PhD/PsyD I love psych, but I want money..

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entitlement said:
Good points and I edited my post to correct the R01/R1 issues. This is what happens when one is in full NIH grant writing mode for the last few days!

And yes, please do investigate these salaries. While getting information on salaries for folks in private practice or doing clinical work might be difficult, you can easily look up information on salaries in public positions, such as public universities, the federal/state/city governments, etc. Look up positions for psychologists on sites like usajobs.gov, or your local county, and you will start getting an idea of what types of salaries you might expect. Many psychologist positions on indeed.com also post salary ranges. Take sites like glassdoor with a grain a salt, for many of the reasons lurking oracle outlined.
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I assumed that you knew the difference, but since there are folks of a variety of experience levels here I wanted to make that clarification.
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entitlement said:
Not to get off topic lurking oracle but why do you believe billing insurance for psychoed evals is committing fraud?
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Not a "medically necessary" service provision.
 
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Lurking Oracle said:
Just a few comments, not directed at anyone in particular, but I hope that @vashibashi finds them useful. In no particular order… 1) Be sure to appreciate the difference between “salary” and “income.” I have seen several instances in this thread of the two terms being interchanged, and even used incorrectly. A salary is a fixed annual amount of money that you are basically guaranteed to receive if you show up and do your job as agreed upon. An income is the total of all the money that you have coming in from all revenue streams, day job, private practice, consulting, rental property, other passive income, whatever. What some people have described as “salary” is actually total income from multiple sources. For example, if you have a day job at an R1 academic medical center, and then see patients in the evening and every other Saturday, all of that is your total income, not salary. This is not a mere semantic issue. In neuropsychology, there is an oft-cited (and often useful) periodic survey that is always referred to as the “salary survey.” It is not. It is a self-reported income survey. This beings me to my next point. 2) Anyone can report any level of income that they please in a forum such as SDN. No one will check. I also think that it is those individuals that truly have exceptional salaries (“exceptional” = “exception;” i.e., not the mean or mode, or what any newbie will actually earn just out of training) are more likely to post in a forum like this. This is also called bragging. Yes, yes, “it ain’t braggin’ if you did it,” but just recognize that these folks did not step out of internship and waltz into $200-$300K on Day One. Which brings me to my next point… 3) The reliably higher earning areas in psychology require additional training and credentialing beyond the minimum. For neuropsychology, particularly forensic neuropsychology, a two-year REAL postdoc will be mandatory, generally followed by board certification. Sure, there are people making great scratch without these FOR NOW, but ten years from now the playing field will be different, as in more competitive. For Rx psychology, after completing all of the required clinical psychology training, you will have to earn a post-PhD/PsyD masters in clinical psychopharm (2 yrs, I believe?), and pass the additional national exam, and be licensed (and then physically practice) in New Mexico or Louisiana (at present). A lot of folks also have an excellent income from psychoeducational evals. These are great, as they are cash-only (unless one is engaging in insurance fraud, but that’s for another post), but it is very hard to break into as a newbie. You also really need to know what you are doing. If you don’t, it will show. 4) Some of the most fiscally irresponsible people that I have known have been surgeons, and they have wickedly high incomes. Since that is anecdotal, I will just leave it there. 5) Don't forget about benefits. An institutional position will likely have full benefits. Private ventures might not. Sure, there are group practices that can purchase discounted plancs, but even a large, thriving group practice is unlikely to have the purchasing power of a major medical center with thousands of employees. Also, some benefits cannot be purchased by a private practice at any price (e.g., free tuition for dependents of psychologists with faculty appointments at R1 medical centers) 6) One additional pet peeve and I will shut up: Please do not confuse “R1" and “R01." An “R1” is a Carnegie Level 1 Research University or Medical Center. An “R01” is a type of federal grant. They are not even remotely interchangeable. 7) A final comment to vashibashi: You have been given great feedback in this thread. Please seriously consider ALL of it, and verify on your own. Please do not simply jump with happiness over the few posts that promise “riches.” Please carefully read and investigate (outside of SDN) all of the responses. And then investigate more. Best wishes!
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Thank you so much! I've set up an appointment with my school's psych career counselor for the upcoming quarter. Hopefully I will be more swayed one way or the other, as right now I'm on the fence. As for getting my hopes up when reading about riches, I'll try not to do that. Though it is good to hear that such possibilities exist within this field.
 
I completely agree that the districts should be doing (and paying for) the testing but unfortunately, many (most?) are ill-equipped to do testing with anyone that isn't the most straightforward of LD cases.

My experiences both training and professional have never involved being anywhere that accepts private insurance. However, most placements/jobs I've had do take Medicare and/or some version of a county level health access program, maybe you all are referring to private insurance panels, not Medicare? Not really arguing it one way or another, just curious, as most of my work has been with pretty reputable and large medical systems/hospitals. I can even remember attending a county training when I first began internship on appropriate billing and they discussed billing for psychoeducational testing. This may also be a "language" issue in terms of referral, i.e., I rarely in practice had kids come in because they wanted academic accommodations. Typically, they were referred by a pediatrician or another medical provider because they were experiencing school behavioral problems (whether internalizing or externalizing) and the referring medical provider felt that these issues were being precipitated by an underlying lD/ID, and wanted testing. I can see how the former is not medically necessary but the latter would be. Might be just a semantics issue?
 
Insurance companies don't want to pay for anything that even resembles a "school"/education problem. If the child suffered a brain injury....ok, but short of s direct medical condition, it'd be difficult to justify.
 
entitlement said:
I completely agree that the districts should be doing (and paying for) the testing but unfortunately, many (most?) are ill-equipped to do testing with anyone that isn't the most straightforward of LD cases.

My experiences both training and professional have never involved being anywhere that accepts private insurance. However, most placements/jobs I've had do take Medicare and/or some version of a county level health access program, maybe you all are referring to private insurance panels, not Medicare? Not really arguing it one way or another, just curious, as most of my work has been with pretty reputable and large medical systems/hospitals. I can even remember attending a county training when I first began internship on appropriate billing and they discussed billing for psychoeducational testing. This may also be a "language" issue in terms of referral, i.e., I rarely in practice had kids come in because they wanted academic accommodations. Typically, they were referred by a pediatrician or another medical provider because they were experiencing school behavioral problems (whether internalizing or externalizing) and the referring medical provider felt that these issues were being precipitated by an underlying lD/ID, and wanted testing. I can see how the former is not medically necessary but the latter would be. Might be just a semantics issue?
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As you stated, these people are not looking for school accommodations. If you are dxing ADHD, intellectual disability, or any other medical issue, then it is covered as medically necessary. Especially if coming from a physician consult for other issues. If you are addressing educational issues, then it is not. It goes to the referral question and the way the report is written. That said, testing with most insurance companies requires pre-authorization and good luck getting them to pay if they catch any whiff of psycho-educational testing for accommodations. often times, it becomes hot potato between the schools and medical insurance as no one wants to pay the bill.
 
Fraud? I don't think so. I don't see any distinction in ICD-10 that says F81.0 is not medical and F90.0 is. I diagnose it and the coders submit the bill. If the insurance doesn't want to pay for it, that is their business. As I was writing this, Sanman put in his comment and that is the issue, getting a pre-auth, not fraud.
 
smalltownpsych said:
Fraud? I don't think so. I don't see any distinction in ICD-10 that says F81.0 is not medical and F90.0 is. I diagnose it and the coders submit the bill. If the insurance doesn't want to pay for it, that is their business. As I was writing this, Sanman put in his comment and that is the issue, getting a pre-auth, not fraud.
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Yeah- I don't think "fraud" is the right word, unless your doing one thing and billing for another, or outright lying about the reasons for testing. If you do something knowing the insurance or school won't pay for it and then stick the family with the bill without forewarning, then you're just being an a**hole.

With insurance cases, we do an intake, then submit a request for a pre-auth. If it's not pre-authorized by insurance, we request funding from the school. If school refuses, we discuss private pay with family (schools are 50/50 with this stuff before push comes to shove, but most are aware of their FEDERALLY MANDATED OBLIGATION to pay for necessary ed testing, and a few of them come around with some strong advocacy by the parents). If school doesn't agree to pay and insurance won't pre auth, we refer out. We won't stick the parents with a bill they have not been definitely told in advance they will have to pay, and won't do watered down assessments or use testing done by the schools to augment things. I keep saying "we," but I actually stick to kids under 4, and really only focus on ASD testing, so I don't have to deal with the ed testing fee cases.

As to the original post, I do psychology and like making money, and find these two things to not be mutually exclusive. Do it right, and you'll be ok. Sure there are other fields that pay more (and MANY MORE that pay less), but you can be comfortable financially as a psychologist.
 
Doing ADHD evals can be a nice niche (find a private school, cash pay), but I tend to stick purely on the medical side of things out of convenience. I avoid dealing with schools for the most part, not that medical insurance is a cakewalk, but proving medical necessity is far easier.
 
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smalltownpsych said:
Fraud? I don't think so. I don't see any distinction in ICD-10 that says F81.0 is not medical and F90.0 is. I diagnose it and the coders submit the bill. If the insurance doesn't want to pay for it, that is their business. As I was writing this, Sanman put in his comment and that is the issue, getting a pre-auth, not fraud.
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The fraud comes into play if you choose to bill insurance for explicit psycho-educational testing that is not a medical necessity and bill it as if it is such. Again as I said, it is a fine line and often comes down to how the report is written and circumstances. Pre-Auth takes care of most issues as they will say,yes or no. However, billing medical insurance to do a testing so a kid can get extra time on the SAT or get into a gifted program would likely be pushing past that line. Determining more serious issues of intellectual disability, adhd, emotional disturbance, etc is much easier to code under the medical necessity as well as the educational end.
 
Sanman said:
The fraud comes into play if you choose to bill insurance for explicit psycho-educational testing that is not a medical necessity and bill it as if it is such. Again as I said, it is a fine line and often comes down to how the report is written and circumstances. Pre-Auth takes care of most issues as they will say,yes or no. However, billing medical insurance to do a testing so a kid can get extra time on the SAT or get into a gifted program would likely be pushing past that line. Determining more serious issues of intellectual disability, adhd, emotional disturbance, etc is much easier to code under the medical necessity as well as the educational end.
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A few questions come to mind. Who is drawing the line between medical necessity and educational testing? If a kid is having problems in school, then why wouldn't diagnostic testing be indicated? Has there been a legal case where a psychologist billed for educational testing saying that they thought was medically necessary and it was found to be fraudulent? I'm not just asking you specifically or being argumentative, it is just an interesting and thought provoking topic that happens in other contexts as well. One that comes to mind is that some insurances, UBH in particular, won't pay for 60 minute sessions without a specific diagnosis and pre-auth. Another is the oft-heard, although I haven't run into it myself, that they won't pay for an Axis II dx which is sort of funny since DSM5 got rid of the multiaxial system.
 
Here's my take:
If the clinical question that is to be answered by testing relates to the members ability to perform academically in some capacity, then it will always be labeled as not medically necessary and thus coverage of the testing will be denied.

Contrast this with if the clinical question that is to be answered by testing relates to the need to establish a diagnosis for purposes of a treatment (read as NOT an IEP, tutoring, change in educational delivery method, etc.) that will be administered by a healthcare professional, then it will often be considered medically necessary even if the evaluation ALSO informs or changes things in the educational setting (e.g.., AD/HD).

The twisting of the first scenario to make it fit, or seem like the second would indeed be insurance fraud.
 
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Just a side note, ADHD does not require testing of any manner for a diagnosis, unless there are other things that need to be ruled out. This is one of my top reasons for canceling referrer's consults.
 
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WisNeuro said:
Just a side note, ADHD does not require testing of any manner for a diagnosis, unless there are other things that need to be ruled out. This is one of my top reasons for canceling referrer's consults.
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Agreed. Other seems stuck in myth, however.
 
I am pretty sure that we don't have much problem getting pre-auths for testing for learning disability so no need to stretch it or misrepresent the case. I'll have to ask my colleague to confirm though as she does the majority of those here.
erg923 said:
Here's my take:
If the clinical question that is to be answered by testing relates to the members ability to perform academically in some capacity, then it will always be labeled as not medically necessary and thus coverage of the testing will be denied.

Contrast this with if the clinical question that is to be answered by testing relates to the need to establish a diagnosis for purposes of a treatment (read as NOT an IEP, tutoring, change in educational delivery method, etc.) that will be administered by healthcare professional, then it will often be considered medically necessary even if the evaluation ALSO informs or changes things in the educational setting (e.g.., AD/HD).

The twisting of the first scenario to make it fit, or seem like the second would indeed be insurance fraud.
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My question on this is who determined that? I understand why the insurance companies would not want to pay for this if they can get the schools to do it, but I would argue that when a kid is struggling in school, then finding out what is going on is medically necessary. I also question how we have left it up to the schools to do this testing. just because it is done this way in many states, doesn't mean that it should be.
 
smalltownpsych said:
My question on this is who determined that? I understand why the insurance companies would not want to pay for this if they can get the schools to do it, but I would argue that when a kid is struggling in school, then finding out what is going on is medically necessary.
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But you could make that argument with anything really, and I understand an insurance company's need to limit what is determined to be, and/or how "medical necessity" is defined.

Obviously, you could not get typical medical insurance to cover a fitness for duty evaluation requested from someone's current or potential employer, right? Of course, we could make the argument that something may be found and thus the evaluation is "medically necessary" for treatment if something happen to be there, but I think that's pushing the obligation and role of a health insurance policy a bit.
 
erg923 said:
But you could make that argument with anything really, and I understand an insurance company's need to limits to what is determined to be, and/or how "medical necessity" is defined.

Obviously, you could not get typical medical insurance to cover a fitness for duty evaluation requested from someone's current or potential employer, right? Of course, we could make the argument that something may be found and thus the evaluation is "medically necessary" for treatment if something happen to be there, but I think that's pushing the obligation and role of a health insurance policy a bit.
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I just spoke with my colleague and she has never run into a problem with getting pre-auths for testing for a learning disability and was as shocked as I was to hear that this testing is not "medically necessary" in other states. I understand the insurance companies desire to limit their coverage, but I think it can be problematic when we determine what is medically necessary based on their rubric. The example that you gave regarding employment screening is much different than what we are talking about in that our patients have come to us for these assessments because they are already having problems in school.
 
smalltownpsych said:
I just spoke with my colleague and she has never run into a problem with getting pre-auths for testing for a learning disability and was as shocked as I was to hear that this testing is not "medically necessary" in other states. I understand the insurance companies desire to limit their coverage, but I think it can be problematic when we determine what is medically necessary based on their rubric. The example that you gave regarding employment screening is much different than what we are talking about in that our patients have come to us for these assessments because they are already having problems in school.
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I think what they are saying is that the schools are legally mandated to assess and treat this. So, why are you asking us? "Not my circus, not my monkey...."

I happen to think they are correct in using that logic.
 
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erg923 said:
I think what they are saying is that the schools are legally mandated to assess and treat this. So, why are you asking us? "Not my circus, not my monkey...."

I happen to think they are correct in using that logic.
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True about schools being legally mandated to assess and treat learning difficulties as it falls under the federal disability act. In more rural locations they don't always have the resources to do that so maybe that's why it is different in our state. Also, these frontier states tend to try and ignore a lot of federal mandates. Ultimately, it is sort of a moot point perhaps because I have yet to see kid who wasn't referred for rule out ADHD and possibly ODD along with the learning disability. I just resist being told what is medically necessary by "the man".
 
smalltownpsych said:
True about schools being legally mandated to assess and treat learning difficulties as it falls under the federal disability act. In more rural locations they don't always have the resources to do that so maybe that's why it is different in our state. Also, these frontier states tend to try and ignore a lot of federal mandates. Ultimately, it is sort of a moot point perhaps because I have yet to see kid who wasn't referred for rule out ADHD and possibly ODD along with the learning disability. I just resist being told what is medically necessary by "the man".
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If every individual practitioner got to define medical necessity for themselves, the whole concept and term would be meaningless.
 
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It's all about the balance between authority/autonomy and order/chaos. I have always been more of a rebel and a rage against the status quo kind of guy. It sort of works with patients since their status quo often needs some raging against. I think we have fully derailed this, but I, for one, was getting a bit bored with the main topic. :)
Anyway, gotta run, on my way to a much needed week vacation.
:banana:
 
smalltownpsych said:
It's all about the balance between authority/autonomy and order/chaos. I have always been more of a rebel and a rage against the status quo kind of guy. It sort of works with patients since their status quo often needs some raging against. I think we have fully derailed this, but I, for one, was getting a bit bored with the main topic. :)
Anyway, gotta run, on my way to a much needed week vacation.
:banana:
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Enjoy! and thanks for your help!
 
erg923 said:
I think what they are saying is that the schools are legally mandated to assess and treat this. So, why are you asking us? "Not my circus, not my monkey...."

I happen to think they are correct in using that logic.
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Pretty much this. Same thing happens in MVA cases between auto insurance and health insurance. Often health insurance pays and get reimbursed or refuses and has you go through your auto policy or that of the at fault person.

As for who decides, there a guy (or gal) in federal office somewhere making that decision and mandating federal guidelines. He or she is making the line as clear as mud and is sitting next to the guy that develops the CPT codes and decided that 16 min of psychotherapy was billable, but 15 min was not. We all just hope that we are on the correct side of his or her decision. On a an annoying side note apparently BC/BS decides that psych services are no longer necessary ever when someone is in a rehab facility...or at least that is the response we just got. Apparently you are not allowed to need rehab and be depressed at the same time.
 
erg923 said:
Here's my take:
If the clinical question that is to be answered by testing relates to the members ability to perform academically in some capacity, then it will always be labeled as not medically necessary and thus coverage of the testing will be denied.

Contrast this with if the clinical question that is to be answered by testing relates to the need to establish a diagnosis for purposes of a treatment (read as NOT an IEP, tutoring, change in educational delivery method, etc.) that will be administered by a healthcare professional, then it will often be considered medically necessary even if the evaluation ALSO informs or changes things in the educational setting (e.g.., AD/HD).

The twisting of the first scenario to make it fit, or seem like the second would indeed be insurance fraud.
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Interesting to read this discussion as the school district for the city I work in is notorious for "slipping in" a form into the stack of consents parents sign when they request an initial CORE evaluation to bill MassHealth (Medicaid for state of MA) for testing/evaluation done by the school. the parents don't realize they are signing it and consenting to this. MassHealth will pay for one psychological evaluation per year, and if the school has billed out to (and gotten reimbursed by) Mass Health, the parents have lost an opportunity to get a second opinion without paying out of pocket. This situation is compounded even more when the masters level school psychologist has simply administered a WISC, BASC, a 15 min "clinical interview", and maybe a sentence completion if you are lucky, and called it a "psychological evaluation" without really interpreting most of the results or providing any kind of conceptualization to the problem(s) the kid is having. The school psychologist won't give a diagnosis and the family is left with limited recourse. In the past this has made my job as the outpatient provider trying to support the family/youth that much harder.
 
Ultimately it is the courts that determine the question of what should be done and whether or not the insurance pays for a service has no bearing on that decision. Think of a suicidal patient who ran out of insurance sessions. The insurance company isn't liable if they die, in fact, they are protected from being sued, but we are. Schools have been held liable to provide certain services by the courts. At the residential treatment facility where I worked at times people would get to schools to foot the tab by suing them.
 
Dear vashibashi,

I appreciate your candor, and believe this is a very fair question to ask. I wish I had considered this much more carefully when I was 18-20.

My shorter answer is, for salary estimates, look at the APA estimates and also the Occupational Outlook Handbook (put out by the government, free online), and take those numbers seriously - you can do better than them for sure but I wouldn't assume blindly that you will, and there's a good chance you will be in those ranges. Consider also that 100k is not 100k, because you will lose a substantial amount due to a variety of taxes (and if you want to live in California, get ready to pay an extra 10% in taxes after 40k or so IIRC), and if you do things prudently, you will be stashing away a lot for retirement also early on in your career.

As for the longer answer, here are some thoughts. While you want to do good things for people, and this is to be lauded, presumably you will have family obligations and don't want to be stressed about money so that you can do what you want and what you believe might be most useful to others. Often in our field a false dichotomy is presented that is something along the lines of "they may make lots of money, but I do something meaningful." I personally do find a ton of meaning in our work, but if finances are neglected, a lot of problems can arise, and I don't believe it has to be this way. Other careers can find a lot of meaning as well, and it may be good to keep thsoe in mind. You mentioned that "as long as I have enough money to live in a comfortable home (not a house), have a decent car, be able to eventually support a family and provide them with nice things (think name brand), and travel the world annually, I think it's safe to say I'd feel accomplished." I think this is a fair goal, and for the aforementioned reasons, you likely need more than 100k, especially in California.

Perhaps more importantly, a big thing about the income isn't the things you want to buy or do, but the freedom it gives you. If you have a job that is terrible, you can quit because you can put your excess salary in savings so that you can wait and find a job that treats you well. I can't begin to tell you how many people, either subtly or explicitly, have told me they have work they don't want to do, but have to do because of needing the income. It could be a completely awful job, but it could also be small things such as taking on a client who pays well but is a total pain to you and your staff, or needing to write a grant on a topic you don't love but you think will get you promoted (and yes, you have to run the grant project if you get the grant, so consider multiple years spent towards something you don't really want). If you get a serious illness, well first always keep good health insurance, but even then after the ACA you may well have to pay 7k/year to cover all expenses, plus lost salary - if you have savings then you can take the time to get all of the R&R you need and not worry about your job, etc. (same goes for if a family member/child gets ill), and you don't spend the time worrying about how you will pay the electic bill or what will your employer think.

I suspect what you are looking for is a return on investment (ROI) calculation (Ollie123 mentioned this as well), instructions for which can be found online (commonly are done in the context of business school). Be sure to include early savings for retirement that otherwise would be lost due to time in school and debt. You may find this factor makes a staggering difference; I recently compared with a 20 year old undergraduate the difference between Psy.D vs. MSW, in her situation her income with a MSW was less but she would actually have an extra $400,000 by her early 30s due to increased savings and less time spent. Early investment is HUGE. A quote attributed to Einstein reads something along the lines of, "the power of compound interest the most powerful force in the universe." Bogleheads.org and mymoneymustache.com are good places to start IMHO if you are curious. From what I have seen the white coat investor blog/book is good and has many good principles, but the advice is often tailored to higher salaries which may or may not leave an information gap in your case.

A BA/BS in psychology is one of the most poorly compensated college degrees (and if someone ends up being compensated well, often it is in a scenario where another degree would have provided the same or better return), and in getting a doctorate at minimum you lose the opportunity to make real-world salaries and add to savings/retirement early in your career, and often debt is added onto the situation. Sadly, many faculty in psychology do an extremely poor job forewarning of financial principles until much damage is done. Given our market economy, they will keep offering these programs as long as people keep applying (and paying their salaries; there is a huge conflict of interest, as if they told you to not be in psychology, they wouldn't have students registered in their classes, which feeds their families). Do something that is good for the world, and you find great meaning in, but don't be a casualty of a one-sided narrative provided by many without being fully aware of the risks, options, and possible win-win solutions.

If I may, allow me to make a couple of suggestions to you. You mentioned that you have narrowed down possible career paths to CRNA, Psych NP, and some psych field requiring PhD/PsyD. My first suggestion is to continue to consider these, but also consider all walks of life (e.g., you can help people with psychological problems as a businessperson who helps start new clinics, and other creative ways). You are still young and have time to change career paths, which will become substantially harder in your late 20s and early 30s. My second suggestion is to find some older people (probably above age 30, people who have to consider things like supporting partners, raising kids, etc.) who are willing to be candid with you about money (might be your family, family friends, people in shared religious group, heck could go to a Bogleheads meetup). Go to lunch with them and ask about prospective incomes vs. happiness in their specific careers, and specifically how much money is needed to do what you want. I've done this, and it's helped me a lot, but it would have helped me much more if I had done it at your age. In particular, I think diversity of career paths are helpful - people in psychology have some more insight than other careers into some aspects of these decisions, but frankly also some blind spots that people in other careers (e.g., finance) usually address better than we do. Ask them for book recommendations (and look at the aforementioned websites for good books), and read them, cover to cover, maybe read 1-2 books/year. If you make the decision correctly the first time, it will save you MUCH time and hassle relative to switching later - make this a big priority, like you would a college class. Best of luck.
 
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FYI,

It is Mrmoneymustache...Pete is a bit intense for me, but the forums are good. If we are talking personal finance, the millionaire next door by Thomas j Stanley changed my world when I first read it at age 16.

The best advice I think I could give anyone at this point is,that sometimes a job is a job and other things become more important later in life, so picking one that makes good money and has, fexibility (this is more important than I ever thought) is what I would look for.
 
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I have not had time to read through the entire thread, and so excuse me if someone has already covered this.

I make my living as a full time private practice psychologist, and I have a diversified practice at that. I find myself competing with the THOUSANDS of other therapists in my county (in SoCal).
If I had it to do over, I would find a territory that has an institutional and/or private practice need (not the same as a lack of practitioners, per se) and I would set up shop there.

I'm more successful at a rather early stage in my career than most of my colleagues, and so I'm not just being pessimistic when I say that I think the field of clinical psych and therapy in general has been ablated in the U.S. In my tiny zip code, and I mean tiny....3.54 square miles...there are 102 therapists just listed on Psychology Today.com. This does not even count the MDs, the senior psychs who do not list online, and so on. Folks, that's insane, and it's coming to a neighborhood near you.

Does this oversupply of therapists mean you can't make a decent living? No. Does it mean that you probably will not be able to make a decent living while also maintaining the quality of life you would like...my experience is, yes. You must diversify your scope, work late and long, and accept insurances. If you don't....there's another therapist out there who will, and he'll get that appointment booked. Thanks, Argosy.
 
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aequitasveritas said:
Does this oversupply of therapists mean you can't make a decent living? No. Does it mean that you probably will not be able to make a decent living while also maintaining the quality of life you would like...my experience is, yes. You must diversify your scope, work late and long, and accept insurances. If you don't....there's another therapist out there who will, and he'll get that appointment booked. Thanks, Argosy.
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You forgot Alliant/Fielding/Albizu.
 
aequitasveritas said:
,,, You must diversify your scope, work late and long, and accept insurances. If you don't....there's another therapist out there who will, and he'll get that appointment booked. Thanks, Argosy.
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Good advice and insight in this entire post from aequitasveritas. I think this last point (copied above) has an valid inverse, in that you can also make a good living if you focus on a specialty ( or population with a need) that is in high demand, with relatively limited supply (that is also reimbursed at a decent rate). Multiple credentials, with the opportunity to bill as each, are also helpful.
 
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Boston2k said:
Dear vashibashi,

I appreciate your candor, and believe this is a very fair question to ask. I wish I had considered this much more carefully when I was 18-20.

My shorter answer is, for salary estimates, look at the APA estimates and also the Occupational Outlook Handbook (put out by the government, free online), and take those numbers seriously - you can do better than them for sure but I wouldn't assume blindly that you will, and there's a good chance you will be in those ranges. Consider also that 100k is not 100k, because you will lose a substantial amount due to a variety of taxes (and if you want to live in California, get ready to pay an extra 10% in taxes after 40k or so IIRC), and if you do things prudently, you will be stashing away a lot for retirement also early on in your career.

As for the longer answer, here are some thoughts. While you want to do good things for people, and this is to be lauded, presumably you will have family obligations and don't want to be stressed about money so that you can do what you want and what you believe might be most useful to others. Often in our field a false dichotomy is presented that is something along the lines of "they may make lots of money, but I do something meaningful." I personally do find a ton of meaning in our work, but if finances are neglected, a lot of problems can arise, and I don't believe it has to be this way. Other careers can find a lot of meaning as well, and it may be good to keep thsoe in mind. You mentioned that "as long as I have enough money to live in a comfortable home (not a house), have a decent car, be able to eventually support a family and provide them with nice things (think name brand), and travel the world annually, I think it's safe to say I'd feel accomplished." I think this is a fair goal, and for the aforementioned reasons, you likely need more than 100k, especially in California.

Perhaps more importantly, a big thing about the income isn't the things you want to buy or do, but the freedom it gives you. If you have a job that is terrible, you can quit because you can put your excess salary in savings so that you can wait and find a job that treats you well. I can't begin to tell you how many people, either subtly or explicitly, have told me they have work they don't want to do, but have to do because of needing the income. It could be a completely awful job, but it could also be small things such as taking on a client who pays well but is a total pain to you and your staff, or needing to write a grant on a topic you don't love but you think will get you promoted (and yes, you have to run the grant project if you get the grant, so consider multiple years spent towards something you don't really want). If you get a serious illness, well first always keep good health insurance, but even then after the ACA you may well have to pay 7k/year to cover all expenses, plus lost salary - if you have savings then you can take the time to get all of the R&R you need and not worry about your job, etc. (same goes for if a family member/child gets ill), and you don't spend the time worrying about how you will pay the electic bill or what will your employer think.

I suspect what you are looking for is a return on investment (ROI) calculation (Ollie123 mentioned this as well), instructions for which can be found online (commonly are done in the context of business school). Be sure to include early savings for retirement that otherwise would be lost due to time in school and debt. You may find this factor makes a staggering difference; I recently compared with a 20 year old undergraduate the difference between Psy.D vs. MSW, in her situation her income with a MSW was less but she would actually have an extra $400,000 by her early 30s due to increased savings and less time spent. Early investment is HUGE. A quote attributed to Einstein reads something along the lines of, "the power of compound interest the most powerful force in the universe." Bogleheads.org and mymoneymustache.com are good places to start IMHO if you are curious. From what I have seen the white coat investor blog/book is good and has many good principles, but the advice is often tailored to higher salaries which may or may not leave an information gap in your case.

A BA/BS in psychology is one of the most poorly compensated college degrees (and if someone ends up being compensated well, often it is in a scenario where another degree would have provided the same or better return), and in getting a doctorate at minimum you lose the opportunity to make real-world salaries and add to savings/retirement early in your career, and often debt is added onto the situation. Sadly, many faculty in psychology do an extremely poor job forewarning of financial principles until much damage is done. Given our market economy, they will keep offering these programs as long as people keep applying (and paying their salaries; there is a huge conflict of interest, as if they told you to not be in psychology, they wouldn't have students registered in their classes, which feeds their families). Do something that is good for the world, and you find great meaning in, but don't be a casualty of a one-sided narrative provided by many without being fully aware of the risks, options, and possible win-win solutions.

If I may, allow me to make a couple of suggestions to you. You mentioned that you have narrowed down possible career paths to CRNA, Psych NP, and some psych field requiring PhD/PsyD. My first suggestion is to continue to consider these, but also consider all walks of life (e.g., you can help people with psychological problems as a businessperson who helps start new clinics, and other creative ways). You are still young and have time to change career paths, which will become substantially harder in your late 20s and early 30s. My second suggestion is to find some older people (probably above age 30, people who have to consider things like supporting partners, raising kids, etc.) who are willing to be candid with you about money (might be your family, family friends, people in shared religious group, heck could go to a Bogleheads meetup). Go to lunch with them and ask about prospective incomes vs. happiness in their specific careers, and specifically how much money is needed to do what you want. I've done this, and it's helped me a lot, but it would have helped me much more if I had done it at your age. In particular, I think diversity of career paths are helpful - people in psychology have some more insight than other careers into some aspects of these decisions, but frankly also some blind spots that people in other careers (e.g., finance) usually address better than we do. Ask them for book recommendations (and look at the aforementioned websites for good books), and read them, cover to cover, maybe read 1-2 books/year. If you make the decision correctly the first time, it will save you MUCH time and hassle relative to switching later - make this a big priority, like you would a college class. Best of luck.
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Thank you for your wise reply. I thought this thread had ended, as I wasn't receiving emails about replies, which is why I just saw this. I've done continuous research since posting this thread, and it seems to me that the psych field will be very competitive and brutal in order for me to make the salary that I want. Thus, I've decided (of course, this is open to change) to pursue the CRNA route. The flexible hours, salary, and job security match what I want, but without having to go through the hurdles that would be required if I pursue psych. However, I'll need to take some very difficult courses in undergrad (for me anyway), the very same that initially drove me away from pursuing a biology degree. I love psychology, but I can't pursue it if it's not financially secure. Oh well.
 
AcronymAllergy said:
CRNAs make very good salaries, particularly relative to the length of schooling. And I believe liability would be limited by working under physician oversight. Could be wrong on that, though.
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The only drawback I see is the path to get there, as I'm not too great at the prereqs.
 
Still sounds like the right call for you. Its very, very easy to excel at undergraduate psych courses at most institutions and entirely possible to be a straight A undergrad psych student with zero hope of passing grad-level neurobiology or bayesian statistics courses (let alone performing the relevant duties that are substantially more important than the coursework itself). I think its well worth it to work hard on the coursework to achieve something that is a better professional fit for you than try and take the "easy" route (that is really only easy in the short-term and arguably harder in the long-term) and be disappointed because the payoff isn't what you wanted.
 
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Ollie123 said:
Still sounds like the right call for you. Its very, very easy to excel at undergraduate psych courses at most institutions and entirely possible to be a straight A undergrad psych student with zero hope of passing grad-level neurobiology or bayesian statistics courses (let alone performing the relevant duties that are substantially more important than the coursework itself). I think its well worth it to work hard on the coursework to achieve something that is a better professional fit for you than try and take the "easy" route (that is really only easy in the short-term and arguably harder in the long-term) and be disappointed because the payoff isn't what you wanted.
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I'm positive I'll excel in my psych courses. Thanks for the support!
 
smalltownpsych said:
A PsyD typically costs more than a PhD, not pays more. In fact the opposite is probably more likely. Be careful of the info on this because there are many profit motivated professional schools that want to mislead naive undergrads. I do have a PsyD myself so am speaking from experience. I do make quite a bit more than 100k, but if you subtract my student loan payments that brings me more in line with a much lower paid PhD who didn't take out the loans.
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Hi smalltownpsych,

Where did you go?
 
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