Psychiatry and Clinical Psychology

[OneNeuroDoctor]

would appear to benefit from being under the same Department or Division. Psychiatrist are somewhat considered the "bastard" half-brother/sister under traditional medicine and Clinical/Counseling Psychologists are the "bastard" half-brother/sister for a MS dominated mental health field of therapist/school psychologist/psychometrist.

Doesn't psychiatry and clinical psychology seem to be a natural match for doctoral prepared practitioners?

Many medical settings have Psychiatrists and Clinical Psychologists under the same division and now many neuropsychologists are in the neurology division.

Medical Psychologists in NM and LA are paid at the same rate as Psychiatrists with MD/DO in the $180,000 to $200,000 range.

Doesn't clinical psychology seem to be a better fit under the psychiatry department/division rather than a psychology department/division?

My current position was as a lead therapist under the social services division with staff trained as LPC, LMFT, and LMSW for my first year. We now have a new CEO at the private Psychiatric Hospital. With the new CEO, additional administrative units have changed and now my position was switched to the psychiatry division and my office is in the psychiatry offices unit with MD, DO, and ANP.

I primarily do neuropsychology screenings and evaluations now and I have a small caseload of individual therapy clients with diagnoses consisting mostly of biological-psychological-health disorders related to having a behavioral medicine focus.

When I was working as a lead therapist with mostly MS prepared professionals, it seemed that there were issue constantly developing from administrators and MS staff about billable hours and we were often over booking clients to cover for no shows.

Now that I am able to bill up to 32 units or 8 hours for psychological and neuropsychological evaluations that generate $500 to $1200 per evaluation, the administrators are able to justify my existence due to these billable hours.

I think clinical psychology is a much better fit under psychiatry and neurology divisions rather than psychology or social science divisions from my recent switch of divisions.

I gather that many other clinical psychologists are working in the psychiatry or neurology divisions and I am curious about your experiences?

Seems that psychologists are now focusing in oncology, gastrointestinal, sleep disorders and many other medical sub-specialties from looking at recent advertisements in the APA online career.

---

Members don't see this ad.

 

[erg923]

What are "Biological psychological health disorders???"

 

[OneNeuroDoctor]

Seems that I have a number of clients with mental health complications from physical health disorders such as MS, Parkinson's, Epilepsy, Diabetes, ect...

Biopsychology, Health Psychology, and Behavioral Medicine... You must know about theses areas of emphasis or do they not teach this in Counseling Psychology PhD programs?

There are a number of BS, MS, and PhD programs in Biological Psychology and some are called PhD programs in Neuroscience.

 

[erg923]

I am a health psychologist in primary care, and I have never heard anyone refer to "biological psychological health disorders." Seems nonsensical (hence why I didn't understand it) and redundant, kinda like "neurocognitive"

Diabetes is a metabolic disorder, Parkinsonism is neurologic, etc. Both can produce or induce psychiatric side effects of course.

 

[erg923]

And I guess I don't even understand your orginal concern and question. Why would a psychologist who studies schadenfreude need or want to be in the same academic department as a psychiatrist? Psychology is a very broad discipline (spanning social science, biological science) and thus require is own department. In the clinical realm/world, there are psychology and neuropsychology divisions within psychiarty and neurology departments. This is common place. What exactly is the problem here?

Honestly, I'm still just trying to figure out if you are an actual neuropsychologist, and how you were training in neuropsychology without any regular, live supervision.

 

[AcronymAllergy]

I agree with erg that in a purely academic (e.g., university) setting, psychology should be its own department. In a clinical setting, there are pros and cons to being subsumed under a psychiatry department. If psychology is its own independent service, your professional "voice" in the organization may be stronger than if you're a section of a larger department, particularly if said department's chair doesn't strongly value what you do.

I think psychology being a part of a psychiatry department seems to make more sense than psychology and social work being grouped together without the additional inclusion of psychiatry (ala a general mental/behavioral health department).

In the end, it's probably more a matter of general hospital/clinic atmosphere and politics than it is in what department psychology is found. Although the latter factor may speak to the former.

I can say that at least in my personal experience, when you're one of a small number of psychologists included in a non-psychiatric/non-mental health department, you tend to be treated better than when you're one of a large number of psychologists in a large mental health service. But again, that is likely primarily a factor of hospital politics.

How much/what we bill really isn't affected by any of this. However, how much we're expected to bill and how our RVUs "convert" can certainly be a function of departmental affiliation, and/or how much your administrators know about what you do.

 

[OneNeuroDoctor]

I have been supervised in neuropsychology pre and postdoctoral and I am in my second year of neuropsychology postdoctoral training this year. I actually did it the right way rather than teach in a PsyD program while waiting for a VA opening like you since the VA does not require a postdoc!

 

[erg923]

I have been supervised in neuropsychology pre and postdoctoral and I am in my second year of neuropsychology postdoctoral training this year. I actually did it the right way rather than teach in a PsyD program while waiting for a VA opening like you since the VA does not require a postdoc!

You posted not to long ago that you did not have any regular supervision in your post doc, and that your supervisor simply signed notes/reports, did you not? Mike Parent and I both commented how strange we found this, remember?

And I think you have been misinformed. I do not practice neuropsychology.

But back to the original topic, please better explain what you are talking about here. I dont really get it. If you are advocating the service line model as opposed to departmental organziation models (within health organizations), I would agree with you. But I am not quite clear if thats what you are trying to say.

 

[smalltownpsych]

In my current setting psychiatry is in the department of behavioral health that is headed by a psychologist.

 

[AcronymAllergy]

In my current setting psychiatry is in the department of behavioral health that is headed by a psychologist.

Somewhat similar to my current setting as well.

 

[starsinnight]

I think your issue/concern is strangely worded and I am not sure what you are asking.

Are you questioning the logistics behind where "psychology" falls? As a science or art? As clinical or counseling? as medical or behavioral?

I too work in primary care at a VA -- and it is directed by a psychologist (who also makes on par to what MDs make although not as much but she trains the doctors on how to be more mindful of psychological diagnoses). Our sole job is to integrate health care and reduce the stigma of mental health in a medical setting. So our jobs are very different than psychiatrists and medical professions, if that is what you are asking. I see psychiatry as very different too -- as a friend of mine is in med school now and only spent a month with psychiatry and the training, in my opinion, of the doctors I work with is very much lacking in the mental health arena, many of which even seem frightened of mental health problems, handing the patients off to me!

Medical psychologists usually work in private practice, from what I've seen and are their own bosses based on how much demand and how booming their practice is at the moment. Therefore, they aren't lumped into any such category, whether it be psychiatry, psychology, neuroscience, behavioral medicine, etc.

I think the answer is then.... we all can choose to do different things and get paid what we want, based on how hard we work, our choice of career setting, and choice of degree. I personally don't like your decision to bash "counseling" programs, because I work with clinical folk and they don't even know my training background really or notice a difference. I also have considered skipping the post-doc route because I believe my 5-8 years of training in mental health have been enough, of quality, and comprehensive. To each their own.

 

[OneNeuroDoctor]

Response to ERG... I have normally held positions in Social Service Departments or Psychology Departments until this recent change under The Behavioral Medicine Division at the Hospital where I work. I was being supervised by the clinical director of the Social Service Department but my neuropsychology postdoctoral supervision is by a clinical neuropsychologist who is in private practice and consults with the Hospital. He is on grounds 2-3 days per week and reviews and signs my reports and meets with me weekly for supervision. I also work evenings and weekends in his private practice so I am doing 10 or more neuropsychology evaluations weekly.

It is not a formal neuropsychology fellowship.

Since we have had administrative unit changes, my administrative supervisor is the new CEO and my clinical supervisor is the consultant neuropsychologist.

I feel more accepted in the Behavioral Medicine Unit as in the Social Services Unit there was pressure for billable hours as bonuses where tied into the unit having a specified percentage of billable hours.

I believe there needs to be a similar organizational model where psychiatry and psychology partner in training and in service delivery.

Basically the mental health field is saturated with primarily only masters level practitioners and doctoral level practitioners positions are filled with masters level practitioners when PhD practitioners leave.

 

[erg923]

I believe there needs to be a similar organizational model where psychiatry and psychology partner in training and in service delivery.

Organizationally, this is called a "service line" model and it is common in healthcare settings, especially large hopsital systems. It has been around for decades now.

At the individual practitioner level, I "partner up" all the time with psychiatrists, although more so with primary care docs. Whats stopping you from doing this, exactly?

Basically the mental health field is saturated with primarily only masters level practitioners and doctoral level practitioners positions are filled with masters level practitioners when PhD practitioners leave.

In your particular work setting, that may be the case.

 

[smalltownpsych]

I agree that the OP was a bit confusing. I work in a medical setting and every specialty tends to make fun of the others - until our patient needs the other's expertise. Mature practitioners don't take it too seriously. If I break a leg skiing, I go to the ortho doc and when he has questions about his kid who is struggling, he comes to me.

As far as organizational dynamics of psychology and psychiatry and social work that varies from setting to setting and in many inpatient settings they are part of the same multi-disciplinary team.

 

[AcronymAllergy]

RE: Neuropsychology, if you aren't getting formal coursework in neuroanatomy, I personally would strongly recommend you look into it. The online NAN course, for example, while not the greatest thing ever, would certainly be better than nothing. The amount I use neuroanatomy/neurophysiology and related knowledge on a daily basis really can't be overstated. I can't imagine conceptualizing my cases without it.

But yes, I don't see any reason why psychology and psychiatry shouldn't be partnered in service delivery. Psychology can and generally has been effectively integrated into a variety of settings.

 

[Therapist4Chnge]

I'd prefer to avoid working in a dept of psychiatry, as it can feel like too many cooks in the kitchen…and -ology would be severely outnumbered. Of course, 95% of my pts come from PM&R, Neurology, and NeuroSurg, so I typically avoid that area all together. I've had multiple psychiatrists want to learn more about TBI, so I've worked with them on my unit and it has been a pretty positive experience.

 

[smalltownpsych]

I am also a little confused about what distinction the OP is making about clinical psychologists especially when referring to them as being perceived as lesser than MA providers.

 

[Therapist4Chnge]

RE: Neuropsychology, if you aren't getting formal coursework in neuroanatomy, I personally would strongly recommend you look into it. The online NAN course, for example, while not the greatest thing ever, would certainly be better than nothing. The amount I use neuroanatomy/neurophysiology and related knowledge on a daily basis really can't be overstated. I can't imagine conceptualizing my cases without it.

Didactic training is a HUGE component of fellowship training (at least in my eyes). For example, our first year of didactics was composed of: 1hr neuropsych (50% adult, 50% child), 1hr rehab psych, neurology didactics 2-3x wk, 1hr brain cutting case conference 2-4x a mon, and usually 1hr clinical case conference (rotated btw Seizure, Stroke, Parkinsons, et al.) The second year didactics were more flexible about expectations outside of the 1hr neuro & 1hr rehab…but the foundation was mostly set in the first year. This approach allows hundreds/thousands of more cases to be seen during fellowship, which makes a huge difference when you are trying to work with the nuance that makes up the field.

I'd also recommend taking the "Neuroanatomical Dissection: Human Brain and Spinal Cord" continuing education course at Marquette University. It has been around for quite awhile and many clinicians use it as a primer to start studying for the ABPP-cn exam.

 

[AcronymAllergy]

Didactic training is a HUGE component of fellowship training (at least in my eyes). For example, our first year of didactics was composed of: 1hr neuropsych (50% adult, 50% child), 1hr rehab psych, neurology didactics 2-3x wk, 1hr brain cutting case conference 2-4x a mon, and usually 1hr clinical case conference (rotated btw Seizure, Stroke, Parkinsons, et al.) The second year didactics were more flexible about expectations outside of the 1hr neuro & 1hr rehab…but the foundation was mostly set in the first year. This approach allows hundreds/thousands of more cases to be seen during fellowship, which makes a huge difference when you are trying to work with the nuance that makes up the field.

I'd also recommend taking the "Neuroanatomical Dissection: Human Brain and Spinal Cord" continuing education course at Marquette University. It has been around for quite awhile and many clinicians use it as a primer to start studying for the ABPP-cn exam.

The course looks great, thanks for the rec. We did weekly dissection/wet lab work as part of the med school neuro courses I took on fellowship, but a review might not be a bad idea.

And agreed on all counts re: didactics.

 

[Therapist4Chnge]

I took the course a number of years ago and it was great. The morning lectures could have been more in-depth (I'm a nitty-gritty guy), though it was at a nice level for ppl reviewing everything. I think 5-6 of the attendees were all studying for the ABBP-cn written exam, so they stuck together and reviewed before/after too. The lecturers were very good and willing to talk before/after the lectures. The wet lab portion was definitely the best part, as they used a blunt dissection approach for the brain (as opposed to cross section cuts). The spinectomy portion was useful for review of innervation, particularly as it relates to spinal cord damage. The icing on the cake for me was taking it alongside Dr. Woodcock (WJ assessment guy!), who decided to take the course on a whim. Great guy to grab a drink or three with and talk shop.

 

[WisNeuro]

Basically the mental health field is saturated with primarily only masters level practitioners and doctoral level practitioners positions are filled with masters level practitioners when PhD practitioners leave.

Maybe in some places, but not in any of the VA's or AMC's where I have worked/trained.

 

[OneNeuroDoctor]

I had two neuropsychology courses in my program and I took six other neuropsychology courses from another PhD program with neuropsychology specialty that included neuroanatomy and brain dissection.