Job satisfaction for clinical psychologists?

[2012PhD]

Hi everyone,

I'm wondering if there are any decent employment places left for clinical psychologists who are interested in clinical work as a career? VA's were supposed to be the "best" option for those of us interested in clinical work, but i've been learning by talking to various mentors and collegues at VA's that psychologists at VA's are seeing patients once per month or less and have caseloads of 250 individual patients at any given time (psychotherapy patients not assessment patients). Some are seeing patients for 15 minutes or doing quick intakes for 15 minutes. This is an alarming trend and is getting worse given the numbers of returning veterans.

At Kaiser, many psychologists see patients once/ month, have large caseloads, and see 10 patients per day. Most Counseling centers and community mental health centers pay abysmally low, have few resources, and don't offer good care. I interviewed at counseling centers last year and was surprised to learn that most had a 6-9 session limits for each student and large caseloads. Some didn't even offer weekly therapy anymore to students.

I'm wondering if anyone on the clinical side is satisfied with his/her job and is able to practice clinical psychology the way they would like to?

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[aequitasveritas]

If you are good, private practice is the best place.
It takes some networking and some luck but it can be done.
I could never work at the places you mentioned-not real therapy.

 

[Therapist4Chnge]

Fyi:

The tcn/aacn 2010 "salary survey": Professional practices, beliefs, and incomes of u.s. Neuropsychologists

abstract: doctoral-level members of the american academy of clinical neuropsychology, division 40 (clinical neuropsychology) of the american psychological association, and the national academy of neuropsychology, and other neuropsychologists, were invited to participate in a web-based survey in early 2010. The sample of respondents was 56% larger than a prior related income and practice survey in 2005. The substantial proportional change in gender taking place in the field has continued, with 7 of 10 post-doctoral residents being women and, for the first time ever, more than half of the total sample of respondents being women. Whereas the median age of apa members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists remains at 47 and has remained essentially unchanged since 1989, indicating substantial entrance of young psychologists into the field. The houston conference training model has influenced the vast majority of residency training sites, and is endorsed as compatible with prior training by two-thirds of all respondents. Testing assistant usage remains commonplace, and is much more common in institutions. The "flexible battery" approach has again increased in popularity and predominates, whereas endorsement of the "fixed/standardized battery" approach has continued to decline. The vast majority of clinical neuropsychologists work full time. Average length of time reported for evaluations increased significantly from 2005, which does not appear to be explained by changes in common referral sources or common diagnostic conditions being evaluated. The most common factors affecting evaluation length were identified, with the top three being goal of evaluation, stamina/health of examinee, and age of examinee. Pediatric specialists are more likely than others to work part time, more likely to be women, more likely to work in institutions, and report lower incomes than respondents whose professional identity is purely adult or a combination of adult and pediatric. Incomes once again vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, and income satisfaction and job satisfaction are moderately correlated. Job satisfaction of neuropsychologists in general is higher than reported for other us jobs. Fewer than 5% of respondents are considering changing job position. As was true in the 2005 survey, a substantial majority of respondents reported increased incomes over the last 5 years. Actual reported income values were meaningfully higher than in 2005 across general work settings and professional identities, and were also higher for entry-level positions. Numerous breakdowns related to income and professional activities are provided.

authors: sweet, jerry; meyer, dawn giuffre; nelson, nathaniel; moberg, paul

source: the clinical neuropsychologist (neuropsychology, development and cognition: Sec, volume 25, number 1, january 2011 , pp. 12-61(50)

 

[2012PhD]

Fyi:

Thanks! Looks like neuropsych. is doing pretty well compared to other areas. I wouldn't mind spending 30% of my time doing testing/assessment, but i can't imagine specializing in an area i'm not passionate about and doing a 2 year post-doc in this area.

 

[erg923]

Hi everyone,

I'm wondering if there are any decent employment places left for clinical psychologists who are interested in clinical work as a career? VA's were supposed to be the "best" option for those of us interested in clinical work, but i've been learning by talking to various mentors and collegues at VA's that psychologists at VA's are seeing patients once per month or less and have caseloads of 250 individual patients at any given time (psychotherapy patients not assessment patients). Some are seeing patients for 15 minutes or doing quick intakes for 15 minutes. This is an alarming trend and is getting worse given the numbers of returning veterans.

At Kaiser, many psychologists see patients once/ month, have large caseloads, and see 10 patients per day. Most Counseling centers and community mental health centers pay abysmally low, have few resources, and don't offer good care. I interviewed at counseling centers last year and was surprised to learn that most had a 6-9 session limits for each student and large caseloads. Some didn't even offer weekly therapy anymore to students.

I'm wondering if anyone on the clinical side is satisfied with his/her job and is able to practice clinical psychology the way they would like to?

Unless one is doing strict protocol therapies such as PE, CPT, or CBT for insomnia and the like, it is not uncommon for us to (somewhat reluctantly) see patients every other week and sometimes once per month if its just supportive/existential counseling. This has to do with the rural area surrounding my VA though (many ppl I see drive for over an hour to get here), not from admin pressure or unreasonably high caseloads. To my knowledge, there is none of that here. We certainly dont do 15 minute intakes..however, there is no reason why therapy really HAS to be 50 minutes either. I have a 2 people I am doing some supportive stuff with every other week and I see them for half hour or so. I am not in the general outpatient mental health clinic here though, and it is my understanding that the dude had to literally beg the admin to get him another psychologist recently. I know they are very busy over there.

All my supervisors are very happy with their respective positions. Some will have very light days where they only see a few patients (largely due to no-shows) and some days where they see 9 in a row. Many of my supervisors also have split-time positions (ie., 60% clinical and 40% administrative/national training committees). These seems very sweet to me, as they tell me these help from getting burnt out or overwhelmed clinically.

We do alot of very focused, EVT Txs here. However, I would disagree that this is not "real therapy." I mean, PE for PTSD. We aren't talking about mommy and daddy for 6 months or a year....but its sure does work! Its focused, problem solving focused therapy. Basically, its what this population needs and what they desire most.

 

[Therapist4Chnge]

Thanks! Looks like neuropsych. is doing pretty well compared to other areas. I wouldn't mind spending 30% of my time doing testing/assessment, but i can't imagine specializing in an area i'm not passionate about and doing a 2 year post-doc in this area.

the caveats are: insurance rates are being slashed, it's still very competitive to get into, and it is still top-heavy w. senior people. Salaries are good, but that's due mostly to private practice work. Boarding is also strongly recommended, so that is another hurdle to navigate.

 

[Zigman]

insurance rates are being slashed.

This is something that is really confusing to me. I'm on the NP list-serves and see this mentioned every other week, usually with panic-inducing thoughts about how NPs will soon be without work. At the same time, the academic med center where I recently started internship is expanding its clinical neuro faculty and another one back home is doing the same.

Also, from time to time I check the NP job listings on different websites and see no shortage of employment opportunities. In fact, many of these job listings keep being reposted, suggesting that they aren't being filled? What gives? If institutionally-employed NPs were truly in trouble, why would these things be happening?

 

[Therapist4Chnge]

This is something that is really confusing to me. I'm on the NP list-serves and see this mentioned every other week, usually with panic-inducing thoughts about how NPs will soon be without work. At the same time, the academic med center where I recently started internship is expanding its clinical neuro faculty and another one back home is doing the same.

Private practice has different economic issues than academic medicine. PP has a much stronger reliance on the billing codes, what insurance covers, and what they get reimbursed. Academic medicine still needs to maximize billing and justify their salaries, but the bottom line is a bit fuzzier. Many neuropsychologists connected to academic medicine only need to cover a % of their billing because they bring in grants and have a certain % of their time written off for activities that are needed but not billable (consulting with physicians and other providers about a case).

Also, from time to time I check the NP job listings on different websites and see no shortage of employment opportunities. In fact, many of these job listings keep being reposted, suggesting that they aren't being filled? What gives? If institutionally-employed NPs were truly in trouble, why would these things be happening?

My guess: Not a good fit, the benefits package is not in line with the seniority they are seeking, and/or many neuropsychologists are quite happy with their current gig (see above). I've been meaning to look up the data on % change reported for PP v. Academia v. Other for neuropsychologists. I'd guess the majority are in PP.