1997: Medical School Psychologists Report
Steven Williams, Marlene Wicherski, Jessica Kohout
APA Center for Workforce Studies
The 1997 Medical School Psychologists Employment Survey is a collaborative effort between the American Psychological Association's (APA) Research Office and the Association of Medical School Psychologists' (AMSP) Executive Committee. This survey represents the first effort by the APA to collect national-level employment and salary data on psychological personnel who are employed within medical school settings. Although previous literature has examined employment characteristics of this group (e.g., Nathan, Lubin, and Matarazzo, 1981; Nathan, Lubin, Matarazzo, and Persely, 1979), there has not been recent literature of this nature. Even though the APA Research Office has examined this population in other reports (e.g., Williams, Wicherski, and Kohout, 1998), these reports have focused only on salaries and have made only brief mention of medical school psychologists. This undertaking was prompted by the paucity of recent research on psychologists in medical school settings, along with the continuing changes and cutbacks that medical schools are experiencing in this era of managed care. Given that psychologists are a relatively small group of professionals in medical school settings, it was deemed essential to identify these psychologists, provide descriptive employment and salary characteristics in several domains, and begin to explore how they have been impacted by recent changes in the health care system.
In March, 1997, the survey was mailed to 4,958 psychologists who were employed in medical school and allied health settings. These psychologists were identified from membership lists of the APA, Association of American Medical Colleges (AAMC), and the Council of Deans of the American Association of Colleges of Osteopathic Medicine. All psychologists were doctoral-level, with varying licensure status, degree types (Ph.D., Psy.D., Joint MD/Ph.D.), and specialty areas (clinical psychology, neuropsychology, experimental psychology). The survey was not anonymous so that nonrespondents could be tracked. Postcard reminders were mailed in April, 1997 and a second survey and reminder letter were mailed in May, 1997 as a final attempt to contact non-respondents. As a result of membership with more than one association, some psychologists were inadvertently mailed duplicate surveys. Their surveys were identified and then de-duped to yield a final pool of 3,894 psychologists who actually were sent surveys.
The eight-page survey comprised six sections (see Appendix A): (1) Information About Appointments, (2) Characteristics of Department and School, (3) Employment Activities, (4) Salary Information, (5) Demographic Information, and (6) Experiences. The survey, which was in a scannable format, contained mostly closed-ended questions/items. A select few questions allowed for more detailed, open-ended responses. Respondents were provided postage-paid envelopes to return their surveys.
Structure of Report
The report is divided into six main sections:
(1) Demographic Characteristics
(2) Employment Characteristics
(3) Characteristics of Employers and Institutions/Departments
(4) Activities, Privileges, and Benefits
(5) Factors Influencing Employment and Salary, and
(6) Earned Income.
The first section, Demographic Characteristics, provides information about the sex, race/ethnicity, and years of experience of responding psychologists in medical school settings. The next section, Employment Characteristics, details the appointment status (full time or part time), academic calendar (9-10 months or 11-12 months), rank, tenure status, and number of years spent in current position. Section 3, Characteristics of Employer and Institutions/Departments, offers information about the types of departments in which psychologists are employed, and whether these departments have a separate psychology administrative unit and a chief psychologist. Fourth, Activities, Privileges, and Benefits focuses on the numerous roles that psychologists have within their respective primary departments, as well as in other external departments/institutions. These roles include providing clinical service, research, administration, and training. This section further discusses the privileges afforded to and restrictions imposed on those psychologists who are members of the medical staff. Finally, this section examines whether or not medical school psychologists receive the benefit of employer-paid malpractice insurance. The remaining two sections of this report concentrate on earnings. Section 5 focuses on the factors that influence earnings such as "soft money" income arrangements, supplemental income, overhead rates, and managed care. The largest section in this report, Section 6, illustrates earned income of psychologists in medical school settings. In this section, salaries are broken down by department type, academic rank, years since doctoral degree, geographic region, and sex. Salaries for non-tenured faculty also are provided in this section.
Each section begins with a brief summary, followed by its respective tables and figures.
A total of 1,938 useable surveys were returned, yielding a response rate of 50%. This response rate is far below the 60-70% response rates typically obtained with other surveys conducted by the APA Research Office. Surveys were excluded from analyses if the respondent provided incomplete data on pertinent variables.
Readers of this report should consider the notes and caveats to the text, tables, and/or figures that are enumerated below:
This report contains sample statistics, not population estimates. That is, the data represent only those psychologists who responded to the survey, and therefore, inferences about nonrespondents based on the survey results cannot be made. All tables include the number of respondents who provided information on a specific item/question. Although the percentages for several characteristics are reasonably accurate, readers of this report should consider possible error that may be introduced by nonresponse.
The data in this report are drawn from doctoral-level psychologists with varying degrees (e.g., Ph.D., Psy.D.), specialty areas (e.g., clinical psychology, neuropsychology, experimental psychology), and licensure status. Readers should be aware that differences in the data may exist on these three variables alone.
One should always exercise caution when comparing the results of this survey with other national surveys that report data on psychologists (e.g., National Science Foundation, Commission on Professionals in Science and Technology). Factors such as the population sample used, differences in grouping data, and the time frame in which data are based can yield varying results.
Unless otherwise specified, the descriptive statistics in the brief summaries that precede the tables and figures are typically based on the cumulative data across all departments within medical school settings. Statistics for particular department types may be found in the tables and/or figures that correspond to that section.
For salary data, no statistics are provided where the N is less than 10 or where the standard deviation is 0. In these instances, only the N is provided.
The number of respondents in some categories is very small. Therefore, the statistics reported should be viewed with caution.
Column percentages may not total to 100% due to rounding.
In some instances, respondents are asked to provide multiple responses. Therefore, percentages may exceed 100%.
Medians, quartiles, means, and standard deviations are reported for several analyses. The median may be the most useful measure of central tendency since it is less influenced by extreme values than the arithmetic mean. In most of the tables, both median and mean salaries are presented; observed differences reflect the skewness in the distributions.
Data in this report are based on a nationwide sample. For locations where the cost of living differs significantly from the national average, salaries would be expected to vary accordingly. Section 6 contains information on salaries by region and for selected metropolitan areas.
The nine geographic regions comprising states in this report were adapted from the categorization used by the U.S. Department of Commerce's Bureau of the Census. The states comprising each cluster are listed in Appendix B.
The category "Years Since Doctoral Degree" is included to provide a broad gauge of the years of experience that a psychologist has accrued. Readers should be mindful, though, that years since doctorate and years of experience are not parallel terms, and may not necessarily coincide.
The tables report salaries for medical school psychologists on an 11-12-month basis. Nevertheless, a small number of these psychologists operate on a 9-10-month academic year. In these cases, the 11-12-month salaries can be converted to their 9-10-month equivalents by multiplying by 9/11.
Section 1 — Demographic Characteristics
Table 1 indicates that just under 56% of the responding psychologists in medical school settings were men. With the exception of departments of Pediatrics, men were in the majority (above 50%) across various types of departments. In departments of Pediatrics, women comprised 65% of the faculty.
As shown in Table 1, the majority of respondents were white (92%). Each one of the other racial/ethnic groups were represented at less than 2% of the faculty. The largest number of persons of color were faculty affiliated with Departments of Psychiatry and Behavioral Sciences. One percent of the respondents identified themselves as multi-ethnic, and about 2% did not specify their race/ethnicity.
Years Since Doctoral Degree
The largest percentage of medical school psychologists received their doctorate within the last 5-19 years (1978-1992). More specifically, 20% of faculty indicated receiving their degree within the last 5-9 years (1988-1992), 19% received their doctorate within the last 10-14 years (1983-1987), and 18% within the last 15-19 years (1978-1982). About 7% of the responding psychologists were awarded their doctorate within the last four years from the time of this survey (1993-1997).
Section 2 — Employment Characteristics
Table 2, Figure 1, and Figure 2 illustrate the employment characteristics of psychologists within medical school settings. Seventy-four percent of the medical school psychologists indicated having a full-time academic appointment, compared to 20% whose appointment was part time. The majority of these psychologists (85%) operated on an 11-12-month academic year; only 1% indicated working on a 9-10-month basis. This latter trend is in contrast to traditional academic settings in which the majority of faculty operate on a 9-10-month academic year (Wicherski, Williams, and Kohout, 1998).
The rank and tenure of psychologists within medical school settings differ markedly from that of psychologists in traditional academic settings. In their primary academic setting, assistant professors represented the largest percentage of medical school faculty (34%), followed by associate professors (26%), and then full professors (22%). About 6% of the faculty identified themselves as lecturers. A reverse trend is evidenced in traditional academic settings where full professors comprise the majority of faculty (48%), followed by associate professors (29%), and then assistant professors (22%) (Wicherski, Williams, and Kohout, 1998). In terms of tenure status, 40% of medical school psychologists are not on a tenure track. Twenty-three percent of these psychologists reported having tenure, and a little under 15% are currently on a tenure track. Thirteen percent of these psychologists are employed in an institution in which the tenure system is not used and approximately 6% do not have an academic appointment in their primary medical school/health center. Conversely, in traditional academic settings, tenure is still the norm with 70% tenured faculty and 25% of the faculty on a tenure track, and only 6% not on a tenure track (Gehlmann, Wicherski, Kohout, 1995).
Overall, these psychologists have spent a median of 8 years in their current employment positions.
Section 3 — Characteristics of Employers and Institutions/Departments
Table 3 and Figure 3 illustrate the percentage of psychologists who are with appointments across various types of departments within medical schools. Slightly more than half of the psychologists in medical school settings are placed in departments of psychiatry and behavioral sciences (56%). Other psychologists are positioned in departments of pediatrics (9%), departments of neurology/biology/physiology/anatomy (8%), departments focusing on family/health/community/prevention (7%), and departments practicing traditional medical specialities (5%) (e.g., cardiology, oncology, obstetrics/gynecology, radiology). Only three percent of these psychologists are situated in departments of rehabilitation and pain management and departments of psychology.
Overall, 36% of psychologists are employed in a medical school setting that has an independent psychology administrative unit, and 48% are within departments/colleges that have a psychologist who serves as Chief Psychologist or Administrative Head for psychology.
Section 4 — Activities, Privileges, and Benefits
Tables 4-9 depict the activities, privileges, and benefits of psychologists within medical school settings, many of which varied depending on department type. In terms of the collective percentage of time across all departments devoted to medical school activities (see Table 4), the single largest proportion was spent conducting research (30%). Clinical services followed at 25%, 15% was devoted to teaching, and 10% was allocated for administrative tasks.
As depicted in Table 5 and Table 6, a large number of psychologists were involved in training. Slightly more than half of the medical school departments/colleges supported pre-doctoral internships (50.8%) and post-doctoral fellowships (53%) in psychology. In several instances, departments did not provide opportunities for training in psychology at the predoctoral and/or postdoctoral levels. For those departments that did not offer a predoctoral internship program in psychology, 40% of the psychologists have the opportunity to train these students elsewhere within the medical school and 7% were involved in training at another institution. Similarly, 21% of psychologists train postdoctoral fellows outside their primary departments but within the medical school and 4% train fellows at another institution.
Table 7 shows that psychologists reported that they were mostly responsible for training medical students (54%) and psychology students (52%). Only a modest number of psychologists taught nursing students (6%), physician's assistant students (3%), or dental students (3%). Forty-nine percent of the psychologists indicated that they were responsible for training students other than those in the categories listed. Closer inspection of the data indicated that these students in the "other" category consisted mostly of psychiatry residents.
Overall, 56% of the psychologists in medical schools were on the medical staff or were members of the medical staff within their departments, compared to 36% who did not have official membership status (see Table 8). About nine percent of the respondents did not specify whether they were members of the medical staff. Although over half of the psychologists were official members of the medical staff, only 21% acknowledged that they receive full privileges as members and about 12% did not specify the extent of their privileges. Of those 56% of psychologists on the medical staff or who were members of the medical staff within their departments, 87% were not authorized to admit patients, 64% were not permitted to write patient orders, 37% could not participate in the voting process, and 5% had some other type of restriction. In particular, psychologists who were employed in departments of family/ community/health/prevention, pediatrics, and psychiatry and behavioral sciences were less likely to receive full privileges.
The majority of psychologists in medical school settings enjoyed the benefit of having their employer incur the cost of malpractice insurance. Specifically, as shown in Table 9, 61% of medical school psychologists have employer-paid coverage, 24% did not have coverage paid by their employer, and 14% did not specify whether their employer covered malpractice insurance costs.
Section 5 — Factors Influencing Employment and Salary
Tables 10-13 address factors that influence employment and earnings such as "soft money" income arrangements, supplementary income, overhead rates, and changes in the health care system.
Psychologists within medical school settings are often expected to generate their own income through clinical work and/or research grants, unlike psychologists in other settings where such demands are less common. This arrangement is commonly known as "soft money." The majority (57.5%) of respondents with full-time positions in medical schools reported that they were required to earn a portion of their salary through clinical work, research grants, or both. The sources of these mandatory salary contributions were distributed about equally, with 19% deriving part of their salary through clinical work, 18.5% through research grants, and 19.5% through both. Less than half (42.5%) reported that they had no such requirement--that their salary was fixed and fully funded by their employer. The requirements varied by type of department. That is, some departments placed more emphasis on deriving salary through research grants, other departments placed more importance on clinical work, while still other departments required both clinical work and research grants as sources of mandatory salary contributions. About a third of those psychologists in departments of traditional medical specialties (32%) reported that part of their salary was drawn from research grants. Of those psychologists in Family/Prevention/Health departments, 27.5% had to generate clinical income. And about a third of psychologists in Rehabilitation and Pain Management departments had to earn income from both sources. "Soft money" constituted respondents' salaries in varying proportions, and as seen in Table 10, the levels differed by department type. Collectively, however, psychologists who were expected to supply part of their salary through clinical work had to contribute a median of 55%. Those required to generate research grants had to fund 90% of their salaries. And those who had to generate both types of income funded themselves fully at 100%.
Many of these psychologists have found opportunities for clinical work outside of their primary institutions or have earned additional income through consulting and other outside activities. Overall, about 43% of the responding psychologists were able to supplement their salary with income from independent clinical practices external to the medical school workplace. Similarly, 47% of these psychologists were able to augment their salaries by serving in other non-clinical and adjunct roles (e.g., consulting, teaching). Opportunities for supplemental income were fairly consistent across department types with only minor exceptions. Table 11 illustrates the supplementary income of medical school psychologists across various departments.
An additional factor that indirectly influenced salary was overhead rates for clinical work and/or grant income. Overhead rates differed markedly depending on whether clinical work or research was involved. The median overhead rate for clinical work was 28%, compared to a 48% overhead rate for grant income (see Table 12).
Perhaps the most talked about concern influencing employment and earnings of medical school psychologists is the proliferation of changes in the health care system in the last decade (e.g., managed care, provider panels) (see Table 13). Across all departments, almost 39% of psychologists claimed that their clinical income or salary was affected by these changes. Thirty-two percent reported that their hospital underwent a merger with another organization within the past five years, and of those, 22% claimed that psychology positions were lost as a result of the merger. The impact of the merger as a result of changes in the health care system reportedly caused 19% of these psychologists to undergo an increase in required clinical hours, 17% to experience less time for professional development, 15% to receive less support for teaching, and 13% to experience less research support. Still, the majority of psychologists (61%) working in hospitals that experienced a merger reported no impact on their daily work activities.
Section 6 — Earned Income
This section presents several tables and figures that illustrate the full-time salaries of psychologists within medical school settings. These data can be found in Tables 14-89 and Figures 4-17. The data have been analyzed by department type, academic rank, years since doctorate, geographic region, and gender. Where possible (given sufficient Ns) the data also have been broken down by base salary, clinical income, other additional income, and total income. Salaries of non-tenured research faculty only are presented in Table 89.
Some general conclusions may be drawn from the data. Namely, psychologists employed within Traditional Medical Specialities (e.g., cardiology, oncology, obstetrics/gynecology, radiology) were among the highest paid psychologists within medical schools, and those in departments of pediatrics had the lowest median salaries. As expected, salaries steadily increased with increasing academic rank. Full professors earned the highest income, followed by associate professors, and then assistant professors. Further, also as anticipated, salaries generally increased with increasing years of experience.
All full-time-employed respondents were categorized into regions and metropolitan areas on the basis of zip code. Salaries varied according to geographic region of the United States and selected metropolitan areas. Tables 49-71 should only be used to make general comparisons among the different regions and metropolitan areas, and should not be applied to individual salaries. This is because it is likely that median salaries are affected by differences in cost of living, as well as other factors such as department type, academic rank, years of experience, and gender.
Generally, the median salaries of men were notably higher than that of women, with only few exceptions. This was typically the case regardless of department type, academic rank, and years since doctorate (i.e., years of experience). Also noteworthy was that, for men, salaries steadily increased with increasing years of experience. In contrast, salaries for women did not share the predicted steady trend of increasing with years of experience.