Is Neuropsychology the right route for me?

[jaredc]

Hi all,

I've spent the last three years going through a career change, heading back to school, and preparing for a graduate degree. At first, I was interested in getting a Master's in Counselling (As a former teacher, counselling my students was my favourite part of the job), but as I went through my undergraduate classes, I excelled in a lot of my neuroscience, statistics and research-based courses; I also really enjoyed them!

As such, I began to look into a Ph.D. in Clinical Psychology, specializing in Neuropsychology. In my head, this seemed like a great way for me to combine my interests in Neuroscience, Psychology, and Research-based skills all into one. Fast forward a bit, and I landed a job as a full-time RA at an R1 school, working under the mentorship of a Neurologist specializing in Neuroimaging.

I absolutely love my job. Since I was 13 years old, I've been working, and this is easily the best job I've ever had, but I am dealing with a feeling I can only describe as...Neurologist/Psychiatrist envy?

Specifically, my work here revolves around learning about and using neuroimaging (fMRI mainly) and seeking non-pharmaceutical methods of treating brain diseases. I spend my days in meetings mostly filled with Neurologists and Psychiatrists, and I find myself completely absorbed and fascinated by their research, clinical responsibilities, etc. There have only been two Neuropsychologists involved in any of our research so far, and this has me feeling a little scared.

I applied, unsuccessfully, for Ph.D. programs this year, and I find myself a little relieved? The schools I interviewed with confirmed that any interest I had in neuroimaging, neurology, neuroanatomy would have to be pursued on my own (auditing classes, studying on my own, etc.). Is this the norm for a Clinical Psych Ph.D. specializing in Neuropsych? I applied to these schools before I had cemented my interests, so if I do apply again next year, I know I want to focus on PI's and school programs that emphasize neuroscience. Is this kind of training realistic for a Clinical Psych program?

On the career side, from what I understand, as a Neuropsychologist, my primary responsibility will be clinical assessment/evaluation. Is that the limit of a Neuropsychologists clinical career options? I'm not saying this to undermine the importance of evaluation or assessment. I am just genuinely curious and have no one I can ask.

How about clinical research? As I mentioned, my interactions with Neuropsychologist has been minimal so far, and I fear research specializing in the clinical treatment of brain disease might be outside their realm? It sounds stupid when I put these words on paper, but that's been my experience here and with other labs, I volunteer with.

A part of me says Med school is the path I truly want to take. But at age 30 and lacking all kinds of undergraduate application requirements, I fear I am too late.

I had a hard time putting my thoughts into words here. I apologize for that. To sum up, I am worried that the training of a Clinical Psych Ph.D. program might not encompass learning about Neuroimaging, neuroanatomy, and neurology to the extent I am interested. I also worry that the clinical and clinical research responsibilities may not extend beyond assessment and evaluation.

Thanks to anyone who takes the time to read this. I would appreciate any insight (especially from current working Neuropsychologists and those in training!)

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[szymk1sm]

Lots of thoughts, not all coherent so bear with me...

I went to a Clinical Psychology PhD program known for producing neuropsychologists (amongst other specializations). We were required to take a neuroanatomy course as part of our curriculum and my dissertation was a fMRI study - so there are Clinical Psych programs out there that will allow for these things.

Regarding neuroimaging, I imagine smaller schools may not have the facilities for this, so look at larger programs associated with a med / neuroscience program? There are also neuroanatomy courses you can take if your program doesn't offer it (e.g., Marquette's course).

Neuropsychologists vary widely in their day-to-day activities. Some are only clinical, some are only research, and some are able to merge the two (and even this combination looks different between individuals). I would encourage you to see if you can meet with the neuropsychologists on your team to get an idea of what their schooling and career trajectory has looked like - this is very different from MDs.

I am an early career neuropsychologist, so my path is still evolving. I was very heavy into research in grad school (but also did a lot of psychotherapy and assessment), matched at a 50/50 internship (half of year was in neuropsych assessment and other half was in general psychology), and then did a 2-year clinical neuropsych postdoc within a neurology department.

Currently, I'm in a psychiatry department and my split is 80/20 (80% of my week is involved in clinical research activities and 20% is in clinical neuropsych assessment). My neuropsych colleagues have different splits (one is 90 research / admin & 10 clinical, other is 100 clinical). My research extends beyond assessment into non-pharmacological interventions to improve brain and cognitive functions in geriatric mental health conditions.

All of this is to say that there is flexibility in what you do as a neuropsychologist and chatting with some may give you more knowledge on what to expect (especially if you're at a R1 - there may be some neuropsych's outside your dept / research group - email both clinically focused ones and research ones to see if you can chat). There are also mentoring organizations through various neuropsychological organizations (AACN, SCN, SBN, ANA, etc.) that may be able to provide additional guidance.

It really boils down to what you want your day-to-day life to look like and then figuring out how to get there (whether it is via a PhD or MD).

 

[summerbabe]

The schools I interviewed with confirmed that any interest I had in neuroimaging, neurology, neuroanatomy would have to be pursued on my own (auditing classes, studying on my own, etc.). Is this the norm for a Clinical Psych Ph.D. specializing in Neuropsych?

Every program will be different but expect this to be the norm. What’s a likely option would be to use elective credits to take classes offered by other grad depts at your school (assuming they give you permission) or try to pay/audit courses at other institutions in this area. This would obviously be impossible in a small area where your school is the only game in town.

Another option would be to get plugged in with neuropsych predoctoral and postdoctoral programs in your area if those exist and see if you can attend the didactics for their interns and fellows. So both geography and program match can be really important, not just whether there is a neuropsych track or neuropsych faculty.

For the most part, your average clinical psych PhD program is there to cover the basics: therapy, assessment (including personality), research, and general coursework. Nobody needs neuroimaging to be a competent clinical psychologist so consider all of this as elective and for your career and personal development.

Edit: one last thought about pursuing neuropsychology.

You would be pursuing training to become a psychologist first and foremost. Some of us specialize in a specific area like neuropsych, which may or may not work out, even for talented and hardworking individuals. If you can’t see yourself happily working as a general clinical psychologist, this might not be the field for you.

It would be akin to somebody saying they want to be a psychiatrist but have zero interest in physical medicine. And if your interests are so specific, you might not be seen as the best fit from an admissions perspective.

 

[bcliff]

First... I'll note that a big draw for me, when debating MD/DO vs. PhD was the full funding offered by most scientist-practitioner and clinical-scientist training programs (which it sounds like you're most strongly considering). I would imagine that, at 30, minimizing your debt burden is something you're likely considering as well (i.e., < ~$20k for a fully-funded PhD vs. ~$200k for an MD/DO). In addition to being accessible via free-to-low-cost degree, recent salary survey data for neuropsychology place median salary well within the six-figures range: https://www.tandfonline.com/doi/epub/10.1080/13854046.2020.1849803?needAccess=true (look at Tables 6 and 7)

Second, there are plenty of opportunities for neuropsychologists to directly provide evidenced based, cognitive-behavioral interventions to patients with a wide range of clinical presentations -- I would maybe look into "rehabilitation neuropsychology" and specifically examine the intersection of neuropsychological assessment and interdisciplinary rehabilitation. I have found that any residual MD/DO "envy" I may have had has dissipated working within an interdisciplinary setting (i.e., I have a unique expertise that is valued by the other providers on the team -- including PTs, OTs, SLPs, physicians, nurses, etc.).

It is not uncommon for neuropsychology, especially within these interdisciplinary settings, to make pretty specific recommendations about potential need for pharmacologic interventions -- At its best, there is synthesis between neuropsychologist expertise in brain-behavior relationships and physician expertise in broader human physiology and functioning. I love having the opportunity to conceptualize why a patient is experiencing a specific cluster of symptoms, and I have found that physicians (and other providers) often appreciate the insight offered from a neuropsychological evaluation. Being embedded within a rehabilitation setting, there are also opportunities for me to directly intervene upon these symptoms. In retrospect, had I pursued an MD/DO, I don't think I would find the work I would be doing as a physician as engaging as the work I'm currently doing in neuropsychology.

Third, on the topic of research, I'll note that I'm much more interested in measurement, psychometrics, and treatment outcomes than I am in neuroimaging, which are likely more "traditional" research interests for a psychologist, so I can't speak specifically to that piece of your question -- With that being said, our dual training in science and practice, in addition to our training in brain-behavior relationships, renders neuropsychologists uniquely qualified to apply these more "traditional" interests within larger, interdisciplinary research projects involving neuroimaging. I also have neuropsychologist colleagues who lead their own neuroimaging studies, so that's definitely a possibility as well. I'm not the right person to ask about the specifics of physician training, but... I would describe most MD/DO training (without a dual PhD) in statistics and research design/methodology as light in comparison to a more research heavy clinical psychology PhD program. I would weigh this if you're interested in pursuing a career as an independent researcher.

I echo the sentiments of others that I would only pursue a career in clinical neuropsychology if you, at the end of the day, are at least somewhat interested in the broader field of clinical psychology. Based on your post, I would examine your interest in both the science and practice of clinical psychology during this self-assessment. You don't necessarily need to "love" every aspect of clinical psychology, but there are a few concepts that I would consider to be particularly important. An interest (or willingness, at least) to provide psychotherapy is an important one that comes to mind right now. If you're entirely disinterested in pursuing a clinical career, then you could also consider pursuing a PhD in neuroscience or another bench science.

FWIW, I come from a fully funded PhD program at a smaller, state university (without a medical school affiliation), where there were still on-site opportunities for training in neuroimaging, so it's definitely not impossible to find this experience at the kinds of programs you're considering. I'll also add that it's not uncommon for the majority of a student's predoctoral training in neuropsychology to occur "off-site" (e.g., external clinical and research practica, etc.), prior to transitioning to a more dedicated neuropsychology training program (i.e., internship and fellowship) -- Feel free to PM if you're interested in chatting more about specifics. Good luck!

 

[Sanman]

Would be happier as a psychologist or a physician? There are plenty of ways to get to your desired goal, but what do you want if you lose the desire or cannot get there? Bottom line, neuropsychologists can do this kind of research, but they need to land somewhere that they have access to the equipment. The graduate programs and the future jobs will be limited if you want to take the neuropsych path and want to conduct fMRI research. Just as there are fewer future programs with access, there are fewer future jobs as well. How much do you want to sacrifice for your career? Two years of community college courses is a drop in the bucket in terms of time and money if you want to go to medical school.

 

[jdawg2017]

Hi all,

I've spent the last three years going through a career change, heading back to school, and preparing for a graduate degree. At first, I was interested in getting a Master's in Counselling (As a former teacher, counselling my students was my favourite part of the job), but as I went through my undergraduate classes, I excelled in a lot of my neuroscience, statistics and research-based courses; I also really enjoyed them!

As such, I began to look into a Ph.D. in Clinical Psychology, specializing in Neuropsychology. In my head, this seemed like a great way for me to combine my interests in Neuroscience, Psychology, and Research-based skills all into one. Fast forward a bit, and I landed a job as a full-time RA at an R1 school, working under the mentorship of a Neurologist specializing in Neuroimaging.

I absolutely love my job. Since I was 13 years old, I've been working, and this is easily the best job I've ever had, but I am dealing with a feeling I can only describe as...Neurologist/Psychiatrist envy?

Specifically, my work here revolves around learning about and using neuroimaging (fMRI mainly) and seeking non-pharmaceutical methods of treating brain diseases. I spend my days in meetings mostly filled with Neurologists and Psychiatrists, and I find myself completely absorbed and fascinated by their research, clinical responsibilities, etc. There have only been two Neuropsychologists involved in any of our research so far, and this has me feeling a little scared.

I applied, unsuccessfully, for Ph.D. programs this year, and I find myself a little relieved? The schools I interviewed with confirmed that any interest I had in neuroimaging, neurology, neuroanatomy would have to be pursued on my own (auditing classes, studying on my own, etc.). Is this the norm for a Clinical Psych Ph.D. specializing in Neuropsych? I applied to these schools before I had cemented my interests, so if I do apply again next year, I know I want to focus on PI's and school programs that emphasize neuroscience. Is this kind of training realistic for a Clinical Psych program?

On the career side, from what I understand, as a Neuropsychologist, my primary responsibility will be clinical assessment/evaluation. Is that the limit of a Neuropsychologists clinical career options? I'm not saying this to undermine the importance of evaluation or assessment. I am just genuinely curious and have no one I can ask.

How about clinical research? As I mentioned, my interactions with Neuropsychologist has been minimal so far, and I fear research specializing in the clinical treatment of brain disease might be outside their realm? It sounds stupid when I put these words on paper, but that's been my experience here and with other labs, I volunteer with.

A part of me says Med school is the path I truly want to take. But at age 30 and lacking all kinds of undergraduate application requirements, I fear I am too late.

I had a hard time putting my thoughts into words here. I apologize for that. To sum up, I am worried that the training of a Clinical Psych Ph.D. program might not encompass learning about Neuroimaging, neuroanatomy, and neurology to the extent I am interested. I also worry that the clinical and clinical research responsibilities may not extend beyond assessment and evaluation.

Thanks to anyone who takes the time to read this. I would appreciate any insight (especially from current working Neuropsychologists and those in training!)

Sorry this cycle didn't work out for you... it sounds like you are getting good experiences as you are transitioning into the field.

I would say you will pretty commonly encounter neuropsychologists involved in projects that have neuroimaging components. Less commonly will the neuropsychologist be the PI (maybe CO-PI), unless that neuropsychologist got a lot of neuroimaging training along the way. As someone in the later stages of my training to become a clinical neuropsychologist, I echo the sentiment that having an interest in clinical psychology broadly is key for success in the field. The cliche adage is "we are trained as clinical psychologists first, and neuropsychologists second." While I don't know for certain how this weighs in my lab's admissions process, I can personally tell you that I have relayed to my mentors the message that I have gotten from some applicants over the years that they have zero interest in therapy. It is totally okay to feel that way after your training, as many clinical neuropsychologists do, but the amount of patients you will interact with in the assessment context where there is significant psychiatric overlap is quite high (even higher if you work at a place like a VA medical center).

Many programs, especially in states in the U.S. with more stringent licensure requirements, cannot formally fit neuroimaging/neuroanatomy courses into the standard curriculum of clinical psychology trainees (vs. all of the legally required courses in assessment, therapy, etc.). You may more commonly find built-in opportunities at schools with formal neuropsychology tracks (e.g., the University of Florida comes to mind). Other places, perhaps more commonly, you will see what you mentioned, like opportunities to take neuroimaging/neuroanatomy courses as an elective, or to audit the courses. NAN and other groups also put on web-based workshops all the time (they cost some $$, but are good).

I resonate with the sentiment that med school might be a long (and more expensive) path. Factoring in the pre-req courses (while I assume you work full-time), plus 4 years of med school, plus ~4+ years of residency, you are looking at a decade before you are a full-fledged professional. However, the path is similarly long in clinical psych... let's say you got in next cycle, the standard PhD student takes 5-6 years (including APA internship), then at least 2 years for a neuropsych post-doc. Your earnings potential will be less as a clinical psychologist/neuropsychologist vs. our MD/DO colleagues (probably even PA colleagues...?), but if you attend a fully-funded program you will take on little-to-no debt.

It sounds like you have some soul searching to do... glad you could post on the forum and happy to answer questions!

 

[jaredc]

Wow, so many AMAZING replies. I am new here but what an amazing community and forum. Thank you all.

Neuropsychologists vary widely in their day-to-day activities. Some are only clinical, some are only research, and some are able to merge the two (and even this combination looks different between individuals). I would encourage you to see if you can meet with the neuropsychologists on your team to get an idea of what their schooling and career trajectory has looked like - this is very different from MDs.

I am an early career neuropsychologist, so my path is still evolving. I was very heavy into research in grad school (but also did a lot of psychotherapy and assessment), matched at a 50/50 internship (half of year was in neuropsych assessment and other half was in general psychology), and then did a 2-year clinical neuropsych postdoc within a neurology department.

Noted. Thank you for sharing your experience. I will take your advice and reach out to the Neuropsychs I'm working with here!

You would be pursuing training to become a psychologist first and foremost. Some of us specialize in a specific area like neuropsych, which may or may not work out, even for talented and hardworking individuals. If you can’t see yourself happily working as a general clinical psychologist, this might not be the field for you.

I should've included this in my original post. I've been volunteering as a Crisis-Responder for over a year now and I love the talk-therapy/psychotherapy aspect of my job. I just know I don't want to be doing only that. I also know I want my clinical services (including therapy/counselling/guidance, etc.) to be based on Neuroscience. It is something personal to me.

First... I'll note that a big draw for me, when debating MD/DO vs. PhD was the full funding offered by most scientist-practitioner and clinical-scientist training programs (which it sounds like you're most strongly considering). I would imagine that, at 30, minimizing your debt burden is something you're likely considering as well (i.e., < ~$20k for a fully-funded PhD vs. ~$200k for an MD/DO). In addition to being accessible via free-to-low-cost degree, recent salary survey data for neuropsychology place median salary well within the six-figures range: https://www.tandfonline.com/doi/epub/10.1080/13854046.2020.1849803?needAccess=true (look at Tables 6 and 7)

Agreed. It's such a huge advantage of the program and also one of the reasons I was kinda relieved to get rejected last week from a program that was non-funded. Didn't make sense in the big picture to go there.

Second, there are plenty of opportunities for neuropsychologists to directly provide evidenced based, cognitive-behavioral interventions to patients with a wide range of clinical presentations -- I would maybe look into "rehabilitation neuropsychology" and specifically examine the intersection of neuropsychological assessment and interdisciplinary rehabilitation. I have found that any residual MD/DO "envy" I may have had has dissipated working within an interdisciplinary setting (i.e., I have a unique expertise that is valued by the other providers on the team -- including PTs, OTs, SLPs, physicians, nurses, etc.).

Noted! I will look into that for sure. Love hearing that your work is respected by physicians and other doctors. I noted many of the Neurologists refer their patients to Psychiatrists when there was an aspected psychological dimension to their illnesses. I wondered if Clinical psychologist and Neuropsychs specifically were not considered to be "At the same level" by MDs. Childish thoughts, but something I think about nonetheless.

Sorry this cycle didn't work out for you... it sounds like you are getting good experiences as you are transitioning into the field.

Thank you for your kind words and insight.

Thank you all again so much.