Why should someone pursue neuopsych boarding?

[erg923]

If I could side track us back to the boarding issue for just moment, I have a few questions, and Jon Snow is probably gonna be the one who knows the most about this, so I specifically am requesting his input as well:

My question is relatively simple: Why should I pursue the boarding process once im practicing clinical neuopsychology after post doc? Please note, I am not asking why boarding is good or valuable to a profession (i know all those answers). I am asking why should I do it? What's the payoff? Whats in it for me? Before anyone answers, here are my gripes (they are the gripes of many in my position).

I have yet to hear a compelling argument as to why I would put myself through yet another ordeal in this profession (an another series of tests). I know enough about testing to know that it doesn't "prove" anything. Especially one test, with no follow-up certifications. Am I suppose to belive that this one test ensures the public that I am practicing th most competetly possible? Get real! Furthermore, where is the evidence that boarded practioners are any more competent or otherwise "better" neuopsychologists than the non-boarded ones? Marty Rohling presented some research at NAN several years ago, and from what I recollect, there was no real evidence that boarding has any relationship to being more knowledgable or more competent in your practice. Why should I endure extra stress and pay thousands of dollars in travel and study materials for piece of paper that tells me something I will already know by that time-That I am competent to practice neuropsychology! I thought thats what the 2 year post-doc in neuro was for?!

Like other early career professionals, I have a young family that I want to spend time with - maybe this isn't relevant to the "elders" of the profession, but it's definitely important to me, and I'm going to venture a guess that it's important to the increasingly female demographic of this pofession. After all the hoops and all the moves a family goes through, enough is enough, and I am not in the mood for yet another arbitrary test-so I can join a "club." Especially when I dont see any real benefits to me by joining said "club." The only benefits I can see is that it makes neuropsych look more like a medical model and makes it "appear" united. Obviously its not, because only like 10 percent of neuopsychs are boarded. I'm often offended by the "suck it up" attitude expressed by some in this profession (especially the elder members) that I should just readily sacrifice my money and "family-time" to do all this ABPP-CN stuff......and be damn greatful for the opportunity. How out of touch are these people?

Board certification is a nice idea, but I have yet to see a compelling reason to pursue it. What exactly is the return on my investment here anyway? I care about the profession and future of npsych, but i care about my finances, my wife, and family a even more, and I am not really willing to continue sacrficing them after my Ph.D for some greater good of the profession as a whole. Especially when I'm not even sure boarding adds that much to the profession anyway.

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[Therapist4Chnge]

*MOD NOTE: I thought this was a really good question, so I split it out to its own thread. -t4c*

 

[IT514]

I've been wondering the same thing. I think I understand the value of boarding in neuropsych, I just havent noticed a difference in those who are boarded and those who arent. However, at this stage of my training (2nd yr) I'm always open to the possibility that I am an ignorant neophyte and that I might be persuaded to change my mind.

I've heard some interesting things about the history of board certification in neuropsych...something about VAs and pay raises based on being "board certified" like physicians...even though it seems like licensure to us is what board certification is for physicians. Anyway, now there are mulitple boards...ABPP-CN, ABPN, and the pediatric one (ABPdN?). So, 3 boards? Whats up with that?

So, if anyone could shed some light on ergs question, as well as why there are three different boards, that would help a great deal. Thanks.

 

[erg923]

I too understand the theoretical value of boarding. Who would not want a united npsych in a perfect world? However, its not a perfect world and npsych isnt united and it might never be. It just too varied, with too many different perspectives and unresolved issues, both profesional and theoretical. Blind adoption of the medical model (boarding) seems an odd fit with the the profession, and the current way and process in which we are trained in npsych. I would be much more calm if people would admit that the boarding process is more for the perceptions of the public than it is for us, as I do not see any evidence that jumping through yet another arbitrary hoop produces, or ensures, better npsych service to your patient.

If the value of boarding is to project a united front that instills confidence to the public, why should we not standardize the exit exam in post-doc training programs and have that serve as a the final compentency exam for both the residency and for one united board? This eliminates the added expense and time that is placed on young career npsych with families, gets rid of the "old boy elitist club" perception that exists the profession, and presents a united front of competent npsychs to the public- Which should be the main goal of this proces anyway.

I mean the idea of having multiple boards defeats the purpose of boards, because the public sees one major board (ABPP-CN) with only 10% of the profession in it. To the public, this comes off as only 10 percent of the entire profession is competent! This is not good and seems to be the opposite of what boards are suppose to accomplish. Make it madatory for the good of the proffesion if you wish, but be inclusive of all appopriately trained post-docs after the post doc-Not some "best of the best" subgroup 5 years into practice. Having an "top dog" board that people are not willing to go through the ringer for defeats the whole purpose of a board.

 

[NeuroPhD]

My question is relatively simple: Why should I pursue the boarding process once im practicing clinical neuopsychology after post doc?

The field is changing very rapidly and it is easy to see the direction it is moving. Attorneys increasingly expect you to be board certified, some insurance companies require credentialing to be listed as a neuropsychologist (board certification will likely be the standard "someday"), and the concept of "boarding" is ubiquitous among the other doctoral providers you are most likely to have as your referral source (neurologists, neurosurgeons, psychiatrists). When I finished postdoc, every interview I went on resulted in at least one question about my estimated timeline for the boards. It is true that there are many great neuropsychologists who are not board certified, but the letters will separate you from the far too prevalent "weekend workshop" providers who often do major damage to the field. Quality control in professional psychology is generally abysmal and the neuropsychology reimbursement rates make it very attractive for untrained psychologists to offer neuropsychological assessment.

A better question for you to ask might be, "How many current post-docs are pursuing board certification?" What happens if you need to switch jobs after five years and you are competing for positions where the applicant pool is made up of half ABPPs? I don't think new neuropsychologists have much of a choice.

 

[erg923]

Thank you for the response. I am aware the profesion is moving that way, so I am aware that there will be "peer pressure" of sorts to get diplomate. However, my questions still remains, what is does boarding really mean, or prove? What is the pay-off of of this hoop for me, not just the profession. My point is, it seems to be blindly pushed by some in the profession, and I see no real evidence of its advantages as of right now, other than people "expect" you to get it for some reason. Like a said, it feels like a blind push with no evidence behind it, and no compasion or sympathy for how this effects early career professionals who have finally finished their doctorate and post-doc and now want to focus on their family. It seems like another hoop to jump through, that is ultimately a "club" that tells me something I already new-That I am competent. And if im not competent without it (as some have insinuated), how/why the hell have I been allowed to practice npsych for the 5 years before I can board!? In addition, the test and the travel seems inordinately expensive considering the debt and salaries of most new youg npsychs. What is the resistance to a much more inclusive and simpliistic version off all this that i suggested in my 2nd post of this thread?

"If the value of boarding is to project a united front that instills confidence to the public, why should we not standardize the exit exam in post-doc training programs and have that serve as a the final compentency exam for both the residency and for one united board? This eliminates the added expense and time that is placed on young career npsych with families, gets rid of the "old boy elitist club" perception that exists in the profession, and presents a united front of competent npsychs to the public-soemthing that the existence of multiple boards undermine IMHO.

To answer your question, It seems the rate of boarding is increasing, but seems to be a snails pace. Which again proves my point that the current boarding process in flawed in some way, or else I would suspect 80-90 percent of people who be boarded by now. Thats not the case. Having an "top dog" board that people are not willing to go through the ringer for defeats the whole purpose of a board. And, the numbers tell me, that up to this point, the majority are not willing to do it. Something seems wrong here.

 

[NeuroPhD]

Your points are all valid, but at your level of training you are in no place to care about the bigger picture. There is a bigger picture. Becoming a neuropsychologist is a grueling process but like it or not you are training to be a medical professional operating in an environment where you want to be on equal footing with other doctors. Neuropsychology follows a training model that is very similar to the one used by physicians. Why do physicians take boards? All of your arguments apply to them as well.

It is incredibly frustrating to be at the end of your training and still see hard work ahead. Especially when you realize that you are a "doctor" but your training/travel/study/interview expenses alone take up a big chunk of your annual salary.

 

[erg923]

Thank you for the responses and the perspectives. Ok, fair enough, I dont want to beat a dead horse, so lets look at the boarding process itself, rather than my personal qualms with the idea.

Why are so many practitioners, up until the present (i know the numbers are increasding slowly) resitant to it, or otherwise have not pursued it. It seems like there has to be something wrong here. 10 percent of eligible people have gone through, 90 percent haven't. Why? Do you think its because of the issues i have been thinking about, or is there something else? Apparently the majority of npsychs are not willing to go through the ringer for ABPP-CN (or an other board). That much is clear. So why is this? Have members of the board(s) considered that is might be something with the process, or do they chalk it all up to lazy npsych practitioners?

 

[Therapist4Chnge]

From what I've seen:

1. Too many hoops....which seems to be the most common.
2. Don't "need to" because they still get work.
3. Alternative vanity boards are willing to board for less.

If there was a standard, I think it would help with raising the #'s.

 

[Cosmo75]

I agree with T4C on having a standard for boarding, as well as why people opt not to go through it (which is unfortunate). I plan on getting board certified in health psychology. Yes it's a PITA, but I feel like it will help me in working in the academic medical world as NeuroPhD pointed out. Perhaps a part of this is related to my degree containing 4 letters versus 3 and the inevitable need to "prove" myself to some colleagues in medicine. Regardless of that, I think that boarding is important for those who want to sub-specialize in psychology.

My $.02

 

[Ollie123]

Not familiar enough with the procedures to comment on the main topic, but I'd like to add I find it interesting that while it doesn't sound like it has really "Caught on" in neuropsych at the moment - it seems like it has FAR more than in other areas. For example, even though I'm IN an academic med center working in health psych, Cosmo is the first person I've heard of planning to pursue boarding In part I'm sure that's a result of the fact that many health psychologists I work with are in 100% research positions, and some do not even maintain active licensure, so boarding would make little sense.

I'd be curious to see the breakdown in the different areas, by employment setting, etc. because I have a feeling that neuro is actually "Leading the pack" in terms of what percent of people are actually pursuing boarding.

 

[erg923]

Ollie, if I see any more of these () in your posts from now on...I'm going to punch you. Just kidding......sorta.

 

[Ollie123]

So my plan to incorporate it into my signature is....not recommended?

In all seriousness, overuse of smileys IS a very bad habit of mine that I blame on excessive use of the internet as a child. I always have to double-check professional emails to make sure I didn't accidentally include a wink or a smiley face to a faculty member who might find it inappropriate. Fortunately, I think most of the people I work closely with are unlikely to care.

 

[Neuro-Dr]

Kira Armstrong wrote a little book on this recently and she highlights a few issues that probably affect a few of us:
10% pay increase in VA and several hospital systems
peers know you and more often refer to you
clearly hightens forensic value
better for demonstrating you train students well when you recommend them to training posts
license portability
leg up on other applicants in job searches
etc.

I went through my first boards because I worked at a neurology/neurosurgery practice that advertised that all of their docs were boarded in their filed. One day they told me they were extending that to the NPs and so we all went through it. The second time I got sucked in because of a friend who was pushing me.
I have a hard time with recommending it to everyone. However, most practice studies do show higher incomes for boarded NPs. Obviously this could be due to other reasons as well. My personal feeling is that we are trying to establish a standard by which changes at all levels of training from grad school on will occur such that a systematic process of training that builds in complexity through fellowship will become the standard for producing NPs. The larger the boards (all three really) get the more influency we have on what a NP is. you certainly could obtain this training and never seek boarding, but without a significant voice from the boards there is no pressure to forces all levels of training to seek some standards for how they produce NPs.

I have small kids and a wife and found ample time to complete the process. My most valued contacts and friends I met because of the boards and I have been offered several positions and publication opportunities because of it. This is not dat, I know, but is part of my rationale for encouraging you. Also, as I have stated before, if you feeling any of your training positions is less than the best, you can always demonstrate the highest level of competency by getting boarded. I have met others who went to better grad schools, internships and fellowships than me. However, once the see those letters after my name, there is no questions from them as to whether I know what I am doing.