2003: Report of the Medical School/Academic Medical Center Psychologists Employment Survey
William E. Pate II and Jessica Kohout
APA Center for Workforce Studies
The 2003 Medical School / Academic Medical Center Psychologists Employment Survey was 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 second effort by the APA to collect national-level employment and salary data on psychological personnel employed within medical school settings – the first effort was conducted in 1997 (Williams, Wicherski, and Kohout, 1998). 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, prior to the current series. 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 may have been impacted by recent changes in the health care system.
The target population for this study was defined as all doctoral-level psychologists employed in medical schools/academic health centers. Membership lists of the APA and the Association of American Medical Colleges (AAMC) were used to identify the population. An attempt was made to obtain a mailing list from the Council of Deans of the American Association of Colleges of Osteopathic Medicine in order to fully replicate the previous study conducted in 1997, but none was unavailable for use in the current study. As a consequence, the current study began with a smaller universe of potential participants than was the case in 1997. After eliminating duplicate names, the sample included 2,926 individuals. Another reason behind the smaller universe in 2003 is an increase in the number of APA members who did not specify their employment setting when submitting their personal information for the APA 2003 membership directory. There was a marked rise in missing data for job setting; the percentage who did not provide employment setting information had increased from 20% for primary setting and 35% for secondary setting in 1997, to 60% for primary and 60% for secondary in 2003. This meant that in 2003 there were over 50,000 APA members for whom employment setting was not available; who otherwise might have been included in the sampling universe.
For the purposes of this study, the term psychologist included those who held a doctorate in psychology but who did not necessarily consider themselves to be psychologists. For example, through anecdotal correspondence, some respondents reported that they held a medical degree in addition to a doctorate in psychology, and they saw themselves primarily as a medical doctor. However, less than 3% of the original sample included individuals with both a doctorate in psychology and a medical degree.
The 2003 Medical School / Academic Medical Center Psychologists Employment Survey was a reiteration of the 1997 Medical School Psychologists Employment Survey, with some minor changes in several of the items for purposes of response clarity. These changes were a result of review by the APA Research Office and an AMSP research group of the older instrument and findings from the 1997 study. As with its predecessor, the survey was an attempt to obtain information from psychologists on their academic appointments, characteristics of their department or school, employment activities, salary information, demographics, and experiences in medical school settings.
Two versions of the instrument were used. A traditional paper form was mailed to 1,380 individuals without a viable email address in March 2003. Non-respondents were sent a postcard reminder in April and a final reminder with another copy of the survey instrument in May. The 1,546 psychologists with email addresses on file were sent an email solicitation, in place of the paper invitation, directing them to an online version of the survey. Due to technical difficulties in development and testing of the online form, initial emails were not sent until August of 2003. Non-respondents in this group were sent an email reminder in September and a letter with a paper copy of the instrument in October 2003. The data for this survey were gathered in 2003, and with the exception of salary, which was based on data from the preceding year (2002); reflect the situations of respondents in that year.
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 survey.
Notes and Caveats
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 area 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. 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. In these cases, 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 at the bottom of each table and 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.
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 restriction 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 1,309 useable surveys were returned, yielding a response rate of 45%. This is comparable to the 50% response rate for the 1997 survey (Williams, Wicherski, & Kohout, 1998).
Table 1 indicates that 54% 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 the various department types. In departments of Pediatrics, women comprised 61% of the faculty.
As shown in Table 1, the majority of respondents was white (91%). Each one of the other racial/ethnic groups was represented at less than 2% of the faculty, with the exception of Hispanic (3%). The largest number of persons of color was faculty affiliated with Departments of Psychology. One percent of the respondents identified themselves as multi-ethnic, and less than 4% did not specify their race/ethnicity.
Years Since Doctoral Degree
The largest percentage of medical school psychologists received their doctorate within the last 10-24 years (1979-1993). More specifically, 17% indicated receiving their degree within the last 10-14 years (1989-1993), 18% received their doctorate within the last 15-19 years (1984-1988), and 15% within the last 20-24 years (1979-1983). About 1% of the responding psychologists were awarded their doctorate within the last four years from the time of this survey (1999-2003).
Table 2, Figure 1, and Figure 2 illustrate the employment characteristics of psychologists within medical school settings. Seventy-seven percent of the medical school psychologists indicated having a full-time academic appointment, compared to 17% whose appointment was part time. The majority of these psychologists (85%) operated on an 11-12 month academic year; less than 1% indicated working on a 9-10-month basis. This latter trend is in contrast to traditional academic settings in which the majority (92%) of faculty operates on a 9-10 month academic year (Wicherski, Washington, and Kohout, 2004).
The rank and tenure of psychologists within medical school settings is similar to that of psychologists in traditional academic settings. In their primary academic setting, full professors represented the largest percentage of medical school faculty (29%), followed by associate professors (29%), and then assistant professors (27%). About 3% of the faculty identified themselves as lecturers/instructors. A more distinct trend is evident in traditional academic settings where full professors comprise the majority of faculty (45%) in doctoral departments of psychology, followed by associate professors (28%), and then assistant professors (25%) (Wicherski, Washington, and Kohout, 2004). In terms of tenure status, 38% of medical school psychologists are not on a tenure track. Twenty-eight percent reported having tenure, and a little under 10% are currently on a tenure track. Another 14% are employed in institutions in which the tenure system is not used. The remaining respondents did not specify (6%), reported a different type of system (4%), or did not have an academic appointment (1%) in their medical school/academic medical center. Conversely, in traditional academic settings, tenure is still the norm with 63% of faculty on tenure, 27% on a tenure track, and only 5% not on a tenure track among doctoral departments of psychology (Wicherski, Washington, and Kohout, 2004).
Overall, these psychologists have spent a median of 11 years in their current employment positions.
Characteristics of Employers and Institutions/Departments
Table 3 and Figure 3 illustrate the percentage of psychologists 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 (54%). Other psychologists are positioned in departments of pediatrics (11%), departments of traditional medical specialties (9%) (e.g., cardiology, oncology, obstetrics/gynecology, radiology), and departments focusing on family/health/community/prevention (8%). Less than three percent of psychologists each are situated in departments of rehabilitation and pain management and departments of psychology.
Overall, 33% of psychologists are employed in a medical school setting that has an independent psychology administrative unit, and 44% are within department/colleges that have a psychologist who serves as Chief Psychologist or Administrative Head for psychology.
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 (40%). Clinical services followed at 20%, with teaching and administration at 10% each.
As depicted in Table 5, a large number of psychologists was involved in training. One third of the medical school departments/colleges supported pre-doctoral students (33%), students on internship (38%), and post-doctoral students (44%) in psychology. In several instances, departments did not provide opportunities for training in psychology at the predoctoral and/or postdoctoral levels. Departments also reported the availability of training elsewhere at the respondent's institution (14% predoctoral, 8% internship, 8% postdoctoral) or at another institution (9% predoctoral, 4% internship, 3% postdoctoral).
Table 7 shows that psychologists reported that the largest single category of students they were responsible for teaching was in psychology (56%). This was followed by general medical (50%) and psychiatry (44%). Categories with the lowest percentages included nursing (8%), physician assistants (4%), and dental students (3%). Only a modest number of psychologists taught nursing students (6%), physician’s assistant students (3%), or dental students (3%).
Overall, about half (51%) of psychologists in medical schools were on the medical staff or were members of the medical staff within their departments (see Table 8). Of these, 68% were not authorized to admit patients, 47% were not permitted to write patient orders, 26% could not participate in the voting process, and 2% had some other type of restriction. Only 23% of psychologists received full privileges as members of the medical staff.
The majority of psychologists in medical school settings enjoyed the benefit of having their employers incur the cost of malpractice insurance. Specifically, as shown in Table 9, 65% of medical school psychologists have employer-paid coverage, 21% did not have coverage paid by their employers, and 14% did not specify whether their employer covered malpractice insurance costs.
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 (62%) 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. Specifically, 34% deriving part of their salary through research grants only, 10% through clinical work only, and 19% through a combination of both. One third (33%) reported that they had no such requirement – that their salaries were 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. For example, those in departments of traditional medical specialties were most likely to be required to derive at least part of their salary from research grants only (49%). For clinical work only, the highest percentage was reported by those in departments of rehabilitation and pain management (18%). The highest percentage of those required to derive their salary from both research grants and clinical work was also found in departments of rehabilitation and pain management (36%). “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 90%. Those required to generate research grants had to fund 75% of their salaries. And those who had to generate both types of income funded themselves almost fully at 90%.
Many of these psychologists have found opportunities for clinical work outside their primary institutions or have earned additional income through consulting and other outside activities. Overall, about 34% of the responding psychologists were able to supplement their salary with income from independent clinical practices external to the medical school workplace (Table 11). Similarly, 50% of respondents 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 supplemental 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 30%, compared to a 49% 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 Tables 13a and 13b). Across all departments, nearly 24% of psychologists claimed that their clinical income or salary was affected by these changes. Twenty percent reported that their hospital underwent a merger with another organization within the past five years, and of those, 20% 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 11% of these psychologists to undergo an increase in required clinical hours, 21% to experience less time for professional development, 16% to receive less support for teaching, and 12% to experience less research support. Still, a large percentage of psychologists (41%) working in hospitals that experienced a merger reported no impact on their daily work activities.
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 departments of psychology were among the highest paid psychologists within medical schools, and those in departments of rehabilitation and pain management 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).