What is the career outlook for neuropsychologists?

[biogirl236]

I love psychology and neuroscience and want a job that involves research. If I pursue this field, will I have a hard time finding a job? Is this a very small field?

I'm considering a clinical job, and would like to contribute to scholarly articles as well.

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[WisNeuro]

Clinical job, AMC job, faculty at R1, faculty at AMC, etc? Depends on what you want to do, the outlook is fairly wide ranging depending on role.

 

[smalltownpsych]

Not if you are highly capable and skilled. Becoming a clinical psychologist of any kind is highly competitive, but if you can navigate the countless hurdles, it is likely that you will be employed and adequately compensated. Neuropsychology has a slightly more challenging path in some ways (e.g., board certification), but also leads to mo' money according to most salary surveys.

 

[Therapist4Chnge]

If you do a search, there have been a number of recent threads about the future of the field and the future of neuropsych.

1. Go to a solid program.
2. Match to an APA internship.
3. Secure a 2yr neuro or neuro-rehab fellowship.
4. Get boarded.
5. Work at an AMC, VA, or private practice.

This is not easily done, but if you jump through the hoops you should do just fine. Cut any corners...and you'll be limited to private practice and you may or may not be competitive.

 

[psych.meout]

Clinical job, AMC job, faculty at R1, faculty at AMC, etc? Depends on what you want to do, the outlook is fairly wide ranging depending on role.

When you say "AMC job" and "faculty at AMC," are these primarily clinical roles vs teaching/supervision and research roles, respectively?

 

[Therapist4Chnge]

All of those options. They have 100% clinical, 100% research, and blended positions. Generally the best pay is outside of psychology dept, places like Neurology, PM&R, etc.

 

[Pragma]

FIRE and BRIMSTONE!

 

[ClinicalABA]

I know that there is currently a strong demand for pediatric neuropsychologists in my area (actually in my office!)

 

[Therapist4Chnge]

Not to be a wet blanket, but students (and prospective students) are best served to really investigate the variety of speciality areas because what students think they are and what they are in practice can be very different worlds. In the neuropsych world it is definitely not all puppy dogs and neurons. Neuroscience is a part of it, but there is a lot of other technical knowledge about psychometrics, statistics, and other fascinating areas of study that can really liven up a dinner party. For every discussion I have with colleagues about differentials for different dementias I have five discussions about which medical code are "accepted" and three discussions about how to respond to the latest set of requests from lawyers trying to get free work from me in the form of a "quick letter" or "summary stating if there is a causal relationship" for their client's injuries. My standard score conversion sheets are worn like old money…even though I know most by memory at this point. The training path is long and the competition is some of the hardest amongst specialities. The boarding process is…challenging.

The work isn't for everyone, as it tends to be quite different in day to day practice than most other areas of clinical psychology. You better love statistics, be very comfortable going through research, and have strong mentorship or it will be a very rough road. Even with great mentorship you will constantly need to read, learn, and adapt. The work can be pretty isolating (at least in private practice) and you will spend a ton of time reviewing records and writing reports. If you do your own testing that has its own challenges. Most clinicians don't read your reports or might only read the last page, but you still need to write an adequate report in case you need to go to court and defend your findings 3 years later because even though the patient said they weren't involved in litigation…they were…and now you got dragged into it.

In a hospital setting there is constant pressure to see more patients in less time and work faster. Being able to really take time with a case is often at the expense of your own time (unless you are cash pay); like I'm doing tonight. :/ Cases can be interesting, but other times it's like making sausage….something that most people really don't want to see or do. You'll also probably deal with lawyers with some frequency (more for certain areas of practice) and many people won't understand what you do.

Just some thoughts about the other side of things.

 

[biogirl236]

Not to be a wet blanket, but students (and prospective students) are best served to really investigate the variety of speciality areas because what students think they are and what they are in practice can be very different worlds. In the neuropsych world it is definitely not all puppy dogs and neurons. Neuroscience is a part of it, but there is a lot of other technical knowledge about psychometrics, statistics, and other fascinating areas of study that can really liven up a dinner party. For every discussion I have with colleagues about differentials for different dementias I have five discussions about which medical code are "accepted" and three discussions about how to respond to the latest set of requests from lawyers trying to get free work from me in the form of a "quick letter" or "summary stating if there is a causal relationship" for their client's injuries. My standard score conversion sheets are worn like old money…even though I know most by memory at this point. The training path is long and the competition is some of the hardest amongst specialities. The boarding process is…challenging.

The work isn't for everyone, as it tends to be quite different in day to day practice than most other areas of clinical psychology. You better love statistics, be very comfortable going through research, and have strong mentorship or it will be a very rough road. Even with great mentorship you will constantly need to read, learn, and adapt. The work can be pretty isolating (at least in private practice) and you will spend a ton of time reviewing records and writing reports. If you do your own testing that has its own challenges. Most clinicians don't read your reports or might only read the last page, but you still need to write an adequate report in case you need to go to court and defend your findings 3 years later because even though the patient said they weren't involved in litigation…they were…and now you got dragged into it.

In a hospital setting there is constant pressure to see more patients in less time and work faster. Being able to really take time with a case is often at the expense of your own time (unless you are cash pay); like I'm doing tonight. :/ Cases can be interesting, but other times it's like making sausage….something that most people really don't want to see or do. You'll also probably deal with lawyers with some frequency (more for certain areas of practice) and many people won't understand what you do.

Just some thoughts about the other side of things.

Thank you for your insight and honesty. I certainly would like to have a good amount of human interaction within a job, as well as the ability to take as much time as needed with patients without the constant pressure to move on to the next. I am fond of seeing the same patients repeatedly rather than seeing someone new everyday. I really do enjoy psychology, but I feel I will miss the technical or research-oriented aspects of science that are not present in some psych-oriented jobs, so I would definitely like to find a career that employs those to a certain extent.

 

[PsyDr]

I'll add that for most neurological disease states, there is a heart breaking story behind it. Tell a few dozen people with glioblastoma that their life expectancy is about 14-18 months. Or a few dozen persons suffering from hiv dementia that their life expectancy is measured in months. Keep going. The available and effective treatments for Major neurocognitive disorder due to probable ftd or Alzheimer's?


Give that feedback for 4-8hrs a week to devastated families. Imagine that part. Because it's a thing.

 

[Therapist4Chnge]

I am fond of seeing the same patients repeatedly rather than seeing someone new everyday.

The vast majority of neuropsych and work is an out-pt consult model. You see a patient for an intake, then testing (either w you or a psychometrician), and then feedback. That's the end of the services in most cases.

Some (a small minority) may do cog rehab or (a smaller minirity) may carry a few therapy pts...but that's not the meat of the work. By design you see many patients and purposefully refer out for therapy interventions bc there isn't enough time in a day. Also, many don't like therapy and/or prefer the assessment parts more.

Rehabilitation Psychology (APA Div22) does more intervention work and less neuropsych. They may be worth checking out...great ppl too. I'm a member and do a lot of rehab work, though I more strongly identify as a neuropsychologist.

 

[Therapist4Chnge]

PSYDR is spot on about the intake and feedback challenges. I try and space out my rough referrals, when possible. It happens in other settings too, it just evolves differently in feedback because you are often the bearer of bad news and/or the confirmation of a patient's fears. Whether it is a dementia diagnosis, being the provider who recommends someone can't drive anymore, recommending gaurdianship, etc.

 

[biogirl236]

PSYDR is spot on about the intake and feedback challenges. I try and space out my rough referrals, when possible. It happens in other settings too, it just evolves differently in feedback because you are often the bearer of bad news and/or the confirmation of a patient's fears. Whether it is a dementia diagnosis, being the provider who recommends someone can't drive anymore, recommending gaurdianship, etc.

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

 

[bcliff]

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

neuropsychologists are specialized clinical psychologists -- comfort handling difficult situations and breaking bad news are essential components of clinical psychologist training. all clinical psychologists, regardless of specialty, receive (extensive) training in assessment and providing feedback.


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[Therapist4Chnge]

We (psychologists) are often the providers who teach residents/staff how to deliver bad news. Many times the "tough" conversations are designed to happen with us and/or for us to be there to help a patient deal with the implications of what they need to be told.

 

[ClinicalABA]

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

A lot of clinical psychology is about "bad news." Much of the job involves working with people who are struggling/suffering greatly. It's a common perception that psychotherapy is a series of chat sessions that often end in "aha, I'm cured, thank you doctor" moments for the clients. While it may not be the same impact as delivering a difficult diagnosis (I speak from experience here- my job description is, basically, "tell parents what's wrong with their children"), clinical psychology largely exist because people are having a very difficult time with life. As to saying that you're "not cut out for that"- recognize that part of good training should involve teaching you how to deal with these types of situations in a manner that best serves your clients, as well as ways of caring for yourself as a clinician. I'm guessing that nobody goes into this field because they're really good at and really enjoy delivering bad news. It's something you learn how to do. Remember, "clinical psychologist" is a job title. You are trained to do it, not "born to do it."

 

[bmedclinic]

We (psychologists) are often the providers who teach residents/staff how to deliver bad news. Many times the "tough" conversations are designed to happen with us and/or for us to be there to help a patient deal with the implications of what they need to be told.

True as this is, I find on multidisciplinary teams, I'm virtually the only one willing/capabale/comfortable/ready to discuss bad news with patients....

Getting out of grad school and into the real world, I've been plesantly surprised at how helpful this skill has become. I certainly did not like/want to discuss bad news before getting into psych, but now I wish other disciplines spent a little more time on it.

 

[Grenth]

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

I'm just a clinical psychology PhD student, so I can't speak to this the way the actual psychologists can but so far even as a practicum student I have had to bear bad news. I've had to call CPS, work with couples who are fighting custody battles, I've even had to work on getting clients higher levels of care because they are gravely disabled or at risk of harm . I haven't even worked a particularly intense settings, a university counseling center and community mental health. The great thing is my training and supervisors have been where I'm at and helped me learn how to handle these situations, so maybe with training you could do better than you think.

 

[erg923]

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

biogirl236,
The truth is like poetry, and most people ****ing hate poetry.

You don't get some kind of pass on giving honest and tough to swallow feedback to your patients just because you're not performing a eight hour neuropsychological evaluation. It's not like we would say that internists are free from providing bad news or negative feedback to their patients just because they aren't evaluating and treating neurological disease like their neurologist colleagues, right?

Examples:
Many of your patients will have **** lives. While using a strengths based approach to their therapy is advisable, sometimes you have to tell people that there is really nothing you can do to help them.

Having to report your patients to CPS or APS

Having to initiate involuntary (unwanted) hospitalization

Recommending to surgeons that the patient in not appropriate for a surgery (gastric bypass/sleeve, pain pump/spinal stim, DBS) that they desperately want.

Declaring someone an unfit (psychologically) parent.

No. I'm not signing your disability paperwork/you are not disabled from work

No, you do not have Bipolar Disorder. You have raging personality pathology.

Your irritability is not a psychiatric problem or disorder. You are just choosing to be an ass to people.

You are enabling your child's behavior and then you are complaining about their behavior.

No. You cannot have 4 bourbon and cokes every night and expect your diabetes to be well controlled

Your pain is real, but it is also highly mediated by psychosomatic and lifestyle factors.

Taking Hydrocodone for the rest of your life is bad for you.

Marijuana is not an appropriate treatment for your... [insert any symptom or psychiatric disorder here].

 

[smalltownpsych]

biogirl236,
The truth is like poetry, and most people ****ing hate poetry.

You don't get some kind of pass on giving honest and tough to swallow feedback to your patients just because you're not performing a eight hour neuropsychological evaluation. It's not like we would say that internists are free from providing bad news or negative feedback to their patients just because they aren't evaluating and treating neurological disease like their neurologist colleagues, right?

Examples:
Many of your patients will have **** lives. While using a strengths based approach to their therapy is advisable, sometimes you have to tell people that there is really nothing you can do to help them.

Having to report your patients to CPS or APS

Having to initiate involuntary (unwanted) hospitalization

Recommending to surgeons that the patient in not appropriate for a surgery (gastric bypass/sleeve, pain pump/spinal stim, DBS) that they desperately want.

Declaring someone an unfit (psychologically) parent.

No. I'm not signing your disability paperwork/you are not disabled from work

No, you do not have Bipolar Disorder. You have raging personality pathology.

Your irritability is not a psychiatric problem or disorder. You are just choosing to be an ass to people.

You are enabling your child's behavior and then you are complaining about their behavior.

No. You cannot have 4 bourbon and cokes every night and expect your diabetes to be well controlled

Your pain is real, but it is also highly mediated by psychosomatic and lifestyle factors.

Taking Hydrocodone for the rest of your life is bad for you.

Marijuana is not an appropriate treatment for your... [insert any symptom or psychiatric disorder here].

Have you been spying on my sessions?

 

[AcronymAllergy]

Agreed with what others have said. Healthcare professions in general often involve challenging interactions that involve bad news, and/or news the patient may not want to hear. I would actually suggest that this can be even more difficult in a therapy context than via neuropsychological feedback, as the therapist has to find a way to maintain rapport while not only providing the information, but then confronting maladaptive responses in a therapeutic manner.

Psychologists (of all types) are often tasked, as T4C said, with providing bad news and/or with interacting with "difficult" patients, either long-term or to diffuse volatile situations.

I don't say this to scare you, or to turn you off from a career in psychology. But it's important to have a clear idea of the types of services psychologists often provide. And not all "bad news" is the same. There are certain types of feedback sessions that I don't generally mind at all, for example, while there are others that I still genuinely dread.

 

[Therapist4Chnge]

Agreed with what others have said. Healthcare professions in general often involve challenging interactions that involve bad news, and/or news the patient may not want to hear. I would actually suggest that this can be even more difficult in a therapy context than via neuropsychological feedback, as the therapist has to find a way to maintain rapport while not only providing the information, but then confronting maladaptive responses in a therapeutic manner.

Absolutely. I tell my therapy colleagues frequently that they are doing the "heavy lifting" because I typically am one and done with seeing the patient after testing, whereas they will start/continue to see the patient for weeks/months.

 

[AcronymAllergy]

Absolutely. I tell my therapy colleagues frequently that they are doing the "heavy lifting" because I typically am one and done with seeing the patient after testing, whereas they will start/continue to see the patient for weeks/months.

Yep, just had this exact conversation with a psychologist colleague the other day. I don't know how they do it some days.

 

[WisNeuro]

Yeah, I did some therapy with a patient on SCI who just had a diagnosis of small cell lung cancer that had various mets. I was there when the medical resident pretty much tried to pull the wool over his eyes with talk about how "we're going to fight this, we have very good treatments, etc." I then had to have the actual discussions about mortality and, what was overwhelmingly likely, his last 6-12 months alive.

Rather than look at it in terms of having to deliver the bad news, I look at it as sometimes we are the only ones who will actually talk to the patients about what is happening and the realistic prognosis. Far too often, providers gloss over many things that need to be said, so that they don't have to have those conversations. You can actually make a difference by helping these people, patients and their families, prepare for some very difficult and challenging times ahead.

 

[Therapist4Chnge]

There is a great deal of responsibility in being able to provide patients with the knowledge to make an informed decision about how to live their lives, whether they have 6 months or 60 years left.

 

[PsyDr]

There is also a great deal of fortitude required to provide people uncomfortable information rather than soothe them.

When a patient complains of 50lbs weight gain, and says "I never eat", it is easy to try to soothe them and collude with the reality distortion. Doesn't help the patient. Does help the provider.

 

[ClinicalABA]

There is also a great deal of fortitude required to provide people uncomfortable information rather than soothe them.

When a patient complains of 50lbs weight gain, and says "I never eat", it is easy to try to soothe them and collude with the reality distortion. Doesn't help the patient. Does help the provider.

I think this point out the difference between being a comforting friend who says what is need to make someone feel better in the moment and a trained clinician who is able to develop and implement strategies for longer term well-being. Often, people who want to go into the field because everyone tells them they are really good at helping others are, in fact, good at the former, with little regard for the latter. The latter comes from good training, and skill with the former may not be predictive of skill with the latter.

As I alluded to earlier, delivering objective news (good or bad) as part of a comprehensive treatment plan is a skill that psychologists learn. Don't abandon career goals because you aren't good at this or it makes you uncomfortable now. It's not fair to think that you would be able to do so effectively (or even imagine doing so) without training. Again- "clinical psychologist" is a job title, not a personality classification.

 

[FionaGoode]

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

I really appreciate the fact that you are asking so many questions and starting various posts (I'm sure it'll be helpful for people down the road). However, this post for some reason reminded me of this. Please feel free to watch this video for further info on what it's really like to be a clinical psychologist. I am sure many people disagree with several parts, and I haven't and watched in years, but it felt too accurate during graduate school (which is probably why I chose to avoid it, haha). Edit: I just re watched this and can say some of this is still accurate while some is certainly (thankfully) not actually accurate for me! The supervision part still kills

 

[LETSGONYR]

Thank you all. Will all this information I think I can conclude that a career as a Neuropsychologist is not for me. I would not fare well as the "bearer of bad news". I am very much more cut out for clinical psychology.

From my experience, whether news is perceived as positive or negative is really variable. I work with kids, and there have been times where I was absolutely dreading a feedback because I thought the parents would be distraught... but instead they were relieved, because they had known something was wrong for so long and no one believed them. And now they had a name for it and a plan to address it. The reverse has also happened, where I went into a feedback thinking that it would be a cakewalk, but the parents broke down because of a mild adhd dx.

It can be humbling at times... people have different life experiences, so I need to try to suppress my assumptions about how they will react to the results. It's a good reminder to let the data do the talking and then use our psychology skills to assess and address families' reactions.

There are definitely a lot of sad stories and bad news, as others have said, but it's not exclusively negative. There's a reason I like my job, and it's not because I like to make children cry.

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[ClinicalABA]

but instead they were relieved, because they had known something was wrong for so long and no one believed them. And now they had a name for it and a plan to address it.

This is the mode response that I get from parents.