Clinical Psychology (Neuropsychology) Academic Career Outlook?

[fellwynd2]

I’m a 2nd year PhD student in clinical psych specializing in neuropsych and I’m hoping to be a professor. Obviously the academic job market isn’t great at the moment, but I’ve heard that clinical psych positions are relatively easier to obtain due to the increased flexibility of the degree. Is this the case? What does the academic job market look like for clinical psych? What about neuropsych? Thank you!

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[PsyDr]

1) You should look at the Sweet salary survey.

2) When you say “professor”, do you mean

a. A clinical professor who sees patient in an academic setting and maybe does some limited research and teaching

b. A university professor who does research for a living and teaches a few classes

c. A university based adjunct affiliate (insert other adjectives) who teaches classes to pay their repair bills on their 1998 Honda Accord

 

[fellwynd2]

1) You should look at the Sweet salary survey.

2) When you say “professor”, do you mean

a. A clinical professor who sees patient in an academic setting and maybe does some limited research and teaching

b. A university professor who does research for a living and teaches a few classes

c. A university based adjunct affiliate (insert other adjectives) who teaches classes to pay their repair bills on their 1998 Honda Accord

1) I didn’t realize it would have that kind of info, I’ll have to check it out!

2) ideally b is what I’d like, though I think I could be content with a. If I did b I’d likely want to try and slip in some form of clinical work for an additional income stream, and if I did a I’d likely want to buy out as a good deal of time for research with grants.

 

[WisNeuro]

At least with b you can go a little classier with the 2015 Honda Accord, maybe rent out a nice townhome.

 

[PsyDr]

1) I didn’t realize it would have that kind of info, I’ll have to check it out!

2) ideally b is what I’d like, though I think I could be content with a. If I did b I’d likely want to try and slip in some form of clinical work for an additional income stream, and if I did a I’d likely want to buy out as a good deal of time for research with grants.

I’m sure you’re aware that you don’t get that kind of job without having a substantial publication history, combined with some form of history of getting extramural funding. If you graduate with 50+ publications, then you can probably get a job offer somewhere. If you have a few publications and a few posters, you’re screwed.

Other posters know a lot more about that.

 

[summerbabe]

2) ideally b is what I’d like, though I think I could be content with a. If I did b I’d likely want to try and slip in some form of clinical work for an additional income stream, and if I did a I’d likely want to buy out as a good deal of time for research with grants.

I have zero insight into neuropsych academic job market.

But something to consider is that you're potentially committing to the longest training haul (PhD, internship, 2 year postdoc) for what would almost certainly be a below average salary (even if you supplement it with PP income) so one should be really passionate about this path.

Like reading journal articles on a Saturday night for fun and excited to work on personal manuscript projects during winter break type of passionate.

 

[jdawg2017]

I wish we had a job market crystal ball but who’s to say what the next 5 years will hold, especially in the current political climate in many states. I would advise keeping your options open and being flexible in a way that your work could be done in either an academic hospital or a university (e.g., I know lots of people in the dementia space who work in both). Hospital-based folks get paid a LOT more usually, but many academic hospitals don’t have the same tenure system as the university system (a few here and there do… but it’s rare). PP folks can make even more but have to be quite entrepreneurial.

 

[PsyDr]

@fellwynd2 I thought about this last night. I am a bit concerned that you are not using the normal terms associated with this career field (e.g., UCC, AMC, R1, R2, etc). That seems to indicate that you haven't done a lot of reading on this subject. Maybe you should. If I were in that position, I would read through everything that futureapppsy2 has written, then people like Calmich et al. Familiarize yourself with terms, expectations, maybe even go through their posting in a chronological order to see how their career went.

 

[Ollie123]

Job market definitely better in clinical psych than other fields. That said, it is still very competitive.

Not anything you don't know, but publish as much as you can and go after grants. Quality of pubs and the skills you develop matter too. The person with 40 pubs that were all surveys of undergrad psych students, mturk samples, or random subreddits, etc. is going to be much less marketable than someone with 10 pubs and an F31 who has skills in mobile app development, was the first to apply a newly developed signal processing method to a clinical problem, designed a new cognitive task, contributed to an R package, has experience with intensive longitudinal models for EMA data, etc. Obviously best of all to be the latter person and still have 40 pubs, but at least the search committees I've been on would take #2 over #1 in a heartbeat. Also should mention I'm not saying you need to do all of those obviously, but early graduate school is the time to dabble with the goal of focusing in as you move along. Bonus is that you also get more options to exit academia with the latter.

I'll let others speak to the specifics of the neuropsych job market - I'm more "neuroscience" than "neuropsych". AMC jobs are relatively easy to get with a remotely decent CV, but will expect you to have funding or be on a very clear path to get it if you want research time. They will (generally) flood you with patients 50 hours/week unless the second you aren't covering your salary with grants. University side jobs (i.e. psych depts) will usually pay less on average, come with more teaching responsibilities but usually relatively less grant pressure. These are generalities of course, so take that for what it is worth.

 

[msc545]

At least with b you can go a little classier with the 2015 Honda Accord, maybe rent out a nice townhome.

Possibly so, but not here in California. Maybe in Mississippi...

 

[NewNeuroDemic]

Hybrid positions also exist but they are rare, as someone suggested above. I am at an a large R1 AMC on the tenure track, so I do 75% research, 25% clinical, and 10% IME (I know the math is wrong, I'm a go-getter). The only teaching I do are seminars for med fellows or grand rounds. I love it because I can generally make my job how I want as long as I produce at a high level.

 

[tr]

2) When you say “professor”, do you mean

a. A clinical professor who sees patient in an academic setting and maybe does some limited research and teaching

b. A university professor who does research for a living and teaches a few classes

c. A university based adjunct affiliate (insert other adjectives) who teaches classes to pay their repair bills on their 1998 Honda Accord

In the academic medical center setting, A and B are essentially a fluid continuum at this point. This is a reasonably attainable job with the right CV. Getting on B at the bottom rung is pretty competitive, but getting on A at the bottom rung is not too hard. The better you are at attracting grant dollars, the farther you can move away from A and towards B.

Also there is a D, which is what most undergrads probably mean when they say 'professor': a tenure-track, non-contingent, full time faculty member whose work is mostly teaching with a dab of research (at a small college usually).

Of course these D jobs are rapidly disappearing and almost impossible to get so shouldn't be considered a dependable career path. People who insist on aiming for them often end up with C, which is a pit of despair to be avoided at all costs.

 

[Sanman]

In the academic medical center setting, A and B are essentially a fluid continuum at this point. This is a reasonably attainable job with the right CV. Getting on B at the bottom rung is pretty competitive, but getting on A at the bottom rung is not too hard. The better you are at attracting grant dollars, the farther you can move away from A and towards B.

Also there is a D, which is what most undergrads probably mean when they say 'professor': a tenure-track, non-contingent, full time faculty member whose work is mostly teaching with a dab of research (at a small college usually).

Of course these D jobs are rapidly disappearing and almost impossible to get so shouldn't be considered a dependable career path. People who insist on aiming for them often end up with C, which is a pit of despair to be avoided at all costs.

With D disappearing, I am mostly seeing C take its place with a bit of E) Visiting assistant professor/lecturer. Both C and E pay quite a bit less than D and require taking on additional jobs to make a living (sometimes admin duties at the university, sometimes Starbucks barista)

Honestly, most of my friends in research and academia who are not absolute rock stars are dying to get on the government payroll right now. This has included several clinical AMC folks.

 

[tr]

Honestly, most of my friends in research and academia who are not absolute rock stars are dying to get on the government payroll right now. This has included several clinical AMC folks.

The thing about A is that it is objectively a bad deal compared to private practice - same or more work for less money usually.
For this reason, I don't think too many people stay at A for an entire career anymore.

When I was in training (-iatry/neuroscience, not -ology, although the types of career choices seem extremely similar) there were more of the A lifers because the A job was less/easier/more fun work for less money, which is a reasonable tradeoff.

Now my observation is that most of the solid As seem to realize it's a bad deal and peel off to private practice by midcareer.

 

[Therapist4Chnge]

A lot of people seem to put in some years early career at an AMC and then bail to private practice to do a mix of clinical and forensic work; this was the route I took. I put in 7yrs at AMCs, published a bunch of articles, and served on various boards.

People would love an 80/20 or 50/50 split between clinical and research time. Unfortunately, if you don’t bring in substantial grants, it’ll be hard to actually get protected time for research. That 80/20 is really 100/20 (on your own time), and 50/50 is a grind once you add the administrative and training mtgs too.

 

[bcliff]

For a neuropsychologist, the AMC route seems like the "best" / clearest path for someone with academic / research interests, IMO - This is assuming you're at an institution with realistic productivity expectations *and* full psychometrist support.

RE: the point of leaving AMC for solo practice. I think this is different for folks who prioritize research and only do as much clinical work as they have to (e.g., when unable to fully support themselves with grant funding). The episodic nature of neuropsychology seems to lend itself particularly well to this model - You don't have to build up a full psychotherapy caseload; you can just request that admin staff start adding NPEs to your schedule in anticipation of a funding gap.

I know folks who have gone the AMC route without any funding at their hire date and have still ended up with 50%+ effort supported by grant funding and training / educational activities after a couple of years.

 

[tr]

This is assuming you're at an institution with realistic productivity expectations

 

[Sanman]

For a neuropsychologist, the AMC route seems like the "best" / clearest path for someone with academic / research interests, IMO - This is assuming you're at an institution with realistic productivity expectations *and* full psychometrist support.

RE: the point of leaving AMC for solo practice. I think this is different for folks who prioritize research and only do as much clinical work as they have to (e.g., when unable to fully support themselves with grant funding). The episodic nature of neuropsychology seems to lend itself particularly well to this model - You don't have to build up a full psychotherapy caseload; you can just request that admin staff start adding NPEs to your schedule in anticipation of a funding gap.

I know folks who have gone the AMC route without any funding at their hire date and have still ended up with 50%+ effort supported by grant funding and training / educational activities after a couple of years.

The problem is that the bolded is fast disappearing. Both AMC and government jobs are not what they used to be. More places are pushing you to justify your position fiscally.

 

[WisNeuro]

The problem is that the bolded is fast disappearing. Both AMC and government jobs are not what they used to be. More places are pushing you to justify your position fiscally.

Which, on the clinical side of the equation, becomes harder to do every year.

 

[Sanman]

I think it is sensible to justify your position fiscally, whether it be in private practice or in academia. Tenured or not. Teaching, service, grants, IP, clinical activities, administration, fund raising.

Clinical pay rates are stagnant and aren't going to be a path to a good income if that's your only activity. They won't be if you are using conventional insurance billing anyway.

To be successful in academia and make a decent living in psychology requires a fundable and funded program of research. By decent living I mean somewhere within shooting distance of the medians on the Sweet survey. Across all available career options, this is a somewhat pedestrian income relative to other high level options, but one also must consider the competitive space is different. How many academic physicians or psychologists would have been on the FAANG gravy train (or equivalent) had they focused on that? Some, surely. Most? No.

This is a little dated. The more recent data require a subscription to access. You can see the numbers here for PhD.

Faculty salaries increased 2.7% in 2018

The AAMC’s annual Faculty Salary Report highlights mean salaries across departments and specialties, academic ranks, and degrees in all regions of the country.

www.aamc.org

The NIH max is 212K right now. To exceed that requires cost sharing or other revenue sources. Think endowed chairs, this sort of thing.

These numbers aren't terrible to me. The problems are:

- It takes a long time.
- It's an outlier group. There's a combination of elite ability, perseverance, luck/opportunity, and survivorship bias.
- There's no net. Because of the time involved, the opportunity cost is massive. There is risk.*

You have the same opportunity to develop an academic career as a physician. The latter pays more, typically, and faster (sadly enough).

*clinical work can be a net. Don't neglect clinical training and experience.

The problem with justifying your existence fiscally is how they do the measuring. I teach interns and post-docs and I enjoy it. However, it is counted as "service" and not as part of your fiscal existence as it generates no revenue (the didactics that it is, clinical supervisors get credit for student encounters at the VA). The problem is there are easier ways to get that service credit. Some committee work is an occasional meeting and a signature. Training committee is a lot of work (interviews, training schedules, etc).

Don't bring up FAANG stuff. 20 years ago my college research interests were in neural networks/linguistics/AI. I opted for the more practical (at the time) healthcare route. That still smarts when I hear about FAANG and AI salaries in particular.

 

[PsyDr]

1) There are always a few superstars that get this weird position where they have a ton of:

a. Research support, allowing them to publish crazy amounts, leading to more funding, leading to more research support…

b. Clinical support, such as 6 psychometrists, standardized batteries, and dictation. If every patient is the same testing and billing procedure, you can bill crazy amounts. When admin looks at your billing, they are willing to give you anything you want.

This is NOT TYPICAL. Even for heads of AACN.

2) While this has been said since 1979: it is only a matter of time before neuropsych becomes irrelevant. We’ve become increasingly irrelevant in diagnosis. Which is why the research has been calling for proof of value added (Donders), or a move towards generic non supported interventions like “brain health” (Ruff). I think that should be considered by ECPs and students. Unless someone makes the entire assessment into a 45 minute, hands on examination that starts looking like a neurological exam, without much testing.

3) @tr There are a myriad of other options. I just don’t think OP knows about them.

Option E: doing one academic project at an AMC and forever being labeled a “professor” on their phone system.

Option F: allowing students to shadow you, which makes you an associate something something something clinical professor

Etc

4) @neothanos You know a psychology grad student partially won Netflix’ algorithm prize, right?

 

[bcliff]

1) There are always a few superstars that get this weird position where they have a ton of:

a. Research support, allowing them to publish crazy amounts, leading to more funding, leading to more research support…

b. Clinical support, such as 6 psychometrists, standardized batteries, and dictation. If every patient is the same testing and billing procedure, you can bill crazy amounts. When admin looks at your billing, they are willing to give you anything you want.

I'm an ECP neuropsychologist but will add that I'm expected to hit around 23 billable hours per week, which includes time spent by psychometry (we don't have six... but close to that), my time spent conceptualizing and writing, plus my time spent in interview and feedback.

My remaining time is spent in research, teaching, and admin. Without getting into details, this is without external research funding at present. My base salary is consistent with the Sweet survey, and my bonus is tied directly to what I bill over and above that billable hour target. This is at an R1 AMC. We have dictation services, straightforward billing, an easy to use EMR, etc.

This type of position was essentially the norm for what I was considering when on the job market, as well as for my peers, most of whom are neuropsychologists with strong research interests / backgrounds. I'm learning here that these positions should not be taken for granted.

I've anecdotally heard from senior colleagues that there's been a shortage of qualified clinician-scientists for open AMC positions, particularly since many folks left during the height of COVID. I'm not sure the degree to which that has impacted my ECP experience of the neuropsychology AMC job market. I’ll add that I did not have any geographic limitations when applying for faculty positions.

 

[tr]

I'm an ECP neuropsychologist but will add that I'm expected to hit around 23 billable hours per week, which includes time spent by psychometry (we don't have six... but close to that), my time spent conceptualizing and writing, plus my time spent in interview and feedback.

My remaining time is spent in research, teaching, and admin. Without getting into details, this is without external research funding at present. My base salary is consistent with the Sweet survey, and my bonus is tied directly to what I bill over and above that billable hour target. This is at an R1 AMC. We have dictation services, straightforward billing, an easy to use EMR, etc.

This type of position was essentially the norm for what I was considering when on the job market, as well as for my peers, most of whom are neuropsychologists with strong research interests / backgrounds. I'm realizing now based on the experiences of others in this thread that I shouldn't take these types of positions for granted - I've heard from senior colleagues that there has been a shortage of qualified clinician-scientists for open AMC positions, particularly since many folks left during the height of COVID. I'm not sure the degree to which that has impacted my ECP experience of the neuropsychology AMC job market. I’ll add that I did not have any geographic limitations when applying for faculty positions.

Wow. That's... incredible. So maybe neuropsychology is the unicorn protected niche.

I have ~3 days/week covered by external research funding and ~2 days/week clinic (psychiatry subspecialty), which comes out to 17 theoretically available patient hours per week. (Not all of them fill, I almost always have a few empty slots from last minute cancellations etc, which I use to get my clinical admin tasks done so I don't have to deal with them on my research time). I do some lecturing and resident supervision but my current institution doesn't provide protected time for this unless you have an official administrative role in education.

I like clinical work and I'm very happy with this split generally, but no way I would want to do clinic 5 days/week. My research days are much more controllable.

 

[ClinicalABA]

I'm an ECP neuropsychologist but will add that I'm expected to hit around 23 billable hours per week, which includes time spent by psychometry (we don't have six... but close to that), my time spent conceptualizing and writing, plus my time spent in interview and feedback.

My remaining time is spent in research, teaching, and admin. Without getting into details, this is without external research funding at present. My base salary is consistent with the Sweet survey, and my bonus is tied directly to what I bill over and above that billable hour target. This is at an R1 AMC. We have dictation services, straightforward billing, an easy to use EMR, etc.

This type of position was essentially the norm for what I was considering when on the job market, as well as for my peers, most of whom are neuropsychologists with strong research interests / backgrounds. I'm learning here that these positions should not be taken for granted.

I've anecdotally heard from senior colleagues that there's been a shortage of qualified clinician-scientists for open AMC positions, particularly since many folks left during the height of COVID. I'm not sure the degree to which that has impacted my ECP experience of the neuropsychology AMC job market. I’ll add that I did not have any geographic limitations when applying for faculty positions.

That's pretty much my arrangement too (at what is best described as a private group assessment practice). I'm not currently doing any of my own research (but chairing 3 dissertation projects), so I just see more clients. If i did do research and get it published, my agency would pay me a few thousand bucks or so, depending on the journal.

 

[Therapist4Chnge]

Don't bring up FAANG stuff. 20 years ago my college research interests were in neural networks/linguistics/AI. I opted for the more practical (at the time) healthcare route. That still smarts when I hear about FAANG and AI salaries in particular.

Me too. I was in the tech sector and was being actively recruited by tech firms like G and defense contractors. I was an early adopter of leveraging Big Data before 99% of the world had ever heard that term. I hated my day-to-day in the tech industry, so I bailed.

 

[Dazen]

Me too. I was in the tech sector and was being actively recruited by tech firms like G and defense contractors. I was an early adopter of leveraging Big Data before 99% of the world had ever heard that term. I hated my day-to-day in the tech industry, so I bailed.

I had the premiere job at one of the top finance companies right out of undergrad and was miserable. Even on my grad student stipend, I only regret leaving one day in a hundred. About half my college friends are living the FAANG life (I studied engineering and CS) and although their quality of life seems fantastic, I think I’d only enjoy it in one of the more niche research-y roles. Still, depends on goals. Intellectual fulfillment beats money for me every time.

 

[ThatPsyGuy]

I've always had the thought of going into Neuropsych while being a "type-b" professor, but I've also had that nagging thought in the back of my head "Do I like neuropsych? Or do I just like psych evals/assessments?"

I think this thread is pushing me toward the latter. While I may still go into some neuro training opportunities, I'm not sure if it's something I want to commit that 2-year post-doc to. I just wanna jump into IMEs, clinical evals, etc and do my lil research.

I do wonder though, how is the quality of life between academia and PP? While I know work is still being done during summer and winter break, having it must be nice.

 

[Ollie123]

I had the premiere job at one of the top finance companies right out of undergrad and was miserable. Even on my grad student stipend, I only regret leaving one day in a hundred. About half my college friends are living the FAANG life (I studied engineering and CS) and although their quality of life seems fantastic, I think I’d only enjoy it in one of the more niche research-y roles. Still, depends on goals. Intellectual fulfillment beats money for me every time.

Picked up CS as a double major with finance as a Freshman. Was apparently the only one in a class of 100+ to successfully complete the final project per my prof, who was utterly baffled when I told them I decided it wasn't for me and dropped the major

Turned down an internship at Merrill Lynch in NYC summer of my junior year to work in a psych lab.

....I've made some mistakes in my life.

 

[Sanman]

That's pretty much my arrangement too (at what is best described as a private group assessment practice). I'm not currently doing any of my own research (but chairing 3 dissertation projects), so I just see more clients. If i did do research and get it published, my agency would pay me a few thousand bucks or so, depending on the journal.

Just had to comment that your group practice seems like such a unicorn from everything you have mentioned. I have worked in a group practice that had ongoing research projects. I got co-opted into extra free research work and there was no pay bump for publications.

 

[Sanman]

I've always had the thought of going into Neuropsych while being a "type-b" professor, but I've also had that nagging thought in the back of my head "Do I like neuropsych? Or do I just like psych evals/assessments?"

I think this thread is pushing me toward the latter. While I may still go into some neuro training opportunities, I'm not sure if it's something I want to commit that 2-year post-doc to. I just wanna jump into IMEs, clinical evals, etc and do my lil research.

I do wonder though, how is the quality of life between academia and PP? While I know work is still being done during summer and winter break, having it must be nice.

Not a decision you need to make now. I ended up doing all the grad and internship level stuff to be competitive for neuropsych post-doc but ended up pivoting into geriatrics rather than doing the neuropsych post-doc. The background in neuropsych still helps if you are in an adjacent area.

 

[Sanman]

Picked up CS as a double major with finance as a Freshman. Was apparently the only one in a class of 100+ to successfully complete the final project per my prof, who was utterly baffled when I told them I decided it wasn't for me and dropped the major

Turned down an internship at Merrill Lynch in NYC summer of my junior year to work in a psych lab.

....I've made some mistakes in my life.

My college roommate/best friend got an internship at one of the other NYC financial firms. They hired him out of college with a five figure signing bonus and a starting salary that most of us are making mid career. He currently makes more than some of my physician friends.

But our karma is better @Ollie123 (I'm going to keep reminding myself of that)

 

[tr]

My college roommate/best friend got an internship at one of the other NYC financial firms. They hired him out of college with a five figure signing bonus and a starting salary that most of us are making mid career. He currently makes more than some of my physician friends.

But our karma is better @Ollie123 (I'm going to keep reminding myself of that)

I wouldn't want that job. Sounds like your friend had unusual longevity for that field; but most of the people I know who joined finance firms right out of college for $$$ burned out within a few years. The lifestyle is horrendous. Not to mention the cognitive dissonance of dedicating your life to being a parasite on the capitalist machine.

 

[Sanman]

I wouldn't want that job. Sounds like your friend had unusual longevity for that field; but most of the people I know who joined finance firms right out of college for $$$ burned out within a few years. The lifestyle is horrendous. Not to mention the cognitive dissonance of dedicating your life to being a parasite on the capitalist machine.

Not sure if I made it clear and not sure which side @Ollie123 landed on with the double major, but my best friend is on the CS side of things (Bloomberg terminals) and has since gone on to other tech things. I have friends working on the finance side of things as well, including investment banking. Most of the I-banking guys were in it less than 10 years but all saw 7 figure bonuses. One jumped to a hedge fund while a few others left for other industries. As a group, some of the smartest people I have ever met. The securities guys have much more average education and are salaried more in line with psychologists, but have been doing it for decades.

EDIT: As for being a parasite on the capitalist machine, I am not sure healthcare is much better in that respect nowadays.

 

[tr]

Not sure if I made it clear and not sure which side @Ollie123 landed on with the double major, but by best friend on the CS side of things (Bloomberg terminals) and has since gone on to other tech things. I have friends working on the finance side of things as well, including investment banking. Most of the I-banking guys were in it less than 10 years but all saw 7 figure bonuses.

Yeah the i-banking guys used to come recruit on our college campus every spring. They'd tease the summer interns with plush offices, then hire them straight out of college for 120 hour weeks. That 7 figure bonus was all going to the insane upkeep of hiring out everything in their lives because they had no time to do anything but work. By the time they realized they had sacrificed their 20s to the man, Goldman Sachs had chewed them up and spit out a crumpled shell of a human being. No thanks.

I think the quants in finance might have a little more breathing room because of their more specialized skill set?, but the general overwork and cognitive dissonance issues seem to remain.

 

[Ollie123]

Not sure i-banking/hedge funds would have been for me, but rebooting at 30 with a few million banked wouldn't have been a bad thing. Comp sci could have been in the right spot, though I have profoundly little respect for the bulk of the industry. Startups are mostly about trying to trick enough people into buying/investing in such a wildly defective product that eventually a megacorp gets annoyed and pays them to go away. The megacorps are mostly rearranging the deck chairs on the titanic every few months to justify a new release while ignoring gaping flaws. That said, there is truly creative and high-quality work being done in a handful of places and without the academic bureaucracy. In retrospect, I think I'd have been happier in that space even putting aside any income differences.

Agree that healthcare isn't much different these days, sadly. At some point we shifted the mindset to "What is the lowest quality care I can legally get away with providing" and I don't see us coming back from that anytime soon. Nearly everyone I know with even minimally complex health situations had to walk the physician through the diagnostic workup and then just use them as prescription vending machine because they can't be bothered to google "treatment guidelines for x". Which works for highly educated folks in healthcare and healthcare-adjacent fields, but I can't imagine is effective for the general public.

 

[tr]

Agree that healthcare isn't much different these days, sadly. At some point we shifted the mindset to "What is the lowest quality care I can legally get away with providing" and I don't see us coming back from that anytime soon.

Really, I feel a bit insulated from this in academics. At least, we seem to have reached some sort of detente where they don't complain about my taking the time to do a reasonably thorough patient evaluation, as long as I don't complain about my (comparatively) miserable salary.

Nearly everyone I know with even minimally complex health situations had to walk the physician through the diagnostic workup and then just use them as prescription vending machine because they can't be bothered to google "treatment guidelines for x". Which works for highly educated folks in healthcare and healthcare-adjacent fields, but I can't imagine is effective for the general public.

Horrifying but sadly true in several notable cases of my experience as well

 

[Dazen]

I wouldn't want that job. Sounds like your friend had unusual longevity for that field; but most of the people I know who joined finance firms right out of college for $$$ burned out within a few years. The lifestyle is horrendous. Not to mention the cognitive dissonance of dedicating your life to being a parasite on the capitalist machine.

I was at a hedge fund and the majority of people I started with are out of the industry. And even when I quit, almost everyone I told said they wished they could do the same but were too entrenched in the lifestyle to give up their salary. As @Ollie123 said, though, my ~3 years there has massively improved my quality of life as a grad student and is the only way I’ve been able to afford having a dog as a single person. I am constantly grateful for the financial cushion I was able to build by choosing to save instead of buying a fancy new car right after being hired.

 

[ClinicalABA]

Just had to comment that your group practice seems like such a unicorn from everything you have mentioned. I have worked in a group practice that had ongoing research projects. I got co-opted into extra free research work and there was no pay bump for publications.

yeah- we have a pretty interesting set up. While only 5 psychologists spread out throughout the state at different clinics, we are attached to a larger (300+ employee) agency that provides direct services. Many of our benefits derive from the larger agency and would not be the case for a small psychology group practice.

 

[AcronymAllergy]

Yeah the i-banking guys used to come recruit on our college campus every spring. They'd tease the summer interns with plush offices, then hire them straight out of college for 120 hour weeks. That 7 figure bonus was all going to the insane upkeep of hiring out everything in their lives because they had no time to do anything but work. By the time they realized they had sacrificed their 20s to the man, Goldman Sachs had chewed them up and spit out a crumpled shell of a human being. No thanks.

I think the quants in finance might have a little more breathing room because of their more specialized skill set?, but the general overwork and cognitive dissonance issues seem to remain.

I know a very small handful of people who went into i-banking straight out of college. This is pretty much dead on for the first 5-7 years of their professional lives. Accountants at the big 4 don't seem to have it a whole lot better early on, although it might not be quite that high pressure. Seems like attorneys at larger law practices are much the same.

All in all, there are better bang-for-the-buck fields than psychology, but there are certainly worse ones as well, especially when also considering factors like flexibility and quality of life.

 

[Therapist4Chnge]

I've always had the thought of going into Neuropsych while being a "type-b" professor, but I've also had that nagging thought in the back of my head "Do I like neuropsych? Or do I just like psych evals/assessments?"

I think this thread is pushing me toward the latter. While I may still go into some neuro training opportunities, I'm not sure if it's something I want to commit that 2-year post-doc to. I just wanna jump into IMEs, clinical evals, etc and do my lil research.

I do wonder though, how is the quality of life between academia and PP? While I know work is still being done during summer and winter break, having it must be nice.

Just to cover the bases for others who may read this thread, I’m going to touch on a few different areas of practice.

Psych evals w assessment measures to do differential diagnosis for example is rarely paid for by commercial insurance. If you can convince a commercial insurance to pay for it, they’ll make you jump through hoops bc you’ll be paneled on the behavioral health side, and they’ll likely only give you a couple/few paid hours. They’ll require a list of assessment measures and your rationale for using them. Then they’ll limit your hours for your report. Paneling through medical eliminates most hoops, but traditionally I’ve only seen this for rehab & neuropsych. It’s been a number of years since I took any commercial or gov’t (Medicare or Medicaid) insurance, so YMMV.

For straight forensic work, I sometimes see work doing differential dx for PTSD, but a lot of those cases also have polytrauma injuries include brain injury, so neuropsych will cover both. There are some cases where you can do the record review (forensic billing rates) and do PTSD differential, but there isn’t a ton of actual assessment involved, but the record review at least can get you some premium billable hours.

In the work comp world they usually will just ask for a 90791, but you are free to give assessment measures, but you cannot bill extra for it on the first visit where you bill 90791. 90791 as a CPT code is one of the few untimed paych codes, so you can spend 1 hr or 5hr doing the intake, and you’ll get paid the same. I’ll get a handful of requests per year from WC insurers to do differential dx for psych (usually w PTSD included), but that is mostly bc they know me from my neuro, pre-surg, and other assessment work. Sometimes I’ll get straight adjustment following MVA, but there really isn’t much psych testing, bc you can run though the criteria in your 90791.

There can be quite a bit of variance btw WC coverage between states, so others may share different experiences. In the three states I’ve practiced, none have had this as a big area and two of the three regularly fought psych to even be involved. It’s fine if you are only looking to do a few a year, but it’s hard to build a practice around psych assessment unless you also offer clinical interventions.

I know of a speciality clinic that mostly does PTSD cases, but treatment is the majority of the work. They carved out a niche in WC and legal work to provide counseling. They do expert work for PTSD, so there is some assessment and forensic rate hours, but they carved out a very unique niche w WC and first responders. They also have some fellowship trained forensic ppl, though not all.

There could be other niches for psych assessment, but you’d need to likely create it. Maybe doing pre-employment screens for police dept, but those are likely going to be closer to commercial rates than forensic rates. Same for EAP programs. Some sub abuse screeners maybe, but not actual personality assessment.

All of this to say that there is quite a bit of assessment work out there in the forensic world, but most of it is in head injury bc that’s where the $$$ settlements are in play. Many lawyers won’t spend the money for just psych unless it is PTSD, and even then it’s not like you’ll be giving a ton of assessment measures, but you can bill for the record review and your report findings.

I don’t mean to rain on your parade, but psych assessment has really been devalued over the past 10+ years and most payors won’t pay much for it. Many lawyers never liked it, so educating lawyers about times when it is useful can yield some cases, but you gotta do the leg work.

Hopefully there are others who do this work regularly in the forensic arena that can chime in, as 90% of my forensic work is TBI and 5% is PTSD differential diagnosis.

 

[clausewitz2]

I know a very small handful of people who went into i-banking straight out of college. This is pretty much dead on for the first 5-7 years of their professional lives. Accountants at the big 4 don't seem to have it a whole lot better early on, although it might not be quite that high pressure. Seems like attorneys at larger law practices are much the same.

All in all, there are better bang-for-the-buck fields than psychology, but there are certainly worse ones as well, especially when also considering factors like flexibility and quality of life.

When I was initially evaluating a young attorney patient of mine, I asked him about his work and how he found it. He paused for a moment and said, "You know that song from Crazy Ex-Girlfriend? 'Don't be a Lawyer'? Yeah, basically that."

 

[PsyDr]

All in all, there are better bang-for-the-buck fields than psychology, but there are certainly worse ones as well, especially when also considering factors like flexibility and quality of life.

Psychology is a nice, but weird profession. It is generally socially fitting. It has a long educational requirement. The pay is much lower than physicians, finance, most types of law, etc. There are fewer financial vehicles available to us, relative to the other professions (eg, resident mortgages). BUT... it's not like we have a call schedule, or have to look into anyone's butts, or are expected to work 120hr weeks to make partner status, or have to wear a suit. It's really hard to kill someone if we screw up.

Just to cover the bases for others who may read this thread, I’m going to touch on a few different areas of practice.

It’s been my observation that the “new” thing in psychology ends up creating the most earnings. The early adopters of new subspecialties end up making a lot of money. Then the earning potential slowly goes down, while barriers to entry increase. While neuropsych is newer, the real money is whatever’s next.

But like 85% of my income is making fun of other psychologists, psychiatrists, neurologists, and other physicians.

 

[ThatPsyGuy]

All of this to say that there is quite a bit of assessment work out there in the forensic world, but most of it is in head injury bc that’s where the $$$ settlements are in play. Many lawyers won’t spend the money for just psych unless it is PTSD, and even then it’s not like you’ll be giving a ton of assessment measures, but you can bill for the record review and your report findings.

I don’t mean to rain on your parade, but psych assessment has really been devalued over the past 10+ years and most payors won’t pay much for it. Many lawyers never liked it, so educating lawyers about times when it is useful can yield some cases, but you gotta do the leg work.

But in all seriousness, I truly appreciate the insight into the field. It helps me figure out what I want to do with my trajectory. IMEs and Psych evals were the first to pop into mind. But pre-surg evals, academic evals, vocational assessments, and whatever new things coming up are potential areas of interest. Honestly, I just need to get out there during my training to find what niche I'd like to carve out for myself. I think I'm fairly satisfied with where I'm going right now, but it's nice to be aware of the bumps on the way.

Besides, any rain on my current parade only 2 years into my studies helps the flowers grow to make the next parade prettier.