PhD/PsyD Neuropsychology blues

[f1b0]

Hello everyone,

My goal with this post is to learn from others' experiences who have been through or helped support friends or loved ones who have pursued board certification (ABPP-CN) whether it led ultimately to certification or to a choice not to pursue this goal.

I am the spouse of an individual in the first year of a two year neuropsychology fellowship at a well regarded and highly demanding private practice. We'll call my spouse A. I will be using layman's terms to describe A's experience and probably mince my words as my profession is not medical in nature. I am seeking advice to help support A through these difficult times and help A make choices that take into account A's health but also A's goals.

A's goal has been to become a board certified neuropsychologist (probably lifespan), move back to A's home state and run a private practice while also engaging in some work within hospital settings. A is more driven and sharp (you might call it a rather intense level of processing speed) than anyone I've ever known and I've worked with hundreds of the highest regarded individuals in my specialty field so I have the sense that of anyone A has the capability to achieve what A chooses. However, A has experienced periodic depression beginning in graduate school which has become significantly worse both in length and amplitude during A's internship and now into A's first year as a fellow. Despite A's capabilities, A feels that a decade of effort has left A with no life, no real friends, many irrecoverable lost years of youth, persistent depression and a variety of health issues. A has the PhD, is a phenomenal psychologist generally speaking, absolutely loves what A does in neuropsychology, and I know that A will be successful no matter which avenue A pursues. The pressure currently being applied at A's fellowship is driving A to a choice that A never thought would be a consideration. A is contemplating not obtaining board certification as A cannot see doing another year of this insanity. The main issue at the fellowship is not so much personality conflict (some but nothing A can't handle) as it is purely work pressure - 90-100+ hour weeks, week in and week out. It might be possible for A to reduce those to perhaps 80 hours per week but quality of work would absolutely suffer. Surprisingly, this is not new, this level of effort A has been putting forth for so many years that I've lost count. I would describe the difficulty in more detail but I am trying to be sensitive to PII.

The untenable position is that A has dedicated so many years of effort to this goal that it seems inconceivable to switch course while at the same time it appears impossible to continue further beyond the one year necessary to obtain enough postdoc hours to simply become a licensed psychologist and move on. Can A go on for two years like this? My heart is so heavy with dispair in typing these words to you... probably not.

I am sure that many of you have experienced similar issues, known others that have either pushed through or switched course, and I would like to know what are your general thoughts on how I might help support A. I've always known the right things to say, or thought I knew. Now I just don't have any words left to keep A going or to help A decide to do something different.

The choice is in A's hands of course, but if there are any words of wisdom that you might share, I would be very grateful to hear them.

Best regards,
A's loving spouse.

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[PsyDr]

get him treatment

 

[psych.meout]

Ah, so is this one of those infamous, bad neuropsych post docs where they just use the post docs as workhorses?

 

[psych.meout]

get him treatment

Yeah, it sounds like this is a chronic, untreated problem.

 

[WisNeuro]

Echo others with the seek treatment advice. I would do whatever it takes to just finish out year 2 of the postdoc. Even if it sucks, it will suck a lot less than trying to get boarded another way down the line, as well as closing off a lot of job opportunities. I'd say when I was looking for jobs last time, about 90% of them required "board certification or board eligibility within 3 years of hire."

 

[f1b0]

The training is excellent, A very much values the knowledge being gained and A is absorbing far more than ever at this point. A's supervisors are all well qualified and have a great amount of knowledge to share. But you know how it is at INS when they tell you that X number of reports per week are required irrespective of case complexity, you say "no problem" and you march forward because what else are you going say? Postdocs aren't growing on trees. In terms of chronic untreated problem, yes this is something we need to address - specifically the depression. I don't know when during the work week A would be able to fit in therapy but you are 100% correct, A desperately needs it. In my industry we have a triangle composed of points Scope, Time, and Cost. You can have two but never three. At this postdoc, this principle does not seem to be understood. Another item of concern that I personally have is that in my industry the health of the employee is fundamental to the health of the organization. Take care of the people that work with you and they will more than likely take care of you, your patients and your clients. Surprising to me, in a health related field that this is not understood whereas in my field which is completely unrelated to health, this is an embedded concept essential to success.

But now I'm just airing my own grievances. Thank you so much for replying, I deeply appreciate it and will try and get A some therapy to help with the depression and also try and provide words of wisdom that you share, thank you!

 

[WisNeuro]

. Surprising to me, in a health related field that this is not understood whereas in my field which is completely unrelated to health, this is an embedded concept essential to success.

I wouldn't say that this is indicative of the field. Plenty of us went to top sites that averaged a 40-50 hour work week on postdoc. Unfortunately, there are some "workhorse" sites around the country.

 

[psych.meout]

I wouldn't say that this is indicative of the field. Plenty of us went to top sites that averaged a 40-50 hour work week on postdoc. Unfortunately, there are some "workhorse" sites around the country.

Yeah, it seems like people try to convince themselves that the training is so good and that's why they are treated like workhorses, or at least why it's acceptable to be treated that way.

A place that isn't taking advantage of you as an underpaid neuropsych-in-training to crank out as many assessments and reports as possible isn't going to make you work 100-hour weeks.

 

[singasongofjoy]

I'm not in neuropsych and my internship and postdoc experiences have been more of the 50 hour a week variety, thank god. But there was a point earlier in grad school where I just gave my advisor a spreadsheet of how I was spending my time every week, and said something to the effect of "this is untenable and some things have to go. I need to get 15-20 hours a week back." It went way better than I expected. It is also one of the most important skills I learned in grad school; wish I'd learned it before I was 30 years old. Anyway - would that be a possibility for your spouse? Sometimes I think supervisors honestly have no idea how much they're asking/expecting -- especially when there are multiple supervisors in the picture -- and we're often brought up in the idea of just having to do it all and suffer through, when that might not actually be the case. Although there are also just sh***y places where they work you to death which is enough to make many people depressed even without a pre-existing tendency. But what's the worst that could conceivably happen if your partner says "look, I can't do this much anymore, help me figure out what I can cut back on." It's not like they're going to get fired, right? Maybe they get a mediocre rather than outstanding letter of rec if they have a terrible supervisor? Is that so terrible? I doubt that would be career-ending. Or maybe their supervisors are actually more reasonable than your spouse suspects because depression and self-expectations are making it difficult to accurately assess, and taking steps to better manage self care and thus improve quality of service would actually reflect positively on them in the eyes of the supervisors. Most of us would consider than an important professional skill. Would also be better than having to take a medical leave of absence which is where this could potentially end up.

Anyway, best of luck. I feel for you. It's a tough spot to be in for both of you.

ETA: Also, are there any corners they can cut without affecting client services? Like dropping a project or two, or delegating some work, or asking some other folks if they want to help out with a publication? Doing a "good enough" job on presentations rather than trying to make them the most fantastic thing ever? I used to work in a clinic when on my way out one of the supervisors would always ask me if I could "just help out with this one little thing" and i started taking a different, longer route out of the building. I think that's unfortunately sometimes an important skill to learn when you're in those "just have to survive this" spots.

 

[f1b0]

Those are all excellent pieces of advice @singasongofjoy and you may be correct that the workload problem is coming from the multi-supervisor situation in combination with a lack of communication around effort and time. A loves spreadsheets and organizational systems so I will suggest that approach! We will still need to find some solutions to A's depression starting with therapy, to somehow scrounge an hour out of the week. However, if A's supervisors were able to reduce the workload somewhat I think that would go a very long way in helping A do whatever it takes to get through it as @WisNeuro mentioned. I do worry that A will deeply regret not pushing through having invested so much already. Also interesting point about corners that can be cut, we're working on some things to improve efficiency with regard to the time it takes to get through each report. Great suggestions and information, thank you!