Purpose of the FORMAL post-doc

[edieb]

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To those of you completing a formal post-doc fellowship, I am curious how you expect these fellowships to impact your career. In other words, what is the real benefit of completing a formal post-doc? Even in neuropsych, the majority of neuropsychologists I see aren't formally boarded and, it seems that if one was dedicated enough, she could go home and read every night and acquire a very structured knowledge of neuropsych without the paycut required by taking a fellowship... Just curious!

 

[psycecream]

bracketing the neuro question, I have the same concern. Why do a postdoc instead of a job?

 

[erg923]

Further training and supervsion are needed in order to progress and become competent in such a complex dicipline. Supervision, research outlets, didactics, and the range and types of patient population seen in places that offer formal post-docs (ie., academic-medical centers) are the benefits here.

 

[Therapist4Chnge]

That should be restated. . .

The majority of people that pass themselves off as neuropsychologists aren't formally boarded.

+1.

I'm still learning, but the more I learn....the more I realize the difference between real training, and someone who throws together a WAIS, WMS, and a few executive functioning assessments and calls it a day.

Here were my reasons for only considering fellowship placements:

1. The training is setup to meet boarding standards, and often there is training to assist the fellow in their preparation.
2. Formal didactic trainings.
3. Better research opportunities.
4. Better networking opportunities.
5. More prestigious.
6. Access to working at top academic medical centers.
7. Better options for jobs afterwards.
8. Better chance to present at major conferences and/or get involved with division politics.

Obviously someone can find a job and have it work for them, but I'd rather invest the time to try and get a leg up on everyone else. The types of jobs available to people after completing a 2-year fellowship seem much more attractive than if that person worked somewhere for 2 years. Every fellowship I spoke with placed people into quality positions, often Assistant Director/Director level positions at medical centers, TBI centers, etc. Other people chose to stay in academia, and they were able to do that.

I chose my fellowship based on the training and the types of opportunities I will have afterwards. They money doesn't have to be bad, as I'm starting close to what the VA pays for an unlicensed post-doc...while also having options to publish, present, teach, and compete for top positions. I'll probably work 60/hr a week, but if that gets me into a position that pays $15k-$20k more....it'll be worth it. I want to get as high up the food chain as possible, because year to year raises usually aren't much.

 

[docma]

There is also the reality that "real jobs" are hard to come by in this economy, especially before you are licensed. Post-docs become a transitional phase while license requirements are met and systems of care can attract a pool of candidates, work with them a year, and then decide who are the best potential employees--and students can try out the system to decide if they would want to be a settled employee.

Post-docs are definitely more expected in academic/medical center careers. For community and private practice careers a post doc can go either way. They can be a nice way to develop specialty skills (chemical dependency, pain management, etc.). But if you have the option of a job that is a gateway to a career you want (eg university counseling, community mental health, PPO) it can be an equally wise decision to take the position and jump right in. Imagine not have to be worrying in a year about job search again....and even having real benefits and a salary. I know students who were disappointed not to get a post-doc who landed in jobs that paid better, lasted longer, and qualified for loan repayment. Keep all the options on the table as long as you can.

 

[Therapist4Chnge]

There is also the reality that "real jobs" are hard to come by in this economy, especially before you are licensed.

Very true, and the ones that are open often offer low salaries ($25k or lower) and work you hard.

 

[manko7]

Thank you for coming forth Therapist4Chnge. Your perspective on this topic is invaluable.

Hmm... so doing the post-doc gets board certification. Board certification is a snapshot evaluation of your abilities by peers.

Supposing one is publishing and receiving grant funding. Those too are evidence of peer review to guarantee quality and can be garnered without doing an arduous post-doc.

If this were the case that leaves quite a bit of superficial reasons for post-doc (notions such as prestige and "networking").

The argument that post-doc confers greater experience and training is a truism. One could be in school perpetually and yet still be insufficiently prepared. If one is able to demonstrate publishing and ability to secure funding I fail to see the value of post-doc. Already for nearly a quarter of graduate student intern applicants, their future has been delayed.

It seems that the field has artificially inflated the worth of a post-doc past it's true value, by setting up exclusionary parameters for those who do not seek it. The same people that set up these exclusions were cool with "grandfathering" themselves and their buddies in though. This despite the fact that todays interns are likely to have nearly twice as much experience upon graduation as those of their forebears. I'm flummoxed!😕

+1.

I'm still learning, but the more I learn....the more I realize the difference between real training, and someone who throws together a WAIS, WMS, and a few executive functioning assessments and calls it a day.

Here were my reasons for only considering fellowship placements:

1. The training is setup to meet boarding standards, and often there is training to assist the fellow in their preparation.
2. Formal didactic trainings.
3. Better research opportunities.
4. Better networking opportunities.
5. More prestigious.
6. Access to working at top academic medical centers.
7. Better options for jobs afterwards.
8. Better chance to present at major conferences and/or get involved with division politics.

Obviously someone can find a job and have it work for them, but I'd rather invest the time to try and get a leg up on everyone else. The types of jobs available to people after completing a 2-year fellowship seem much more attractive than if that person worked somewhere for 2 years. Every fellowship I spoke with placed people into quality positions, often Assistant Director/Director level positions at medical centers, TBI centers, etc. Other people chose to stay in academia, and they were able to do that.

I chose my fellowship based on the training and the types of opportunities I will have afterwards. They money doesn't have to be bad, as I'm starting close to what the VA pays for an unlicensed post-doc...while also having options to publish, present, teach, and compete for top positions. I'll probably work 60/hr a week, but if that gets me into a position that pays $15k-$20k more....it'll be worth it. I want to get as high up the food chain as possible, because year to year raises usually aren't much.

 

[Metta]

Regarding post-doc certification... I'm curious to hear how people on this forum view the credential provided by the National Register of Health Service Providers in Psychology. Any thoughts?

 

[Therapist4Chnge]

Hmm... so doing the post-doc gets board certification.

Not exactly. Division 40 (neuropsychology) established a set of standards called the Houston Guidelines, which outlines the training that they believe is needed to be a neuropsychologist. Division 22 (rehabilitation) also has standards, etc. There are also other requirements, depending on your area of expertise. For people seeking ABPP boarding, picking an eligible post-doc helps meet those standards, though additional requirements are needed after post-doc. I am most familiar with the ABPP boarding process for neuro and rehab boarding, though I think I can safely say that it is an involved process. There are other boards, though they vary in prestige and difficulty to attain.

Supposing one is publishing and receiving grant funding. Those too are evidence of peer review to guarantee quality and can be garnered without doing an arduous post-doc.

If this were the case that leaves quite a bit of superficial reasons for post-doc (notions such as prestige and "networking").

There are a number of reasons why boarding can help a psychologist (ABPP talks about it on their site), though it is up to the individual if they want to go through the process.

It seems that the field has artificially inflated the worth of a post-doc past it's true value, by setting up exclusionary parameters for those who do not seek it. The same people that set up these exclusions were cool with "grandfathering" themselves and their buddies in though. This despite the fact that todays interns are likely to have nearly twice as much experience upon graduation as those of their forebears. I'm flummoxed!😕

I actually think boarding is a great thing, and one way to separate the top people from everyone else. It can be very useful for psychologists who work in a medical setting because most of our physician colleagues are boarded in their areas of expertise. As someone who wants to work in an academic medical setting (at least to start), there is typically an expectation that I'd be board eligible and seeking boarding when able.

I'm actually attending a presentation on ABPP boarding this morning, so if/when I get a chance I'll post some additional comments about it.

 

[Therapist4Chnge]

In today's economy where Ph.Ds/Psy.Ds are competing with LMHCs/MSWs/etc. for therapy positions, I think anything we can do to differentiate ourselves further will be beneficial. In the past few weeks I've been talking to professionals farther along in their careers, and most of them agreed that if given the option, a fellowship is advisable. The money may or may not be as good as you can find at a job, but I consider it (another) investment in my career.

*edit*

I'm not sure what a competitive job will pay for the post-doc year, but many fellowships are in the low 40's, which isn't bad considering many of the informal post-docs I've seen are $25-$30k.

 

[AcronymAllergy]

While publication and grant writing do entail peer review, this review is usually focused on research methodologies, which don't always necessarily entail clinical work and competence.

As far as neuropsychology goes, a post-doc offers an additional two years of supervised training, which in all honesty is usually the only ethical way to gain competence in a particular area of practice. Sure, you could go and read Lezak cover to cover and have a good grasp of various neuropsychological assessments and concepts, but without active clinical supervision and collaboration, there's no way to tell whether or not you're properly applying those concepts. Post-docs provide a structured setting for such supervision to take place, thereby alleviating you of the responsibility of having to set it up yourself in an attempt to gain professional competence.

 

[PSYdMHC]

T4C
Hello... I was reviewing the ABPP certification application and it is really long and a bit intimidating. I was wondering if you had any suggestions on how to tackle the process to make it less daunting. The sample tapes also are somewhat confusing (I didn't really read in depth) since I'm trying to understand if we test a patient as we tape them throughout the whole evaluation.... Any thoughts regarding the app process would be appreciated 🙄

 

[Therapist4Chnge]

T4C
Hello... I was reviewing the ABPP certification application and it is really long and a bit intimidating. I was wondering if you had any suggestions on how to tackle the process to make it less daunting. The sample tapes also are somewhat confusing (I didn't really read in depth) since I'm trying to understand if we test a patient as we tape them throughout the whole evaluation.... Any thoughts regarding the app process would be appreciated 🙄

I split this out HERE because I think it is a great question and the general topic is worth discussing in more detail.

 

[manko7]

While publication and grant writing do entail peer review, this review is usually focused on research methodologies, which don't always necessarily entail clinical work and competence.

As far as neuropsychology goes, a post-doc offers an additional two years of supervised training, which in all honesty is usually the only ethical way to gain competence in a particular area of practice.

I understand this. However, this line of thinking can yield a mindset of perpetual preparation for a lifetime. Regarding the statement that 2 extra years is the only ethical way to gain competence- What is the criterion of competence? Does the improvement in training yield discernible outcome benefits that justify delaying full privilege practice and adequate compensation, especially given the low compensation to training burden already in place (and escalating).

Moreover, we can continue pushing the bar. 4 years of further training will yield greater competence than 2-year post-doc. 6 years of further training will yield greater competence than 2-year post-doc. 8 years of further training will yield greater competence than 2-year post-doc. I also wonder if the post-doc system is a proxy for a glutted system without accessibility to job. I've observed post-docs who were employed as a post-doc merely because they could not find employment elsewhere.

Frankly, after the internship fiasco (disclosure: I matched), I'm not sure I trust the field of professional psychology. If there were sufficient evidence to restore my confidence in the leadership I would certainly embrace it. But as it stands the recurrent theme of "Post-docs are great because I learn more stuff and feel good about myself" does not justify the costs. But if anyone has more data please share. Thank you!

 

[AcronymAllergy]

I understand this. However, this line of thinking can yield a mindset of perpetual preparation for a lifetime. Regarding the statement that 2 extra years is the only ethical way to gain competence- What is the criterion of competence? Does the improvement in training yield discernible outcome benefits that justify delaying full privilege practice and adequate compensation, especially given the low compensation to training burden already in place (and escalating).

Moreover, we can continue pushing the bar. 4 years of further training will yield greater competence than 2-year post-doc. 6 years of further training will yield greater competence than 2-year post-doc. 8 years of further training will yield greater competence than 2-year post-doc. I also wonder if the post-doc system is a proxy for a glutted system without accessibility to job. I've observed post-docs who were employed as a post-doc merely because they could not find employment elsewhere.

Frankly, after the internship fiasco (disclosure: I matched), I'm not sure I trust the field of professional psychology. If there were sufficient evidence to restore my confidence in the leadership I would certainly embrace it. But as it stands the recurrent theme of "Post-docs are great because I learn more stuff and feel good about myself" does not justify the costs. But if anyone has more data please share. Thank you!

I agree that it's a very slippery slope, which is one of the reasons neuropsychology (as an example) is attempting to push the boarding concept. It's a way of ensuring adequate competence in a specialty area, thereby providing an "end goal" to hedge the possibility of us being stuck in school forever.

As for perpetual preparation for a lifetime--essentially we're already saddled with that in the form of mandated CE credits (not that I actually have any qualms with the concept, mind you).

 

[erg923]

I understand this. However, this line of thinking can yield a mindset of perpetual preparation for a lifetime. Regarding the statement that 2 extra years is the only ethical way to gain competence- What is the criterion of competence? Does the improvement in training yield discernible outcome benefits that justify delaying full privilege practice and adequate compensation, especially given the low compensation to training burden already in place (and escalating).

Moreover, we can continue pushing the bar. 4 years of further training will yield greater competence than 2-year post-doc. 6 years of further training will yield greater competence than 2-year post-doc. 8 years of further training will yield greater competence than 2-year post-doc. I also wonder if the post-doc system is a proxy for a glutted system without accessibility to job. I've observed post-docs who were employed as a post-doc merely because they could not find employment elsewhere.

Frankly, after the internship fiasco (disclosure: I matched), I'm not sure I trust the field of professional psychology. If there were sufficient evidence to restore my confidence in the leadership I would certainly embrace it. But as it stands the recurrent theme of "Post-docs are great because I learn more stuff and feel good about myself" does not justify the costs. But if anyone has more data please share. Thank you!

So, you feel having a neuroanatomy class, 2 practicums in neuropsychology during grad school, and an internship (which can be 50% neuro at most) is sufficient enough to produce a fully competent neuropsychologist? While this may have been true 30 years ago, there is so, so much more to know and learn these days, that I do indeed think that having full-time, post-doctoral training exclusivley focused on the practice of neuropsychology is necessary to gain a fully competent knowledge base.

Who would you rather send your grandma to?

 

[SingingCow]

Will additional training that is focused and of high quality help? Most likely. On top of the whole debate about formal/ informal post-doc, I think we also need to consider the role of good CE. I will also take into consideration an individual's learning curve, motivation to learn and grow as a competent clinician...etc.

To answer one of the posters' question, I would send my grandma to a compassionate, reputable clinician or a student in training working with a supervisor who will be able to sign the forms (for insurance and other legal purposes, for example.) With ample experience and good training there will likely be expertise, but not necessarily.

 

[AcronymAllergy]

So, you feel having a neuroanatomy class, 2 practicums in neuropsychology during grad school, and an internship (which can be 50% neuro at most) is sufficient enough to produce a fully competent neuropsychologist? While this may have been true 30 years ago, there is so, so much more to know and learn these days, that I do indeed think that having full-time, post-doctoral training exclusivley focused on the practice of neuropsychology is necessary to gain a fully competent knowledge base.

Who would you rather send your grandma to?

This being another reason that the higher-ups in neuropsych are really trying to push for currently-practicing neuropsychologists (and us neuropsychologists-to-be) to embrace the boarding process. Neuropsych is a bit of an odd field, though, given the rather ecclectic crossroads between mental health, neuroscience, and medicine...which is partly why it's so exciting and interesting. It can oftentimes get a bit overwhelming to sit down and realize just how much information there is available that we should know, though.

 

[Therapist4Chnge]

This being another reason that the higher-ups in neuropsych are really trying to push for currently-practicing neuropsychologists (and us neuropsychologists-to-be) to embrace the boarding process. Neuropsych is a bit of an odd field, though, given the rather ecclectic crossroads between mental health, neuroscience, and medicine...which is partly why it's so exciting and interesting. It can oftentimes get a bit overwhelming to sit down and realize just how much information there is available that we should know, though.

One of the biggest issues of generalists who call themselves neuropsychologists is that they don't know what they don't know. The boarding process for neuro (and all of the other speciality areas) is currently the best process out there to show for competency. I'd guess that the vast majority if not all of the generalists who call themselves neuropsychologists would absolutely bomb the neuro written exam, as many people with all of the required formal training still struggle with the exam. I know I would bomb it if I had to take it tomorrow, because my knowledge isn't fully integrated yet, and I'd be license elligible in a few months for the states that don't require a post-doc.

The more I learn about the neuro, the more I realize that there is WAAAY more to learn than is taught even in your basic neuro assessment classes and practicum. One of the major reasons for formal fellowships is to prepare the professional to work within a speciality area, and to do so ethically.

Internship has provided me with more of a rehab slant to my neuro training, but it has also has informed how much more learning I need to do a comprehensive neuropsych evaluation. Understanding how diseases impact the person's performance, and that not all FSIQ 87 on the WAIS are created equal. I wrote a report last week that had an estimated FSIQ difference of 8, depending on which norms I used. The general WAIS norms weren't appropriate for my person, so I had to use 3rd party data to find something more representative...and even then it wasn't perfect.

I'm looking at the different competencies between rehab and neuro, and I'm finding a large variance in required knowledge. I'm looking at possibly double boarding, and the amount of training needed to do it right is pretty intimidating. I'm lucky in that my fellowship will provide training that is in line with my goal, but I'll still need to pursue additional mentorship to ensure I am well trained in both areas. I can't imagine people who general assessment experience jumping in and providing testing in the same area.

The majority of people will not complete a formal fellowships/post-doc, and that is fine in most instance. However, if you are looking to work in a speciality area, a fellowship should be viewed as a required step in the process. The level of supervision, didactic experience, and training is far different at a formal program than at a more traditional job. I don't want to come off as elitist, because that is not the intent, but the training required to work in certain areas of psychology really require this additional training.

Jon Snow talked about this a few years ago, and back then I had an idea of what he was talking about, but now I really can appreciate what he meant. Post-doc for many is a first job, and I think people who want to do therapy or general assessment practice ethically and do fine. The people who want to work in more specific areas like health psychology, forensic psychology, etc...I think they would really benefit from post-doc training in the specific area. I consider myself pretty solid on most assessments, but I still wouldn't feel comfortable working in the forensic arena without that additional training.....at a higher level of independance. I believe completing practica work can be helpful, but when your work is done more independantly, it carries a different weight of responsibility.

Now that I've run a bit off topic, I'll stop my diatribe now. 😀

 

[Therapist4Chnge]

Moreover, we can continue pushing the bar. 4 years of further training will yield greater competence than 2-year post-doc. 6 years of further training will yield greater competence than 2-year post-doc. 8 years of further training will yield greater competence than 2-year post-doc.

I've read some reports by seasoned psychologists that make me want to pull my hair out, so I don't believe it is as much about years as it is about training. I think the goal is to reach a certain base-level standard of training, which is where boarding can be helpful. The vast majority of people aren't going to go through the boarding process because they are already licensed.

I also wonder if the post-doc system is a proxy for a glutted system without accessibility to job. I've observed post-docs who were employed as a post-doc merely because they could not find employment elsewhere.

I think one side effect of the post-doc year (as it is now, not so 20 years ago), is that it is another year of cheap labor because of the current laws about hour accrument. Unfortunately states aren't going to change this because they don't want to be accused of lessening training, though some states have dropped post-doc hours because of need and they have cited the hours of training as being comparable as 20+ years ago. I happen to agree with the latter, but I worry about the people coming out after internship who want to specialize in an area, but without the extra 1-2+ years of post-doc training.

Frankly, after the internship fiasco (disclosure: I matched), I'm not sure I trust the field of professional psychology. If there were sufficient evidence to restore my confidence in the leadership I would certainly embrace it. But as it stands the recurrent theme of "Post-docs are great because I learn more stuff and feel good about myself" does not justify the costs. But if anyone has more data please share. Thank you!

It depends what you do, and where you go. I talked with friends who were deciding between formal post-docs and taking a job, and the money sometimes was significant. In my case the money I was considering for fellowship versus what I could get in a job wasn't different (40's and low 50's, depending on the setting), though my opportunity for jobs after 2 years was significantly different. Going the fellowship route I would be qualified to step into a leadership position, and not just into a Staff Psychologist position. Obviously it will vary on the setting, but the extra training and opportunity for advancement was much better going the fellowship route.....though it was much harder to secure one of the handful of positions that would allow me that jump.

 

[AcronymAllergy]

One of the biggest issues of generalists who call themselves neuropsychologists is that they don't know what they don't know. The boarding process for neuro (and all of the other speciality areas) is currently the best process out there to show for competency. I'd guess that the vast majority if not all of the generalists who call themselves neuropsychologists would absolutely bomb the neuro written exam, as many people with all of the required formal training still struggle with the exam. I know I would bomb it if I had to take it tomorrow, because my knowledge isn't fully integrated yet, and I'd be license elligible in a few months for the states that don't require a post-doc.

The more I learn about the neuro, the more I realize that there is WAAAY more to learn than is taught even in your basic neuro assessment classes and practicum. One of the major reasons for formal fellowships is to prepare the professional to work within a speciality area, and to do so ethically.

Internship has provided me with more of a rehab slant to my neuro training, but it has also has informed how much more learning I need to do a comprehensive neuropsych evaluation. Understanding how diseases impact the person's performance, and that not all FSIQ 87 on the WAIS are created equal. I wrote a report last week that had an estimated FSIQ difference of 8, depending on which norms I used. The general WAIS norms weren't appropriate for my person, so I had to use 3rd party data to find something more representative...and even then it wasn't perfect.

I'm looking at the different competencies between rehab and neuro, and I'm finding a large variance in required knowledge. I'm looking at possibly double boarding, and the amount of training needed to do it right is pretty intimidating. I'm lucky in that my fellowship will provide training that is in line with my goal, but I'll still need to pursue additional mentorship to ensure I am well trained in both areas. I can't imagine people who general assessment experience jumping in and providing testing in the same area.

The majority of people will not complete a formal fellowships/post-doc, and that is fine in most instance. However, if you are looking to work in a speciality area, a fellowship should be viewed as a required step in the process. The level of supervision, didactic experience, and training is far different at a formal program than at a more traditional job. I don't want to come off as elitist, because that is not the intent, but the training required to work in certain areas of psychology really require this additional training.

Jon Snow talked about this a few years ago, and back then I had an idea of what he was talking about, but now I really can appreciate what he meant. Post-doc for many is a first job, and I think people who want to do therapy or general assessment practice ethically and do fine. The people who want to work in more specific areas like health psychology, forensic psychology, etc...I think they would really benefit from post-doc training in the specific area. I consider myself pretty solid on most assessments, but I still wouldn't feel comfortable working in the forensic arena without that additional training.....at a higher level of independance. I believe completing practica work can be helpful, but when your work is done more independantly, it carries a different weight of responsibility.

Now that I've run a bit off topic, I'll stop my diatribe now. 😀

Agreed on all accounts. One of the potential pitfalls that comes with creating increasingly-standardized testing/assessment protocols and materials is that it can often times make you feel MUCH more competent than you really are.

That's not at all meant as an insult to anyone, mind you--after giving my first dozen or so WAISes, I figured the interpretation process would become increasingly simplified over the next few years. A hundred or two WAISes later, and I've come to realize that interpretation in many ways becomes more difficult as I attempt to integrate all of the information I now know (as well as the stuff I know I don't know). The same sort of thing has happened with SEM after the release of AMOS--now pretty much anyone who can work PowerPoint can run an SR model, but that doesn't mean it's something we should all go out and do without proper training.

All in all, I think boarding in specialty areas is a great step forward, as are formal post-doc requirements. As psychology matures as a field, the issue of establishing (and assessing) proper competence to practice in specialty areas becomes increasingly relevant.

Oh, and as for forensic work--I think one of the presenters at this year's NAN conference put it best: "you haven't really lived until you've had your report scrutinized by Ralph Reitan."

 

[erg923]

Agreed on all accounts. One of the potential pitfalls that comes with creating increasingly-standardized testing/assessment protocols and materials is that it can often times make you feel MUCH more competent than you really are.

That's not at all meant as an insult to anyone, mind you--after giving my first dozen or so WAISes, I figured the interpretation process would become increasingly simplified over the next few years. A hundred or two WAISes later, and I've come to realize that interpretation in many ways becomes more difficult as I attempt to integrate all of the information I now know (as well as the stuff I know I don't know). The same sort of thing has happened with SEM after the release of AMOS--now pretty much anyone who can work PowerPoint can run an SR model, but that doesn't mean it's something we should all go out and do without proper training.

All in all, I think boarding in specialty areas is a great step forward, as are formal post-doc requirements. As psychology matures as a field, the issue of establishing (and assessing) proper competence to practice in specialty areas becomes increasingly relevant.

Oh, and as for forensic work--I think one of the presenters at this year's NAN conference put it best: "you haven't really lived until you've had your report scrutinized by Ralph Reitan."

Well he would crap all over mine and about 99 percent of my current and former superviors because we used a flexible battery approach. I think ill pass on that.....

 

[AcronymAllergy]

Well he would crap all over mine and about 99 percent of my current and former superviors because we used a flexible battery approach. I think ill pass on that.....

I've yet to personally meet anyone who uses a definitively-fixed and utterly-unchangeable battery, although I know it's obviously still done. So at least know that y'all aren't in the minority 🙂

 

[Therapist4Chnge]

Oh, and as for forensic work--I think one of the presenters at this year's NAN conference put it best: "you haven't really lived until you've had your report scrutinized by Ralph Reitan."

Well he would crap all over mine and about 99 percent of my current and former supervisors because we used a flexible battery approach. I think ill pass on that.....

As do I, but it'd be rather entertaining to hear the comments. I do 2-4 hours...the latter feeling rather long. It pays to have a specific referral question.

 

[manko7]

So, you feel having a neuroanatomy class, 2 practicums in neuropsychology during grad school, and an internship (which can be 50% neuro at most) is sufficient enough to produce a fully competent neuropsychologist?

Hello Erg923,

I never made this statement. I do not disagree with a stipulation of classes beyond a neuroanatomy class. But I think you are generalizing this experience to all students. I have 5 years of neuropsychology training. Next year will be internship and that will probably be the sixth year. Now the demand for 2 more years at bottom-rung pay. I think the profession demands too much for entry level neuropsychologist given years of education/training. Sure, there will always be more to learn. But a stable core curriculum should be established such that the goalposts are not perenially shifting beyond what is reasonable (again, given financial compensation and limits of service delivery). In 20 years there will be even more literature to digest. Should a 4-year post-doc then be mandated as well? I would argue against that proposition. Instead the core curriculum should be revised and expected competencies should be re-prioritized.

As to the question of my grandmother, I'd rather she refrain from getting sick altogether.

 

[manko7]

I've yet to personally meet anyone who uses a definitively-fixed and utterly-unchangeable battery, although I know it's obviously still done. So at least know that y'all aren't in the minority 🙂

Just an aside-I've seen a fixed battery approach in academic settings where researchers seek to accrue large datasets for future comparisons. I'm sure the interpretations in the individual report varies. I always thought it was a bit on the unethical side to charge clients for tests that are not germane.

 

[manko7]

I've read some reports by seasoned psychologists that make me want to pull my hair out, so I don't believe it is as much about years as it is about training. I think the goal is to reach a certain base-level standard of training, which is where boarding can be helpful. The vast majority of people aren't going to go through the boarding process because they are already licensed.



I think one side effect of the post-doc year (as it is now, not so 20 years ago), is that it is another year of cheap labor because of the current laws about hour accrument. Unfortunately states aren't going to change this because they don't want to be accused of lessening training, though some states have dropped post-doc hours because of need and they have cited the hours of training as being comparable as 20+ years ago. I happen to agree with the latter, but I worry about the people coming out after internship who want to specialize in an area, but without the extra 1-2+ years of post-doc training.



It depends what you do, and where you go. I talked with friends who were deciding between formal post-docs and taking a job, and the money sometimes was significant. In my case the money I was considering for fellowship versus what I could get in a job wasn't different (40's and low 50's, depending on the setting), though my opportunity for jobs after 2 years was significantly different. Going the fellowship route I would be qualified to step into a leadership position, and not just into a Staff Psychologist position. Obviously it will vary on the setting, but the extra training and opportunity for advancement was much better going the fellowship route.....though it was much harder to secure one of the handful of positions that would allow me that jump.

Hello Therapist4chnge,

I appreciate the time you took to answer the concerns. It certainly isn't on your shoulders to have to defend the mandates of the field so I appreciate you taking "the heat." I do not mean to disparage you or the endeavors of anyone who undertakes a post-doc. I remember attending a talk by Linas Bieliauskas awhile back on the reasons for the post-doc. I wasn't impressed with the presentation, which was short on empirical justification for the post-doc. His central thrust was that it translates into a small increase in compensation on average and that it also confers respect. Now I certainly would not disagree on these principles. Moreover I can't argue with the benefits of increased training. But I still need to see the data justifying this formal requirement. Perhaps Division 40 has published it and I just need to get around to it.

 

[erg923]

I'm pretty confident we were all referring to clinical evaluations in that exchange. Yes, obviously, one would need to administer the same battery to each subject in a research study for comparison purposes.

Personally, I do not believe that one has to standardize an entire battery on a single population for it to be useful (Reitan's main argument for only using the HRB). In fact, if there is any sampling bias in that single normative group, you may have severely limited the generalizability of your findings on a particular patient (e.g., SB-IV edition). There is clinical utility in having assessment data from multiple normative samples to avoid such sampling bias. For example, when one conducts a meta-analysis, you are combining effect sizes on different instruments administered to different populations to generate a single conclusion about the influence of one variable on another (e.g., depression on memory). The logic here is that with enough data points, the signal will outweigh the noise. The different normative samples do not necessarily prohibit statistical comparisons across the different tests, you simply have to take into consideration the noise introduced via sampling error.

In short, I believe that the assessment process should be flexible as long as it adheres to many of the pricinples of research we all learned about in graduate school, that have been echoed in the writings of Meehl, Faust, Chapman & Chapman, and Cook and Campbell. etc. IMHO, the dogmatic restriction of clinical assessment to batteries that were normed decades ago may actually be introducing more sampling error than a well administered and analyzed flexible battery.

 

[erg923]

Hello Erg923,

Now the demand for 2 more years at bottom-rung pay.

I agree and have made that same complaint and argument before. This is time my wife and I could be using to actually buy and house and start our family. But on 35K per year with loans and 60 hour work weeks....not likely.

I'm actually not even that big a proponent of boarding-at least not in its current form. Too many hoops and I have yet to hear a compelling personal reason to pursue it. Whats in it for me!?-Thats right I said it...a reason that that extends beyond serving for the "greater good" of the profession in general. Well thats nice and all, but 4K for a piece of paper that tells me something I already know by that time-that I am competent to practice neuropsychology? I thought thats what the 2 year post-doc was for.... What about just requiring an exit exam for successful completion of the post-doc? Oh right, this is psychology, nothing can be simple, rationale, and straightforward....

 

[Therapist4Chnge]

Hello Therapist4chnge,

I appreciate the time you took to answer the concerns. It certainly isn't on your shoulders to have to defend the mandates of the field so I appreciate you taking "the heat." I do not mean to disparage you or the endeavors of anyone who undertakes a post-doc. I remember attending a talk by Linas Bieliauskas awhile back on the reasons for the post-doc. I wasn't impressed with the presentation, which was short on empirical justification for the post-doc. His central thrust was that it translates into a small increase in compensation on average and that it also confers respect. Now I certainly would not disagree on these principles. Moreover I can't argue with the benefits of increased training. But I still need to see the data justifying this formal requirement. Perhaps Division 40 has published it and I just need to get around to it.

I don't feel like I have to defend the post-doc, but more simply I want more information out there about the aim for (most of) them. When I was considering "personal" reasons (after erg923 mentioned), I think one of mine is to get myself the best training I can for where I am at. I have seen some of the CEs out there, and some leave much to be desired.

I'm not sure if Div 40 has any published data on the topic, though I know if I want to climb out of clinical work and into administration, an ABPP will help me with that goal. It is far from infalliable, but it is what we have at the moment.

I agree and have made that same complaint and argument before. This is time my wife and I could be using to actually buy and house and start our family. But on 35K per year with loans and 60 hour work weeks....not likely.

I agree with the money side, making 40-something may have been appropriate at 22-23 with a bachelors, but going into years 7 and 8 of doctoral training...it is ridiculous.

 

[AcronymAllergy]

I agree and have made that same complaint and argument before. This is time my wife and I could be using to actually buy and house and start our family. But on 35K per year with loans and 60 hour work weeks....not likely.

I'm actually not even that big a proponent of boarding-at least not in its current form. Too many hoops and I have yet to hear a compelling personal reason to pursue it. Whats in it for me!?-Thats right I said it...a reason that that extends beyond serving for the "greater good" of the profession in general. Well thats nice and all, but 4K for a piece of paper that tells me something I already know by that time-that I am competent to practice neuropsychology? I thought thats what the 2 year post-doc was for.... What about just requiring an exit exam for successful completion of the post-doc? Oh right, this is psychology, nothing can be simple, rationale, and straightforward....

I'd imagine those are the main arguments that, at the very least, give many people pause while considering a formal two-year post doc. Personally, as with T4C, I plan on pursuing one after graduation, but I can see why people are frustrated with the current system.

I believe the "powers that be" are attempting to model things, at least in part, on the medical profession and its specialty boarding procedures. We just aren't quite as efficient with it yet. I, too, would be happy with a post doc exit exam. I think the problem at the moment is just that people are having trouble agreeing on the specifics of what you really NEED to know to be a qualified and competent neuropsychologist. Hence the inclusions of peer review, work sample review, etc...keeping the human component in it provides a check for potentially sub par formalized examination (e.g., multiple choice testing).

 

[deleted176373]

I agree with the money side, making 40-something may have been appropriate at 22-23 with a bachelors, but going into years 7 and 8 of doctoral training...it is ridiculous.

It's not going to change until supply of psychologists diminishes as a result of the poor pay... until then, wages will remain soft and we will continue to live on substandard wages for the training we have.

In today's economy where Ph.Ds/Psy.Ds are competing with LMHCs/MSWs/etc. for therapy positions, I think anything we can do to differentiate ourselves further will be beneficial.

And getting a Ph.D. wasn't enough already to differentiate ourselves? Perhaps that is not the problem, but rather the problem is in showing that the added value is commensuate with a higher billing rate and thus a higher salary as well.

Face it, the problem lies not in differentiating ourselves, but showing that we have additional value above and beyond those who have less training. So either we are over-trained for the work that we are doing, or we are not doing work that is appropriate for the level of training we have, otherwise we would have greater value in the marketplace.

This is the real problem, justifying a higher cost of services... either by showing increased productivity, efficacy of treatment, or providing services outside the capabilities of lesser trained providers. We should, with just the Ph.D. be able to show that our additional training brings additional value... any inability to do so should lead us to question the training model.

Mark

 

[erg923]

I'd imagine those are the main arguments that, at the very least, give many people pause while considering a formal two-year post doc. Personally, as with T4C, I plan on pursuing one after graduation, but I can see why people are frustrated with the current system.

Yes, probably the 2nd most important reason why I have chosen not to do a formal post-doc in neuro.
1.) uprooting my wife and her career yet again is not something I am willing to do. As an aside, locations/sites for medical residencey education are widespread and many applicants don't neccesarily have to move yet again for residencey if they so choose. Not the case with neuro, bc they're are too few post-docs training sites and they only take 1-2 people every year. 2.) We want to have kids and daddy actually wants to see them more than a few hours each night. 3.) Money. 4.) To me, the post-doc in neuro appears more and more to be a poor economic investment. The average starting npsych makes only about 5k more per year than the average starting clinical psychologist. Considering I might be looking at making 25k less for 2 years than I would have if I was working, it would take me taking a decade to see any financial benefit from this post-doc.

I think the problem at the moment is just that people are having trouble agreeing on the specifics of what you really NEED to know to be a qualified and competent neuropsychologist.

Yes, and this is very sad....