PhD/PsyD Better states to work as a psychologist?

[bigpsychguy]

I am a second year PhD student and have a couple questions on state differences regarding working as a psychologist and navigating a field semi-saturated with midlevel/masters-level practitioners.

Is it as simple as the better states to work as a doctorally educated psychologist are the states where LPC/LMHC/LCSW have a defined smaller scope? Which states are those?

Are there states that have a stronger delineation of/protection of the scope and ability of a psychologist (set apart from other disciplines?) Is it generally the same state to state? The state where I'm attending university for my PhD allows masters practitioners to administer higher level psychological testing, leaving me wonder if other states protect psychologists' scope of practice more vigilantly.

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[bigpsychguy]

I am a second year PhD student and have a couple questions on state differences regarding working as a psychologist and navigating a field semi-saturated with midlevel/masters-level practitioners.

Is it as simple as the better states to work as a doctorally educated psychologist are the states where LPC/LMHC/LCSW have a defined smaller scope? Which states are those?

Are there states that have a stronger delineation of/protection of the scope and ability of a psychologist (set apart from other disciplines?) Is it generally the same state to state? The state where I'm attending university for my PhD allows masters practitioners to administer higher level psychological testing, leaving me wonder if other states protect psychologists' scope of practice more vigilantly.

I know there are a handful of states that license the discipline of "psychology" at the masters level ("masters-level psychologist"). Functionally/day to day, what do those clinicians' scope look like in comparison to a full fledged psychologist?

 

[smalltownpsych]

The states that I am familiar with only have “school psychologists” as master degree folk that do testing and call themselves psychologists, that they are legally limited in practice setting and scope. None of the states that I have been licensed in prevented other masters professionals from doing psychological testing but I have seen very few who have done it because of a variety of other reasons. I have most of my experience with western states so others on here can chime in on other areas. I find being a psychologist is valued and can be a good way to make a living in all of the states that I am familiar with and we tend to do much better salarywise than the MA. About double has been my experience.

 

[WisNeuro]

My state used to license masters level, but changed that a couple decades ago. The ones that were already licensed were grandfathered in. I peruse board actions regularly, and despite being a small minority of "licensed psychologists," these grandfathered midlevels constitute a highly disproportionate number of providers who have had actions taken against them by the board. Almost always for very clear violations.

 

[R. Matey]

One state I'm licensed in has master's level 'psychological associates' that act as psychologists under the supervision of a doctoral level psychologist. Otherwise, I think there are limited provisions for master's level clinicians to do some testing, but they do routinely get in trouble for practicing outside their area of competence by their boards.

 

[Therapist4Chnge]

Personally, I would never want to be a psychologist in KS or MI, as last I checked (a few yrs back) they both had some kind of “grandfathering” statute for non-doctoral-trained clinicians. KS also has/had very low CEU requirements, which is why I was told people in the VA like to get licensed there. I looked into the requirements initially bc you used to be able to sit for the EPPP earlier in KS than other states, though I’m not sure this is still true.

TX is another state bc they have very unfavorable laws around PI cases, for anyone doing expert work. While Greg Abbott was able to get his catastrophic injury paid for (~$11m) when he became governor, he decided to slam the door behind himself and screw everyone else who suffers a catastrophic injury. Texas also has had to fight against “school neuropsychologists” and encroachment from midlevel “psych associates” who want full autonomy with a fraction of the training. I still get recruiting calls from various AMCs from TX every year, and also inquiries to take legal cases, which are all quickly declined.

I personally wouldn’t bother with California between their added licensure requirements and glut of sub-standard “clinicians” that impact competitiveness in the clinical world. The MedMal landscape is not as favorable as some other states either, especially when you consider the added taxes and other costs bc CA is a bit of a unicorn with some of their laws.

 

[Ollie123]

It is good to be aware of these issues and they absolutely have a macro-level impact, but good jobs also obviously still exist everywhere. It is entirely possible to be in a state with laws strongly protective of scope, but in a region that is still immensely saturated with providers or a state with weak laws but in an area where demand for services vastly exceeds supply.

Long story short, I'm not sure I'd let this be a primary driver behind any decisions - especially early in your career. These things also tend to evolve over time so how the laws are today is not any guarantee they'll be the same a year from now, let alone 10 years from now.

 

[PsyDr]

I would suggest that you look for additional factors:

1) Quality of Life: real estate cost, school quality (if you want/have kids), restaurants, entertainment, climate, state tax rate, distance from an airport, universities for your kids, etc

2) Malpractice Environment: some states have malpractice tort reform laws, some do not. Some state boards file a large amount of board complaints, some states file very few. Those issues are easily searchable.

3) Payment: CMS fee schedule has different payments for different locations. It would be smart to look at that data to know what is being paid to PPs and employers.

4) Population relative to incidence of psychiatric diagnoses. If neuropsych, or pediatrics, look at the percent of elderly or young in the population data. Usually that is included in wikipedia.

5) Number of private practices in the area. Look at their websites to see how old they area, see if they look like retirement age, and if they have been able to support themselves over the years. Look up their last name to ensure they don't have a high earning spouse to support the practice.

6) Number of Psychologists in the State: Usually state boards have this information.


If you keep an eye on those things over time, you will be very well informed about any area you consider.

 

[WisNeuro]

I would suggest that you look for additional factors:

1) Quality of Life: real estate cost, school quality (if you want/have kids), restaurants, entertainment, climate, state tax rate, distance from an airport, universities for your kids, etc

2) Malpractice Environment: some states have malpractice tort reform laws, some do not. Some state boards file a large amount of board complaints, some states file very few. Those issues are easily searchable.

3) Payment: CMS fee schedule has different payments for different locations. It would be smart to look at that data to know what is being paid to PPs and employers.

4) Population relative to incidence of psychiatric diagnoses. If neuropsych, or pediatrics, look at the percent of elderly or young in the population data. Usually that is included in wikipedia.

5) Number of private practices in the area. Look at their websites to see how old they area, see if they look like retirement age, and if they have been able to support themselves over the years. Look up their last name to ensure they don't have a high earning spouse to support the practice.

6) Number of Psychologists in the State: Usually state boards have this information.


If you keep an eye on those things over time, you will be very well informed about any area you consider.

Regarding this point, OP, call a handful of providers who do the work you do in the area you are thinking of, ask what their current waitlist is. That can give you a decent look at demand. For example, in this area, both adult and peds neuro have lengthy waitlists, and one could fill a clinical schedule quite easily with minimal networking.