Neuropsychologist - career options?

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sunshine008

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Hello all.

I am a first year doctoral student in a clinical psychology program. My area is neuropsychology. It has taken me all of one and a half semesters to grow to dislike research. It is not so much that I "dislike" it as it is that I feel I am bad at it and as such will not be happy pursuing a career doing research. I'm okay with doing it while in school, but am concerned about my career.

What are my options as a neuropsychologist outside of academia? I think I WOULD like to teach, but not do research. I also really like doing assessments.

I am not familiar with career path options or how the job market is for these other options.

Thanks so much for your help, all. I really appreciate it.

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Hello all.

I am a first year doctoral student in a clinical psychology program. My area is neuropsychology. It has taken me all of one and a half semesters to grow to dislike research. It is not so much that I "dislike" it as it is that I feel I am bad at it and as such will not be happy pursuing a career doing research. I'm okay with doing it while in school, but am concerned about my career.

What are my options as a neuropsychologist outside of academia? I think I WOULD like to teach, but not do research. I also really like doing assessments.

I am not familiar with career path options or how the job market is for these other options.

Thanks so much for your help, all. I really appreciate it.

I'm not really sure what the question is, but suffice to say that most folks who complete the two year fellowship in order to be a neuropsychologist work in applied settings, not academia. Hospitals (VA, academic med centers, rehab), outpatient clinics (often affiliated with hospitals), and private practice are common settings in which to see a neuropsychologist working.

If you would like to stay an academic (you said you like teaching) but aren't wild about research, then seeking faculty positions at small colleges/universities where tenure doesn't not depends on so much on publishing would be an option as well. Many of these somewhat lower demand faculty positions will allow you time for private practice of neuropsychology on the side, which would be good since you said you like conducting assessments. You would probably be compelled to frankly, as salaries (even when tenured) at these small schools usually aint that great. I am faculty at one right now. :)
 
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It is not uncommon for graduate students to become disinterested in research during graduate school. Overtime, you may find you like it more with different individuals or more appealing topics. Regardless, teaching neuropsychology is great; however, the demand for teaching neuropsych at a non-research institution will likely not be there, as neuro is a highly specialized field. With that said, of the subspecialties, neuro is in relatively high demand at VAs, Academic Medical Centers, Forensic Centers, Private Practice, etc. You can definitely have a stable clinical career, and teach/lecture in a smaller role at a larger institution for extra income.
 
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... neuro is in relatively high demand at VAs, Academic Medical Centers, Forensic Centers, Private Practice, etc. You can definitely have a stable clinical career, and teach/lecture in a smaller role at a larger institution for extra income.

..if you go to an APA-acred.iInternship, formal 2yr post-doc, and are boarded or at least board eligible. Literally every position I have seen for a neuropsych job required the person be at least board eligible, so it is a long road.

It isn't easy work, taking insurance can be tricky, and it is still a very competitive marketplace. I don't recommend it for anyone who doesn't *really* like the nitty-gritty required to learn to do it right. Practice can be as niche or broad as you want, but most find their niche.
 
If you would like to stay an academic (you said you like teaching) but aren't wild about research, then seeking faculty positions at small colleges/universities where tenure doesn't not depends on so much on publishing would be an option as well. Many of these somewhat lower demand faculty positions will allow you time for private practice of neuropsychology on the side, which would be good since you said you like conducting assessments. You would probably be compelled to frankly, as salaries (even when tenured) at these small schools usually aint that great. I am faculty at one right now. :)

If you do private practice on the side, you should get board certification regardless of whether you teach or not.
 
..if you go to an APA-acred.iInternship, formal 2yr post-doc, and are boarded or at least board eligible. Literally every position I have seen for a neuropsych job required the person be at least board eligible, so it is a long road.

It isn't easy work, taking insurance can be tricky, and it is still a very competitive marketplace. I don't recommend it for anyone who doesn't *really* like the nitty-gritty required to learn to do it right. Practice can be as niche or broad as you want, but most find their niche.

Very, very, true. Psychologists seem to have many more loopholes than other professions, but every profession in a way has many obstacles if you want a rewarding career.
 
If you do private practice on the side, you should get board certification regardless of whether you teach or not.

Why? Of all the places I mentioned, that setting is the one where is is least necessary (alot of employers and agencies are starting to highly encourage it or require it...or give pay bumps for it). In private practice, no one will know, not many would care, and you don't get paid anymore by insurance companies.
 
Why? Of all the places I mentioned, that setting is the one where is is least necessary (alot of employers and agencies are starting to highly encourage it or require it...or give pay bumps for it). In private practice, no one will know, not many would care, and you don't get paid anymore by insurance companies.

My personal argument would just be for the "health" of the specialty as a whole. Not sure what specific reasons Member6523 might've been thinking of, though.
 
My personal argument would just be for the "health" of the specialty as a whole. Not sure what specific reasons Member6523 might've been thinking of, though.

That's fantastic and all, but unless I see return on the investment, it ain't happenin...

I think that's a pretty universal way of looking at an investment that involves considerable effort and/or money too. In this case, its both. If I spend hundreds of hours and thousands of dollars, I need to see that pay off (seems like this mindset would be especially salient in PP, where income is contingent upon patients seen and nobody is reiburseing you for the process/travel/materials, etc). If you the we keep beating this drum of "for the good of the profession," will will never see board cert increase over 20%. Its basic social psych principles, IMHO.

Relatedly, board cert has been around for well over 30 years now and I'm not sure what concrete good it has done for the profession in that time anyway. Nobody outside the profession even knows what it is/what it means...:laugh:
 
My personal argument would just be for the "health" of the specialty as a whole. Not sure what specific reasons Member6523 might've been thinking of, though.

Health of the profession and personal ethics. If you are calling yourself a neuropsychologist with no board certification, I question your capabilities to deliver best practice to clients. This is after going through the right steps myself and realizing the extensive learning curve required to competently practice.
 
That's fantastic and all, but unless I see return on the investment, it ain't happenin...

I think that's a pretty universal way of looking at an investment that involves considerable effort and/or money too. In this case, its both. If I spend hundreds of hours and thousands of dollars, I need to see that pay off (seems like this mindset would be especially salient in PP, where income is contingent upon patients seen and nobody is reiburseing you for the process/travel/materials, etc). If you the we keep beating this drum of "for the good of the profession," will will never see board cert increase over 20%. Its basic social psych principles, IMHO.

Relatedly, board cert has been around for well over 30 years now and I'm not sure what concrete good it has done for the profession in that time anyway. Nobody outside the profession even knows what it is/what it means...:laugh:

That sort of mentality is what the RxP advocates have..."I need the most bang for my buck so I'm going to grab any opportunity I can, including prescription privileges." Fine, go for it.
 
Health of the profession and personal ethics. If you are calling yourself a neuropsychologist with no board certification, I question your capabilities to deliver best practice to clients. This is after going through the right steps myself and realizing the extensive learning curve required to competently practice.

You can question their capabilities all you want. Will they care if they are making money? I'm sure that there are those out there practicing without a post-doc too. I see generalists dabbling in all kinds of areas in PP without proper training. I see people hired to work with populations they have minimal experience with as well. That is a market reality.
 
That's fantastic and all, but unless I see return on the investment, it ain't happenin...

I think that's a pretty universal way of looking at an investment that involves considerable effort and/or money too. In this case, its both. If I spend hundreds of hours and thousands of dollars, I need to see that pay off (seems like this mindset would be especially salient in PP, where income is contingent upon patients seen and nobody is reiburseing you for the process/travel/materials, etc). If you the we keep beating this drum of "for the good of the profession," will will never see board cert increase over 20%. Its basic social psych principles, IMHO.

Relatedly, board cert has been around for well over 30 years now and I'm not sure what concrete good it has done for the profession in that time anyway. Nobody outside the profession even knows what it is/what it means...:laugh:

Given the change in reported levels of adherence to Houston conference guidelines, I'd say if nothing else, board certification has helped to shape that (i.e., greater standardization of training criteria). It's effects have also been seen in the VA and AMC-type job postings requiring board eligibility that've been mentioned here and elsewhere.

Finally, just looking at my own postdoc site, it's allowed neuropsychologists to more-easily delineate who should and shouldn't be conducting neuropsych evals. Without board cert, it becomes more difficult to vet credentials: "well, if you're going to do this type of assessment, you need to have trained in X, Y, and Z" rather than just, "ok, you need to be board certified or eligible."

As for return on investment, again, I see it as having a (admittedly nebulous) positive net effect on the specialty as a whole. It allows neuropsychologists to (at least theoretically) self-advocate and better protect their interests and scope of practice by providing a clearer definition of what a neuropsychologist actually is.
 
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You can question their capabilities all you want. Will they care if they are making money? I'm sure that there are those out there practicing without a post-doc too. I see generalists dabbling in all kinds of areas in PP without proper training. I see people hired to work with populations they have minimal experience with as well. That is a market reality.

I agree, but:

1) Over time the number of board certified neuropsychologists will increase.

2) Those individuals will be motivated to better protect their practice.

3) This will extend towards who is hired both in and out of institutional settings. One of the oost docs at where I work is applying for PP and the employers of both sites do care that he is board eligible. Would they hire someone who is not? Maybe, but this post doc gets first consideration. This will be all the more important over time.

4) It does matter for forensic settings where ABPP-CN folks will be preferred over others, if only because it adds extra weight in considering who is an "expert."

5) You can skulk in PP settings (which will become increasingly more selective) but if you want to be professionally active and involved outside of your setting, going about as a non-boarded individual will be met with increasing criticism...both overt and covert. Some people may not care at first but when they try to branch out or network, it will matter.

So even if you are purely motivated by self-interest and don't care about ethics of practice, not getting board certified will in the long run limit your $$$.
 
I agree, but:

1) Over time the number of board certified neuropsychologists will increase.

2) Those individuals will be motivated to better protect their practice.

3) This will extend towards who is hired both in and out of institutional settings. One of the oost docs at where I work is applying for PP and the employers of both sites do care that he is board eligible. Would they hire someone who is not? Maybe, but this post doc gets first consideration. This will be all the more important over time.

4) It does matter for forensic settings where ABPP-CN folks will be preferred over others, if only because it adds extra weight in considering who is an "expert."

5) You can skulk in PP settings (which will become increasingly more selective) but if you want to be professionally active and involved outside of your setting, going about as a non-boarded individual will be met with increasing criticism...both overt and covert. Some people may not care at first but when they try to branch out or network, it will matter.

So even if you are purely motivated by self-interest and don't care about ethics of practice, not getting board certified will in the long run limit your $$$.

Are you talkin about like 100 years from now with some of this stuff?

And, "ethics of practice?!" Get real...
 
I am not sure how we get board membership to increase if their are only vague and aspiration incentives. Its not the Army ("be all you can be"). Its a job. It will need more than rhetoric to really increase to a number in which it would really mean much to anyone besides us. I am not against it per se, but I think until we create a real need for it, people are going to default to the natural mode of "what's in it for me." Why do you think its only like 15% of npsychs?

In PP, would it increase your standing on the stand and a referrals for forensic work? Maybe. Seems to depend on who you talk to. Most npsychs dont do forensic work anyway, so seems like a less than compelling argument to me. Better motivated to protect their practice? I don't really even know what this means, much less if their is any evidence for it. I don't know what to day about the "ethics of practice piece" thing. Somehow we now think that not joining a very optional and very expensive club speaks to our ability to do clinical work? I dont follow...
 
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I am not sure how we get board membership to increase if their are only vague and aspiration incentives. Its not the Army ("be all you can be"). Its a job. It will need more than rhetoric to really increase to a number in which it would really mean much to anyone besides us. I am not against it per se, but I think until we create a real need for it, people are going to default to the natural mode of "what's in it for me." Why do yoiu think its only like 15% of npsychs, right?

In PP, would it increase your standing on the stand and a referrals for forensic work? Maybe. Seems to depend on who you talk to. Most npsychs dont do forensic work anyway, so seems less than compelling to me. Better motivated to protect their practice. I dont really even know what this means, much less if their is any evidence for it. I don't know what to day about the "ethics of practice piece" thing Somehow we now think that not joining very optional and expensive club speaks to our ability to do clinical work? I dont follow...

Would you estimate that maybe...85% of neuropsychologists don't get/do forensic work? From what I've seen, ABPP seems to be preferred in that area, which happens to also be the surest road to an increase in compensation.
 
My personal argument would just be for the "health" of the specialty as a whole. Not sure what specific reasons Member6523 might've been thinking of, though.


I don't see how it helps the health of neuropsychology to be boarded. What would make the speciality healthier is to give the money you spend on boarding every year to NAN or some other PAC supporting neuropsychology.
 
I don't see how it helps the health of neuropsychology to be boarded. What would make the speciality healthier is to give the money you spend on boarding every year to NAN or some other PAC supporting neuropsychology.

The "argument" has been that it shows a united front (please...there are 3 different boards and nobody outside knows what it is, what it means,etc.), denotes "competence" (although there is no evidence that it increases any desirable indices in practice, and is dumb on the face of it because "competence" is judged by group consensus by others members in said club), and is a "humbling learning process." Spare me. In its current form, its unnecessary hoop jumping and the resources would be better spent ensuring the profession doesn't become obsolete, outdated, and/or financially untenable in the larger healthcare arena.

If we wanna make it required, like physician boards are fine, but please spare me the personal ethics and for the good of the profession junk. Because, like it said, in its CURRENT form, it appears, empirically, to indicate squat.
 
No and yes.


This kind of mentality needs to change within psychology. THe realistic payback to become a psychologist pales in comparison to all the opportunities (family time, personal time, etc) we give away to earn the PhD. I remember when I was completing my training that I was willing to move from one end of the country to the next for college, grad school, internship, post-doc because I thought that it would matter in the end. In reality, as long as my internship was APA-accredited, I could have stayed locally because nobody cares where my internship was or what types of rotations were on my internship.

Now we are asking people to do these fancy post-docs and get boarded for the same low compensation that those without these post-docs and boarding. So, instead of "if you do this post-doc you will be compensated for your time and effort" the bar is "if you do this post-doc, you will not earn any more money at our hospital but without it we won't consider your application" is NOT healthy for the profession.

We are not M.D.s and we do not earn M.D.-level salaries. I could see doing a post-doc if I were making $250K a year. Why? Because if I make that much a year, I can work less than 40 hours without hurting my lifestyle and study for the exams. When I make $60K a year, i think it's ridiculous to ask someone to come home at night and spend more of their time on a profession that is already WAY under-compensated. '

The only reason I earned my post-doc in psyhcopharm is because it is the only post-doc that increases compensation from the primary payer of psychological services (insurance). Post-docs in neuropsychology, behavioral medicine, etc will not earn you a penny more.

I care a lot about the health of psychology and I put my money where my mouth is: I give to PACS supporting our scopes of practice (testing, diagnosis, etc) but I don't see how these post-docs do anything but make us cheap labor for 2 more years Also, remember to keep your boarding credentials you have to pay $400 or 500 a year. Any one step increase you receive from a V.A. goes to pay for this. Add to it the cost of the board certification (approx $1000 ) and you lose money and time
 
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I have to agree with Edieb on this one. It seems like a wonderful theoretical exercise to promote board certification and I am seeing more ads for hospitals wanting Houston conference guidelines. However, many of the real world jobs I see just don't care about any of this stuff. It is nice, but at the end of the day the fact that you had an APA accredited internship and that you are licensed seem to really matter the most. Sometimes the internship does not matter either. I work for a large provider (over 250 mental health professionals) and the truth is that I did everything right. However, there are not that many academic positions in geropsych or health psych. Do post-docs and board cert matter for those few positions? sure. But, if you are looking at the places that often need people and hire a lot (underfunded hospitals, pp, nursing home, private contractors), they really do not care. I work with people trained in child psych seeing adult and geriatrics, people from non-accredited internships, fpsp grads, etc. No one seems to care as long as you are licensed and you can see people and make money for them. We make the same money and work side by side. For neuropsych, that you have been supervised for two years doing neuropsych seems to matter more than the quality of the post-doc or whether your supervisors met guidelines.

I initially regretted not leaving my area to complete an academic post-doc and taking a job instead. However, now that I am looking for licensed jobs, I really cannot see any jobs in health or gero psych that make me regret my choice. I am still better trained than most people applying for the most readily available jobs in the area. Will I go for board certification? I am considering it, but it really depends. If I accomplish my goals without it or end up in a satisfying position that does not require it, I may decide it is not worth the trouble.

For those who disagree with this point of view, I have a bit of a challenge. We all have our own personal medical doctors. How many people can name where their doctor went to medical school and completed a residency? How about the quality of his residency? How about whether he is active in the profession and keeps anything above the necessary professional certifications? If your doctor moved, would you go about picking a doctor based on his credentials or choose one that is in-network for your insurance, close by in location, and has an available time slot for you?
 
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Board certification is increasingly becoming promoted, as is board eligibility. I intend to get boarded myself but don't feel that I need to do it immediately.

Now, people in PP can do whatever they want, sort of. But if they are calling themselves neuropsychologists or doing neuropsychological testing without meeting training standards agreed upon in the HC, then I'd say they are practicing outside of their area of competency.

I don't really care that there are ways around this at the moment - restrictions will only get tighter (in fact, I recall seeing some payers requiring board eligiblity to use neuro testing codes). As someone who is board eligible, I can say that the bulk of my competency came on the 2 years of full time work on postdoc. Someone who skipped that and thinks they can just do it anyways doesn't know what they don't know. I can think of some exceptions which are already accounted for in the boarding process (e.g., grandfathering in applicable experience). But new graduates skipping postdoc and doing neuropsych testing are doing something without adequate training, according to the standards of the specialty.
 
Board certification is increasingly becoming promoted, as is board eligibility. I intend to get boarded myself but don't feel that I need to do it immediately.

Now, people in PP can do whatever they want, sort of. But if they are calling themselves neuropsychologists or doing neuropsychological testing without meeting training standards agreed upon in the HC, then I'd say they are practicing outside of their area of competency.

I don't really care that there are ways around this at the moment - restrictions will only get tighter (in fact, I recall seeing some payers requiring board eligiblity to use neuro testing codes). As someone who is board eligible, I can say that the bulk of my competency came on the 2 years of full time work on postdoc. Someone who skipped that and thinks they can just do it anyways doesn't know what they don't know. I can think of some exceptions which are already accounted for in the boarding process (e.g., grandfathering in applicable experience). But new graduates skipping postdoc and doing neuropsych testing are doing something without adequate training, according to the standards of the specialty.

I agree; as someone in the first year of a postdoc, I can say that the amount I've learned just in the past seven-ish months has significantly increased my knowledge base, skill set, and the competence of my practice.

As for knowledge outside of our specialty, in all honesty, how many people can name the individual board credentials various physicians hold? How about for OTs, PTs, SLPs, etc? That's not an excuse for not supporting the concept of board; quite the opposite, actually. The only way to increase the visibility of boarding is to have more people complete said process. And beyond that, in my mind, the most important part really is about establishing a minimal level of competence to practice. Is the currently-defined ABPP criteria perfect? No, but it's the most widely-accepted such criteria out there, and we've gotta start somewhere. Beyond that, I have yet to hear complaints about the process from anyone who's completed it. Biased sample? Certainly, but many of these folks don't have any semblance of a problem voicing their opinions if they don't like something.

Do we, as psychologists and psychology trainees, understand there's a difference between someone who had significant neuropsych training in grad school, internship, and possibly postdoc vs. someone who completed one three-month neruopsych externship in grad school and a minor rotation on internship, if neither is board-certified? Sure, but the general public (and even most hospital/practice administrators outside of psych) don't. Thus, I feel that it falls on us to continue to establish what it means to be a neuropsychologist, and what type(s) of credentialing that requires.
 
Board certification is increasingly becoming promoted, as is board eligibility. I intend to get boarded myself but don't feel that I need to do it immediately.

Now, people in PP can do whatever they want, sort of. But if they are calling themselves neuropsychologists or doing neuropsychological testing without meeting training standards agreed upon in the HC, then I'd say they are practicing outside of their area of competency.

I don't really care that there are ways around this at the moment - restrictions will only get tighter (in fact, I recall seeing some payers requiring board eligiblity to use neuro testing codes). As someone who is board eligible, I can say that the bulk of my competency came on the 2 years of full time work on postdoc. Someone who skipped that and thinks they can just do it anyways doesn't know what they don't know. I can think of some exceptions which are already accounted for in the boarding process (e.g., grandfathering in applicable experience). But new graduates skipping postdoc and doing neuropsych testing are doing something without adequate training, according to the standards of the specialty.

I'm [ EDIT: not*] disagreeing with you, but as there is no licensing board that requires you to get certified it will conitue being a problem. I know of a number of people that did their two year neuropsych 'post-doc' in private practices and were glorified psych techs for people that wanted to make more money. Now, if insurance companies start requiring be/bc for billing purposes, we have an incentive.
 
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What code is said unboarded person violating?

Professional competency. A neuropsychologist requires experience in psychometrics, behavioral neurology, psychopharmacology, and the cognitive and behavioral sequalae that result from neurological disorders (as well as psychiatric disorders) and environmental and medical factors that might influence scores as well.
 
I'm disagreeing with you, but as there is no licensing board that requires you to get certified it will conitue being a problem. I know of a number of people that did their two year neuropsych 'post-doc' in private practices and were glorified psych techs for people that wanted to make more money. Now, if insurance companies start requiring be/bc for billing purposes, we have an incentive.

Incentive or obligation?

Postdocs that follow the training model include a variety of experiences and increasing independence. I saw hundreds of patients and took on more and more responsibility. Are the examples your are citing from formal neuropsych postdocs? Because the formal ones follow training standards.

Hey I am happy that you were able to circumvent the postdoc process and jump into practice. But I would never consider you a part of my specialty and would urge patients to see someone with adequate training.
 
I am not sure how we get board membership to increase if their are only vague and aspiration incentives. Its not the Army ("be all you can be"). Its a job. It will need more than rhetoric to really increase to a number in which it would really mean much to anyone besides us. I am not against it per se, but I think until we create a real need for it, people are going to default to the natural mode of "what's in it for me." Why do you think its only like 15% of npsychs?

In PP, would it increase your standing on the stand and a referrals for forensic work? Maybe. Seems to depend on who you talk to. Most npsychs dont do forensic work anyway, so seems like a less than compelling argument to me. Better motivated to protect their practice? I don't really even know what this means, much less if their is any evidence for it. I don't know what to day about the "ethics of practice piece" thing. Somehow we now think that not joining a very optional and very expensive club speaks to our ability to do clinical work? I dont follow...

The fact remains that there are an increasing number of trainees obtaining board certification IN NEUROPSYCHOLOGY (this doesn't apply to health or gero, it is increasingly relevant for rehab) who are receiving specialized training that most psychologists simply do not obtain. This doesn't make us better or more competent in general practice, it does make us more competent in neuropsychological assessment. Do you know how to evaluate candidacy for DBS in a patient showing signs of mild dementia secondary to PD, or factor in crowding effects of a left hemisphere tumor and how that may compromise a college student's academic achievement? Can you parse apart score patterns that can rule in or out MCI vs pseudodementia in a patient with major depressive disorder? Can you interpret and synthesize a multitude of psychiatry, neurology, and PP reports and integrate them cohesively into your own report? Can you identify any lasting cognitive impairments in a patient with TIA who learned English as a second language? There is an enormous amount of information that requires capable practice. It's far more than administering a WAIS-IV and CPT and calling it ADHD.
 
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I'm disagreeing with you, but as there is no licensing board that requires you to get certified it will conitue being a problem. I know of a number of people that did their two year neuropsych 'post-doc' in private practices and were glorified psych techs for people that wanted to make more money. Now, if insurance companies start requiring be/bc for billing purposes, we have an incentive.

I know a number of people who ddi their two year post doc at academic medical schools and went on to have very successful careers. Neuropsychology requires a good degree of medical knowledge, particularly in behavioral neurology, to successfully practice it. People think it's glorified psychodiagnostic assessment but if you review the literature much of the science holds together, and there's years of knowledge that our field has built upon over the years.
 
As someone who is board eligible, I can say that the bulk of my competency came on the 2 years of full time work on postdoc. Someone who skipped that and thinks they can just do it anyways doesn't know what they don't know. I can think of some exceptions which are already accounted for in the boarding process (e.g., grandfathering in applicable experience). But new graduates skipping postdoc and doing neuropsych testing are doing something without adequate training, according to the standards of the specialty.

I think this is the best point to rely on for advocating board certification in neuropsychology.

Since psychology does not have any other way to designate specialties, there has to be some standard especially in a field like neuropsych which requires a high degree of knowledge and experience outside of general clinical psychology training. It is not about people wearing their ABPP credential on their shoulder as a sign they are better (although we all probably know a few who do). Truth is, there is no evidence for that and some have made cogent arguments regarding the real necessity for board certification with respect to competency/skill (see Marty Rohling's opinion on this topic). I advocate for it simply because it helps to document that a person has the appropriate training and experiences and has demonstrated a basic level of competency in the field. This is akin to medical board certification which is not considered a badge of honor but an expectation for entry into the subspecialty. Board certification does not tell you a whole lot about how “good” your physician is just that they have the appropriate training in their field and have demonstrated basic competence per peer review. On the other hand, it tells you a lot when your physician is not boarded. I think this is where boarding is headed in psychology, well at least for neuropsych.

Certainly I would never suggest that someone could not practice neuropsychology competently and ethically without being boarded, especially if they have the appropriate training (i.e., board eligible). I have mentioned before that some of the best neuropsychologist I know are not boarded and a few of the worst I have seen are. Although the latter tend to be folks who got in prior to the increased training restrictions of the Houston guidelines.
 
The "argument" has been that it shows a united front (please...there are 3 different boards and nobody outside knows what it is, what it means,etc.), denotes "competence" (although there is no evidence that it increases any desirable indices in practice, and is dumb on the face of it because "competence" is judged by group consensus by others members in said club), and is a "humbling learning process." Spare me. In its current form, its unnecessary hoop jumping and the resources would be better spent ensuring the profession doesn't become obsolete, outdated, and/or financially untenable in the larger healthcare arena.

If we wanna make it required, like physician boards are fine, but please spare me the personal ethics and for the good of the profession junk. Because, like it said, in its CURRENT form, it appears, empirically, to indicate squat.

That's fine if you don't want to do it, but don't call yourself a neuropsychologist.
 
Certainly I would never suggest that someone could not practice neuropsychology competently and ethically without being boarded, especially if they have the appropriate training (i.e., board eligible). I have mentioned before that some of the best neuropsychologist I know are not boarded and a few of the worst I have seen are. Although the latter tend to be folks who got in prior to the increased training restrictions of the Houston guidelines.

i do think some of the older folk can avoid being board certified, but then, they are established in their careers and often were the ones who built the knowledge base we younger ones rely on.
 
Wow, didn't mean to start anything! Thank you to the two people who answered my question! Carry on with your debate :p
 
That's fine if you don't want to do it, but don't call yourself a neuropsychologist.

I think you need to take it easy on this. Even the Houston guidelines do not go as far as you are on this. I have no problem with a non-boarded individual calling him/herself a neuropsychologist if they have appropriate training. I have been training neuropsychologists at the intern and postdoctoral level for about 7-8 years and I am boarded. Being an advocate for board certification is fine and will score you points in some circles, but the field is not even close to drawing a line in the sand as you seem to be advocating for.
 
I think you need to take it easy on this. Even the Houston guidelines do not go as far as you are on this. I have no problem with a non-boarded individual calling him/herself a neuropsychologist if they have appropriate training. I have been training neuropsychologists at the intern and postdoctoral level for about 7-8 years and I am boarded. Being an advocate for board certification is fine and will score you points in some circles, but the field is not even close to drawing a line in the sand as you seem to be advocating for.

Fair enough, but how do we determine appropriate training?
 
Fair enough, but how do we determine appropriate training?

I think Houston conference guidelines does a reasonable job of delineating this. Other than that, It is up to the individual psychologist to practice within the boundaries of their competence. There is no neuropsychology license and technically any psychologist could call themselves one just like I can call myself a child psychologist. Most insurance companies now require neuropsychs to be at least board eligible, which basically means training according to Houston conference guidelines. I have no problem with them requiring some documentation of training in the field. At the VA or medical centers, they typically require a formal 2-year postdoc, again consistent with Houston conference guidelines. So the training requirement is becoming a standard. I think that is a good start.
 
I think Houston conference guidelines does a reasonable job of delineating this. Other than that, It is up to the individual psychologist to practice within the boundaries of their competence. There is no neuropsychology license and technically any psychologist could call themselves one just like I can call myself a child psychologist. Most insurance companies now require neuropsychs to be at least board eligible, which basically means training according to Houston conference guidelines. I have no problem with them requiring some documentation of training in the field. At the VA or medical centers, they typically require a formal 2-year postdoc, again consistent with Houston conference guidelines. So the training requirement is becoming a standard. I think that is a good start.

That's really what I was aiming for...it just irritates me when members on this board spit on the process. It strikes me as opportunistic. I do understand many competent neuropsychologists are not board certified.
 
Incentive or obligation?

Postdocs that follow the training model include a variety of experiences and increasing independence. I saw hundreds of patients and took on more and more responsibility. Are the examples your are citing from formal neuropsych postdocs? Because the formal ones follow training standards.

Hey I am happy that you were able to circumvent the postdoc process and jump into practice. But I would never consider you a part of my specialty and would urge patients to see someone with adequate training.

Lets clarify a few things, shall we.

1. I do NOT practice neuropsychology. I work in geropsych and behavioral medicine mostly.

2. I did complete a subinternship in neuropsychology at an AMC with a div. 40 post-doc and internship. I also completed advanced classes in neurpsych that included interns and post-docs at said AMC. I also worked in psychophysiology and behavioral medicine.

3. I completed an APA approved internship with a neuropsychology component to leave myself eligible for a Div 40 post-doc should I decide to pursue that path.

4; I, personally, am for board certification for a number of specialties including neuropsych, health psych, and geropsych.

The problem I have is seeing colleagues in the real world break all these rules with little problem. I know of a number of people including someone that I interned and was on sub-internship with that completed 'post-docs' at private practices that are not Div 40 approved. One of these people had minimal assessment training and no neuropsych training prior to internship and is now in private practice administering neuropsych assessments under the 'supervision' of a neuropsychologist and seeing therapy clients. My point was not that board certification was a bad thing. I am simply tired of seeing these things happen. The idea that individuals getting board certified will fix the problem is a non-starter. You need some larger entity to force the issue (APA, insurance companies, etc.) because otherwise business people and others that are taking over healthcare will continue to not care. Outside of Academic medicine and the VA few do care about credentials. Most major hospitals will require a neuropsych post-doc (but not board cert). I have yet to see a rehab hospital job opening that asks for a rehab post-doc. Most want neuropsych post-docs. I see plenty of larger nursing homes that have rehab facilities and other major issues including mine (I have seen tbi, double amputees, brain tumors, etc) and the truth is that no one other than me (at my facility) is remotely qualified to see these people for treatment and would not know the first thing about delineating cognitive factors from mood issues and would know when to call for a neuropsych assessment. Even when I got the neuropsych report from the person that we have on staff, it really gave me minimal new info.

A case study for you. I have a pt now that i was consulted for months ago. Quadriplegia and TBI following an MVA, multiple CVA during recovery, speech is slurred and nominal aphasia is present at times. Previous dx of Bipolar d/o. Pt had been through several well known rehab facilities before landing in long term care. Consult was put in due to depressed mood and behavioral disturbances (screaming and yelling). After seeing the pt, I was the first person to request a neuropsych consult as no facility had previously (this was one yr after the incident). The neuropsych was only mildly useful (pt bottomed out and there was almost no limits testing to asses the pt's capabilities). I was able to utilize the fact that memory difficulties were significantly improved with cueing to help the family put together a behavioral plan that reduced the confusion and allowed pt to remember after a few weeks when family would come over and to help her establish a routine. Psychiatry is still treating like plain old depression and trying to push more and more meds. Had I not picked up the case, the other options were a child psychologist by training, an eating disorders specialist,a few generalists, and someone that worked mostly with inpt psychiatric illness. Like I said, very few non-academic facilities care about gold standard care and are more interested in the bottom line.
 
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Yep, appropriate training. Board certification in and of itself doesn't mean a ton yet, but it is starting to slowly become a standard. However, you can't really argue with the training standards. A clinical psychologist fresh out of graduation is not competent, period, due to lack of appropriate training in the specialty.
 
Sanman, I assume you mean division 40?

A lot of us had excellent neuropsychology experiences on practicums and internship, but those aren't anything that can replace a formal postdoc.

I agree with you that there are no teeth behind the standards now. But hopefully as 3rd party payers get on board , we will make some progress. But people practicing outside of their area of competence is common as you say. Within neuropsychology, this is hugely problematic as there ARE published training standards and a clear path to competence. It confuses the public when people ignore them and I have seen way too many inaccurate reports coming from PP where individuals lacked appropriate training.
 
Sanman, I assume you mean division 40?
.

I do indeed. Sorry about that. I was on the independent practice division website earlier.

I am not suggesting that these neuropsych experiences take the place of a post-doc. I am arguing that the limited availability of proper post-docs and experiences means that standards vary widely and the lack of teeth will continue to allow that to be so. While I am sure that you will need a formal post-doc to practice a VA or academic environment, I am much less sure that many facilities and contractors will be apt to make the distinction without formal pressure rather than telling individuals to do these things for the good of the profession with absolutely no financial benefit to them. A guideline is a formal requirement. What we have currently is a Houston Conference suggestion as to gold standard training.

I would like to go for a board certification in health psych or gero, but as I mentioned earlier the benefit seems nebulous while the costs are quite apparent.
 
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I do indeed. Sorry about that. I was on the independent practice division website earlier.

I am not suggesting that these neuropsych experiences take the place of a post-doc. I am arguing that the limited availability of proper post-docs and experiences means that standards vary widely and the lack of teeth will continue to allow that to be so. While I am sure that you will need a formal post-doc to practice a VA or academic environment, I am much less sure that many facilities and contractors will be apt to make the distinction without formal pressure rather than telling individuals to do these things for the good of the profession with absolutely no financial benefit to them. I would like to go for a board certification in health psych or gero, but as I mentioned earlier the benefit seems nebulous while the costs are quite apparent.

I agree in that there need to be mechanisms for enforcement. Although I feel that one of the first steps in establishing the standard (and thereby helping to convince policy makers that the standard is justified) is by having "pillars in the field" and/or large numbers of practitioners adhering to and supporting the standard.

I believe Louisiana actually protects the term "neuropsychologist" in its state licensing law, with the ability to use said title requiring additional vetting by the licensing board. This at least shows that it's possible to get something like this added in as a provision (and provides a blueprint for doing so), and board certification could provide an easy way to vet professionals.
 
I agree in that there need to be mechanisms for enforcement. Although I feel that one of the first steps in establishing the standard (and thereby helping to convince policy makers that the standard is justified) is by having "pillars in the field" and/or large numbers of practitioners adhering to and supporting the standard.

I believe Louisiana actually protects the term "neuropsychologist" in its state licensing law, with the ability to use said title requiring additional vetting by the licensing board. This at least shows that it's possible to get something like this added in as a provision (and provides a blueprint for doing so), and board certification could provide an easy way to vet professionals.

Agreed. It is a start. I really do feel that it is a minor start. We need more movement in other areas as well. Allowing anyone to legally do anything really hurts the way we are viewed. However, when people like Ralph Reitan openly disagree with conference guidelines, what does that say to the outside world? The other side of the issue is that until there are enough centers to train psychologists properly without having move across the country for a second or third time, it will be hard to enforce these standards in the real world. Lets also keep in mind that the number of professionals being trained in ways some here might consider subpar is swelling in many specialty areas. They, too, will have a say about adopting these standards.
 
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Agreed. However, when people like Ralph Reitan openly disagree with conference guidelines, what does that say to the outside world?

Which is exactly what's wrong with the profession as a whole (i.e., we're much more likely to lambaste one another than to band together and work toward constructive solutions).

Although we're obviously never going to please everyone, so regardless of whether or not Reitan decides he wants to support boarding for whatever reason, if enough folks in the field think it's a good idea (which would be evidenced by boarding rates/proportions), then he'll just have to adapt or be left behind.
 
Agreed. It is a start. I really do feel that it is a minor start. We need more movement in other areas as well. Allowing anyone to legally do anything really hurts the way we are viewed. However, when people like Ralph Reitan openly disagree with conference guidelines, what does that say to the outside world? The other side of the issue is that until there are enough centers to train psychologists properly without having move across the country for a second or third time, it will be hard to enforce these standards in the real world. Lets also keep in mind that the number of professionals being trained in ways some here might consider subpar is swelling in many specialty areas. They, too, will have a say about adopting these standards.

With all the respect in the world to Reitan, one man's opinion is irrelevant in the face of general consensus.
 
With all the respect in the world to Reitan, one man's opinion is irrelevant in the face of general consensus.

Yeah - as if dissent doesn't exist with regard to the training models across multiple professions. The HC guidelines make it pretty clear what the minimum standards are in order to practice clinical neuropsychology, and my reading of them doesn't view them as particularly harsh. They has them out pretty well in this thread (http://forums.studentdoctor.net/showthread.php?t=789621). Sure, I griped about a 2 year postdoc at times, but I definitely would not have felt ready to practice without that experience. I don't see how someone who did some of this work on externship and internship could view themselves as ready for independent practice.

Some of the dissent I think just comes from people who want to be able to practice doign whatever they want without obtaining the minimum training.
 
Which is exactly what's wrong with the profession as a whole (i.e., we're much more likely to lambaste one another than to band together and work toward constructive solutions).

Although we're obviously never going to please everyone, so regardless of whether or not Reitan decides he wants to support boarding for whatever reason, if enough folks in the field think it's a good idea (which would be evidenced by boarding rates/proportions), then he'll just have to adapt or be left behind.

I'm not saying it does, However, a lack of consensus among professionals, minimum standards to ensure that guidelines are met, and only a small minority willing to board certify leads to a stratified field rather than a unified one. Now, I am not a neuropsychologist. However, I have followed all the gold standard requirements up to post -doc for my area of the profession (health psych and gero psych). The reason I did not complete is a post -doc was a lack of options in in my geographical area (where I needed to stay for personal reasons) for my chosen specialty area. However, what I have found in the profession is a vast chasm. While I may not be considered for the few available academic positions in my area of the field without a post-doc (which I cannot apply for anyway as they are no where near my significant other), most of the available everyday clinical positions care about very little beyond my ability to have a clinical license and bill for them. So, we have recommended gold standards of training that allow a person to work in a more academic environment (lets say the top 15% of jobs ) and a whole lot of jobs that simply don't care about your specialty as long as you are licensed (85%). We also have a growing number of professionals in the field that do not meet the gold standard of training (no post-doc, no apa internship, etc) that will not endorse strict standards that would adversely affect them. My issue is where does that leave us? With ever tightening standards for a of minority positions and that will only consider a minority of applicants and a majority of positions that do not care with a growing number of clinicians trained in a sub par manner. What happens when you follow all those strict standards and jump through the hoops and don't get one of those minority jobs that require them? Where are we really when we are pushing for board certification and post-docs in a profession where a large percentage can't even secure an APA approved internship?
 
I'm not saying it does, However, a lack of consensus among professionals, minimum standards to ensure that guidelines are met, and only a small minority willing to board certify leads to a stratified field rather than a unified one. Now, I am not a neuropsychologist. However, I have followed all the gold standard requirements up to post -doc for my area of the profession (health psych and gero psych). The reason I did not complete is a post -doc was a lack of options in in my geographical area (where I needed to stay for personal reasons) for my chosen specialty area. However, what I have found in the profession is a vast chasm. While I may not be considered for the few available academic positions in my area of the field without a post-doc (which I cannot apply for anyway as they are no where near my significant other), most of the available everyday clinical positions care about very little beyond my ability to have a clinical license and bill for them. So, we have recommended gold standards of training that allow a person to work in a more academic environment (lets say the top 15% of jobs ) and a whole lot of jobs that simply don't care about your specialty as long as you are licensed (85%). We also have a growing number of professionals in the field that do not meet the gold standard of training (no post-doc, no apa internship, etc) that will not endorse strict standards that would adversely affect them. My issue is where does that leave us? With ever tightening standards for a of minority positions and that will only consider a minority of applicants and a majority of positions that do not care with a growing number of clinicians trained in a sub par manner. What happens when you follow all those strict standards and jump through the hoops and don't get one of those minority jobs that require them? Where are we really when we are pushing for board certification and post-docs in a profession where a large percentage can't even secure an APA approved internship?

There is more than one route to meeting the training standards. If you don't have the formal Division 40 postdoc, you can still find some other experiences and work your way into the field.

You seem to think about this from the end of what employers want, while the specialty created the standards for the integrity of the profession. Just because some for-profit PP employer is willing to pay someone who is licensed to do neuropsychological assessments when they lack the consensus minimum training standards doesn't mean that that person should do it.

I have a feeling that you will start to see 3rd party payers moving in the direction of requiring postdocs or equivalent. When I credentialed with some insurance companies I had to provide evidence of my postdoctoral training in order to be listed as a clinical neuropsychologist. If that becomes widespread, then what do you think those employers will do next?

I don't view the standards as something only necessary for practice in academic settings. I made the conscious choice to get my formal postdoctoral training, despite the fact that I am primarily an academic, because I did not want to practice outside of my area of competency (even on a part time basis). It was grueling hours, a major financial sacrifice (I had options to get on the tenure track earlier), but ultimately necessary in order to develop competency for independent practice.

There definitely should be more training sites available as more people get boarded. I don't necessarily agree with the notion that anyone ought to be able to practice in whatever specialty they want without finding appropriate training experiences. If it is a competitive specialty, then it is a competitive specialty.
 
There is more than one route to meeting the training standards. If you don't have the formal Division 40 postdoc, you can still find some other experiences and work your way into the field.

You seem to think about this from the end of what employers want, while the specialty created the standards for the integrity of the profession. Just because some for-profit PP employer is willing to pay someone who is licensed to do neuropsychological assessments when they lack the consensus minimum training standards doesn't mean that that person should do it.

I have a feeling that you will start to see 3rd party payers moving in the direction of requiring postdocs or equivalent. When I credentialed with some insurance companies I had to provide evidence of my postdoctoral training in order to be listed as a clinical neuropsychologist. If that becomes widespread, then what do you think those employers will do next?

I don't view the standards as something only necessary for practice in academic settings. I made the conscious choice to get my formal postdoctoral training, despite the fact that I am primarily an academic, because I did not want to practice outside of my area of competency (even on a part time basis). It was grueling hours, a major financial sacrifice (I had options to get on the tenure track earlier), but ultimately necessary in order to develop competency for independent practice.

There definitely should be more training sites available as more people get boarded. I don't necessarily agree with the notion that anyone ought to be able to practice in whatever specialty they want without finding appropriate training experiences. If it is a competitive specialty, then it is a competitive specialty.

I know there are other routes to get into the field. I think that is part of the problem. Who is ensuring the standards of those other routes? What I think we need is to close such loopholes, but also ensure that enough formal post-docs are available to satisfy need.

I am thinking from the end of want employers want because they are the ones who pay us. It is not just some for-profit pp. It is how I see the majority of for-profit pp and non-academic settings practicing. Money always seems to trump ethics in the real world. Telling psychologists not to take the job is a bit silly though. In a world where medical care is run by MBAs instead of providers, that is the equivalent of putting the ethical pressure on the employ instead of the employer. I am all for third party payors setting stricter standards. I do wonder what said standards will do if it turns out that not enough clinicians meet those standards though. The other question is where they are going to draw the line between psych testing and neuropsych testing. I do wonder if they will see a shift to more psych assessment codes.
 
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