realistic salaries

[WisNeuro]

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IME, even in psychotherapy between some disciplines. Earlier someone stated that psychiatrists got 45 minutes with patients at a time. That has not been the norm in the half a dozen private and public institutions I've worked in. 10-15 was more the norm. I also rarely see psych NP's doing therapy.

 

[Sanman]

Differential diagnosis makes a huge difference when it comes to proper management of a case. Throwing a cocktail of Seroquel, Depakote, Ativan, etc. at a person may "reduce" behavioral problems, but not address the underlying problems,

Agreed, just like coordination of care after proper management improves outcomes and reduces unneccessary overmedication. Many people talk about that, but nobody will actually pay you to do it. How much accurate dx do you see in the real world? Most axis II dx get medication to manage behavior anyway, though it is fairly ineffective and then I get called in the manage the sx. In other cases, if the sx are managed and medication accurately prescribed, no one cares most of the time. Then again, my job is to keep people stable for the most part.

 

[bostongal109]

I feel like the "passion" stuff can be a quick and slippery excuse at times. Anyone in this field clearly isn't here for the money, but it's also important to be realistic about what you can afford. My professional passions and what is feasible for myself and my future can also be two separate things, unfortunately.

So, am I passionate about getting a doctorate? Absolutely. Is it financially something will be haunting me for the rest of my life, making it difficult to ever support a family or buy a house? That's what I'm trying to understand. I don't think passion is an excuse for financial irresponsibility. Just as many people advise others against a 250k PsyD program for this reason.

It's just a very tough decision. I am quite lucky to have a well paying MA position that will only continue to get higher. So a lot of this depends on each individual's situation. That makes sense Sanman, that it is personal.

It's also nice to know that other people have struggled with this 🙂

 

[edieb]

I feel like the "passion" stuff can be a quick and slippery excuse at times. Anyone in this field clearly isn't here for the money, but it's also important to be realistic about what you can afford. My professional passions and what is feasible for myself and my future can also be two separate things, unfortunately.

So, am I passionate about getting a doctorate? Absolutely. Is it financially something will be haunting me for the rest of my life, making it difficult to ever support a family or buy a house? That's what I'm trying to understand. I don't think passion is an excuse for financial irresponsibility. Just as many people advise others against a 250k PsyD program for this reason.

It's just a very tough decision. I am quite lucky to have a well paying MA position that will only continue to get higher. So a lot of this depends on each individual's situation. That makes sense Sanman, that it is personal.

It's also nice to know that other people have struggled with this 🙂

I agree with this post 100 percent. I want to add that passions change throughout your life. As witnessed by my posts on here when I was earning my clinical PhD, I was very passionate about obtaining wonderful training and learning all I could. However, as I matured, the intensity of that passion faded a bit and I wanted to earn a good living. Although I am still interested in cognitive models of psychopathology, etc., and still read journal articles, that is no longer my #1 priority. Rather, I am more interested in making a good living to support myself and my family. Thus, I no longer have time to do 3 hours of research after every patient I see and many times I will give a bipolar NOS diagnosis rather than spend 3 hours teasing bipolar II vs cyclothymia because (1) I have to move on to the next patient (2) Most providers don't care about the difference (3) IME, most patients don't care either and (4) I am going to prescribe the same medications regardless.

While a psychologist's training in the assessment and treatment of psychiatric pathology is generally superior when compared to an NP or counselor, a lot of the training I received is just an academic exercise. I remember studying for the EPPP three years ago and then studying for the Psychopharmacology Examination for Psychologists (PEP) last last year and noticing how much useless materal was on the former versus how much clinically relelvant material was on the latter (EPPP = Psychological Models of White Racism, Freud's developmental stages, different types of aphasias, etc; PEP = what is Neuromalignant Syndrome, which medications increase or decrease CYP enzymes, what does Serotonin Syndrome look like and how does one manage it, What medications can cause Torsaddes de Pointes) I think all this extra training is irrelevant and causing us to lose ground in the marketplace

I can see this is the demand for my skills as a prescribing psychologist verus a clinial psychologist. As a prescriber, I get so many calls from recuriters and the patients flood in. As a standard psycologist in the same geographic area who did therapy and assessment, I had to fight to keep a full patient load

 

[WisNeuro]

So, am I passionate about getting a doctorate? Absolutely. Is it financially something will be haunting me for the rest of my life, making it difficult to ever support a family or buy a house? That's what I'm trying to understand. I don't think passion is an excuse for financial irresponsibility. Just as many people advise others against a 250k PsyD program for this reason.

As with anything, your own financial planning goes into this. I have plenty of colleagues, and myself included, who have no debt, own their own home, car, etc and have families. As with any training and career, how you plan for things greatly influences these life choices above and beyond that career path.

 

[Sanman]

I feel like the "passion" stuff can be a quick and slippery excuse at times. Anyone in this field clearly isn't here for the money, but it's also important to be realistic about what you can afford. My professional passions and what is feasible for myself and my future can also be two separate things, unfortunately.

So, am I passionate about getting a doctorate? Absolutely. Is it financially something will be haunting me for the rest of my life, making it difficult to ever support a family or buy a house? That's what I'm trying to understand. I don't think passion is an excuse for financial irresponsibility. Just as many people advise others against a 250k PsyD program for this reason.

It's just a very tough decision. I am quite lucky to have a well paying MA position that will only continue to get higher. So a lot of this depends on each individual's situation. That makes sense Sanman, that it is personal.

It's also nice to know that other people have struggled with this 🙂

Absolutely, passion is great, but it will not feed you. More important than that IMO is what you can realistically do to make a living. You may have a passion for Freudian psychoanalysis, but that will not feed you. I have a few colleagues who learned that harsh reality quickly following internship. The importance of proper dx issue going through this thread is another example of that. I am very well trained at dx and if I can to see 6-8 pts per day, I would,be able to do so. However, when you have to see double that due to the poor compensation for psychologists, all the passion in the world won't make up for working a 20 hr day doing it right for everyone. That is the real world.

 

[smalltownpsych]

All I can say is that I find this perspective of passion being not needed to be saddening. Obviously, I am not talking about some vague sentimental feeling akin to romantic attraction. I am referring to a commitment to the field and to a love of the study of the mind. This is not just a job and I don't think it should ever be viewed on that level, human lives are affected by what we do so you damn well better have some passion. To become a psychologist is an extremely challenging and, in my opinion, worthy endeavor that should be well compensated and I am passionate about that!

 

[edieb]

All I can say is that I find this perspective of passion being not needed to be saddening. Obviously, I am not talking about some vague sentimental feeling akin to romantic attraction. I am referring to a commitment to the field and to a love of the study of the mind. This is not just a job and I don't think it should ever be viewed on that level, human lives are affected by what we do so you damn well better have some passion. To become a psychologist is an extremely challenging and, in my opinion, worthy endeavor that should be well compensated and I am passionate about that!

Outright distortion of what everybody said -- people responded that passion is there but it shifts to the background, rather than the foreground, once you have been practicing for awhile

 

[smalltownpsych]

Outright distortion of what everybody said -- people responded that passion is there but it shifts to the background, rather than the foreground, once you have been practicing for awhile

I wasn't really commenting directly on what you said which I do tend to agree with, but we were talking about somebody pre-doctoral so i would hope they start with some fire! 🙂

 

[Sanman]

All I can say is that I find this perspective of passion being not needed to be saddening. Obviously, I am not talking about some vague sentimental feeling akin to romantic attraction. I am referring to a commitment to the field and to a love of the study of the mind. This is not just a job and I don't think it should ever be viewed on that level, human lives are affected by what we do so you damn well better have some passion. To become a psychologist is an extremely challenging and, in my opinion, worthy endeavor that should be well compensated and I am passionate about that!

I am all for passion as long as it is informed. As I said before, passion over having a psychoanalytic practice may just lead to bitterness and anger if you cannot fulfill those expectations realistically. How many passionate people have come here and said that they will take on $200k of loans because they will be the exception and be making six figures. Passion has to be tempered with balance and a dose of reality. I would argue that sometimes it is just a job and there is nothing wrong with that. We all need to go home and have balance. I used to think of it as more than a job when I started doing this. The problem with that is that you then get drawn into every emergency and problem with every pt as if it were life or death . If I treat it as such, I ignore my family and that is not correct either. In spite of what it might seem, I do enjoy my job. I just wish that we were compensated fairly enough that I would see 6-8 pts a day rather than having to see 10,12,or 15 to mae a living. It is when that happens you begin to burn out if you don'r learn to balance quiality of pt care with self care. That balance is still something I am working out.

 

[smalltownpsych]

I also think that my comments about passion about psychology are being read as passion about helping people. Two different though related issues. i saw that one response was sure I am passionate about getting a doctorate. To me that type of sentiment is counter to being devoted to the field of psychology. I argue on these boards all of the time about asking for more money for psychologists That is because I feel very strongly that we provide valuable services. I think that people need to realize that to be a clinical psychologist is akin to becoming a medical doctor which even requires that people take an oath to reflect their level of commitment to the principles of the field.

 

[Sanman]

I also think that my comments about passion about psychology are being read as passion about helping people. Two different though related issues. i saw that one response was sure I am passionate about getting a doctorate. To me that type of sentiment is counter to being devoted to the field of psychology. I argue on these boards all of the time about asking for more money for psychologists That is because I feel very strongly that we provide valuable services. I think that people need to realize that to be a clinical psychologist is akin to becoming a medical doctor which even requires that people take an oath to reflect their level of commitment to the principles of the field.

Oaths aside, I think that in some ways we have stuck to our principles more than medical doctors and that is part of the problem in our field. Most of the psychologists I meet hold to the therapeutic relationship and even the 45 minute/1 hr session. Physicians have largely increased work load to maintain or increase salaries and tapped midlevel providers to extend the scope of practice. This has eroded much of the doctor-patient relationship. Sometimes I believe that we hold too staunchly as a field to outdated ideals in an era of managed care with massive pt loads for many physicians and psychologists. The truth is that we need to change our practice in certain ways to both increase salaries and utilization of our services. Of course part of this is me being more of a behaviorist and cognitive assessment guy. Psychodynamic folks would try and kill me if some of my thoughts were implemented. Therein lies the issue... we are a field in an identity crisis. We try pleasing everyone and instead please no one.

 

[WisNeuro]

Physicians have largely increased work load to maintain or increase salaries and tapped midlevel providers to extend the scope of practice. This has eroded much of the doctor-patient relationship. Sometimes I believe that we hold too staunchly as a field to outdated ideals in an era of managed care with massive pt loads for many physicians and psychologists. The truth is that we need to change our practice in certain ways to both increase salaries and utilization of our services.

At the same time, yes physicians have increased work loads. Is this better for the patient? We have the highest medical cost per patient in the world, but we are miles away from the top in patient outcomes. If the outcome data is there, e.g, 30 minutes of PE is just as effective as 90 minutes of PE, go nuts. But I'll go down with the ship before I deliver service I know is, or that I strongly suspect, is ineffective.

 

[Sanman]

At the same time, yes physicians have increased work loads. Is this better for the patient? We have the highest medical cost per patient in the world, but we are miles away from the top in patient outcomes. If the outcome data is there, e.g, 30 minutes of PE is just as effective as 90 minutes of PE, go nuts. But I'll go down with the ship before I deliver service I know is, or that I strongly suspect, is ineffective.

Spoken like a person that is on salary at the VA 😉 .

I'm not suggesting that we do so without outcome data, but the fact is,that many private practice individuals are already cutting session from 45 to 40 min to squeeze in a client after the latest billing changes. It is happening with or without our consent, so we may as well get ahead of it. 45 min session did strike me as an arbitrary number though.

 

[WisNeuro]

Salaried or not, it's what I would do. Like I said, if that's what we want to do, let's get some RCT's and other research done to see if this is good clinical practice. Rather than being complicit in our nation's declining health outcomes, let's try to actively work in the positive direction.

 

[Sanman]

It might be what you would do. Most RVU systems for companies or hospitals are based on billable session time. If your rvu count goes up, no one will complain if you spend an extra hour or two at work everyday to give the best tx possible. However, you will burn out. It is something all PP and insurance based companies have to deal with to make a living/profit. It was actually easier for me when I was fee-for-service than it is when I am on salary becuase I can choose to forgo a couple of dollars for a bad day or week. Unfortunately, fee for service does not include benefits and I need health insurance. I already stay an hour later than necessary most days to call families and coordinate care, but we all have our limits.

 

[WisNeuro]

We actually do measure productivity via RVU's in the VA. I'm pretty good about keeping to my 40 hour weeks and stay well over my expected productivity. Granted, that is primarily testing hours. Still, there is no push to test unnecessarily long to jack those hours up. Similar for when I was at an AMC. I think I would burn out much faster doing something poorly that I was sure was not effective than by trying to keep doing what I believe is best for the patent according to the known outcome data.