Here to help if I can

[PsyDDoc]

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Hi,

I am a clinical neuropsychologist and graduate of the Chicago School of Professional Psychology (CSPOPP) (PsyD). I am currently practicing in Central Florida at one of the larger hospitals.

I have been reading through the forums and am dismayed at the impressions some students have of the practical differences between the PsyD and the PhD (there are really very few, if any) in clinical practice.

I am here to answer any questions you folks may have about the realities of practicing as a doctor of psychology in a hospital, i.e. responsibilites, flexibility, salary etc. I am here to help some of you makes some decisions either way (Ph.D. or Psy.D.) and shed light on the recent changes in reimbursement and medicare. I am in a unique position as my wife is also a practicing neuropsychologist with a Ph.D.

Just as an aside, we (my wife and I) both conducted rigerous clinical externships (I did three, she did two) and we both completed quantitative disserations (not a CRP). So fire away. Again, I can only speak to hospital or clinic based practice. My practice is split between inpatient rehabilitation (CVA, head injury, spinal cord) and outpatient neurology (dementia).

Glad to be here.

PsyDDoc

 

[CheetahGirl]

Welcome! 😉

 

[nobleheart]

Thanks...I am sure we are all grateful for your time.

I have a few comments/questions. I am coming from a biology background(B.S.) and am a physical therapist asst. working in acute care neuroscience. I am planning on applying to several Psy.D. programs this coming year(completing a masters of public health). All in all it seems that the majority of students that come from a lab science background seem to prefer neuropsych. I have been looking into both neuro and health psych...comments or field experience contrasting the two, especially in a hospital setting? It seems that neuropsych is a specialty that, well, would make it difficult to find employment. Is this true? Also, how do you feel about your role in the hospital team. The hospitals that I have been employed do not have neuropsychs. Do you participate in a transdisciplinary model? If so, what are your thoughts about the teams cohesiveness in implementing care? If not, how is your relationship with your colleagues and pt's structured?

Thanks again,
T🙂

 

[Therapist4Chnge]

Welcome!

-t

 

[Therapist4Chnge]

It seems that neuropsych is a specialty that, well, would make it difficult to find employment. Is this true?

Just the opposite. It is a GREAT area to be in; it gives you a leg up over generalists. If you are willing to work with the older populations....you should be able to have plenty of opportunities (VA's, etc). If I did it over again, I would have gone neuro.

-t

 

[thewesternsky]

How, exactly, does one become a clinical neuropsychologist? Is a specialized program important? A specialized internship? Are both crucial?

 

[Baloo]

Welcome!!! Good to have you on board!!! I will be attending the Georgia School of Professional Psychololgy this fall and will be pursuing the neuropsych track. I would really like to know how much a clincial neuropsychologist in a clinical setting (hospital) makes after post-doc? And if the salary is satisfying? Also, once a clinical neuropsychologist has enough clientele to open a private practice, how much is their income? Thanks, if you don't feel comfortable discussing this on the board I completely understand! You can always private message me, or not!! Thanks again!

 

[PsyDDoc]

Hello again,

Noble Heart, to answer your questions:

"All in all it seems that the majority of students that come from a lab science background seem to prefer neuropsych."

In actuality, I completed a BS in psychology/minor in English, not exactly heavy sciences but i did enjoy Bio/Chem/physics. I thought that I wanted to be a psychotherapist initially, a real glorified Freudian...ha...sometimes it is finding out what you DONT like to help you decide what you do. Well, I became burned out after two externships conducting therapy with DCF families.

Neuropsych is a fair amount of neuroanatomy, neurology, and the combination of brain dysfunction and behavioral change and so there is a fair amount of science to contend with but I like that. It is a "cleaner" part of psychology but certainly not perfect in any way.

While you do need to focus a significant amount of clinical workings in a PsyD program, you can decide what type of clinical work you want (i.e. assessment versus therapy). I enjoyed the complexities of diagnostic testing, clinical interview, and melding all of the medical/psychosocial/psychiatric/behavioral test data together to help understand and ultimately diagnose a patient (in essence what a neuropsychologist will do).

"It seems that neuropsych is a specialty that, well, would make it difficult to find employment. Is this true?"

No actually it is easier to find employment as you can engage in so many different venues (for example, Independent Medical Evaluations, Forensic Evaluations, Work Compensation cases, leading or helping to direct inpatient/out patient rehabilitation teams, consulting at bedside on neuro/oncology/acute care floors, in the school system etc.) Specialization is the way to go. As well, all bills a neuropsychologist submits are typically medical and therefore reimbursed at higher rate and easier to track. For example, if a patient is sent to me for dementia related problems, then regardless of what I find from a mood standpoint, the diagnosis remains 780.93 - memory loss, a medical diagnosis not a DSM-IV behavioral diagnosis. Because you are billing medical codes and using the new CPT codes (check nanonline.org for the newly updated reimbursement values) you typically make more money as a neuropsychologist. Finding work in geographical areas in need of neuropsycholgy is the key.

"Also, how do you feel about your role in the hospital team. The hospitals that I have been employed do not have neuropsychs."

Many cannot afford a neuropsych in their budget, don't realize that you can bill for their time, or simply do not understand what we do. Also, many neuropsychologist do not like to work for a hospital for fear of losing some autonomy. That is unfortunately true to some extent whenever you work for any organization period. I however, have no "boss" and have good autonomy in my practice. I simply work for the hospital.

Our inpatient rehabilitation floor requires a psychologist/neuropsychologist to be on staff to receive their accredidation each year. Our memory disorder clinic needs each patient to be evaluted by a neuropsychologist in order to confirm or deny diagnosis. I very much feel as an important part of the team and of the hospital. It is true however that in terms of actual testing, the inpatient acute care side is not the best place and many assessments are performed by OT and SLT. However, for behavioral direction, mental status checks, affective evaluation, and capacity evaluation, psychologist are best (not psychiatrists who rarely if ever have the time or dare I say, bedside manner?).

"Do you participate in a transdisciplinary model? If so, what are your thoughts about the teams cohesiveness in implementing care? If not, how is your relationship with your colleagues and pt's structured?"

I do participate in a interdisciplinary model, OT/PT/SLT/Social Work/Physician etc. The cohesiveness is key and works very well once roles are clearly established (as is the case on any team). Everyone must work and be flexible around the patients need for three hours of PT/OT/SLT (neuropsych does satisfy 1 of their 3 required hours per day). If I come in a take a patient away from a therapist, this causes resentment, and that cannot take place on the team long term as it will trickle down to patients. However, I am on consult on most but not all patients on the floor, and ultimately my need to see the patient takes precedence over others. The benefit of a multidisc team is that I have twenty eyes instead of two and I can get a more true understanding of a patients abilities and can have more confidence in my diagnosis (as opposed to seeing the patient for one or two hours and basing diagnosis on that cross section of time).

Hope this is helpful, check out the graduate program in depth before applying. I can help give an opinion if you want.

Take care 🙂

 

[nobleheart]

Excellent feedback! Lots of things to consider. Thanks for your time and input.....T😀


Did you or your wife find that the neuropsych internships/post-docs were extraordinarily competitive?

Do you think it was harder for you to match with the Psy.D. than for her with the Ph.D.?

Thanks again....

 

[lakewood]

What did you think of the Chicago School in general, and how did it prepare you for neuropsych?

How are salaries in neuropsych? To what extent does it help compensate for the cost of grad school? (numbers always appreciated!)

 

[Neuro-Dr]

I guess I would ask how you received training in neuropsychology given that your program has no track, minor, concentration or organized coursework in the area of neuropsychology. I'm not criticizing your choice of school or program's clinical training, but I don't see any NP work there.

 

[Livethedream]

Great thread! 😀

Is it necessary to do a neuropsych pathway as part of your doctorate to be eligible for a neuropsych post-doc? Or is a doctorate which has adequate emphasis on neurpsych/neuroanatomy/brain-functioning etc ok? Also, which schools provide neuropsych pathways and which ones have a strong emphasis on neuro-related aspects of psychology? I know UCLA has a strong interest in neuroscience etc but I'm not sure whether it has a specific neuropsych pathway integrated into the doctorate program. It does however have a neuropsych route as part of its internship program. Would this be adequate to obtain a neuro-psych post-doc?

 

[PsyDDoc]

Hello,

To respond to a few comments:
Both:

---Is it necessary to do a neuropsych pathway as part of your doctorate to be eligible for a neuropsych post-doc? Or is a doctorate which has adequate emphasis on neurpsych/neuroanatomy/brain-functioning etc ok?

---I guess I would ask how you received training in neuropsychology given that your program has no track, minor, concentration or organized coursework in the area of neuropsychology. I'm not criticizing your choice of school or program's clinical training, but I don't see any NP work there.Yesterday 08:39 PM

To clarify, CSOPP does not have a Neuropsych track per se but they do have multiple classes in neuropsychology and neuroscience (at least when I was there four years ago) which were very good. Coupled with neuropsych experience on internship and post doc, it was a good foundation. But the learning does not stop here. Now if you mean engaging in a formal neuropsych research project so that I could explore the menutia of one question or aspect, no I did not do that.

Dr.'s Ronnie, Konofka, and Larson were key neuropsychology/forensic influences at the CSOPP. Also keep in mind that in practice, Neuropsychology is a mixture of clinical work, knowledge of psychosocial issues, good clinical interviewing, psychopharmacology, neuroanatomy/physiology, knowledge of cultural issues, and most importantly the strengths and limitations of your test battery and knowing why you use it or do not use it.

I have found that continued consultation with colleauges, my own reading and becoming a member of various organizations (NAN, DIV 40 and 22, INS) and learning through CE is a key aspect of post doctorate education. Students be warned....the learning does not stop after graduation and engaging in your own practice. It is just beginning. One schools or professors ideas/approach toward neuroassessment (i.e. fixed versus flexible etc.) is not the golden rule. This is a blessing and a curse in the field (lack of standardization of practice). I have altered my practice patterns several times and continue to hone my skills as a new practicing neuropsychologist each day. The key is not thinking that you know everything and that there is always room to learn.

I had no problem receiving neuropsych training at my VA internship. However, it was a generalist internship with neuropsych as one rotation and clinical rehab/PTSD in the other two. Post doc was a mixture of rehabilitaton and neuropsychology assessment on an inpatient brain injury floor. There is more than one way to accomplish your goal of becoming a neuropsychologist without a dedicated doctoral program, internship, and post doc, however, if you know initially that this is what you want to do with your life's work, focus early.

BTW, I very much enjoyed the CSOPP experience in general. Heavy clinical focus, still has disseration a main component (qualitative or quantitative). Heavy focus on multicultural issues. Neuropsych is no longer as much a focus as it has been I understand. Overall one of the best professional schools out there in my opinion. They just received a seven year accredidation from APA.

My wife's pediatric neuropsych internship was very competitive (she got the only position available in Miami. I was very proud of her. Her's is a dedicated neuropsych position. As I said earlier, mine was more generalist with neuropsych one third. BTW, I got my second ranked site and she got her first. No big difference there. I know of a few sites that actually prefer PsyD over PhD due to the strong clinical focus. But in the end it is the program itself not the degree that makes the difference.

One last thing, I have begun the ABPP process in Rehab psychology (DIV 22 - diplomatic status). Some of you may wish to persue this as opposed to dedicated neuropsych diplomatic status (DIV 40) if you work in a rehab setting as this certificate incorporates many areas including neuropsych proficiency.

Cheers.

PsyDDoc

 

[Neuro-Dr]

I think you may be correct that something has happened with CSPP in regards to NP. They only currently list 2, 2-credit course in the area. Having said that, I think students would appreciate your approach to continued learning. The Houston Conference Guidelines and their upcomming successor, "the Summit" meetings have favored a hierarchical approach to training in NP. This would include competencies as opposed to courses for training. In this way, a program that was heavy in coursework (I had 28 hours in grad school) would meet the competencies in neuroanatomy/neuropathology, functional imaging, psychopharm, assessment and interventions at the graduate level. Others from less coursework may address these domains on internship or fellowship. I went through NP boards a few years ago and it is a lengthy process that asks as much about what you have done since graduating as what you did in school. ABCN is still very concerned about organized training and I'm still not sure what makes the grad school years so magical that skills can't be acquired at other levels, but if you have a good fellowship it makes a huge difference. Partly, because the powers that be run those fellowships and partly because the board sees them as a way to do the due diligence on an applicant for them.

Glad to have you on board. Always good to have another NP around.

 

[PsyDDoc]

Thanks much, Neuro-Dr. Glad to be here 🙂

 

[PsyDDoc]

Jon, My post doc was 1 year, 85% neuro/clinical psychological assessment (neurobehavioral exams and comprehensive evals) on a general rehab patients (spine, head injury, altered mental status etc). This was done on an inpatient/outpatient basis on a multidisc. team. The rest was acute short term crisis management and psychoeducation etc. What about yours? 🙂

I think the Houston approach is a great idea however, professional schools would have to adapt this idea and created dedicated tracks for their clinical programs. My school did not. The real concern is that for many graduate students, they might not know for sure that they wish for a dedicated neuropsych track until their second or even third year. Generalist training with specific training on externships, internship, and post doc is essential. I found that my clinical psychological assessment externship during my first year helped the most in terms of directing me toward a career of neuro/psychological assessment. One year after postdoctoral training, while working in a neurosurgery/neurology clinic, I continued to receive weekly consultation on difficult cases (and still do from time to time). This is essential I believe. Afterall, one is not an "expert: or "advanced" clinical psychologist after post doc, don't you agree?

 

[psydplease]

hi just wanted to know your thoughts on csopp as i will be attending in the fall in clinical psych in the child and adolescent track

 

[PsyDDoc]

Jon, while I have no regrets, I only wish I had known my intended career path earlier on in my graduate training and I likely would have done things a bit differently as my wife has, but you know what they say about hindsight. One can do the best they can and continue to learn. Check your pm. I have a question for you.

 

[PsyDDoc]

PsyDPlease:

I enjoyed CSOPP very much, however, the school is very different than it's been in the past. My class was 32 students with only one track (clinical) and now it is well over 100 (at least, with multiple terminal programs). As long as the student-faculty ratio remains consistent then from a clinical perspective your training should be good. I still think that CSOPP is a good clinical program compared to others but I can only comment on my experience. I like the school's commitment to the multicultural diversity and addressing these issues head on and not in some direct manner. I think I am doubly aware of the need for better normative data and am always somewhat more hypervigalent to cultural factors because of my training there. Chicago is a wonderful resource for practicum experience, however, as in many PsyD programs, the research perspective is limited. Just my two cents. Good luck and enjoy the journey that lies ahead. PsyD or PhD aside, graduate school in clinical psychology is a long, rewarding, and challenging road (and it should be). Have fun.

 

[Lunabin]

I'm soon to be graduating with my PhD from California School of Prof. Psych, and just got accepted into a 2 year neuropsych postdoc (mostly forensic)... I'm under the impression that adhereing to Houston Conf. guidelines has become imperative to the future of neuropsych, and especially in terms of board certification, and am planning this stage of my training accordingly. Though, I wonder if you have thoughts on that? I've heard mixed opinions on this from neuropsychologists already practicing...

Also, though you mentioned something to this effect above, I'm wondering how easy/hard it is to find work (consultation or otherwise) within a hospital setting (this is my ultimate goal)? Like you said, we aren't hired on due to general lack of funding, but I'm under the impression that neuropsych is somewhat still an unknown science to many in the medical field. Do you see this as an expanding area? It just seems like neuropsych is still very concentrated in private practice. What do you think?

 

[Therapist4Chnge]

For those of you interested, here is more info on the Houston Conference. (I googled it, since I didn't know specifics about it)

-t

 

[PsyDDoc]

To answer your questions Lunabin-

--Also, though you mentioned something to this effect above, I'm wondering how easy/hard it is to find work (consultation or otherwise) within a hospital setting (this is my ultimate goal)? Like you said, we aren't hired on due to general lack of funding, but I'm under the impression that neuropsych is somewhat still an unknown science to many in the medical field. Do you see this as an expanding area? It just seems like neuropsych is still very concentrated in private practice. What do you think?


Lunabin- I do not believe it is hard to find consultative work in a hospital setting however, you must understand (and I think you do) that many hospitals do not understand the role of the neuropsychologist. However, that said, there is a great need for adminstrative education. If, for example, you work on an acute rehabilitation team (In or outpatient) they will likely require neuropsychological testing in some capacity (neurobehavioral examinations, capacity evaluations, family education about their loved ones head injury or disease, and comprehensive return to work/school evaluations). The education to the hospital administrators must be one of clinical utility (an obvious one) and of financial viability (they can be reimbursed for your services.) With the new medicare fee schedule this is more possible than ever. Workers compensation is another very lucrative partnership.

I guess, as I said previously, location is a big issue. Our hospital in central Florida had no neuropsychologists (or clinical psychologists) at the time I started the department. Since then I hired another Ph.D. neuropsychologist to join the practice. We are swamped. There is such a need in central Florida that the opportunity is great. I am hoping that you have some flexibility in your eventual job placement, but even if you don't, call all of the hospitals and clinics in your area and see where opportunities exist. That by the way, is how I got my first post licensure position, by calling a local neurology clinic (neurosurgeons/neurologists) and pitching my idea in a powerpoint presentation over lunch. One month later I was seeing patients performing both presurgical and dementia evaluations. It was a great first job.

Good luck. 🙂