Career Transparency: What should I know about clinical psychology before diving into a Phd or PsyD?

[u/Salad_Ill]

My dream has always been to help people and be in the healthcare field. I did a bachelors in Neuroscience and Psychology and after auditing classes, talking to some students, and generally getting a feel for a bunch of different healthcare pathways, I zeroed in on clinical psychology/neuropsychology. In my opnion, with the growing senior population in America, that brings the need for health professionals that are able to treat, assist, and help those with neurodegenerative disorders, dementia, things of that nature and being able to be a part of that would be a dream come true.

I think that for a lot of people this field, amongst many other healthcare fields, are their personal dream and their way of helping people. But I want to know the practicalities of this career path. I know that to become a clinical psychologist/neuropsychologist, in terms of education, I have to do a bachelors in psych or something related, masters (optional but ive heard it help some people), a Phd or PsyD in clinical psychology or neuropsychology depending on whats available, then an internship, passing the EPPP, and finally obtaining state licensure.

But to people who have went through this process or going through it, what's something you wish you knew before you started the path? Salary, opportunities available after licensure, too much education not enough output, pros, cons, advantages that aren't really advertised, anything really that you wish you had figured out or learned along the way? I've googled and researched as much as I could, but I think real anecdotal evidence is a good reflection for how the career and journey is like. Personally as much as I'd love to do this as a dream career, I also do prioritize being practical and would appreciate any advice anyone could give.

[u/SUDS_R100]

Practical advice: this is the psych grad school advice Bible: https://mitch.web.unc.edu/wp-content/uploads/sites/4922/2017/02/MitchGradSchoolAdvice.pdf

Other thoughts: My PhD is in school psychology, but no matter what you do, becoming a licensed psychologist is a grind. You’re looking at a minimum of 5 years plus post doc (not counting any additional time required to accrue research experience/boost GPA to get into a program).

This journey usually involves moving at least once, but in most cases more. I moved 3x (once for graduate school, once for internship, once for post doc). You will also most likely be sacrificing a lot of income during training if you’re currently employed. Some schools are better than others funding-wise, but my annual stipend was about 20k in years 1-4.

It’s hard, and there are faster ways to make more money in healthcare. If psychologists are living their dream, it’s probably because of survivorship bias and the sample skews toward people who literally couldn’t see themselves doing anything else. Neuropsych in particular will be exceptionally tough/competitive through pretty much every step.

I don’t say any of this to scare you, but rather to prepare you if this is the route you choose. Clinical work can be incredibly rewarding, but a PhD is a lot. Look through the guide and it will answer many of your questions.

[u/maxthexplorer → u/SUDS_R100]

People always have a reaction when I tell them doing my degree in 5 years is accelerated LOL

[u/dontouchmybutt → u/SUDS_R100]

This was such a validating response. It is definitely a grind. 😭

[u/The_Neuropsyche]

Hi there! I'm a currently in a "neuropsych" track in a clinical psych PhD program. As others have said, it's a long path that requires a lot of delayed gratification.

I'm getting the gist that you're mostly interested in whether its worth the sacrifice. Can't speak for other people but I love doing assessments. Being a deciding factor in high stakes decisions will keep you sharp and interested. I love the sheer complexity that every case presents (even though many of them are not neatly "solved," so to speak). Helping patients make sense of their inner world can be very meaningful, too.

The flexibility a PhD in clinical psych affords you is kind of insane. You could be a psychotherapist, a professor, an assessment focused psychologist (e.g., neuropsychologist), work in a hospital, a community mental health center, private practice, forensics, etc. You will be trained in clinical work (intervention/assessment), research skills, and education/teaching. You get to choose how you want to specialize in any of these skills and blend them together in any of the settings I mentioned earlier. Sky is the limit, which is simultaneously daunting and exciting.

While I'm not finished with my training yet, the salary at the end of the journey seems to be sufficient. That said, I would not choose to be a neuropsychologist if I had to pay for my own tuition (e.g., many PsyD programs). Jerry Sweet publishes a "salary survey" of clinical neuropsychologist in the US every five years or so. Here is the one from 2020: https://www.tandfonline.com/doi/full/10.1080/13854046.2020.1849803

• Median entry-level salaries are $100k or more (meaning after you are done with postdoc)
  
• Salary varies widely depending on professional practices and work setting (e.g., the ceiling is a lot higher for those in private practice and those who do a lot of forensic work, well above $200k/yr)
  
• There are other data here about various aspects of career satisfaction, etc.

[u/ohhluckywhimsy]

If you attend a non funded program and you DO NOT have financial help from family or partner, you will be struggling with student debt for at least 10-15 years as you will not have a salary that easily helps you pay it off. The financial aspect is substantial.

[u/LemonPotatoes45]

I didn’t know that most states required a post-doc until I started my program. I didn’t know how abused I would feel getting paid so little and being so under-valued for my clinical work for years. I wish I knew that going into a specialty would have made it more worth it: children, family/couples, neuropsych, hospital work, VA and so on. I don’t have a speciality and just wanted to do general work like at a counseling center but that really limited my job opportunities postgrad. There’s a big need for specific specialties from psychologists but not as much for generalists. I think it’s only worth it if you know you will specialize in something. Otherwise, the time & requirements are not worth how little you get paid and how much time and income you lose being in school for so long.

[u/Appropriate_Fly5804]

A self funded PsyD will give you crippling debt and negatively impact all of major life decisions post graduation, even if you achieve exactly what you want career wise.

Some PsyDs are taking on MD levels of debt to work a job that pays a third of an MD, which sounds like a terrible ROI.

Neuropsych can be more lucrative but there is no guarantee that every interested student can achieve this goal since there are a ton of steps/things that need to fall into place before you can be board certified, some of which may be out of your direct control. 

Also, there are more active players every season in the NFL than board certified neuropsychologists in the US (and that disparity is even greater if you include the practice squad and injured reserve). 

[u/Deep_Sugar_6467 → u/Appropriate_Fly5804]

there are a ton of steps/things that need to fall into place before you can be board certified, some of which may be out of your direct control.

I'm interested in forensic neuropsych, could you elaborate please? Thank you.

[u/Appropriate_Fly5804 → u/Deep_Sugar_6467]

1. Get into an APA accredited program

2. Be able to receive practicum training experiences in these areas (easier to get therapy experience for anxiety treatment than forensic neuropsych)

3. Some areas (like rurally located schools) may not those experiences at all

4. Some metros have plenty of options for training but you may not be selected (eg other trainees are chosen over you since there is a max number of supervisors available at any time)

5. Match to an internship with these training opportunities, which is a competitive process and your past experiences carry lots of weight

6. Match or be selected for a postdoc with these opportunities (also competitive and influenced by past experiences/CV)

7. Get board certified

So missing on out earlier steps can make future steps difficult if not impossible. 

And we don’t have control over things like supply and demand dynamics such as how many people are available and willing to supervise in a given area and whether they want to work with us (since training is not required).

[u/ThatGuyOnStage → u/Appropriate_Fly5804]

Reasons I'm going straight to the VA for that sweet, sweet EDRP.

[u/Appropriate_Fly5804 → u/ThatGuyOnStage]

I hope it’s around in the future but I have significant doubts that EDRP will survive this upcoming restructuring given that a bunch of psychologists will either voluntarily leave federal service or be involuntarily removed in the very near future, which makes it harder to justify approving incentives for future hiring. 

Even when EDRP was more common, it wasn’t something to bank on because it may not be available for a specific position or facility that one would actually want to work in and could get hired for.

[u/ThatGuyOnStage → u/Appropriate_Fly5804]

I'm about a year out from internship, so I'm reaaallly hoping that it's still around by the time I'm looking for a staff job. It's one of the major incentives for me to go for VA rather than private practice since I'm primarily interested in public safety.

[u/_R_A_]

I often suggest to people that if your emphasis is on helping people, one should look into social work or counseling. I know that's not exactly what you are saying with neuroscience and all, but it's worth taking a hard consideration about what is the best way to align your path to your values, interests, and goals. That's not to say psychology isnt about helping people, but there is much more focus on the study of people than other disciplines.

[u/Holiday-Hungry]

I wish I knew:

My empathy has real bounds. Burnout is real. The stories you hear will change you forever in complicated ways. Some people have jobs they don't think much about, and are still happy in life. There are many ways to help others without going to school for 6yrs. Do not pause your life for this - keep living life every day regardless of whether you're "busy with grad school" or choosing a different path. Your degree is not more important than your personal life. Your degree is not your end all be all.

Go forth and know you will be okay no matter what you choose ❤️ this is your journey!

[u/neuroscentologist]

You won’t get paid what you deserve for the amount of investment in time, energy, mental health, and sacrifice.

[u/DrUnwindulaxPhD]

Search the sub.

[u/gumbaline]

Good on you for doing your research on this! I think this one you probably already know but I didn’t (and maybe it’s different for Canada) - it is insanely hard to get in. It took me four cycles, in part because I didn’t know what I was doing the first two. But I had a masters degree from a well-known UK university, 4 years of research and healthcare jobs, and great grades.

Another thing that is probably dependent on your supervisor’s research and what you choose to do as a thesis is the amount of statistics involved. I didn’t not know how much I needed to rely on stats and especially stats program coding to complete my degree. I know that part sounds silly but it can make a difference if it’s not a strength of yours.

Last thing I can think of right now is how little research output I’ve been able to manage compared to what I thought I would be able to crank out. I’m hoping to keep my foot in academia and so was gung ho about getting papers out but if I’m totally honest, it’s been really hard to do that on top of clinical, thesis, and course work. I’ve put out maybe one in a year and a half. Which is still great, it’s just not what I expected.

[u/Creaturr1]

Commenting to follow. I personally see a large divide based on funded v. unfunded programs. The (realistically) 5-8 year timeline to complete your degree and internship while taking on 150k+ in debt and having to manage that for 10-15 years post graduation is daunting.

I recently declined my PsyD program I got into because of some personal reasons but have been debating my career path due to the above and the time commitment needed to pursue a PhD (research experience, realistically 2-4 cycles, then the schooling) being for me around 7 - 9 more years and I am 25.

I have been debating going the CMHC route to be a therapist, while this is not research based and limits scope to therapy and not assessments (which is a large interest of mine) I am just not sure if the turnaround is the best for me personally.

Very conflicted myself so my heart goes out to you, hope you find what you need. Unfortunately a very underpaid field for many until you are very deep into it. (I often see substantially large success coming to 10 or 15 year plus psychologists).

Glad to hear other thoughts too!

[u/Proof_Cable_310]

sounds like you are seeking a psychologist role in a hospital setting. go job shadow one.

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[u/cad0420]

If there is no neuropsychology specific master programs, I think you would be better off doing a neuroscience master first doing research on neurodegenerative diseases, then going to PhD than a master in clinical psychology doing research on other unrelated mental disorders. Profs who do research on the same health issues usually know each other even though they are from different disciplines, but clinical psychology profs do not know each other at all if they research on different disorders. Also, have you considered MD+PHD program? A lot of the students in my school’s neuroscience department is doing MD+PHD degree. And there are far more of them researching neurodegenerative diseases than neuropsychology students. Depending on the school, but some programs offer to pay students’ tuition and there is also stipend too. You will get trained to be a doctor (neurologist if you like to specialized on that) while also doing researches. 

It also really depends on what your research interests lies. If you want to know more about the neurology of these diseases then MD/PHD program would suit you much better. If you are more interested in the cognitive and behavioral aspects of those degenerative diseases then neuropsychology is more suitable for you. If your school is one of those that have a med school, you should check on their website and see what those profs are doing comparing to what the neuropsychology profs are doing.