PhD/PsyD Psychometry, neurosurgery, student, and family...

[Phi784]

Where to start...

I have found some helpful information on this site, but not quite enough to make an informed decision.

Context: I am a 35 year old career changer (former business owner), married father of infant twins. I am one year away from applying to internship. I am in a counseling psychology PhD program from a reasonably well respected school. One year ago, I applied and gained employment as a psychometrist, which was primarily motivated by compensation. The first week, the head neuropsychologist tells me they are developing tests for use in awake craniotomies, and asked if I would be interested. I was like: "hell yes, thats awesome!" And it was! In fact, if I could do this for the rest of my life, I would. I did very little of the typical paper and pencil np testing until recently, as a new NP was hired to head the program. Subsequently, the head NP to suggest I now work on testing skills to better prepare myself for internship. I am also a practicum student in a chronic pain clinic. I have yet to propose my dissertation. Although I do live aspect of np, I also enjoy more typical therapy with testing as an adjunct. Finally, I love conceptualization, but not sure how much I love doing memory evals day in and day out.

Problem 1: I bloody hate testing, at least as it is done in a large healthcare system. On a given day, I do something to the tune of 25 tests. My boss flys through patients. In contrast, my academic mentor takes exponentially more time with patients, but in a private practice. Moreover, I am not great at delivering standardized instructions in such a fast paced testing scenario. What made me a good awake surgery test administrator was the knowledge foundation and ability to solve problems on the fly. This same capacity/preference makes me a less ideal typical test admin, IMO.

Problem 2: I think that opportunities in neurosurgery are very, very few and far between. I also suspect that such positions would be filled with more qualified candidates. I have some experience, as well as some brain cuttings and a few advanced classes under my belt. But I am also unable to commit much time to enhancing my resume further, am in a counseling program with no np speciality, and very concerned about problem 3.

Problem 3: I have a family that I'd much rather be with than be working. I have also made a fair bit of income before, more than 70 something K reported as typical average. I realize that there is a pretty big upside, especially for np, but it is hard to justify the opportunity cost.

Dilemma 1: Given that aversion to testing procedures, is np even a good fit?

Dilemma 2: Even if I do np, I suspect there is no chance of finding a neurosurgery job?

Dilemma 3: How on earth do I justify sacrificing the time with my family, while making virtually no money, for the proceeding 4.5 years (1.5 academic/1 internship/2 postdoc)?! I will be 40 by the time I am done.

Primary question to for the forum: Does anybody have any insight into similar problems? Perhaps most importantly, how did some of you resolve the cost/time/delay of savings & retirement problem?

If you read all this, I sincerely thank you!

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[psych.meout]

Try rehab psych.

 

[deleted343839]

Dilemma 3: How on earth do I justify sacrificing the time with my family, while making virtually no money, for the proceeding 4.5 years (1.5 academic/1 internship/2 postdoc)?! I will be 40 by the time I am done.

What did you tell yourself when you applied to graduate school? Surely you went through some version of this question in mind at the time of your career change.

Even if I do np, I suspect there is no chance of finding a neurosurgery job?

I don't think that's an accurate statement. But even among the neuropsychologists I know who work in neurosurgical settings, none of them do all neurosurgery, all the time. If you don't like the rest of neuropsych I think you'd be setting yourself up for disappointment. Is there any reason, other than money, that attracted you to the specialty?

 

[WisNeuro]

OP, I think I know where you're coming from, the job setting sounds very familiar, as does the person who is doing test development for awake craniotomies. Even he generally does a mix of things, the awake craniotomies are a more recent career development on his part. I can't actually name a single colleague who does all neurosurg. That being said, there are some who are embedded in neurology departments and generally get a more heavy neuro flavor, though they are still seeing a good share of memory evals. I'm with MamaPhD, if you can't stomach the generalist work of a neuropsychologist, probably not the career path for you. You'll hate it, and, if you try and only find, say, a neurosurgery job, your employment opportunities will be extremely limited.

 

[Phi784]

What did you tell yourself when you applied to graduate school? Surely you went through some version of this question in mind at the time of your career change.


I don't think that's an accurate statement. But even among the neuropsychologists I know who work in neurosurgical settings, none of them do all neurosurgery, all the time. If you don't like the rest of neuropsych I think you'd be setting yourself up for disappointment. Is there any reason, other than money, that attracted you to the specialty?

The choice was made when my wife was earning nearly double what she is now, and pre kiddos. These two changes have fundamentally changed my vantage point. Additionally, i was not originally considering a two year post-doc.

I like the conceptualization, and absolutely love functional neuroanatomy and behavioral correlates. I suppose I like much of the knowledge more than the practice, at least in the healthcare systems (x2) I am familiar with.

 

[Phi784]

OP, I think I know where you're coming from, the job setting sounds very familiar, as does the person who is doing test development for awake craniotomies. Even he generally does a mix of things, the awake craniotomies are a more recent career development on his part. I can't actually name a single colleague who does all neurosurg. That being said, there are some who are embedded in neurology departments and generally get a more heavy neuro flavor, though they are still seeing a good share of memory evals. I'm with MamaPhD, if you can't stomach the generalist work of a neuropsychologist, probably not the career path for you. You'll hate it, and, if you try and only find, say, a neurosurgery job, your employment opportunities will be extremely limited.

I think the mix would be fine. I am more concerned with keeping pace with productivity expected in the kind of settings where neurosurgery is performed. I appreciate the feedback.

 

[WisNeuro]

I think the mix would be fine. I am more concerned with keeping pace with productivity expected in the kind of settings where neurosurgery is performed. I appreciate the feedback.

Outside of PP and some VA hospitals, the expected productivity is going to be pretty high in most hospital/clinic settings. There are places where they have full testing support and the npsych does not do any testing, but you better be able to write a full report in under an hour and be used to seeing at least 2 patients a day.

 

[PsyDr]

I know who you are talking about too.

Problems:
1) Neuropsych gonna= testing. That's the biz. Even if you don't administer the tests, you'll have to check, and interpret the tests. It is unfair to judge your own speed against someone who has administered tests on a daily basis for a decade more than you. Try putting on your wife's make up and see how stupid she thinks you are at this. It's not dissimilar.
2) If you have experience, and are willing to relocate not really.
3) If you hustle, and have a high risk tolerance, you can make money in psychology. I personally know two psychologists who average $650k/yr with no clinical employees. Neither are neuro. So the specialty isn't as important to income as other factors.

Dilemma:
1) Probably not, but the standard line is to consider rehab psych.
2) Not true
3) Do whatever you want to do. But you're gonna have to justify any of those choices.
a. The time function is a spurious variable. You're gonna get older despite what you do, unless you drop dead.
b. The money function will require you to justify time for money, unless you lucked into an industry where effort has little to do with output. Work 9+hrs/week to make a ton of billables? Gonna have to explain that. Work 2hrs/week to spend every second possible with your kids? Gonna have to explain that.

Extraneous
1) You didn't come into the education thinking neuro, so it's not like you can punish yourself for changing( again).
2) In ANY subfield of psychology, productivity is going to determine income. That's how a service job works.

 

[deleted343839]

The choice was made when my wife was earning nearly double what she is now, and pre kiddos. These two changes have fundamentally changed my vantage point. Additionally, i was not originally considering a two year post-doc.

Ah, that puts things into perspective. My only answer to the "how do I justify this" question is the reverse question - how would you justify the alternative?

 

[Phi784]

I know who you are talking about too.

Problems:
1) Neuropsych gonna= testing. That's the biz. Even if you don't administer the tests, you'll have to check, and interpret the tests. It is unfair to judge your own speed against someone who has administered tests on a daily basis for a decade more than you. Try putting on your wife's make up and see how stupid she thinks you are at this. It's not dissimilar.
2) If you have experience, and are willing to relocate not really.
3) If you hustle, and have a high risk tolerance, you can make money in psychology. I personally know two psychologists who average $650k/yr with no clinical employees. Neither are neuro. So the specialty isn't as important to income as other factors.

Dilemma:
1) Probably not, but the standard line is to consider rehab psych.
2) Not true
3) Do whatever you want to do. But you're gonna have to justify any of those choices.
a. The time function is a spurious variable. You're gonna get older despite what you do, unless you drop dead.
b. The money function will require you to justify time for money, unless you lucked into an industry where effort has little to do with output. Work 9+hrs/week to make a ton of billables? Gonna have to explain that. Work 2hrs/week to spend every second possible with your kids? Gonna have to explain that.

Extraneous
1) You didn't come into the education thinking neuro, so it's not like you can punish yourself for changing( again).
2) In ANY subfield of psychology, productivity is going to determine income. That's how a service job works.

Some excellent, and well received, considerations.

As it pertains to productivity, I am concerned with the loss of quality secondary to productivity (read financial) expectation of large institutions. It makes good sense why there is a focus a maximizing billable hours, but at what expense? I worry that I will have to sacrifice quality for quantity, and in turn, come to resent the restraints. To be fair, I do not have much experience (1 year/2 sites) in these setting, nor do I have all the relevant information, but it would seem my concern is shared among *some* recent grads I have spoken to.

As it pertains to time, I am more concerned with the sacrifice of time vs. income over the training years. I don't have an illusions about working 2 hours a day. From my perspective, age isn't spurious, as any interest on student loans, any unpaid principle, and any unearned income causes X increase in required income/time to compensate. Perhaps my perspective is too short-term or perhaps my perspective is clouded by self-doubt. But, while I am in the thick it, it seems a prudent concern.

Thanks for the feedback!

 

[WisNeuro]

Some excellent, and well received, considerations.

As it pertains to productivity, I am concerned with the loss of quality secondary to productivity (read financial) expectation of large institutions. It makes good sense why there is a focus a maximizing billable hours, but at what expense? I worry that I will have to sacrifice quality for quantity, and in turn, come to resent the restraints. To be fair, I do not have much experience (1 year/2 sites) in these setting, nor do I have all the relevant information, but it would seem my concern is shared among *some* recent grads I have spoken to.

This is a debate among all of us. Some us fall a little more closely to efficiency in this regards. Honestly, you should be able to do a chart review, interview, test administration, score, integrate, and write a report for a run of the mill memory disorder patient in 6-8 hours. I still have colleagues who do something like 4-6 hours of testing with these patients. It's unnecessary. As you go forward and become more efficient, you'll see that you don't need to spend 2 days to conceptualize every patient. you can do it in about an hour. Way too many people spend needless hours trying to manufacture zebras in their patients. Just answer your referral question in the most efficient way you know how and be helpful to your referral sources. All it takes. You don't have to sacrifice quality for quantity, you need to find a balance. Many people struggle with that.

 

[Phi784]

Ah, that puts things into perspective. My only answer to the "how do I justify this" question is the reverse question - how would you justify the alternative?

There in lies the problem. There are many variables/outcomes floating around in my head, many of which can be put together in a compelling justification for opposite tack. Reflecting on the original question, I suppose it is not really possible for others to answer, it is just a dilemma I will have to sort out.

 

[PsyDr]

The choice was made when my wife was earning nearly double what she is now, and pre kiddos. These two changes have fundamentally changed my vantage point...

HINT HINT

 

[temppsych123]

I don't know how useful this is, but I did a rotation with a neuropsychologist who is embedded in a neurosurgery (not neuro general) department of a major hospital. He actually does some testing during awake craniotomies, but it's very rarely (like less than 1x/month), most of his time is spent doing testing with patients pre and post surgery. So, I can't speak to most of your other questions, but I can say that even positions in neurosurgery departments aren't going to necessarily be entirely filled with testing during surgeries themselves :/