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The Practice of Clinical Neuropsychology: Viability, Utility, Future Directions?

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by erg923, Mar 19, 2011.

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  1. Sanman

    Sanman O.G. 10+ Year Member

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    Interesting thread...I am sad I missed it on the first go round last year. I think a lot of the points mentioned are still salient and while the in-fighting may stop, there is a lot of work to be done. For starters, board certification is really needed throughout psychology. As mentioned above, outside of academic centers and the VA, it is the wild west out there. Without that, poorly trained/unethical psychologists are as much of a worry as encroachment from other professions. The issue I see before hand is not that neuropsychology does not have a place in the science. Rather, as a health professional, what kind of bread and butter case can a neuropsychologist expect in changing times? Everyone from SLPs to Rehab psychologists,School psychologists, etc will be encroaching on the territory. I spent a good deal of time learning assessment and while I do not consider myself a neuropsychologist (no npsych post-doc), I can certainly administer an RBANS or Cognistat and screen for dementia. I can also do a capacity/risk assessment, etc. So, does that leave neuropsych as specialists that only see those that pass a screening or will neuropsych be in a turf war with other psychologists regarding who gets to do these screeners? The bottom line is that in any area of practice, there needs to be a steady niche to pratice in and the lack oversight legally and within the field is causing problems as everyone runs to the few areas that make money and a glut forms.
     
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  3. 0000001

    0000001

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    Sorry to bump an ancient thread, but I'm just curious as to how the field of npsych has progressed (or regressed) in the last 4 years since this post. Are these concerns still mostly valid? What new issues have arisen? How has the outlook for npsych changed?
     
  4. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Depends on who you ask, really. I'd say the opinions run the gamut of some wearing sandwich boards proclaiming that the end is nigh, to those who say that things are looking up as long as we adapt to the times.
     
  5. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    1. I think there has been more of a push for boarding, which is a positive thing (in my eyes). Job postings at most/all hospitals and many/most private groups now require formal fellowships, board eligibility, and have the expectation the person will become boarded within a certain amount of time.

    2. Insurance companies continue to suck, but some states have made some progress. Moving forward and having to navigate ACOs (accountable care organizations) will be interesting. I'm still unsure if they will help/hurt us, but making sure we are part of the conversation will be important.

    3. We still need more outcome research to support the belief that NP can inform treatment AND save money in the long run. The AACN has been sponsoring this type of research in recent years.

    4. NY State just passed a law to regulate the use of psych techs to provide testing, which is a win for anyone who practices in the NY area.

    5. I still feel underwhelmed by the APA's support of neuropsych issues overall, though Div 40 and AACN have both stepped up and should be supported by every neuropsychologist. Hopefully Tony Puente will win the APA presidency this coming year, as we could use someone at the highest position to help shift some of the efforts of APA towards more pressing issues like insurance reform, etc.
     
  6. Pragma

    Pragma Neuropsychologist 5+ Year Member

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    +1 to all of this.

    I think one interesting thing is the push towards Board Eligibility at most, but not all places. Any reputable institution is going to require that individuals meet HC training standards in order to practice as a neuropsychologist. The problem that I see is that a lot of people still are marketing themselves (in PP, in crappier clinical settings) as neuropsychologists, or indicate that they are doing neuropsychological testing. This within-field problem is something that I see as continuing to confuse the public and dilute our value. Here's a good recent blog post from SCN about that: http://scndiv40.blogspot.com/search...d-max=2016-01-01T00:00:00-08:00&max-results=1

    We are starting to see outcome studies. At the most recent INS conference, it was encouraging to see people looking at the neuropsychological testing process as having outcomes. There is also a shift in thinking to get us ready to be more adaptable within the changing healthcare system. Neil Pliskin had a great message about this recently: https://www.scn40.org/presidents-corner.html

    I'd say the ones wearing sandwich boards (as Wisneuro alluded to earlier in the thread) are the ones that aren't adapting to the times. It's sad that we haven't empirically demonstrated the value of our services as well as we should have, but that data is coming (and some of it is already here).
     
  7. Existenz

    Existenz Clinical Neuropsychologist 5+ Year Member

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    I'll be happy when we have just one board (ABPP)
     
  8. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    It'll happen, just slowly as the old guard retires and dies off.
     
  9. smalltownpsych

    smalltownpsych 2+ Year Member

    Just wanted to add that as a general practice psychologist who does some cognitive testing from time to time (and has quite a bit of interest in neuro-stuff), I am completely in support of maintaining neuropsychology as a distinct specialty. I have seen standard assessment batteries (you know, an MMPI, a WAIS, and maybe an SCT thrown in) labeled as neuropsych assessments and it frustrates me. First, it devalues the appropriate information that can be obtained from psychological testing by trying to make it seem like it has to be more. Second, as you mentioned, we all suffer when we blur the lines as opposed to having a clear scope of practice within our competency. I believe we as a field need to continue to move in specialty directions with neuro, child, adolescent, health, geriatric, forensic being a few off the top of my head.
     
    Pragma likes this.
  10. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    This seems to indeed be happening, and is likely just a side-effect (of sorts) of psychology becoming a more mature applied science and discipline as a whole.

    On a personal note, I don't purport to be an expert in sleep disorders, substance abuse, SPMI, health psychology, or trauma despite having trained in those areas previously, and so I get a little irked when I see folks who feel justified in conducting "neuropsychological evaluations" because they conducted a few cognitive evaluations in grad school and had a neuropsych rotation on internship.

    Even with pretty darn neuro-intensive grad school and internship training, the amount I learned via formal postdoc was significant.
     
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  11. Pragma

    Pragma Neuropsychologist 5+ Year Member

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    I try to explain this to students considering this specialty and others all the time. Postdoc is really where the rubber meets the road in specialty training. You can have solid training up to that point, but during those two years that's where you develop the automaticity and competency that is needed for independent practice. Exposure to patients is a big part of it, but you also really need the didactics, quality supervision, and opportunities to work with other medical professionals to learn more about a variety of conditions.

    I try to imagine myself practicing "neuropsychology" without that experience, and it would be scary. We need to get rid of the charlatans out there.
     
  12. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Agreed, I came from a fairly heavy neuro background in grad school (worked in a neuroscience lab with eeg and fMRI, 1.5 years 2 days a week neuro prac at top site), did a half-time neuro internship, and will still say that I was nowhere near ready for practice in Neuropsychology until the end of my postdoc. Absolutely crucial.
     
  13. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    I had a pretty solid assessment background in grad school and spent probably 50% of my time doing neuro-related work on internship (with close mentorship) and fellowship was still at an entirely different level. The pure volume of cases and variety of presentations were two of the biggest differences on fellowship. I had no idea how much I didn't know coming out of internship until I started on fellowship and got dumped into the deep end of the pool.
     
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  14. Pragma

    Pragma Neuropsychologist 5+ Year Member

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    In addition to volume of cases and variety of presentations, I'd say the opportunities for more extensive neuroanatomy training (e.g, brain cutting) and procedures (e.g WADA, awake craniotomy) stood out. The variety of different consults across a whole medical center also provides necessary perspective. Moreover, the interactions with physicians and other health professionals helped to define scope of practice.

    But hey, who's to say someone who gave a few RBANS on externship can't do neuropsychological testing?
     
  15. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    Didactic training really helps inform on the applied clinical work. During my fellowship years we had 2hr of formal didactic lectures per wk (1hr Peds, 1hr Adult), extensive neuroanatomy training (w. wkly wet lab), and then weekly neurology didactics for two years. Add in optional weekly didactics and case presentations by a variety of departments and the breadth of exposure was pretty awesome.

    Of course, I could probably just take some classes online and get the same experience. ;)

    The above is why I value formal fellowships over informal or private practice fellowships.
     
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  16. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    Agreed with all of the above. The neuroanatomy coursework was something I placed a premium on in my postdoc "hunt," and even though I'd had some of it before, the intensity (i.e., med school classes) was new, and being able to build on that prior exposure and knowledge is really what helped it all to sink in.

    Same goes with pretty much everything else, which is why the "where the rubber meets the road" comment is so accurate. It's not that you're seeing things you haven't seen while on postdoc (although some of that happens as well), it's that you're appreciating things you haven't appreciated before, and at a level of depth and understanding that reflects the advanced nature of the training.
     
  17. PsychePsych1

    PsychePsych1

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    Hey everybody, I'm a first-time poster here. I'm honestly not sure if I will have any sort of longevity on this website (on this account), as I didn't really intend to post anything. So, with all of that in mind: I apologize if this is an inappropriate time to try and revive an old thread.

    Lately, I have had a real developing interest in the field of neuropsychology, and this website has been an absolute boon in regards to deciding if neuropsychology is what I want to pursue for a career or not. As I have been reading up on the subject and its field (and its respective content on this website) -- this thread really stood out to me (as somebody who is trying to determine if this field is right or not for me [the job itself definitely is, but, the aforementioned reasons in previous posts have made me question if it is a plausible career to pursue]), so I figured that others in the same boat would benefit from a continued discourse on the thread topic (and for those interested/previously engaged here, perhaps an avenue to blow off some stream and/or evaluate the contemporary state of neuropsychology).

    On an unrelated note: I apologize if this is a dumb question/notion, but, on the topic of the 'future of neuropsychology', it seems like a lot of worry is with regard to other professionals invading in on neuropsychological assessments. My question is, as I am trying to better understand neuropsychology and its respective subculture, can neuropsychologists play a role that goes further than just assessments (e.g., ameliorate the workload of neurologists by quarterbacking some of their responsibilities, like helping patients and their families make social/behavioral adjustments after a patient receives a Multiple Sclerosis diagnosis)? I apologize if that doesn't make any logical/coherent sense -- I'm just trying to further the discourse here because this thread was awesome.
     
  18. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    The assessment piece is only a small part of our overall role. We already are involved in things such as " helping patients and their families make social/behavioral adjustments after a patient receives a Multiple Sclerosis diagnosis." Or other things like helping patients/families understand a diagnosis of dementia, the need for things like advanced directives, consideration of skilled nursing care, being part of a treatment team deciding if someone is a good candidate for DBS placement, helping with intraoperative brain mapping for resection surgery in epilepsy, assessing cognitive change and/or offering therapeutic interventions in neurooncology patients, and on and on. Testing is the least of what we do.
     
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