The Ugly Truth about the Clinical Psychology PhD

[JockNerd]

I believe there is a misnomer in this statement ... it is not that midlevels can do what we do it is that they are permitted to do what we do.

I agree. Scope creep, in particular with assessment, is terrible. I think as far as assessment goes we can thank our test publishers for a large part of this, as they help contribute to unqualified people administering tests then handing out the Pearson-generated "report." Guh.

I realize there is some data that suggests nearly equivalent outcomes but (not having time to do a full lit review) I, nevertheless, find this conclusion suspect. I have come in contact with an ever increasing number of midlevels and more and more of them are "counselors" in the generic sense of the word and not "psychotherapists" in the specific sense of that word.

I'd wager that you're right about this too. When psychologists finally learn how to properly do an outcome study, I think this point will have evidence to back it up.

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[JockNerd]

How many of you:

1 - Are members of the APA?
2 - Are members of your SPA?
3 - Check the APA legislative center (http://capwiz.com/apapractice/home/) and contact your reps?
4 - Participate in any kind of advocacy on behalf of professional psychology?

1-Yes
2-Yes
3-Yes
4-Just watch me.*


*Oh, I just realized that nonCanadians won't get this. Here. http://www.youtube.com/watch?v=XfUq9b1XTa0

 

[psychwhy]

"1 - Are members of the APA?" No
"2 - Are members of your SPA?" No
"3 - Check the APA legislative center (http://capwiz.com/apapractice/home/) and contact your reps?" No
"4 - Participate in any kind of advocacy on behalf of professional psychology?" No

I've all but given up on psychology as a professional discipline. I will continue to do research and make my money with grants and other sorts of business ventures, and I will do clinical work for fun (perhaps some play money). But, I think psychology's future is pseudo-professional. With the abundance of *******es in our field combined with the greater abundance of *******es pushing on our field, I just don't see much reason for hope.

Jon, I know we have had our disagreements in the past, but I never thought something you posted would just utterly sadden me as much as this.

I would venture to say psychology is in the predicament you describe precisely because of the behavior you describe.

Many of your criticisms of the profession -- midlevel encroachment, proliferation of professional schools/debt load, evaporation of available internships, pathetic cost/benefit ratio to pursuing the credential, etc -- occurred precisely because those in active in the profession at the time buried their heads DEEP in the sand and then wondered where the profession went when they came up for air.

I've said it many times before, nursing has gone in the diametrically OPPOSITE direction of psychology over the past twenty years, precisely because their senior practitioners said "Enough of being treated as if we do not matter in the healthcare realm -- can't beat 'em? Overwhelm them! Find where they are weakest and exploit that!"

Today we have mid-level nurses competing with MDs/PhDs because they worked the system and carved out a nice piece of the health care pie for themselves.

Their accomplishments ain't rocket science .. and we have them to copy from.
But it requires real life practitioners to stand up and tell people in power, "Hey, let us do this" (even more appropriate "We're better at doing this!") not just sitting on the sidelines whining, "Why won't they let us do this?"

Read a nursing journal recently? Most are 1/3 practice related research; 1/3 public policy/advocacy primer; 1/3 practice expansion/business management/blatant cheerleading.

How did graduate school prepare ANY of us to manage a clinical practice? How many practitioners even know that the APA Practice Directorate has a Business of Psychology Network (BOPN)?

Sorry Jon, but which is worse -- the "*******es" who took over the profession? Or the "lameasses" who watched it happen and did nothing?

 

[amphigory]

Much of this thread has been spent comparing a psychologist's salary with that of other healthcare professionals. But what about just the comparison to other PhDs? I work in a med school lab with a bunch of (biochem) PhDs who don't make much more than I do with my BA. But it's essentially their identity, a career in the field they've spent their entire lives working in. And none of them wishes they were MDs (the MDs are in their own club, and consider themselves superior, and grant each other favors, and get first author papers after bumbling around in the lab for a year while the techs do the real work, but any of the PhDs would laugh at the idea of being an MD.)

And what about people who get PhDs in Literature, or Philosophy, or whatever else? They obviously aren't doing it for the money. It's just what they are. So I'm trying to be Zen about the whole thing. Education for its own sake. Hiding out in an ivory tower for your whole life isn't the worst thing in the world.

 

[medium rare]

The discord evident on this thread is largely the result of supply-demand economics with psychology being undeniably left out of the demand component. I have posted similar sentiments in other threads, but this topic is clearly pertinent here.

Mid-levels are in demand and command larger salaries in psych/mental health because they are able to perform a service we and most other providers cannot - prescribe medication. Does this mean they have better training or are more able to provide the service? Of course not. But the "should've, would've, could've; we deserve more because we have more training" lamentations are pointless in this market.

I have a unique perspective on this issue because I am both: psychologist and NP. And, even today, I have my share of mixed feelings on being a nurse practitioner after already becoming a psychologist. I learned very little in the NP program that I did not already know or was not exposed to in my psychology training with the exception of neuropathophysiology and pharmacotherapy. The non-pharm, psycho-social training in my NP program was laughable compared with what I was expected to master in my psychology doctoral training, and I came out knowing that essentially what I had 'earned' was a DEA# and a Rx pad at the completion of my NP training. But, this change has been substantial and has had a tremendous impact on my practice. Why? Largely because I am now able to fill a huge demand in the market in a way that was closed before.

And again, as I've mentioned before, Rx authority is not the 'be-all, end-all' some would like us to think it is, nor is it in any way a panacea to the problems faced by professional psychology today. But, it IS something that psychologists are entirely capable of learning to do through post-doctoral speciality training. We don't need to become physicians or nurses in order to be able to prescribe safely and effectively - my experience down this road has made this crystal clear.

Psychology does need to advocate better for itself and, I believe, one of the best ways to do this is to push tirelessly for prescriptive authority. Nurses have done this and so can we. Even if this is something you do not see yourself pursuing personally, the ability to prescribe will give psychologists a huge bargaining chip and allow us to become part of the 'demand side' of the supply-demand market we all practice within.

I have has this conversation with some of my prescribing psychologist colleagues in New Mexico and they all confirm that this has been the case for them: significantly increased demand for their services via their Rx authority. And, what de facto follows this increase in demand is an increase in receptiveness to our recommendations and 'orders' as providers. For example, now if I write an order for "psychotherapy with a psychologist," it is followed through on. Whereas before my 'recommendation' largely went unheeded, ignored, or dismissed entirely - usually by a psychiatrist.

Whoever has the gold makes the rules, and we need to do a much better job of getting more gold.

 

[psychmama]

I think what distinguishes clinical psychology is that it blends aspects of academia and professional practice. The mindset of someone who would gladly hole up in an ivory tower is a bit different from the mindset of a healthcare professional. Both may have identical Phds, but I'd submit they're looking for different things from their degree.

Of course, lots of psychologists blend both aspects into their identity -- ivory tower and professional services provider.

 

[psychmama]

To medium rare -- what do you make of the movements within psychology to oppose prescribing? Is it fear of being required to prescribe in order to remain professionally competitive? Philosophical problems with the medical model within mental healthcare. What?

 

[medium rare]

To medium rare -- what do you make of the movements within psychology to oppose prescribing? Is it fear of being required to prescribe in order to remain professionally competitive? Philosophical problems with the medical model within mental healthcare. What?

The opposition by some psychologists is there, but I think it is a relatively small, vocal group of largely non-practicing and/or academic psychologists. Many of these individuals also continue to remain opposed to the licensing of psychologists or the regulation of psychology as a profession. They assert that psychology is and should be only an academic discipline. But, that ship sailed long ago, and psychology is clearly also a profession and practicing psychologists are indeed health care providers.

I have been interested in RxP for a while now and did my dissertation on the topic. As part of it, I conducted a national, randomly-selected survey of practicing psychologists on their opinions about RxP. I had a response rate of 44% and 84% of respondents either agreed or strongly agreed that appropriately trained psychologists should be allowed to prescribe. Unfortunately, although I intended to submit this for publication, I never got around to it with post-doc, then private practice, followed by my venture into the NP world. I've thought about re-conducting the survey again now and comparing the results of the two - perhaps in the future sometime.

I do think there is some legitimate concern about the 'medicalization of psychology.' However, my response is that psychology is already being substantially medicalized but without our input. If we are not able to fully be part of the decision making process, then we are and will remain ancillary providers and have no say regarding to what extent our practice is being medicalized.

It really is no different than other psychology post-doctoral specialties (neuro, forensics). Most won't pursue the training, but the option should be available for those who desire it. Especially when one takes the future of psychological practice into consideration.

 

[psychmama]

T
I do think there is some legitimate concern about the 'medicalization of psychology.' However, my response is that psychology is already being substantially medicalized but without our input. If we are not able to fully be part of the decision making process, then we are and will remain ancillary providers and have no say regarding to what extent our practice is being medicalized.

I agree on this point. Thanks for offering your perspective.

 

[psychwhy]

I believe my clinical skills are valuable, but the government (i.e., medicare) seems to think $50.00 an hour or so is acceptable (factoring in actual hours worked by billables and denials). How do you reasonably fight the government? We have universal healthcare right around the corner. What's that going to do?

I'm not sure where people are getting their data, but in upstate NYS (NOT NYC), the Medicare reimbursement rate for a 90806 is $97.45. Sorry, but I think nearly $100/hr is a reasonable reimbursement. I understand that rates are set regionally ... but where is being paid $50?

I do agree that academia is a rewarding experience. I like it. It's fun. But, I also kind of had high hopes for the field in general when I started down this road. Now, not so much.

 

[psychwhy]

I believe my clinical skills are valuable, but the government (i.e., medicare) seems to think $50.00 an hour or so is acceptable (factoring in actual hours worked by billables and denials). How do you reasonably fight the government? We have universal healthcare right around the corner. What's that going to do?

I'm not sure where people are getting their data, but in upstate NYS (NOT NYC), the Medicare reimbursement rate for a 90806 is $97.45. Sorry, but I think nearly $100/hr is a reasonable reimbursement. I understand that rates are set regionally ... but where is being paid $50?

I also believe that currently we are hamstrung by anti-trust regulations which prevent collective negotation with various health care insurers about rates. This means we have dozens of practitioners in a region, none of whom are legally permitted to discuss their rates with each other, basically forced to go one-on-one with the insurers who KNOW what everyone is being paid. They get to say "Want access to our subscribers? $40/hr is our max reimbursement."

If, however, we had a public option -- there would be only ONE agency to
lobby and I do not believe we would hobbled by the same anti-trust limitations. It would all be public.

I do agree that academia is a rewarding experience. I like it. It's fun.

As do I ... and I started this journey KNOWING that I would combine teaching and clinical practice. Fortunately, I am also qualified in one of those rare psych "cash cows" -- forensic evaluation -- so I probably have a rosier future than many of my colleagues.

That said, I still think a plain vanilla clinical psychologist should be able to make a low six figure income just like the chiropractor, podiatrist, and nurse practitioners, most of whom do not have to be encouraged to "branch out" into non-clinical ventures in order to make a reasonable living.

 

[PrisonPsych]

I'm not sure where people are getting their data, but in upstate NYS (NOT NYC), the Medicare reimbursement rate for a 90806 is $97.45. Sorry, but I think nearly $100/hr is a reasonable reimbursement. I understand that rates are set regionally ... but where is being paid $50?

Yeah, when the patient actually shows up. Only direct patient contact is billable, though - doesn't account for paperwork time, completing authorization requests, fighting them when they deny you, no shows, phone contacts, etc., etc. And the no-show rate for Medicare/Medicaid clients is *high*.

 

[deleted176373]

If, however, we had a public option -- there would be only ONE agency to
lobby and I do not believe we would hobbled by the same anti-trust limitations. It would all be public.

That said, I still think a plain vanilla clinical psychologist should be able to make a low six figure income just like the chiropractor, podiatrist, and nurse practitioners, most of whom do not have to be encouraged to "branch out" into non-clinical ventures in order to make a reasonable living.

1. If you believe that government run health care is going to help us as a profession, I think that you are gravely mistaken.

2. Are you making a 6 figure income? Anecdotal evidence suggests, from what I see, that many early career psychologists don't.

Mark

 

[tomfooleries]

The pessimism in this thread makes me wonder why anyone would choose clinical psych as a profession. And I have spent the past two years 2,000 miles from home, as an RA, so I could become research reliable on the "gold standard" measures of autism evaluations in order to be a competitive candidate for clinical psych programs.

The pre-reqs for med school take two years, right? Even though care is heavily standardized, at least I would be compensated for the hard work put forth in graduate school and the long hours at work.

I honestly want to make something more of neuropsych, but I imagine the percentage of quacks to be high as well, and the amount of respect they receive in academia, despite increased consultation with physicians, to be minimal.

 

[Cosmo75]

I'm pretty sure I could write a similar tirade about working in the corporate IT world....the ridiculous hours, the outsourcing, the corporate bull***t politics, the constant need to be connected to your crackberry/email/phone, meetings to prep for meetings that are preparation for the actual meeting, the stupid end-users, etc. etc. etc.

Much of our happiness in a profession comes from things other than the level of compensation that we get. So I suppose if you focus on how not making 6 figures is some sort of abomination, then yes you're likely going to be disappointed in this field. The points raised here are valid and should be discussed. I had some professors who shared similar negativity about reimbursement and average salaries. However, I take these comments with a grain of salt. I'm prepared for what may be a challenging road, but as someone who walked away from a 6 figure salary in IT I have zero qualms about my decision to come back to clinical psych. I suspect with the niche I've carved for myself that I'll do ok in terms of money. But money certainly wasn't a primary motivator.

 

[psychwhy]

1. If you believe that government run health care is going to help us as a profession, I think that you are gravely mistaken.

2. Are you making a 6 figure income? Anecdotal evidence suggests, from what I see, that many early career psychologists don't.

Mark

1) If you believe that unilaterally declaring that "government run health care" is the problem, you are sadly uninformed and doing a disservice to legitimate dialogue.

When people are willing to look past the talking points and propaganda, there are multitudes of examples of how government-run, assisted, fully- or partially-funded programs are more than able to be operated well -- in other countries and here in the US!

Is government sponsored health care perfect? Of course not.
However, it is just stunning that many Americans reflexively dismiss successful programs from around the world (or parts of the country they feel do not represent "real" America).

[You might want to read Bob Herbert's column in the NY Times about a federally supported network of community health care clinics in Vermont which has essentially provided universally accessible medical and dental care in the state - http://www.nytimes.com/2009/08/15/opinion/15herbert.html]

Prisonpsych, there are no show problems with private insurance as well! Part of the reason is the reputation we've allowed to flourish that mental health care is not "real" health care and therefore of questionable value. Establish a pervasive and recognizable message that good mental health impacts physical health and improves quality of life then more people will make it a priority. (Oh, simplifying access would help too!)

Additionally, paperwork is not unique to Medicare/Medicaid -- try navigating "provider panels" or "utilization reviews" of the private companies. Oh, and the claim problems with Medicare/Medicare are less about the program and more about the private claims processors that "anti-government/free market" advocates insisted be inserted between the providers and the program to allow funds to be channeled from direct care to corporate bureaucrats (how's that for irony?)!

2) I never suggested that an early career psychologist should be making six figures -- that would be rather arrogant. Remember the BLS statistics average all members of a profession, from the brand new to the most senior.

But, personally, once I am able to navigate the choppy waters of post-doc and licensure, I will be in line for a six figure income with a combination of clinical and teaching work - in large part because I live in a shortage area.

 

[psychwhy]

I'm pretty sure I could write a similar tirade about working in the corporate IT world....the ridiculous hours, the outsourcing, the corporate bull***t politics, the constant need to be connected to your crackberry/email/phone, meetings to prep for meetings that are preparation for the actual meeting, the stupid end-users, etc. etc. etc.

Cosmo, of course there are many factors in job/life satisfaction.
(Study for the EPPP and you'll be immersed in many of the theories!)

But in this case it boils down to the cost-benefit ratio.

Yes, there are some untangibles involved in our profession.
What is directly measureable, however, is what we must endure in order to qualify for the profession and the average compensation one will likely receive.

When an IT grad with a BS starts off making $50K and a PhD/PsyD psychologist starts of making the same thing, it is only natural that the psychologist is going to look back the mountain climbed to arrive at the same (financial) location and ask "Was it worth it?"

Hopefully, it is not all boiled down to the bucks.
But even if you are feeling professionally fulfilled, when you drive home in your 10+ year old car, to your rented residence in a working-class neighborhood, with garage sale furnishing, etc., etc., it is likely you will ask "Was it worth it?"

 

[cara susanna]

Must.. not... step... into...universal...healthcare...debate...

 

[RileyG]

Much of our happiness in a profession comes from things other than the level of compensation that we get. .

 

[cara susanna]

Oh, screw it.

psychwhy: What about the government-funded healthcare programs that don't work? Because there are plenty of them as well.

Finally, I think markp's point is that wages for medical professionals will go down with universal healthcare, which is pretty much certain. The government will likely seek to cut costs of the program by lowering salaries.

 

[Cosmo75]

Hopefully, it is not all boiled down to the bucks.
But even if you are feeling professionally fulfilled, when you drive home in your 10+ year old car, to your rented residence in a working-class neighborhood, with garage sale furnishing, etc., etc., it is likely you will ask "Was it worth it?"

This made me chuckle. I drive a 13 year old car, which I love and have no intention of upgrading any time soon. Partially because I rely on public transportation most of the time (gasp! A *doctor* on the subway??). And it's a classic style BMW that is so much prettier than what they make now But that's not really important.

I owned a townhouse when I was still making "crappy" wages in IT (~50K/yr). I had student loan payments at the time, though they were considerably smaller than my doctoral loan payments will be. I now own a house in a nice neighborhood without any garage sale furnishings. Grant it I'm married and we're DINKs (dual income, no kids...just in case).

So yes, I am satisfied and am not looking back saying "was it worth it?" I am older and took time off to work in between undergrad and grad school. I've already worked my way up from low wages once, so maybe that's why I don't see it as such a big deal now. My post-doc pay is about what I made at my first IT job 6 years ago. Now that I have to build my earnings up all over again, I don't stay up at night worrying about it in the slightest.

 

[socialcog]

My understanding is that you definitely won't see psychiatrists doing therapy in hospitals, but they can do private practive if they so chose. My understanding is also that this is far, far, far less lucrative than med management.

Yes. Often the attendings will not do therapy as the inpatient level of care is, for the most part, for brief stabilization periods--anywhere from 3-14 days. Further, many of the patients are admitted to the hospitals by MDs that do not follow them on an outpatient basis. The attending MDs are often those with admitting privileges and are chosen from a short rotation list of docs. So the focus is to stabilize with meds and discharge to the outpatient team which may involve the IP attending but often does not.

btw, this thread (ie: dose of reality) makes me sad.

 

[socialcog]

Respect in academia for neuropsychology and psychology in general is very high. Psychology is a broad academic discipline.

thank you. This is hopeful. However, does RESPECT= increase salary?

 

[tomfooleries]

Respect in academia for neuropsychology and psychology in general is very high. Psychology is a broad academic discipline.

Is that right? I imagine neuroscientists to be received with some respect. I witness the lack of respect clinical psychologists receive every day.

I work in an academic center renowned for early-intervention research and assessment of autism. The past year, I've worked on a repository study designed to create a stadard of care. Our meetings consisted of 4 or 5 psychologists, a developmental pediatrician, neurologist, child psychiatrist, neurogeneticist, gastroenterologist, sleep specialist. The psychologists were expected, on every occassion, not to speak. The PI of the study, a world renowned psychologist, hardly spoke. If they did, they were met with opposition. They are open with one another, and those of us working for them, about how irritating it is. One of the psychologists has been there 20 years, another is young and flirting with "guru" status, well-known, already, throughout the country.

thank you. This is hopeful. However, does RESPECT= increase salary?

There's no money in academia for assessment. So increased salary means private practice; and how is one to build a private practice, with any sort of specialty, without spending significant time in academia? (that is, after 7 years of further education, and another 2 for post-doc).

I get so irritated by those who don't care about salary. How do you sleep at night? You've spent the better part of your youth in school, working your tail off (often) in an extremely competitive environment. Your services are as necessary, in academia, as those of the physicians in many cases. And yet, your pay will mirror that of the 23 year-old that does 3 hours of actual work each day, buried away in his cubicle.

 

[cara susanna]

It's not that we don't care, it's that we don't see it as a reason to stay away from a career that interests us and which we enjoy.

 

[Cosmo75]

It's not that we don't care, it's that we don't see it as a reason to stay away from a career that interests us and which we enjoy.

Agreed

 

[helga]

I work in an academic center renowned for early-intervention research and assessment of autism. The past year, I've worked on a repository study designed to create a stadard of care. Our meetings consisted of 4 or 5 psychologists, a developmental pediatrician, neurologist, child psychiatrist, neurogeneticist, gastroenterologist, sleep specialist. The psychologists were expected, on every occassion, not to speak. The PI of the study, a world renowned psychologist, hardly spoke. If they did, they were met with opposition. They are open with one another, and those of us working for them, about how irritating it is. One of the psychologists has been there 20 years, another is young and flirting with "guru" status, well-known, already, throughout the country.

The ATN project is explicitly focused on defining a standard of medical care for people with asd. Given this mandate its pretty obvious why the psychologists on the team are not playing leading roles in discussions. I worked in the same type of academic medical center and found that the psychologists tend to lead when the topics are in their explicit areas of expertise (i.e. diagnostic issues, cognitive profiles, etc) and the MDs lead when the issues are in their areas of expertise (i.e. meds, suspected neurological issues, etc). Be aware that each research team has its own dynamics.

 

[futureapppsy2]

I work in an academic center renowned for early-intervention research and assessment of autism. The past year, I've worked on a repository study designed to create a stadard of care. Our meetings consisted of 4 or 5 psychologists, a developmental pediatrician, neurologist, child psychiatrist, neurogeneticist, gastroenterologist, sleep specialist. The psychologists were expected, on every occassion, not to speak. The PI of the study, a world renowned psychologist, hardly spoke. If they did, they were met with opposition. They are open with one another, and those of us working for them, about how irritating it is. One of the psychologists has been there 20 years, another is young and flirting with "guru" status, well-known, already, throughout the country.

On the flip side, I've worked on a grant proposal with a very multi-disciplinary team--counseling psychs, a clinical psych, an IM MD, a statistician, a nurse, and an advocate/policy person, and we (even I, an UG RA) were allowed and encouraged to speak during meetings and via email. The proposed PI (a Counseling Psych) was treated as the PI and with much--greatly deserved, imo--respect, as were the other psychologists on the team.

 

[psychwhy]

[tried to delete]

 

[psychwhy]

It's not that we don't care, it's that we don't see it as a reason to stay away from a career that interests us and which we enjoy.

But let's expand it then ...

Some here have already come out as asserting that mid-levels have "taken" therapy from us and make pretty much the same wages. Given that, what's the benefit -- personal, spiritual, professional, karmic -- for spending more time, exerting more effort, enduring more turmoil to become psychologists?

I'm sure there will be a few folks for whom the plan has always been securing a faculty/researcher position at an R1 university. Obviously, such a person needs a PhD from a top-notch school for that career plan.

But for those who are seeking the training primarily to become clinicians -- why? Why didn't you go social work, nurse practitioner, MA in Counseling (especially since many suggest securing an LMHC/LPC license during post-doc to be able to earn a living)?

Cosmo: I owned a townhouse when I was still making "crappy" wages in IT (~50K/yr). I had student loan payments at the time, though they were considerably smaller than my doctoral loan payments will be. I now own a house in a nice neighborhood without any garage sale furnishings. Grant it I'm married and we're DINKs (dual income, no kids...just in case).

Happy for you ... really!
But why should psychology require DINK finances?
1) Should a doctoral practitioner need a second income to achieve a decent standard of living; and
2) Some of us actually have/desire families.

My wife used to say that being a schoolteacher was the last profession which expects practitioners to martyr themselves for the "nobility" of the calling.
Seems psychology expects the same.

 

[cara susanna]

psychwhy: Because I genuinely believe there are differences in the training of a midlevel practitioner vs. a psychologist. I want the highest quality training I can receive.

Well, that and my love of research.

 

[deleted176373]

1) If you believe that unilaterally declaring that "government run health care" is the problem, you are sadly uninformed and doing a disservice to legitimate dialogue.

Believe me, after 12 years of military service, I know what government run health care looks like... and it can be very good or very bad. How long have you had experience with government run health care?

I won't wade deeply into this debate, but be careful what you wish for...

My point is precisely as Cara mentioned, I worry about the continued erosion of the field by other less trained professionals. Look at Military medical, most times your primary care "physician" is a PA and not a physician, they may even be an independent duty corpsman with no more than a high school education and vocational school. Where does this leave the general practitioner?

2) I never suggested that an early career psychologist should be making six figures -- that would be rather arrogant. Remember the BLS statistics average all members of a profession, from the brand new to the most senior.

But, personally, once I am able to navigate the choppy waters of post-doc and licensure, I will be in line for a six figure income with a combination of clinical and teaching work - in large part because I live in a shortage area.

Why not???

I do not think that it's unreasonable for an early career psychologist (in particular a graduate of a professional program) who has invested 5 or 6 years of their life and spent well in excess of $100k in pursuing a professional degree to earn a 6 figure salary.

Hell, graduates of top law schools are spending 1/2 that time in school and if you go to one of the top programs the AVERAGE starting salary is $160k, and if you go to a top tier school it's in excess of $100k!

Mark

 

[Therapist4Chnge]

*MOD NOTE: Please direct all political/healthcare related talk over here: http://forums.studentdoctor.net/showthread.php?t=657286 *

 

[Cosmo75]

Happy for you ... really!
But why should psychology require DINK finances?
1) Should a doctoral practitioner need a second income to achieve a decent standard of living; and
2) Some of us actually have/desire families.

My wife used to say that being a schoolteacher was the last profession which expects practitioners to martyr themselves for the "nobility" of the calling.
Seems psychology expects the same.

The only reason we require DINK finances right now is I'm just getting started. My point wasn't that I would rely on the 2nd income forever, but that it certainly is helpful as I start out and is a reason why I am where I am right now. I have every intention of making more later in my career than I do as a post-doc.

It has nothing to do with martyrdom at all. I'm curious why it is so difficult for some people to understand that some people genuinely are seeking a comfortable living wage and aren't striving for a massive salary? And that we can be perfectly content with that? And that contentedness does not equate to complacency or mediocrity, rather seems to lead to considerably less anxiety. These questions are probably more applicable at our societal level rather than solely applying to people in clinical psych. But that's a whole other discussion.

 

[tomfooleries]

The only reason we require DINK finances right now is I'm just getting started. My point wasn't that I would rely on the 2nd income forever, but that it certainly is helpful as I start out and is a reason why I am where I am right now. I have every intention of making more later in my career than I do as a post-doc.

It has nothing to do with martyrdom at all. I'm curious why it is so difficult for some people to understand that some people genuinely are seeking a comfortable living wage and aren't striving for a massive salary? And that we can be perfectly content with that? And that contentedness does not equate to complacency or mediocrity, rather seems to lead to considerably less anxiety. These questions are probably more applicable at our societal level rather than solely applying to people in clinical psych. But that's a whole other discussion.

I actually do understand this train-of-thought. And I most likely will pursue a career in clinical psych. It just doesn't seem fair; the work for a very skilled, conscientious clinician seems to warrant a larger salary. I don't mean to attack the professional as a whole at all, and I feel badly for having done so here - my apologies for being abrasive. I'm just struggling with this notion at this particular stage in my life. I've sacrificed a lot already - as all of us have, respectively - just to make clinical psych an option for my future. And I know now, more than ever, just how draining (albeit rewarding) the work can be.

 

[Cosmo75]

I actually do understand this train-of-thought. And I most likely will pursue a career in clinical psych. It just doesn't seem fair; the work for a very skilled, conscientious clinician seems to warrant a larger salary. I don't mean to attack the professional as a whole at all, and I feel badly for having done so here - my apologies for being abrasive. I'm just struggling with this notion at this particular stage in my life. I've sacrificed a lot already - as all of us have, respectively - just to make clinical psych an option for my future. And I know now, more than ever, just how draining (albeit rewarding) the work can be.

No need for apologies. I also understand how it is unfair for clinical psychologists not to make more. I guess I've decided not to get bent out of shape about it. For one, I have no idea where I will end up in the salary spectrum. For every story of a clinician making "peanuts" there are stories of those making 6 figures.

I'm a little bit older (33) which doesn't make me some friggin' sage, but I've had time to have some experiences that reshaped how I view things now. In my early 20's I was focused on making more money and diverted into a career that would certainly allow for that. Then around 27 I had a "come to jesus" moment in my previous career which led me back to psychology. That has a lot to do with my current perspective on what's important in my life.

 

[hkusp]

The pay differential between medicine and psychology is largely due to the history of non-parity for MH. Psychologists have not done themselves any favors by not paying attention to the money issue.

I think that once full MH parity arrives in 2010 the pay differentials will be decreasing. Think of the average psychologist making $120 per hour. The copay is 50% so the health insurance company pays $50 of their "allowable" $100. The patient pays the other $50 - maybe. The other $20 is stiffed. When things change to the average 80/20 is now $20 to the Patient. Guess who is coming more often now?

Most folks don't pay much attention to the cost of medical health care because they don't "pay" for it directly at the appointment beyond a small $20 copay. It will not surprise me if they start doing that with MH when it is reimbursed at the same rates.

The insurance companies don't mind MH parity becuase they discovered that MH care actually decreases medical care costs. Imagine that!!

 

[DrTLin]

Just wanted to add some points to the discussion:

I agree with a post by Ollie123, I am not really having a very touch time as a graduate student as well and things are not as difficult as graduate reference or tip books say including what other's say. Every graduate school experience is different and we should probably keep in mind that the intensity or lack thereof of a program, is probably due to the individual, the individual's lifestyle, etc.
Living as a graduate student isn't always easy, there are definitely times when things are hard and a bit discouraging (like most of life). But for the most part, living as a graduate student if you spend wisely (use coupons and catch sales), purchase fuel economy cars (such as small Fords), spend less at Starbucks and other resturants, and be willing to spend less than $600 a month, you will be just fine.

As far as the difficulty of juggling life and graduate school in psychology, my experience so far is rather easy and more easy than I expected. A full-time student in my program takes only 3-4 classes. Most of my week is free for studying or working. We meet only once a week for 3hrs and sometimes for 2hrs. It is rather smooth sailing, especially as long as you are willing to study and stay up on your work. The only thing I can see really impeding a smooth sailing graduate school career is money. Sometimes assistantships or fellowships do not come in, causing you to borrow more, call grandma, or work more hours off-campus.

Otherwise, I think some of the media's reports and even the commenters statements on post-graduate school finances are perhaps a bit overexaggerated. $3,300 a month certainly is not bad especially if you save and spend less (even after taxes). Loans may take most of your money, but who really needs cable, to pay high rent or mortgage, coffee every morning from Starbucks, or to shop for Raph Lauren clothing? Thrift stores, home bought coffee, living with parents, siblings, or trusted friends (that is, until you can afford to live alone), and utilizing DVD's, the radio, or the internet instead of cable can work just fine!
You can go to the Bureau of Labor Statistics at: http://www.bls.gov/oco/ocos056.htm for information on salary by field and state. Some states such as Pennsylvania pay psychologists or professonal licensed counselors less per hour than states such as Ohio. If you ask me...$36,00 really isn't that bad either. I assume one would have to just get use to spending less and spending wisely. If you purchase only the essentials, you can still have a good amount left to save and build on.

The internship process can be made easy if you do your research ahead of time using graduate school reference guides. I found it easy to search for potential practicum and internship sites a year or few months before I needed to apply. When the time came, I was able to choose one site out of say 10 different sites I had pre-searched.
Staying up on things and doing much research about the internship process should make things go more easy. This is really the least of our troubles!!!
Here are a few books that might be of help:

Insider's Guide to Graduate Programs in Clinical and Counseling Psychology: 2008/2009 Edition (Insider's Guide to Graduate Programs in Clinical Psychology) - Paperback by John C. Norcross Phd, PhD Michael A. Sayette PhD, and Tracy J. Mayne PhD

The Complete Guide to Graduate School Admission: Psychology, Counseling, and Related Professions - Paperback (Mar 1, 2000) by Patricia Keith-Spiegel and Michael W. Wiederman

Life After Psychology Graduate School: Insider's Advice from New Psychologists - Paperback (May 1, 2004) by Robert D. Morgan

 

[edieb]

I am sorry but your statement is ludicrous. Whether you believe so or not, we deserve fair compensation for our work Attitudes like yours are precisely why we are underpaid. You may be happy living with mom and dad, but don't drag the rest of us down with you!

Just wanted to add some points to the discussion:

I agree with a post by Ollie123, I am not really having a very touch time as a graduate student as well and things are not as difficult as graduate reference or tip books say including what other's say. Every graduate school experience is different and we should probably keep in mind that the intensity or lack thereof of a program, is probably due to the individual, the individual's lifestyle, etc.
Living as a graduate student isn't always easy, there are definitely times when things are hard and a bit discouraging (like most of life). But for the most part, living as a graduate student if you spend wisely (use coupons and catch sales), purchase fuel economy cars (such as small Fords), spend less at Starbucks and other resturants, and be willing to spend less than $600 a month, you will be just fine.

As far as the difficulty of juggling life and graduate school in psychology, my experience so far is rather easy and more easy than I expected. A full-time student in my program takes only 3-4 classes. Most of my week is free for studying or working. We meet only once a week for 3hrs and sometimes for 2hrs. It is rather smooth sailing, especially as long as you are willing to study and stay up on your work. The only thing I can see really impeding a smooth sailing graduate school career is money. Sometimes assistantships or fellowships do not come in, causing you to borrow more, call grandma, or work more hours off-campus.

Otherwise, I think some of the media's reports and even the commenters statements on post-graduate school finances are perhaps a bit overexaggerated. $3,300 a month certainly is not bad especially if you save and spend less (even after taxes). Loans may take most of your money, but who really needs cable, to pay high rent or mortgage, coffee every morning from Starbucks, or to shop for Raph Lauren clothing? Thrift stores, home bought coffee, living with parents, siblings, or trusted friends (that is, until you can afford to live alone), and utilizing DVD's, the radio, or the internet instead of cable can work just fine!
You can go to the Bureau of Labor Statistics at: http://www.bls.gov/oco/ocos056.htm for information on salary by field and state. Some states such as Pennsylvania pay psychologists or professonal licensed counselors less per hour than states such as Ohio. If you ask me...$36,00 really isn't that bad either. I assume one would have to just get use to spending less and spending wisely. If you purchase only the essentials, you can still have a good amount left to save and build on.

The internship process can be made easy if you do your research ahead of time using graduate school reference guides. I found it easy to search for potential practicum and internship sites a year or few months before I needed to apply. When the time came, I was able to choose one site out of say 10 different sites I had pre-searched.
Staying up on things and doing much research about the internship process should make things go more easy. This is really the least of our troubles!!!
Here are a few books that might be of help:

Insider's Guide to Graduate Programs in Clinical and Counseling Psychology: 2008/2009 Edition (Insider's Guide to Graduate Programs in Clinical Psychology) - Paperback by John C. Norcross Phd, PhD Michael A. Sayette PhD, and Tracy J. Mayne PhD

The Complete Guide to Graduate School Admission: Psychology, Counseling, and Related Professions - Paperback (Mar 1, 2000) by Patricia Keith-Spiegel and Michael W. Wiederman

Life After Psychology Graduate School: Insider's Advice from New Psychologists - Paperback (May 1, 2004) by Robert D. Morgan

 

[erg923]

living with parents, siblings, or trusted friends (that is, until you can afford to live alone),

You have got to be sh--ting me pal. How out of touch are you? Do you actually believe this is an option for most people? What world are you in? Moreover, do you really think its appopriate to tell people to adopt your thrifty values and mooching so we can justify being underpaid? Yea....thats why we came to get a ph.d..... so we wouldnt have enough money to live in a decent neighborhood and apartment therefore we can just mooch off mom and dad at the age of 30! You actually think that is a reasonable expectation and that we would should just accept it? I sure my wife would be pleased if we moved in my mom and dad....right? by this point in outr lives, many oif us are not living "alone." Some people even have...(gasp)...families of their own.

And seriously.....you think the fact that psych is so undervalued that predoc internships programs are losing funding for spots and that the market is so flooded that there were 700 more people appplying for predoc intership this year than there were spots doesnt suggest big trouble somehow? I am not all that worried about matching myself, but you honestly think this is not a big problem for people and the profession at large? It sure as heck suggests a huge underlying problem to me! And how do you think this makes psych look in he eyes of the medical profession?

 

[cara susanna]

I am a poor grad student and I am still forking over money for cable TV. I will never, ever be able to go without cable TV. I mean, I'd survive, but I'd be miserable.

 

[hamsterpants]

You have got to be sh--ting me pal. How out of touch are you? Do you actually believe this is an option for most people? What world are you in? Moreover, do you really think its appopriate to tell people to adopt your thrifty values to we can justify being underpaid? Yea....thats why we came to get a ph.d..... so we wouldnt have enough money to live in a decent neighborhood and apartment therefore we can just mooch off mom and dad at the age of 30! You actually think that is a reasonale expectation and that would should just accept it?

And seriously.....you think the fact that psych is so undervalued that internships are losing funding and that the market is so flooded that there were 700 more people appplying for intership than there were spots doesnt suggest big trouble somehow? I am not all that worrieds about matching myself, but you honestly think this is not a big problem for people? And how do you think this makes psych look in he eyes of the medical profession?

Agreed. Some of us don't have parents we can mooch off of. In fact some of us may need to support parents in the not so far future. I have been in the working world (and I have a BA from a well regarded school) for over 12 years and I still have problems making ends meet. I have no tv and no car. I don't buy designer clothes. and yes, I make my coffee at home.

 

[coloradocutter]

A random thought for a late night of reading journal articles that involves more levity than thinking that I am pursuing a dead end profession after exiting one. It's a hard niche to get into, but it does exist. People in my former profession (law) and others (medicine, etc.) do not want any record of psychotherapy. If you have psychotherapy, it's contained in a written record, somewhere. If it affects your professional handling of a case, it would matter in law. Your therapist would not be obligated to disclose perhaps, but you would. If you try to get professional liability insurance or life insurance, boom your premium just goes through the roof. Your therapist is not going to lie on an insurance questionnaire under penalty of perjury and you just have to deal with the disclosure or you get no insurance. Lawyers are generally just a great source of money. Most are substance abusers and severely depressed and then they want to pay out of pocket. You just can't go wrong. Seriously, I worked in a large law firm, and it was not uncommon, at least for the female associates and partners openly to mention "an appointment with their therapist."

 

[Therapist4Chnge]

I have a family friend who was hired by a large firm (not law) to be "available" for the management. No insurance record, no notes, etc. He is paid to be there on certain days and gets paid regardless if someone uses his services. Talk about a sweet gig! Unfortunately those kind of gigs are few and far between.

 

[DVel]

People in my former profession (law) and others (medicine, etc.) do not want any record of psychotherapy.

I understand the desire for many to have their therapy sessions "off-the record", however, isn't that completely unethical to not have notes? How do people in this niche deal with the records issue?

 

[deleted176373]

I understand the desire for many to have their therapy sessions "off-the record", however, isn't that completely unethical to not have notes? How do people in this niche deal with the records issue?

If you are not providing "psychotherapy", but simply there to act as a management and performance consultant I don't think it's unethical to work without notes. It's a different and non-medical role that a clinical psychologist with the right training could be perfect for. It makes little sense to have therapy notes when you are not doing therapy.

Now if you were providing under the radar therapy to people and not documenting it, that could be unethical. It's all a matter of the role that you are in. I don't document how I interact with my classmates and underclassmen who seek my advice with school, I do however give them valuable advice, some of which may be psychological in nature... but certainly is not a form of therapy. In mentoring them, am I now required to have notes? I would hardly think so, unless it was formal supervision.

Mark

 

[psychmama]

I have a family friend who was hired by a large firm (not law) to be "available" for the management. No insurance record, no notes, etc. He is paid to be there on certain days and gets paid regardless if someone uses his services. Talk about a sweet gig! Unfortunately those kind of gigs are few and far between.

Oh man, would I love that gig!

 

[Therapist4Chnge]

Oh man, would I love that gig!

Ditto....but the people who get those gigs tend to be very experienced and in demand, so I think I have a few years before that.

 

[psychmama]

Ditto....but the people who get those gigs tend to be very experienced and in demand, so I think I have a few years before that.

drat!

 

[Minnesotan4PsyD]

I am a poor grad student and I am still forking over money for cable TV. I will never, ever be able to go without cable TV. I mean, I'd survive, but I'd be miserable.

My sentiment exactly, haha. I have never lived without cable TV, so to try to do so now would be impossible. I'll gladly fork over extra $ a month for cable tv/high-speed internet.