Dr. Talya Miron-Shatz

Talya Miron-Shatz, PhD, is a decision scientist, studying the way people interpret medical information. She teaches consumer behavior at Wharton and is a keen public speaker, advocating the importance of understanding the psychological aspects of medical decision making.

She recently sat down to speak with SDN about how consumers and health care providers make medical decisions.

What is decision science, and how does it apply to health care decisions that consumers make?

Imagine you are designing a sticker promoting flossing. Should you say, “Flossing helps you prevent gum disease,” or should you emphasize the loss of protection that results from neglecting to floss? It turns out that people are more motivated to act when something they have is about to be taken away from them. So, when you’re in the bathroom at night, being aware of the potential risks to your gums might prompt you to dedicate a few extra minutes to the fine art of flossing. This, in a nutshell, is what decision science is about.

Decision scientists make sense of people’s judgment and decisions, even when these seem random, erroneous or irrational. Decision science was developed by Amos Tversky and Daniel Kahneman, Nobel Laureate of Economics, 2002, with whom I had the honor of working closely at Princeton University. This science draws on psychology and, rather than concluding that people are unpredictable, or just plain dumb, helps explain their behavior.

A really cool thing that decision science does is that it incorporates emotions into the equations. After all, the facts don’t change in the flossing example – what matters is how the information is presented. We show that the way alternatives are presented often dictates, or at least influences, how people feel and the choices they make.

Does this apply to every medical setting?

I always tell my students that there is no such thing as a neutral way of presenting information. The beauty of decision science is that the principles apply across the board, even where you least suspect it.

Consider an expectant mother who arrives at a prenatal clinic. The genetic counselor presents her with a list of the available screening tests for the fetus. Some tests are standard at the clinic, while others need to be specifically opted into. This varies across clinics. When a woman receives a list of, say, seven standard tests and five optional ones, adding the optional tests seems unnecessary, perhaps even overly anxious.

Now consider an expectant mother who arrives at a clinic where all 12 tests are standard, and the counselor tells her she can opt out of five of them. Opting out feels different from opting in. The woman may feel that by neglecting to take some of the tests, she is jeopardizing her unborn child. Thus, she will keep all 12 tests.

Most people tend to stick with the standard option or the default, which means that medical students need to be mindful of what they set as the standard.

What trends do you see in health care decisions by consumers that will impact current health professional students?

The emerging trend is patient autonomy – delegation of choice and decision to patients.  The premise is that, given sufficient information, patients will make the health choices that are best for them. This shift poses a huge challenge to doctors, who are trained to treat patients but not to explain treatment options in a way that patients will easily comprehend. Medical students and residents seldom receive training on these types of communication skills.

Nowadays patients have access to online medical information. Does this make a provider’s work any easier?

You would think that greater availability of information should relieve some of the burden off of doctors’ shoulders, but such is not always the case. Medical information is often presented in a way that is confusing and hard to grasp. Probabilities, which are key in risk evaluation, are a particularly tricky concept.

I showed people text from reputable websites that supposedly cater to a wide audience. It is distressing that fifty percent of the participants misinterpreted what lifetime risk probability means – and this concept is broadly applied.

I also inquired about a test for the BRCA 1 or BRCA 2 gene mutations, associated with increased risk of breast cancer. Half the participants knew that the test could not tell them with certainty whether they will develop breast cancer. Yet about a third of the participants expected this kind of certainty from the test. Just imagine how misguided they were.

Doctors cannot assume that their patients are in the know just because there’s more information out there.

Don’t issues of misunderstanding apply only to certain patients?

People with low numeric skills and low health literacy are more prone to misunderstandings. However, doctors are not so good at detecting patients with low health literacy. Moreover, patients are good at hiding their bafflement, because it is embarrassing to tell your doctor you do not know what he or she is talking about.

Recently I heard about a man who had a prostatectomy. Before the surgery the doctor said, “You are going to be impotent,” to which the man replied, “It’s ok. I already have children.” The doctor had assumed that “impotent” is a common term.

The same thing happens when a doctor explains how to titrate medication. The patient nods, then returns weeks later having never increased the dosage.

Are doctors and medical students themselves immune to miscomprehensions and judgment biases?

Not quite.  In one of the most inventive studies, conducted by Gerd Gigerenzer and his colleagues, a healthy heterosexual white male went to a few dozen doctors’ appointments with a positive HIV test result. Almost all of the doctors told him he had HIV. Only a minority remembered that the test is not 100% diagnostic, that there is a 1:10,000 chance of a false positive result. Various ways of presenting probabilities and risk information help medical students and doctors understand those concepts.

How did you become involved in medical decision making?

I was a grad student in psychology, studying decision science, when the mission of making medical information comprehensible snuck up on me.  One of my professors asked if I might be interested in teaching a decision making course to Masters’ students of genetic counseling. I accepted, then realized I had no idea what knowledge would most benefit my future students.  So I sat in on genetic consultations.

I will never forget the first couple I encountered. The father was albino, and both parents were hearing impaired, so they were accompanied by an interpreter. They also brought their two year old, for want of a babysitter. The wife was pregnant, and the couple wanted to know what to expect from the newborn – what were the chances that he or she would also lack pigmentation and/or be deaf. They just wanted to know. They were also curious as to whose “fault” the baby’s condition would be, mom or dad. It mattered to the mother-in-law, who constantly blamed the husband for the first child’s lack of hearing.

The genetic counselor was just the kind of health expert you would want to meet – highly professional, well-prepared, and very caring. She spread out the charts of paternal and maternal heritage, then methodically explained how genetics worked, starting with chromosomes and genes.

None of this was redundant for me despite my education. I did not major in science and had not taken a biology class since, I believe, the 9th or 10th grade – it had been quite a while. Remembering which was the bigger unit, chromosome or gene, was not easy. I had to dig in my memory to figure out that there were 23 pairs of chromosomes and, well, lots of genes.

Meanwhile, the counselor was explaining this to the translator, who would explain it all to the couple. The interpreter seemed no less bewildered than I was. Information just kept coming in, which had to be conveyed to the couple through sign language. I could not help but wonder what they would say if we asked them to translate back what they’ve just been told.

The couple was physically there, but they were not really listening, and it wasn’t because they required hearing aids. They had gotten lost fairly early. You could see it in their faces. Chromosomes, genes, dominant, recessive – lots of terms, but not a lot of meaning.

Of course, the confusion had nothing to do with being hearing-impaired or albino. It had everything to do with being a patient. For all my fancy graduate training, I don’t think I would have fared any better than they did. The added layer of concern for the baby certainly did not make things easier.

Knowledge doesn’t just pour out of the medical system and into the patients’ minds, I realized. It has to be understood, processed, and dealt with emotionally. It was the counselor’s job to explain and the patient’s job to get it. Leaving the medical center that day, I still thought I was just going to teach decision making to genetic counselors. I did not realize that making medical information comprehensible was going to take over my interests to become my vocation. I did not realize it just then, but that was when my mission began.

For more information on medical decision making, please visit “Baffled by Numbers”, Dr. Miron-Shatz’s blog published on the Psychology Today website:

http://www.psychologytoday.com/blog/baffled-numbers

Dr. Kirsh, assistant professor in the Department of Pharmacy Practice and Science at the University of Kentucky, is a licensed clinical psychologist. His particular areas of interest include chronic pain management, pain and its interface with abuse and addiction, and palliative care issues in cancer populations. He was recently kind enough to sit down with SDN and give some perspective into clinical psychology as a career choice.

1.Tell us about your educational background.
I attended a rather unique doctoral program at Indiana University – Purdue University in Indianapolis. The program was entitled ‘Clinical Rehabilitation Psychology’ and I was drawn to it as it was basically one of the few dedicated, medical psychology programs in the country. It was a small program but very thorough and challenging. Out of 6 people who entered in my year, 3 of us would eventually graduate. I picked up an M.S. degree along the way and eventually earned the Ph.D.

2. How long have you been with the Pain Treatment Center? What were you doing before?
My current position is an interesting blend. As a psychologist, it is strange that I split my time as an Assistant Professor in Pharmacy at the University of Kentucky (UK) as well as serving as a pain psychologist at The Pain Treatment Center of the Bluegrass (PTC). I have been with the PTC for about 18 months. Before that, I was an assistant director for a Symptom Management and Palliative Care initiative at the Markey Cancer Center at UK.

3. Did you plan to enter this specialty when you were in school?
My training was in medical psychology, so I somewhat could have envisioned my current love of pain management. However, my training was really leading me towards broad-based symptom management and assessment for people with head injury and stroke. Moving to cancer patients, and later pain patients (both malignant and non-malignant) was an ongoing and evolving process.

4. Describe a typical day at work.
The fun part of my job is that there is no ‘typical’ day. I am able to spend some time teaching in the College of Pharmacy, a day or so per week clinically seeing pain patients, and then a lot of time doing research activities. The pain management world is still relatively young and there are a lot of research needs that need to be filled.

5. For what types of problems are patients referred to the Pain Treatment Center?
As a specialty clinic, the PTC only accepts patients by referral. We will accept people with any sort of chronic pain concern, but the bulk of patients have non-malignant pain of some variety (i.e., low back pain, knee pain, arthritis, peripheral neuropathy, etc.). That said, we do have a sub-population of cancer patients with pain issues as well as just about any other type of pain you can imagine. We have over 8,000 patients and serve them with a mixture of medication therapy, physical therapy, behavioral medicine, surgical procedures and interventions, etc. It is a truly multidisciplinary clinic, which is becoming more rare these days.

6. What is the biggest challenge you face in serving your patient population?
The biggest challenge is also the thing that is the most interesting for me. My specialty is really pain management in the face of abuse, addiction, and diversion. Living in central Kentucky, we are an epicenter of sorts for prescription drug abuse. This creates a huge challenge with regards to trying to sort out genuine pain patients, doctor shoppers, addicts, and those patients who might have genuine pain but also some of these other problems.

7. There is significant social stigma attached to pain treatment and prescribing opioids specifically. How does that affect patient care?
There is a growing sense of opiophobia in the country. Some patients are afraid to take opioids for fear of being turned into addicts, while some doctors refuse to write for any controlled substances out of fear from regulatory sanction or being duped by a patient.

8. How do legal and law enforcement issues affect the practice of pain treatment and management?
As above, there is a great deal of fear on the part of prescribing physicians. We have seen many small pain practices shut down after receiving pressure and threats from law enforcement. It is true we have seen some bad doctors who, in my book, were no longer practicing medicine (e.g., seeing 50-60 patients per hour, giving each the same prescription, accepting cash only for the service, etc.). However, there has been a tendency to try to limit all prescribing of opioids by putting pressure on doctors. That said, I think we are starting to see a new trend of law enforcement working with pain management professionals in a collaborative way. The National Association of Drug Diversion Investigators (NADDI) is a great example. I recently joined NADDI and have been really impressed by how that subgroup folks want to work with us and learn about pain management as opposed to assuming all healthcare professionals are misguided and contributing to prescription drug abuse.

9. What is the difference between chronic and acute pain, and how does that affect patient treatment and management of pain?
Acute pain is temporary by definition and is a response to some trauma or insult to a person (i.e., accident, surgery, new disease process, etc.). Acute pain is usually accompanied by physical manifestations such as tears and sweating that let us know there is a real problem. It does serve a survival purpose, such as telling us to quickly remove our hand from an open flame. Chronic pain is a maladaptive, lingering process that no longer serves a survival purpose. Some argue today that all chronic pain eventually becomes neuropathic pain due to a rewiring of the nervous system. Patients with chronic pain can state they have 9/10 pain while sitting in an office looking otherwise pleasant and comfortable. Not seeing the overt signs of acute pain often leads people to think chronic pain patients are faking it or exaggerating their pain levels, which is not necessarily the case.

10. What types of modalities, besides pharmacotherapy, are available to help manage chronic pain?
As I alluded to above, our clinic offers multimodal approaches to pain. Part of the reason for this is that no one thing usually works alone. Indeed, much of chronic pain treatment is trying to take away as much pain as possible while getting the patient to be more functional in their daily lives. We rarely get people “pain free” and try to communicate to patients that drugs alone will not be adequate. Other options include physical therapy, TENS units, injections, behavioral medicine, hypnosis, dry needling, intra-thecal pumps and stimulators, pacing, deep breathing, and various relaxation techniques to name a few.

11. What is the number one thing you wish the general public understood about the problem of chronic pain?
I would like to teach people that opioids do not create addicts simply by exposure. Simply put, there is no iatrogenic addiction associated with exposure to opioids. Patients need to have a unique constellation of genetic, familial, social, psychological, and spiritual components to be vulnerable to addiction. I spend a great deal of time explaining to patients (who have no risk factors) why it is highly unlikely they will become addicts.

12. What aspects of your practice have most challenged or surprised you?
The biggest surprise has been the complexity of patients in this region of the country. I have a few colleagues who were here for a while and then went back to other parts of the country who all had the same thought. We might associate difficult patients with bigger cities, but the truth is the more rural areas have been hit hardest by prescription drug abuse and the tendency to self-medicate to escape their daily existence.

13. Your practice combines clinical and academic work. Do you find that these areas complement each other or is it hard to strike a balance?
They do complement each other, but it is still a challenge. Time management is always an issue and I do feel scattered at times. The nice thing is that psychology affords the training to let me be involved in research, teaching, and clinical work. While I’ll never be rich, I’ll also never be bored or looking for something to do!

14. What is your favorite aspect of teaching? Least favorite?
I love performing and being in front of crowds. I’m a somewhat shy person in other ways, but have always liked being in front of groups. Being able to tell some jokes, make an impression that students might take with them, and connect with a group is definitely a highlight. The least favorite is definitely grading papers and test. Yuck, enough said.

15. Tell us about your research and publishing activities.
I have published nearly 60 refereed articles and 20+ book chapters along with other types of publications. Most of my work focuses on cancer pain, non-malignant pain, addiction, abuse, diversion, and symptom management broadly defined. This takes up a lot of my time.

16. Do you have a family? If so, do you find that your career leaves adequate time to spend with them?
I am married to a wonderful woman named Kristy. We do not have children, but were crazy enough to adopt 4 full sized collies. My career keeps life busy, but I do try to maintain some balance in my life. It is hard to do with constant deadlines buzzing about, but I feel it is important to keep balance so I don’t look back with regret. That said, I do have to confess I have not been on a vacation since I went to Disney World with my family when I was about 6 years old! Guess I still have a ways to go.

17. What do you like to do in your spare time? Do you have any hobbies or volunteer activities you’d like to tell us about?
I am an avid musician and play in a local acoustic-based, roots and Americana band. I play upright bass, electric bass, guitar, ukulele (yes, ukulele), drums, and mandolin. I am primarily a bass player, but have been really taken with the ukulele. Outside of music, my wife and I do volunteer with a Collie Rescue organization. While our house is too small to take any more dogs, we do act as “runners,” picking up dogs in a tri-state area and delivering them to the host organization shelter.

18. In what professional organizations are you involved?
I have to admit that I have never been much of a “joiner” in my life. I am trying to get better in that regard, and am now part of the National Association of Drug Diversion Investigators (NADDI), Kentucky Pain Society, and the Kentucky Psychological Association.

19. Where do you see yourself in 10 years?
That’s a good question. I’ll let you know in a couple of years if I get tenure or not! I have a vision of paying off my student loans and going to a Hawaiian beach to play ukulele, but I think my wife likes Kentucky too much to leave. I try not to think too far ahead, but want to keep my options open. Maybe car sales….

20. What advice do you have for students considering a career like yours?
Don’t. Just kidding! I wish I could say my career worked along some predetermined and focused path, but a lot of things fell into place in bizarre ways for me. So, I’d say develop some interests and broad-based skills, but always keep your eyes open for new and different possibilities. As a medical psychologist, I always need to be a chameleon and mesh with other health professionals such as nurses, physicians, physical therapists, pharmacists, etc. Thus, exposing yourself to a lot of different areas of education is of vital importance so you can fit in and “talk the talk.”

SDN contributor Tim Shea (Therapist4Chnge) is currently in his fourth year of a PsyD in Clinical Psychology and his second year of a MS in Clinical Psychopharmacology at Nova Southeastern University in Ft. Lauderdale, FL. Tim received a BA in Psychology from Goucher College in Baltimore, MD and an MS in Clinical Psychology from Nova Southeastern University. When not dividing his time between his studies, providing mentoring to the SDN community or indulging in his love of piano and photography, Tim also hosts a website – Struggling With Food (www.strugglingwithfood.com) – that provides information about eating disorders.

In a recent interview, Tim spoke about his life, the challenges of clinical psychology, and the need for education about eating disorders.

Please tell us a little about your background—family, educational, professional?
I grew up in New Jersey. Whether academic, athletic, or recreational, my folks really supported me in all of my endeavors. I’m a classically trained pianist—I have been playing for the last 20 years or so. Music, along with athletics, has been a consistent outlet for me. I played football, lacrosse, and track and field during high school, and I was recruited to play lacrosse in college. As for music, I still compose for the piano, though most of my spare time is spent behind my camera’s lens (www.tsphotogallery.com). I shoot mostly nature, but I dabble in landscape and sports photography as well.

Do you feel that there is a specific experience from your past that had a major impact on who you are today?
My undergraduate experience at Goucher College certainly shaped the person I am today because it provided me an enriching environment and encouraged personal and academic exploration. They found me, and I fell in love with the academic energy when I stepped foot on campus. They encourage all students to take classes in a wide range of disciplines, so in addition to my psychology classes, I was able to take classes in the hard sciences, sociology, feminist studies, and philosophy. My undergraduate experience, coupled with my mentor, were a large influence on my career.

Did anyone inspire your career choices?
I was lucky enough to work with a great mentor in Dr. Rick Pringle, and also study under Dr. Norm Bradford and Dr. Brian Patrick. Dr. Pringle encouraged me inside of the classroom and outside in the world while providing me with sound guidance that really helped shape my current career path. He was the person who first got me involved with body image and trauma work, which eventually expanded to include eating disorders. Dr. Bradford and Dr Patrick provided a solid grounding in theory, while also providing the space and opportunity to explore psychology at a much deeper level than I expected during my undergraduate training.

What strengths do you have that have allowed you to be successful?
I think the most important think is to know what you are good at and focus on that. Flexibility and determination are definitely two qualities that have served me well. I have also been told that I am personable, and I think no matter what you do in life, it helps if you can get along with most of the people you encounter.

What led you to choose a career in clinical psychology? In what field did you obtain your M.S.?
I have always been interested in the field, though it took a detour for me to fully realize that it was a career option—not just a hobby. Previously, I ran a chapter of a non-profit organization, took a chance on two start-up firms, and then worked at a Fortune 50 company. Each experience contributed greatly to my learning, and I am thankful for the crash courses in business, consulting, and management I picked up along the way. Yet, each job fell short in being able to provide the balance and enjoyment that I require from a career. Even though I worked 70-90+ hours weeks, I still found time to read my psychology journals and research; it just took me some time to realize that is what I really wanted.

I obtained my MS in Clinical Psychology while pursuing my PsyD at Nova Southeastern University, where I am currently a 4th year student. I am also pursuing an MS in Clinical Psychopharmacology.

What specialties are you interested in pursuing and why?
My clinical interests involve both eating disorders (specifically low-weight anorexics) and trauma. The complexity and depth of both are what first piqued my interest, though the clinical work and research is what pulled me in further. I think there is an opportunity to make some significant contributions to the field in this area, and I would like to be a part of that.

You’ve put together a website called Struggling with Food—tell us about that. What motivated you to create it?
Struggling With Food was an idea I have been kicking around since 2004. I wanted to have a place for people to come together to talk, support, and learn about eating EDs. Issues with eating disorders and nutrition have been interests of mine for a number of years, and they have become a focus of my research.

My ultimate goal is to reach globally and act locally. I think eating disorders are often misunderstood, both by society and within the healthcare field. I would like to get to a point where I can go into communities and help educate them, as well as help educate professionals who want to learn more about working within the ED population.

Do you feel that work on the website has influenced your career path? How?
I think it has provided me an opportunity to connect with other organizations that are doing great work to help in this enormous area of need. Unfortunately, I have not had as much time to dedicate to my website lately, but I hope to develop it as I become established. I am always open to anyone want to contribute articles, information, resources, and/or research to the website.

For others who might be considering a career in psychology, how would you characterize your experience as a student?
It has been challenging, but incredibly rewarding. Graduate school pushes you academically, but I think the real challenge is finding balance in the work. I think the people who are most successful are the ones who can balance their academic, research, and personal goals. Overall, I have enjoyed my training, though it definitely has been a grind at times. I am especially thankful to be surrounded by others who are as passionate as I am about the field.

Where do you see yourself practicing once you have completed school? Have you found that that ambition has changed over time?
I would like to settle in or around a place like Nashville, TN or Charleston, SC. My goal has always been to open up a consulting practice and combine my clinical and business training. As for clinical work, my focus will be in eating disorders, and I would like to start with an intensive outpatient practice and eventually fund my own boutique transitional program for people in eating disorder recovery.

Can you explain what a clinical psychologist is and what they do?
A clinical psychologist is trained in research, assessment, and psychotherapy at the doctoral level. They are the highest trained professionals in their field, and they use research to inform their clinical work. Clinical psychologists can work in a range of areas: teaching, research, consultation, administration, assessment, psychotherapy, etc.

What kind of training is required for someone to pursue this discipline?
A PsyD/PhD is required to become a Clinical Psychologist. Typically, a person will graduate with a bachelors in psychology or a related field, gain additional research and/or clinical experience, and then look towards graduate school to further their training. It takes at least 4 years of full-time graduate education, a 1 year internship, and a 1-2 year post-doc before you are license eligible. It is a long road, but it allows for a great deal of professional flexibility in regard to career choices.

What trait or special skills would you describe as being important for someone considering becoming a clinical psychologist?
Whether you are primarily a researcher/academic or clinician in private practice, a clinical psychologist needs to have excellent communication skills. Clinical psychology is unique in that there are many intangibles that contribute to a personal ability to be successful. Book knowledge is merely one part. Analytical skills are also vital: being able to process large amounts of information is important, but equally important is the ability to synthesize your learning and apply it clinically.

I am curious about the kind of lifestyle one might expect from practicing as a clinical psychologist—what kind of hours do you think it will require? How busy do you expect it will keep you?
There is a wide range in salary for clinical psychologists because of the plethora of career opportunities, so it is hard to put a number on that. I think one consideration is the type of work you would like to do, and work/life balance you want to achieve. I know many professionals have hybrid careers where they may teach or conduct research and then carry a private practice on the side. Others choose to focus primarily on assessments, while some take their training to the corporate world.

Starting up a practice will definitely take more hours, but if you can get a sustainable practice, many clinicians can design a very flexible work schedule. Ultimately, it is up to each individual to define what kind of lifestyle they want to live. Clinical psychology allows for non-traditional hours, as well as working in a number of different arenas.

What’s the most important or rewarding thing that you feel you have done at this point in your career?
I decided to do what I love, even if that meant up and leaving a stable and successful career. Too many people end up in a career that is either not fulfilling or a compromise. I want to get up in the morning and love what I do, and try and make a difference in some people’s lives.

We often expect in interviews to hear only about the positives of a chosen field, but some may be curious about whether there is a flip side to that question. Are there downsides that you can see to being a clinical psychologist? If so, what might they be?
I think the biggest challenge is the increased competition from other professionals. Clinical psychologists are the highest trained professionals in their field, though with the squeeze of managed care, it has become more competitive for general private practice. Specialization has become more popular, and allows clinical psychologists to differentiate themselves from other professionals doing therapy.

What do you think perspective students ought to look for in a program when considering clinical psychology as a career?
I believe a program needs to provide an even balance between clinical and research training. Each inform each other and though a person may prefer one area to another, I believe solid training in both is necessary to be an effective professional. Whether you are looking to do primarily research, clinical practice, or some combination, it is important to have a mentor or mentors that match your interests and needs.

If you had an opportunity to speak to your younger self when first starting out, what kind of advice might you offer?
I would probably tell myself not to stress as much and to take everything as it comes. I think this field self-selects people who have always been very successful (myself included), though at various times it will challenge you, and you will feel as if you are in over your head. I think it is important to understand that part of the training is to be overwhelmed and then learn how to work through it. I look at the people coming in now and I try to pass this on, but part of the process is going through that struggle.

What issues do you see as particularly important within psychology at the moment? Where do you stand on those issues?
I think clinical psychologists are woefully under-represented at the legislative level, and we need to do more as a profession to protect our interests and the interests of our clients/patients. It seems that most clinical psychologists are not as active as they should be, and the general public, as well as legislature, really fails to understand what we do as a profession, why it is important. I wish the [American Psychological Association] did more to be pro-active in this area. The [National Alliance of Professional Psychology Providers] has recently taken a larger role, and I am hoping they can work together in support of our profession.

Do you see any changes or movements happening within your field in the near future?
The prescription privileges movement has been an ongoing hot-button topic. I believe it can be beneficial for many of the under-served areas, but I think ultimately it will be a niche area within clinical psychology. I think the most eminent change is the push towards universal healthcare, which in its current proposal is scary for everyone in the field. I believe the mental health/health/medical communities need to band together and ensure that this push is not going to further erode services to patients and reimbursements for professionals.

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1. What is your primary area of practice?

I now primarily work with children and adolescents and their families. The focus of our center is on individuals with developmental disabilities such as autism and tourette’s disorder, but much of our practice also deals with complex emotional and behavioral disorders. I provide diagnostic services, treatment, and consultation, and I am involved with educating medical students, residents, and psychology graduate students. I am able to work with providers from across many disciplines and in a variety of locations, which makes for a very stimulating job.

2. Describe a typical day at work.

I might arrive at the office and perform a series of clinical services, such as psychological evaluations, feedback sessions with families, or treatment sessions with young persons and/or their caregivers. On other days, I might go to a school in a remote location in KY and consult with school staff about addressing some particular issue that has arisen. I sometimes provide professional development activities. I lecture residents on a monthly basis regarding psychological data and learning-related problems. I serve as faculty for ethical training within the introductory clinical medicine course. I provide supervision for graduate practica students in psychology and for post-doctoral psychologists. My days are rarely typical!

3. How many hours per week do you work? Does your work involve much travel?

My work week is 37.5 hours although I tend to be at the office a bit more. I sometimes travel around my home state and also work in near-by states occasionally. I am able to present papers at conferences and attain continuing education experiences in many places.

4. What are the characteristics of your primary patient population?

My clients are most commonly between 2 and 12 years of age, although both younger and older persons are seen. Many have problem behaviors. Sometimes that is the primary diagnosis. Other times, the behavior problems are secondary to some other condition, such as a language disorder, autism, ADHD, or mental retardation. I see persons from all socio-economic strata, representing many ethnic and racial groups. Working at a university affiliated clinical program tends to increase the diversity of our referral base.

5. What is the most challenging aspect of working with this patient population?

One of the greatest challenges we face is the lack of access to services that many people experience when they need mental health services. Many people do not have health insurance. Second, many who do have insurance cannot find providers who are covered by their particular plan with the needed expertise. Finally, there are many barriers to accessing services, such as lack of transportation or lack of child care. That is very frustrating for clients as well as providers.

6. Does your job involve teaching responsibilities? If so, please describe.

My teaching duties are diverse. I do trainings/continuing education programs for psychologists as well as educators and mental health and medical professionals. I do a monthly lecture for residents in pediatrics and internal medicine/pediatrics about psychological data and learning problems. I serve as a faculty facilitator for second year medical students studying ethical issues as part of the introductory course in clinical medicine. I supervise psychologists and students, providing training for them. I sometimes teach a traditional graduate course in developmental disabilities for psychology students. I often provide guest lectures for courses in the School of Social Work. Teaching is perhaps about a tenth of my total job activity.

7. What is it like being a non physician working in an academic department of a college of medicine?

For the most part, I find it very comfortable being a non-physician within the medical school faculty. My colleagues are respectful of my expertise and do not seem to view non-physicians as a lesser species! Many of our most successful researchers within the medical school are not physicians, which I think has contributed greatly to the physician faculty’s positive attitude toward those of us who are not M.D.’s.

8. How long have you been in your current position? What did you do before?

I have been working at my current site since 1995. I was away from the Center, doing my pre-doctoral internship for one year during that time, but I continued to work part-time even while on internship. Before that, I practiced within a large multi-specialty medical group in a small town.

9. Do you do any outside consulting or other professional activities?

At present, I do almost all my work in the context of our Center. From time to time, I present workshops on the weekend or take on an outside project if there is no conflict with my role at the university.

10. Do you participate in research, conferences or presentations?

My research participation has been very limited to date. I have begun to collaborate with a student on a large data set which we hope will lead to publications. I provide many conference presentations ranging from brief local events to more extensive presentations at national conferences.

11. What do you like best about your specialty? What do you like least?

I like psychology’s many tools and the potential they offer for making the lives of children and families better. As we recognize the value of early intervention and address issues near their inception, there is much potential benefit for the individual, as well as society!

12. Are you satisfied with your income and opportunities for career satisfaction?

Like most people, I really feel compensation for psychologists should be better. However, I do feel that my salary is certainly adequate. Our culture values some things more than others. Human services are not high on the totem pole of priorities.

13. What do you tell parents who ask you about the hypothetical link between autism and childhood vaccines?

I tell parents that major scientific organizations have repeatedly concluded that childhood immunizations are safe and cannot be linked with increased rates of autism. There is excellent data from multiple sources to support that. I want my grandchildren immunized, as there is more risk from some of these preventable diseases than from the immunizations.

14. What is the future of autism treatment? What hope can we offer families with affected children?

In the years to come, I expect autism treatment to improve in quality and in availability. As more and more people become aware of this diagnosis, sometimes less than ethical individuals invent a “treatment” and market it effectively. Over time, people will become more aware of what is supported by solid data and what is simply a well-marketed hoax. Many investigators are currently trying to establish the most efficacious treatment protocols for the variety of presentations that one sees among persons diagnosed with autism. Their work will have great value in years to come.

15. If you have a family of your own, does your career leave you enough time to spend with them?

If I had young children, I am sure that I would feel some pressure in juggling work, family and personal interests. Since my children are grown and I am, in fact, a grandmother, I am in a different place with regard to work-family conflict.

16. Do you have any hobbies?

I enjoy reading. Swimming and walking are other activities that I enjoy. I also enjoy working with refugees from the Sudanese civil war who live in my community. I am active in church work. I live in a neighborhood that often gathers to socialize, so my life is rich and full!

17. What types of volunteer activities or community service are you involved in?

I am involved with the Tourette Syndrome Association. I serve on a regional advisory council for that group, and I am the support group leader for our local affiliate group. I serve as a non-stipendiary clergyperson of the Episcopal Church and have several committee roles in governance on the diocesan level. I work with international refugees, particularly the Sudanese, as time allows and try to assist them in furthering their educational goals (attaining U.S. citizenship, etc.). I am an active member of several professional organizations, including the American Psychological Association and our state association.

18. Where do you see yourself in 10 years?

It is exciting to think that I see myself retired in 10 years. I do not expect to retire to the rocking chair. Rather, I see myself “retiring” to travel, as well as consulting and training professionals on an occasional basis. I am developing competency in parenting coordination, divorce mediation, etc., and I hope to do some work in that area after I “retire” from my university position.

19. If you could do it over again (become a clinical psychologist), would you?

Actually, I probably would. With psychologists likely to gain the ability to prescribe medication in most jurisdictions over the next 10-15 years, I think the discipline will have wonderful opportunities for practitioners. Psychologists are ideally trained as scientist-practitioners with unique capacity for serving people with a variety of needs. All of our training is focused on human development. We have wonderful gifts to offer society.

20. What advice do you have for students desiring to pursue a career in clinical psychology?

Students should do their very best to avoid incurring a large amount of debt in getting their training. For those individuals who find themselves unable to get what they need without loans, I would strongly encourage them to explore options for practice which qualify them for loan forgiveness or repayment. Salaries in the field simply are not high enough to let us graduate, repay our loans, and get on with the business of buying homes, establishing families, etc. It is a wonderful field, but one that is not compensated as well as it should be.

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