Where to work when nothing seems appealing?

[Spydra]

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I'm pondering how to expand my postdoc opportunity searching and am surprised to be in my intern year realizing I haven't really liked any clinical setting that much. I work with adults, which is preferred, and do enjoy research but am not fixated on a high demand research setting. Now I'm wondering what other settings there are to try hoping to like something. While yes there is always the possibility that a different abc setting in a different city might be a better experience than one I had, but I find that I'm not super excited about continuing to try the same type of settings with the hopes that one may be different. I get that I may not like 100% of everything about a setting, but I also don't think its unreasonable to want to like at least 70% and that hasn't occurred yet.

Already tried.......
University counseling center - no thanks
Prison - ok
Nursing home - no thanks
Inpatient - somewhere between ok and no thanks
Private practice - somewhere between ok and no thanks
Community mental health - no thanks
Partial hospital - somewhere between ok and no thanks
Military - no thanks
Academic medical center - no thanks
Substance use treatment center - no thanks

On my to try list so far.....
State hospital
VA

 

[summerbabe]

am surprised to be in my intern year realizing I haven't really liked any clinical setting that much....Now I'm wondering what other settings there are to try hoping to like something.

It's super common to realize that certain clinical settings are poor fits. A bigger question might be whether you can see yourself fulfilled doing full-time clinical work in an ideal setting (even if you haven't experienced that setting just yet). If that's hard to imagine, perhaps part-time clinical work can be rewarding as some people may not be wired to do 40 hrs/wk in any clinical setting. Or one could try to quickly progress into admin/supervisory roles within one of these settings.

In re-grouping your list, what commonalities exist for the OK/ok-ish places? Do you consider yourself a generalist or somebody with some more specialized training/interests? Is it the clinical work itself (e.g., more assessment and/or brief interventions, common clinical presentations)? Is it the physical setting (e.g., captive patients vs outpatient)? Co-worker interactions? Work style/environment? And I'd wonder the same about common factors that got settings onto the 'no thanks' list.

Prison - ok

Inpatient - somewhere between ok and no thanks
Partial hospital - somewhere between ok and no thanks
Private practice - somewhere between ok and no thanks

University counseling center - no thanks
Community mental health - no thanks
Nursing home - no thanks
Military - no thanks
Academic medical center - no thanks
Substance use treatment center - no thanks

On my to try list so far.....
State hospital
VA

I've worked/trained in far less settings than you have but my hunch is that a state hospital gig won't be too drastically different from what you've already experienced (combo of inpatient, prison, & partial hospital) and the same might be true for VA (combo of AMC, military, UCC, & CMH) so I would be curious about positive work environment characteristics and your vocational values/needs (e.g., achievement, altruism, autonomy, etc) to better triangulate postdoc and early career options.

 

[Spydra]

I think I haven't gotten to the point of determining how many hours of clinical work is desirable because there isn't a setting I enjoy enough yet (and if I decide on part time I'd still have to figure out what the heck to do with the rest of my time lol). I do prefer assessment to therapy, but therapy can be enjoyable so I'm not unwilling to do either. I have both generalist and specialist training, so it would seem that would give me options, yet here I am not sure that's actually true. To group the list based on common factors I'd say...

'Ok' to 'somewhere between ok and no thanks' are settings that always have plenty to do, but lack variety in what those things are or the options to actually help patients are limited by the setting itself with zero willingness for change. 'No thanks' are settings that are either poorly organized and/or cut so many patient care or ethical shortcuts that I fail to see how the doors are still open.

Captive patient vs outpatient? I'm probably on the edge of despising outpatients. This might be heavily informed by the underpaid student/intern stipends and my resources are simply too limited to be wasted waiting for patients who need care and won't show up for it. Yes I understand there are a number of barriers for patients as well, but it is not easy to prioritize that over my own circumstances. I find this so aggravating now I find it hard to believe that more money in the future is sufficient motivation to try again.

Co-worker interactions? These matter less if there is enough that is worthwhile to be doing. I show up to work to do my work, not hang out with co-workers. I hope that they're all enjoying their roles or actively making changes if they don't, but I'm not someone who feels the need to be overly involved with co-workers outside of patient care needs.

Admin/supervisory roles? I've never had an interest in being an administrator and am unlikely to consider such a role until reaching mid-career or later. I have had zero supervision experiences with me as the supervisor so I cannot say if I would like/dislike this role. There won't be an opportunity for this during my internship year, so I'm interested in trying this on as a postdoc and seeing what I think.

Triangulation of options........ I'll think about this more. I keep coming back to.....'something that doesn't suck' which is not helpful lol.

 

[summerbabe]

I'm probably on the edge of despising outpatients. This might be heavily informed by the underpaid student/intern stipends and my resources are simply too limited to be wasted waiting for patients who need care and won't show up for it.

Between some patients being somewhat to very motivated by seeking or maintaining service connection (the VA’s version of disability), a population with a high prevalence of PTSD (avoidance influencing no shows/cancellations), arbitrary bureaucratic decisions informing certain elements of clinical care, administrators who aren’t necessarily promoted due to merit, and a generally heavy focus on therapy (outside of neuro, rehab, or SMI postdocs), I don’t know if you’d find what you’re looking for in the VA.

But a state hospital role could be a good fit (captive pts, lots of assessment opps, decent variety in your day to day routine) especially if you’ve enjoyed working with the severely mentally ill and feel like the recovery model is a good fit for your values/clinical orientation (or perhaps a better fit than the medical model).

 

[WisNeuro]

I'll put in a plug for focusing more on what gives you the most career flexibility in postdoc. Think about it in terms of spending that one year, maybe doing some rotations that you aren't very psyched about, that gives you the flexibility to take a variety of jobs heading forward. Depending on your region, jobs for psychologists in healthcare orgs are not as plentiful as they once were. Get more of that specialized training if you can, because many places would rather hire SWs and other midlevels for most therapy jobs.

 

[R. Matey]

Be careful not to overgeneralize your experiences. Just because you have experience in one setting and it wasn't a good fit, doesn't mean it will be a poor fit for you in every similar type of setting everywhere all of the time. There isn't a work environment out there that doesn't have its own set of complications or stressors. In this field, you can count on some level of Kafkaesque tomfoolery baked into every clinical system. The trick is deciding what you want to live with.

I've worked/trained in far less settings than you have but my hunch is that a state hospital gig won't be too drastically different from what you've already experienced (combo of inpatient, prison, & partial hospital) and the same might be true for VA (combo of AMC, military, UCC, & CMH) so I would be curious about positive work environment characteristics and your vocational values/needs (e.g., achievement, altruism, autonomy, etc) to better triangulate postdoc and early career options.

This is fantastic advice. If you don't have access to a copy of the MIQ, at least go to O*Net and complete their questionnaire on work related values. Then look at postdocs/job postings and ask yourself: "How is this meeting my value of x?"

 

[AcronymAllergy]

The above advice is all excellent. I'd just add that honestly, it sounds like you're burnt out. I also wonder if this may to some extent be unique to the specific places you've worked/trained, although with the large number and variety of them, that may be unlikely. Or perhaps just to the role of being a trainee in general, which maybe is having more of an impact than you're realizing?

Think about what specific parts of the work you've done were enjoyable (in addition to summerbabe's advice to identify what it was about the "ok" settings you liked and the "no thanks" settings you absolutely disliked), and then maybe try building postdoc and job ideas around that.

 

[PsyDr]

1) You're going about it the wrong way. You wouldn't walk into a car dealer and say, "I don't want a car with a black interior.".
2) If you can't think of the work factors you like, think about what YOU get from work (e.g., Income, free time, vacations, etc). All of these lifestyle factors are partially defined by your job. Each setting has a different set of benefits. Some pay more, some have more flexibility in scheduling, some have better healthcare benefits, some have pensions. Look at those. Do you value the safety and security of a sure deal paycheck? Do you need great healthcare insurance because of a chronic condition? Do you value having some emotional need met through your work, more than you value money? All of those things play a role.
3) Network. Talk to people. Ask about their practice. Pay attention to their lifestyle while you ask. Do they seem happy? Stressed? Dressed in a specific way? Do they talk about outside hobbies, family, friends?
4) Google people. Learn about what they do. Got an author you like? A member of a professional organization? Someone on LinkedIn? Google them. Maybe their stuff is awesome. Maybe it isn't. But that can be learned in under 5 minutes via a search.
5) If you hate the setting, does one offer you more flexibility to do what you want? Maybe it's easier to hide in your office at a prison, or take a long lunch at a nursing home, or take summers off in a college setting.
6) It might be the case, that you don't like what you do. You can still pick the lesser of the evils. Many people dislike their work. Why shouldn't that happen in this field?

 

[Sanman]

I think I haven't gotten to the point of determining how many hours of clinical work is desirable because there isn't a setting I enjoy enough yet (and if I decide on part time I'd still have to figure out what the heck to do with the rest of my time lol). I do prefer assessment to therapy, but therapy can be enjoyable so I'm not unwilling to do either. I have both generalist and specialist training, so it would seem that would give me options, yet here I am not sure that's actually true. To group the list based on common factors I'd say...

'Ok' to 'somewhere between ok and no thanks' are settings that always have plenty to do, but lack variety in what those things are or the options to actually help patients are limited by the setting itself with zero willingness for change. 'No thanks' are settings that are either poorly organized and/or cut so many patient care or ethical shortcuts that I fail to see how the doors are still open.

Captive patient vs outpatient? I'm probably on the edge of despising outpatients. This might be heavily informed by the underpaid student/intern stipends and my resources are simply too limited to be wasted waiting for patients who need care and won't show up for it. Yes I understand there are a number of barriers for patients as well, but it is not easy to prioritize that over my own circumstances. I find this so aggravating now I find it hard to believe that more money in the future is sufficient motivation to try again.

Co-worker interactions? These matter less if there is enough that is worthwhile to be doing. I show up to work to do my work, not hang out with co-workers. I hope that they're all enjoying their roles or actively making changes if they don't, but I'm not someone who feels the need to be overly involved with co-workers outside of patient care needs.

Admin/supervisory roles? I've never had an interest in being an administrator and am unlikely to consider such a role until reaching mid-career or later. I have had zero supervision experiences with me as the supervisor so I cannot say if I would like/dislike this role. There won't be an opportunity for this during my internship year, so I'm interested in trying this on as a postdoc and seeing what I think.

Triangulation of options........ I'll think about this more. I keep coming back to.....'something that doesn't suck' which is not helpful lol.

1. Slow down. You don't need it all figured out right this second. Plenty of people get licensed and try different things the first few years out. I tried Nursing homes, outpatient PP, 1099 contractor, full-time employee, supervisory roles, etc before landing in my current gig. There is plenty that you have not been exposed to yet (like the business side of practice) that may change your opinions in the future.

2. What are your immediate needs? I enjoyed the freedom of PP and as an independent contractor very much. However, I wanted a steady income and health insurance until my student loans were paid off and I had the healthy finances to weather the ups and downs. I also only wanted to work daytime hours M-F (no nights and weekends) at this point in my life. Some folks were married and had health insurance and a steady income from a spouse. Some have a greater appetite for risk than me.

How geographically flexible are you? There are more prison, PP, and nursing home jobs than academic or even state hospital jobs.

3. Does one setting fit all your goals or might you need more than one? There is a reason that many people have a day gig and a side gig in this field.

4. Think about what you disliked about each of these settings. Some may be specific to organizations rather than true for all settings. For example, a private, for-profit nursing home is often run differently than a non-profit nursing home, is different from a VA CLC. If you like the population, but not the setting you may need to consider what other options are out there.

 

[Ollie123]

Thoughts on teaching/mentorship? Experience? I bring it up just because that is another common avenue I don't see on your list. You've iterated through most of the clinical settings I can think of so if none of those work, I feel reasonably confident saying you don't like clinical work. If organizational "Zero willingness for change" is a concern for you, VAs and state hospitals are going to be literal hell for you.

I'm reading between the lines a bit but I'm getting the sense that the bureaucracy/systems are a big part of your frustrations. Sounds like you have little interest in pursuing a hardcore research role, but a small university or teaching college might be worth considering if you haven't. Pay usually isn't great, but you often have a bit more breathing room to pursue other things in such roles. What about PP was unappealing to you? It seemed like this would at least help you escape the systems issues. Having a boutique-ish side practice on top of a teaching gig would allow you to be a little more selective in who you take on as a patient, set your own rules to minimize no-shows, and have a stable enough base you won't necessarily have to be as flexible just to stay full if you don't want, etc.

Thinking outside the box, there might be some unique roles outside traditional venues. Some might require additional training based on backchannel conversations we've had, but its worth considering. We had a program that provided educational testing through our university via the disability office run by a PhD who did much of the testing (I think - never fully understood the administrative structure). I'm sure similar things exist elsewhere and would be assessment-focused. Any interest in public advocacy? Such roles exist in a variety of settings. If you are frustrated by monolithic systems that don't serve patients, does the idea of working from the outside to change them sound appealing or is that even worse?

I agree with PsyDr that I think its worthwhile to step back and ask what you DO want in a job. Think broadly and - honestly - ignore the fact that you have a PhD for the time being.

 

[Spydra]

Thanks everyone, this has all been very helpful and I have many more thoughts and things to consider. Hmmm.

@summerbabe Your description of a state hospital was what I expected from inpatient and am not experiencing. I'll keep it on the 'to try' list as it does seem to have potential as I like non-medical models and am interested in more SMI training.

@R. Matey I'm not familiar with the MIQ, will have to look into that. I've taken other values tests and the results generally say I like achieving things and problem-solving, but am not competitive or focused on status.

@AcronymAllergy Definitely bored vs burnt out. Bored, bored, and more bored. I put my self-care first and have zero problem setting firm boundaries around that. It has not been uncommon for me to be in settings where most people are doing little to no self-care and the consequences of that are clearly seen. That definitely contributes to the 'this is not worthwhile' perspective.

@PsyDr Funny thing, I actually did do that years ago when car shopping and it took forever to find something. With my current car I decided to go with a car buying service and made them spend their time looking for all of my nitpicky requirements, 6 months later I got a car I am still very happy with. So maybe there should be a postdoc shopping service......

@Sanman I don't have any ties or expectations from others to be anywhere specific, but I have no intention of going somewhere cold, too small, or with zero diversity. Pre-COVID I was always up for visiting new places to see what I thought about future options there. I also wouldn't say I expect one setting to be everything, but as of right now there isn't even one setting I can say I like. Being 'ok' might work for a side gig, but then I'm not sure what I'd do all day. I've also been in a mix of private, non-profit, and state run settings and I really can't say that made much difference.

@Ollie123 I decided so long ago teaching was not an option that I now forget it is an option for others. I liked learning about the research on how to teach well, but the outcome was me realizing I didn't want to do any of what is required to teach well. I could see myself being a guest speaker regarding specialized training I have, but that is it. With private practice there were too many extremes. I saw either people who focused on something narrow and did the same thing all the time, did a variety of things and were grossly underpaid and overworked, or made a ton of money seeing what I call privileged whiners. Public advocacy hasn't been considered because the people I see doing it are semi-retired or retired and don't need an income which is not a reality for me. I'm also not one to wade into political waters ever so I'm not sure I'd be useful to a cause.

 

[Sanman]

Thanks everyone, this has all been very helpful and I have many more thoughts and things to consider. Hmmm.

@summerbabe Your description of a state hospital was what I expected from inpatient and am not experiencing. I'll keep it on the 'to try' list as it does seem to have potential as I like non-medical models and am interested in more SMI training.

@R. Matey I'm not familiar with the MIQ, will have to look into that. I've taken other values tests and the results generally say I like achieving things and problem-solving, but am not competitive or focused on status.

@AcronymAllergy Definitely bored vs burnt out. Bored, bored, and more bored. I put my self-care first and have zero problem setting firm boundaries around that. It has not been uncommon for me to be in settings where most people are doing little to no self-care and the consequences of that are clearly seen. That definitely contributes to the 'this is not worthwhile' perspective.

@PsyDr Funny thing, I actually did do that years ago when car shopping and it took forever to find something. With my current car I decided to go with a car buying service and made them spend their time looking for all of my nitpicky requirements, 6 months later I got a car I am still very happy with. So maybe there should be a postdoc shopping service......

@Sanman I don't have any ties or expectations from others to be anywhere specific, but I have no intention of going somewhere cold, too small, or with zero diversity. Pre-COVID I was always up for visiting new places to see what I thought about future options there. I also wouldn't say I expect one setting to be everything, but as of right now there isn't even one setting I can say I like. Being 'ok' might work for a side gig, but then I'm not sure what I'd do all day. I've also been in a mix of private, non-profit, and state run settings and I really can't say that made much difference.

@Ollie123 I decided so long ago teaching was not an option that I now forget it is an option for others. I liked learning about the research on how to teach well, but the outcome was me realizing I didn't want to do any of what is required to teach well. I could see myself being a guest speaker regarding specialized training I have, but that is it. With private practice there were too many extremes. I saw either people who focused on something narrow and did the same thing all the time, did a variety of things and were grossly underpaid and overworked, or made a ton of money seeing what I call privileged whiners. Public advocacy hasn't been considered because the people I see doing it are semi-retired or retired and don't need an income which is not a reality for me. I'm also not one to wade into political waters ever so I'm not sure I'd be useful to a cause.

You still haven't answered PsyDr's question of what you actually want. At the end of the day you pick the most important things to you and accept the good with the bad. However, nothing seems good if you don't know what you want.

 

[Spydra]

@Sanman I didn't say I had an answer for everything, just that there was much to think about.

 

[Sanman]

@Sanman I didn't say I had an answer for everything, just that there was much to think about.

@Spydra , I push...it's the therapist in me. 😏

 

[PsyDr]

If every response is met with a negative, the problem isn’t the question.

 

[R. Matey]

If every response is met with a negative, the problem isn’t the question.

I might have to steal that.

 

[futureapppsy2]

At the risk of sounding insensitive, work is work for a reason. Every job is going to have downsides or frustrating tasks or various forms of BS or stress or whatever, Yes, you should pick something where you like a good amount of what you're doing and the general structure of it, but at the end of the day, it's still work.

 

[PsychPhDone]

What have you actually enjoyed during your training?

 

[Spydra]

What have you actually enjoyed during your training?

Assessments, but in most settings I have been in there are no assessments to do. They're either not done because of the pain of dealing with insurance, licensed psychologists hate them, or no one wants to work with trainees. I'd like more training on postdoc. I like many aspects of research, especially the writing, why does no one like writing? Group interventions or brief individual treatment are also enjoyable, but definitely not all day every day. I like working with diverse populations, so much so that I tend to cherry-pick such cases when the setting allows. Of the things I've been given opportunities to try I think this is it.

 

[summerbabe]

Assessments, but in most settings I have been in there are no assessments to do...Group interventions or brief individual treatment are also enjoyable, but definitely not all day every day...I like working with diverse populations, so much so that I tend to cherry-pick such cases when the setting allows.

This seems to overlap really well with the clinical work that's happening in inpatient and prison settings. So what made those training experiences only OK or OKish? And if day to day variety is important to you, a lot of full-time clinical roles in other settings will likely be less than fulfilling.

Earlier advice on not generalizing too much from one particular experience, finding ways to cope with bureaucracy, and how the less pleasant elements of work as part of why we get paid may be applicable as you move forward with clinically oriented roles .

 

[PsychPhDone]

Assessments, but in most settings I have been in there are no assessments to do. They're either not done because of the pain of dealing with insurance, licensed psychologists hate them, or no one wants to work with trainees. I'd like more training on postdoc. I like many aspects of research, especially the writing, why does no one like writing? Group interventions or brief individual treatment are also enjoyable, but definitely not all day every day. I like working with diverse populations, so much so that I tend to cherry-pick such cases when the setting allows. Of the things I've been given opportunities to try I think this is it.

Have you don't anything in rehab psych? It might take some extra training later if your first exposure is on postdoc but lots of opportunity for assessments and possibly groups depending on setting.

 

[Spydra]

Have you don't anything in rehab psych? It might take some extra training later if your first exposure is on postdoc but lots of opportunity for assessments and possibly groups depending on setting.

No, those opportunities have not been available but I could certainly consider it. Thanks for the suggestion!

 

[foreverbull]

You might want to reconsider PP. If you’re bored working at settings full-time, PP part-time work may provide stable income while leaving open options for other more rewarding pursuits or more interesting part-time work using a different skill set than clinical work (perhaps a lower paying job at a non-profit), but a more rewarding opportunity if you value advocacy and that would meet that need in your life.

Something to think about as you reflect on what you want in your career. PP offers the flexibility of a mix-and-match kind of work set up.

 

[Spydra]

You might want to reconsider PP. If you’re bored working at settings full-time, PP part-time work may provide stable income while leaving open options for other more rewarding pursuits or more interesting part-time work using a different skill set than clinical work (perhaps a lower paying job at a non-profit), but a more rewarding opportunity if you value advocacy and that would meet that need in your life.

Something to think about as you reflect on what you want in your career. PP offers the flexibility of a mix-and-match kind of work set up.

I think I need to see more private practice setups others are in. The ones I have seen weren't great, but I'm also not sure what 'better' options would look like. Is private practice really limited to assessment or therapy? Or is there a place for research? I really miss in person conferences, there's probably a vendor table with answers.....hmmm......

 

[WisNeuro]

I think I need to see more private practice setups others are in. The ones I have seen weren't great, but I'm also not sure what 'better' options would look like. Is private practice really limited to assessment or therapy? Or is there a place for research? I really miss in person conferences, there's probably a vendor table with answers.....hmmm......

You can do research in PP, just not many do, probably for a few reasons. One, this will generally be unreimbursable time, so it'd be more of an unpaid hobby. Two, the only PP people I know doing it were either well involved with an institution doing research and then went into PP, but maintained relationships, or they are stellar at stats and were brought on as a consultant for that reason. There are plenty of faculty who have a small side practice, but their main jobs are academia.

 

[Sanman]

I think I need to see more private practice setups others are in. The ones I have seen weren't great, but I'm also not sure what 'better' options would look like. Is private practice really limited to assessment or therapy? Or is there a place for research? I really miss in person conferences, there's probably a vendor table with answers.....hmmm......

I do know a person that does research in PP, but this person owns a large practice and is doing it to develop and sell their own assessment materials and other things.

 

[Spydra]

Hmmm I think what I would like to be doing is starting to make sense, I'm just not sure its actually possible. I am picturing a small assessment practice and establishing an assessment supervision relationship with a department. That supervision relationship would allow me access to the university IRB and other resources so I can conduct research. My research projects would be smaller, not NIH level stuff, and would be conducted in the community. Occasionally I might run treatment groups in a non-outpatient setting or see a couple of individual clients via telepsych. Hmmmm now to figure out how it could work.......

 

[Sanman]

Hmmm I think what I would like to be doing is starting to make sense, I'm just not sure its actually possible. I am picturing a small assessment practice and establishing an assessment supervision relationship with a department. That supervision relationship would allow me access to the university IRB and other resources so I can conduct research. My research projects would be smaller, not NIH level stuff, and would be conducted in the community. Occasionally I might run treatment groups in a non-outpatient setting or see a couple of individual clients via telepsych. Hmmmm now to figure out how it could work.......

Or just hit the easy button and get an AMC job.

 

[Spydra]

Or just hit the easy button and get an AMC job.

That of course is an option, but those come with strings I don't want to be bothered with. And I think that's what I'm realizing annoys me so much about so many of the settings I've been in. So now I'm wondering if its possible just to take the few pieces I do like and build something with just those.

 

[summerbabe]

I am picturing a small assessment practice

What types of assessment are you interested in and more importantly, who will pay for this? When I was acute inpatient, I loved comprehension diagnostics on patients with unclear medical histories and non-baseline symptom presentations and there is zero chance I could ever do that in another setting.

Some common ‘boutique’ assessment practices focus in areas where your training doesn’t seem to specialize (children, neuropsych, forensics) so competency could also be a limiting factor.

establishing an assessment supervision relationship with a department

My assessment experience is all hospital-based so I can’t speak to PP directly but quality supervision takes a lot of time. And maybe somebody else can chime in on whether having a trainee work on a case impacts insurance billing or other factors.

Occasionally I might run treatment groups in a non-outpatient setting or see a couple of individual clients via telepsych

The latter seems more feasible than the former as those units should already have group staffing covered. However, I know somebody who does a good amount of surgical and pain-type evals in PP and they also run chronic pain IOP-style groups (but hired LCSWs to facilitate).

 

[Spydra]

What types of assessment are you interested in and more importantly, who will pay for this? When I was acute inpatient, I loved comprehension diagnostics on patients with unclear medical histories and non-baseline symptom presentations and there is zero chance I could ever do that in another setting.


My assessment experience is all hospital-based so I can’t speak to PP directly but quality supervision takes a lot of time. And maybe somebody else can chime in on whether having a trainee work on a case impacts insurance billing or other factors.

I've learned that I enjoy assessments broadly as long as its an adult population. I like variety, so boutique is unlikely to be sustainable. And of course there are some assessments that tend to only occur in non-private practice settings, I'd be open to an arrangement where I went to such a setting for a half day or day for such cases.

And I do know there are insurance challenges in regards to trainee's. Settings I've been in frequently had trainees work on non-insurance cases. I could see myself doing that as well. It is also possible that whatever department will have its own clinic that conducts assessment and want supervision there. Of course good supervision takes time, but my experience has been good assessment supervision is extremely difficult to find. This seems like an appropriate place to be of service to the field.

 

[WisNeuro]

My assessment experience is all hospital-based so I can’t speak to PP directly but quality supervision takes a lot of time. And maybe somebody else can chime in on whether having a trainee work on a case impacts insurance billing or other factors.

It gets a little different when it's not an intern or postdoc wanting supervision. Liability issues and all, I can't see doing this without charging my cash hourly rate, which I am pretty sure would be out of reach for many people who are just starting out.

 

[futureapppsy2]

It kind of seems like you don't want a job, tbh. There's not a single job, anywhere, in this field or not, that doesn't require some sort of boring BS or unpleasant tasks. It's just the cost of doing anything. An ex of mine went into academia after 15 years or so in (fairly high-level) clinical admin, and she was venting about nitpicky publication BS one day and then stopped and pointed out if she was still in clinical admin, she'd just have profit-and-loss BS to complain about instead.

 

[Sanman]

That of course is an option, but those come with strings I don't want to be bothered with. And I think that's what I'm realizing annoys me so much about so many of the settings I've been in. So now I'm wondering if its possible just to take the few pieces I do like and build something with just those.

It's your choice, but everything in life comes with strings. You can accept them or try and reinvent the wheel. However, reinventing the wheel comes with difficulties as well.

 

[Spydra]

It's your choice, but everything in life comes with strings. You can accept them or try and reinvent the wheel. However, reinventing the wheel comes with difficulties as well.

Well right now I'm just pondering, not married to any particular option.

 

[summerbabe]

Well right now I'm just pondering, not married to any particular option.

Totally makes sense and you definitely don’t need to be. However, there’s also some really good advice and perspectives being shared about what the future holds, whether you do a postdoc or not.

And to be honest, there’s gonna be plenty more headaches/BS/etc ahead because even in less than idea training situations, trainees are still shielded from consequential and not so pleasant things such as productivity requirements (e.g., having a convo with not so competent middle management type on why you have x amount of no-shows and how to ‘fix’ it).

As a postdoc, I was given some really good advice on looking for a first job. You’re not gonna get everything you want so prioritize your top 3+ needs (location, job duties, salary/benefits, schedule, etc) and shoot for something with 2+ on your list and hopefully you won’t have to settle for only getting one of your top needs. And the more non-negotiables you have, the more you will likely sacrifice elsewhere. Perhaps that can be a helpful way of framing postdoc and first job choices as you narrow things.

And of course there are some assessments that tend to only occur in non-private practice settings, I'd be open to an arrangement where I went to such a setting for a half day or day for such cases.

I don’t know much about behavioral health/medical administration but I’m not sure if moonlighting with a hospital/government agency is feasible between credentialing procedures, FTE justification, and how there would either be staffing already or those services would just not be offered.

Variety unfortunately tends to be one of those things that many of us sacrifice in exchange for a steady W2 job with good benefits and the W2 jobs with more variety will also have their own built in problems so it’ll depend on what one can tolerate and ultimately laugh at.

 

[thebalmofhurtminds]

Totally makes sense and you definitely don’t need to be. However, there’s also some really good advice and perspectives being shared about what the future holds, whether you do a postdoc or not.

And to be honest, there’s gonna be plenty more headaches/BS/etc ahead because even in less than idea training situations, trainees are still shielded from consequential and not so pleasant things such as productivity requirements (e.g., having a convo with not so competent middle management type on why you have x amount of no-shows and how to ‘fix’ it).

As a postdoc, I was given some really good advice on looking for a first job. You’re not gonna get everything you want so prioritize your top 3+ needs (location, job duties, salary/benefits, schedule, etc) and shoot for something with 2+ on your list and hopefully you won’t have to settle for only getting one of your top needs. And the more non-negotiables you have, the more you will likely sacrifice elsewhere. Perhaps that can be a helpful way of framing postdoc and first job choices as you narrow things.


I don’t know much about behavioral health/medical administration but I’m not sure if moonlighting with a hospital/government agency is feasible between credentialing procedures, FTE justification, and how there would either be staffing already or those services would just not be offered.

Variety unfortunately tends to be one of those things that many of us sacrifice in exchange for a steady W2 job with good benefits and the W2 jobs with more variety will also have their own built in problems so it’ll depend on what one can tolerate and ultimately laugh at.

I received a lot of the same advice, but I will add just one caveat. While it's certainly true that trainees are shielded from some aspects of the job, I had a somewhat different experience. For me, the cons of being a trainee - lack of control over a lot of your schedule, a very specific minor role in the place of employment, constant supervision, micromanagement, etc. - went away and contributed to a much better experience as an employee rather than a trainee. Yes, now I'm aware of very frustrating aspects of the job, but at least I have the information/knowledge about why those things exist and some power to influence them. As a trainee, I felt relatively aimless and unconnected to the actual profession.

 

[Sanman]

Totally makes sense and you definitely don’t need to be. However, there’s also some really good advice and perspectives being shared about what the future holds, whether you do a postdoc or not.

And to be honest, there’s gonna be plenty more headaches/BS/etc ahead because even in less than idea training situations, trainees are still shielded from consequential and not so pleasant things such as productivity requirements (e.g., having a convo with not so competent middle management type on why you have x amount of no-shows and how to ‘fix’ it).

As a postdoc, I was given some really good advice on looking for a first job. You’re not gonna get everything you want so prioritize your top 3+ needs (location, job duties, salary/benefits, schedule, etc) and shoot for something with 2+ on your list and hopefully you won’t have to settle for only getting one of your top needs. And the more non-negotiables you have, the more you will likely sacrifice elsewhere. Perhaps that can be a helpful way of framing postdoc and first job choices as you narrow things.


I don’t know much about behavioral health/medical administration but I’m not sure if moonlighting with a hospital/government agency is feasible between credentialing procedures, FTE justification, and how there would either be staffing already or those services would just not be offered.

Variety unfortunately tends to be one of those things that many of us sacrifice in exchange for a steady W2 job with good benefits and the W2 jobs with more variety will also have their own built in problems so it’ll depend on what one can tolerate and ultimately laugh at.

The truth about this conversation is that while it might feel angst ridden for a student in this position, the decision will involve much less choice and be much easier than one anticipates. Much like an angst ridden college application season that only results in 1 or 2 acceptances.

For what it is worth, my cohort and the ones behind me all started in different places with varied interests. As time has marched on, most of us have ended up in similar settings. Generally, those with some stability and a good salary. Then there were a few rockstars that decided to forge their own path.

 

[PsySeeker]

@summerbabe Your description of a state hospital was what I expected from inpatient and am not experiencing. I'll keep it on the 'to try' list as it does seem to have potential as I like non-medical models and am interested in more SMI training.

In many states psychiatry absolutely dominates state hospitals, the medical model is certainly prevalent, and patients are far too often “snowed” or “chemically restrained”. In some states (at least) staff are often extraordinarily undertrained (e.g. the orderlies/psych/activities aids/staff can be HS grads with a week of on the job training). Staff at all levels are often at skeleton crew levels and frequently highly miserable. Facilities are often decades past outdated, many are depressingly dilapidated. Of course, YMMV, and perhaps some states are wholesale better than where I worked.