I was going to say, you might be the only psychologist I've heard of who wants to go into C&P. And I'd be shocked if a position weren't available or someone weren't willing to trade with you in the future if you decide that's what you want to do.
At least from what I've heard, it's primarily been that not much time is given to actually perform the evaluations, not many psychologists actually like doing them and working in that context, and (as WisNeuro said), some feel frustrated depending on where they are that it all just seems like a rubber stamp--if someone is denied, they just appear until it's eventually approved.
typical clinical time at most jobs varies between 20-30 hours a week, so if you are getting 5-6 hours a day of contact time on average, you're full time after you consider lunch, paperwork/admin, etc. If that is primarily assessment, I would be doing less than 30 and turning reports fast instead. If you are seeing 5-6 clients a day for therapy and not grossing over 150k you're doing something terribly wrong.
malingering base rate issues, lack of structural support for conclusions except "yes", outsourcing for low pay, and high amounts of admin time needed that aren't supported by reimbursement/facility guidance.
Yep, I believe so.
The murderer had a PTSD claim denied. Murderer was a clerk at the VA. Murderer sees Dr. F, who was the chief of psych, at a grocery store and threatens him. Dr. F files a complaint with the VA. VA does nothing. Murderer walks into Dr. F's office and shoots him, then walks to a second location and suicides. Somehow this murder is evidence that the murderer had PTSD.
100% agree.
no thank you.
100% agree.
I remember when I "fired" a bunch of patients during the start of my out-pt rotation on internship. I definitely caught some blowback, but thankfully my DCT and supervisor backed me because I had a clear and empirically supported plan. Surprise surprise, the majority of those "fired" patients came back after we established behavior contracts and reviewed acceptable v unacceptable behaviors. I worked almost exclusively w Axis-II diagnoses (by choice), so it actually offered quite a bit to pull from the get-go. NPD was one of my fav diagnoses to treat back then....now.....
The vast majority of my training was w. severe mental illness, significant behavioral problems (e.g. ODD, etc), and for whatever reason....a lot of personality disorders. Back then I found it interesting and I enjoyed the challenge. Now...hard pass. For any clinical referral these days I screen out all severe pathology and I don't take straight psych referrals, only cases with physical injury that includes a psych component. I still get challenging cases, but I really try to limit the level of psychiatric acuity at the front-end because out-pt is just so limited in what we can accomodate safely; that's the reality of out-pt practice.
