skills and experiences were tailored for specializing in health psych/geriatrics. Right now, I am straddling the line trying to decide which way to go with boarding. I think health psych/Gero tend to have a lot of real world overlap much like neuropsych and rehab, so it may come down to what position I take next year as I need to move to be with my SO. So far, geriatrics seems to be winning in the real world practice category. Health psych positions tend to be more academic and there seem to be fewer available in a given geographic area (though I recently applied to a VA position).

 

[Therapist4Chnge]

Next year will be my first year, and I thought one needed to start paving the way to specialization right away due to competitiveness of the fellowships. For instance I've heard that neuro fellowships are exceeding hard to obtain.

You'll serve yourself best by getting a solid foundation in being a clinical psychologist first. This is different than being a generalist. The best neuropsychologists have a solid foundation from which to build, as specializing too early can leave large holes down the road.

As for being competitive for neuro fellowships...have a solid foundation, good mentorship (pref. from boarded supervisors), and prior experience doing neuropsych assessment is what will land you a neuro post-doc, not if you start learning neuro on year #1. I think some DCTs are pretty vocal about not wanting trainees to specialize until they get a solid foundation. This can be seen in the multiple paths outlined in the Houston Guidelines. Of course, you just need to convince one site to rank you first.

....I'm in the Pittsburgh metro and there seems to be a lot of opportunities here)!

That's a good area to be in if you don't want to be in the Tri-State Pit of Ridiculous Housing (NJ/NYC/Westchester 😀 ). U of Pitt is a legit academic medical center. They were on my short-list for faculty gigs, and all things being equal that is a great place to work and live (I just chose a different but equally great place 😉 ). Allegheny is also there (I believe it is the competing health system), and they have some good mentors in their own right. Back when I looked at internship they had two neuro guys there, though I'm not sure if that is the same now. I think they did kids and adults, which was a nice option to have exposure to both. Western is also there (I think that is the name of the psych hospital)...it is very well regarded.

As for PP in that area...it is a big enough area to support a PP, you just need the right niche.

Besides being home to the Steelers...it's a great town!

Go Ravens!

😀

 

[Doctor Eliza]

I second what Pretzals said about this seeming contrary to what I've been interpreting, and is one of the reasons I started this thread. Next year will be my first year, and I thought one needed to start paving the way to specialization right away due to competitiveness of the fellowships. For instance I've heard that neuro fellowships are exceeding hard to obtain.

The part about being geo-restricted really hits home for me as well, as I already am for the reasons you stated above . I can relocate for my APA internship, I'm willing to go to my best match for a year, but I certainly can't swing two years away after that (though I'm in the Pittsburgh metro and there seems to be a lot of opportunities here)! You think my best bet is to become and excellent generalist so that I can obtain a position and eventually build a PP in the area I live in? (whatever branch I take I intend to eventually do PP).

Basically I want to best position myself to take advantage of where the demand will be. I appreciate all the thoughts posted so far 👍

I cringed a little when you said your ultimate goal is PP. Before you said that, I was going to jump into the thread and suggest you look at job postings in your area to see what sort of background would make you more likely to be hired. I think a lot of folks get into the field thinking PP is a great gig, but after being in PP for almost 4 years, having an employer seems pretty appealing. Granted, I am in a group practice where I have a 50-50 split, so my earnings are quite modest, and that makes things more challenging too. However, even if you are in solo practice, there are some things that do not come with PP: health insurance, paid sick/vacation days, retirement, maternity leave, any sort of temporary disability or unemployment benefits. This has really hit home for me lately because due to a medical situation, I am unable to work for the next 3+ months. This is financially devastating to my family. Fortunately, my husband has good medical insurance. This would have been even worse had it occurred when I was unmarried and uninsured (rejected by all insurance carriers for private insurance due to a relatively minor condition that has nothing to do with the current situation).

So I will amend my advice...at least specialize in something that will give you the flexibility to be hired, should you so desire. Maybe you will be happy with a PP gig, but if you find it doesn't work for you, at least you will have options.

Best,
Dr. E

 

[ResearchGirlie]

I cannot lie...it's kind of "a thing" now.

Mostly it involves people arguing over a handful of topics, though the actual cases can be quite interesting. People want to flock to neuropsych because it seems fun/sexy...but it is *a ton* of work to do it right, and then once you start practicing it can be a grind. I practice in a rehabilitation setting (doing in-pt, out-pt, consultation, and research) because I don't want to burn out just looking at data. Being a neuropsychologist (or rehabilitation psychologist) is far from sexy, but I happen to think the work can be pretty interesting.

I'm just glad at least some part of psychology is considered sexy!

 

[Sanman]

I'm just glad at least some part of psychology is considered sexy!

Lol, I just attended a conference on aging today and one of the talks was about having more honest conversations about sex during your later years. I can tell you studying sexual behavior is definitely a sexy part of psychology, lol .

 

[PHD12]

I'm just glad at least some part of psychology is considered sexy!

PP sounds sexy, but living without health insurance and sick leave = not so sexy

Psychologists made the list of the top 10 sexiest jobs according to the "very reputable" site career builder.com:

http://www.careerbuilder.com/Article/CB-1078-Job-Search-10-Sexy-Careers-You-Never-Thought-Of/

9. Psychologists
Whether or not you find your psychologist sexy is a personal matter that you might want to take up with him or her. But as a rule, people want to be heard and they like to talk about themselves, and psychologists make a living listening to people talk about themselves. They also help you solve your most pressing issues and you can rely on them for support (for a hefty fee, of course). What more could you want?

 

[Dirkwww]

When does one usually specialize? Looking to apply to graduate school and i have a general idea but feel it is too early to really know.

 

[PsySeeker]

That's a good area to be in if you don't want to be in the Tri-State Pit of Ridiculous Housing (NJ/NYC/Westchester 😀 ). U of Pitt is a legit academic medical center. They were on my short-list for faculty gigs, and all things being equal that is a great place to work and live (I just chose a different but equally great place 😉 ). Allegheny is also there (I believe it is the competing health system), and they have some good mentors in their own right. Back when I looked at internship they had two neuro guys there, though I'm not sure if that is the same now. I think they did kids and adults, which was a nice option to have exposure to both. Western is also there (I think that is the name of the psych hospital)...it is very well regarded.

As for PP in that area...it is a big enough area to support a PP, you just need the right niche.

Besides being home to the Steelers...it's a great town!

Go Ravens!

😀

Haha thanks for the great advice. Your Ravens had a good year... Lewis is gone now though (but so is Harrison) so things will be different this year lol

 

[PsySeeker]

I cringed a little when you said your ultimate goal is PP. Before you said that, I was going to jump into the thread and suggest you look at job postings in your area to see what sort of background would make you more likely to be hired. I think a lot of folks get into the field thinking PP is a great gig, but after being in PP for almost 4 years, having an employer seems pretty appealing. Granted, I am in a group practice where I have a 50-50 split, so my earnings are quite modest, and that makes things more challenging too. However, even if you are in solo practice, there are some things that do not come with PP: health insurance, paid sick/vacation days, retirement, maternity leave, any sort of temporary disability or unemployment benefits. This has really hit home for me lately because due to a medical situation, I am unable to work for the next 3+ months. This is financially devastating to my family. Fortunately, my husband has good medical insurance. This would have been even worse had it occurred when I was unmarried and uninsured (rejected by all insurance carriers for private insurance due to a relatively minor condition that has nothing to do with the current situation).

So I will amend my advice...at least specialize in something that will give you the flexibility to be hired, should you so desire. Maybe you will be happy with a PP gig, but if you find it doesn't work for you, at least you will have options.

Best,
Dr. E

PP sounds sexy, but living without health insurance and sick leave = not so sexy

Thanks for the feedback guys. My situation is a bit unique in that my wife's job, while not high paying, has excellent benefits including a pension (though this promise is presently under major attack as is the entire teaching profession here by our extreme right wing governor, but I digress). The other downside of the job is its utter lack of decent portability, which I hinted at above.

This is a second career for me, one that I am really excited about. My prior career was in business. I was a minority partner and COO in a mid-sized retail and rental housing company, so I feel that I will be comfortable with the business aspect of PP, though I'm sure it will take time to learn the intricacies as it is a totally different model.

So my plan is to hang onto my wife 😍, and find a niche I really enjoy and hopefully generate decent income from. I'm okay with earning my compensation with no benefits, so PP should be a good fit.

Dr. E I totally here you on the health insurance issue. If I had to buy benefits on the open market I would not be able to do PP (unless the Affordable Care Act really changes things). I too have a preexisting condition, though mine would be considered rather serious. I feel great as long as I have my medication, a bi-monthly biologic infusion that would costs 8k or so a pop on the open market 😱.

Maybe we should move to Canada? I hear Canada is good.

 

[PHD12]

This is a second career for me, one that I am really excited about. My prior career was in business. I was a minority partner and COO in a mid-sized retail and rental housing company, so I feel that I will be comfortable with the business aspect of PP, though I'm sure it will take time to learn the intricacies as it is a totally different model.

So my plan is to hang onto my wife 😍, and find a niche I really enjoy and hopefully generate decent income from. I'm okay with earning my compensation with no benefits, so PP should be a good fit.

One thing to consider since you are older and have a previous career as a COO, is the starting salary and income potential in PP. It's going to be much tougher than you think to make a decent salary in PP. We are talking about salaries in the 40-50K range for early career folks who are just starting their practices. The median goes up to about 85K (with 22 years of experience), based on the APA salary survey of full-time PP folks. This is going to be after 5-6 years of school and possibly re-locating for internship and postdoctoral fellowship. I don't think this is a great field for people who are geographically limited. You may have to make some sacrifices (either taking a less desirable position or long distance relationship).

 

[PsySeeker]

One thing to consider since you are older and have a previous career as a COO, is the starting salary and income potential in PP. It's going to be much tougher than you think to make a decent salary in PP. We are talking about salaries in the 40-50K range for early career folks who are just starting their practices. The median goes up to about 85K (with 22 years of experience), based on the APA salary survey of full-time PP folks. This is going to be after 5-6 years of school and possibly re-locating for internship and postdoctoral fellowship. I don't think this is a great field for people who are geographically limited. You may have to make some sacrifices (either taking a less desirable position or long distance relationship).

Fortunately I was able to secure a position in a good program locally for my doctorate. I agree being geo-restricted comes with some limitations, but it is doable, and frankly it has allowed someone like me to enter the field. I'm willing to do the long distance thing for a year for my internship, I want the best match and training possible. I'm okay with the money (yes it is less, but there is more to life), and yes, I might have to make some sacrifices position wise, perhaps for a fellowship, which is why I'm trying to get a handle on what and how to specialize early. I plan to supplement my income teaching where I did my undergrad as well. In other words my eyes are wide open.

That being said I know several clinical psychologists in the area in PP making mid-six figures 15 to 20 years in (and have likely been there for years). One averages about 150k doing exclusively therapy, another makes about the same doing assessments and teaching, and another is closer to 125k doing a bunch of odd jobs and therapy. A good friend of mine is an MFT 2 years into PP who will break 70k this year and growing quickly.

I know there are plenty of people out there well below these figures, and I know it isn't easy, but it seems to me if one has good business sense and is good at their particular area one can do much better than the averages in PP.

 

[PHD12]

That's pretty good. Location is key. You may be in a less saturated area for PP. Wow, I haven't heard of an MFT bringing in 70K early on and i'm in CA. Are these figures with insurance or private pay patients?

 

[PsySeeker]

She takes a mix but is fairly heavy on insurance, I think particularly Highmark. Part of the reason is she had worked at another practice accumulating hours for her license for two years and maybe a year after. I believe many clients followed her out of there. Still she is 5 years out of school and that is where she presently stands. Caveats, she is very good at what she does, and has very high referral rates, and like me she does not have to provide health insurance for her family (seems to be clutch to starting a PP!)

 

[PsyDr]

I'll offer a dissenting opinion. IMO, the biggest demand for psychologists is psychologists who are willing to work hard. If you want to do clinical work, then you can consult fee schedules and determine what you can potentially bring in. If you want to do forensic work, then you can see what the average of that is. If you want to do academic, then those numbers are pretty easy to find.

But give me a psychologist who wants to work 10 billable hrs/day, 5-7 days a week, while averaging 90hrs continuing education a year, writing 1-2 paper a year, and I can show you someone who will have a job. Bonus points if you are nice.

 

[erg923]

But give me a psychologist who wants to work 10 billable hrs/day, 5-7 days a week, while averaging 90hrs continuing education a year, writing 1-2 paper a year, and I can show you someone who will have a job. Bonus points if you are nice.

I like to play golf to much for all that nonsense...

Oh and I have a wife and kid too. 😀

 

[PsySeeker]

I like to play golf to much for all that nonsense...

Oh and I have a wife and kid too. 😀

I have one of each too! I don't golf though... 🙁

 

[PsyDr]

I can understand. That is your values and hopefully your choices support those. As for your significant others, I hope they meet and match your values.

I value having no debt, travel, multiple investment strategies, academic freedom, being able to retire in 10 years, exercising, and dating. To each their own.

OP's question wasn't "how do you want to be a content family person" though.

 

[PsySeeker]

I'll offer a dissenting opinion. IMO, the biggest demand for psychologists is psychologists who are willing to work hard. If you want to do clinical work, then you can consult fee schedules and determine what you can potentially bring in. If you want to do forensic work, then you can see what the average of that is. If you want to do academic, then those numbers are pretty easy to find.

But give me a psychologist who wants to work 10 billable hrs/day, 5-7 days a week, while averaging 90hrs continuing education a year, writing 1-2 paper a year, and I can show you someone who will have a job. Bonus points if you are nice.

So you don't believe it's a demand issue? Even those practicing mostly therapy seem pretty booked around here... But I keep reading therapy as provided by clinical psychologists is eroding. I'm not sure what to think. I'm certainly wiling to put the time in, what you describe is my normal routine and I enjoy it. (No Sunday though and half day Saturday after I'm established please)

 

[PsyDr]

I think demand is partially a function of willingness to work.

Imagine it from the referral's source. You call a psychologist, because you have a problem in the form of a patient, emergent business need, grant deadline,...whatever. You call psych A, who asks you all sorts of questions about payment, then starts looking at a schedule a month out, while saying things about family vacations coming up. You call psych B who immediately agrees and handles it.

Would you choose the person who immediately solves your problem or the person who adds to or complicates your problem?

I have used both techniques to grow and throttle business.

 

[Doctor Eliza]

Fortunately I was able to secure a position in a good program locally for my doctorate. I agree being geo-restricted comes with some limitations, but it is doable, and frankly it has allowed someone like me to enter the field. I'm willing to do the long distance thing for a year for my internship, I want the best match and training possible. I'm okay with the money (yes it is less, but there is more to life), and yes, I might have to make some sacrifices position wise, perhaps for a fellowship, which is why I'm trying to get a handle on what and how to specialize early. I plan to supplement my income teaching where I did my undergrad as well. In other words my eyes are wide open.

That being said I know several clinical psychologists in the area in PP making mid-six figures 15 to 20 years in (and have likely been there for years). One averages about 150k doing exclusively therapy, another makes about the same doing assessments and teaching, and another is closer to 125k doing a bunch of odd jobs and therapy. A good friend of mine is an MFT 2 years into PP who will break 70k this year and growing quickly.

I know there are plenty of people out there well below these figures, and I know it isn't easy, but it seems to me if one has good business sense and is good at their particular area one can do much better than the averages in PP.

You probably should have those friends of yours mentor you! They apparently are good at making money as a therapist! And they know what will be successful in your area.

My other thought is that perhaps we (the people answering you) are overestimating how much money you'd like to make based on our own values. If your wife makes a comfortable income, you might not need to stress so much about what sorts of PP services people want. For example, I work in a huge PP that provides me as many clients as I want. If it were humanly possible to see 60 clients a week, I could. I definitely get to do the type of clinical work I want to do and I never have to worry about finding patients for myself. However, the catch is that it is a 50-50 split. Therefore, I made 44K (before taxes) last year in spite of working about 45-50 hours per week (not all billable client hours, of course). For me, this was really not satisfying. I need my income to be a major part of our household income. If my husband had an awesome job, I wouldn't care so much. I'd work a comfortable amount of hours and enjoy my work. Unfortunately this is not the case and so money is a major stressor in my life.

All that was a long way to say...do you have a goal in mind for how much you'd like to earn in PP?

Best,
Dr. E

 

[Sanman]

For example, I work in a huge PP that provides me as many clients as I want. If it were humanly possible to see 60 clients a week, I could.

Best,
Dr. E

Oh, it is possible. A colleague mentioned a very successful psychologist that saw 77 clients/wrk for full sessions.

 

[JeyRo]

Oh, it is possible. A colleague mentioned a very successful psychologist that saw 77 clients/wrk for full sessions.

It's all about values, as PSYDR said. I don't know about golf, but I've got two rugrats at home and the tradeoff is time and memories generated with the children and family vs. money earned now, with the end goal being maximization of happiness and life satisfaction (biggest value for me). Money *in* *general* doesn't seem to make people happy or more satisfied with their lives after a certain threshold of comfort is reached (as we all know) - and that's an empirical finding that resonates with me.

Substantial wealth and early retirement would be nice, though.

 

[Sanman]

It's all about values, as PSYDR said. I don't know about golf, but I've got two rugrats at home and the tradeoff is time and memories generated with the children and family vs. money earned now, with the end goal being maximization of happiness and life satisfaction (biggest value for me). Money *in* *general* doesn't seem to make people happy or more satisfied with their lives after a certain threshold of comfort is reached (as we all know) - and that's an empirical finding that resonates with me.

Substantial wealth and early retirement would be nice, though.

Oh, I absolutely agree. I work hard, but I cannot fathom seeing that many pts a week. One of the hidden benefits of geropsychology is being able to pull of a regular schedule. Most of my pp clients, non geropsych pts, prefer evening and weekend appointments. Though to disagree with PSYDR, I find clients (the ones who pay cash anyway) generally have plenty of vacations booked themselves during school holidays. I used to work some of these holidays as I don't have children, but I am finding that it really is not worth the trouble.

 

[erg923]

exercising, and dating. To each their own.

Is that code for something? I kid, I kid. 😀

 

[JeyRo]

is that code for something? I kid, i kid.

 

[PsyDr]

Dr. Eliza,

your numbers don't add up. 44k at a 50/50 split is 88k in gross. With a 100hr fee schedule and two week vacation per year, that is a 17.6 pt per week schedule. That is not even half time. At the general medicare fee schedule rate for nonurban areas, at two weeks vacation, this is a little less than 22hrs/week.

There are other confusing things about your position. You state your employer will fill your schedule however you want and that you are at work for 55hrs a week. Yet you say it is not humanly possible to see 60 patients a week.

What's up with that?

 

[erg923]

Yet you say it is not humanly possible to see 60 patients a week.

What's interesting to me is that, the kind of person that would do this is likely thinking from a very business/money mindset, right? Maximizing productivity, billable hours, whatever, etc. However, the kind of person that could tolerate that and remain an effective clinician is ALSO someone who is SUPER into clinical work, psychotherapy, being with emotion, etc. These seem like they often dont exist in the same personality very often. I'm sure I'm wrong here, but this is what I have observed in graduate school and in now out in my local community. There is absolutely no way I could ever do that. I would not be able to "be present" in the room for all 60 patients, thus making myself miserable and providing less than optimal care. I'm curious who really could stay present in the room for 12 hours of psychopathology per day?!

Frankly, I dont have either of these to a strong degree. Im destined to be SLAC professor forever...or an admin person, I just know it. 😀

 

[PsychPhDHopeful]

My impression from going through the post-doc/job market is that geropsychology positions may actually be less competitive than other specialty areas as well (like health psychology, PTSD) since very few people are actually trained in this area or want to work exclusively with this population. This is not my area though.

So post-docs in geropsych tend to be less competitive. Do any of you feel the same way about internship positions in geropsychology? Do they tend to be less competitive as well? For example, somebody mentioned Palo Alto VA has a great geropsych program. Is it typically less competitive than the internship positions in the other areas there (behavioral health, etc.)? I mean relatively, considering that an internship at the Palo Alto VA is super competitive regardless.

Also, if my research background is with an aging population (dementia, etc.), is that a good way to be competitive for geropsych positions? Or would more practicum experience be needed?

Sorry for all the questions! Just want to get all of this sorted out before I start my program.

 

[JeyRo]

So post-docs in geropsych tend to be less competitive. Do any of you feel the same way about internship positions in geropsychology? Do they tend to be less competitive as well? For example, somebody mentioned Palo Alto VA has a great geropsych program. Is it typically less competitive than the internship positions in the other areas there (behavioral health, etc.)? I mean relatively, considering that an internship at the Palo Alto VA is super competitive regardless.

Also, if my research background is with an aging population (dementia, etc.), is that a good way to be competitive for geropsych positions? Or would more practicum experience be needed?

Sorry for all the questions! Just want to get all of this sorted out before I start my program.

I'm not really sure that posdocs in geropsych tend to be less competitive, that is, quality postdocs.

I think a research background with an aging population plus some clinical work with the population would be even more ideal.

The thing us geropsych people like the best is that you really have a demonstrated interest in working with older folks. On interview, if you can really send the message that you got bitten with the "geropsych bug" somehow and that this is really your passion counts for a lot (assuming your credentials are solid and you have a minimum level of clinical and research experience with older people that you can demonstrate).

 

[PHD12]

There are other confusing things about your position. You state your employer will fill your schedule however you want and that you are at work for 55hrs a week. Yet you say it is not humanly possible to see 60 patients a week.

What's up with that?

Working hours isn't really the reason why people in our field aren't making enough money. It's the dwindling reimbursements and the saturated market. Seeing 60 patients per week is not a realistic option. That means you are working 80 hours per week at least with paperwork and phone calls. This is a huge recipe for burnout and subpar patient care. All my former supervisors recommended not to see more than 6 patients per day to avoid burnout. If you are going to work 80 hours per week you might as well become an investment banker and go where the money is at. It's much tougher to work 80 hours a week in a "helping profession" where you have to be on all the time and manage very emotionally labile patients then in other professions.