PsyD cohort sizes/Nova

[psych.meout]

This is why debt matters so much, but is left out of your talking points. In this field we simply cannot afford to take on med school level debt. Because, as you say in point 3 (and implied in point 1), we don't make physician level income. And, when taking on any debt the assumption should always be that you WILL have to pay it back. Depending on external funding sources for your debt is, in my opinion, foolish. If you end up successfully applying for PSLF, then bonus, but students shouldn't be taking educational loans that they have no intent, plan, or ability to pay back. And I don't believe ethical educational programs should require students to take on this level of debt either.

I feel like this is where poor understanding of science and statistics comes into play. People pay so much attention to anecdotes from the top of the distribution that they ignore modal outcomes and thereby get themselves into terrible situations. The unfunded programs themselves are mostly to blame, but students also need to be more conservative when it comes to planning their financial futures..

In typical fashion of my opinions: I honestly believe that most of the PsydD vs PhD nonsense is driven by money.

1) Psychologists make stupidly low incomes. Regardless of Degree.

2) Reducing the number of psychologists will do nothing to change incomes. Hourly is derived from cms, which does not use availability for how they determine rates.

This is why we need better professional advocacy so that we can get those sweet, sweet EM codes

3) Its all about productivity. Income is simply hoursly rate times hours billed. A typical office job has 40hrs/week; 50 weeks a year. This means 2000 hrs worked a year. Medicare pays around $90/hr for psych services. Go look up ER docs hourly wages. It’s like $130/hr. Now explain why their median income is reported to be around $250k and psychologists are reporting a median income of around $80k without using productivity. You can’t.

5) I honestly believe that the field would be saved by an increase in productivity and aggressive training in assertiveness in contract negotiations.

This seems like a significant problem in grad school in general, especially clinical science programs. Faculty don't want to talk about money, working in industry, or any other business side of things. I don't know if it's that they are career academics and don't have experience in that realm, if talking about money in that manner seems uncouth, or what else it might be, but it's really doing a disservice to students.

I don't think psychologists lack the training, scope, or other necessary features to help close the gap with physicians (though not entirely), it's more that grad programs, internship, and post doc generally don't seem to provide the tools to do this.

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[StellaB]

This seems like a significant problem in grad school in general, especially clinical science programs. Faculty don't want to talk about money, working in industry, or any other business side of things. I don't know if it's that they are career academics and don't have experience in that realm, if talking about money in that manner seems uncouth, or what else it might be, but it's really doing a disservice to students.

I don't think psychologists lack the training, scope, or other necessary features to help close the gap with physicians (though not entirely), it's more that grad programs, internship, and post doc generally don't seem to provide the tools to do this.

ITA. There is not enough business training in psychology. While I'd guess medical schools don't talk a ton about this either, at the very least med schools expect their students to go into industry. At good psych programs, there is stigma against admitting outright that you don't want to go into academia - it's like a dirty secret you have to keep until you're a third year or higher. Our prof's usually don't even have the know-how as far as helping with the business side, and their interest in APA or other professional organizations is usually about publishing and academic prestige. There's nothing wrong with that, of course, but it crowds out the other important needs of our field like political advocacy for those of us who pursue applied work.

 

[ClinicalABA]

5) I honestly believe that the field would be saved by an increase in productivity and aggressive training in assertiveness in contract negotiations.

I think there is a lot to this last statement. Look at the recent outcomes from my other credentialled field of endeavor- Applied Behavior Analysis. Over the past 10 years, through strong advocacy at the state and, to a lesser extent, national level, things have truly taken off. I can recommend 30 hours per week of ABA therapy and- at least in my state- the insurance company has to fund it. No annual or lifetime caps, no age restrictions. Some plans will reimburse non-direct treatment planning time. The result is BCBA salaries that in many cases are equivalent to the mid-career median of of psychologists. There's a "pyramidal" clinical/business model, where the majority of the treatment in done by lower paid (non-credentialled) staff at higher margins, with credentialled (e.g., BCBAs or Licensed ABA Therapists) providing supervision. End result of this is that agencies can pay BCBA good salaries at near (or even sub) break-even rates. This has come about through strong lobbying for regulations (e.g., autism treatment mandates) and tough negotiations with payers (e.g., "if you don't pay us, we'll walk and you can tell your plan subcribers why we did"). A lot of this is done with interagency cooperation, often organized or spurred on by state or regional professional advocacy organizations. A few other things have helped, too:

1) A growing population of children with an ASD diagnosis
2) A large (and growing) body of research that demonstrates that our techniques are effective and, when started early, significantly reduce lifetime costs of care
3) ASD is an equal opportunity diagnosis, that effects all SES levels. Some VERY rich and connected people have been impacted at the personal level and have been staunch advocates for ABA treatment and researh
4) Our served population is comprised mainly of super-cute kiddos. It's much more difficult for a politician to vote against a bill supporting treatment for a cute kid, vs., say, a homeless man with a diagnosis of schizophrenia or an opiate addict with neck tattoos.

All that said, ABA has really cornered itself into ASD. There is a growing amount of research relating to it's applicability to other populations, but ABA hasn't made many inroads as an independent treatment discipline outside of ASD.

 

[psych.meout]

I think there is a lot to this last statement. Look at the recent outcomes from my other credentialled field of endeavor- Applied Behavior Analysis. Over the past 10 years, through strong advocacy at the state and, to a lesser extent, national level, things have truly taken off. I can recommend 30 hours per week of ABA therapy and- at least in my state- the insurance company has to fund it. No annual or lifetime caps, no age restrictions. Some plans will reimburse non-direct treatment planning time. The result is BCBA salaries that in many cases are equivalent to the mid-career median of of psychologists. There's a "pyramidal" clinical/business model, where the majority of the treatment in done by lower paid (non-credentialled) staff at higher margins, with credentialled (e.g., BCBAs or Licensed ABA Therapists) providing supervision. End result of this is that agencies can pay BCBA good salaries at near (or even sub) break-even rates. This has come about through strong lobbying for regulations (e.g., autism treatment mandates) and tough negotiations with payers (e.g., "if you don't pay us, we'll walk and you can tell your plan subcribers why we did"). A lot of this is done with interagency cooperation, often organized or spurred on by state or regional professional advocacy organizations. A few other things have helped, too:

1) A growing population of children with an ASD diagnosis
2) A large (and growing) body of research that demonstrates that our techniques are effective and, when started early, significantly reduce lifetime costs of care
3) ASD is an equal opportunity diagnosis, that effects all SES levels. Some VERY rich and connected people have been impacted at the personal level and have been staunch advocates for ABA treatment and researh
4) Our served population is comprised mainly of super-cute kiddos. It's much more difficult for a politician to vote against a bill supporting treatment for a cute kid, vs., say, a homeless man with a diagnosis of schizophrenia or an opiate addict with neck tattoos.

All that said, ABA has really cornered itself into ASD. There is a growing amount of research relating to it's applicability to other populations, but ABA hasn't made many inroads as an independent treatment discipline outside of ASD.

Messaging is really important for getting funding and support. Just look at the opioid epidemic. When opioid use was associated with the stereotypical, stigmatized heroin user getting addicted and overdosing, the government and general public didn't give a crap. Now that opioid use and addiction has crossed so many demographics lines, people are finally interested in doing something about chronic pain and opioids. It doesn't really matter what the actual profile of opioid users and chronic pain patients was, what mattered was how the public saw the issue.

This reminds me of an interesting talk I saw on CSPAN (NERD ALERT) about media portrayals and popular beliefs about schizophrenia. A century ago, schizophrenia in the popular consciousness was viewed as a disorder of white women. As such, people with schizophrenia were debilitated and afflicted with something beyond their control, so they should be pitied and cared for. The conceptualization of schizophrenia eventually shifted to African-American men, which then meant that people with schizophrenia were dangerous and should be avoided or institutionalized to protect the public from them.

 

[StellaB]

Messaging is really important for getting funding and support. Just look at the opioid epidemic. When opioid use was associated with the stereotypical, stigmatized heroin user getting addicted and overdosing, the government and general public didn't give a crap. Now that opioid use and addiction has crossed so many demographics lines, people are finally interested in doing something about chronic pain and opioids. It doesn't really matter what the actual profile of opioid users and chronic pain patients was, what mattered was how the public saw the issue.

This reminds me of an interesting talk I saw on CSPAN (NERD ALERT) about media portrayals and popular beliefs about schizophrenia. A century ago, schizophrenia in the popular consciousness was viewed as a disorder of white women. As such, people with schizophrenia were debilitated and afflicted with something beyond their control, so they should be pitied and cared for. The conceptualization of schizophrenia eventually shifted to African-American men, which then meant that people with schizophrenia were dangerous and should be avoided or institutionalized to protect the public from them.

Same can be said for the crack epidemic (black) being a legal problem and the opioid epidemic (white working class) being a medical crisis. It's a tad ironic that so many psychology undergrads go on to work in marketing, and so many psychology doctorates are bad at it / don't realize the importance of good PR.

 

[ClinicalABA]

Same can be said for the crack epidemic (black) being a legal problem and the opioid epidemic (white working class) being a medical crisis. It's a tad ironic that so many psychology undergrads go on to work in marketing, and so many psychology doctorates are bad at it / don't realize the importance of good PR.

And going back even further, many "mental disorders" were attributed to "femaleness" (hence the word "hysteria"- pertaining to the uterus). It was not until after the world wars where things like "shell shock" (i.e. PTSD/Conversion disorders) started noticeably impacting men that you saw major advances in treatment.

 

[Sanman]

AND doing so does not necessarily limit success or ultimate career goals if one is intentional, planful, and hard-working. I took an increasingly flexible approach in my application and ended up landing an R1 job straight out of internship publishing with the exact major researchers with whom I hoped to work with during my initial program searches.

Absolutely. If anything, having geographic flexibility and being willing to move many times to get the required training will eventually lead to advantages and money. This is a small field and when you get into a specialty even smaller. That is something people really need to consider. I know many specialists that are being underpaid and underutilized. Myself included in some ways. The reason? There is an already established specialist(s) in the area and there is no job in that niche. You have to go where there is no one to have local success. That is where this field still holds on to its academic roots. You don't need that many pediatric neuropsychologists, professors of name your specialty, etc in a given area. Training a bunch of people in the same geographic area for the same few jobs will always end poorly in some way.

 

[PsyDr]

This is why debt matters so much, but is left out of your talking points. In this field we simply cannot afford to take on med school level debt. Because, as you say in point 3 (and implied in point 1), we don't make physician level income. And, when taking on any debt the assumption should always be that you WILL have to pay it back. Depending on external funding sources for your debt is, in my opinion, foolish. If you end up successfully applying for PSLF, then bonus, but students shouldn't be taking educational loans that they have no intent, plan, or ability to pay back. And I don't believe ethical educational programs should require students to take on this level of debt either.

I think the argument of "People have to take bad paying jobs because they are in debt" doesn't hold water. If I could hire people at a cost of $80k, and be guaranteed to gross $200k on each; I would be sitting outside of every school's graduation.

I feel like this is where poor understanding of science and statistics comes into play. People pay so much attention to anecdotes from the top of the distribution that they ignore modal outcomes and thereby get themselves into terrible situations. The unfunded programs themselves are mostly to blame, but students also need to be more conservative when it comes to planning their financial futures..



This is why we need better professional advocacy so that we can get those sweet, sweet EM codes



This seems like a significant problem in grad school in general, especially clinical science programs. Faculty don't want to talk about money, working in industry, or any other business side of things. I don't know if it's that they are career academics and don't have experience in that realm, if talking about money in that manner seems uncouth, or what else it might be, but it's really doing a disservice to students.

I don't think psychologists lack the training, scope, or other necessary features to help close the gap with physicians (though not entirely), it's more that grad programs, internship, and post doc generally don't seem to provide the tools to do this.

I woudl love EM codes, but I think that so long as people are being lazy and not assertive; we will continue to see low income.

Psychologist clearly have the math skills necessary to see what revenue they generate. And they should have the clinical skills necessary to speak directly. Many want a relaxed work pace. Many are timid. Many are not honest with themselves about what money they are making.

Bring in 280k, and it's easy to demand 200k.


@StellaB that's a false equivalence. Crack vs meth is more accurate.

 

[StellaB]

@StellaB that's a false equivalence. Crack vs meth is more accurate.

In what way? I was only talking about the way society has characterized and responded to the crack vs. opioid epidemics, not about the drugs themselves. I'm open minded to being wrong, but I don't know what you're trying to say.

 

[Sanman]

I think the argument of "People have to take bad paying jobs because they are in debt" doesn't hold water. If I could hire people at a cost of $80k, and be guaranteed to gross $200k on each; I would be sitting outside of every school's graduation.





I woudl love EM codes, but I think that so long as people are being lazy and not assertive; we will continue to see low income.

Psychologist clearly have the math skills necessary to see what revenue they generate. And they should have the clinical skills necessary to speak directly. Many want a relaxed work pace. Many are timid. Many are not honest with themselves about what money they are making.

Bring in 280k, and it's

I think the argument of "People have to take bad paying jobs because they are in debt" doesn't hold water. If I could hire people at a cost of $80k, and be guaranteed to gross $200k on each; I would be sitting outside of every school's graduation.





I woudl love EM codes, but I think that so long as people are being lazy and not assertive; we will continue to see low income.

Psychologist clearly have the math skills necessary to see what revenue they generate. And they should have the clinical skills necessary to speak directly. Many want a relaxed work pace. Many are timid. Many are not honest with themselves about what money they are making.

Bring in 280k, and it's easy to demand 200k.

I would love to see E/M codes. It would take a lot geriatric work from the garbage heap to decent practice. As it is, you are incentivized to do the least amount of work possible.

 

[PsyDr]

In what way? I was only talking about the way society has characterized and responded to the crack vs. opioid epidemics, not about the drugs themselves. I'm open minded to being wrong, but I don't know what you're trying to say.

Yeah, I know. I am saying that comparing the crack epidemic to the meth epidemic is a more valid comparison.

You might be interested especially in the 2010 congressional move for federal sentencing guidelines, and their stated motivations.

 

[DynamicDidactic]

It definitely is. I didn’t know that about psychiatry. So does that mean they’ve been successful in getting an approximately equal number of clinicians in rural vs. metro areas?

finally found that citation
Psychiatry Online

and I had the numbers reversed. Simply speaking, there aren't more psychiatrists in poor/rural counties.

 

[GradStudent2020]

finally found that citation
Psychiatry Online

and I had the numbers reversed. Simply speaking, there aren't more psychiatrists in poor/rural counties.

Thank you! I realized right after I responded that I misunderstood what you had posted.

I just read the summary, it looks like the authors may be in favor or prescription rights for psychologists for this reason? I’ll read more. It’s no surprise that rural communities are underserved by mental health across fields.

 

[GradStudent2020]

As far as I know all are more financially comfortable than that. One was recruited a few weeks after obtaining full licensure to a six figure position. Another works part-time for a private practice; super flexible schedule with benefits and seems well-compensated. A third is at a major medical center locally, seems to work a lot but enjoys it. I don’t know about their student loan situations, but that doesn’t seem like any of my business.

FWIW, even attending a FSPS school I will be very comfortable bringing in $75-80k with the student loan debt I will have accrued. Maybe I’m an outlier. I am married so not the only earner, which likely makes a huge difference for some graduates.

Someone “liked” this post so I thought I’d give a quick update as an ECP who recently graduated from a FSPS. I graduated last fall, passed the EPPP and state level licensure tests within 3 months (slight delay as my EPPP was cancelled/rescheduled twice due to covid), and am now making around $88k with full benefits on post-doc. I’ll continue receiving supervision for a full year for licensure reciprocity across states, but was fully licensed last year.

I had 4 post-doc offers without applying for a single one, clearly the stigma of attending a FSPS was not the death knell some warn of.

My personal career goals were a great match for the educational route I took. I can meet my financial goals with the career I have. I have student loans but they are manageable. I received excellent education and training, and am well positioned to further specialize with the populations I prefer to work with. I don’t regret the choice I made.

 

[Sanman]

Someone “liked” this post so I thought I’d give a quick update as an ECP who recently graduated from a FSPS. I graduated last fall, passed the EPPP and state level licensure tests within 3 months (slight delay as my EPPP was cancelled/rescheduled twice due to covid), and am now making around $88k with full benefits on post-doc. I’ll continue receiving supervision for a full year for licensure reciprocity across states, but was fully licensed last year.

I had 4 post-doc offers without applying for a single one, clearly the stigma of attending a FSPS was not the death knell some warn of.

My personal career goals were a great match for the educational route I took. I can meet my financial goals with the career I have. I have student loans but they are manageable. I received excellent education and training, and am well positioned to further specialize with the populations I prefer to work with. I don’t regret the choice I made.

Glad to hear you are doing well, but care to clarify a few things:

1. It sounds like you are licensed and working full-time and getting supervision on the side, not in a formal post-doc correct?

2. How are you getting 4 post-doc offers if you did not apply?

 

[Therapist4Chnge]

Thousands of years ago, before Sigourney Weaver...(ATHF ref for you millennials). But, generally speaking, back when there actually was an internship imbalance.

No, I was actually asking the question that I asked. You often reference “years” of experience so I’m curious what that is.

There’s still an imbalance...more applicants than APA accredited internships. Not imbalanced if you consider non-accredited internships as a valid option, but I thought you did not hold that opinion.

At the height of the imbalance, the total number of APA-acred slots was something like 46% of total applicants. A portion of applicants drop for a lack of interviews, but it was still some scary odds to see.

 

[WisNeuro]

At the height of the imbalance, the total number of APA-acred slots was something like 46% of total applicants. A portion of applicants drop for a lack of interviews, but it was still some scary odds to see.

Yeah, always have to have context for the numbers. Still, even at the height of the imbalance, many programs still had 95%+ long term match rates. Anything lower than 90% these days is concerning IMO. Back in the lean times I would have said sub 80

 

[GradStudent2020]

Glad to hear you are doing well, but care to clarify a few things:

1. It sounds like you are licensed and working full-time and getting supervision on the side, not in a formal post-doc correct?

2. How are you getting 4 post-doc offers if you did not apply?

Sure, happy to answer.

1. I am at a formal post-doc receiving supervision (supervisor is on site). The state I am in allows licensure with total supervised hours rather than a full year post-doc. My site had no issue with me obtaining full licensure while completing post-doc.

2. The directors of two sites contacted me and asked if I would do my post-doc with them. A colleague I worked with in the past knew funding was opening for a new post-doc and asked me to apply before it was publicly posted (I didn’t, it wasn’t the best fit). A colleague I worked with as an LPA has a group practice and contacted me to be their first post-doc. The first 3 are all sites that have APA-accredited internships and formal post-docs. The site I chose didn’t require interviews or an application of any kind.

 

[Sanman]

Sure, happy to answer.

1. I am at a formal post-doc receiving supervision (supervisor is on site). The state I am in allows licensure with total supervised hours rather than a full year post-doc. My site had no issue with me obtaining full licensure while completing post-doc.

2. The directors of two sites contacted me and asked if I would do my post-doc with them. A colleague I worked with in the past knew funding was opening for a new post-doc and asked me to apply before it was publicly posted (I didn’t, it wasn’t the best fit). A colleague I worked with as an LPA has a group practice and contacted me to be their first post-doc. The first 3 are all sites that have APA-accredited internships and formal post-docs. The site I chose didn’t require interviews or an application of any kind.

Is $88k the fully licensed salary or did you have a billable license beforehand? I have never heard of an unlicensed post-doc that could not bill making that much money.

 

[WisNeuro]

Is $88k the fully licensed salary or did you have a billable license beforehand? I have never heard of an unlicensed post-doc that could not bill making that much money.

If you entered into the VA as a faculty member out of internship you could approach that while being supervised, but that would be incredibly rare in other settings. One of the reasons people need to consider mean and median outcomes rather than outliers.

 

[GradStudent2020]

Is $88k the fully licensed salary or did you have a billable license beforehand? I have never heard of an unlicensed post-doc that could not bill making that much money.

That is the fully licensed salary, my post-doc salary before LP was less but I had a billable license before. I’d have to look because I only had that salary for a few months, I think it was $74k.

I don’t intend to stay at $88k much longer than this post-doc year.

 

[futureapppsy2]

That is the fully licensed salary, my post-doc salary before LP was less but I had a billable license before. I’d have to look because I only had that salary for a few months, I think it was $74k.

I don’t intend to stay at $88k much longer than this post-doc year.

What kind of COL area are you in?

 

[Sanman]

That is the fully licensed salary, my post-doc salary before LP was less but I had a billable license before. I’d have to look because I only had that salary for a few months, I think it was $74k.

I don’t intend to stay at $88k much longer than this post-doc year.

That makes much more sense to me.

 

[GradStudent2020]

What kind of COL area are you in?

I would say low but our normal is a large city in Texas. If I google current city median rent for a 3 bedroom is $1k per month? Low COL and a great ECP salary kept us here for one more year.

 

[Sanman]

I would say low but our normal is a large city in Texas. If I google current city media rent for a 3 bedroom is $1k per month? Low COL and a great ECP salary kept us here for one more year.

Damn that is low. Safe to say you are not in NYC or CA right now.

 

[GradStudent2020]

Damn that is low. Safe to say you are not in NYC or CA right now.

Solid Midwest at the moment. Not rural, although the Target could be bigger IMO.

I could be making a similar salary in Texas as a LPA without full LP licensure. LPA jobs can be a little tricky to find, though. Changing legislation over the last 3 years has made that licensure potentially more lucrative.

 

[cara susanna]

God, I made half that on fellowship and was in a very high CoL city.

 

[Sanman]

God, I made half that on fellowship and was in a very high CoL city.

Me too, but I was not fully licensed and in a state that required post-doc for full licensure.

 

[GradStudent2020]

God, I made half that on fellowship and was in a very high CoL city.

I was definitely offered and aware of positions paying half this. One of the positions that came up for me was just over half and would have been amazing, but the long-term clinicians were barely clearing $90k.