Figuring out my Pathway/General Advice/Plan B

[whatishappeningpm]

---

Members don't see this ad.

I graduated a psychology degree in 2019 and quickly and thoughtlessly went for a criminology masters degree from 2021-2022. Long story short, I felt overwhelmed by the prospect of a PhD at that point, felt a little "selfish" indulging my passion for Psychology, and also was told that an MA in Psychology was useless and I just didn't have any guidance whatsoever. Fast forward, this pause between undergrad to now has given me time to reflect on my career goals, - I've decided clinical psychology is the route that is the best suited for me. I am a full time worker, but have been applying to basically every opportunity I can find to get a paid or unpaid research/coordinator position in order to get some publication/conference/poster experience. I was in two labs during undergrad, but never did any of the things I aforementioned. I've been applying for a year + with no responses. Its beginning to feel a bit hopeless, and im also concerned about the timeline because I'm the main income earner for my family and would eventually like to marry my girlfriend and afford a family. I've decided to go with a plan B if I can't make it work in the next 2-3 years. I was hoping I could get some advice for alternative avenues, so I am going to list below my primary motivators and career desires:

1. I want to be able to work in a hospital setting. If I were able to pursue a PhD, I'd love to specialize in neuropsych/assessments for serious mental illness in a hospital setting. I think the hospital is a perfect place given that I'd love to work clinically, but also conduct some research, specifically I'm interested in doing some institutional/structural research and maybe even help implement new programs in this space. I'm also interested in some biological mechanisms of schizophrenia and clinical intervention/translational research.

2. As I stated above, I do have research ideas I want to pursue but this isn't the most important element of the job to me. I'd be willing to forgo the research aspect, as long as if I had the opportunity at some point (probably in school) to conduct research.

3. Long term, I am interested in dividing my time between a hospital setting and private practice. I also really like teaching, and have experience teaching psychology to college students/post-grad students.

I heard that an LMHC license is much more limited in NY than a LCSW, so I am bearing that in mind while constructing this 'plan B,'- even though the focus on psychotherapy in LMHC programs is more in line with my overall goal. Currently, the only 'Plan B', I can think of is to go for the LCSW with a focus on Mental Health, and try to find research opportunities while in the program. In terms of money, certain SW positions, especially supervisory ones, don't seem that bad. If anyone has insight into alternative career paths for the things I'm interested above ^, I'd love to hear it. I want to be able to afford a nice lifestyle with my family, while also helping people with psychotic disorders.

 

[summerbabe]

1. I want to be able to work in a hospital setting. If I were able to pursue a PhD, I'd love to specialize in neuropsych/assessments for serious mental illness in a hospital setting.

A true neuropsych/comprehensive assessment will require a doctorate. But social workers and other MA/MS holders do lots of psychosocial assessments in hospital settings.

3. Long term, I am interested in dividing my time between a hospital setting and private practice. I also really like teaching, and have experience teaching psychology to college students/post-grad students.

A lot of people start off with aspirations to do many things simultaneously but end up settling for one primary role for their full-time work. Some people add some light private practice or adjunct teaching to either generate needed income or to have more variety.

But that will cut into your work/life balance, especially if you have kids and other major responsibilities.

2. As I stated above, I do have research ideas I want to pursue but this isn't the most important element of the job to me. I'd be willing to forgo the research aspect, as long as if I had the opportunity at some point (probably in school) to conduct research.

It is hard for full-time clinicians to do research since we are primarily paid to provide clinical services & full time academics are paid to do academia.

It will also likely be harder as an LCSW or LPC to engage in research since there are generally less pathways to get that experience in grad school and to find funding to do it postgrad (ie funding is competitive and there are likely PhDs who will be more competitive).

I want to be able to afford a nice lifestyle with my family, while also helping people with psychotic disorders.

Not sure about pay but there are lots of clinical positions to serve this position. Of the MA/MS options, I think the LCSW will be by far the best option since it’s broadly recognized and the case management training will be very relevant for this population, even if you end up in therapy focused jobs. Good luck!

 

[R. Matey]

1. I want to be able to work in a hospital setting. If I were able to pursue a PhD, I'd love to specialize in neuropsych/assessments for serious mental illness in a hospital setting. I think the hospital is a perfect place given that I'd love to work clinically, but also conduct some research, specifically I'm interested in doing some institutional/structural research and maybe even help implement new programs in this space. I'm also interested in some biological mechanisms of schizophrenia and clinical intervention/translational research.

These are really broad interests. If you want to do research, I'd pick one of these. YMMV, but from what I've seen, it's really uncommon for people who do mechanistic work to also do translational work (aside from the occasional meta, maybe).

Agree with summerbabe that neuropsych is something that's done with a doctorate. It is also a two-year postdoctoral residency (i.e., after your Ph.D. you have training to do, making trainee wages). Important to clarify too that neuropsych isn't really for serious mental illness as it is for neurocognitive disorders. Any well-trained clinician can evaluate for a serious mental condition.

2. As I stated above, I do have research ideas I want to pursue but this isn't the most important element of the job to me. I'd be willing to forgo the research aspect, as long as if I had the opportunity at some point (probably in school) to conduct research.

Something else to think about would be like a research coordinator or study clinician on someone's grant after you finish your degree. You could be involved with research, even if it's not your main thing.

3. Long term, I am interested in dividing my time between a hospital setting and private practice. I also really like teaching, and have experience teaching psychology to college students/post-grad students.

Based on your timeline, I think these goals are pretty achievable with a social work degree. It will be on you to be sure that you get good quality post-degree supervision (not just what is offered by whatever job you get pre-licensed). There are dozens of institutes in NY that offer such training so it shouldn't be too difficult to find. I'd suggest honing an area of interest clinically and seeking advanced training in that area post-degree.

 

[whatishappeningpm]

Thank you so much for responding so thoroughly. I'm new here, so I'm not sure how to break up the reply up the way you did but let me respond by each point:
1. Regarding my research interests, I am primarily interested in the second half: neuroscience of schizophrenia paired with clinical intervention, but also have some ideas for material life changes for these people, and I know sometimes scientist in hospitals do QI/QA on new mental health models/programs/initiatives. Is it really rare to see a single scholar take on these two different types of research? I am really only interested in research with psychotic disorders, but have different angles I think would make for important research.
To your second point about neuropsych, that's disheartening. I thought as much, but I really love neuroscience and wanted to combine clinical psych/neuroscience in my studies/research. Then, I heard from some clinicians that some neuropsychologists do work in psychiatric wards/clinics, but its hard to find anything online verifying that. I would've imagined differential diagnostics & cognitive assessment was important in neuropsychiatric crisis, especially first episode/hospitalization.

2. Yup, I've been applying nonstop to positions like this. It hurts that I'm geographically limited to NYC, but still. Thank you for the suggesting though.

3. Thanks for the advice!

 

[whatishappeningpm]

A true neuropsych/comprehensive assessment will require a doctorate. But social workers and other MA/MS holders do lots of psychosocial assessments in hospital settings.

A lot of people start off with aspirations to do many things simultaneously but end up settling for one primary role for their full-time work. Some people add some light private practice or adjunct teaching to either generate needed income or to have more variety.

But that will cut into your work/life balance, especially if you have kids and other major responsibilities.

It is hard for full-time clinicians to do research since we are primarily paid to provide clinical services & full time academics are paid to do academia.

It will also likely be harder as an LCSW or LPC to engage in research since there are generally less pathways to get that experience in grad school and to find funding to do it postgrad (ie funding is competitive and there are likely PhDs who will be more competitive).

Not sure about pay but there are lots of clinical positions to serve this position. Of the MA/MS options, I think the LCSW will be by far the best option since it’s broadly recognized and the case management training will be very relevant for this population, even if you end up in therapy focused jobs. Good luck!

Thank you for your reply!

 

[R. Matey]

1. Regarding my research interests, I am primarily interested in the second half: neuroscience of schizophrenia paired with clinical intervention, but also have some ideas for material life changes for these people, and I know sometimes scientist in hospitals do QI/QA on new mental health models/programs/initiatives. Is it really rare to see a single scholar take on these two different types of research? I am really only interested in research with psychotic disorders, but have different angles I think would make for important research.

Yeah, if you think about it, your program of research is about developing expertise and disseminating knowledge based on your expertise. You can't be an expert in everything so people usually pick a certain area and take deep dives there. If you want to do more mechanistic work (i.e., hooking people up to EEG machines and then using their x data to predict y clinical outcome), that's one avenue. Intervention work, which monitors treatment response is another, much more expensive (in terms of grant dollars needed to conduct the study) avenue requiring a slightly different set of skills. People do both for sure, but the incentive structure in academia is such that it's more effective in terms of your time and publishing record to do one over the other, at least that's my sense. For instance, I'm a coauthor on an RCT, but I was only really involved as the stats-person after the data had already been collected. The rest of my published work is more in the assessment area.

To your second point about neuropsych, that's disheartening. I thought as much, but I really love neuroscience and wanted to combine clinical psych/neuroscience in my studies/research. Then, I heard from some clinicians that some neuropsychologists do work in psychiatric wards/clinics, but its hard to find anything online verifying that. I would've imagined differential diagnostics & cognitive assessment was important in neuropsychiatric crisis, especially first episode/hospitalization.

My guess is that inpatient consulting work really isn't worth it for many neuropsychologists in terms of pay and hours. Bigger AMCs/hospital systems do have neuropsychological clinics, which I'll leave to the neuro-folks here to describe in more detail, but I will say that most clinicians can diagnose a psychotic disorder without ever sending someone for a neuropsych evaluation.

 

[summerbabe]

Then, I heard from some clinicians that some neuropsychologists do work in psychiatric wards/clinics, but its hard to find anything online verifying that. I would've imagined differential diagnostics & cognitive assessment was important in neuropsychiatric crisis, especially first episode/hospitalization.

I've worked in a variety of SMI settings (acute inpatient, residential for SMI populations, IOP and outpatient) and these assessments can almost always be done by any psychologist who should have competency to do cognitive screeners like the RBANS, which can then point to whether a full neuropsych eval is needed or to rule out cognitive causes.

And overall, I would say that cognitive screening is not usually part of an eval for SMI/first episode. And if it does become relevant, often times it's to assist with things like competency to make medical decisions and conservatorship, rather than diagnosis (in which case a neuropsychologist might be consulted).

In hospital settings, you'll most likely see neuropsychs utilized in geriatrics, rehab, and outpatient dementia/memory clinic type settings instead.

 

[chicandtoughness]

Are you against going for a doctorate? It sounded from the last bit of your post you’re only interested in the LMHC or LCSW pathway, is that correct? (Totally legit if so; I recognize not everyone has the time or financial means to pursue extended schooling)

If you’re not against going for a doctorate, I was actually going to say something mildly blasphemous for this area of SDN and suggest…. going to med school 🤣 Hear me out.

Getting to med school and through it, while tough, still has higher chances than getting into neuropsychology tbh. Once you’ve graduated, you can take a psychiatry residency and then a neuropsychiatry fellowship. (Yes I recognize the -iatrists are not the same as the -ologists but based on your description you’re primarily just interested in integrating biological models with treatment for SMIs). You will get plenty of neuro on the way to your degree and opportunities for diversified research in a way you might not as a psych doctoral student. You also heavily emphasize wanting to work on the acute psych wards, which is much more common as a physician than a neuropsychologist.

As an MD, you are set up to hold those dual roles you so desire - professor, clinician, researcher, private practice. Many, many MDs especially at academic centers have their fingers in all these pies at once. The time to completion will be similar to going the PhD/PsyD route + neuropsychology postdoc, but med school acceptance rates are actually higher than psych doctorate programs (minus the FSPPs which you shouldn’t attend anyways).

I’m an LPC/LMHC who ended up going this route for very similar reasons so feel free to pick my brain.

 

[whatishappeningpm]

Are you against going for a doctorate? It sounded from the last bit of your post you’re only interested in the LMHC or LCSW pathway, is that correct? (Totally legit if so; I recognize not everyone has the time or financial means to pursue extended schooling)

If you’re not against going for a doctorate, I was actually going to say something mildly blasphemous for this area of SDN and suggest…. going to med school 🤣 Hear me out.

Getting to med school and through it, while tough, still has higher chances than getting into neuropsychology tbh. Once you’ve graduated, you can take a psychiatry residency and then a neuropsychiatry fellowship. (Yes I recognize the -iatrists are not the same as the -ologists but based on your description you’re primarily just interested in integrating biological models with treatment for SMIs). You will get plenty of neuro on the way to your degree and opportunities for diversified research in a way you might not as a psych doctoral student. You also heavily emphasize wanting to work on the acute psych wards, which is much more common as a physician than a neuropsychologist.

As an MD, you are set up to hold those dual roles you so desire - professor, clinician, researcher, private practice. Many, many MDs especially at academic centers have their fingers in all these pies at once. The time to completion will be similar to going the PhD/PsyD route + neuropsychology postdoc, but med school acceptance rates are actually higher than psych doctorate programs (minus the FSPPs which you shouldn’t attend anyways).

I’m an LPC/LMHC who ended up going this route for very similar reasons so feel free to pick my brain.

WOW. I'll be honest, I did model my career path off doctors, - I actually work at an IRB in a hospital and watching the doctors discuss research during our meeting inspired me to go clinical. I did have some frustrations about the limits of a clinical psych degree, but I've made peace with it and also my primary research interest is investigating the neuroscience of internal monologue, inner dialogicality, and reported qualia of auditory hallucinations in individuals schizophrenia but I'd love to take that research further, I just wanted to be realistic about the license I was going to get. Given my phobia of needles and general queasiness, and the fact that I have a mild mathematics learning disability...the idea of med school or even passing physics/chem/calc courses in a pre-med post-bac seems incredibly far-fetched. I only passed biology/neuro-classes in undergrad because I was absolutely enthralled and those science courses make more "sense" to my brain. Still, I'd be fascinated to learn more about your pathway. Would you mind me sending you message?

 

[whatishappeningpm]

WOW. I'll be honest, I did model my career path off doctors, - I actually work at an IRB in a hospital and watching the doctors discuss research during our meeting inspired me to go clinical. I did have some frustrations about the limits of a clinical psych degree, but I've made peace with it and also my primary research interest is investigating the neuroscience of internal monologue, inner dialogicality, and reported qualia of auditory hallucinations in individuals schizophrenia but I'd love to take that research further, I just wanted to be realistic about the license I was going to get. Given my phobia of needles and general queasiness, and the fact that I have a mild mathematics learning disability...the idea of med school or even passing physics/chem/calc courses in a pre-med post-bac seems incredibly far-fetched. I only passed biology/neuro-classes in undergrad because I was absolutely enthralled and those science courses make more "sense" to my brain. Still, I'd be fascinated to learn more about your pathway. Would you mind me sending you message?

also to add on, im more interested in extended education but i am somewhat financially limited, everything would be loans or stipends basically. Im considering the LCSW as a back up if i cant get research experience and into school by my 30s (currently 27.)

 

[chicandtoughness]

Yes, please shoot me a message! I started med school at 33 with financial hardship (I can’t even pull grad plus loans because my credit score is so bad), failed physics and chem in college, puke whenever I have blood drawn, and untreated ADHD 😂 I love my journey and it hasn’t been easy, but I feel like I’m on the right path. Hopefully we can figure out one that works for you too!

 

[R. Matey]

OP, also check out the psychiatry board to ask about working with SMI folks as a doctor, if that's the direction you want to go.

 

[whatishappeningpm]

OP, also check out the psychiatry board to ask about working with SMI folks as a doctor, if that's the direction you want to go.

I will, thanks (=

 

[whatishappeningpm]

A true neuropsych/comprehensive assessment will require a doctorate. But social workers and other MA/MS holders do lots of psychosocial assessments in hospital settings.

A lot of people start off with aspirations to do many things simultaneously but end up settling for one primary role for their full-time work. Some people add some light private practice or adjunct teaching to either generate needed income or to have more variety.

But that will cut into your work/life balance, especially if you have kids and other major responsibilities.

It is hard for full-time clinicians to do research since we are primarily paid to provide clinical services & full time academics are paid to do academia.

It will also likely be harder as an LCSW or LPC to engage in research since there are generally less pathways to get that experience in grad school and to find funding to do it postgrad (ie funding is competitive and there are likely PhDs who will be more competitive).

Not sure about pay but there are lots of clinical positions to serve this position. Of the MA/MS options, I think the LCSW will be by far the best option since it’s broadly recognized and the case management training will be very relevant for this population, even if you end up in therapy focused jobs. Good luck!

Hi sorry to come back this, but I've been doing a lot of reflection of my goals since I posted this. You and and R Matey aren't the first to suggest that some of my interests may be too wide for a clinical psych (being interested in the neurobio of schizophrenia AND material conditions of psych units, but also my interest in working multiple roles), - it seems to be suggested that being a professor/researcher/clinician isn't something clinical psychologists do. I currently work at Mount Sinai and a huge professional inspiration for me is Dr. DePierro, a clinical psychologist who is an Associate Professor of Psychiatry at Mount Sinai, who (at least per his website) still sees patients, is the director of a psychiatric center at the hospital, as well as actively contributing to published research. Is it really uncommon for psychologists to wear all these hats like this? I was kinda basing my future off of this type of trajectory. I don't have any access to clinical psychologists in my personal life, so I have no idea what the true possibilities and limits are.

 

[R. Matey]

You and and R Matey aren't the first to suggest that some of my interests may be too wide for a clinical psych (being interested in the neurobio of schizophrenia AND material conditions of psych units, but also my interest in working multiple roles),

The only point I'm making is neuropsychologists typically aren't involved in assessment of psychotic disorders. That isn't meant to suggest that this isn't an area that clinical psychology has no interest in (I've met some of people who very much are). You might study this in graduate school and then go on to do neuropsychology, which would be fine, but you probably won't work in inpatient assessing psychotic disorders because there are other areas for which you may be better suited.

s it really uncommon for psychologists to wear all these hats like this? I was kinda basing my future off of this type of trajectory. I don't have any access to clinical psychologists in my personal life, so I have no idea what the true possibilities and limits are.

No, but think of it like majoring in one area and minoring in another. At an AMC (AMC= academic medical center), people are typically funded by some combination of clinical and/or grant dollars. This person might do one clinical day and then spend the rest of their time in research and admin. You also only have so much time, and at the end of the day, this is a job, not your life.

 

[summerbabe]

it seems to be suggested that being a professor/researcher/clinician isn't something clinical psychologists do. I currently work at Mount Sinai and a huge professional inspiration for me is Dr. DePierro, a clinical psychologist who is an Associate Professor of Psychiatry at Mount Sinai, who (at least per his website) still sees patients, is the director of a psychiatric center at the hospital, as well as actively contributing to published research. Is it really uncommon for psychologists to wear all these hats like this?

We were probably speaking to modal career outcomes, which I think is really important to consider alongside our biggest dreams/hopes.

Some chefs wear lots of hats and get their own shows on Food Network and have marketing deals with Walmart and travel the globe opening new restaurants every year but 99% are cooking for 50-60 hrs a week in an unglamorous kitchen somewhere.

Generally speaking, the most common place where this type of arrangement happens is at an academic medical center setting like Mt Sinai & a position like Dr. DePierro's is probably pretty competitive to obtain and takes a lot of tenure/skill at navigating institutional politics/luck.

For broader context, the largest employer (including mine) of psychologists is the Dept of Veteran Affairs. 92% of my work time is blocked for clinical duties with the remaining 8% is allotted for admin duties & that's standard for just about everybody employed in a front line role.

If I want to do research, it's on my own time and my own dime (assuming I can get affiliated with an IRB board/active research group). There are also people who work a split supervisory/admin and clinical role and people who are 100% in operations/management.

AMC settings are more likely to offer a research and clinical split. How much time you'll have for research is more complicated and the more research heavy it is, the more likely that you'll need a strong & specific CV to be considered.

One common route is that somebody secures 1 or more grants (usually external like via NIH but sometimes smaller ones internal to the AMC and guaranteed to the position) which 'buys out' a chunk of their clinical time.

So if that person was originally slotted to have 26 pt hours a week, a grant covering half their salary would free up 50% of their work time for research. But if you can't secure grant funding, you'll be doing those full 26 direct care hours.

The tricky part is, how do you do everything well when you want to wear multiple hats? How do you stay competitive in the research/grant space if your job requires you to do a bunch of clinical work to pay the bills so that you can advance and get a job like Dr. DePierro someday? An obvious answer is to make lots of personal sacrifices and do a bunch of stuff outside of our paid work hours.

And being a research beast as you apply for a PhD and during graduate school so that you can set yourself up for a prestigious first academic position upon graduation, which can then transition into other even more desirable jobs in the future.

If your first job is an assistant professor at Pudunk State U or as a staff psychologist at Nowheresville State Hospital, your career trajectory is probably not as rosy (if advancement is the goal). But by no means are those bad jobs or careers, it just depends on what will make us happy.

And lastly, the easiest piece to achieve in all of this is clinical work. Get licensed, start an LLC, get credentialed if you want to take insurance, get an EHR subscription and some other things and voila, you have a private practice! So it's infinitely easier for a full-time researcher to transition into clinical work than the other way around.

 

[R. Matey]

And lastly, the easiest piece to achieve in all of this is clinical work. Get licensed, start an LLC, get credentialed if you want to take insurance, get an EHR subscription and some other things and voila, you have a private practice! So it's infinitely easier for a full-time researcher to transition into clinical work than the other way around.

So true. Much easier to be a .75 researcher and .25 clinical than the other way round.

 

[whatishappeningpm]

We were probably speaking to modal career outcomes, which I think is really important to consider alongside our biggest dreams/hopes.

Some chefs wear lots of hats and get their own shows on Food Network and have marketing deals with Walmart and travel the globe opening new restaurants every year but 99% are cooking for 50-60 hrs a week in an unglamorous kitchen somewhere.

Generally speaking, the most common place where this type of arrangement happens is at an academic medical center setting like Mt Sinai & a position like Dr. DePierro's is probably pretty competitive to obtain and takes a lot of tenure/skill at navigating institutional politics/luck.

For broader context, the largest employer (including mine) of psychologists is the Dept of Veteran Affairs. 92% of my work time is blocked for clinical duties with the remaining 8% is allotted for admin duties & that's standard for just about everybody employed in a front line role.

If I want to do research, it's on my own time and my own dime (assuming I can get affiliated with an IRB board/active research group). There are also people who work a split supervisory/admin and clinical role and people who are 100% in operations/management.

AMC settings are more likely to offer a research and clinical split. How much time you'll have for research is more complicated and the more research heavy it is, the more likely that you'll need a strong & specific CV to be considered.

One common route is that somebody secures 1 or more grants (usually external like via NIH but sometimes smaller ones internal to the AMC and guaranteed to the position) which 'buys out' a chunk of their clinical time.

So if that person was originally slotted to have 26 pt hours a week, a grant covering half their salary would free up 50% of their work time for research. But if you can't secure grant funding, you'll be doing those full 26 direct care hours.

The tricky part is, how do you do everything well when you want to wear multiple hats? How do you stay competitive in the research/grant space if your job requires you to do a bunch of clinical work to pay the bills so that you can advance and get a job like Dr. DePierro someday? An obvious answer is to make lots of personal sacrifices and do a bunch of stuff outside of our paid work hours.

And being a research beast as you apply for a PhD and during graduate school so that you can set yourself up for a prestigious first academic position upon graduation, which can then transition into other even more desirable jobs in the future.

If your first job is an assistant professor at Pudunk State U or as a staff psychologist at Nowheresville State Hospital, your career trajectory is probably not as rosy (if advancement is the goal). But by no means are those bad jobs or careers, it just depends on what will make us happy.

And lastly, the easiest piece to achieve in all of this is clinical work. Get licensed, start an LLC, get credentialed if you want to take insurance, get an EHR subscription and some other things and voila, you have a private practice! So it's infinitely easier for a full-time researcher to transition into clinical work than the other way around.

Thank you (both) for your responses. That makes a lot of sense. I've been running around trying to understand what's best for my career goals and trying to understand what these jobs are actually like day-to-day but it's hard. There aren't shadowing opportunities like with physicians, which makes sense, but it's still hard to navigate. I really appreciate R Matey's & your responses.

 

[PsyDuck90]

Just wanted to tack onto the already great advice you’ve received from several other folks. You mentioned being interested in neuropsych assessment of people with psychotic disorders. I’m a neuro postdoc, so I definitely don’t claim to know everything about neuropsych, but I am at a large VA hospital that also has an inpatient psychiatric unit that occasionally consults us for evals. Our utility is hit or miss. If someone is floridly psychotic, you are not getting through a neuropsych eval. End of story. Usually the consults come after they are no longer in a psychotic episode and are planning on discharge. The questions are usually related to discharge planning and concerns of if there is a dementia process in addition to a history of schizophrenia or bipolar with psychotic features, etc. I’ve had some consults where it was an individual with their first psychotic episode and there was concern of if it is behavioral variant FTD vs. psychosis vs. substance use. These consults are few and far between though, and depending on the individual, there have been times where the chart looked like they were testable, and then I get to the unit, and they are clearly responding to internal stimuli and ignoring me and my questions. So while a neuropsychological coming to an inpatient psychiatric unit is not completely unheard of, it is not something that is all that frequent either. Definitely not enough to try and create even a part time gig out of it. Depending on the hospital, referrals from inpatient psych units may be discontinued immediately, with the recommendation being that outpatient can reconsult after the person is discharged and stable.

 

[chicandtoughness]

I saw your PM and will reply to it shortly!

The thing I did want to touch on - which seems trivial but really isn’t - is Dr. DePierreo is faculty in the dept of psychiatry. Most clinical psychologists by and large do not seek out academic medicine careers (emphasis on medicine, which is distinct from academic clinical psych which tends to lean more on a researcher identity). His story is likely in the (small!) minority.

Can you get there? Perhaps, with a ton of hard work, luck, and the stars aligning correctly. I like the metaphor presented earlier about chefs who have tv shows and brand deals and many different avenues for money…. But most chefs will be working a standard job in a kitchen. Given the inherent risks of being relegated to said “standard job”, what would you enjoy more: the “standard job” of an LCSW/LMHC, a clinical psychologist, or a psychiatrist? You’ve been given a lot of feedback that specifically mentions neuropsychologists do not often show up on the inpatient units, so if that is an area of utmost importance to you (SMI, schizophrenia, facility improvements) then neuropsych is likely not going to be your best bet. If research is highly important to you, then LCSW/LMHC is probably not what you want either.

Perhaps a useful exercise is to sit down and rank all of your needs/wants, and try to align the “standard job” of these various options to your rank list to see which fits most.

 

[whatishappeningpm]

Just wanted to tack onto the already great advice you’ve received from several other folks. You mentioned being interested in neuropsych assessment of people with psychotic disorders. I’m a neuro postdoc, so I definitely don’t claim to know everything about neuropsych, but I am at a large VA hospital that also has an inpatient psychiatric unit that occasionally consults us for evals. Our utility is hit or miss. If someone is floridly psychotic, you are not getting through a neuropsych eval. End of story. Usually the consults come after they are no longer in a psychotic episode and are planning on discharge. The questions are usually related to discharge planning and concerns of if there is a dementia process in addition to a history of schizophrenia or bipolar with psychotic features, etc. I’ve had some consults where it was an individual with their first psychotic episode and there was concern of if it is behavioral variant FTD vs. psychosis vs. substance use. These consults are few and far between though, and depending on the individual, there have been times where the chart looked like they were testable, and then I get to the unit, and they are clearly responding to internal stimuli and ignoring me and my questions. So while a neuropsychological coming to an inpatient psychiatric unit is not completely unheard of, it is not something that is all that frequent either. Definitely not enough to try and create even a part time gig out of it. Depending on the hospital, referrals from inpatient psych units may be discontinued immediately, with the recommendation being that outpatient can reconsult after the person is discharged and stable.

This makes A LOT of sense. Yeah, I think my interest in neuropsych came from an intense interest of both neuroscience & psych, and also caring a lot and wanting to learn more about how co-morbid or underlying conditions are caught/treated in the psych units and comprehensive approaches to care, especially considering so many psychotic patients coming in are homeless and keeping up with treatment is so difficult with that pop. Thanks for helping me get a better understanding of that.

 

[whatishappeningpm]

I saw your PM and will reply to it shortly!

The thing I did want to touch on - which seems trivial but really isn’t - is Dr. DePierreo is faculty in the dept of psychiatry. Most clinical psychologists by and large do not seek out academic medicine careers (emphasis on medicine, which is distinct from academic clinical psych which tends to lean more on a researcher identity). His story is likely in the (small!) minority.

Can you get there? Perhaps, with a ton of hard work, luck, and the stars aligning correctly. I like the metaphor presented earlier about chefs who have tv shows and brand deals and many different avenues for money…. But most chefs will be working a standard job in a kitchen. Given the inherent risks of being relegated to said “standard job”, what would you enjoy more: the “standard job” of an LCSW/LMHC, a clinical psychologist, or a psychiatrist? You’ve been given a lot of feedback that specifically mentions neuropsychologists do not often show up on the inpatient units, so if that is an area of utmost importance to you (SMI, schizophrenia, facility improvements) then neuropsych is likely not going to be your best bet. If research is highly important to you, then LCSW/LMHC is probably not what you want either.

Perhaps a useful exercise is to sit down and rank all of your needs/wants, and try to align the “standard job” of these various options to your rank list to see which fits most.

This is great advice, I'll def do that. Also, no rush at ALL. I can't imagine busy you are. I have some questions I'm exploring and I'd love to chat about your pathway, but I have a lot of time this month so whenever you get to it, you get to it. Thanks again (=

 

[R. Matey]

The thing I did want to touch on - which seems trivial but really isn’t - is Dr. DePierreo is faculty in the dept of psychiatry. Most clinical psychologists by and large do not seek out academic medicine careers (emphasis on medicine, which is distinct from academic clinical psych which tends to lean more on a researcher identity). His story is likely in the (small!) minority.

PSA, folks: It's not uncommon for psychologists to have appointments in psychiatry departments. I'm in a large AMC and I work in a psychiatry department. About a third of the departmental faculty are psychologists either on the clinical or research side.

 

[whatishappeningpm]

PSA, folks: It's not uncommon for psychologists to have appointments in psychiatry departments. I'm in a large AMC and I work in a psychiatry department. About a third of the departmental faculty are psychologists either on the clinical or research side.

Ok, this is comforting at least because i know this is the setting i want to work in.

 

[chicandtoughness]

PSA, folks: It's not uncommon for psychologists to have appointments in psychiatry departments. I'm in a large AMC and I work in a psychiatry department. About a third of the departmental faculty are psychologists either on the clinical or research side.

I stand corrected! I've only been in one AMC so will defer to those who have more experience than me 🙂

I was primarily commenting on the fact that of all graduating psychologists, most will not be in academic medicine, but my phrasing was extremely confusing.

 

[R. Matey]

I stand corrected! I've only been in one AMC so will defer to those who have more experience than me 🙂

I was primarily commenting on the fact that of all graduating psychologists, most will not be in academic medicine, but my phrasing was extremely confusing.

Yeah, no worries. It's kinda niche, but AMCs do employ a lot of psychologists in both clinical and academic roles. Not just in psychiatry either, but also in like family medicine (primary care), pediatrics, anesthesiology (pain psych), etc. I did a rehab psych prac in a plastic surgery department, for instance.