Is rural clinical psych in demand the way psychiatry is?

[goatcrossing]

I'm a college student, currently premed psychiatry hopeful, thinking about switching over my goals to Clinical Psych Ph.D. but still mulling it over.

One big selling point for me about going into Psychiatry is my desire to live somewhere rural when it's all said and done-- set up a PP, do a little therapy too, etc. I've heard that rural areas are hurting for psychiatrists and so you can find more favorable employment arrangements, no shortage of patients, leading to bigger and easier money, or so the legend says.

Does the same hold true for clinical psych? Most of the higher earning jobs I'm finding in the field seem to be attached more to major institutions like the VA.

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[borne_before]

One way to qualify demand is average salary. In my region, the median psychologist takes home 75k.

 

[Sanman]

The short answer to the question is yes. The longer answer for both professions is that it is complicated. There is increased demand for all mental health services in rural areas. The number of people in those areas that can afford services you may want to provide at the price you want will differ.

For example, there may be a long list for both services paid for by medicare/medicaid that might pay $60-90/hr for psychotherapy and $100-130/hr for medication management (these are made up ballpark figures). In many large cities, psychologists charge $200/hr and psychiatrists might charge $400/hr cash (no insurance). If you are expecting to charge those higher cash rates, there might be demand or not in rural areas. If you are willing to take lower insurance rates there will most certainly be more demand. Do you want to take the lower rates in PP? Now running a rural inpatient hospital psych unit is different and you can usually request more money from a hospital for a salaried job like that than in a more popular living area. It really depends on what you mean by demand.

 

[summerbabe]

I live in a very rural area with shortages in mental health providers but personally choose to work for the VA. I don't know of any private practice psychologists in mine or surrounding counties and the nearest ones are about an hour away in a town with a population of almost 50k. I think the nearest private practice psychiatrists are 45+ minutes as well.

A few things to consider:
- Need does not equal demand, especially for cash pay services. For example, are people wanting psych meds largely already getting them from their local family doc/NP? Are there strong mental health help seeking stigmas that would prevent use of psychotherapy?
- When you're thinking about rural places you may want to live, what's the median income? What percentage of people work W2 jobs with decent health insurance and/or make enough income to consider cash pay mental health services?
- People in rural areas are used to driving distances for some services. I imagine that some may be more willing to drive multiple counties to see a psychiatrist 2-3 times a year, versus somebody for weekly therapy, although telehealth adoption could negate some of these concerns.
- My guess is that a private practice rural psychologist (or MS level clinician) would need to be a jack of all trades versus somebody who specializes. I'm personally a generalist but I've had many colleagues who had certain types of cases that they really preferred to not work with and may not enjoy that type of variability.

 

[AcronymAllergy]

As others have said, the short answer is definitely yes, there's no shortage of need for psychological services in rural settings/areas. The sticking point is who/what is able and going to pay, and how realistic it would be for your client/patient base to attend weekly appointments when things like transportation and paid leave from work aren't necessarily widely available.

Odds are, you may also be taking quite a few Medicare and Medicaid patients in those areas, and I don't know how tenable a practice with a majority of patients from those payors would be. And beyond all that, it can often be the case that larger clinics and state-/government-run facilities hire a very small number of psychologists and a larger number of masters-level clinicians.

 

[BuckeyeLove]

A close friend or mine is the only (and I mean only) psychologist in a town in Iowa for hundreds of miles in all directions. She consistently notes that this has not been a good thing for her, for a variety of reasons.

 

[cara susanna]

There are certain services that are desperately needed IMO, like specialty treatments (OCD, actual real DBT, evidence-based treatment for PTSD that isn't EMDr and brainspotting, etc).

 

[ThatSerb]

A close friend or mine is the only (and I mean only) psychologist in a town in Iowa for hundreds of miles in all directions. She consistently notes that this has not been a good thing for her, for a variety of reasons.

I'm curious what some of these reasons are?

 

[BuckeyeLove]

I'm curious what some of these reasons are?

She often gets asked (code word for pressured) by multiple agencies/parties to do work that she either a. doesn't want to do or b. is not competent to do. She also feels incredibly siloed, and has no way to get real in person consultation.

 

[PsyDr]

There is/was a poster here that made a killing as a rural provider. You might want to read smalltownpsych’s stuff for some insight.

 

[Sanman]

She often gets asked (code word for pressured) by multiple agencies/parties to do work that she either a. doesn't want to do or b. is not competent to do. She also feels incredibly siloed, and has no way to get real in person consultation.

Is she employed? I would not want to be the only agency employee who is a psychologist due to the misunderstandings of what it is we do.

 

[BuckeyeLove]

Is she employed? I would not want to be the only agency employee who is a psychologist due to the misunderstandings of what it is we do.

Yep, this is part of (the majority) the problem.