Neuropsychology Fellowship Caseload - outpatient

[Carson_Tay]

I'm trying to figure out if my caseload for my Neuro fellowship is typical. I'm feeling overworked but am being told this is a normal caseload so wanted to get a better idea.

What was is/was your caseload? And if you or psychometrist/student completed testing (with sharing the name/type of the site if willing)

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[WisNeuro]

I had 4 OP evals scheduled most weeks and did inpatient evals on an EMU one year and a TBI rehab floor the next.

Edit, also forgot about my minor rotations, inpatient PTSD treatment (individual and groups); SCI, and another one I have since forgotten.

 

[PsyDuck90]

Alternates between 2 and 3 scheduled evals (mix of outpatient and inpatient rehab), but I also carry a small therapy caseload, facilitate a cog rehab group, and do consult-liaison work on inpatient med when they come through. I’m at an APPCN member VA site, for reference.

Edited to add we don’t have a psychometrician (since other folks brought that up). And for sake of transparency of time spent, also I’m primarily clinical (only 10% carved out for research).

 

[jdawg2017]

I see four outpatient cases per week (3 with a psychometrician). I’m at a 60-40 clinical-research split site.

 

[WisNeuro]

Also, I would urge postdocs, particularly in their second year to look at this as a way to ramp up to what you will need to be looking at once you get int a real job. I was at a site once where the postdocs responsibilities were 2-3 OP evals a week, that's it. The whole time. I tried to get that increased, to no avail. My reasoning, more cases means more exposure to different presentations. Also, those students were in for a rude awakening once they got a real full-time workload. We did them no favors, among other issues with that program.

 

[PsyDr]

Iirc, like 4 outpatient evals. Depending on use of a psychometrician, there were an additional 1-3 inpatient evals per week. Keep in mind that most inpatient evals were often very very impaired, or very very focused, so testing was limited.

 

[szymk1sm]

I was at an APPCN site - clinical postdoc - I can't remember if I saw 3 or 4 outpatients per week (and then we had an inpatient week every 1-2 months). We had 6-month rotations - so cases were similar-ish (think pre-surgical PD / epilepsy evals, memory disorders, medical neuropsych, general neuropsych, etc.). First 6 months, you did your own testing - and then you had more psychometrist involvement as time went on. I think at best a psychometrist saw most of my cases and I did my own testing once per week. We had like 5 psychometrists and 2 postdocs (1 per year). I had no trainees (but the postdoc after me had a practicum student). For any one rotation, you had 2 to 3 supervisors (so different battery length and report expectations - which can be overwhelming).

 

[AcronymAllergy]

Similar to what other folks have said--4 outpatient evals/week typically, along with a minor rotation (can't remember if that was 1 or 2 days/week) and inpatient evals/work, which as PsyDr said for theirs, were usually much shorter (think RBANS-plus). No psychometrician, but occasionally I'd provide tiered supervision of an extern, intern, or non-neuro fellow who would do some of the testing and report writing. Plus the other usual requirements like didactics (neuro and general fellowship), research, and meetings.

APPCN site, VA hospital.

Edit to add: I never really felt overworked. Some weeks were busier than others, but it was never overwhelming. It also helped that our supervisors were great.

 

[PsyDr]

@Carson_Tay I would HIGHLY recommend asking your supervisor for their versions of “ideal” reports, for whatever rotation you’re on. Like in grad school, you have to play to their narcissism. “Dr. X, I think I could do better on my Alzheimer’s reports. Is there an old report of yours that I could review?”. Then you take that report, retype it without ID information. Put a low frequency letter in the parts with a name, another low frequency letter in the parts with a number, another in gender, etc.

Now you have a report template. Plug and play. Repeat for the next type of report or patient. You have to space it out, lest they get wise. Once you have that down, you can experiment with modifications. If you do, it would be wise to use something from a book. Some of the old test manuals have examples. If the supervisor asks about it, you then have the backing of some reference.

 

[AcronymAllergy]

To add to what PsyDr said: if I remember correctly, I was given report examples/templates for every neuropsych rotation, because every supervisor had a slightly different style and preference. I'm sure it was as helpful for them that I use their template (e.g., so that they knew where to find everything) as it was for me.

As an externship and internship supervisor, I always provided report examples/templates to trainees.

 

[bcliff]

I was at an APPCN site with partial psychometrist support. We had two-to-three outpatient "days" per week (depending on rotation) and were expected to complete 1-to-2 outpatient evaluations on those days, depending on rotation. The remaining two-to-three days were being the first contact for the inpatient neuropsychology service on a rehabilitation unit. We were expected to carry an inpatient caseload of 4-to-8 patients depending on rotation. We had variable psychometrist support for outpatient cases; none for inpatient cases, as is typical. We typically carried an outpatient psychotherapy caseload of 3-6 patients with a range of neurologic and cognitive factors. This was at an R1 AMC but there was minimal opportunity (or expectation) for research engagement. A good chunk of time was also spent in rounds for various services we were staffing - For better or worse (to Wis's point), I never felt particularly overworked but did routinely do some report writing on weekends.