Very true, and this is what worries me about training in this field at present. Our skillset is diverse and we need to take better advantage of that. How often do we see doctoral level psychology framed/described as "Top notch therapy training plus assessment" on this board. To me, those are just the tip of the iceberg and not our "claim to fame". That describes the training of a technician, not a professional, and reflects a somewhat outdated view of what the field of psychology has become and what it can offer. I obviously support assessment, but I don't think that has any more long-term viability than therapy and should not be made into the defining characteristic of our profession. We need to get back to our roots and understand that we should be training experts at solving problems related to human behavior. Therapy and assessment are two useful skills for achieving that and we should certainly be learning them in graduate school, but they should not be the all-encompassing embodiment of the profession.
Lets talk $
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Great point. I spend most of my time on an in-patient unit (not psych), and most of my consultation focuses on making sense of a mixed bag of symptoms and behaviors exhibited by my patients, and providing actionable recommendations and interventions to address the needs of the patient (and staff).
If I have someone who sustained a severe TBI (e.g. motorcycle v. tree...motorist lost) who is aggressive towards staff, how do I help the patient and staff deal with the situation? I need to check the research to see if the behavior is consistant with the type of injury (yes) and corrolates with the imaging (yes). I need to talk to the nurses/aides about what has/hasn't worked with the patient. I need to consult with the resident/attending to check on medical & medication factors that may contribute to the behavior (med interaction, infection, pain, etc). I need to address patient, family, and staff concerns.
I know my examples tend to be neuro & rehab, but you can swap out TBI for schizophrenia, and make the setting a locked psych unit or group home....and you have the same thing problems that require similiar knowledge and solutions.
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Judging from my recent foray into the job market, I can agree with most of what is being said. Several of my classmates struggled to find their first jobs and were not offered much ($50-60k) at college counseling centers and schools. I have had several post-doc/ unlicensed job offers and I also had one interviewer offer me a $75-90k standing offer for next year when I am licensed. However, from my first year in grad school, I geared my clinical experiences to behavioral medicine, neuropsychology, and geriatrics. My research is also in a cutting edge area of behavioral medicine and several offers (clinical) have come from this area of expertise. Having these specialized experiences and training in newer/growing areas of care rather than traditional therapy have helped me tremendously in this job market.
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Those aren't bad offers...I have heard of some folks being offered much less starting out. Being involved in a specialty is absolutely going to be helpful.
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blah...this is all quite demotivating. It seems the field is inflated, non-competitive, underpaid, under-respected, and just completely going down hill...maybe i was coming from a very unrealistic mindset..and perhaps i need to recalibrate what i should pursue as a career. My goal is to make around 70-80k as a LCSW, and i want to work with inner-city youth..specifically with minority youth..its something i'm very passionate about. Maybe i can do that in a different way.
thank you all for your input.
thank you all for your input.
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Those two things are pretty incongruent...short of running a private program where you do more administration work.
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i know...i was in over my head.
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Always take any survey with a grain of salt....also, please do not go into neuropsychology because we have enough people. Thanks. 😀
Neuropsychologist Salary Ranges
Payscale.com:
$48k-$119k
2010 TCN Salary Survey:
<1-5 years in practice
n=304
Mean: 94.1
Median: 86.0
SD 51.2
25%: 75.0
75%: 100.0
95%: 160.0
99%: 219.2
The HUGE caveat here is that these data came from an org. that is a strong supporter of boarding, so these data are typically from fellowship trained neuropsychologists who may already be boarded. Boarded doesn't mean you will make more money, but many people who are boarded do make more money.
I've heard $75k-$85k is realistic for fellowship trained rehabilitation psychologists / neuropsychologists just starting out in an academic medicine position. There can be a large SD because I know people who make $100k+ w. a little bit of side work and/or reseach $'s. However, I also know private practices where "you eat what you kill", so it can often be much less than the above if you struggle to get referrals. While there is no such thing as a "cheap" neuropsychological assessment, there can still be a sliding scale that is far less than the $2k-$4k+ evals that some people regularly charge, so you can be very busy and still not get ahead.
Neuropsychologist Salary Ranges
Payscale.com:
$48k-$119k
2010 TCN Salary Survey:
<1-5 years in practice
n=304
Mean: 94.1
Median: 86.0
SD 51.2
25%: 75.0
75%: 100.0
95%: 160.0
99%: 219.2
The HUGE caveat here is that these data came from an org. that is a strong supporter of boarding, so these data are typically from fellowship trained neuropsychologists who may already be boarded. Boarded doesn't mean you will make more money, but many people who are boarded do make more money.
I've heard $75k-$85k is realistic for fellowship trained rehabilitation psychologists / neuropsychologists just starting out in an academic medicine position. There can be a large SD because I know people who make $100k+ w. a little bit of side work and/or reseach $'s. However, I also know private practices where "you eat what you kill", so it can often be much less than the above if you struggle to get referrals. While there is no such thing as a "cheap" neuropsychological assessment, there can still be a sliding scale that is far less than the $2k-$4k+ evals that some people regularly charge, so you can be very busy and still not get ahead.
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I'd agree that these seem somewhat incongruent. You are picking a lower-paying field in general (social work) coupled with a desire to work with a population that inherently has few resources at their disposal and will typically pay at the lower end even within social work, yet your financial expectations are at the upper end. This is not a recipe for financial success.
Mind you, that doesn't mean its impossible and I'm sure there are folks out there in those positions earning similar salaries somewhere, but I''d wager it took them awhile to work up to that salary. Similarly, there is a risk involved that only you can answer. Is it that you MUST earn 70-80k? Are you willing to take a gamble that 10 years from now, it will be more like 50? That's not something we can answer for you, it depends on your priorities. I'm not sure exactly what you want your day to day to look like, but if that is the salary you expect I would encourage you to look into more hands-off positions than an LCSW/therapist would be. You are likely to get far more money working in administrative/government areas on things like education reform, healthcare access, etc. than in 1 on 1 interventions with that population. I mean, just thinking about it logically, one of the reasons many in that population struggle is lack of financial resources to pay people like LCSWs a fair wage to help them out, which leads to them being left behind. Its a very noble cause, but part of what makes it that is the financial sacrifices that go along with pursuing it.
Mind you, that doesn't mean its impossible and I'm sure there are folks out there in those positions earning similar salaries somewhere, but I''d wager it took them awhile to work up to that salary. Similarly, there is a risk involved that only you can answer. Is it that you MUST earn 70-80k? Are you willing to take a gamble that 10 years from now, it will be more like 50? That's not something we can answer for you, it depends on your priorities. I'm not sure exactly what you want your day to day to look like, but if that is the salary you expect I would encourage you to look into more hands-off positions than an LCSW/therapist would be. You are likely to get far more money working in administrative/government areas on things like education reform, healthcare access, etc. than in 1 on 1 interventions with that population. I mean, just thinking about it logically, one of the reasons many in that population struggle is lack of financial resources to pay people like LCSWs a fair wage to help them out, which leads to them being left behind. Its a very noble cause, but part of what makes it that is the financial sacrifices that go along with pursuing it.
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My understanding about those numbers is that you have to go where the good jobs are as well.
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i agree...perhaps i'm trying to have my cake and eat it too.
The reason i like the field is because i grew up in a community that doesn't really look highly upon mental health. Kids need help but because of the social stigma nobody gets help. I grew up in a Muslim community with arabs, blacks, whites, asians, and latinos...and i wanted to build a practice that although caters to all, could provide a comfortable and trusted relationship with a community that lacks people in teh field. Everyone from my culture goes into medicine or engineering so me going into mental health is breaking the mold.
I have never met someone from my race/religion who was a LCSW or Psyd/PhD and i everyone in my community agrees that theres a huge need for one.
Anyways, i believe that if i lower my financial expectations and focus on my goals things will work out fine. My family also owns a psychiatric clinic, and we have a therapist (not a lcsw or psyd), so i do have a backup place to work but i kinda wanna make my own path.
anyways thats a separate story.
gracias
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Sorry to pile on the bad news, but people need to know what they may be getting themselves into. I recently was offered a position working with adolescents/young adults in an inner-city (albeit a relatively small city) clinic. The starting pay was "mid- to high-thirties." I am a licensed Ph.D. level psychologist and a Board Certified Behavior Analyst, 20+ years experience, publications, etc. Also offered a job in a similar setting, with more educational and psychological assessment involved, with starting salary of 55K. Both positions were advertised for "MA or Doctoral Level Licensed Clinicians". In both cases, the salaries were established in union contracts, so there was little to no room for negotiation. The OP mentioned wanting to be in a "Group Private Practice." In my area, clinical services to lower income populations (e.g. those with government based insurance programs like medicaid) are almost exclusively provided through clinics run by larger non-profit human service agencies. I also turned down a Psychologist position with a state agency (working with residential programs for adults with developmental disabilities, more at the systems level than direct therapeutic services). The pay for that position was comparable to my current job (~105k) and insurance and retirement were a little better, but it would have added 45 minutes each way to my commute and only came with 2 weeks vacation per year (compared with my current 6 weeks per year- very important benefit when you have young children). It was also a unionized position, with no room to negotiate salary/benefits. I also teach an evening course one semester in the MA Psych. program at a local university ($3700 per semester), and that would not have been possible with the added commute.
So, I suppose all that is both bad and good news!
Bad= jobs that are "just" therapy in general don't pay great, particularly when they are at non-profit outpatient clinics (the mode service delivery model in my area for lower income populations) and are advertised as "MA or Doctorate prefferred.
Good= there are jobs for psychologist that offer good pay and benefits, particularly if you look beyond "just" therapy/assessment. As an added bonus, a lot of these jobs are at non-profits or state agencies, thus potentially qualifying you for student loan forgiveness after ten years of employment (I can't wait for 2017 to roll around and save me that monthly payment of $400!)
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True. In the last few months I've seen postings for: NYC (NYU), Dallas (Baylor), Madison (UWis), Ann Arbor (UMich), Jacksonville (Mayo, satellite)...all great institutions in pretty good locations. However, it assumes you are either local or are willing to re-locate, which I know is not easy for many people. I know one of my requirements is to be in/near a major metro area. It is almost always harder to find people for jobs in MN, MS, MT, etc. Some of the more remote places will pay better and/or offer better loan assistance, so the right person could do quite well. I have thought about a place like Missoul, MT because I love the outdoors, but the snow...I just don't know about the snow. Some places can and do offer more money, so that can be quite inticing.
Run...do not walk, away from those kind of jobs. In the best scenario it is an HR mistake, in the worst it is a place that doesn't bother to appreciate the differences in the trainings between Social Work, Counseling, Clinical Psych, etc. Most of the time it is a place that is hoping to land a doctorally-trained clinician, at a mid-level salary.
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Right. So even with neuropsychology, a speciality, you are not guaranteed to be making a high salary in the location that you want to be after completing 7+ years of training.
I am a neuropsychology postdoc and I know of others. Some have really found good positions, but almost always moving or having to make some sort of sacrifice.
As far as the TCN Salary survey, I don't know anyone making above those averages aside from the people who trained me. In all honesty, I don't think new neuropsychologists can expect to sustain that level of income without lots of side work or really getting a fantastic placement. Forensics is not only an exclusive field, but it is also extremely popular in training programs. With all of the other encroachment happening in the area, and not to mention non-neuropsychologists out there charging neuro rates for shoddy work, it is going to be a stiff fight to maintain high levels of reimbursement. People can charge out of pocket, but you can imagine that those clients are going to flock to the established practices, not the newer folks.
To be honest, I am a little frustrated that the specialty did not do an adequate job of advocating for itself earlier on. Some of our predecessors worked very hard to do so, but it is no lie that some went for the $ and are leaving us with headaches, in-field arguments, and not to mention debt many of them never had to incur.
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It isn't their fault. But is also something that many of them never had to deal with. Different set of issues facing the newer generation of neuropsychs. Even with tuition being covered, many in PhD programs still have some debt. I recall my own postdoc supervisor acting pretty pompous when I was applying for loan deferment.
Times have been changing. Many NPs got comfortable in the field and organization when it came to boarding and political lobbying to protect our profession sounds like it was lacking years ago. Things are much better now, but I fear the efforts have come too late.
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I do not consider myself a neuropsychologist despite the fact that I have completed a neuro track in grad school, a sub-internsheip (25-30hrs/wk), and spent some time doing neuropsych during internship. I consider myself more of a behavioral medicine specialist with a good grasp of neuropsych. One of my internship colleagues came from a psychodynamic program with little to no assessment background and did not have much interest in it. Her interest was primarily therapy. Imagine how shocked I was recently when she passed her licensing requirements and sent me a link to her private practice page that advertised her as doing neuropsych assessments. Simply a ridiculous assertion that she could be considered truly competent.
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It's a big problem! Imagine those "neuropsychology" reports being circulated to physicians, patients, etc. This subfield, and other subfields, have taken steps to promote board certification as a standard for competence. But I think it reflects poor foresight to have made those efforts in that area without protecting what you are called in the first place.
The problem is more of a psychology problem than a neuropsychology problem. if we can't regulate our own field legally at the state level and within APA (let alone non-psychologists who are starting to give these tests), the public is ultimately going to be confused, our credibility suffers, and ultimately newly entering professionals I think are the ones who will face salary problems - not established folks. We can help ourselves through Board certification, but the mess isn't making it any easier for us to make a case for higher salaries.
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No, this is very true. The problem is that even though there is a push for specialty guidelines, they are almost too little too late. Given that there is only standardized training for neuropsych and maybe rehab and those guidelines may only be followed in academic communities (Rusk or Hopkins may not hire me to be a rehabilitation psychologist, but I could probably get hired at a community hospital due to lack of properly specialized rehab psychologists and my having some related/prior experience), it is a difficult enforce such standards after years of allowing general practitioners to do as they please.
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I got a bit during internship and a lot on fellowship. It really helps to better understand expected deficits and provides great info to aide in treatment.
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More training and exposure would probably be a good thing, although I also think it's important for neuropsychologists not to fall into a bad habit of relying too much/placing too much credence in neuroimaging. A big part of the value added by our specialty is our ability to provide information not necessarily available through current imaging techniques.
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I also did a year of neuropath (and I still go if an interesting/rare case pops up), and it really helped tie everything togehter. I believe neuropathology provides for a much better appreciation of how the various regions of the brain interrelate, and how clinical presentation can have direct neuroanatomical corrolates.
For any SDN'ers who have an interest in neuroanatomy...Marquette offers a wonderful course called Neuroanatomical Dissection: Human Brain & Spinal Cord. It is a popular training course for fellows and people looking to sit for the ABPP-cn written exam. To get the most out of the course, you really should regularly attend neuropath case rounds so you can be oriented to typical dissection methods, as blunt dissection (the method they use at the training) offers a slightly different slant on dissection. Fans of white matter tracts will be in heaven.
I think our most valuable contribution to a case is our ability to work and try and makes sense of various data from across disciplines. The imaging doesn't always line up, but it can often provide additional insight into why a pt. is experiencing a certain grouping of symptoms. A typical radiology note will rarely if ever speak to functional impact, as they tend to stick to what can be appreciated on the imaging, so it is up to the neuropsychologist to translate how their findings may impact the patient..based on what we know about the anatomical functioning of the effected nuclei.
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Yes, but imaging in some cases can render a neuropsych eval superfluousness.
What neuropsych does is exciting and everything, but we need imaging training, especially as the technology becomes affordable in the next decade or so.
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Short of administering neuropsych tests under functional MRI, imaging will not give any sort of functional assessment of disability. The most a radiologist/neurologist can do is look at imaging and correlate any apparent deficits as being likely related to lesions seen. A full neuropsych assessment is still the gold standard in determining functional impairment in any type of tbi. In any event, you can learn about imaging all you want but they will not pay you to be a radiologist.
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I think what imagining training would most help us with is essentially "speaking the same language" as our frequent referral sources. That, and as T4C mentioned, the more you understand it, the more you might be able to integrate the findings into your own hypotheses and conclusions.
I don't see imagining rendering neuropsych superfluous or obsolete anytime soon, though, depending on the type of question being asked. Things have of course changed from a few decades back when the field was often called upon to localize lesions and such, which is no longer as necessary given (as you've said) the affordability and availability of imaging. But I don't think we're anywhere near knowing enough about the brain and how it works to be able to say, "ok, we see a lesion here, so we know the person is going to have this degree of deficit in X, Y, and Z."
What are you? What?
No, read Lezak foo. Beginning the 1950s' imaging techniques have made organic deficits so obvious that you do not need to pay another professional to confirm it. Don't fool yourself, a machine that lets you look inside a skull can answer the basic yes or no question of "Is something off". And that can often be enough as far as what the customer needs in terms of compensation.
Seriously, I'm in good company with my statement. Neuropsych needs to evolve and increase their scope of practice.
so the dementia evals I do are a waste of time because they could just get imaging done to show they have alzheimer's?!?
and the return to work or driving evals for stroke/TBI patient's similarly useless 'cause a brain scan will clearly show their level of functional impairment!?!
ahhh pug, I missed your ignorance and arrogance.
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I agree that neuropsychology needs to evolve, but imaging is not necessarily where it's at.
Ever been in a room with neurologists, neurosurgeons, oncologists, radiologists? Heck, even PCPs look at brain images. Everyone and their mother in the medical community thinks they are qualified to read imaging and explain it to patients. And they DO. To those who spoke earlier in the thread about neuropsychologists being uniquely qualified to give these explanations, we are not. We can certainly be helpful (mostly as a function of how much time we have with patients), but I'd take a neurosurgeon's explanation over my own any day.
Highly regarded neuropsychologists who were involved with my training loathed when people got too seduced by neuroimaging. It is a tool to supplement our other tools (for our purposes). I've been encouraged to study for Board exam assuming that you have no imaging information, as that IS a scenario you are likely to be in.
Do I love being involved with neuroimaging because it is informative/cool/cutting edge? Absolutely! Do I talk with patients about it - yes, sometimes. Am I more qualified than a physician to explain these things to patients - hold your horses. I'd say, being in the neuropsychology world, the biggest issue I have with the profession is the "physician complex."
Can we integrate imaging into our research studies? Yes, and we should in collaboration with other professionals. The distinction I am drawing is that we don't need imaging to do our jobs, and our primary job (answering the referral question) is what makes us a useful resource. As someone else mentioned, we often answer the questions that imaging cannot.
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I've read Lezak, among others, no worries there. As I said, neuropsych's focus has shifted from so often answering the, "where's the lesion?" question to instead examining, "what does the lesion mean?" Beyond that, because of the foundation in clinical psychology, we're generally uniquely qualified to comment on the contributing psychopathology, if any (e.g., PTSD and depression presenting as "memory problems").
Neuropsychology has most certainly evolved from the 1950's, and it will continue to do so. There are situations in which imagining may not tell the whole (or any of) the story; and even in those situations where imagining easily shows us, "did event X injure Mr. Y's brain?," it still doesn't tell us exactly what he can and can't do.
We should always be on the look out for new ways to employ our skillset for the benefit of our patients and ourselves. And while having more training in neuroimagining would likely be helpful, I know plenty of neuropsychologists myself who become concerned when too much attention and credence is placed on imagining alone.
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There are still a lot of issues with neuro imaging research, too (see: dead fish FMRI study)
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Do you come from the school of npsych that only cares about diagnosis/differential diagnosis? That's a very "academic" mindset, IMHO
Clinical neuropsychology is much, much more than this (think functioning) and sometimes, yes, sometimes, diagnosis does not matter and/or is not relevant. GASP!
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I wouldn't call that an "academic mindset", though I think it is more common in "old school" neuropsychology. I think the field is moving towards including more functional recommendations, which extends on the 'Dx only' approach.
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Out of curiosity, of what big city are you thinking?
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Westchestertonfieldville, Iowa...and....?
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This just raised my GAF.
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WAAAAAAAAY too much time/effort/debt for it to be worth it. If you already have a J.D. and you have a fully-funded Ph.D.....maybe. The two areas are relatively exclusive, unless you do something very specific like expert testimony or assessment in forensic cases, and even then it probably isn't worth the debt of law school.
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My JD friends tell me that the financial return on the investment into law school isn't all that great unless you're some kind of litigator or industry consultant. As you know, it's a similar story with a PhD. So, I don't really see how the two combined will make much. I feel like the knowledge of one profession just might make you a more informed practitioner of the other profession, but I'm not sure that translates into more money.
The research skills of the PhD might even be superfluous since a JD student interested in research can get an SJD. I'm not sure of any unique position out there that requires both the PhD and the JD other than patent law, While science PhDs are usually desired, I'm not sure a clinical psych PhD is going to be of any use to patent lawyers.
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The joint programs often pay for the law school portion, however. So funding the law degree isn't necessarily an issue if you do both at the same time.
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The "at the same time" part seems to be the rub. I looked at a few programs way back when, and it seemed like you had to do a couple years in one, then do the other, then clerking, then to clinical internship, etc. Maybe things have changed since I looked.
The programs for which I've gotten interviews would almost or completely fund the JD. The idea is to become involved in psycholegal policy research. I also have friends with JD's who point out that on the law school side of academia, PhD's are increasingly de rigueur for professors. And it's not unheard of for professors to be cross-listed at the law school (Mental Health Law) and the psych department. I suppose I'll need to wait until the interviews to find out what exactly graduates are doing with these combined degrees.
