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The Mentor's Corner |
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Students/Early Career Professionals |
Jeffrey Barnett, Psy.D. & Michael Murphy, Ph.D. |
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Anne Owen asks: I have a question for the Mentors List! I am a newly licensed psychologist. I currently work at a local VAMC, but plan on leaving that job for private practice when the time is right. The question is, I can’t seem to figure out when that “right” time might be. I have two options for private practice right now — to continue at the VA, and to sublet from a colleague (psychologist) I really like for evenings and weekends when she is not using her office. The plan is that some day she and I would move into bigger office space and I would be there full time. I really like her and think it would be very pleasant to work alongside her. My other option is to join a group practice with a well-regarded local psychiatrist and two social workers. They have practiced together in the past -- the psychiatrist has a busy practice, but does not tend to refer to psychologists for therapy. He sees patients for therapy himself, or refers them to his social worker colleagues. He has told me that he would see MY patients for medication management, but that he would not necessarily refer back to me, as he has made a commitment to his social work colleagues to keep their practices full. I do not have any clients and have not yet been active in marketing myself. I am just not sure how to weigh the pros and cons of these various options. I believe that my reputation would be more enhanced by aligning myself with the psychiatrist’s practice. However, I would definitely feel like the outsider since they have a 20-year-long association. I am also a little concerned about him being a good referral source for me, which seems to me should be one of the key potential benefits of sharing an office with a psychiatrist. There would also be higher overhead at this office, as there is a secretary etc — although that would certainly free me up from some of the tedious business aspects. I feel that I would be able to develop a more comfortable working relationship with the other psychologist. We are more similar and when we made our practice it would be from scratch. However, it may be a year down the road before we get all the details, timing, office space, etc. worked out. She offers me the option of affordably developing my part-time practice while I still work at the VA. Part of the problem is that I can’t decide how long to stay at the VA. I wonder if the time ever feels right to jump into practice and away from the security of a steady paycheck, even if the job is not what I really want to be doing. I realize this is much too complex a situation for me to adequately convey over E-mail, or for you to respond to... But if anyone who’s been there and done that could offer me their words of wisdom as I approach this decision, I would greatly appreciate it. Loraine Van Tuyl responds: Hi Anne, Sounds like you feel more comfortable with the colleague (which I think is MOST important) and at this point I don’t see any major benefits for joining the group practice. Just sharing an office with a well-known psychiatrist is not going to get you any clients if he does not refer to you. I myself had hooked up with someone with a beautiful office, but the lack of support and competitiveness (could not hang my sign up, person seemed to feel threatened, etc.) made me switch, and I love where I am now. You may really enjoy having your colleague there to share your initial struggles and build your new practice together.I think it is great that you can choose when to end you work at the VA. The fact that your practice will gradually grow might be a good thing to get used to the feel, forms, your own groove, etc. You can see how fast you’re growing (about one new client a month is average) and decide when you make enough or like it enough to stop working at the VA.Good luck, Loraine Jeff Barnett adds: Hi Anne. This is a great question and a situation that many practitioners face. Many psychologists don’t just jump right into a full-time private practice. The idea of working at the VA and starting and building a practice part-time sounds like a great idea. You’ll have a steady income and your benefits as well and the stability they bring. You’ll also continue to build your clinical skills and experience. As Loraine pointed out, and as you already seem to know, the ‘fit’ is so important where you work. You won’t just be renting space, but sharing an office together. Good working relationships are crucial for you to enjoy your work. You’ll be spending a lot of time there and don’t need lots of tension and headaches. The other option is to find an existing group that is busy and that will give you referrals as an independent contractor. The difference is that you’ll be working in their practice and they take a cut of all the money you bring in. But, you can build up your caseload much faster that way. Both ways work. Either route you go, be careful about any contracts you sign and have an attorney review them for you first. Look at previous posts on the Mentors list for information about marketing your practice, developing niche practice areas, and related issues. Visit the Division 42 website at www.division42.org for lots of helpful information and products that will help you be successful in practice. Best of luck - Jeff. Beth Cieslak Jennings contributes: Anne, I too would suggest that you stick with the VA and start your practice part-time with the psychologist you feel comfortable with... I am currently in the same situation and the most helpful advice I have received on this issue is to choose a practice/partner with whom you feel comfortable working (assuming that you can get clients and the arrangement works). For those of us just starting out, I think there is a push to be practical and business-minded in regard to aligning ourselves with the “right” niche/group, reputation, etc. While these are important elements to consider when beginning private practice, listening to your gut and choosing a place that “feels” right is just as important. I’m reading a very helpful book right now, Independent Practice for the Mental Health Professional (by Earle and Barnes) and I would recommend it for newly licensed psychologists thinking out private practice.Good luck!! Beth Christine Szostak asks: Hi All, I have a Psy.D. Vs Ph.D. question. Several students in my Psy.D. program have been bringing up frustrations about the fact that the Ph.D. is much better than the Psy.D. First, is this true? Second, is it true that Ph.D.s will most likely be given any job which they apply for over Psy.D.s unless the Psy.D.s have a great deal of extra academic work, phenomenal experience, or extra degrees (i.e. more post-doctoral experience or highly competitive emphasis area/specialization)? For those of you who have chosen to do either degree, may I ask why you chose that specific degree and what benefits or downfalls you have found in it (mainly related to the above mentioned degrees)? Steve Walfish responds: I believe the research on this topic comes to the following conclusions: If you want an academic job in a traditional psychology program get a Ph.D. The PsyD will be discriminated against. If you want an applied job (including private practice), there is no such discrimination. Mitchell Hicks contributes: I would agree with Steve on this one. I think it really depends on the match between your EXPERIENCES and what you are trying to do. The PhD who has few to no publications isn’t going to be very competitive for academic jobs. On the other hand, the PsyD with a lot of publications and research experience may be quite competitive for an academic slot... but there will be some favoritism toward the PhD in academe. I’m a little partial to the PhD, but that really is personal and self-serving. Erica Black adds: I would think most of these questions depend on what you want to do with your degree, which hopefully you sorted out before you started a graduate program. Employers aren’t generally looking for a particular degree - they’re looking for a match between your skills and their wants and needs. In the broadest of senses, a Psy.D. is more likely to be a match for clinical positions and a Ph.D. is more likely to be a match for a research or academic position. Miguel Gallardo replies: I agree with Erica’s statement above. If you have an interest to combine clinical work, with teaching, etc., you can do this with a PsyD. My PsyD degree has not impacted me in anyway at this point in my career. I am also not applying for highly research oriented teaching positions or research positions. I do not have an interest in simply being a researcher. If this is what I wanted to do, I would have been better off with a PhD. Even if you decided to teach full time, there are many programs in which your PsyD degree would be more than suitable. I have a full time job in a university counseling center and teach as an adjunct in a psychology graduate program. Spend time creating a good psychologist and the rest will follow. I hope this is helpful. Christine Szostak asks further: Thank you all for the information. Next, I have one more question. Personally my interests lie in private practice, academic teaching, and minor research respectively. Thus, my question, is, as my main interests fall within practice and followed by teaching, would the Psy.D. fit my needs enough to allow me to become competitive within the field. I know that the primary difference that sets the Ph.D. apart from the Psy.D. is research, and considering I do not have this as a major interest, and my school tends to put a more hands-on emphasis of clinical work on the Psy.D. degree, this would seem to be the way for me to go. I simply do not want to make it through 4 years of training and than find out that I can not compete with my Ph.D. peers when looking for a teaching position in addition to clinical practice. Steve Walfish replies: It depends on what type of teaching you want to do. With a PsyD you can probably teach at a PsyD program, 4 year liberal arts college, possibly a medical school, and possibly a masters level program. However, not at a major research university as PsyD’s will not be competitive (and not valued) by the faculty compared to PhD’s. The reason is that research is the primary mission of these universities, with teaching secondary (though they do like it if you’re a good teacher, but you get few kudos for it). If you want to teach as your primary career path, or even think that you might, I would suggest the PhD. It will give you more options in this regard while a PsyD may close some doors. Frank Cushing responds: If your PRIMARY interest is in clinical practice, it will not make a hill of beans difference once licensed. Also, I believe you will get much better practical training from practicing psychologists in most Psy.D. programs compared to the academicians/researchers at Ph.D. programs. I would not be as concerned about being competitive with Ph.D.’s for academic positions if you are going to be in full time practice...for one, you will have to take a huge hourly cut in reimbursement to teach so you may not be as interested in it as you think now, once your practice isbooming....On the other hand, if you still want to teach, or if you are going to teach part-time, even from the beginning, the competition for such slots is not nearly the same as for full time faculty positions. As was said earlier, four-year liberal arts schools looking for adjunct staff, junior colleges, medical schools and even University programs needing someone to teach a course or two are NOT that picky about the degree. And, it is not like you will have a degree to be anything but extremely proud of.Rather than see the Psy.D. as less than, I see it as more than.....you would be a DOCTOR OF PSYCHOLOGY, not a Dr. of Philosophy: trained in the PRACTICE of psychotherapy and psychological testing more so than those who take all the research and statistics class work in the Ph.D. program. Like most elitism, the Ph.D. vs. Psy. D. debate at times may get wrapped in the false pretense that one (usually the older, more established one) is better than the other--For practitioners this is NOT the case—either way, your license will say “Clinical Psychologist” and insurance panels must reimburse by license, not degree...referral sources will know you as a Psychologist and won’t care about Ph.D./Psy.D./Ed. D.Courts will recognize you as an “expert” based on experience, license and specialization and patients will only know (and care) whether or not you are helping them.......I have been practicing psychology for 30 years and have an Ed.D.--if I could have gotten a Psy.D. then, I would have, even when compared to a Ph.D.........either way, though, I am not sure you can go wrong because both lead to the same license--it is up to you with regard to which areas in which you “specialize” or “niche” once practicing. Good luck. Tanna Mellings asks: Hello. I have been asked to give a 1 hour seminar to psychiatry residents about some aspect of psychological assessment (but not personality assessment). I am not a neuropsychologist so would like to leave that topic to those more competent in that area. I was wondering if people had some ideas about what they would like psychiatrists to know about psychological assessment? What would make our lives easier as psychologists if psychiatrists knew this about assessment? Any ideas would be appreciated. Thanks a lot! Jeff Barnett replies: Hi Tanna. I always think that it is important to teach them what psychological testing is, and is not. I also like to use such seminars as an opportunity to teach them how to utilize our services effectively. To me, one of the most important points is to teach them how to make a referral for psychological evaluation or assessment. The goal is for them not to say things like “Give me an MMPI on this guy” or “Do a Rorschach on Mrs. Jones” or “Do your IQ test on Mr. Smith.” I would prefer that they tell us the questions they have that they want answered. Then, we can decide the best way to find those answers. Depending on what they are looking to figure out about a person the tests or other procedures we use may vary. I would also teach them the difference between “testing” and an evaluation. Just having test results (scores) will likely not answer the questions that resulted in them referring to a psychologist for evaluation. I would recommend you instruct them on the types of referral questions psychologists can appropriately receive and the types of information we can provide based on the types of evaluations we conduct. This may be more useful to them than a review of a list of tests we use and what each is for. I would also focus on how we work to provide information that can be integrated into the treatment plan of the referring physician. Actually, it raises a very important general issue for us all; how we interact with physicians. We may do this in a variety of ways depending on the setting we’re in. But, each interaction is an opportunity to educate them about what we offer individually and as a profession. It also raises the issue of finding out from them exactly what they want from us. In graduate school we may be trained to conduct comprehensive evaluations that result in long evaluation reports. This may not be what they want. They may want a brief report that answers their questions quickly and clearly with useable recommendations. No jargon and no intellectual discussions are needed or appreciated. I hope this is of some help. Steve Walfish adds: I would second that Jeff’s response would be helpful to anyone making a presentation to physicians. It is a great educational opportunity.To follow-up one of Jeff’s points I would also stay away from what tests psychologists may administer and to have them focus most directly on framing the referral question. Sometimes physician’s, especially psychiatrists, have favorite tests that they like for psychologists to administer (e.g., “please do projectives”). I think it important to let them know that it is your role to choose the tests to administer (if any) just as a psychologist you cannot tell a physician to do a thyroid test or a blood draw. The psychologist can only have referral questions (e.g., are there any biological reasons for this person’s depression or anxiety) and based on their training, experience, and expertise, the physician will determine the best protocol to answer the question. Mitchell Hicks responds further: Tanna, I would completely agree with Jeff and Steve on this. Since psychiatrists and other physicians are not otherwise trained to administer and interpret psychological tests, teaching them about the tests themselves is probably not a good use of time. I think that there are other things. Just like I don’t say to the psychiatrist “Could you give this guy a pill?” or “Give him Prozac,” I don’t want to hear “figure out what’s wrong with him,” or “Give her a Rorschach.” Thus, proper and useful formulations of referral questions [and not getting annoyed that the psychologist failed mind reading and has to ask clarifying questions] is where I’d spend the bulk of my time. Also, I think setting a realistic picture in terms of the process and results can be helpful. To let them know that to give someone a full neuropsychological battery and score, interpret, etc. in 24 hours is pretty unrealistic (I think, certainly this is not my area). Moreover, there are just come questions we can’t answer definitively. On the flip side of that, what questions can we answer through testing (e.g., types of referrals). Finally, and there was a thread about this a while back, don’t send a referral where all you want is confirmation of your diagnosis. That’s a waste of my time and is a disservice to the patient. Good luck with the presentation. (oh yeah, don’t give them anything to read because they won’t). Steve Walfish adds further: Let me slightly disagree with Mitch. I agree that it is disrespectful to the patient just to have a psychological evaluation that will solely confirm the psychiatrist’s diagnosis. However, I have had referrals in the past in which the psychiatrist genuinely did want a second opinion. That is, they thought the diagnosis was such and such, but weren’t entirely sure. If the psychiatrist can tolerate the results of the evaluation being different from their diagnosis then I would see this as a valuable service for the patient. Mitchell Hicks replies: We don’t disagree, Steve. That is what I was saying... if the psychiatrist ONLY wants confirmation, e.g., not open to another perspective, then this is a poor referral and is not a good service to the patient. Genuine desire to have a second professional’s opinion IS NOT a problem... Bud Newsome contributes: I agree with all of the above, and would add just one additional consideration. Don’t assume much background; these folks may think of “assessment” as a brief mental status exam. It might be helpful to get across the idea that most mainstream psychological tests are well-normed and scientifically sound. Not sure how to do this briefly, but it may suffice to just describe the logic of a standardized test and mention the size and diversity of the standardization samples for a couple of tests, and maybe a few of the better correlations regarding concurrent or predictive validity. But avoid a detailed discussion of different kinds of validity and reliability, SEM, etc., which would just make their eyes glaze over. Beverly Celotta adds: I wish psychiatrists knew about the depth of our training in statistics and measurement. So, I would take them through some idea about validity and reliability. And, I would tell them what criteria we use when we pick an instrument (e.g. normed for the population we are testing, and so on.). |
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