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Clinical Neuropsychology Job Market

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by PublicHealth, Dec 20, 2005.

  1. PublicHealth

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    What kinds of jobs do clinical neuropsychologists take after completing post-doctoral training? What are the salary ranges for these positions?
     
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  3. positivepsych

    positivepsych Member
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    Not to bag on the field of Clinical Neuropsychology, but this seems to be the "hot speciality" that is continually discussed on the forum for no other reason than its salary potential. I don't mean to be judgemental, but in my experience I've seen a lot of people do very well for themselves by picking a focus that they really cared about, which gave them the motivation to succeed. I think this "follow the money first" style of picking a career or a speciality is ultimately detrimental. Rather, I think an honest self-appraisal of strengths/weaknesses, one's passions, what one finds meaningful, and whats a good fit in terms of lifestyle and values is a better way of going about it.

    By the way, there was a relevant study done of Singapore Business School students. The students who put "making money" as their #1 goal in post-graduate jobs not only ended up less satisfied witht their jobs, but also made less money in the long run than their counterparts. Just food for thought.
     
  4. PsychEval

    PsychEval Senior Member
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    I think neuropsych is cutting edge and prestigious. Some of my friends in graduate school chose neuropsych because they hated therapy, others because they loved neuropsych. If I were to follow the money in psych, it seems I/O is the place to be.
     
  5. PublicHealth

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    I'm a second-year medical student who is intent on "following the money" (or lack thereof) in psychiatry. Clinical neuropsychology has been an interest of mine since my undergraduate years. Just wondering...sheesh!

    Let's be a little more positive, positivepsych! :D
     
  6. PublicHealth

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    What, you mean to tell me that clinical psych grad students interested in the brain aren't into psychodynamic therapy!? Blasphemy! :p

    Interestingly, many I/O jobs are open to clinical PhDs. Take look at the APA website classifieds.
     
  7. PsychEval

    PsychEval Senior Member
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  8. Cajal

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    "What kinds of jobs do clinical neuropsychologists take after completing post-doctoral training? What are the salary ranges for these positions?"

    Well, I can give a partial answer to the first part. My current research advisor gave me a list of the careers of students who graduated from the clin neuropsych phd program. (1995-2004). I list a some of them below:

    -School Psychologist
    -Neurorehabilitation Assessment Specialist
    -Clinical Neurosychologist, Medical Center, and Instructor of Neurology at a University
    -Staff Neuropsychologist, Rehab facility
    -Assessment specialist
    -Director of Neuropsychology,Medical center, and assisstant prof of Neurology
    at a University
    -Grant Administrator and clinical neuropsychologist in private practice
    -Clinical Neuropsychologist, developmental disabilities center at a hospital
    -Senior Psychologist Neuropsych service, Rehab center and instructor of rehabilitation medicine
    -Neuropsychiatric Program supervisor, hospital
    -Neuropsychologist, hospital
    -Supervising Neuropsychologist, epilepsy center

    etc etc...

    Plus, a ton of post-doctoral fellows at various institutions.
     
  9. Neuro-Dr

    Neuro-Dr SDN Advisor
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    There is a practice survey for NP that is published every few years. The last one was done in 2003 and published in the Archives of Clinical Neuropsychology, which is the journal of the National Academy of NP. In the articles, you'll find salary job placement, reimbursment and the like. The average salary continues to go up (about $105,000) and the job market is fairly diverse.

    The problem is that the Houston Conference Guideline (www.theabcn.org) has been adopted in part or total from all NP boards (ABCN, ABPN, ABPdN) and is pretty specific about training and coursework. If you are considering NP, be aware that you need doctoral coursework consistent with the Houston or Div 40 guidelines, an APA internship (preferable with >50% NP) and a 2 year fellowship (of which their might be 80 spots per year). You can deviate from these standards but it makes each placement more difficult.

    Lots of people are interested in NP, but a little learning is a dangerous thing, so be prepared for serious rigor.
    Enjoy!
     
  10. PublicHealth

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    What's up with so many "Professional Boards" in clinical neuropsychology? Is it a sign of dissension in the ranks? Who regulates all these boards?
     
  11. Neuro-Dr

    Neuro-Dr SDN Advisor
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    The ABCN board has been around since the mid 80's and is part of the ABPP specialties in psychology, it has about 550 members. ABPN has been around since the late 80's and was founded by original members of ABCN who felt that the ABCN board was essentially made up of academics who knew little about clinical practice and thus could not really hold themselves out to the public. It is around 300 members. The ABPdN (peds board), I think started in the mid 90's and was a reaction to the concern that most members of ABCN had little training in peds and that the exam process addressed peds minimally although the pathology and assessment needs are quite different than for adults (e.g. types of tumers, seizure, toxic/metabolic/genetic d/o).

    All are self regulated, with the exception of ABCN which, also follows the ABPP policies for general guidelines for board certification. All use the Houston model more or less and it is not unusual for their to be schisms or different bodies, several psych specialties (i.e. Forensics) started as their own board, reached a critical mass and then applied for ABPP recognition.

    I think the problem in NP has been that ABCN never lived up to its mission statement. In general all psych boards make up about 14% of their membership. In medicine it would be more like 65-75%. Thus, all boards are elitist status at the moment until they really become the standard of care for the field. My guess is that the peds board will eventually go for ABPP the way clinical and clinical child are set up and ABPN will stay an alternative. The key is that they are recognized by the National Register, have members who pass written, orals, work samples and credential reviews as well as maintain membership and exam logs for the public.

    Probably more than you wanted to know...
     
  12. PublicHealth

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    No, this is great! Thank you for taking the time to type it. So what is the "state of the art" in clinical neuropsychology? Is it ABPP-Cn or ABCN or ABPN?
     
  13. Jon Snow

    Jon Snow Senior Member
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    ABCN/ABPP-Cn (same thing) is the "state of the art." ABPN has weaker reqs.
     
  14. Neuro-Dr

    Neuro-Dr SDN Advisor
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    That is a whole other can of worms, there are many that feel that the ABCN model still promotes the APPCN fellowship system, which has requirements including "other medical or NP residents, at least one ABCN faculty member, inclusive in a medical facilty" that serves to further facilitate the model, but may not capture the whole field of NP. I would agree that ABCN is still the most widely recognized board, but there is a real feeling that it may also be out of touch and as I mentioned, not living up to its own mandate of boarding all qualified NP. Thus, there will continue to by multiple boards until some resolution is reached.

    My advice to all students has been to follow the Houston Guidelines as close as possible, for as long as possible and keep your options open. Again, the overwhelming majority of NP (and all psychologists) are not boarded. However, you need to have the proper training and frankly, you won't get placed at the next level without it. I have seen students sit out a year because they didn't get an APPCN site for fellowship, when they got offers from great residencies and I just don't agree with it. Philosophically, if a board puts so much pressure on a student through their restrictions that they are willing to put their life on hold, then the board has failed. I spoke with the president (then) of ABPP (not NP, but in general) and he was shocked at the latest changes effective 01/01/05. So, you will find that as you move forward with your career, you gravitated to those groups that share your views.

    Disclaimer: my board certification is not from ABCN, so take this as you will
     
  15. PublicHealth

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    Would you mind sharing your background?
     
  16. Jon Snow

    Jon Snow Senior Member
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    Hmm. My understanding is that ABCN does not require an APPCN fellowship. It suggests it. Following the houston guidelines is sufficient. They also do not require that a board certified neuropsychologist be part of fellowship training. I have participated in the process for reviewing case samples and oral testing for ABCN. There is no question that the ABPN reqs are less stringent. I agree there is an academic/practioner slant to ABCN and ABPN, respectively (or at least there was), though those lines have blurred substantially. I am always a proponent of more stringent reqs. Psychology needs strong boards. APA is not good with their accredidation procedures and specialties remain ill-defined. We need more reqs for board certification for specialty work and we need insurance tie-ins for that. The legal system has caught on somewhat (it pays to be ABPP-Cn in the legal arena). In any case, I think less than 15% of people claiming to be neuropsychologists are board certified at present. There is alot of fluff out there passing for neuropsychology (weekend workshops, folks that never had neuroscience/neuropsych training in grad school, no neuroanatomy, no neurophysiology).


    There will never be consensus until certain folks die off. The Reitaners for instance are truly out of touch.
     
  17. Jon Snow

    Jon Snow Senior Member
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    From ABCN's website:

    or persons receiving their doctoral degree after 1/1/05:
    • Training conforms to guildelines of The Houston Conference (PDF).*
    • Houston Guidelines require that the residency be the equivalent of 2 years and completed on at-least a half-time basis. ABCN will accept minor deviations from these requirements that may arise based on medical, personal or professional factors. Under these circumstance the candidate must provide written documentation from the residency director that the candidate:
    1) left the residency in good standing,
    2) met all requirements of the residency,
    3) obtained the requisite skills and knowledge base described by the Houston Guidelines.
    • ABCN will not require that the faculty of the 2-year residency include a board certified neuropsychologist (as stipulated in the Houston Guidelines). However, under these circumstances the candidate may be asked to provide a curriculum vitae for their primary neuropsychology supervisors.

    For persons receiving their doctoral degree between 1/1/90 and 1/1/05:
    • The equivalent of three years of experience in the specialty area, met by:
    • three years of experience, only one of which can be predoctoral, or
    •
    one year of pre- or postdoctoral experience and successful completion of an accredited postdoctoral program in the specialty.
    • Two years of supervision in the practice of the specialty, met by:
    • two years of postdoctoral supervision, or
    • one year of predoctoral and one year of postdoctoral supervision, or
    •
    successful completion of an accredited postdoctoral program in the specialty.
    • Training and experience in basic neurosciences, functional neuroanatomy, neuropathology, clinical neurology, psychological assessment, clinical neuropsychological assessment, psychopathology, and psychological intervention.
     
  18. Neuro-Dr

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    I realize that they (ABCN) has backed off this board-cert requirement for fellowship, but the issue is the decision making process. The majority of the members making requirements for ABCN are also the ones running the APPCN fellowships and I think that is a conflict of interest. I am not saying that I want more fluff, what I am saying is that the ABPN requirements are not "too little" necessarily. In addition, the passing rates for ABCN published on their website are difficult to replicate and there has been more than a little talk about exactly how many people have been able to pass. I have been nothing but pleased in the past 3-5 years with the direction ABCN has gone in terms of addressing the needs of practicing NP. However, the recent stance taken on the changes for 2005 and on were released after most students had applied and been accepted in the internship and fellowship match process for that year. Many of us who run fellowship programs not on APPCN were a little annoyed by the timing and lack of grace period. For example (and remember they backed off some of this so it has changed), a student who applied to our fellowship program would be working under 4 NPs (2 are ABPN and one ABPdN) with 12 neurologists, 14 neurosurgeons, residents and full PT, OT, and rehab and our site was told that we would not qualify under the new model. I have not since asked since they backed off a little, but you can imagine the outrage we felt at being told our site was not sufficient. This is not the intent of the board. The intent is to certify all those who meet training standards and can pass written and orals to be held out as NP to the public, not to develop elitists standards. When I brought this up, I was told "well, do you really want more NPs out there, we have enough already". I was shocked. So again, students who read this should be aware I do have some bias in this area.

    As for the job outlook (the original point of the thread) I still feel great about what I do. Sorry for the rant...
     
  19. Jon Snow

    Jon Snow Senior Member
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    Good points. I agree that APPCN cannot be the standard. For one, the clinical component is too aggressive. Most of those programs are nearly 80% clinical.
     
  20. Jon Snow

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    Interesting. I do believe we, as a field, need to be aware of our numbers, especially with the presence of certain types of graduate programs.
     
  21. Neuro-Dr

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    I understand as well, but I was still a little upset that the model was changed outside of a major discussion in the field, national conferences, etc. I still wish that the boards were seeing percentages similar to medicine. I still believe that every NP who meets Houston conference or Div 40 guidelines should be boarded. If it were the standard, I think we would all worry less about the graduate schools becasue they would comply with those standards. I feel bad about precluding a new graduate who would be great as a practitioner from getting a fellowship because there are only 80 spots in APPCN sites per year. But things change slowly and like I said I've been pleased with many of the other changes. Good postings, for you students I hope this was helpful.
     
  22. Sanman

    Sanman O.G.
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    ok perhaps I have missed the point here, but what negative effects would going to a non-APPCN fellowship cause? Since it is not necessary for practice or to make certification for the ABCN, what exactly is the point of attending such a spot? Also, how many two year fellowship spots are there overall for neuropsych?
     
  23. Jon Snow

    Jon Snow Senior Member
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    I wonder the same thing, Sanman (the negative effects). The APPCN sites are fine, but there are plenty of non-APPCN sites that comply with Div 40 standards. To be honest, I think many of them are better than the APPCN sites, particulary, for research oriented folks that still want board certification. I agree with Neuro-Dr that div 40/houston guidelines should be the standard. However, I don't agree that conforming to that should automatically grant you board certification. I like the idea of written and oral exams. Moreover, we still need to be aware of numbers. Saturating our own field is not a smart move.

    As for your questions. . the number of 2 years fellowship spots varies. The source of funding is an important variable. It is possible to put together 2 year fellowships that conform to div 40 standards with research dollars (e.g. you find a research lab, setup a 50/50 research/clinical position with neuropsych being the clinical component, throw in a few didactics, and you're golden).

    The APPCN sites are nice if your only interested in clinical work, as that's what you will be doing. They are also competitive and networking is a must to get a position (as it is anywhere).


    It isn't necessary for practice, but board certification is good for the field as it gives us better control over quality and practice standards. There have been some moves to support APCN through insurance (california). It's useful in forensic applications (bigger dollars).
     
  24. PublicHealth

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    I agree. So why is board certification so restrictive in clinical neuropsychology?

    Can you elaborate on these points?
     
  25. Jon Snow

    Jon Snow Senior Member
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  26. PublicHealth

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  27. Jon Snow

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  28. Neuro-Dr

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    I'm not saying that anyone who completes training according to Houston Conference Guidelines should be handed a board. The written and orals are key. What I am saying is that there is a real bias in the APPCN directors (not all obviously) who sit on the Academy policy board who want to see the mill of low paid, overworked (of which I was once one) fellows stay deep enough. There are 48 active APPCN sites with on average 80 positions per year (not all of which are always available because most stay 2 years;one year longer than is required for licensure). So, even at 80 new APPCN trained NPs per year, only about 10-12 go through the APCN boards in a year (I have no idea how many try). Thus, most NPs simply don't do it. The question would be why?

    Given the changes in the CPT codes for 2006, a strong lobbying body is pretty critical to the relevance of the field and the advances in neurosciences suggest an evolution to come. Especially since the NP codes have lost 40% of their value in the past 10 years. There are only about 850 boarded NPs in the coutry between all boards, despite the fact that NANs membership is over 4,500. This country alone puts out 3,000 psychologists per year. I don't have an open appointment for 8 weeks and see 15 patients per day. In my state there only 10 boarded NPs in the whole state. If there is a surplus of boarded NPs out there, I'd like to know where they are. A strong base of boarded NPs at a rate of about 50% would make the board more likely to be the standard.

    As for funding, I make no more money per patient or per hour than I did before I went through boards. I would agree that it helped me get on judge's lists and I'm more frequently sought after in civil litigation cases, but I don't charge any more (it would only come out of the patient's settlement). I went through boards because the neurology clinic where I work told me I had to and the university where I teach paid for them.

    This is all of course just my opinion, but I remeber when I was going through how everyone was saying then the sky is falling and they are still doing it, at the expense of new docs whose only sin is that they graduated after them and now they feel there is no room at the in. For what it is worth, my colleagues and I are paid very well, we do what we want, we have time for conferences and research, we still train students and were are all pretty happy and I wish you the same.
     
  29. Sanman

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    Well I think the reason so few NP's are boarded is simply that they don't need to be. From some the NP's I have talked to, it is simply unnecessary for them and costs more time and money. If there is demand for their services without the certification the question is why should they.
     
  30. Neuro-Dr

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    The main reason is to protect the public. As it stands there are a number of psychologists who attend weekend workshops, have taken a class here or there and then want to practice NP and will call themselves a neuropsychologist. You can be a mediocre therapist and you probably won't hurt anyone, if you are a medicro diagnostician (particularly in NP) you are going to do some damage. The tests, medications, sympotms and syndromes are not covered in clinical programs, but the money and increases CPT codes for NP over psych testing makes it more attractive. How else can the public be served without a body to oversee and establish criteria for propoer training. This is the same reason boards were created in medicine, they all have an MD, but the residency and boards establish their competency. Your point is weel taken though that the return may not always justify the cost. But, if that is true, then why haven't the boards made themselves more accesable to NPs
     
  31. Jon Snow

    Jon Snow Senior Member
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    I think I agree with you (Neuro-DR) more than not.



    My understanding is that the new codes are a benefit to neuropsychs. We finally have a professional code. The rate is higher than it has ever been? It supports a technician model and provides for non-technician model approaches. The new codes appear to be a good thing. NAN's membership is over 4,500, but how many of those are students (if you've already parsed those, my apologies)? How many are people from other professions? I'm not a member of NAN, but INS.

    Regarding membership rates in the boards. They are increasing. There needs to be an incentive to join, as in access to higher billing codes or restrictions on calling oneself a neuropsychologist, or restrictions in the use of certain materials. Once things like that happen, board membership will skyrocket. It is paramount that we maintain adequate standards, as we don't want them to become meaningless like APA accredidation of graduate psychology programs.
     
  32. PublicHealth

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    Yeah, but how many states allow neuropsychologists to use technicians for testing? I've heard that there are lobbying efforts toward this end. Jon, do you or Neuro-Dr know which states allow NPs to use technicians?

    Also, if a neuropsychologist simultaneously bills for an hour or neuropsychologist work, technician work, and computer work, what does that equal in dollars? $200/hour?
     
  33. Jon Snow

    Jon Snow Senior Member
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    I think all states except New York allow technicians. I'm not 100% sure on that. The New York decision was pretty silly and it was also recent. I think there are lobbying efforts to reverse that.


    I'm fairly certain you can only bill once per eval for computer work. It isn't something you can repetitively bill. Also, I don't think you can simultaneously bill for technician and professional time (not sure, but sounds dubious). A technician model might look something like this.

    Professional time: 1 - 2 hours
    Tech time: 5 hours
    Computer: 1

    If you have a large practice, you might be able to simultaneoulsy see 3-5 patients, depending on your resources.
     
  34. PublicHealth

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    Is there any official publication or list on this?

    Do you think the new CPT codes will increase salaries of NPs?
     
  35. PublicHealth

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    Ok, here are the reimbursement rates: http://www.apapractice.org/apo/payments.html#

    So, let's say you're billing for 2 hours of professional time at $124/hour, 5 hours of technician time at $63/hour, and 1 hour of computer time at $46/hour. That's $609/patient. So if you conduct 3 evaluations per day for a week, you're making $1,827/day or $9,135/week or $456,750/year (2 weeks vacation :D). Is this possible? Even with overhead costs, you'll take home a pretty penny.

    Perhaps medical school and $200K in debt was a bad choice! :eek:
     
  36. Jon Snow

    Jon Snow Senior Member
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    Possible? Yes, but unlikely. It takes time to build a practice. It's hard to schedule patients solidly like that. In some academic medical centers, using a technician model, it's not unheard of for a neuropsychologist to see 5 patients a day under the above conditions. It's alot of work to build a practice like that. The medical school route is an easier way, in my opinion, to get big dollars.
     
  37. PublicHealth

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    How much are the neuropsychologists where you are make in terms of a salary? I read that the average is just over $100K/year. What, in your experience, have you found?
     
  38. Jon Snow

    Jon Snow Senior Member
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    I've read the same thing. I don't really know anyone's salary.
     
  39. Neuro-Dr

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    Jon's data is all correct. Where I work we typical schedule 12-15 patients per day for intakes and follow-ups, routniely get about 10 to show up and the psychometricians bill 40-60 hours of testing per week. Each staff NP bills between $350,000 to $450,000 per year. With contract reduction the collections are around 60%, so you can figure collections at $210,000 to $270,000 per year. Depending on your arrangement, most staff NPs who are not salaried will get 50-65% of what is collected, with the rest going to overhead and psychometricians. NAN reports average salaries close to 104K and that is all pretty consistent with my experience. So, if you go to med school to be a GP or pediatrician, you won't make too much more than the average NP. The new codes may reduce this a little for those of us who use techs a lot and particularly for those of us whose techs are all MA level and are paid well.
     
  40. PublicHealth

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    Thank you, Neuro-Dr! I've read that many NPs conduct forensic evaluations. Do the above figures factor in forensic work or is that billed separately? To what extent do hospitals control private practice for NPs?
     
  41. Neuro-Dr

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    Psychologist
    Forensic evals are much different becasue you generally bill 2-3 times your U&C and the collection rate is 100%. Some NPs do quite a bit. they are pretty seductive in terms of pay and ego.

    Hospitals can control your pay quite a bit. Generally most hospitals and rehab clinicals want you on salary. The last informal survey on the listserve indicated that they see far fewer patients per week, but it varied quite a bit.
     

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