PhD/PsyD Job after postdoc

[irishgoodbye]

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Hey everyone,

I just started a one year postdoc at the beginning of this month. In your experience, when did you start looking and applying for jobs during postdoc? Is there a timeframe when clinical vs academic jobs tend to be posted?

Thanks!

 

[WisNeuro]

Well, all caveats are that most of us did this in a non-pandemic year. I started looking with about 10 months left in my 2-year postdoc, but I was also looking at mainly VA's, which have a long interview/on-boarding process at most places. For non-VA sites, looking in the 6-9 month range would be fine, always need to leave some time for credentialing and on-boarding, unless you want a gap in employment.

Also, you can always apply, even if it's a long ways out. Some places may be willing to hold a spot for the right applicant.

Once again, who knows what timelines look like now. Budgets are royally f'd all over the place. It may be a tight market in some areas for the next year, our org is pretty much in a hiring freeze outside of dire need situations.

 

[irishgoodbye]

Thanks for this, makes sense! I am definitely concerned about the job market due to covid. I appreciate the tip about applying early and knowing that some places may still consider me based on fit. Thanks!

 

[WisNeuro]

Thanks for this, makes sense! I am definitely concerned about the job market due to covid. I appreciate the tip about applying early and knowing that some places may still consider me based on fit. Thanks!

If anything, it's good practice in terms of interviewing and initial negotiations. Back when I was applying real early in postdoc, I made to the final two for a VA position that wanted to build a new assessment rotation. They were pretty frank that the other person got it because they could start right away. Still, helped with gaining interview experience for jobs after training. And, I assume now, most places are doing virtual interviews and such, so you don't even have to travel and such.

 

[Ollie123]

In normal times, academic postings start in summer and continue through fall/winter, then largely taper off in spring. That is for traditional university jobs...AMCs, cancer center and the like may be off-cycle since they are not beholden to a semester schedule. Clinical jobs are a bit more year round. A lot depends on what you want - academic jobs it is very easy common to delay acceptance for quite some time. Heck even deferring your start date for a full year is not unusual.

This year is probably going to be insane, so who knows. I expect the hiring cycle may be delayed. I am dead certain that once applications are in the actual hiring process will drag out. Negotiations are going to be an utter nightmare.

 

[irishgoodbye]

In normal times, academic postings start in summer and continue through fall/winter, then largely taper off in spring. That is for traditional university jobs...AMCs, cancer center and the like may be off-cycle since they are not beholden to a semester schedule. Clinical jobs are a bit more year round. A lot depends on what you want - academic jobs it is very easy common to delay acceptance for quite some time. Heck even deferring your start date for a full year is not unusual.

This year is probably going to be insane, so who knows. I expect the hiring cycle may be delayed. I am dead certain that once applications are in the actual hiring process will drag out. Negotiations are going to be an utter nightmare.

I didn’t think about the hiring and negotiation process being more difficult, but makes sense. Time to buckle up!

 

[WisNeuro]

This year is probably going to be insane, so who knows. I expect the hiring cycle may be delayed. I am dead certain that once applications are in the actual hiring process will drag out. Negotiations are going to be an utter nightmare.

Yeah, with how much most hospital systems are losing money in buckets, my assumption would be that HR is going to have some hard lines on salary negotiations for many positions.

 

[Ollie123]

Yeah, with how much most hospital systems are losing money in buckets, my assumption would be that HR is going to have some hard lines on salary negotiations for many positions.

I actually think salary negotiations would be the (comparatively) easy part right now - at least for academic hospital jobs. And honestly, I'd negotiate softer on salary right now than I would have ever considered recommending someone do in the past (assuming you need the job). Ask for more certainly, but at least with us anyone trying to play hardball right now is just going to get their offer yanked.

Startup is where people are going to get killed because it seems more discretionary. Space will be even harder, since there seems a very real possibility you will have to do it without ever getting to see it in-person, places are reorganizing their space anyways so many places won't even know what space is/is not available, etc..

 

[PsyDr]

I wouldn't try to negotiate much on salary or benefits. I would politely ask HR to put the specifics in my job offer (e.g., hours per week).

 

[Ollie123]

I am not sure anything has ever scared me as much about the financial state of the field as Psydr stating that one should not try to negotiate on salary/benefits right now.

 

[PsyDr]

I am not sure anything has ever scared me as much about the financial state of the field as Psydr stating that one should not try to negotiate on salary/benefits right now.

I don't think things are bad, in the long term. I think things are bad in the near term.

1) Practices, hospitals, etc, are gonna have about 3-9 months of substantially reduced income.
2) There is essentially no change in overhead for #1.
3) I believe that there is no change in demand. Or, if there is any change, there is increased demand.
4) When this all opens back up again, employers are going to want to recapture as much income as possible.
5) If one looks at the 2008 financial crisis, employers pressured employees to work MUCH harder, with the average employee efficiency increasing about 20-50%. This employee productivity did NOT return to baseline after the end of the crisis.
6) It might therefore be reasonable to expect employers to try to hire ECPs at a lower rate, tell them how bad the financial picture is, and ask for extra hours/assessments to get them through "this tough time".
7) I HIGHLY doubt that some bean counter in a hospital or practice is going to say, "Well, we lost about $500k in revenue in 2020. But we made an extra $500k in 2021. We should tell the workers to go back to working normal hours and duties." Wall Street always expects increased profits, every year. So does the IRS.
8) Putting that all together, I think ECPs are gonna have a hard time getting a "job". I think those employers are gonna offer lower salaries. I am guessing that employers will be 50/50 in telling new employees that they expect extra work, with bigger employers lagging due to bureaucracy. I estimate that most employee contracts will say, "full time" without much other statements. I think that asking them to add something like, "consistent with a standard work week" would be advisable. I would take what I could get for the short term. I would work 60hrs/week, no questions. However, a year in I would start asserting my work hours (e.g., "Dave, no one defines a standard work week as 60hrs."). It would be MUCH easier to look for other work after this year.
9) For those in PP, the demand is UNREAL. We will be fine in the long run. Those of us that were working in 2008 can attest to how busy we were.

 

[Ollie123]

Oh I know. Just poking fun as that is a...marked difference...from what I imagine you would have said a year ago.

On the clinical side, demand is sky high - at least on the therapy side (may be for assessment too - I just can't say). Heck, we're getting 60-80 new referrals per DAY and have been for months. Our field typically runs inverse to economic cycles. We're also just about the only healthcare field that can function effectively (even if not fully effective) when remote. Surgery sure can't.

Everything is going to be a hot mess the next 1-3 years. I worry more about the academic side in the medium/long-term as the forces at play there are just more multifaceted and complex. The need for mental health treatment will not go away any time soon.

 

[WisNeuro]

Assessment demand is still high, though people are waffling on in-person. So, those who are willing to do in-person have no issues with filling their practice, though they had no problems before either. Our admin is still debating things. So, while that happens, I'll keep enjoying my full salary, working ~20 hour weeks.

 

[PsyDr]

It's gonna be gang busters.

Academics will have incredible opportunities to publish about teletherapy's effectiveness, remote assessment equivalence, social isolation's impact on relationships/disease states/ etc, neurocognitive impacts of covid, educational stuff about distance education, etc etc etc. I HIGHLY HIGHLY HIGHLY encourage some youngster to start publishing on this ASAP. This is a unique time when some kiddo in grad school could become a world expert in 2 years.

Clinicians will have increased demand for pediatric stuff, couples' stuff, health stuff, cognitive stuff, emotional impacts in change of life circumstances, etc. You can't tell me there are not an increase in the number of parents who think lil Johnny has ADHD because he can't silently do zoom classes for 30hrs/week. Or increased substance abuse. Or increased spouses who don't like their SO after being stuck inside with them. Or grannies who were socially isolated so the family only sees a start decline after not seeing her for months.

 

[beginner2011]

It's gonna be gang busters.

Clinicians will have increased demand

The one caveat to this is that it seems like people seeking services will also be less able to afford full fee and may not have health insurance.

 

[PsyDr]

The one caveat to this is that it seems like people seeking services will also be less able to afford full fee and may not have health insurance.

I mostly call BS on that. Let me tell you my ECP experience with the elderly:

I go to work. Do a full neuropsych. Medicare caps how many hours I can work on this case, even if I'm confronted with some rare disorder like Mariana's Trench encephalopathy. So I work 12 hours, and get paid for 8 hours. I submit a bill to medicare, get paid for those 8hrs. Then I submit a bill to the patient about their co-pay. They tell me some sob story about how they can't afford their co-pay, how their grandkids need new sportsball equipment, etc. Tugs at my heart strings. Then I realize this person has a paid off house, drives an S-class mercedes, goes on three vacations a year. Then I compared my financials, with an apartment, a car with a loan, and constant revenue concerns. This is a wealthy person who is asking me to take a hit because they want to keep their own money. Took me about 3 years to establish the boundary that I deserve to be paid for my services, and someone else's money troubles are their own.

Now with non-geros: Same as above, but the patient or family is about 3x more insistent that this needs to happen RIGHT NOW!. Then I bill, and they say they can't afford it. If I listened to those exact same people, I'd hear about them having several luxury items I did not have, drove nicer cars, or vacations I couldn't afford to take as a single person, never mind a family. Straight up not my problem. Go without cable for a year and you can afford my work. And which is more important? This family watching Fox news or me being able to retire?


Once those boundaries were FIRMLY in place, I was able to differentiate real need from those who just didn't want to use their discretionary income for healthcare. I'm happy to do pro bono work, but only in certain circumstances.

 

[foreverbull]

The one caveat to this is that it seems like people seeking services will also be less able to afford full fee and may not have health insurance.

This is exactly what is happening in communities that aren’t higher SES right now. People with white collar jobs are fine to pay out of pocket, but the middle class is getting really crunched if they don’t have the same income they did before the pandemic and/or they work in the service industry. Yes, a lot of folks need therapy, but now fewer can pay out of pocket in communities like mine.

That said, for ECPs who are in this boat, now might be the time to either get paneled or have a sliding fee scale that is low enough to capture folks in the community.

 

[beginner2011]

Once those boundaries were FIRMLY in place, I was able to differentiate real need from those who just didn't want to use their discretionary income for healthcare. I'm happy to do pro bono work, but only in certain circumstances.

Have you found a good way to differentiate before starting psychotherapy with a patient?

This is exactly what is happening in communities that aren’t higher SES right now. People with white collar jobs are fine to pay out of pocket, but the middle class is getting really crunched if they don’t have the same income they did before the pandemic and/or they work in the service industry. Yes, a lot of folks need therapy, but now fewer can pay out of pocket in communities like mine.

As a graduate student in a major metro I was the intake coordinator and I can say there were a ton of low SES folks that came through. Because we were a training clinic we didn't take insurance, and we had admin staff who would do a review of patient financials to set appointment fees for folks who requested reduced cost. I'm curious how things look now and will look throughout the ongoing economic crisis. Anecdotally, I know of a colleague who was running a cash only independent psychotherapy practice at about 2x the rate of insurance fees prior to COVID and felt self-conscious about it so they decided to switch to primarily insurance patients during the crisis.

 

[WisNeuro]

As PsyDr said, no shortage of people seeking services who either have insurance or can pay out of pocket. We cater to a low SES population in my hospital job, and that's straight salary, so no issues there.

That being said, when I do eventually go clinical PP in addition to my IME PP work, I will have no qualms with getting paid what I am worth. Between this job and the VA, I already put in my time with the under served. And, as was mentioned, the better off I am in seeing the PP clinicals and IME work, the more opportunity I'll have for some pro-bono or lower cost work. I have plenty of referral sources I trust who can determine the financial necessity piece before I see the person.

 

[foreverbull]

As PsyDr said, no shortage of people seeking services who either have insurance or can pay out of pocket. We cater to a low SES population in my hospital job, and that's straight salary, so no issues there.

That being said, when I do eventually go clinical PP in addition to my IME PP work, I will have no qualms with getting paid what I am worth. Between this job and the VA, I already put in my time with the under served. And, as was mentioned, the better off I am in seeing the PP clinicals and IME work, the more opportunity I'll have for some pro-bono or lower cost work. I have plenty of referral sources I trust who can determine the financial necessity piece before I see the person.

Okay, good for you, then?

I’m glad some folks are confident that psychotherapy PP will be fine, but my experience in a middle class community that has been stretched thin doesn’t support this claim, so this is highly dependent on the community. People in my community are relying on insurance more than ever, from the calls I get weekly. I went from turning away about 3/4 up to 9/10 or higher purely due to cost alone, and I charge the going cash rate in my community, not an exorbitant amount by any means, but a fair rate for a psychologist. It’s just that that rate is even less attractive to folks now when they consider the longterm cost, especially if they have insurance and want to be able to use it.

 

[PsyDr]

Have you found a good way to differentiate before starting psychotherapy with a patient?

Sure.

1) So first you need to remember that YOUR contract with THEIR insurance company requires you to get a co-pay. The insurance has the right to audit your books. They can state that if you are not getting co-pays, you have mis-represented your going rate, and then have you pay the difference back to them for the last several years. So any time you're considering this stuff, you're literally risking getting an audit from a private insurance who can demand tens of thousands of dollars. If you're talking about medicare, not trying to get co-pays is literally a federal crime. Seriously, CMS says under billing is fraud. I would not do well in prison.

2) When I have worked with reputable charities, the patient who requests a sliding scale has to submit their tax returns to include their dependents, a receipt for their rent, and receipts for their major expenses (e.g., school tuition, insurances, etc). It sounded extreme when I started, but damned if people didn't actually provide that all the time.

3) On a less formal basis, I've searched the property tax records and the median household income for their area. If they're living in a ritzy part of town, and paying a bajillion dollars in rent to keep up appearances... their money problems are not my concern. If they have an expensive home, again, not my concern. Between the patient and myself, I know who I would prefer to take out a second mortgage. If they live in an apartment in a middle or lower class area, work in a job that I know the income of, etc, I'm happy to help.

4) When confronted with requests when I am unsure, I just refer them to a local pro bono clinic. Sometimes that request makes people decide they have the money.

5) When people get mad at my rates, I give them the name of another guy in my area who is booked out 6 months in advance and costs more.


It's my experience that the people who have money, and don't want to spend it, get angry when you ask them to prove the need. However, those in need seem to be more grateful and happy to prove it.

Psychotherapy specific: some confrontation is probably necessary.

 

[Sanman]

Have you found a good way to differentiate before starting psychotherapy with a patient?

If not taking insurance, ask for payment prior to the session. Same thing with Copays really. If they want to use their session time hemming and hawing about a few bucks, it is their time to waste.

 

[Ollie123]

My big concern medium-long term for academia is the impact on NIH dollars and how these get distributed. We entered a weird period where NIH was allowing idle effort openly for several months and now sorta-but-with-some-qualifications while promising supplements to cover costs to complete work. These dollars will have to come from somewhere. Funding rates are already < 10% at some institutes. Historically, when funding dips it is the small institutions and junior folks who get hit the hardest just because of how the review process works. Charities/foundations will also likely take a hit, so I suspect non-govt funding will dive.

It will come back eventually. The need for science sure isn't going anywhere. It just ain't gonna be pretty for probably 3-5 years.

 

[WisNeuro]

Okay, good for you, then?

I’m glad some folks are confident that psychotherapy PP will be fine, but my experience in a middle class community that has been stretched thin doesn’t support this claim, so this is highly dependent on the community. People in my community are relying on insurance more than ever, from the calls I get weekly. I went from turning away about 3/4 up to 9/10 or higher purely due to cost alone, and I charge the going cash rate in my community, not an exorbitant amount by any means, but a fair rate for a psychologist. It’s just that that rate is even less attractive to folks now when they consider the longterm cost, especially if they have insurance and want to be able to use it.

It is indeed good for me, and pretty much most people in the field aside from certain saturated markets. We'll see how things turn out as everything progresses, but I haven't seen much to suggest that the sky is falling yet. And, when it does, it won't be due to decreased demand, it'll likely be falling reimbursement and more people flooding into PP.

 

[AcronymAllergy]

Okay, good for you, then?

I’m glad some folks are confident that psychotherapy PP will be fine, but my experience in a middle class community that has been stretched thin doesn’t support this claim, so this is highly dependent on the community. People in my community are relying on insurance more than ever, from the calls I get weekly. I went from turning away about 3/4 up to 9/10 or higher purely due to cost alone, and I charge the going cash rate in my community, not an exorbitant amount by any means, but a fair rate for a psychologist. It’s just that that rate is even less attractive to folks now when they consider the longterm cost, especially if they have insurance and want to be able to use it.

I wouldn't doubt the middle- and lower-class are getting hammered; I'm sure there's data out there on it, and we know which sectors are generally the hardest hit. I wonder if this may finally be the dam breaker for pressuring insurance companies to improve their mental health coverage and rates. Then again, that's likely overly-optimistic. We'll probably just see an influx of less-credentialed/less-trained folks being drawn to the field by the demand and ok'd by insurance companies due to agreeing to lower rates.

 

[WisNeuro]

I wouldn't doubt the middle- and lower-class are getting hammered; I'm sure there's data out there on it, and we know which sectors are generally the hardest hit. I wonder if this may finally be the dam breaker for pressuring insurance companies to improve their mental health coverage and rates. Then again, that's probably overly-optimistic.

You'd have to get legislation that actually gives parity laws regulatory teeth. Those provisions were stripped by a certain party when the bills were passed.

 

[AbnormalPsych]

5) When people get mad at my rates, I give them the name of another guy in my area who is booked out 6 months in advance and costs more.

This is pretty clever. Good market research and information to have on hand.

 

[WisNeuro]

This is pretty clever. Good market research and information to have on hand.

Yeah, for non-VA neuropsych, artificially keeping your waitlist low is definitely a crowd pleaser. Adult waitlist here is 6-12 months for most, peds is like a year+.

 

[Grenth]

It's gonna be gang busters.

Academics will have incredible opportunities to publish about teletherapy's effectiveness, remote assessment equivalence, social isolation's impact on relationships/disease states/ etc, neurocognitive impacts of covid, educational stuff about distance education, etc etc etc. I HIGHLY HIGHLY HIGHLY encourage some youngster to start publishing on this ASAP. This is a unique time when some kiddo in grad school could become a world expert in 2 years.

My school has already had two students defend explicitly Covid related quantitative dissertations this year. I honestly don't know exactly how, they're not in my lab but these were students who already had dissertations proposed and data collected for other topics but dropped them and got expedited IRBs/proposals to capitalize on a hot research area.

 

[mypointlesspov]

My school has already had two students defend explicitly Covid related quantitative dissertations this year. I honestly don't know exactly how, they're not in my lab but these were students who already had dissertations proposed and data collected for other topics but dropped them and got expedited IRBs/proposals to capitalize on a hot research area.

I can't imagine being like 60% done with my dissertation then scrapping it. Oof, that hurts my feelings. I'm definitely curious about their research though. I don't want to pry, but do you know if they're going to submit to a journal?

 

[Neuropsyclone]

Related to this thread: Can people refer me to some good informational resources about navigating the job hunt and negotiations (neuropsych, AMCs, but broader things may be helpful too). I am also a post doc, and I feel like I need to start reading on the topic.

 

[psychlife19]

Proven negotiation tactic. I’ll let you have this tip for free but if you want more tips, ya’ll are gonna have to pay me.