Health Psychology: support and vent thread

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What type of site do you work at?

  • Private practice

    Votes: 0 0.0%

  • University hospital

    Votes: 2 16.7%

  • Academic medical center

    Votes: 5 41.7%

  • Public hospital

    Votes: 1 8.3%

  • Private hospital

    Votes: 1 8.3%

  • VA

    Votes: 4 33.3%

  • Prison

    Votes: 0 0.0%

  • Community health center

    Votes: 1 8.3%
  • Total voters
    12
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nicolascagephd

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Good morning! I'm excited to see support for a regular thread for health psychologists.

To get the conversation started, what are the common struggles/annoyances at your workplace?

For me, it often feels like psychologists are viewed as the lowest tier in the university hospital in which I work. I am still trying to navigate it!
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For those that work in health psychology, which area do you work in? I work in surgery and am finding it tough to manage the pressures from business admin compared to enjoying the clinical work.
 
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I'm trained as a health psychologist, but hang out in general mental health because my colleagues integrated in PC seem really stressed.
 
nicolascagephd said:
For me, it often feels like psychologists are viewed as the lowest tier in the university hospital in which I work. I am still trying to navigate it
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I mean, the modal (read: midlevel) therapist is overconfident and undertrained so I kinda get it, but it does suck to constantly be proving ourselves. For my part, I had mixed reception when I was in primary care. Some people were really great about deferring to me for MH stuff, others wanted to send patients to psychiatry for any MH issue, but I think that says more about them than it does about me.
 
Shiori said:
I'm trained as a health psychologist, but hang out in general mental health because my colleagues integrated in PC seem really stressed.
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Depending on the PC clinic, it can be stressful, though I've been in some that are great. Specialty care is the best, though.

R. Matey said:
I mean, the modal (read: midlevel) therapist is overconfident and undertrained so I kinda get it, but it does suck to constantly be proving ourselves. For my part, I had mixed reception when I was in primary care. Some people were really great about deferring to me for MH stuff, others wanted to send patients to psychiatry for any MH issue, but I think that says more about them than it does about me.
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And the third category of providers who want to refer to you in lieu of having good bedside manner.

In my job in MH before grad school, someone got referred by their physician because they cried when being diagnosed with an STI. They were fine by the time they got to us, so the situation really just needed the provider to be a human for like 2 minutes.
 
Starting a medical/health psych external practicum at a large hospital system in August so hopefully I can contribute to this thread in the near future! In the meantime I'll be stalking...
 
R. Matey said:
I mean, the modal (read: midlevel) therapist is overconfident and undertrained so I kinda get it, but it does suck to constantly be proving ourselves. For my part, I had mixed reception when I was in primary care. Some people were really great about deferring to me for MH stuff, others wanted to send patients to psychiatry for any MH issue, but I think that says more about them than it does about me.
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I do a lot of psychological assessment and it seems that there is the most resistance if the findings slow down the process of a patient getting surgery, which I can understand. However, it's really tough to be in the position where the patient is upset with psych and the surgeon is less than supportive too. On the other hand, as soon as someone is struggling post-op, the surgeons tend to have an urgency about them being referred back to psych.
 
nicolascagephd said:
I do a lot of psychological assessment and it seems that there is the most resistance if the findings slow down the process of a patient getting surgery, which I can understand. However, it's really tough to be in the position where the patient is upset with psych and the surgeon is less than supportive too. On the other hand, as soon as someone is struggling post-op, the surgeons tend to have an urgency about them being referred back to psych.
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That's a common problem with doing pre-surg in any specialty. Surgeons have the ultimate say-so (generally), despite it being an ostensible interdisciplinary team effort, resulting in some of them acting like the pre-surg psych eval is pro forma. I've seen some of them set a surgery date before the psych eval appointment. Not that the eval is done, but the report isn't submitted yet and they've consulted with you for the thumbs up or down. They've already decided on the surgery and may have even told the patient, which sucks so much. And like you said, they or someone else on the team comes to you in a panic once things go bad post-op.

This is an even bigger problem if there are separate pre- and post-op teams. The pre-op teams often just focus on saying "yes" to every patient and overlooking or intentionally making excuses for things that are well-establishing problems (though not necessarily strict contraindications) on the back end post-op. This then leaves the post-op teams to clean up the mess. This creates animus between the teams and makes a toxic work environment that they then often look to psych to resolve instead of fixing it themselves.
 
RxPsych said:
Starting a medical/health psych external practicum at a large hospital system in August so hopefully I can contribute to this thread in the near future! In the meantime I'll be stalking...
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I'm also a current student and really excited about doing a combo of behavioral health in a rural community health center, autism and neurodevelopmental disorder assessment at a specialized interdisciplinary clinic, and our local LEND (Leadership Education in Neurodevelopmental and related Disabilities) program. We unfortunately don't have any hospital practica, so I'm trying to get broad health psych experiences to set myself up for a potential internship/post doc. Really excited to learn from everyone!
 
I did LEND - it def helped me get my foot in the door!
Dazen said:
I'm also a current student and really excited about doing a combo of behavioral health in a rural community health center, autism and neurodevelopmental disorder assessment at a specialized interdisciplinary clinic, and our local LEND (Leadership Education in Neurodevelopmental and related Disabilities) program. We unfortunately don't have any hospital practica, so I'm trying to get broad health psych experiences to set myself up for a potential internship/post doc. Really excited to learn from everyone!
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Shiori said:
There is brewing battle among some of the physicians about standards of care. I have been pulled into it, so I feel more like a health psychologist today.
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I have also noticed the tension about standards of care. Lately it seems like there is less of an understanding between MDs about professional autonomy and more about wanting to be seen as correct. Not to mention the tensions between internal medicine and surgeons in my department, oof.
 
Yeah, I was involved in a discussion about following traditional methods versus adopting evidence-based practices to reduce patient burden. The issue was we were about to require a patient to undergo unnecessary procedures based on outdated protocols instead of assessing their individual needs. I think we got it mostly fixed though.
 
borne_before said:
AC is down at the clinic today. It's already 80 in here...
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Last summer for about a week my PI found a spare office I could use. The reason being that the AC was down in my building and my particular office was sitting at around 90ish for most of the day.
 
psych.meout said:
And the third category of providers who want to refer to you in lieu of having good bedside manner.
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This brings back memories. I rotated through an oncology unit where the attending wanted me on rounds just so he could just drop the bad news about the diagnosis and leave me there with the patient after walking away with the residents.
 
borne_before said:
They ended up cancelling clinic. Thank god. I did a feedback and it got above 85 in my office. It's the time of the year where the rains come and overnight temps seldom dip below 88 degrees. I can actually handle 90 degree 5am runs pretty easily. But when the humidity gets about 40%, it's like oppressive, man. Dry heat is so nice. Oh well, the meme is "if you can't handle june/july/august, you don't deserve (my city) for the rest of the year."
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Dry heat is nice, but I've had "closer calls" with dry heat far more than humid. When I was in Singapore last August all I could think about was getting to AC, it felt worse than it was. Meanwhile we get to about 100F here in the desert and I tend not to "notice it" until I start getting pretty light headed. Then again, trying do a 20 mile mountain bike ride when it was 104 outside was just begging for a Darwin Award.
 
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Really feeling the burnout today. I don't know if I can continue working in a discipline that is so profit-focused and influenced by surgeons who don't respect what we do as psychologists. I'm exhausted from trying to prove my competence to a team that could not care leas about mental health.
 
nicolascagephd said:
Really feeling the burnout today. I don't know if I can continue working in a discipline that is so profit-focused and influenced by surgeons who don't respect what we do as psychologists. I'm exhausted from trying to prove my competence to a team that could not care leas about mental health.
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All of healthcare is profit focused excepting a few places like the VA (that are politically focused). Finding a good medical team to collaborate with is important. That said, you are a psychologist and not a pre-surgical evaluator. There are many things you can do and many people you can choose to collaborate with on care. Learning what you like and don't like is an important part of managing your career.
 
Sanman said:
All of healthcare is profit focused excepting a few places like the VA (that are politically focused). Finding a good medical team to collaborate with is important. That said, you are a psychologist and not a pre-surgical evaluator. There are many things you can do and many people you can choose to collaborate with on care. Learning what you like and don't like is an important part of managing your career.
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Didn't they say earlier that they're doing pre-surg evals?
 
psych.meout said:
Didn't they say earlier that they're doing pre-surg evals?
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I could be wrong, but I think Sanman was saying that they're not just a pre-surgical evaluator. Just like physicians aren't just "prescribers," neuropsychologists aren't just testers, etc.
 
AcronymAllergy said:
I could be wrong, but I think Sanman was saying that they're not just a pre-surgical evaluator. Just like physicians aren't just "prescribers," neuropsychologists aren't just testers, etc.
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the simpsons me fail english thats unpossible GIF
 
psych.meout said:
Didn't they say earlier that they're doing pre-surg evals?
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AcronymAllergy said:
I could be wrong, but I think Sanman was saying that they're not just a pre-surgical evaluator. Just like physicians aren't just "prescribers," neuropsychologists aren't just testers, etc.
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Exactly, my point was that the OP should not confuse a bad job with a bad career choice. That may be a bad team, pre-surgical evaluation may be a bad fit careerwise, etc. but that does not mean they cannot do anything else within their scope of practice. Careers don't have to follow a single trajectory. You can find something different that is more satisfying to you. I see folks change what they do even decades into practice.
 
I appreciate that response. I love health psychology but I may need to shift gears in terms of the team environment. My fellowship had very happy psychologists that were even friends with some surgeon. But my current site feels conflictual and almost hostile. One of our surgeons told us that we should not require that a patient can verbalize a (very) basic understanding of the surgery and its risks, which is in direct conflict with our psychology guidelines. Even after explaining this, it was poorly received and challenged again. It is a recipe for burnout, unfortunately. Which health psych areas have you seen your colleagues transition into? Sometimes I worry my population/skillset is too niche.
 
nicolascagephd said:
Really feeling the burnout today. I don't know if I can continue working in a discipline that is so profit-focused and influenced by surgeons who don't respect what we do as psychologists. I'm exhausted from trying to prove my competence to a team that could not care leas about mental health.
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I come from a school psych background and had a huge learning curve on my first teams.

But, then I realized, it's very similar to working in a school and being on that kind of team.

Do you want to know how I think about working with any team? A huge part being a school psychologist is going into school, which is like someone else home, and trying to effect change. It's a daunting task, political, and fraught with ego and competing positions/interests/goals.

A framework for understanding this involves involves French and Raven's bases of power? Are you familiar?
 
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nicolascagephd said:
I appreciate that response. I love health psychology but I may need to shift gears in terms of the team environment. My fellowship had very happy psychologists that were even friends with some surgeon. But my current site feels conflictual and almost hostile. One of our surgeons told us that we should not require that a patient can verbalize a (very) basic understanding of the surgery and its risks, which is in direct conflict with our psychology guidelines. Even after explaining this, it was poorly received and challenged again. It is a recipe for burnout, unfortunately. Which health psych areas have you seen your colleagues transition into? Sometimes I worry my population/skillset is too niche.
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Pre-surgical evaluations are a recommendation. The surgeon can choose to ignore it. The record will reflect the same when they get sued for malpractice for operating on someone that did not have the capacity to consent. That is the only answer I would give in that discussion as someone trained in capacity assessment.
 
nicolascagephd said:
I appreciate that response. I love health psychology but I may need to shift gears in terms of the team environment. My fellowship had very happy psychologists that were even friends with some surgeon. But my current site feels conflictual and almost hostile. One of our surgeons told us that we should not require that a patient can verbalize a (very) basic understanding of the surgery and its risks, which is in direct conflict with our psychology guidelines. Even after explaining this, it was poorly received and challenged again. It is a recipe for burnout, unfortunately. Which health psych areas have you seen your colleagues transition into? Sometimes I worry my population/skillset is too niche.
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I think it's more about team members/culture, etc. vs. the health psych area (e.g., onc vs. transplant vs. bariatrics). I do pre-surg evals for liver and kidney transplants and one team is super integrative, really respects psychology's recommendations, etc. and one is...not that way and they do what they want.
 
coffee&CBT said:
I think it's more about team members/culture, etc. vs. the health psych area (e.g., onc vs. transplant vs. bariatrics). I do pre-surg evals for liver and kidney transplants and one team is super integrative, really respects psychology's recommendations, etc. and one is...not that way and they do what they want.
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As someone that has worked on multiple interdisciplinary teams over the years, my experiences have been similar. However, as you get older, the question becomes whether you want to deal with those dynamics at all. Folks in private practice that work as therapists or even consultants completing evaluations do not. Some can find a long-term fit, some put up with it, and some move on.
 
Agreed with the above; there can be a lot of variability across teams in terms of the respect for, and appreciation of, pre-surgical psych evals. Some surgeons and teams greatly appreciate our perspective and others tend to view us as an annoying box they need to have checked. Sort of like VA--if you know one surgical team, you know one surgical team. Although that can be the same across pretty much any medical specialty/area outside of mental health in which a psychologist is embedded or used.

But I would say the same types of skills you're using in performing pre-surgical evaluations are going to be potentially useful in all sorts of positions. There are plenty of psychologists out there who seem very uncomfortable doing any sort of assessment, let alone one that has immediate and recognizable consequences. And the ability to competently interact with other healthcare professionals is a very useful skill.
 
Anyone know of a ACT-chronic pain specific live training? I want to hone my skills.
 
psycho1391 said:
Yeah that manual isn't my favorite tbh
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Yep, I really don't like that manual (maybe partly because of the creepy drawing on the cover...). I've taken the worksheets from this and modified them for my own use, based on ACT protocols we have in our geropsych shared drive at my site.
 
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