So I’m going to digress a bit here, and try and explain the long and winding path I took in my life to end up here – working in geriatric psychology. I wish I could tell you that I knew from a very young age that I wanted to work with older people, but I don’t have a neat story like that. Here’s what I can tell you – my parents (currently in their 70s, obviously at this point older adults themselves) told me they always thought from an early age I seemed more comfortable than most children speaking casually with adults, even as a toddler, at times I seemed to almost prefer the company of older people.
Aside from that, however, there wasn’t much about my life as a child that seemed to speak to a later career in geriatrics (defined as “of or relating to old people, esp. with regard to their health care”). I liked the company of adults, I felt comfortable with people a generation or two ahead of me, I was reasonably intelligent and curious about myself and others, and I was reasonably extraverted. That was about it – as a child, the idea of specific career aspirations was a confusing abstraction for the most part. I knew what I liked to do – reading nonfiction, writing stories, doing theatre camp, I remember at one point I did a summer camp where I worked in a local cable access TV production studio and made short films with other kids. I enjoyed myself, but through high school and into college, I was all over the map. Which I guess is typical.
When I got out of high school (which I was only too glad to do) and started undergraduate training I took some advice from adults and soft-pedaled my interests in television and entertainment. I was told that getting meaningfully employed in the entertainment world was something akin to winning the lottery – and the sacrifices in time and my personal life in order to be successful in such a field would be huge with a highly uncertain promise of reward. OK, fine. I wanted to be realistic, after all.
Fortunately, I found myself passionate about something else – psychology. While theatre and entertainment-related things scratched my itch for approval from others, one of my many hang-ups (applause after a good performance definitely scratches that itch), studying psychology scratched my own itch for self-reflection and self-knowledge. Or, at least, my yearning to “know thyself” at least provided some pretty strong motivation to move forward in it. While I don’t advise people to pursue psychology as a career because they’re curious about themselves, it’s undeniably a motivator for many, and potentially a powerful one.
I went to Reed College in the mid 90s. At the time, Reed was known in some circles as a place where students studied intensely hard, studied humanities, and where fraternities and sororities had no footprint, but at the time had a reputation that generally marked it as a school for the proverbial undergraduate “square pegs” who didn’t fit into the collegiate round holes of Stanford, Yale, etc. Since I left Reed, it’s reputation has only increased in prominence and respect, and now it’s considered one of the most academically challenging private colleges in the United States, at least by some metrics. I graduated in 1996 with a degree in psychology, with some emphasis on biology (I took biology courses at Reed, which I found incredibly daunting, and also did an honors thesis on neuropsychology).
After college, I did some traveling with my then-girlfriend and now-wife (Beth Trittipo, bio is here) worked as a research assistant for about year prior to attending graduate school at Pacific Graduate School of Psychology (now known as Palo Alto University, or PAU).
A brief, but I think important digression on graduate school in psychology. There may be any number of psychology students, or prospective graduate students in clinical psychology reading this blog who’ve considered the route of attending a professional doctoral program in clinical psychology, which overwhelming refers to unfunded doctoral programs. PAU is one of those programs. Granted, it tends to have a good reputation (arguably one of, if not the best) of unfunded professional programs. An overwhelming majority of its graduates (100% of its Psy.D. students as of last year) secure coveted internships accredited by the American Psychological Association, and tend to do well in terms of research productivity, licensure rates, and scoring high on the EPPP.
However, the biggest problem with professional programs in psychology, without a doubt, is the debt-to-income ratio that most students are left with. It’s a growing problem with all types of graduate and undergraduate degrees, but with students of professional (largely Psy.D.) programs, the problem has gotten out of control, with the average Psy.D. student leaving doctoral programs in psychology with 120K in student debt. At PAU, (which is in Palo Alto, after all) the average debt load is likely more than upwards of 250K at this point.
While 250K of student debt is manageable for a graduate of, say, a physician graduate of medical school who may begin earning six-figures or more immediately upon graduation, the median salary of a psychologist currently in the US is around 70,000 dollars per year according to the Bureau of Labor Statistics. That means if you have 200K-plus of debt as a graduate from a psychology professional program (very common these days), and you land a job paying around the median salary, even with the various repayment programs available to graduates these days (e.g., such as Income Contingent Repayment), the graduate could be sending out half a grand a month in loan repayments. If the graduate has private loans (which don’t qualify for these federal programs), this could drive up the costs further.
I graduated from PAU about a decade ago. While I have significant student loans from that adventure, they don’t approach the numbers I’m currently seeing with many clinical psychology graduate students, my interest rate is extremely low, and my payments, while annoying, are affordable with my VA salary. In short – I think I got lucky and I think I’m probably one of the last generation of professional student graduates from pricey schools like PGSP / PAU that can make the math even somewhat work. Even so, I pay several hundred dollars per month towards student loans, and that’s money that I definitely miss.
Anyways, off my soapbox.
So, I got into PGSP and began my studies. For me, getting into geropsychology was a matter of a bit of taking advantage of luck and propitious circumstance, and then capitalizing on the experiences gained even further, and then lather, rinse, and repeat. In graduate school, after languishing for a year or so doing generalist practicum experiences and toiling unproductively in a research group not related to geropsychology, I approached Larry Thompson and by extension, Dolores Gallagher-Thompson, both geropsychologists with stellar records of accomplishment and who were running a large-scale arm of the REACH-II (Resources for Enhancing Alzheimer Caregiver Health) research project on dementia caregiver interventions through the Older Adult and Family Center (OAFC) at the Menlo Park Department of Veterans Affairs.
Larry Thompson was very kind to me and offered to work with me on a dissertation project, and also found me a practicum training opportunity at the OAFC. This highly successful experience allowed me to attain an internship in geropsychology at the University of Medicine and Dentistry of New Jersey (UMDNJ), and then a fellowship in geropsychology at the University of Rochester Medical Center in Rochester, New York.
Since then, I’ve attained licensure as a psychologist, I’ve worked in community nursing homes, coordinated research projects, published articles, given talks, and have worked at the VA in Livermore as their staff Geropsychologist for approximately seven years now. I love my job, I enjoy what I do, and I think I’m very lucky.
So, what advice would I give to a student considering a career in geropsychology or geriatric mental health, in the future? I’ll break it down for you:
1) Don’t attend a doctoral program at a professional school in psychology, unless you’re independently wealthy or you receive some other form of funding. Just don’t. Make yourself competitive for funded programs. Get stellar grades in college. Get on publications, do research assisting for a year or two before you apply to graduate programs, and get a stellar GRE score, whatever you need to do. Moreover, short from a select number of professional programs like Rutgers, Baylor, perhaps PAU / PGSP, for the most part professional programs in psychology tend to struggle to match the reputations of funded programs, which is an extra cross to bear for professional school graduates. So, don’t do it.
2) Consider applying to nurse practitioner programs (medicine is OK too, but I see reimbursements declining, while tuition continues to rise). One side effect of Obamacare that I can see is that with all of the pressure being put on physicians due to what will supposedly be increased enrollment of the previously uninsured, demand for nurse practitioners will increase. And NPs command significantly greater salaries than psychologists. Consider masters-level programs in counseling or social work, with an emphasis in geriatric mental health as well (far less money and time for a degree that allows you to do many, if not most of the things professional clinical psychologists do).
3) If you’re bent on attending graduate programs in psychology, and you want to go into geropsychology, my advice is specialize, and specialize early. Make sure you get the specialty practicum, internship, and postdoctoral training opportunities where possible, and don’t forget to get elective coursework in geriatric mental health, geriatric neuropsychological assessment – as this will be critical in attaining later boarding as a Geropsychologist with the American Board of Professional Psychology (ABPP, something I talked about here). Geropsychology is a specialty, and in order to get specialized jobs, you’ll need specialized training.
4) Be prepared to not make a ton of money in geriatrics. This is not a glamorous field. Medicare continues to nickel-and-dime us to death. Don’t expect to get rich.
That’s it for now.