Career change options

[hum1]

I have been working as a psychotherapist for the past 15 years but would like to do something different. I also teach occasionally as an adjunct however do not see this as a main career due to the low pay and precarious working conditions. What are other work options with a doctorate in psychology in the US? I am leaning towards assessment, however I have never focused on assessment so I would probability need further training. Where would be a good starting point? I looked at Pearson's website but the trainings are so expensive. What other options are there? Thank you for your thoughts.

---

Members don't see this ad.

 

[PsyDr]

A. Overall
i. I am concerned that you consider the Pearson price point to be expensive. That statement, combined with your desire to do something else, says "I'm not paid enough". Maybe I'm wrong. But if I'm right, if you're in a job, look at the salary surveys, and ask for a raise. If you're in PP, I would strongly encourage you to raise your prices, and ask private insurers for a raise. Look for reimbursement data online. Make some calls to your competitors' offices and ask what they charge per hour for a private pay session. Get rid of the bad insurances, or the ones that give you the worst patients.
ii. Look at jobs elsewhere. I know, I know, you have 18M reasons why you can't. But it might be cheaper to move to a new job than other options.

B. Retraining

i. You should not get training from a test publisher.
ii. If you want to gain assessment training, there are a few programs from educational institutions. That would take about 2 years, with tuition costs, and then you’re looking at a minimum of $3k to buy enough tests to get started.
iii. You should really explore exactly what the assessment market looks like. You would not be qualified to perform neuropsychological testing, relative to the HCG. That leaves a small corner of the assessment market including educational testing, and/or pre-employment testing for industries that require that. How much can you charge? How many can you realistically get? Where does the writing time go into your schedule?
iv. You could also enter the post doc match, and try things that way. Living as a post doc in middle age would be financially devastating for retirement.

B. Other ideas:

i. Get an MSCP, move to an RxP state, and prescribe. If you dislike psychotherapy, I don't know if that would be a better option.
ii. Re-specialize in IO through an educational institution, or get an MBA. Figure out how to apply your skills to an industry in a way THAT IS ACTIONABLE. No one cares if you show up and say some vague things. An industry wants to hire a consultant, who provides actionable recommendations, that result in increased profits in dollars and cents. This market is highly competitive, and you're going to be wearing a suit every day.
iii. Get better at marketing your practice. Spend some money on new furnishings and a new website. Wear something nice, get better patients.
iv. Run groups. That pays so well. Get supervision if needed. Attend some training like from Beck or something.
v. Become a court mediator. IIRC, states have training programs for that. Pays well. Nice offices.

 

[hum1]

Thank you for your thoughts. Yes, I am in PP and 98% of my clients come through insurance. I thought insurance pays a flat CPT fee rate to its paneled providers and that that fee is not negotiable. I might be wrong. Getting private pay clients and being able to raise fees would make my financial situation more stable, however I would still be doing psychotherapy. Do not get me wrong, I like doing psychotherapy however after many years it can become a bit draining so I would like to do something else.

About retraining, I cannot enroll in a 2 year educational institutional program because of costs and time, so that would be out of the question. I am not sure on how the market is because I do not know a lot of people who do assessment. I think I would focus on something simple such as ASD, ADHD, cognitive assessment, etc. Do you know on how the market looks for these?

Thank you for reminding me of the brutality of the corporate world and consultancy. You are right, it is a very competitive and specific market. Never thought of the groups option, it actually can be a bit more interesting since there is a group of people interacting instead of an intense 1 to 1 as in individual psychotherapy. I will investigate court mediation.

Hey, I wear something nice!

 

[PsyDr]

No one can tell you what the assessment market looks like. The easiest way to find out, is to call the front desk of other providers in your area and ask “how much does it cost to get a psychoeducational evaluation?”. You don’t have to tell them who you are or why you are calling. You can also ask if there is a wait list, and how long it is. Then hang up.

Ethics doesn’t bend because you cannot afford something. You are ethically bound to get sufficient training and supervision.

And if you’re seeing insurance only patients, I would suggest that you should probably expand your private pay patients. Define why they would want to see you, rather than anyone else. Market that.

I am pointing out that you can work less, if you earn more through higher pay. You cannot do things you are not trained to do, because you need money.

 

[WisNeuro]

Just a quick point of reference OP, per time spent, therapy codes are paying better than assessment codes for the most part. If you're going to take insurance and think this is the road to a more lucrative life, this is not the way. I would also be concerned about competence above and beyond a fairly straightforward psych assessment.

 

[ClinicalABA]

I think I would focus on something simple such as ASD, ADHD, cognitive assessment, etc. Do you know on how the market looks for these?

There's a huge need for ASD assessments in my area. We exclusively do ASD assessments and have recently had to limit our practice to children under 3 in order to have a manageable waitlist and actually assess a child within a few months of referral. I'm in the relatively rural Western part of MA, but my company has clinics throughout the state with similar issues. We can't find trained psychologist to do this, and understand that we would need to train anyone we hired. It's still almost impossible to find psychologists with reasonable decent education and training, even outside ASD. That said, if all you've ever done is adult (or even adolescent and older) therapy, it might be a tough transition to working with children, and even tougher to working with toddlers.

My clients are pretty much all insurance, and a vast majority of those are medicaid. You should be able to find the CMS rates for neuropsych testing codes for your state. Most psychologists who do this seem to be parts of larger agencies (often ABA provider agencies) or hospitals. Many of those psychologists also have a BCBA and/or are licensed ABA practioners. You can make a good living doing this. You could make more doing private-pay child assessments, but then you get into a parents "requesting" specific results, which I'd much rather not deal with at this point in my career, even if it meant more money (I make up a lot of the difference through adjuncting). My guess is that if you hung up your shingle here and advertised that you were doing child assessments, you'd start out with a pretty big line out your door. You'd get a reputation pretty quickly, which could determine how long that line would be and how long it would be there.

 

[hum1]

Ethics doesn’t bend because you cannot afford something. You are ethically bound to get sufficient training and supervision.

I never claimed nor implied that I would pursue a career in assessment or that I would do things I am not competent to do because I need money. I have applied MMPIs, WISCs, WAISs in the past about 10 years ago, but if I now need a 2 year training program to become competent in it, than this is not an option for me. For example, and in regards to psychotherapy, I have always received supervision because I find it very important in order to be able to see clients. Taking more private pay clients is a good idea on the medium term, and it is relate with marketing, etc.

Just a quick point of reference OP, per time spent, therapy codes are paying better than assessment codes for the most part. If you're going to take insurance and think this is the road to a more lucrative life, this is not the way. I would also be concerned about competence above and beyond a fairly straightforward psych assessment.

I wanted to make it clear that it is not just about the money. It is about doing something else in the field of psychology that is not only psychotherapy work.

There's a huge need for ASD assessments in my area.

I am also in MA. Could you PM me and let me know the name of the company that you work for? Thank you.

 

[Therapist4Chnge]

Just to clarify, if you are paneled w an insurance company, you CAN negotiate your rates. You should have before joining their panel, but if services are in demand in your area, you might be able to call and renegotiate. Insurance companies hope you take their first offer, but you are under no obligation to do so.

 

[PsyDr]

I never claimed nor implied that I would pursue a career in assessment or that I would do things I am not competent to do because I need money. I have applied MMPIs, WISCs, WAISs in the past about 10 years ago, but if I now need a 2 year training program to become competent in it, than this is not an option for me. For example, and in regards to psychotherapy, I have always received supervision because I find it very important in order to be able to see clients. Taking more private pay clients is a good idea on the medium term, and it is relate with marketing, etc.



I wanted to make it clear that it is not just about the money. It is about doing something else in the field of psychology that is not only psychotherapy work.



I am also in MA. Could you PM me and let me know the name of the company that you work for? Thank you.

That’s fair. You can appreciate my position: some unknown is edging on the ethical borders. I can say:
a) something and offend,
B) say nothing and worry about ethical violations.

I didn’t mean to accuse you.

But I really think you’d do better by expanding private pay patients, doing an office remodel, making more money, and working less.

Aside: I am prejudiced against MA, so it might be the case that I should be ignored.

 

[hum1]

I didn’t mean to accuse you.

I didn't take it personally, I know we have ethical duties.

But I really think you’d do better by expanding private pay patients, doing an office remodel, making more money, and working less.

Perhaps this will be the best option, if I get more private clients I can perhaps teach more since teaching does not pay very well.

Aside: I am prejudiced against MA, so it might be the case that I should be ignored.

In what way, if you would like to elaborate.

 

[ClinicalABA]

In what way, if you would like to elaelaborate

Yes, please do. It's a generally pleasant place to live, especially if youreto the left of center politically and ideologically. It's expensive, but not new york city/California expensive. As with most places, the overall image that's portrayed is of the extreme, but also like most places people generally treat you kindly and don't get in your way.

 

[AcronymAllergy]

Any relatively well-trained psychologist could probably do ADHD assessments almost out of the gate, assuming you have familiarity with the condition. At the end of the day, all it really requires is a thorough clinical interview. You can add in a few rating scales/inventories as well, if you'd like and if you're reasonably familiar with them; at the very least, it's justifiable from a validity assessment perspective.

I've had to turn down ADHD referrals because I'd otherwise be inundated with them.

ASD assessment, IMO, would probably require more work if you didn't already have familiarity with it. Unless it's in adults, in which case the measures and methods are variable/scattered/limited. But the need is certainly there, at least where I am. I suspect these evals in the current climate would entail telling a lot of people that they don't have ASD (or ADHD), and there are probably few people better trained and able to do that than a psychologist.

My referrals for both types of evals have come from what might be considered non-traditional sources (e.g., neurology practices). I'm sure PCPs have a slew they could send as well. But whether there's a market for it in your area depends on multiple factors, including how many (if any) other professionals in the area are already offering these types of evals.

You could check in with your state psych association as well. There are other niche-type assessments that might be available, although you'll probably want to set up a formal (paid) supervisory relationship with another psychologist if needed.

 

[Therapist4Chnge]

If you did ADHD evals, they likely would have to be private pay bc insurance companies rarely pays for them. They view ADHD evals as psychoeducational and deny them. Get formal supervision bc communities don’t need more subpar ADHD eval reports.

As for ASD diagnosis, I wouldn’t recommend them. Unless you’ve previously trained on the ADOS and/or have pretty solid assessment skills, there are co-morbidities that can easily be missed and you’d be jumping into the deep end where peds neuro plays, and you’d be woefully unprepared for that.

 

[R. Matey]

If you did ADHD evals, they likely would have to be private pay bc insurance companies rarely pays for them. They view ADHD evals as psychoeducational and deny them. Get formal supervision bc communities don’t need more subpar ADHD eval reports.

In my state, insurance will pay if you're differentiating ADHD from a learning disability or another mental health condition. It's not MA though.

 

[WisNeuro]

In my state, insurance will pay if you're differentiating ADHD from a learning disability or another mental health condition. It's not MA though.

They will pay here, but only for very limited eval, no neuropsych testing, with some slight exceptions with certain ruleouts.

 

[R. Matey]

They will pay here, but only for very limited eval, no neuropsych testing, with some slight exceptions with certain ruleouts.

That's similar to here though I think neuropsych is an option if it's indicated if you're trying to differentiate ADHD from some other neurological condition. It's not work that I would ever do so I don't know that much about the specific.

 

[WisNeuro]

That's similar to here though I think neuropsych is an option if it's indicated if you're trying to differentiate ADHD from some other neurological condition. It's not work that I would ever do so I don't know that much about the specific.

They will here as well, but that neurological condition has to be fairly well documented in the records or the prior auth gets bounced.

 

[ClinicalABA]

They'll pay here (MA) but generally not for some specific neorpsych testing just to identify ADHD, most likely due to the fact that such testing doesn't really exist.

 

[Sanman]

They'll pay here (MA) but generally not for some specific neorpsych testing just to identify ADHD, most likely due to the fact that such testing doesn't really exist.

So, are they just paying for a clinical interview/ 90791 or are they allowing rating scales as well? I assume a that a Connors or TOVA would not be approved.

 

[WisNeuro]

So, are they just paying for a clinical interview/ 90791 or are they allowing rating scales as well? I assume a that a Connors or TOVA would not be approved.

Here they will cover a 90701 and some very limited psych testing codes (timewise), not neuropsych.

 

[R. Matey]

So, are they just paying for a clinical interview/ 90791 or are they allowing rating scales as well? I assume a that a Connors or TOVA would not be approved.

I imagine the Connors rating scales would be fine. Same as above in my state.

 

[ClinicalABA]

So, are they just paying for a clinical interview/ 90791 or are they allowing rating scales as well? I assume a that a Connors or TOVA would not be approved.

My experience has been just 90791. On many of the testing Auth request forms, there's a specific question related to why- if ADHD is the primary concern, 90791 is not sufficient. I've never asked personally had to come up with a justification because all my clients meet criteria for ADHD because they are two year olds.

 

[ClinicalABA]

I imagine the Connors rating scales would be fine. Same as above in my state.

What cpt code would you request for a connors?

 

[WisNeuro]

What cpt code would you request for a connors?

Scoring/interpretation? Would depend on if it was part of a larger neuropsych eval or just psych/ADHD. For the latter 138/130 I presume.

 

[psychconsultant]

I have been working as a psychotherapist for the past 15 years but would like to do something different. I also teach occasionally as an adjunct however do not see this as a main career due to the low pay and precarious working conditions. What are other work options with a doctorate in psychology in the US? I am leaning towards assessment, however I have never focused on assessment so I would probability need further training. Where would be a good starting point? I looked at Pearson's website but the trainings are so expensive. What other options are there? Thank you for your thoughts.

Sounds like you're bored with being a psychotherapist. Try something different. About 10 years ago, I was similarly bored, and pivoted to being a consulting psychologist. I now provide consulting services to non-profits clinics in a few niche areas: integrating EBPs into their programs; program development; staff training; quality improvement; staff recruitment. I also practice via video/teletherapy only 3-4 hours per week at full price ($200 per session), and provide supervision for one post-doc (at $100 per session). My income has been stable, I take about 90-100 days (yes!) of vacation per year to coincide with my partner's academic calendar (I don't work at all during June, July, August, most of Dec-Jan, and a few weeks off in March/April).

 

[quickpsych]

Could always come into the skilled nursing/rehabilitation/healthcare setting realm with mostly the senior and elderly population. For psychologists it's mostly brief evaluations, symptom screeners, collating data in charts, making basic recommendations to patients/family/facilities occasionally. Occasionally some maintenance supportive therapy for long term patients and brief CBT type therapy for short term patients. Most companies that provide these services to facilities offer salaried or per service in multiple locations.

The cons are it can be very volume based, kind of repetitive, facility staff are often a rotating door of varying degrees of incompetence, and the settings you go into, to put it mildly, may not be for the faint of heart. The pros are you can usually work much less hours per week and do ok , make your own schedule, and a silver lining is a lot of folks even the short term subacute patients generally appreciate someone coming in and actually listening to them and talking with them rather than talking at them.

It's helpful to have some prior experience in some type of healthcare setting.

That said I'm considering going back to more traditional psychotherapy perhaps ironically, although I'd probably keep working this kind of work for a while even if on the side.

 

[Sanman]

Sounds like you're bored with being a psychotherapist. Try something different. About 10 years ago, I was similarly bored, and pivoted to being a consulting psychologist. I now provide consulting services to non-profits clinics in a few niche areas: integrating EBPs into their programs; program development; staff training; quality improvement; staff recruitment. I also practice via video/teletherapy only 3-4 hours per week at full price ($200 per session), and provide supervision for one post-doc (at $100 per session). My income has been stable, I take about 90-100 days (yes!) of vacation per year to coincide with my partner's academic calendar (I don't work at all during June, July, August, most of Dec-Jan, and a few weeks off in March/April).

Sounds rough

 

[albatross_at_crossroads]

Sounds like you're bored with being a psychotherapist. Try something different. About 10 years ago, I was similarly bored, and pivoted to being a consulting psychologist. I now provide consulting services to non-profits clinics in a few niche areas: integrating EBPs into their programs; program development; staff training; quality improvement; staff recruitment. I also practice via video/teletherapy only 3-4 hours per week at full price ($200 per session), and provide supervision for one post-doc (at $100 per session). My income has been stable, I take about 90-100 days (yes!) of vacation per year to coincide with my partner's academic calendar (I don't work at all during June, July, August, most of Dec-Jan, and a few weeks off in March/April).

I'd love to hear more about this path if you have the chance. I worked in a consulting firm previously (mostly organizational, leadership development, general HR stuff), but not at the doctoral level. How did you pivot and what did it entail - additional business education, supervision, etc.? Do you consult on your own or do you have a team? Thank you!

 

[psychconsultant]

I'd love to hear more about this path if you have the chance. I worked in a consulting firm previously (mostly organizational, leadership development, general HR stuff), but not at the doctoral level. How did you pivot and what did it entail - additional business education, supervision, etc.? Do you consult on your own or do you have a team? Thank you!

I'm 100% solo, no employees or 1099s. I simply applied my research and clinical background with no additional training beyond my post-doc. Most behavioral non-profits actually have financial resources set aside for program development and most states require locally funded organizations to implement EBPs. My work includes grant writing, collaborating with state and federal agencies on demonstration projects, training on EBPs like CBT and motivational interviewing, and helping primary care clinics integrate mental health services into their service offerings. I suggest getting involved in local and state-level planning councils and workgroups, and going to hyper-local conferences and trainings to network with non-profit agencies.

 

[albatross_at_crossroads]

I'm 100% solo, no employees or 1099s. I simply applied my research and clinical background with no additional training beyond my post-doc. Most behavioral non-profits actually have financial resources set aside for program development and most states require locally funded organizations to implement EBPs. My work includes grant writing, collaborating with state and federal agencies on demonstration projects, training on EBPs like CBT and motivational interviewing, and helping primary care clinics integrate mental health services into their service offerings. I suggest getting involved in local and state-level planning councils and workgroups, and going to hyper-local conferences and trainings to network with non-profit agencies.

Thank you for your response! I'm in Canada so some things are slightly different, but I appreciate the advice on getting involved in local workgroups/councils. My province is testing in some ways integrating mental health services into the healthcare plan, which is a very interesting process to observe. This also has the potential of things going sideways, of course. However, I think that being involved brings a lot of benefits, both for own exposure and for influencing how some things are shaped. Thanks again!