Where do we fit?

[erg923]

I have a well-paying, quite nontraditional job. It is a blend of nontraditional clinical stuff and program oversight/administration. That said, its quite dysfunctional here and for a variety of reasons, I dont see myself here long-term. That is, the hours and pay are good enough to keep here for a couple more years, but certainly not the place I will be retiring from.

In my search for similar positions, albeit with more traditional populations/setting, I am AGAST at the lack of job demands specifically for, or requiring, doctoral-level psychologists in my area. I am talking about both clinical service positions, as well as clinical director/administrative positions. With the excpetion of the typical state prison jobs and VA jobs (which has maybe one or two openings per year here), their is really NO demand for clinical/counseling psychologists in this area. Tons of masters level stuff, with masters level pay of course.

So, I guess the question is, is this just my area, or are we really not that in-demand anymore? Where do we fit out in the community anymore?

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[PHD12]

I've been saying this for quite a few years now, and nobody wanted to believe it in graduate school. It's not just your location.

I've lived in several locations and in each location people from good internships and post-docs (think VA/AMC) were unable to secure jobs in the same location. There may be 1 opening in a nearby VA or hospital once every year or two, and i'm located in a major metropolitan area! Many folks even from good UC schools end up doing PP out here. Many spouses seem to support psychologists from what I can see. You may want to consider PP in the future.

Many clinical jobs in hospitals are pretty dysfunctional or require that you keep insane caseloads, but even job openings in those places are not too common for doctoral-level psychologists.

You can't tell every psychologist to be geographically flexible throughout his/her career. Most people graduate in their 30's and are married. They can't keep moving every time they need a job.

 

[erg923]

I've been saying this for quite a few years now, and nobody wanted to believe it in graduate school. It's not just your location.

I've lived in several locations and in each location people from good internships and post-docs (think VA/AMC) were unable to secure jobs in the same location. There may be 1 opening in a nearby VA or hospital once every year or two, and i'm located in a major metropolitan area! Many folks even from good UC schools end up doing PP out here. Many spouses seem to support psychologists from what I can see. You may want to consider PP in the future.

Many clinical jobs in hospitals are pretty dysfunctional or require that you keep insane caseloads, but even job openings in those places are not too common for doctoral-level psychologists.

You can't tell every psychologist to be geographically flexible throughout his/her career. Most people graduate in their 30's and are married. They can't keep moving every time they need a job.

I will be independently licensed here in about 2 months. The only PP I can see myself doing anytime in the near future is a VERY small, cash only thing (in an affluent area of my city) on the side of a regular position. If it got big enough somehow, I wouldnt mind being my own boss, I'm sure, but I dont think thats very viable/realistic. The cash-only thing would likely keep me down to only a handful of clients at a time. And frankly, thats fine, because I couldnt do therapy all day everyday anyway. Yuk! I am not willing to go along with insurance stuff, as I want part-time PP should be a fun, extra income generator. Add insurace junk into that and it defeats the purpose.

I am married and have a young family, so yea, moving is no longer an option unless I want to get divorced. lol

 

[PHD12]

I will be independently licensed here in about 2 months. The only PP I can see myself doing anytime in the near future is a VERY small, cash only thing (in an affluent area of my city) on the side of a regular position. If it got big enough somehow, I wouldnt mind being my own boss, I'm sure, but I dont think thats very viable/realistic. The cash-only thing would likely keep me down to only a handful of clients at a time. And frankly, thats fine, because I couldnt do therapy all day everyday anyway. Yuk! I am not willing to go along with insurance stuff, as I want part-time PP should be a fun, extra income generator. Add insurace junk into that and it defeats the purpose.

I am married and have a young family, so yea, moving is no longer an option unless I want to get divorced. lol

People seem to do part-time hospital and part-time private practice too. Your hospital may allow you to cut back on hours while still keeping the benefits in a few years. Many hospitals allow you to keep benefits as long as you are 20 hours.

 

[Doctor Eliza]

Nope, not just your area. We are not in demand. When I mention this on SDN people accuse me of being lazy and just not looking hard enough. Of course they aren't out there looking themselves, so they have no idea what they are talking about. My experience is depressingly similar to yours.

I'm less up in arms about it nowadays as career has taken a backseat to raising my kiddo.

Dr. E

 

[erg923]

My hours are flexible and cush. But, no, I wont be able to cut down to half-time or anything. As long as I work 37.5 hours a week, I can do whatever else I want. They dont care.

 

[erg923]

And to clarify, I could get another job, no problem. But, I was shocked at how little there is in the way of higher level admin positions that want/require actual psychologists. I didnt really get the Ph.D. degree to be a frontline provider for the next 30 years. I think my degree gives me more than that. I know it does cause that what I do now and thats why they hired me. I just wish it was little bit more "my cup of tea" here.

 

[paramour]

I will be independently licensed here in about 2 months. The only PP I can see myself doing anytime in the near future is a VERY small, cash only thing (in an affluent area of my city) on the side of a regular position. If it got big enough somehow, I wouldnt mind being my own boss, I'm sure, but I dont think thats very viable/realistic. The cash-only thing would likely keep me down to only a handful of clients at a time. And frankly, thats fine, because I couldnt do therapy all day everyday anyway. Yuk! I am not willing to go along with insurance stuff, as I want part-time PP should be a fun, extra income generator. Add insurace junk into that and it defeats the purpose.

I am married and have a young family, so yea, moving is no longer an option unless I want to get divorced. lol

The agency/institute where I landed is a non-contracted insurance provider and they do quite well with cash only clients. To the point where they recently opened a second location and they're planning a third within the next few years. They have clients dropping several thousand at a time without blinking an eye. So cash only is certainly doable, whether it be part- or full-time.

 

[Therapist4Chnge]

I think there is a much smaller market for therapy-heavy work bc there are far cheaper options, despite lesser training and often questionable scope of practice demands. Clinicians who primarily do talk therapy will need to adjust to the market (brief interventions, EBT preferred/required) and they'll probably have to grind out a decent living as opposed to having a cushy 40-45hr work week. I don't work in this area, so take my comments with a grain of salt, but this is my impression from talking with friends who are primarily talk-therapy based.

The best/most stable jobs now and in the future will be places where psychologists are administrators, clinical researchers (split clinical & research responsibilities), and niche specialists such as health psych, rehab psych, neuropsych, etc. As a profession we have done a horrid job of differentiating ourselves as a field, so only where we have proven we are needed will we be able to keep a foothold. Sadly, even those areas are going to be highly competitive and still have attrition because of market forces outside of our control.

As for "fit in the community"....I think certain specialities (including the ones I listed above) are in the best position to survive and maybe even thrive in the coming years. The ACA will have a major impact on how we practice and what we can do, so a lot of us will be beholden to the downstream impact of that on our healthcare system.

It isn't all doom and gloom, but there are far less favorable conditions out there for psychologists than say 20 yrs ago. We are working harder and longer for less money and less stability. We shouldn't have to have a Plan B and a Plan C, but those who don't are really putting all of their eggs in one basket.

 

[PHD12]

The agency/institute where I landed is a non-contracted insurance provider and they do quite well with cash only clients. To the point where they recently opened a second location and they're planning a third within the next few years. They have clients dropping several thousand at a time without blinking an eye. So cash only is certainly doable, whether it be part- or full-time.

This can work, but only in locations that have enough 1 percenters (NYC area) in a demand niche practice. The practice owner has to have top credentials + excellent business skills.

 

[Sanman]

I think that this is a very good question to ask and one that I wonder myself at times. Most ads for assessment want someone in neuropsych with a post-doc. Most the therapy position I see are PP, counseling centers, or nursing home. I see the occasional academic job pop up and a few VA positions. I applied for two VA positions that I applied for. I had applied for some admin positions as an ABD and actually did get interviews. My plan at the moment is to get a few more years of clinical experience as a provider and then go into admin or some non-traditional routes. I would not mind a CC job if i were tenured and I had enough time for some clinical work. The bigger problem, I find, is not jobs or money. It is the grind. I can pick up a decent (not great) paying job just about anywhere as a therapist, but it is a grind and better positions are fairly rare.

 

[paramour]

This can work, but only in locations that have enough 1 percenters (NYC area) in a demand niche practice. The practice owner has to have top credentials + excellent business skills.

Agreed for the most part.

We have our share of the wealthy folks due to location, but we also have our fair share of lower- to middle-class. Otherwise, some select marketing & networking combined with a particular niche area in which no one else provides these services anywhere close seems to account for their success to date. Their business acumen is fair to middling, which they recognize isn't going to carry them too much longer if they want to continue their expansion plans (and be successful at it)--so this is one area where they're hoping to improve due to various concerns.

 

[erg923]

I think that this is a very good question to ask and one that I wonder myself at times. Most ads for assessment want someone in neuropsych with a post-doc. Most the therapy position I see are PP, counseling centers, or nursing home. I see the occasional academic job pop up and a few VA positions. I applied for two VA positions that I applied for. I had applied for some admin positions as an ABD and actually did get interviews. My plan at the moment is to get a few more years of clinical experience as a provider and then go into admin or some non-traditional routes. I would not mind a CC job if i were tenured and I had enough time for some clinical work. The bigger problem, I find, is not jobs or money. It is the grind. I can pick up a decent (not great) paying job just about anywhere as a therapist, but it is a grind and better positions are fairly rare.

The funny thing is, in my town, the biggest assessment practice could care less if you have a post-doc in neuropsych or not. But that's what you do if you become an associate there. There are 12 of them, and non of them have a post-doc in neuro..and it has the npsych market here locked up. The only real npsychs here are one guy at a rehab hospital, one guy in a PP, and 2 professors at university system (I dont know they practice).

Anyway, the point of all this was that, a big push in my program was training us for administrative roles or program development. That was a big part of my last practicum in grad school. But outside MAJOR hospital systems, I dont see any jobs like this for us..at least here, They all want masters folks, and like I said, give mid-level salaries. Today I saw one for "clinical services director" where I know there are at least to psychologist working. They wanted an MA level person and the pay was 50k. Pathetic!

 

[Ollie123]

I always got the impression those sorts of positions (administrative-types) were most commonly jobs you generally created and worked your way into from within the system or through personal connections. Pushing in this direction is one of the central ideas of the Delaware project/model since its an area we really do have something unique to offer (what other clinicians often have 2+ years of grad level stats?) but as a profession we have put zero effort into developing and marketing ourselves as being able to do.

I think it would be a great area to break into though in the not-so-distant future though, especially with ACA and the increased focus on containing healthcare costs.

 

[Sanman]

The funny thing is, in my town, the biggest assessment practice could care less if you have a post-doc in neuropsych or not. But that's what you do if you become an associate there. There are 12 of them, and non of them have a post-doc in neuro..and it has the npsych market here locked up. The only real npsychs here are one guy at a rehab hospital, one guy in a PP, and 2 professors at university system (I dont know they practice).

Anyway, the point of all this was that, a big push in my program was training us for administrative roles or program development. That was a big part of my last practicum in grad school. But outside MAJOR hospital systems, I dont see any jobs like this for us..at least here, They all want masters folks, and like I said, give mid-level salaries. Today I saw one for "clinical services director" where I know there are at least to psychologist working. They wanted an MA level person and the pay was 50k. Pathetic!

That's funny. The larger assessment practices here that do not require post-docs usually do ADHD and educational assessments largely. I am sure that some likely do neuropsych as well.

You are right, that is a pathetic salary. I have seen MA level director positions that listed $60-70k and considered those low. I do agree that it is hard to find those positions. I did meet one clinical director of an inpatient clinic run by the state that was a pretty nice gig. I think a lot those promote from within and do not often advertise. The most frequent positions I see are for therapists.

 

[docma]

There is a cohort of psychologists in administrative/management positions in state and county systems and the pay and benefits can actually be very good once you advance levels in the civil service system. But many grads are not willing to look at the entry level positions in systems like these (eg; "I don't do case management!; I don't want to be on call; Quality Improvement is just about paperwork...) If you are willing to go through the door, there are definitely options to fit in and rise in the ranks to management and administrative positions, sometimes fairly quickly. Psychologists who have program evaluation and consultation training and are willing to work the front line and apply these skills to the basics can climb the ladder. And their willingness to do the "master's level work" without complaint becomes a qualification for managing because they know the system from the ground up and have demonstrated that they are non-whining team players.

 

[Therapist4Chnge]

...the Delaware project/model since its an area we really do have something unique to offer

I finally got around to reading about this...and I'm pretty impressed. I think it is not only a fresh look at training, but it offers a necessary evolution for our field.

 

[edieb]

I think there is a much smaller market for therapy-heavy work bc there are far cheaper options, despite lesser training and often questionable scope of practice demands. Clinicians who primarily do talk therapy will need to adjust to the market (brief interventions, EBT preferred/required) and they'll probably have to grind out a decent living as opposed to having a cushy 40-45hr work week. I don't work in this area, so take my comments with a grain of salt, but this is my impression from talking with friends who are primarily talk-therapy based.

The best/most stable jobs now and in the future will be places where psychologists are administrators, clinical researchers (split clinical & research responsibilities), and niche specialists such as health psych, rehab psych, neuropsych, etc. As a profession we have done a horrid job of differentiating ourselves as a field, so only where we have proven we are needed will we be able to keep a foothold. Sadly, even those areas are going to be highly competitive and still have attrition because of market forces outside of our control.

As for "fit in the community"....I think certain specialities (including the ones I listed above) are in the best position to survive and maybe even thrive in the coming years. The ACA will have a major impact on how we practice and what we can do, so a lot of us will be beholden to the downstream impact of that on our healthcare system.

It isn't all doom and gloom, but there are far less favorable conditions out there for psychologists than say 20 yrs ago. We are working harder and longer for less money and less stability. We shouldn't have to have a Plan B and a Plan C, but those who don't are really putting all of their eggs in one basket.

The only places that care about post-docs such as health psychology or behavioral medicine are academic medical centers. Unfortunately, the thrust to integrate mental health into primary care is not going to include psychologists but will be more directive to include master's level practitioners because they are cheaper

 

[Sanman]

The only places that care about post-docs such as health psychology or behavioral medicine are academic medical centers. Unfortunately, the thrust to integrate mental health into primary care is not going to include psychologists but will be more directive to include master's level practitioners because they are cheaper

Well, I am starting to see some more primary care positions at VA hospitals and at one non-profit program, but for all the speculation I am not seeing that many jobs. I think a health psych post-doc would be helpful for those jobs, especially the VA, but not a requirement. I don't see much integration outside of the VA though and that does concern me as I am not sure how transferable those skills will be outside of the VA system.

Looking around, outside of geriatrics, I don't see large consistent growth in too many areas of clinical work with such a depressed economy. I think the question becomes in what areas are psychologists seen as a necessity and in what areas are they seen as a luxury?

 

[PHD12]

Looking around, outside of geriatrics, I don't see large consistent growth in too many areas of clinical work with such a depressed economy. I think the question becomes in what areas are psychologists seen as a necessity and in what areas are they seen as a luxury?

It isn't just about the economy. Our society doesn't value mental health treatment, and individual therapy is seen as a luxury. From what I can see at inpatient units, hospitals and clinics, we are only willing to provide short-term treatment for crises, medication management, and groups (co-led by nurses etc). Psychologists do not fit into this model.

If you look at the kaiser model (the largest HMO in the country with 9 million health plan members), the MH plan is focused exclusively on short-term group treatment, medication management and crises. Patients can only get individual treatment once every 8 weeks or if they are very high risk for a short period of time. Everything else is a luxury. Short-term psychoeducational groups are the primary treatment modality. Each Kaiser offer about 50 psychoeducation groups. While Kaiser continues to grow and dominate the market (over 40% of people from CA are enrolled in kaiser plans), they are providing a "model" of MH treatment that is becoming the norm.

 

[AcronymAllergy]

The only places that care about post-docs such as health psychology or behavioral medicine are academic medical centers. Unfortunately, the thrust to integrate mental health into primary care is not going to include psychologists but will be more directive to include master's level practitioners because they are cheaper

Neuropsych seems to have become a bit more wide-spread (although not close to universal, which in my opinion is a shame), but as of right now, I'd agree with what I'm seeing regarding health psych--it's currently largely restricted to VAs and large (academic) medical centers.

Although at the same time, health psych isn't alone in this. I know of at least a few physicians who've entered into exceedingly niche areas of practice that are only feasibly supported at a large hospital with access to lots of resources and expensive equipment. Then again, these folks of course do have the option of practicing at a more generalist-type level that isn't nearly as in demand for psychologists.

My experiences thus far have been that places have typically LOVED having psychologists around after the fact, but that if they've (the other providers) not worked with psychologists in the past, they have difficulty appreciating potential benefits. Thus, it's not that they wouldn't value what a psychologist does, it's that they've had limited exposure to it. From a billing/bean-counter side, though, we do seem to get less love than physicians, of course.

 

[Sanman]

My experiences thus far have been that places have typically LOVED having psychologists around after the fact, but that if they've (the other providers) not worked with psychologists in the past, they have difficulty appreciating potential benefits. Thus, it's not that they wouldn't value what a psychologist does, it's that they've had limited exposure to it. From a billing/bean-counter side, though, we do seem to get less love than physicians, of course.

Very true, I had a respiratory therapist ask me what kind of magic I was working that all the pts who see me (and the previous psychologist) have been doing better on getting off their ventilators. No magic, just treating anxiety, setting goals, and increasing motivation.

 

[Therapist4Chnge]

My experiences thus far have been that places have typically LOVED having psychologists around after the fact, but that if they've (the other providers) not worked with psychologists in the past, they have difficulty appreciating potential benefits. Thus, it's not that they wouldn't value what a psychologist does, it's that they've had limited exposure to it. From a billing/bean-counter side, though, we do seem to get less love than physicians, of course.

I feel like a broken record....but this is one of the biggest issues. We do not prove our value in enough places and with enough providers.

I learned very quickly that to get referrals you need providers to know what you do, how you can help them, trust that you will provide useful information, and can do it in a timeframe that works for them and the patient. The more referrals you get, the more you can bill/cover your costs.

In good situations providers will find you. In great situations providers will demand your services. In bad situations no one knows you and in the worst situations...they don't miss you (and your services).

 

[sockit]

I've been eavesdropping on this thread, and recently came across this article (it's related to private practice & marketing and a bit to insurance). Wonder what you think of it . (Some of the replies are interesting, too, as representative opinions.)

http://www.nytimes.com/2012/11/25/m...ts-to-become-brands.html?pagewanted=all&_r=1&

 

[erg923]

That woman sounds enormously inflexible in her views and approach to psychotherapy. I wonder about the quality of her training.

 

[cara susanna]

I Googled her and she has a Master's degree in clinical psych.

 

[Sanman]

I Googled her and she has a Master's degree in clinical psych.

She has a masters and is licensed as a marriage and family therapist. I actually heard of her long before this article after an article she wrote in Atlantic Monthly turned into a book. Now, I she decided to dispense advice one person at a time rather than in book form. In general, she seems like a really unrealistic woman and it sounds as if she is in her personal life as well as her work. I am not trying to judge her, but I would take the article with a grain of salt.

Here is the Atlantic Monthly article I was talking about:

http://www.theatlantic.com/magazine/archive/2008/03/marry-him/306651/

 

[cara susanna]

Ah, I saw the backlash to her book come up when I Googled her. And reading that article, I can definitely understand why!

 

[erg923]

I mean: "I'm just a person trained to sit in a room and — if I'm really doing my job well and am attuned to all the subtle suggestions and gestures at play in an ongoing, face-to-face therapeutic relationship — help people understand themselves better so they can live more fulfilling lives."

Really? Thats all?! That either your fault or your programs fault. If I go to someone with a problem, i would sure expect a little more from them. Wouldn't you? I am not sure what this demonization of problem solving is about?

 

[sockit]

Ok, I can absolutely see why you might take issue with the author, her training or methods. But what do you think of the larger idea? I guess what I got from the piece -- and maybe more so from the 500 odd comment discussion beneath it, in which people claiming to be therapists and psychologists of a range of stripes participated, as did patients -- was a richer sense of what was most sharply outlined by PHD12 above.

I.e., that there's a lot of confusion around what's offered under the umbrella of 'psychotherapy', great variety in the quality of its delivery, and a mismatch in terms of supply and demand.

What killed me were the patients (comments) desperate for exposure therapy who couldn't find someone to take their insurance, as much as the psychologists who couldn't afford to offer it.

I also thought interesting the idea someone put forward that even if insurance companies attended to data supporting the efficacy of therapy in principle, there's no way they can be assured of the quality of its delivery in practice. I'm not ashamed to say I have sought treatment for anxiety from psychologists (note the plural). All agreed to offer CBT. What actually happened was a lot of meandering conversations, with the CBT quickly dispensed. (I feel that stuff is actually quite hard to do well, difficult I think both for provider and patient.) Providing a solid evidence base & quantifying various approaches might help, as would (I'm sure all here would agree) getting rid of the aromatherapists & life coaches (though I think it'd be hard to stop people wanting them anyway, if they like the idea of aromatherapy).

n=1 obviously, but many many people feel finding a qualified therapist they can afford, who *delivers*, with whom they have a good fit, is kind of a magic unicorn situation. Much easier for a population and industry inclined to the medical model to push & demand pills. Doesn't work? Try another. Still cheaper than therapy, & less work off the bat. (Not later, but that's not what desperate folks see.)

Finally I thought actually that specialization (not the bull marketing proposed) might be a useful thing. Eg it would be great for the patient mentioned above to be able to quickly find someone who *knows* exposure therapy inside and out (& if those practitioners would take their insurance).

 

[sockit]

I mean: "I’m just a person trained to sit in a room and — if I’m really doing my job well and am attuned to all the subtle suggestions and gestures at play in an ongoing, face-to-face therapeutic relationship — help people understand themselves better so they can live more fulfilling lives."

Really? Thats all?! That either your fault or your programs fault. If I go to someone with a problem, i would sure expect a little more from them. Wouldn't you? I am not sure what this demonization of problem solving is about?

I guess she has a psychodynamic orientation, or her supervisor does.

 

[cara susanna]

I also thought interesting the idea someone put forward that even if insurance companies attended to data supporting the efficacy of therapy in principle, there's no way they can be assured of the quality of its delivery in practice.

I would argue the same about psychotropic medication. A lot of its use is off-label and not shown to be efficacious.

 

[sockit]

I would argue the same about psychotropic medication. A lot of its use is off-label and not shown to be efficacious.

Oh, too right. But in that case it's easy enough to explain it away as the reemergence or complication of original symptomatology, until there are enough adverse reactions for a class action suit.

 

[Sanman]

Ok, I can absolutely see why you might take issue with the author, her training or methods. But what do you think of the larger idea? I guess what I got from the piece -- and maybe more so from the 500 odd comment discussion beneath it, in which people claiming to be therapists and psychologists of a range of stripes participated, as did patients -- was a richer sense of what was most sharply outlined by PHD12 above.

I.e., that there's a lot of confusion around what's offered under the umbrella of 'psychotherapy', great variety in the quality of its delivery, and a mismatch in terms of supply and demand.

What killed me were the patients (comments) desperate for exposure therapy who couldn't find someone to take their insurance, as much as the psychologists who couldn't afford to offer it.

I also thought interesting the idea someone put forward that even if insurance companies attended to data supporting the efficacy of therapy in principle, there's no way they can be assured of the quality of its delivery in practice. I'm not ashamed to say I have sought treatment for anxiety from psychologists (note the plural). All agreed to offer CBT. What actually happened was a lot of meandering conversations, with the CBT quickly dispensed. (I feel that stuff is actually quite hard to do well, difficult I think both for provider and patient.) Providing a solid evidence base & quantifying various approaches might help, as would (I'm sure all here would agree) getting rid of the aromatherapists & life coaches (though I think it'd be hard to stop people wanting them anyway, if they like the idea of aromatherapy).

n=1 obviously, but many many people feel finding a qualified therapist they can afford, who *delivers*, with whom they have a good fit, is kind of a magic unicorn situation. Much easier for a population and industry inclined to the medical model to push & demand pills. Doesn't work? Try another. Still cheaper than therapy, & less work off the bat. (Not later, but that's not what desperate folks see.)

Finally I thought actually that specialization (not the bull marketing proposed) might be a useful thing. Eg it would be great for the patient mentioned above to be able to quickly find someone who *knows* exposure therapy inside and out (& if those practitioners would take their insurance).

Well, the problem you speak about is very true. I worked at a private practice that specialized in CBT and exposure therapy. Most of the therapists were completely booked up. As a cash only post-doc that offered discounted rates, I was the unicorn you speak of searching for for a great many of my clients. However, I found that being the unicorn was not much fun and not financially viable. I was adding a disproportionate amount of work for the pay and even with discounted rates many of the clients who needed it the most could not afford to pay on time and consistently, while many of those who could wanted cbt to fix them without actually doing the work/assignments on their own. I had more clients than the author, but what it boils down to is that psychotherapy practice takes time to build if you are not going to get on insurance panels (like the author). Getting on panels means you get filled quickly, but you have to make sure that the rates are high enough to enjoy a comfortable salary. For me, this all meant taking a job as an employee with a salary and likely limiting my private practice to high paying cash clients for therapy or, preferably, short term assessment work. Until there is a better way to ensure better payment for EBTs lead to a more comfortable lifestyle in private practice, I don't see it as a great option unless I need a really flexible schedule. Even then, there are better gigs.

 

[AcronymAllergy]

Well, the problem you speak about is very true. I worked at a private practice that specialized in CBT and exposure therapy. Most of the therapists were completely booked up. As a cash only post-doc that offered discounted rates, I was the unicorn you speak of searching for for a great many of my clients. However, I found that being the unicorn was not much fun and not financially viable. I was adding a disproportionate amount of work for the pay and even with discounted rates many of the clients who needed it the most could not afford to pay on time and consistently, while many of those who could wanted cbt to fix them without actually doing the work/assignments on their own. I had more clients than the author, but what it boils down to is that psychotherapy practice takes time to build if you are not going to get on insurance panels (like the author). Getting on panels means you get filled quickly, but you have to make sure that the rates are high enough to enjoy a comfortable salary. For me, this all meant taking a job as an employee with a salary and likely limiting my private practice to high paying cash clients for therapy or, preferably, short term assessment work. Until there is a better way to ensure better payment for EBTs lead to a more comfortable lifestyle in private practice, I don't see it as a great option unless I need a really flexible schedule. Even then, there are better gigs.

Unfortunately, it really does seem to be the case that if one is going to be building their clinical practice primarily around insurance rather than private pay, one of the only long-term and economically-viable options is to have the person housed in a larger hospital/medical center willing to "eat" those costs. This model could gain traction if we begin conducting and touting research supporting the idea that such services either actually save the hospital money (e.g., fewer ER visits for panic attacks) or somehow increase revenue (e.g., increase patient inflow that then make use of other services) in the long run. Then, they might be increasingly more willing to suck up our salaries. Bonus points, of course, if you can also bring in grant money and/or national news exposure for your research.

 

[erg923]

I Googled her and she has a Master's degree in clinical psych.

Why did it take her 6 years to get a masters?

 

[PsyDr]

IMO, There are two broad types of psychology: those that practice in their own sphere, and those that interact with other professionals. This, IMO, results in two types of psychologist referrals: 1) self referral, 2) referral from another professional. Many prefer the former, as the goals can be things like "self discovery" or whatever. This allows interminable billings, self selected business hours, a low risk of any malpractice, while allowing one to practice however they want. The latter requires quick communication in a language that is not familiar to most psychologists, with a heavy burden of learning the evidence base, and hours that are pretty inflexible.

The ill defined self referral market is absolutely tapped out with any idiot with a license. People are still competing for this because a person who just wants to get to know the real "me", is a gold mine.

The referral from other professionals is a HUGE growth area. Show that you can talk their language, get stuff done, and watch the referrals roll.


If you want to be a healthcare professional, you should learn how the physicians act and adopt it. Asking for a job= midlevel. Asking for hospital privileges= not midlevel.


more specifically erg, if you try to find a job you are already acting like a midlevel. If you are asking for hospital privileges, you are getting closer to being treated like a physician.

Remember, a position of wealth says, "how are we going to do this?", a position of poverty says, "we can't do this".

 

[erg923]

more specifically erg, if you try to find a job you are already acting like a midlevel. If you are asking for hospital privileges, you are getting closer to being treated like a physician.

Remember, a position of wealth says, "how are we going to do this?", a position of poverty says, "we can't do this".

Not quite sure I follow this. I have all the hosptial privldieges here that I need. I can write orders, etc. Moreover, someone has to hire me unless I go into PP full-time, which is not something I am interested in.

 

[Sanman]

Unfortunately, it really does seem to be the case that if one is going to be building their clinical practice primarily around insurance rather than private pay, one of the only long-term and economically-viable options is to have the person housed in a larger hospital/medical center willing to "eat" those costs. This model could gain traction if we begin conducting and touting research supporting the idea that such services either actually save the hospital money (e.g., fewer ER visits for panic attacks) or somehow increase revenue (e.g., increase patient inflow that then make use of other services) in the long run. Then, they might be increasingly more willing to suck up our salaries. Bonus points, of course, if you can also bring in grant money and/or national news exposure for your research.

Well, yes and no. I think you can build a business on insurance if you are selective and are able to negotiate competitive rates. You also have to take into account the number of paneled providers in your area. The licensed psychologists in my practice did fairly well for themselves transitioning from cash to insurance based practice. That said, you have to adjust to all the changes the same as insurance does. That can mean constantly adapting you practice to ensure financial viability. I don't see solo practice as a viable, stable income stream. I can see group practice, run correctly, as viable. Though, I honestly could not see myself in a practice without being the director or a partner. I would train and recruit masters level and early career doctoral practitioners to see lower paying clients/insurances and see higher paying clients in the time that I have.

In my book, there are two ways to go. Certain areas of society will always need our services (inpt or state psych hospitals, prisons, academic medical ctrs, nursing homes, brain trauma/rehab facilities, substance abuse, eating disorders, and a few others). These areas will offer stable jobs in facilities or organizations. General outpt psychotherapy is a bit more of a crapshoot. Though a lot what is mentioned in that article does not seem very different than an md going Botox treatments to make a little cash on the side. That said, I do not think it is a necessity.

 

[AcronymAllergy]

Well, yes and no. I think you can build a business on insurance if you are selective and are able to negotiate competitive rates. You also have to take into account the number of paneled providers in your area. The licensed psychologists in my practice did fairly well for themselves transitioning from cash to insurance based practice. That said, you have to adjust to all the changes the same as insurance does. That can mean constantly adapting you practice to ensure financial viability. I don't see solo practice as a viable, stable income stream. I can see group practice, run correctly, as viable. Though, I honestly could not see myself in a practice without being the director or a partner. I would train and recruit masters level and early career doctoral practitioners to see lower paying clients/insurances and see higher paying clients in the time that I have.

In my book, there are two ways to go. Certain areas of society will always need our services (inpt or state psych hospitals, prisons, academic medical ctrs, nursing homes, brain trauma/rehab facilities, substance abuse, eating disorders, and a few others). These areas will offer stable jobs in facilities or organizations. General outpt psychotherapy is a bit more of a crapshoot. Though a lot what is mentioned in that article does not seem very different than an md going Botox treatments to make a little cash on the side. That said, I do not think it is a necessity.

Good points. I don't have oodles of experience in the business aspects of PP, but the solo practice seems to have been losing ground as financially viable for most (if not all) mental health and healthcare providers for a number of years now. And I don't think the Affordable Care Act is going to be reversing that trend.

Re: segments needing our services, those are certainly areas where, as suggested by PSYDR, we could begin acting more "physician-like" in our negotiations.

 

[futureapppsy2]

Ah, I saw the backlash to her book come up when I Googled her. And reading that article, I can definitely understand why!

I read her book. It was... unusual--and I don't really believe that her 12 year-old self wrote that, without some heavy editing pre-publication.

 

[PsySeeker]

Re: segments needing our services, those are certainly areas where, as suggested by PSYDR, we could begin acting more "physician-like" in our negotiations.

I'm earlier in my career, and I'm not sure exactly what this means. Could you guys elaborate?

 

[erg923]

Read PSYDR post. He explains the differences pretty well.

 

[PsyDr]

erg,

how do you have privileges and perform nontraditional clinical stuff without having passed the EPPP?

 

[erg923]

erg,

how do you have privileges and perform nontraditional clinical stuff without having passed the EPPP?

My state has provisional practice license. its good for 2 years. I just have to have a supervisor in house that i meet with once per week.

I did pas EPPP last week. Wont be licesned until after the oral exam in December though.

 

[Therapist4Chnge]

The referral from other professionals is a HUGE growth area. Show that you can talk their language, get stuff done, and watch the referrals roll.

If you want to be a healthcare professional, you should learn how the physicians act and adopt it. Asking for a job= midlevel. Asking for hospital privileges= not midlevel.

To expound upon this, here are some recs from an article I wrote w. a colleague about being a psychologist working in a medical setting. We wrote these 6-7 years ago, but I think they are all still very applicable in today's healthcare arena. (The bolding was added for this thread, and some shortened for brevity).

1. Interact with medical providers as a colleague, and you will be treated as a colleague. Medical providers are not coming to you with questions so you can defer back to them, they want an answer, a solution, a diagnosis. Provide an answer, and then be flexible to update your diagnosis when more information becomes available.

Differentiate yourself from your "therapist" colleagues, and educate medical providers on your areas of expertise. Become a knowledge expert that is actively sought out by providing timely responses and proactive solutions. This can also provide a great opportunity to network, and build a referral network for your private practice.

3. Seek out additional education and training in the medical aspects of the patients you work with. We believe all psychologists should have at least an RN level of medical/science education, but that currently is not a reality.

4. Express yourself briefly and succinctly. Medical providers are overworked, and have very little time for lengthy explanations of the complex intrapsychic workings, transferences, and life histories.

5. Engage your medical provider colleagues. Seek them out to talk about a shared patient, have lunch with them, attend CME programs, give CME talks to them, and make a concerted effort to move the culture of your facility to an understanding that psychologists are highly educated, confident, and effective doctors.

 

[PsySeeker]

To expound upon this, here are some recs from an article I wrote w. a colleague about being a psychologist working in a medical setting. We wrote these 6-7 years ago, but I think they are all still very applicable in today's healthcare arena. (The bolding was added for this thread, and some shortened for brevity).

Thank you, this was very helpful.

 

[PsyDr]

I'll add: don't accept the name game. It's either both dr surname or both first name. They call you by your first name, you do the same. They call you doctor surname, you do the same. It cannot be dr physician and John Doe psychologist. That type of linguistic stuff just reinforces that psychologists are not "doctors".

Do not do the stupid "dr first name". Get therapy if you cannot handle the power differential.

 

[Therapist4Chnge]

I'll add: don't accept the name game.

Excellent point.

It may sound minor, but how patients view you and how other staff view you are really important factors in day to day work. I spend a majority of my week dealing with difficult pts, their families, administrators, and often other providers...so the perception of others is a big part of being able to get things done.

As an aside, this is where hospital privileges and full faculty appointments come into play too. As a FT faculty we have full voting rights and the same responsibilities as our physician colleagues (e.g. serving on dept/hospital committees, teaching in the residency program, participating in review boards, etc), which has really helped ensure equal footing in clinical, administrative, and research settings. Being relegated to adjunct or auxiliary faculty weakens your position in the hierarchy and it has a very clear difference in pay and responsibility. Some faculty activity avoid committees and the like, but I want to ensure a seat at the table instead of not even being a consideration when important decisions are made.

Anyone who allows themselves to be treated like a second class citizen has no one else to blame but themselves. This applies to titles, pay, and overall responsibilities.

 

[Doctor Eliza]

I
Do not do the stupid "dr first name". Get therapy if you cannot handle the power differential.

Not clear on this comment. I'm guessing you have a really easy last name and don't work with children.