PhD/PsyD Early Career Neuropsychologist Looking for Advice

InYourHead

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Looking for some guidance from some of the more veterans folks here:

I have been working at a large hospital system for < 5 years. I do a mixture of inpatient and outpatient work, with an emphasis on brief evals with a very specialized population. The salary is average, but the issue is there seems to be little room for advancement. Furthermore, this whole COVID situation has really left a bad taste in my mouth, as I haven't agreed with how the admins have handled it (though I do recognize that very difficult decisions have had to be made, and I do not envy them for it).

As a result of this, I've been thinking more about my long term professional and financial goals and thinking about what the options would be. (I'm not sure if I should give it more than 5 years though to see if things change?) I have never been interested in private practice, but wondering if that may actually be my best bet. The problem is I feel I've pigeon-holed myself by my limited clinical interests a bit, and feel extremely out of my comfort level at the thought of moving more into a generalist position. I suppose my questions are:

1) What other employment setting options would be worth exploring?

2) If private practice is indeed the best option, I doubt I'd be interested in setting up shop on my own (right away, or maybe even ever). I never trained in a private practice, so would probably benefit from joining a group, right? That said, with regards to COVID, I can't imagine it's been a great time to be 'fee for service' either. Any realistic insight you could provide on private practice day-to-day life, productivity expectations, salary, etc would be really helpful.

3) Lastly, regarding my renewed sense of imposter syndrome, are there any readings, articles, webinars, etc that you would recommend just to basically re-familiarize myself with more general neuropsych practice?

Thank you in advance for your insight. If you have any follow up questions, please don't hesitate to ask.
 
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WisNeuro

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1) VA, AMC, Private prac, ALF consultant, IME/forensic works. All have advantages and disadvantages.

2) Depends, if you join a practice as a contracted position, or even W2, you're likely to have a fee split of some sort. I imagine most will try to get you to agree to 50/50 or 60/40. I was recruited by a few who offered the latter, the conversation ended right there. Now I'm joining a well-established person in my area for simply rent in a few months. The key here is networking in your area. Know people, see if someone will be willing to act as a mentor of sorts. Learn all about billing and RVUs. You need to know what the services are worth so you can project your expenses and revenue. If you have to supply your own equipment (testing and otherwise) up front, which you likely will, do you have 5 figures of funds to do that? How easy is it to set up an LLC in your state (should be pretty simple)? Do you have an accountant who has familiarity with medical/psych practice and the taxes that go along with it? Do you at least have a recommendation for an attorney should you need legal consult in your area?

3) Latest textbook of neuropsych
 
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AcronymAllergy

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Second what WisNeuro said. To add more to #3, you could setup some peer-to-peer supervision for at least the first few cases you see wherever you end up. If it's a private practice, network ahead of time and see if there's another provider in the state who'd be willing to set some time aside, even if you may need to pay for it. Or reach out to professional society listserves or former supervisors and cohortmates (e.g., from postdoc, internship).

I'm not sure what area you're focusing on right now, but I'd imagine at least some amount of it will be transferable to general outpt neuropsych. Depending on where you work, some of your primary rule-outs are probably going to be neurodegenerative disorders (particularly Alzheimer's), chronic cerebrovascular disease and stroke, influence from general medical conditions (e.g., kidney and liver disease, sleep apnea) and medications, and just good ol' depression/anxiety. Wouldn't hurt to familiarize yourself with some of the newer mTBI literature as well. After reading the textbook chapters in those areas, skim journals (e.g., ACN, TCN, JINS, Neuropsychology) for newer and perhaps more heavily-cited articles on those topics. A lot of the knowledge is probably still there, just unpracticed. And it wouldn't be unusual to feel a bit out of your depth on the first few cases, particularly depending on how complex a patient population you're seeing.
 
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MamaPhD

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It might be helpful to identify your main concerns and which of those problems an alternative employer (or self-employment) would resolve. No situation is going to be perfect.

I was a few years into my first job when I decided to look hard at the job market. I got an attractive offer that I declined only when I realized it wouldn't fix what was really driving me to look elsewhere. But the whole experience of applying and interviewing was worth that insight. If you are considering other employment (as opposed to private practice), it's super helpful to learn about what's out there and get clear on what you want from your career. Though right now is admittedly not a great time to go on the market, the experience is really worthwhile even if you end up not changing jobs.
 
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InYourHead

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Thanks for the responses.

MamaPhD- your point about what it is that bothers me is a good one.

I think the first part is feeling stuck and plateau’d in my niche. That can be fixed at my current job, either by seeking out new CE opportunities or even requesting more diverse cases out of my comfort zone.

However the 2nd part is the seemingly low salary ceiling and I see limited potential for growth here. Not sure how that can be rectified unfortunately.
 

WisNeuro

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However the 2nd part is the seemingly low salary ceiling and I see limited potential for growth here. Not sure how that can be rectified unfortunately.

We've sacrificed a lot of years at low pay, no need to sacrifice more. Start looking around while you still have your current job, and negotiate. I walked into a job offer of 20% raise in salary with better benefits last time I switched.
 
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InYourHead

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Yes, thank you. I should have clarified I don’t see how it can be rectified at my current job. There is always the option to look elsewhere.
 

WisNeuro

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Yes, thank you. I should have clarified I don’t see how it can be rectified at my current job. There is always the option to look elsewhere.

That was pretty clear in your post. My comment was directed at looking around and being willing to walk away from your current job. If they want you on bad enough, they'll negotiate a retention offer, and/or be willing to change some clinic parameters. If not, walk
 
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AcronymAllergy

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Yes, thank you. I should have clarified I don’t see how it can be rectified at my current job. There is always the option to look elsewhere.

If it's not a particularly demanding job, at least in terms of hours, there's also the potential of doing more self-employed/contracted side work while retaining the current job for stability and benefits. But if it's 60-hour weeks and relatively low pay, yeah, I'd start looking elsewhere.
 
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PsyDr

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Things I have found helpful


1) Outlining what I like about X practice area. Academically interesting, emotionally rewarding, interesting in how the work is done, pays well, etc. Sometimes that helps. Correlate any emotional stuff with the factors associated with boundary violations, to ensure you're doing this for the right reasons.
2) Determining how much X practice area is worth to me, in dollars and cents. If someone offered me $10k/yr to never see X again, would I take it ? What about $50k/yr?

3) How else can I engage in X? Could I volunteer in X in some way? Could I write about X in some way? etc.

4) Review the handbook of clinical neuropsych. Maybe read Peppin's book as well.
 
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InYourHead

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Thanks for the replies, all.

What are some settings a neuropsychologist can work other than clinical and research focused? Anything in business or something like that?
 

MamaPhD

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Thanks for the replies, all.

What are some settings a neuropsychologist can work other than clinical and research focused? Anything in business or something like that?

Do you mean industry jobs, like in pharma? Those exist but I'm not sure that's what you're talking about. Can you be more specific?
 

Therapist4Chnge

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Thanks for the replies, all.

What are some settings a neuropsychologist can work other than clinical and research focused? Anything in business or something like that?
We learn useful skills in training that can be transferable to a more traditional business setting, though that's only the start. Things like interviewing skills, improved communication, emotional intelligence, cultural competence (or at least awareness), etc. Heck, I've used motivational interviewing during multiple dinner meetings to help understand the pain points of future referral sources, but you'll need to add additional skills to be marketable outside of traditional clinical work. There are some non-clinical/non-research careers out there, though I'm not sure people in them are going to share a lot of the details...myself included.

What I will say is that if you can identify an area of need/pain point/gap that you can fill, then you have a chance to carve out a spot. Over the years I've consulted across a number of industries and areas, but each was usually something where I saw a problem and/or they came with an idea about a problem...and we figured out a way to make it work.
 
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AcronymAllergy

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Thanks for the replies, all.

What are some settings a neuropsychologist can work other than clinical and research focused? Anything in business or something like that?

Forensic (civil and criminal). There are industry positions for psychologists/neuropsychologists (not the norm, but they exist), but as T4C mentioned, you may not get much information from others; those types of opportunities can involve knowledge, skills, networking, and professional positioning that took the individual a good bit of time and money to accumulate.
 
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PsyDr

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Thanks for the replies, all.

What are some settings a neuropsychologist can work other than clinical and research focused? Anything in business or something like that?

What skills do you have? How can you apply those skills? How would the application of those skills create revenue for a business or other place? Why haven’t others done this before?
 
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