Postdoc or bust?

[CallmeDoc2]

Hello all,

I am currently a few months into my internship at an well-known AMC for my APA accredited internship. I am currently residing in a state that does not require postdoctoral hours for licensure. I am wondering what everyone thinks about going straight into the job market?

FyI: want a primarily clinical role and hope to eventually get into administration, consulting work, and executive leadership within a behacioral healthcare setting.

Also, I am wanting to spend the rest of my working years in this state. I fear that formal specialization Is starting to fade and what often matters is how well one markets their services within the community, where they trained, and ability to network. Frankly, I am tired of moving, being underpaid, and accruing debt. Through seeking career advice, I have also encountered many professionals whose post doc experiences do not line up whatsoever with their current line of professional work.

Thoughts?

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[GradStudent2020]

I’m in a state that does not require a post-doc, I’m pursuing full licensure ASAP and found a position that will provide supervision (AKA a post-doc) for a year as part of my compensation (salary and other benefits are great, too!) If I ever move this year will count as post-doc but I’m getting paid as a LP.

 

[foreverbull]

I fear that formal specialization Is starting to fade and what often matters is how well one markets their services within the community, where they trained, and ability to network. Frankly, I am tired of moving, being underpaid, and accruing debt. Through seeking career advice, I have also encountered many professionals whose post doc experiences do not line up whatsoever with their current line of professional work.

Thoughts?

I’m not sure why you think formal specialization is fading—when I got out of grad school I saw how much having a niche mattered in the job world. An extra year of training in a specialized area can be a boost your CV. In my area, generalists are at the biggest disadvantage in terms of private practice and marketability—and even for other types of clinical jobs they don’t have a niche to set them apart from the many generalists out there. To not take advantage of this training might be more of a disadvantage later career wise, but certainly I echo your frustration about being underpaid and postdoc is another year of being underpaid. Also, if you ever plan to leave the state and work elsewhere or even just want the option, I’d do a postdoc, if for no other reason than job options and getting an extra year of intensive training.

It’s ultimately up to you, but I’d say it doesn’t look as good to employers if you don’t have a postdoc, professionally speaking. That isn’t to say that it’d have to be a “formal” postdoc though.

 

[AcronymAllergy]

Executive leadership and admin positions can be few and far-between, so with those (and consulting) being your career goals, I would say you probably want to keep yourself as geographically flexible as possible. Which means even if you go straight into the job market, as GradStuden2020 did with their position, I would recommend seeing if you can secure supervision for your first year of practice so that you don't close yourself out of licensure eligibility for numerous states.

 

[erg923]

Hello all,

I am currently a few months into my internship at an well-known AMC for my APA accredited internship. I am currently residing in a state that does not require postdoctoral hours for licensure. I am wondering what everyone thinks about going straight into the job market?

FyI: want a primarily clinical role and hope to eventually get into administration, consulting work, and executive leadership within a behacioral healthcare setting.

Also, I am wanting to spend the rest of my working years in this state. I fear that formal specialization Is starting to fade and what often matters is how well one markets their services within the community, where they trained, and ability to network. Frankly, I am tired of moving, being underpaid, and accruing debt. Through seeking career advice, I have also encountered many professionals whose post doc experiences do not line up whatsoever with their current line of professional work.

Thoughts?

Your stated career goals don’t really line up with not being license portable.

 

[cara susanna]

FWIW, I wasn't sure about post doc either and even had an internship TD tell me that they're a scam during an interview. In the end, I did a post doc and I'm really glad that I did.

 

[BuckeyeLove]

I fear that formal specialization Is starting to fade and what often matters is how well one markets their services within the community, where they trained, and ability to network.

1. Point 1 is categorically false. 2. Both point 1 and your subsequent points aren't mutually exclusive.

 

[WisNeuro]

Hello all,

I am currently a few months into my internship at an well-known AMC for my APA accredited internship. I am currently residing in a state that does not require postdoctoral hours for licensure. I am wondering what everyone thinks about going straight into the job market?

FyI: want a primarily clinical role and hope to eventually get into administration, consulting work, and executive leadership within a behacioral healthcare setting.

Also, I am wanting to spend the rest of my working years in this state. I fear that formal specialization Is starting to fade and what often matters is how well one markets their services within the community, where they trained, and ability to network. Frankly, I am tired of moving, being underpaid, and accruing debt. Through seeking career advice, I have also encountered many professionals whose post doc experiences do not line up whatsoever with their current line of professional work.

Thoughts?

If this is your end goal, to reach the ninth circle of hell, look around and see what backgrounds people have that are currently in those roles. As @AcronymAllergy has said, these jobs are few and far between. Executive leadership in most settings is exclusively physician based. Much of the mid-level leadership has a MBA/MPH background. Clinicians tend to be the low level leadership, who are more sponges for criticism to keep it from flowing upwards than anything else. It may vary by location, so make sure you see how this is structured where you want to live.

As others have said, though, if anything, formal specialization is increasing, rather than fading.

 

[erg923]

It should also be noted that while "executive leadership" positions are fairly rare for psychologists (which is why no one here will agree that not being license portable would be a wise way to begin this trajectory), its is also noted that once you take such a position, you really aren't working as a psychologist at all anymore. Which is fine, of course, but just want to make sure you are clear about that.

 

[Sanman]

Mostly agreed with the others. Formal post-doc is helpful for some specialties and less helpful for others. Hard to say not knowing what you want to do. IF your goal is AMC or VA is a popular area/ crowded specialty, formal post-doc can be helpful. After all, why hire you when they can hire someone with an extra year of training in that area? For license portability, get some documented supervision while being licensed at home. It is a minor cost for a licensed salary and keeps you flexible for job opportunities.

 

[AcronymAllergy]

Agreed with the above, including that once you're in executive leadership, you're usually not really working as a psychologist anymore (although having a license can still be helpful).

Getting an MBA/MPH, as was mentioned above, could have a decent ROI given your career goals. That and a healthy chunk of networking.

 

[CallmeDoc2]

I appreciate everyone's feedback. It really means a lot. To provide some more context, I am interested in staying in the substance use space and potentially doing some chronic pain work/presurgical evaluations early in my career. In terms of admin and executive leadership, I could see myself moving up the ranks in an inpatient setting (particularly at a privately funded rehab facility) as I gain a better understanding of behavioral healthcare, extend my reach within the community, and learn and how one manages clinical practice. My externships during grad school were all SUD specific and I am currently doing a rotation in a substance use clinic on internship. I am also getting some chronic pain/presurgical eval experience as well. Since I have a lot of experience in the ax and tx of substance use disorders, I feel that I am ready to make that jump and may not need an extra year of supervision in that space.

I get that some of you feel that specialization training is actually increasing rather than declining. I am naïve obviously, however, the idea of "specialty areas"" seems like an extremely grey area. What actually constitutes a "specialty" if there is no official governing board. For ex, there is no APBP certification for substance use or chronic pain. Though people often pursue postdoctoral training experiences in that area, does that 1-year of specialization render them more competent (assuming they had little to no previous exposure) when compared to someone who worked with that population exclusively during grad school and on internship? I also see people doing chronic pain evals in the community without having pursued a postdoc in that area, as well as custody evals, some neuro ax, etc. I could be wrong, however, if Jane Doe wants to get her kids evaluated for ADHD, or her husband for a SCS eval prior to surgical approval, she likely isn't reading the CV of local practitioners to find out if they did or did not pursue a post-doc in that area.

I hope I am not offending anyone with my verbiage or somewhat cynical perspective. I am trying to understand this process as best as I can to be set up for a rewarding and healthy career.

Thank you all

 

[JustNoticing]

Even if you don't do a formal post-doc (I didn't and share some of your perspective), it can't hurt to get a year of supervision just to make sure you can get licensed elsewhere in case you ever need to. Especially if you can land a job that is willing to provide that supervision to you anyway.

 

[AcronymAllergy]

If you haven't had much experience with the pre-surgical evals until this year on internship, I'd recommend continuing to get some additional supervision (whether via formal postdoc or informally peer-to-peer) after you finish. I don't think you'd need a fellowship year solely for psychotherapy with chronic pain patients, assuming you had a solid training foundation in psychotherapy more broadly (which it sounds like you do).

A lot of this falls onto the individual clinician to police themselves. I think the more unique, differentiated, and/or complex the condition or intervention; the more well-established the practice area; and the more high-stakes the potential outcome and risks; the more likely some type of formal training and supervision would be needed. I've done a handful of pre-surgical epilepsy evaluations in the past while on fellowship, for example, but since it's also been a few years, if I were to do one again, I'd at the very least secure some peer-to-peer consultation. And I'd probably want some direct observation before trying to do a Wada again.

 

[thebalmofhurtminds]

I appreciate everyone's feedback. It really means a lot. To provide some more context, I am interested in staying in the substance use space and potentially doing some chronic pain work/presurgical evaluations early in my career. In terms of admin and executive leadership, I could see myself moving up the ranks in an inpatient setting (particularly at a privately funded rehab facility) as I gain a better understanding of behavioral healthcare, extend my reach within the community, and learn and how one manages clinical practice. My externships during grad school were all SUD specific and I am currently doing a rotation in a substance use clinic on internship. I am also getting some chronic pain/presurgical eval experience as well. Since I have a lot of experience in the ax and tx of substance use disorders, I feel that I am ready to make that jump and may not need an extra year of supervision in that space.

I get that some of you feel that specialization training is actually increasing rather than declining. I am naïve obviously, however, the idea of "specialty areas"" seems like an extremely grey area. What actually constitutes a "specialty" if there is no official governing board. For ex, there is no APBP certification for substance use or chronic pain. Though people often pursue postdoctoral training experiences in that area, does that 1-year of specialization render them more competent (assuming they had little to no previous exposure) when compared to someone who worked with that population exclusively during grad school and on internship? I also see people doing chronic pain evals in the community without having pursued a postdoc in that area, as well as custody evals, some neuro ax, etc. I could be wrong, however, if Jane Doe wants to get her kids evaluated for ADHD, or her husband for a SCS eval prior to surgical approval, she likely isn't reading the CV of local practitioners to find out if they did or did not pursue a post-doc in that area.

I hope I am not offending anyone with my verbiage or somewhat cynical perspective. I am trying to understand this process as best as I can to be set up for a rewarding and healthy career.

Thank you all

Perhaps not central to what you're discussing, but most of the people that I know who predominately work within chronic pain (myself included) did post-doctoral specialization in rehab or health. Additionally, many of them are ABPP in Health Psychology. Does that render them more competent? Not sure if there's data on that, but I think many people would agree that they'd want someone who trained more than "some experience" on internship in pain before treating them.

And as AA stated above, it does fall to self-governing. I would not think myself competent in a subject as vast as chronic pain after one rotation on internship.

 

[Sanman]

I appreciate everyone's feedback. It really means a lot. To provide some more context, I am interested in staying in the substance use space and potentially doing some chronic pain work/presurgical evaluations early in my career. In terms of admin and executive leadership, I could see myself moving up the ranks in an inpatient setting (particularly at a privately funded rehab facility) as I gain a better understanding of behavioral healthcare, extend my reach within the community, and learn and how one manages clinical practice. My externships during grad school were all SUD specific and I am currently doing a rotation in a substance use clinic on internship. I am also getting some chronic pain/presurgical eval experience as well. Since I have a lot of experience in the ax and tx of substance use disorders, I feel that I am ready to make that jump and may not need an extra year of supervision in that space.

I get that some of you feel that specialization training is actually increasing rather than declining. I am naïve obviously, however, the idea of "specialty areas"" seems like an extremely grey area. What actually constitutes a "specialty" if there is no official governing board. For ex, there is no APBP certification for substance use or chronic pain. Though people often pursue postdoctoral training experiences in that area, does that 1-year of specialization render them more competent (assuming they had little to no previous exposure) when compared to someone who worked with that population exclusively during grad school and on internship? I also see people doing chronic pain evals in the community without having pursued a postdoc in that area, as well as custody evals, some neuro ax, etc. I could be wrong, however, if Jane Doe wants to get her kids evaluated for ADHD, or her husband for a SCS eval prior to surgical approval, she likely isn't reading the CV of local practitioners to find out if they did or did not pursue a post-doc in that area.

I hope I am not offending anyone with my verbiage or somewhat cynical perspective. I am trying to understand this process as best as I can to be set up for a rewarding and healthy career.

Thank you all

Once you are licensed, you don't HAVE to do anything or justify your choices. The argument is a bit academic. In SUDs work like geriatrics work there are often many decent entry level jobs. I opted out of a formal post-doc, but did an informal post-doc job. However, I applied to both options and picked one that best worked for my life. As this is not a super competitive area like neuropsych or health psych, you likely will not have to worry about it. I know several folks that opted to work as clinic directors for a SUDs program with supervision arranged as an informal post-doc. It is an option. With regard to the chronic pain patients and (more so) surgical evals, I am not sure how you are thinking about doing this work. You are unlikely to get hired for a job doing these specifically at a medical center. If you are talking contract work as part of someone's PP, they can likely supervise you informally. Otherwise, I am not sure how you are getting referrals as most physicians will not know or refer to you for health psych stuff.

 

[PsyDr]

Some thoughts:

1) What I planned for my career at 25 was different than what I wanted at 30, or 35. (seriously, my plan at 25 was hilariously misinformed). I also had very different ideas about where I wanted to live.

2) The ONLY way I would ever consider not doing a post doc is a situation where I could get ABPP'ed. That might help with mobility, in some states.

3) It would be an extreme shame if you chose to limit yourself to one state, and then got a dream job offer outside of that place. Or met some rich and attractive person of your preferred gender, who wants to sweep you off your feet to another state.

4) There might still be some liability in not having the same training as others. In legal contexts, it would be easy to point to your difference in training as evidence of poor care. And training requirements do increase.

5) Just because you "can" do something, doesn't mean you're doing it competently. Pain evals are incredibly complex, if you're doing them right as they encompass anatomy, pathology, some 50 years of behavioral literature, effort, specific medical terms, etc. You might not need a post doc for this, but justifying engagement in a practice area by saying "no one is looking", is incredibly concerning.

 

[erg923]

I appreciate everyone's feedback. It really means a lot. To provide some more context, I am interested in staying in the substance use space and potentially doing some chronic pain work/presurgical evaluations early in my career. In terms of admin and executive leadership, I could see myself moving up the ranks in an inpatient setting (particularly at a privately funded rehab facility) as I gain a better understanding of behavioral healthcare, extend my reach within the community, and learn and how one manages clinical practice. My externships during grad school were all SUD specific and I am currently doing a rotation in a substance use clinic on internship. I am also getting some chronic pain/presurgical eval experience as well. Since I have a lot of experience in the ax and tx of substance use disorders, I feel that I am ready to make that jump and may not need an extra year of supervision in that space.

I get that some of you feel that specialization training is actually increasing rather than declining. I am naïve obviously, however, the idea of "specialty areas"" seems like an extremely grey area. What actually constitutes a "specialty" if there is no official governing board. For ex, there is no APBP certification for substance use or chronic pain. Though people often pursue postdoctoral training experiences in that area, does that 1-year of specialization render them more competent (assuming they had little to no previous exposure) when compared to someone who worked with that population exclusively during grad school and on internship? I also see people doing chronic pain evals in the community without having pursued a postdoc in that area, as well as custody evals, some neuro ax, etc. I could be wrong, however, if Jane Doe wants to get her kids evaluated for ADHD, or her husband for a SCS eval prior to surgical approval, she likely isn't reading the CV of local practitioners to find out if they did or did not pursue a post-doc in that area.

I hope I am not offending anyone with my verbiage or somewhat cynical perspective. I am trying to understand this process as best as I can to be set up for a rewarding and healthy career.

Thank you all

Wanting an "Executive Leadership" role (of a facility?) in the substance use disorder and/or behavioral health inpatient space is fine, but unless I was in the VA (where you are enormously protected), this is not something I would really want. Liability, liability, liability, and work, work, and more work. 2 and 3 computer screens, early mornings, late evenings, on call (pager), JCHCO and/or CARF, all the staff management and HR and other gripes and liability? No thanks, And what do you get with that? Maybe 30- 50K more than your clinical service (psychologists) cohorts? They wont be paying a psychologist MD level monies for this, I assure you! Again, this is fine. But know what you are going into, right? Oh, and this is all from a Ph.D. trained psychologist who is in a leadership position at a very large behavioral health managed care (insurance) company. Except...I have none of the clinical liability and stress that you would....

Get supervision during post-doc year to make you portable! Its unlikely you would find support for not doing that here. You want top-tier jobs in behavioral health and/or substance abuse facility administration as a psychologist??? You need to be as "marketable" as possible.

 

[SportsNeuroPsych]

I would agree with the overall sentiment here. Why pin yourself into a box down the road as you never know what will come up even as much as you are dead set on staying in one area/position. This is not to disparage the frustration that can mount after years of studying, training, etc. (that we have all gone through) and wanting to just "start" your career. Another good point that was brought up is the potential for opening yourself up to scrutiny in any forensic/legal setting if its you vs. someone who did a "post-doc." Why even let someone open that door?

You have made it this far and honestly, 1 more year of training is nothing in the scheme of your overall career.

 

[deleted343839]

In addition to other excellent points made above, an argument for doing a postdoc is that it gives you a more time to settle into your locale, network, and *dare I say* be taken a little more seriously by those who would go out of their way to recommend you for specialty practice jobs. You mentioned that you want to stay put, more or less. You're so busy during internship you barely get to know the local practice community. By comparison, you tend to get a little breathing room on post-doc, and your supervisors/mentors will be oriented to preparing you for the job market.

If you do a postdoc at an AMC, this could turn into a faculty job offer and that's not a bad way to spend your first few years in practice. If you work for an AMC that has strong name recognition, don't ignore the potential opportunities this could bring your way. At my first AMC job, I could have opened a successful practice based on the visibility I had in the community. (BTW I'm now enjoying a quiet life of being a relative nobody at my current institution.)

potentially doing some chronic pain work/presurgical evaluations early in my career

It's not that people won't hire you to do this with your level of experience, but the population can be very challenging and it's in your interest to get additional training somehow if you plan to continue to work in this space.

 

[cara susanna]

You are unlikely to get hired for a job doing these specifically at a medical center. If you are talking contract work as part of someone's PP, they can likely supervise you informally. Otherwise, I am not sure how you are getting referrals as most physicians will not know or refer to you for health psych stuff.

There's work like this in the VA, although typically your job would entail other things. I do pre-surgical assessments as part of my job.

 

[Sanman]

There's work like this in the VA, although typically your job would entail other things. I do pre-surgical assessments as part of my job.

True, but I am not sure that someone with minimal experience in health psych and no postdoc would get hired for that. All of our health psych positions are staffed by those that are fellowship trained in health psych. I applied for a few of these positions with a lot more relevant experience and was not hired.

As always it may be different in other areas.

 

[futureapppsy2]

Adding to what others have said, depending on the surgery and population, there can be a fair amount of medicolegal risk involved with these types of evals, and in those situations, having credibility through training and supervision can be critical.