Is it too late for me to pursue neuropsych?

[calvicorse]

Hoping some of the neuro people on this forum can help me with a question i'm wondering about. I am currently in my last year of my PhD in a clinical program and am about to start interviewing for internship, mostly at VAs.

I'm not entirely sure what I want to do yet in my career yet---I enjoy doing therapy, testing, as well as research. At this point, I'm not sure if I want to be a full-fledged neuropsychologist, but I also don't want to take the possibility off the table just yet. However, it's not clear to me whether the possibility is even still an option, given how competitive neuropsych is. Several of the VA internships I am interviewing at soon offer neuropsych rotations (e.g., pick 3 4-month rotations; so I could choose one neuro rotation). However, it seems like it would only make sense to do one of these rotations if I would be competitive for a neuropsych post-doc following internship. I suppose my question is: is this realistic?

For some background, prior to graduate school I worked as a full time psychometrist at a nationally very well respected hospital for two years, so I have good familiarity with the administration of most neuropsych tests. During grad school, I did a one year prac for a neuropsychologist doing testing and some report writing (the rest of my pracs were mostly doing therapy). However, I didn't take any specialized assessment courses through my school (e.g., neuroanatomy, etc). Additionally, I published a few papers during graduate school that were neuropsych related, and have a pretty strong research background in terms of publications.

If I did go on internship and did a neuropsych rotation, could this make me sufficiently competitive for a neuropsych post-doc, if I wanted to do one? If not, are there any other routes that I could take to pursue board certification, if thats what I decided I wanted to do? Part of me wonders whether I could be more fulfilled later on having a part-time private practice where I did both therapy and testing. Additionally, and correct me if i'm wrong, it seems like part-time neuropsych work could be a good and more efficient option to generate income rather than only doing therapy.

Thanks for your time!

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[WisNeuro]

Do some soul-searching, it's not too late at this juncture, but you're approaching. If you do want to go through with it, find a good internship with at least a major rotation in neuro, and one that you can do first thing at the internship site, as you will need that letter. Then, get a good APPCN or similar quality postdoc. Without that postdoc, it's very hard to get ABPP'd through other methods.

As for the doing some testing on the side, if you don't get the requisite training, please don't. We already deal with hacks doing this already and misdiagnosing people all over the place. Then we have to clean up your mess, then I have a good talk with the referring neurologist, and he never sends you work again. Neither of us wants that.

 

[PsyDr]

You seem like a better candidate for a rehab psych fellowship.

 

[calvicorse]

Do some soul-searching, it's not too late at this juncture, but you're approaching. If you do want to go through with it, find a good internship with at least a major rotation in neuro, and one that you can do first thing at the internship site, as you will need that letter. Then, get a good APPCN or similar quality postdoc. Without that postdoc, it's very hard to get ABPP'd through other methods.

As for the doing some testing on the side, if you don't get the requisite training, please don't. We already deal with hacks doing this already and misdiagnosing people all over the place. Then we have to clean up your mess, then I have a good talk with the referring neurologist, and he never sends you work again. Neither of us wants that.

Thanks! This is really helpful. If I did do a neuro rotation and decided I did not want to ultimately pursue board certification, in your (and others') opinion, are there any types of assessment that you think I would be adequately prepared to handle? For example, ADHD vs. learning disorder differentials, etc? A good portion of people doing testing in my city (even at HMOs, etc) do not have board certification--do you think this is nearly always inappropriate, or in some cases with less complicated dx is it OK? Surely someone who is ABPP would do a better job, but does this mean it's always inappropriate to do without, even if you have worked for an agency for a few years where you did assessment as part of your job?

@PSYDR would you mind expanding on the differences between neuro and rehab psych and why you thought the latter might be a better fit?

 

[PsyDr]

Thanks! This is really helpful. If I did do a neuro rotation and decided I did not want to ultimately pursue board certification, in your (and others') opinion, are there any types of assessment that you think I would be adequately prepared to handle? For example, ADHD vs. learning disorder differentials, etc? A good portion of people doing testing in my city (even at HMOs, etc) do not have board certification--do you think this is nearly always inappropriate, or in some cases with less complicated dx is it OK? Surely someone who is ABPP would do a better job, but does this mean it's always inappropriate to do without, even if you have worked for an agency for a few years where you did assessment as part of your job?

@PSYDR would you mind expanding on the differences between neuro and rehab psych and why you thought the latter might be a better fit?

Very big generalizations:

Neuropsych: uses neuropsych tests to make differential diagnoses, treatment recommendations, and track progress. Treatment is less common.

Rehab psych: uses neuropsych instruments to measure cognitive abilities, usually in individuals for whom the dx is known, to make treatment recommendations and track progress. Treatment is common.

 

[calvicorse]

Very big generalizations:

Neuropsych: uses neuropsych tests to make differential diagnoses, treatment recommendations, and track progress. Treatment is less common.

Rehab psych: uses neuropsych instruments to measure cognitive abilities, usually in individuals for whom the dx is known, to make treatment recommendations and track progress. Treatment is common.

Any generalizations regarding differences in training for people in one vs. the other? For example, does one tend to be board certified more than the other, etc? Forgive my naivety, but I have noticed that at several large organizations in my city, many of the psychologists (often with backgrounds in rehab or sometimes neuropsych) do not have board certification, but have been doing testing as the primary part of their career for a long time? Anecdotally, it seems the younger clinicians tend to be more board certified than the older ones. I'm trying to figure out whether they are being ethical and operating within their scope of practice by doing so. I know there are a lot of neuropsychologists on this forum who have strong feelings about this subject, so am curious whether they feel some testing is appropriate and ethical to do without board certification, or whether it seems inappropriate across the board regardless of dx.

 

[PsyDr]

Any generalizations regarding differences in training for people in one vs. the other? For example, does one tend to be board certified more than the other, etc? Forgive my naivety, but I have noticed that at several large organizations in my city, many of the psychologists (often with backgrounds in rehab or sometimes neuropsych) do not have board certification, but have been doing testing as the primary part of their career for a long time? Anecdotally, it seems the younger clinicians tend to be more board certified than the older ones. I'm trying to figure out whether they are being ethical and operating within their scope of practice by doing so. I know there are a lot of neuropsychologists on this forum who have strong feelings about this subject, so am curious whether they feel some testing is appropriate and ethical to do without board certification, or whether it seems inappropriate across the board regardless of dx.

1) board certification is always going to be preferable over non. It’s an evolving thing, and the wave of the future. There’s a long story about why psychology, the field that mimics psychiatry, which is a sub specialty of medicine, wants to emulate how medicine specializes. None of it is important because it’s gonna happen. So we have a new standard which is the HCG. Do it or be out of the club. Rehab psych has recently adopted similar post doc standards, called the Baltimore something or other.

2) if you ask me, board certification is a stupid idea. The originals in the subfield did not have fellowships and such. So their admomnistions that fellowship is the only way to achieve their learned status is false at face value. Either there are several ways to learn or the originals training is insufficient and therefore the trainees are incompetent. Notice Kaplan, lezak, reitan, Golden. Reynolds, etc’s two year fellowship? Me either. (I can also tell you that the professional community literally locked one of those people out of a conference room when deciding on professional standards... like adults do.) So are the trainees who didn’t do a two year fellowship not sufficiently trained? And if so, does this mean that all of their trainees are trained by incompetents? Yeah... it’s a load. Now try to explain this to those in power and you’re William the 3rd, fighting the tide.

3) Ethics and professional feelings, in this case, are unimportant. Either someone is doing good work or they are not. I make very decent money in explaining how someone, who graduated from much better schools, screwed up or doesn’t know what they are talking about. The law is 10000x more powerful.

4) if you want to learn more about the training differences, look at the core competencies of abcn vs abrp or the Houston conference guidelines vs the Baltimore guidelines.

 

[AbnormalPsych]

(I can also tell you that the professional community literally locked one of those people out of a conference room when deciding on professional standards... like adults do.

What the hell?

 

[PsyDr]

What the hell?

Ever wondered why the reitan society was formed immediately after the Houston conference?

Psydr remembers....

 

[NeuroTrope]

Ever wondered why the reitan society was formed immediately after the Houston conference?

Psydr remembers....

When I was a student I ran with the Reitan crowd. Still, the past is the past and the mistakes of our forefathers should not be our burdens to bear...

 

[Justanothergrad]

2) if you ask me, board certification is a stupid idea. The originals in the subfield did not have fellowships and such. So their admomnistions that fellowship is the only way to achieve their learned status is false at face value. Either there are several ways to learn or the originals training is insufficient and therefore the trainees are incompetent. Notice Kaplan, lezak, reitan, Golden. Reynolds, etc’s two year fellowship? Me either. (I can also tell you that the professional community literally locked one of those people out of a conference room when deciding on professional standards... like adults do.) So are the trainees who didn’t do a two year fellowship not sufficiently trained? And if so, does this mean that all of their trainees are trained by incompetents? Yeah... it’s a load. Now try to explain this to those in power and you’re William the 3rd, fighting the tide.

I get the idea you're arguing for (and dont disagree 100%, in principle) but it sets up a slippery slope in which you can never require more training than has been required in the past. As a specialty grows, it seems that so does the need for specialization and, with that, training requirements. I suppose you could delay growth of the specialty artificially but that seems counter productive in other ways as well.

 

[PsyDr]

I get the idea you're arguing for (and dont disagree 100%, in principle) but it sets up a slippery slope in which you can never require more training than has been required in the past. As a specialty grows, it seems that so does the need for specialization and, with that, training requirements. I suppose you could delay growth of the specialty artificially but that seems counter productive in other ways as well.

I don't agree that we are growing as a specialty, when I compare what neuropsych was used for in the past. I honestly think that most of the HCG stuff is a money grab, designed to protract the length of training to get free labor.

Solution A: zero grandfathering, everyone has the same re-examination requirements, fellowship year one pays like post docs, second year pays the median for practicioners.

Solution B: acknowledge that there are alternate means of obtaining competence. Remove two year fellowship, and the subjective aspects (i.e., oral exam, and practice sample). All who can pass the written exam are in. Re-exam every 5 years or so.

Solution C: Change fellowship to a 2 year post doctoral masters with a national test at the end. Re-examination every few years. No grandfathering.

 

[NeuroTrope]

I don't agree that we are growing as a specialty, when I compare what neuropsych was used for in the past. I honestly think that most of the HCG stuff is a money grab, designed to protract the length of training to get free labor.

Solution A: zero grandfathering, everyone has the same re-examination requirements, fellowship year one pays like post docs, second year pays the median for practicioners.

Solution B: acknowledge that there are alternate means of obtaining competence. Remove two year fellowship, and the subjective aspects (i.e., oral exam, and practice sample). All who can pass the written exam are in. Re-exam every 5 years or so.

Solution C: Change fellowship to a 2 year post doctoral masters with a national test at the end. Re-examination every few years. No grandfathering.

Have you gone through the process yourself? I found it rewarding and it helped round out my training. To claim it is just a money grab is unfair and makes it seem as if there isn't all that much to learn in neuropsychology (hence we should shorten/simplify the training). Much higher pay for second year post-docs would be nice though.

 

[PsyDr]

Have you gone through the process yourself? I found it rewarding and it helped round out my training. To claim it is just a money grab is unfair and makes it seem as if there isn't all that much to learn in neuropsychology (hence we should shorten/simplify the training). Much higher pay for second year post-docs would be nice though.

I sure have. I make a lot of money in neuro and would honestly benefit from continued restriction of people entering neuropsych. But I should also mention that I have consistently opined that neuropsych is going to continue to go downhill in terms of earnings, acceptance in the medical community, and prestige.

There is a logical inconsistency in the entire idea.


If 2 years is the necessary length of time to be properly trained, explain why the old people were exempt from this training requirement and grandfathered from maintenance of certification.

If the idea of why the old people do not need a two year fellowship is that the field has advanced: they are tacitly endorsing that learning information on the fly as part of one's practice is acceptable. Then they need to explain why the formal fellowship process is the only way to learn.

 

[NeuroTrope]

I sure have. I make a lot of money in neuro and would honestly benefit from continued restriction of people entering neuropsych. But I should also mention that I have consistently opined that neuropsych is going to continue to go downhill in terms of earnings, acceptance in the medical community, and prestige.

There is a logical inconsistency in the entire idea.


If 2 years is the necessary length of time to be properly trained, explain why the old people were exempt from this training requirement and grandfathered from maintenance of certification.

If the idea of why the old people do not need a two year fellowship is that the field has advanced: they are tacitly endorsing that learning information on the fly as part of one's practice is acceptable. Then they need to explain why the formal fellowship process is the only way to learn.

I don't quite follow. If we are to maintain some level of acceptance and prestige, board certification seems crucial.

I get your point that some folks got grandfathered in and it is debatable how valid this is...that's not going to be an issue in thirty years. We're still a young field.

Where I work there are a lot of practitioners who claim to be neuropsychologists. The ones who are not board-certified tend to be the least competent, and there is an obvious reason why (which can be pointed out to attorneys, medical practitioners, etc).

 

[Justanothergrad]

I don't agree that we are growing as a specialty, when I compare what neuropsych was used for in the past. I honestly think that most of the HCG stuff is a money grab, designed to protract the length of training to get free labor.

Solution A: zero grandfathering, everyone has the same re-examination requirements, fellowship year one pays like post docs, second year pays the median for practicioners.

Solution B: acknowledge that there are alternate means of obtaining competence. Remove two year fellowship, and the subjective aspects (i.e., oral exam, and practice sample). All who can pass the written exam are in. Re-exam every 5 years or so.

Solution C: Change fellowship to a 2 year post doctoral masters with a national test at the end. Re-examination every few years. No grandfathering.

I dont disagree that those solutions would be more "fair" or the premises that you are arguing, but it's a problem with a diminishing impact as those aging psychologists retire. If post doc training increases level of proficiency, then why would removing it as a standard help the field. There may be 'better' ways to establish it as a bar but I cant imagine removing it being helpful in any way.

 

[Therapist4Chnge]

Shortening training for any sub-specialty is a non-starter for me, particularly in regard to neuropsych. There is still too much variability at the doctoral level in regard to training standards, so either fix that part or make fellowship a second place to weed out. Having having hacks out there makes my job easier day to day, but it hurts the field and likely hurts patients.

As for training, I view the 2yr fellowship training as essential because of the range of students coming out. Being able to really focus on rounding out the edges and really prepare yourself for every day practice.
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As for the OP, it may be worth checking out some of the more neuro-friendly rehab fellowships: Baylor, Johns Hopkins University (PM&R), University of Michigan (P&MR), Ohio State University (PM&R), etc. Please note, now that the Baltimore Conference Guidelines are out (they didn’t exist when I did my training), some of the training foci may have shifted at those sites, so obviously review the materials and talk with the DCTs at each rehab site.

Keep in mind that D22/B’more Conf Guideline fellowships will be focused on developing rehabilitation psychologists...which can include neuro work, but there will be a lot more intervention training required.

I came from a more neuro-focused place going into fellowship, and resisted some pf the therapy work at first, but I’m a much better clinician for doing it. It’s a delicate balance to walk, but I think strong neuro diagnostic skills can really enhance intervention work; i’m a rehab convert now.

 

[PsyDr]

I don't quite follow. If we are to maintain some level of acceptance and prestige, board certification seems crucial.

My main point:

1. If there training guidelines are clinically necessary, then all need to adhere to them regardless of burden (i.e., if this is for safety, patients should be safe if the neuropsychologist is 30 or 80).

2. If training guidelines are not clinically necessary, then the motivations seem to be to restrict trade.

A. If the motivation to restrict trade is based off a desire to increase income, this is a super stupid approach.

i. Grossly speaking, insurance doesn't pay based upon scarcity. So creating fewer won't work.
ii. The fewer the members, the less lobbying ability a group has.

B. If the motivations to restrict trade are based off of a desire to increase their professional self worth, then the letters mean nothing.