PhD/PsyD Internship life choices and neuropsych/primary assessment careers?

[temppsych123]

I am most of the way through internship, with plans to stay at the site for a research oriented postdoc. I am realizing that I love assessment, have always loved it, and could totally see myself being great in a career where my primary responsibilities are around assessment, formulation, treatment planning, case management. Just not the actual intervention/therapy/treatment piece! I had always previously considered my career options to be primarily "research/academia" and "clinical/therapy provider", but I know there must be people (including but not limited to neuropsychologists) who are primarily doing assessment work, and I want to know what it's like! Pros? Cons? Would you recommend it?

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[barryggg]

I enjoy it, and I was always aware that I preferred assessment. I enjoy the testing, and talking about the results with the families.

I value the skill it takes to be a great therapist but I don't have the patience for it. With some patients, I feel very empathetic/sympathetic for their struggles, while with other clients I feel quite frustrated when they aren't willing to do the work. That can get very draining.

 

[deleted343839]

I am realizing that I love assessment, have always loved it, and could totally see myself being great in a career where my primary responsibilities are around assessment, formulation, treatment planning, case management. Just not the actual intervention/therapy/treatment piece!

The back of the line is over there...

 

[Justanothergrad]

I've also known tons who couldn't stand to do 100% assessment despite loving it and focusing on it. I enjoy it but I need the variability of therapy. It feels good to me to see outcomes and not just see people in a brief, one shot evaluation. I think it would be hard to do nothing but assessment and make effective treatment recommendations if I wasn't keeping myself grounded in treatment modality trends and what that world is like.

 

[temppsych123]

I know ya'll exist, but what is your work actually like? How likely is it that I could make a career out of this, especially given that I'm not a neuropsychologist? What kind of settings are you in, what are you doing, how do you like it, pros and cons, I am just really curious about how to find a career doing this, and sort of embarrassed I hadn't thought to ask about this before...and now don't know who to ask!

 

[WisNeuro]

I think we need to know what kind of assessments you're talking about here before commenting on feasibility.

 

[erg923]

I know ya'll exist, but what is your work actually like? How likely is it that I could make a career out of this, especially given that I'm not a neuropsychologist? What kind of settings are you in, what are you doing, how do you like it, pros and cons, I am just really curious about how to find a career doing this, and sort of embarrassed I hadn't thought to ask about this before...and now don't know who to ask!

Certainly people do this. I know some, both personally and professionally.

You need to be more specific because the answer is: It depends.

Mix of payer sources, along with the local market (competition, demand, population served/targeted, and dominant TPOs in the area) may be the biggest variable that can determine if this is financially feasible or advisable early career. Then will come your actual skills and efficiency...

Not neuropsych and not particularly niched or cash only means you will largely be dependent on medicare/medicaid and/or many of the behavioral health carve out companies like Beacon, Optum/UBH, Magellan, New Directions, Molina, etc. Look into their rates for 96101 (and 91118)? Then look into their coverage policies, especially for "medical necessity", prior-authorization, retro review/utilization review. It's not like this is grad school where you get to do 8 hours of assessment/testing just because you can or want to. And it's not like they can't find ways to get out out of the ACAs parity clause.

 

[barryggg]

I can't speak for other areas..but for Educational Psychology...parents are always willing to pay out of pocket for their kids. They might not care so much about their mental health, but they always do for the kids.

 

[jmiah717]

I've also known tons who couldn't stand to do 100% assessment despite loving it and focusing on it. I enjoy it but I need the variability of therapy. It feels good to me to see outcomes and not just see people in a brief, one shot evaluation. I think it would be hard to do nothing but assessment and make effective treatment recommendations if I wasn't keeping myself grounded in treatment modality trends and what that world is like.

I don't want to derail this thread but I'm searching out how I can carve out some versatility in my work days...I'm thinking something like 25% research/25% teaching/25% neuropsych assessment/25% therapy.....or some combination of those things....Does such a career exist? Too idealistic? AMA's only?

 

[WisNeuro]

I don't want to derail this thread but I'm searching out how I can carve out some versatility in my work days...I'm thinking something like 25% research/25% teaching/25% neuropsych assessment/25% therapy.....or some combination of those things....Does such a career exist? Too idealistic? AMA's only?

Never seen it, and I can't imagine it existing in many institutional settings. If they are hiring you for neuro assessment, they want you to do that. Most waiting lists are like 6+months long, and that is what they can bill for. If you were some kind of soft money position, may be more likely. But, this would be an exceedingly rare kind of position. I do a combination of all of those things, but it is most heavily weighted towards the neuro assessment end.

 

[Therapist4Chnge]

I don't see that being realistic either. Most employers will want you to do as much assessment ($$) as possible, though some may allow for bought out research time (i.e. grant funded).

If you were tenure track then maybe you'd get a mix of mostly research, a small bit of clinical, and maybe teaching a class....but the focus would be on research productivity.

You can be clinical faculty at an AMC, but research is generally on your time if you don't have a grant and teaching is definitely on your own time unless giving a lecture for didactics is good enough for that.

You can do what you want in private practice, though it's easier to collaborate on research and limit to one class bc of the low pay. The pressure will be to do more clinical work to cover your overhead and meet the expected demand.

 

[AcronymAllergy]

Never seen it, and I can't imagine it existing in many institutional settings. If they are hiring you for neuro assessment, they want you to do that. Most waiting lists are like 6+months long, and that is what they can bill for. If you were some kind of soft money position, may be more likely. But, this would be an exceedingly rare kind of position. I do a combination of all of those things, but it is most heavily weighted towards the neuro assessment end.

The bolded point is important . While you may be paid to provide a certain type of service almost exclusively (e.g., neuropsych assessment), you may still be able to build in some additional experiences, such as teaching and research. It's unlikely these would approach 25% of your workload if you're being paid for the assessments, and it'll potentially require working >40 hours/week, but it's certainly possible to participate in those activities to some extent. This being for medical center-type settings.

Although as others have mentioned, a 25% split across the board is going to be difficult to impossible to find.

 

[deleted343839]

I'm thinking something like 25% research/25% teaching/25% neuropsych assessment/25% therapy.....or some combination of those things....Does such a career exist? Too idealistic? AMA's only?

Pick two of those, decide which one you want to do on most days, and then consider whether you want to fit in a third thing on nights and weekends.

 

[ProfessionalStudent5]

So isn't it possible to have a job that's primarily assessment without being neuropsych? I really like assessment and was curious if there are careers out there for it within already established places? I have no interest in starting a private practice. I've mostly heard about these positions in the neuropsych field, but I've had most of my experience in psychodiagnostic and educational testing.

 

[Therapist4Chnge]

There are a number of niches that allow for mostly assessment work....it just depends on the details. Off the top of my head:
1. Neuro: prev discussed, some crossover w rehab. A lot of differential diagnosis.
2. Rehab Psych: crossover w health and also SCS/pain evals, pre-surg evals, some neuro, etc.
3. Health Psych: some crossover w rehab.
4. Forensic: capacity, child custody...ugh, etc. Risk/Re-offending...not an area I know much about, but others might.
5. Psych Eval: This can be done in conjunction w the other areas or completely separately.

There are probably a dozen or more areas to assess, these are just some of the most common areas.

 

[jmiah717]

Never seen it, and I can't imagine it existing in many institutional settings. If they are hiring you for neuro assessment, they want you to do that. Most waiting lists are like 6+months long, and that is what they can bill for. If you were some kind of soft money position, may be more likely. But, this would be an exceedingly rare kind of position. I do a combination of all of those things, but it is most heavily weighted towards the neuro assessment end.

Based on your experience, what's a more realistic breakdown?


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[WisNeuro]

Based on your experience, what's a more realistic breakdown?


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In a VA setting, unless you have a dedicated research position or MIRECC arrangement, you won't really find anything where they let less than 75% neuro. I imagine you can find a split in some AMC type settings for 50% neuro and the rest being mostly research, but you have to continually produce and those positions tend to be more like 60 hour weeks. My breakdown is probably something like 80% neuro, 10% supervision, 5% didactics/teaching, 5% therapy.

 

[erg923]

So isn't it possible to have a job that's primarily assessment without being neuropsych? I really like assessment and was curious if there are careers out there for it within already established places? I have no interest in starting a private practice. I've mostly heard about these positions in the neuropsych field, but I've had most of my experience in psychodiagnostic and educational testing.

Not really sure where you got that idea. It also depends of what you mean by "assessment?"

Compensation and pension psychologists in the VA dont do any treatment, but the "assessment" is largely clinical interviewing, record review, and an MMPI, PAI. Certainly many forensic psychologists in institutional settings or various agencies only do assessment work rather than treatment.

 

[ClinicalABA]

So isn't it possible to have a job that's primarily assessment without being neuropsych? I really like assessment and was curious if there are careers out there for it within already established places? I have no interest in starting a private practice. I've mostly heard about these positions in the neuropsych field, but I've had most of my experience in psychodiagnostic and educational testing.

My job is primarily testing (80-90% of my billables per week, with the rest being ABA supervision and school consult). It's a very niche/specialized area of assessment (assessments for children 4 and under suspected of having and ASD Diagnosis). I'm not a neuropsychologist. Assessement is primarily Medicaid funded, with an occasional commercial insurance (like 1 out of every 20 kiddos I see). There's other clinicians in the office 2-3 days per week, doing the same (though they will see older kids for neuropsych testing too), and we still have a long (several months) waitlist. As others have said- it's possible to do it, just depends on what you type of assessment you want to do and where you are (there is little competition where I am, and most of the families do not have the resources for easy travel to clinics in Boston (about ~2 hours away).

I also teach a few graduate courses (as an andjunct, not as part of the day job), and have a research requirement as part of my day job.