Psychologists Swimming in "Big Ponds"

Advantages and Challenges of Institutions

Are you a psychologist who feels like a small fish swimming in a big pond like a large medical system? Or perhaps you're used to being the big fish in the pond (private practice) and wondering about venturing into deeper waters. Healthcare is increasingly consolidating into large health systems, and many psychologists are considering taking the plunge. APAPO will need to work to advocate for the integration of psychologists in these settings and their practice needs. Working in a large institution for 12 years, I understand both the many advantages for a psychologist in this setting as well as some of the challenges. Here are just a few of my experiences.

Advantages

1. Diversity. Large institutions attract many types of patients and providers, allowing for a diverse and rich environment. From race/ethnicity, socioeconomic status, disability status, gender, sexual orientation, and international patients, psychologists working in large institutions have the advantage of a diverse and exciting range of people with whom to work.

2. Team support. The larger the institution, the more likely you will have a group of psychologists available for consultation, coverage, and peer support. The larger medical team can also offer support and stimulating interaction.

3. Intellectual stimulation. Large institutions have exciting opportunities, including valuing research and education, and offering ways for psychologists to be part of a community of ongoing learning.

4. Cutting edge of healthcare. It’s difficult to get in a rut at a large institution. They have their finger on the pulse of the changing nature of healthcare, and psychologists working at these institutions have the advantage of this institutional knowledge.

5. Job security/benefits. Large institutions often come with the resources to offer benefits such as vacation, sick time, travel allowance, and longterm employment that are highly attractive, especially to early career psychologists.

6. Resources. Billing and coding services, front end staff, a legal department, and credentialing professionals are generally at your fingertips, allowing psychologists to focus on their professional services.

Challenges

1. Minority status. In large hospitals, medical doctors tend to rule the roost. There can be challenges for psychologist to gain staff privileges, rise in administrative ranks, and be seen as doctoral level providers. I believe that these issues are critical for our field and APAPO.

2. Bureaucracy. Any large institution comes with layers of bureaucracy. Psychologists should be prepared to be patient, wade through layers of hierarchy, and endure some tedious meetings. However, with bureaucracy does come checks and balances, knowledge, and resources. It’s worth the trade-off for many psychologists.

3. Politics. Big organizations come with big politics. Psychologists in these settings must learn how to navigate between competing interests, keep their social networks healthy, and work with a variety of professionals.

4. Lack of flexibility. Large institutions tend to have set policies, job descriptions, and move toward change slowly. This can be difficult for psychologists who were trained in a more individualistic mentality. A balance of working within the system and bringing our own flexible perspective can help psychologists thrive in large institutions.

5. Culture. The big medicine culture is not always congruent with other cultures. Psychology culture alone is a very different professional environment than the physician culture. Psychologists in these settings will do well to identify resources and mentors such as a Women’s Staff Association or Minority Staff Affairs Office who can help navigate institutional challenges, promote leadership opportunities, and work toward psychologically healthy workplaces in large institutions.

6. Lack of autonomy. For a private practice professional who essentially is used to being the CEO, transition to a large institution can come with tradeoffs of autonomy and independence. However, in many ways, those same entrepreneurial skills can translate well into big hospital systems such as starting a new service within a hospital or understanding the business of healthcare. Psychologists should consider how their skills from small settings might make them even more desirable in large settings.

In short, there are many considerations for psychologists working in large institutions but overall it can be a very rewarding career choice.