Job security and future of the professions in mental health

[ClinPsycMasters]

Changes are happening and I'm worried. I hear about masters level providers replacing PhD therapists, the decline in APA members' salaries, marginalization of psychological careers, prescription privileges and turf issues of all sorts, general influence of managed care, etc.

What careers and degrees seem most promising, in terms of job security and pay, freedom and control, prestige...in the future? I am particularly interested in clinical psychology (masters vs PhD) and various related specialties, but we can also discuss other branches (e.g. I/O, school) and related professions like social work, psychiatry, psychiatric NP, etc.

Psychiatry is perhaps up there with psychiatric NP jobs. Though they are well paying, I am not interested in nursing (and prescribing meds all day instead of something more creative like therapy or assessment) nor willing to endure four years of medical school (that has little to do with psychology) to become a psychiatrist. Clinical neuropsychology looks promising but on top of its lengthy training, it is very intellectually demanding, and in all likelihood requires an IQ higher than my meager 136.

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[Manicsleep]

Changes are happening and I'm worried. I hear about masters level providers replacing PhD therapists, the decline in APA members' salaries, marginalization of psychological careers, prescription privileges and turf issues of all sorts, general influence of managed care, etc.

What careers and degrees seem most promising, in terms of job security and pay, freedom and control, prestige...in the future? I am particularly interested in clinical psychology (masters vs PhD) and various related specialties, but we can also discuss other branches (e.g. I/O, school) and related professions like social work, psychiatry, psychiatric NP, etc.

Psychiatry is perhaps up there with psychiatric NP jobs. Though they are well paying, I am not interested in nursing (and prescribing meds all day instead of something more creative like therapy or assessment) nor willing to endure four years of medical school (that has little to do with psychology) to become a psychiatrist. Clinical neuropsychology looks promising but on top of its lengthy training, it is very intellectually demanding, and in all likelihood requires an IQ higher than my meager 136.

Consider psych tech. It would be a tough haul for you but you may be able to pull it out. You could do assessment, therapy, run groups AND dispense meds.

 

[ClinPsycMasters]

Hmmm, that sounds interesting. I'm gonna do some research on that, on training programs, job security, etc. Thanks!

 

[loveoforganic]

Consider psych tech. It would be a tough haul for you but you may be able to pull it out. You could do assessment, therapy, run groups AND dispense meds.

Are you referring to a position other than psych aide? In my state, I'm pretty sure a GED isn't even required?

 

[Therapist4Chnge]

The field of clinical psychology still offers some excellent opportunities, however just graduating from a clinical psychology program will not be sufficient to ensure success. Most of the successful people in the field had to go above and beyond their training and subsequent work in the field. Other fields have better security because there is less competition, but there is ample opportunity for those who differentiate themselves from the rest.

 

[stigmata]

Psych Tech, at least where I have lived is a sub-nursing position, similar to a CNA but in a psychiatric facility.???

 

[ClinPsycMasters]

The field of clinical psychology still offers some excellent opportunities, however just graduating from a clinical psychology program will not be sufficient to ensure success. Most of the successful people in the field had to go above and beyond their training and subsequent work in the field. Other fields have better security because there is less competition, but there is ample opportunity for those who differentiate themselves from the rest.

That's a common historical trend with social sciences degrees. First, a bachelor's was enough. Then a bachelor's and something extra, like experience in particular field, personality/intelligence, etc. That's the era my father lived in. Same thing with masters and now PhD and postdocs. God knows what's next. In a couple of decades, are people going to be spending 20+ years of their lives in colleges just to be competitive enough?

 

[Manicsleep]

Psych techs are like LVNs but in psychiatric facilities.

The OP already has experience on the therapist side. The psych techs do a little bit of both. By adding masters level therapist experience, the OP can make themselves very marketable. We have a psych tech/LCSW who works with us and is very versatile. She has a very challenging job but gets paid significantly more than a psych tech or an LCSW.

There is also a very wide variety of duties that she can do and she also helps to train a lot of the staff because of the overlap. It was just an option for the OP to consider. It doesn't take that long to become a psych tech either.

 

[Psy01]

Psychiatry is perhaps up there with psychiatric NP jobs. Though they are well paying, I am not interested in nursing (and prescribing meds all day instead of something more creative like therapy or assessment)

I've been looking through want ads for NPs, and I've seen those in which the job would entail therapy.

 

[medium rare]

I've been looking through want ads for NPs, and I've seen those in which the job would entail therapy.

They are few and far between. Psych NPs are in demand because they have prescriptive authority which helps offset the extreme shortage of psychiatrists in many areas. They typically aren't paying for NPs to do therapy (just like they don't pay psychiatrists to do therapy) - for that they look to Master's level clinicians and generally pay them poorly for it.

Don't think you'll be paid to conduct therapy as a psych NP. Unless you're in private practice, employers looking for psych NPs want them to prescribe and manage meds.

 

[DrGero]

What I did is superspecialize in a particular niche (in my case, geropsychology) and get myself a VA position. So far I have job security, good pay, and a pleasant work environment.

Also, I figure demand for my services will only increase as the years go by (although reimbursement will be a challenge, what with Medicare issues being what they are).

All I know is that if you're a clinical psychologist with generalist skills (regardless of how well-trained you are) looking to succeed in today's marketplace, you're in some trouble. MFTs and LCSWs will eat you for lunch.

 

[ClinPsycMasters]

What I did is superspecialize in a particular niche (in my case, geropsychology) and get myself a VA position. So far I have job security, good pay, and a pleasant work environment.

Also, I figure demand for my services will only increase as the years go by (although reimbursement will be a challenge, what with Medicare issues being what they are).

All I know is that if you're a clinical psychologist with generalist skills (regardless of how well-trained you are) looking to succeed in today's marketplace, you're in some trouble. MFTs and LCSWs will eat you for lunch.

I was told nearly the exact same thing by a recent clinical psychology graduate. 😱

 

[Psy01]

They are few and far between. Psych NPs are in demand because they have prescriptive authority which helps offset the extreme shortage of psychiatrists in many areas. They typically aren't paying for NPs to do therapy (just like they don't pay psychiatrists to do therapy) - for that they look to Master's level clinicians and generally pay them poorly for it.

Don't think you'll be paid to conduct therapy as a psych NP. Unless you're in private practice, employers looking for psych NPs want them to prescribe and manage meds.

Arrh! I am so frustrated right now. I'm trying to figure out if I should do a program to ultimately become a LMHC, or whether I should do an NP program.

I'm so put off but the very low pay of LMHCs, so that pushed me towards NP. I thought that maybe that would be better, bc then I could do some therapy, plus have prescriptive authority as another tool in my belt.

Now, I figured that would entail a lot of Rx work, but I do want to do some therapy.

I don't know what to do. My interests are strongest in anxiety and fear based disorders (and I'm of the mind that would primarily use exposure therapy for this), so perhaps some kind of specializing in that as LMHC might be able to get the salary higher?

 

[futureapppsy2]

I'm hoping the combination of being a School Psych plus being willing to work in rural areas will help somewhat, though I'm not looking forward to the job market in 5-6 years.

 

[rmbsstock]

out..

 

[medium rare]

Arrh! I am so frustrated right now. I'm trying to figure out if I should do a program to ultimately become a LMHC, or whether I should do an NP program.

I'm so put off but the very low pay of LMHCs, so that pushed me towards NP. I thought that maybe that would be better, bc then I could do some therapy, plus have prescriptive authority as another tool in my belt.

Now, I figured that would entail a lot of Rx work, but I do want to do some therapy.

I don't know what to do. My interests are strongest in anxiety and fear based disorders (and I'm of the mind that would primarily use exposure therapy for this), so perhaps some kind of specializing in that as LMHC might be able to get the salary higher?

I would strongly encourage you to go the psych NP route - it will open many, many more doors and allow you much more flexibility (and much better pay) than training as a Master's level therapist. If therapy is your passion, there will always be outlets for that - just not likely to be part of your primary job. Most psych NPs I know who are interested in therapy have small part-time private practices on the side and conduct therapy and/or therapy with med management in that setting.

As stated by other posters, Master's level therapists of all varieties do have a leg up on psychologists in the job market for therapy positions, but that is not to say that Master's level folks have it good. They are a dime a dozen and the positions they are 'taking' from psychologists are generally low-paying - which is why they hire Master's clinicians in the first place - everything is reduced to the lowest common denominator.

As a psychologist though, you have the potential for much more flexibility and numerous options to specialize in various niche areas compared to Master's level therapists which still makes psychology a much more attractive option to me.

 

[stigmata]

I would strongly encourage you to go the psych NP route - it will open many, many more doors and allow you much more flexibility (and much better pay) than training as a Master's level therapist. If therapy is your passion, there will always be outlets for that - just not likely to be part of your primary job. Most psych NPs I know who are interested in therapy have small part-time private practices on the side and conduct therapy and/or therapy with med management in that setting.

As stated by other posters, Master's level therapists of all varieties do have a leg up on psychologists in the job market for therapy positions, but that is not to say that Master's level folks have it good. They are a dime a dozen and the positions they are 'taking' from psychologists are generally low-paying - which is why they hire Master's clinicians in the first place - everything is reduced to the lowest common denominator.

As a psychologist though, you have the potential for much more flexibility and numerous options to specialize in various niche areas compared to Master's level therapists which still makes psychology a much more attractive option to me.

Agree 100%

 

[docma]

For versatility and mobility, the NP and LCSW route are most efficient and practical I think and can lead to work in either public mental health and/or private practice. Neither of those paths is likely to be exclusively doing psychotherapy.

Overall, it is really important to think about what you as an individual adult also want to do while you learn what you can earn.

A PhD or PsyD should not be considered a ticket to a large salary. A doctorate (in any field) may qualify you to teach, do research, or be involved in policy/administration. As for what you "practice", that depends mostly on where you train and is likely to be fairly individualized for the path you chose--and how you present yourself in the job market. And those are the factors that will also determine your income...not just the letters of the degree.

Overall, I think the field will benefit from some of the current hardships because those entering the work are having to look more carefully at what they really want to (and can) do. I'm glad these discussions are happening and that students are reading them before acquiring large debt.

 

[cara susanna]

When people say that you should specialize, what exactly does that mean? Does that mean treating a specific population, getting special training, or what?

 

[Therapist4Chnge]

When people say that you should specialize, what exactly does that mean? Does that mean treating a specific population, getting special training, or what?

(I realized after reading my response that most of my examples involve assessment and not therapy, so if you are talking about strictly therapy, I'd probably defer to someone else more in the know, as I know very little about the "common" range of Dx's a typical clinician will purport to work). However, I do know quite a bit about the business side of things, so I tried to include some very basic information about market place competition.

It means that you should have an area of focus and not just be, "I'll see anyone for anything." For example, if a clinician enjoys working with children they may work with elementary school aged children who have a range of issues: learning disabilities, behavioral problems, etc...though it'd be less realistic for them to see a child in the morning, a geriatric patient in the late morning, and then a forensic patient in the afternoon. That can happen, particularly in a small town (the mental health version of a family physician who does cradle to grave), though it is much harder to market yourself as, "I do everything!"

As for how to specialize, it probably starts while you are still in training, at least it is easier to start then. For instance, if you enjoy working with young children, you'd most likely want to gain experience during your practica, internship, and/or post-doc years. Some people jump into "new" and unrelated areas outside of the area in which they trained, but it is much harder to do well and do ethically. Some people make that jump, but they tend to do it under the mentorship of someone else, at least in the beginning.

I'm not saying you HAVE to know what population you want to work with for your career and you HAVE to gain training throughout or you can't do it, but it really helps. Many times clinicians gain experience in one area and it sort of spills into another area. For instance, a person may handle a lot of ADHD assessment for a school district, though along the way they find an opportunity to do IQ assessment for gifted students. These two areas have a lot of crossover, moreso than someone going from ADHD assessment to doing in-depth trauma work. I'm not saying a person can't do both in-depth trauma work and ADHD assessment, but they are quite divergent areas.

Carving out a niche will allow you to tailor your services to a targeted market and get know as the "go to" person who treats a specific Dx or age range. It is much easier to find referrals when you can be someone's "personality assessment" person, as most people do not treat all types of cases.

I know a clinician who only likes to do therapy, and she will refer out all of her assessment cases to someone else who primarily does assessment work. I also know clinicians who specialize in eating disorders, and while they will see an ocassional non-ED case/referral, most of their business is ED-related because they are well known in the ED community. Could they compete as a generalist in the market...maybe, but it is much easier to compete in the "eating disorder treatment" market.

As for speciality training...let me preface this by saying I have a bias towards boarding and I have pretty conservative views around "scope of practice" issues. I believe there are a number of areas where a person should not practice unless they have significant formal training and significant mentorship (neuropsychology and forensic assessment as it relates to capacity/competency referrals, etc), though many people "dabble". Most people who "dabble" frustrate me to no end because they don't seek out proper training and mentorship, so their "work" is often not equivilant to someone who specializes in that area. This can cause a host of ethical, legal, and professional problems.

I had a professor put the fear of God into me about doing assessment work that had any chance of making its way into court. He is board certified and a leader in the field, and he said that there are plenty of people who "dabble", but it can get ugly if they ever get dragged into court and they have to defend their work. I'm not saying this to scare anyone, but the legal and ethical considerations of working outside of your scope of practice are often minimized in favor of better money. While trying to find your path, be aware that you can't be all things to all people, and if someone asks you to do work outside of your scope, it is your license that is on the line.

Short version: Find your niche so you can be the "go to" person for a specific patient population, or you'll just be another fish amongst the thousands competing for the same food/resources.

 

[Psy01]

I would strongly encourage you to go the psych NP route - it will open many, many more doors and allow you much more flexibility (and much better pay) than training as a Master's level therapist.

Can you expound on this a bit? What "doors"?

I have some ideas, but at this point they're kind of vague. (Basically, I've thought that it would allow me to do Rx, therapy, plus I could have the option of going into general nursing if I found I was into that.)

If therapy is your passion, there will always be outlets for that - just not likely to be part of your primary job.

It doesn't have to be my primary job per se, but I would want to spend a relatively decent chunk of time on it. For example, a group I would particularly want to work with is OCD patients (and exposure-based treatments would be my primary approach with them).

I do like the idea of having Rx as a tool in my belt though, and wouldn't have issues doing meds. I just don't want that to be the ONLY thing I do.

 

[SingingCow]

(I realized after reading my response that most of my examples involve assessment and not therapy, so if you are talking about strictly therapy, I'd probably defer to someone else more in the know, as I know very little about the "common" range of Dx's a typical clinician will purport to work). However, I do know quite a bit about the business side of things, so I tried to include some very basic information about market place competition.

It means that you should have an area of focus and not just be, "I'll see anyone for anything." For example, if a clinician enjoys working with children they may work with elementary school aged children who have a range of issues: learning disabilities, behavioral problems, etc...though it'd be less realistic for them to see a child in the morning, a geriatric patient in the late morning, and then a forensic patient in the afternoon. That can happen, particularly in a small town (the mental health version of a family physician who does cradle to grave), though it is much harder to market yourself as, "I do everything!"

As for how to specialize, it probably starts while you are still in training, at least it is easier to start then. For instance, if you enjoy working with young children, you'd most likely want to gain experience during your practica, internship, and/or post-doc years. Some people jump into "new" and unrelated areas outside of the area in which they trained, but it is much harder to do well and do ethically. Some people make that jump, but they tend to do it under the mentorship of someone else, at least in the beginning.

I'm not saying you HAVE to know what population you want to work with for your career and you HAVE to gain training throughout or you can't do it, but it really helps. Many times clinicians gain experience in one area and it sort of spills into another area. For instance, a person may handle a lot of ADHD assessment for a school district, though along the way they find an opportunity to do IQ assessment for gifted students. These two areas have a lot of crossover, moreso than someone going from ADHD assessment to doing in-depth trauma work. I'm not saying a person can't do both in-depth trauma work and ADHD assessment, but they are quite divergent areas.

Carving out a niche will allow you to tailor your services to a targeted market and get know as the "go to" person who treats a specific Dx or age range. It is much easier to find referrals when you can be someone's "personality assessment" person, as most people do not treat all types of cases.

I know a clinician who only likes to do therapy, and she will refer out all of her assessment cases to someone else who primarily does assessment work. I also know clinicians who specialize in eating disorders, and while they will see an ocassional non-ED case/referral, most of their business is ED-related because they are well known in the ED community. Could they compete as a generalist in the market...maybe, but it is much easier to compete in the "eating disorder treatment" market.

As for speciality training...let me preface this by saying I have a bias towards boarding and I have pretty conservative views around "scope of practice" issues. I believe there are a number of areas where a person should not practice unless they have significant formal training and significant mentorship (neuropsychology and forensic assessment as it relates to capacity/competency referrals, etc), though many people "dabble". Most people who "dabble" frustrate me to no end because they don't seek out proper training and mentorship, so their "work" is often not equivilant to someone who specializes in that area. This can cause a host of ethical, legal, and professional problems.

I had a professor put the fear of God into me about doing assessment work that had any chance of making its way into court. He is board certified and a leader in the field, and he said that there are plenty of people who "dabble", but it can get ugly if they ever get dragged into court and they have to defend their work. I'm not saying this to scare anyone, but the legal and ethical considerations of working outside of your scope of practice are often minimized in favor of better money. While trying to find your path, be aware that you can't be all things to all people, and if someone asks you to do work outside of your scope, it is your license that is on the line.

Short version: Find your niche so you can be the "go to" person for a specific patient population, or you'll just be another fish amongst the thousands competing for the same food/resources.

T4C, interesting you mentioned being able to defend your work in court. That was exactly what my mentors told me when I started writing my very first assessment report. In fact, they have instilled in me a sense of professionalism not only about report writing, but also the way how the assessment is performed, how relevant tools and norms are selected, and how feedback is given. None of my mentors are famous/ significant/ leader in the field, at least not based on the way how most people will define it. None of them are board-certified but they have a specialty area and that is the only thing they do. They are informed by the latest research. They take CE courses. They consult with other medical and mental health professionals on a regular basis. They are not heavily involved in research but they do what they can. They ARE the "go-to" person in the community at large and within the medical community.

I am not against boarding. I agree that life-long education and quality control are crucial to our field. That said, I feel uncomfortable with the idea that those who are not board-certified may be frowned upon in the near future. Does experience really not matter? There are multiple reasons why some people did not, have not, cannot, or will not get boarded. Sometimes, it has nothing to do with ability or dedication. I may have misread the messages here but sometimes there seems to be an underlying assumption that people who are not boarded are lazy; and are ill-equipped to practice in their specialty areas. I really hope it's just my misinterpretation.

 

[Therapist4Chnge]

I am not against boarding. I agree that life-long education and quality control are crucial to our field. That said, I feel uncomfortable with the idea that those who are not board-certified may be frowned upon in the near future. Does experience really not matter? There are multiple reasons why some people did not, have not, cannot, or will not get boarded. Sometimes, it has nothing to do with ability or dedication. I may have misread the messages here but sometimes there seems to be an underlying assumption that people who are not boarded are lazy; and are ill-equipped to practice in their specialty areas. I really hope it's just my misinterpretation.

While I think boarding will be a benefit in certain areas (court, academic medicine), I don't think a non-boarded person will be looked down upon since boarded people are in the vast minority of all psychologists. My comments about "significant" training were directed towards clinicians who declare themselves "experts"/"specialists" without ever receiving mentorship or training in a particular area. Since the vast majority or clinicians out there are considered competent, and the vast majority are not boarded, it is fair to say that the vast majority of non-boarded clinicians are competent. It's not perfect, but I feel comfortable with it as a general assumption. My issue is more with the clinicians who work outside of their scope of practice. Boarding is one of the best ways to ensure quality control, but it isn't the end all and be all.

 

[SingingCow]

While I think boarding will be a benefit in certain areas (court, academic medicine), I don't think a non-boarded person will be looked down upon since boarded people are in the vast minority of all psychologists. My comments about "significant" training were directed towards clinicians who declare themselves "experts"/"specialists" without ever receiving mentorship or training in a particular area. Since the vast majority or clinicians out there are considered competent, and the vast majority are not boarded, it is fair to say that the vast majority of non-boarded clinicians are competent. It's not perfect, but I feel comfortable with it as a general assumption. My issue is more with the clinicians who work outside of their scope of practice. Boarding is one of the best ways to ensure quality control, but it isn't the end all and be all.

I definitely hear you about the scope of practice issue. It irks me when people think anyone can perform neuropsychological and/or forensic assessment, for example. It is also troubling when people think anyone can conduct therapy with children. One won't ask a cardiologist to fix his knees, so I think consumers/clients/patients/referring physicians should also be made aware of different areas of expertise within psychology. In small communities, sometimes people think if you are a psychologist, you should be able to do everything.

 

[Therapist4Chnge]

I definitely hear you about the scope of practice issue. It irks me when people think anyone can perform neuropsychological and/or forensic assessment, for example. It is also troubling when people think anyone can conduct therapy with children. One won't ask a cardiologist to fix his knees, so I think consumers/clients/patients/referring physicians should also be made aware of different areas of expertise within psychology. In small communities, sometimes people think if you are a psychologist, you should be able to do everything.

Agreed on both points.

 

[medium rare]

Can you expound on this a bit? What "doors"?

I have some ideas, but at this point they're kind of vague. (Basically, I've thought that it would allow me to do Rx, therapy, plus I could have the option of going into general nursing if I found I was into that.)



It doesn't have to be my primary job per se, but I would want to spend a relatively decent chunk of time on it. For example, a group I would particularly want to work with is OCD patients (and exposure-based treatments would be my primary approach with them).

I do like the idea of having Rx as a tool in my belt though, and wouldn't have issues doing meds. I just don't want that to be the ONLY thing I do.

The "doors" are that you will be in strong demand for virtually any employer-based position anywhere in the nation. Some states are better than others, but regardless, the demand is unmistakable for clinicians with Rx authority; in many areas, you'll be able to write your own ticket. For example, a local mental health agency has been courting me for about 2 years. They have essentially said "name your price" in order for me to come work for them. I've resisted b/c, frankly, after years of public mental health work, I'm burned out with it.

Private practice can be more of a challenge as a psych NP b/c many insurances don't reimburse NPs yet or don't reimburse more than any other Master's level therapist. This hasn't been a problem for me b/c, as a psychologist, I have more leverage with private insurers. I don't take any insurance myself, but the opportunities are still greater for psychologists than psych NPs when it comes to dealing with private insurance. The opposite is true with agency or other employer-based positions, NPs are in much greater demand and this is what I meant by opening more doors.

 

[Psy01]

I see^^. Thanks for your explanations - it's helped out.

 

[edieb]

I think it is misleading to tell/imply to people that specialization in the field of clinical psychhology is going to lead to a much brighter future than those who are generalists. As has been mentioned in other threads before this one, a large number of these post-docs do not yield any higher income than those who do not specialize. In other words, if you specialize, you may have a better chance of GETTING a job but you will not command any more money in a job.

In addition, a lot of these post-docs aid in specialization for specialties where there are few jobs. For instance, this whole "integrating psychology into behavioral medicine" idea is not going over. For evidence of this, look at a recruting website and see how many behavioral medicine psychology positions there are -- you will see very few, if any. Therefore, it would not be to one's advantage to do one of these post-docs....

There are a few of these specialist positions in ACADEMIC medical centers; however, these are very few and far between. You will most likely end up a generalist who has a post-doc in such and such area rather than actually working exclusively in that area. In other words, if you don't mind taking a paycut in order gain more knowledge, go for it. However don't do a post-doc thinking you're going to make any more money.

The only exception to this would be the M.S. in psychopharmacology. For instance, I have a friend in NM who is prescribing (she is 2 years out of receiving her Ph.D.) and has already made $200 K this year (gross). She stated that because she can prescribe, she can make her money doing med checks in the A.M. and focus on carry 2-3 therapy cases in the afternoon and concentrate on conducting really efficacious therapy.

Psychology is getting its lunch eaten by N.P.s, LPCs and social workers. The marketplace (and even the Veterans' Administration and state governemnts) has moved towards quantity of patients one sees and not the quality of care patients receive. Therefore, if therapy is indicated, a master's level providers will provide it and, if meds are needed, an N.P. or psychiatrist will be doing this.

 

[Therapist4Chnge]

In addition, a lot of these post-docs aid in specialization for specialties where there are few jobs. For instance, this whole "integrating psychology into behavioral medicine" idea is not going over.

There are a few of these specialist positions in ACADEMIC medical centers; however, these are very few and far between.

The VA recently okay'd a new position to be created to do this exact thing, though they are only funding one position per VA, so not exactly plentiful. Academic medicine isn't a bad gig. I'd consider both of these options, but obviously not for most people. Edieb and I have argued the value of specialization in the past, so I'll just say specializing can make a difference in competitiveness and salary, but there is no guarantee that it will make a difference.

 

[DrGero]

I think it is misleading to tell/imply to people that specialization in the field of clinical psychhology is going to lead to a much brighter future than those who are generalists. As has been mentioned in other threads before this one, a large number of these post-docs do not yield any higher income than those who do not specialize. In other words, if you specialize, you may have a better chance of GETTING a job but you will not command any more money in a job.

In addition, a lot of these post-docs aid in specialization for specialties where there are few jobs. For instance, this whole "integrating psychology into behavioral medicine" idea is not going over. For evidence of this, look at a recruting website and see how many behavioral medicine psychology positions there are -- you will see very few, if any. Therefore, it would not be to one's advantage to do one of these post-docs....

There are a few of these specialist positions in ACADEMIC medical centers; however, these are very few and far between. You will most likely end up a generalist who has a post-doc in such and such area rather than actually working exclusively in that area. In other words, if you don't mind taking a paycut in order gain more knowledge, go for it. However don't do a post-doc thinking you're going to make any more money.

The only exception to this would be the M.S. in psychopharmacology. For instance, I have a friend in NM who is prescribing (she is 2 years out of receiving her Ph.D.) and has already made $200 K this year (gross). She stated that because she can prescribe, she can make her money doing med checks in the A.M. and focus on carry 2-3 therapy cases in the afternoon and concentrate on conducting really efficacious therapy.

Psychology is getting its lunch eaten by N.P.s, LPCs and social workers. The marketplace (and even the Veterans' Administration and state governemnts) has moved towards quantity of patients one sees and not the quality of care patients receive. Therefore, if therapy is indicated, a master's level providers will provide it and, if meds are needed, an N.P. or psychiatrist will be doing this.

I don't know that you're making a particularly strong point that it's advisable for clinical psychologists to be generalists, or that being a generalist is better than being a specialist - it seems you're more making a point that clinical psychology is simply in dismal shape as a discipline in terms of it's marketability and competitiveness (which may be true).

All I can speak about is my own success in specializing. I make currently over 100K a year (about 130K with a conservative valuation of my benefits package at the VA). I can (and have) easily commanded 80 bucks an hour doing consulting work as a Neuropsychologist for a neurological rehabilitation firm with my skills built as a specialist (which is primary care psychology - closely related to the skills I built as a geropsychologist). Prior to working at the VA I was courted by a local UC Medical School program and had three interviews for a medical school position (unfortunately fell through due to funding :-( ).

I think my future remains bright due to my specialization as well (geropsychology with some strong experience in neuropsychological assessment). I have some short-term to medium-term anxiety about financial issues on the national level as they relate to funding the care of the baby boom generation, but I am pretty confident I've already done a great job making myself the "go to guy" for complex psychological issues related to aging, loss, dementia, and caregiving in the elderly. And with so few geriatricians out there to compete with, I may have a decent shot at competing for the top (private pay) dollar someday for my services.

I see others in my cohort who graduated with more traditional, generalist skills and they do fine work for Bay Area local community mental health companies like the Seneca Center or the Community Care Alliance making less than half of what I do (which is terrible when you have the kind of debt professional school grads have). Some perhaps have found ways to do OK in private practice because they know how to market themselves. Perhaps not.

I did exactly what I was told when I was a first-year graduate student in my professional school at my professional issues class (which was taught that year by Dr. Roger Greene of MMPI fame). Take every opportunity to specialize, do it early, and do it well. I don't think the advice was misplaced or misleading at all. It worked out for me, and frankly, I think I would probably be just another one of the hordes of psychologists slaving away at a nonprofit somewhere if I had merely just done my practica, internship and post-doc at the various (albeit quality) rotations out there which focus on populations of plain-vanilla, traditional general adult mental health consumers.

Is it rough for psychologists (even specialists?) out there? Surely. My brother graduated from a medical school and practices as a neuroradiologist on the east coast - I bet he makes at least twice as much as I do, with probably the same debt level. If we wanted to be (more) economically viable, we shoulda gone into medicine.

But I don't think I lose out on the work environment either. I can't speak for other VA psychologists, but for my part, 1) there are no beancounters that tell me how many patients I have to see. 2) I have few performance measures placed on me (such as how many consults I see, how quickly I clear them, etc). and 3) I have plenty of time for professional development on the job, and I have very positive interactions with my coworkers. Is my job representative of all psychology jobs at the VA? Perhaps not - geropsychology in the inpatient, long-term care setting at the VA is a new thing for the past few years and I think we operate in an environment of benign neglect as far as Central Office is concerned (as long as the medical center is happy and we hear no bad news, we just don't care what you do).

So, anyways, I could keep rambling but the basic point is that I continue to advise students to specialize early and do it well, like I was advised. It makes obvious sense on a simply logical basis alone - unless you're convinced you could be a generalist clinician that walks on water - clearly the most qualified clinical psychologist ever minted, you should specialize, simply so that you can be assured of a smaller pool of competitors for the services you provide.

 

[Rivi]

http://money.cnn.com/magazines/moneymag/bestjobs/2009/snapshots/23.html

 

[poch]

Re: the OP

I think you should read up on the relevant literature. This is a good start. Here's a choice quote:

A fundamental finding of the present review is that for middle and upper-income people in economically developed nations, acquiring more income is not likely to strongly enhance SWB.

I think rather than using that 136 IQ to figure out how to make the most money, you should use it to work on your priorities. 😉

 

[ClinPsycMasters]

Re: the OP

I think you should read up on the relevant literature. This is a good start. Here's a choice quote:



I think rather than using that 136 IQ to figure out how to make the most money, you should use it to work on your priorities. 😉

Thank you for putting things in perspective. I have in fact read the literature on SWB.

For me money, in a way, comes first. And literature also suggests that it is only after you have certain needs met that earning more is not going to make you that much happier.

The current economical crisis is a fact. The decline in APA members' earnings, the turf wars, managed care, burnout in helping professions, are also matters that concern me. More personally, I want to marry one day and I would like my wife to be able to stay home and take care of the kids in the early years. I would not want to put tremendous financial pressure on my family. I know some two-career people and know all about babysitters raising your kid and I don't like it.

So these are my priorities and they require money. How much? I don't really know. Perhaps, given all that I've mentioned, I need to be able to make six figures mid-career. I will need to take vacations so I don't get burned out and so that I can offer my patients the best care I potentially can. I need to have a reliable vehicle. I want to own a house at some point. There are so many things to consider.

Thanks for making me think about this.

 

[DrGero]

I don't really see the appeal of getting a PhD in clinical psychology and then a nursing degree. If they come up with a recognized prescription path for psychology, I might do it, just because I'm interested in the material, but I'm not going to waste my time learning nursing skills and playing in a world I have no desire to join.

Funny - must be my specialization area, but I've actually contemplated getting a nursing degree, primarily as a means to complement what I do as an inpatient geropsychologist. Conversely, I don't have much interest in getting prescribing authority, but if it came with a significant increase in earning potential, I suppose I'd consider it.....

 

[stigmata]

Also, pursuing a career in a field/specialty in which one is good at is a huge variable. If you are good at something, your patients like you and get better, and you like it you will be more likely to succeed than someone with the best post-doc in that area who is just not very good at it. I see this a lot with prescribing psych meds at all levels of training. There are great and horrible NPs, psychiatrists and psychologists at prescribing psych meds. In my small town one of the best in actually an FNP, and one of the worst a psychiatrist. The reasons for this have to do with many factors including the ability to create rapport with a patient. You may know more about pharmacology, neurophys, whatever than anyone in the world, but if your patients hate you and no provider will refer to you then you effectively are not good at it. Do what you love, and accept that this may change and you go through training and gain experience in the field. When you find that niche, train up as high as you can and you will be set up for success.
I see a lot of family practice residents who bail on a surgical residency part way through when they finally realized they are not good at it, but are good at treating primary care patients. It happenes.