PhD/PsyD APAGS video on the internship imbalance

[psychrat]

http://www.apa.org/apags/resources/internship-crisis.aspx

The American Psychological Association of Graduate Students (APAGS) is committed to ending the internship crisis. Check out this video developed by APAGS, which offers a call to the psychology community for greater awareness, advocacy and action to ensure the availability of internships for all students.

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Members don't see this ad.

 

[cara susanna]

Yeah, but awareness isn't enough anymore. People have to make difficult decisions, and no one with any power seems to want do to that.

 

[463951]

http://www.apa.org/apags/resources/internship-crisis.aspx

The American Psychological Association of Graduate Students (APAGS) is committed to ending the internship crisis. Check out this video developed by APAGS, which offers a call to the psychology community for greater awareness, advocacy and action to ensure the availability of internships for all students.

In the video, it's mentioned that $3 million will be given by the APA to help sites get accredited. Which is great, and I'm glad they are doing something. Will this money go towards the fees involved in sites getting accredited? Which sites would get money? How much does it cost for sites to get accredited? These questions are not necessarily directed at you @psychrat, but anybody who might know the answers.

"Yeah, but awareness isn't enough anymore. People have to make difficult decisions, and no one with any power seems to want do to that."

@cara susanna – yeah, it sucks, the system is broken. Some really great people did not match this year (and years prior obviously), it's completely unfair. And it's unfathomable that just over 50% of us are attending internships that are APA accredited. Let's say that something miraculous happens and all existing internship sites become accredited. There will still be an imbalance as long as certain schools continue admitting an exorbitant amount of students every year.

 

[cara susanna]

Yup. "Increase the number of sites!" is the "safe" (uncontroversial) suggestion, but like you I doubt that will fix it. And it infuriates me that this desire to be politically correct is stopping any real progress from being made.

 

[futureapppsy2]

Yup. "Increase the number of sites!" is the "safe" (uncontroversial) suggestion, but like you I doubt that will fix it. And it infuriates me that this desire to be politically correct is stopping any real progress from being made.

Yep. IMO, the only way to truly fix the imbalance is to cut down on the number of applicants (*cough*FSPS cohort sizes *cough*), but there's been so many indications that the APA is so tied up with FSPS financially and lobbying wise, I doubt they'd do that. Thus, everyone just keeps going around in circles.

 

[463951]

Yup. "Increase the number of sites!" is the "safe" (uncontroversial) suggestion, but like you I doubt that will fix it. And it infuriates me that this desire to be politically correct is stopping any real progress from being made.

Yes exactly! I think if we increased the number of sites it would actually make the problem worse, and FSPS would admit even more students than they already do!

Yep. IMO, the only way to truly fix the imbalance is to cut down on the number of applicants (*cough*FSPS cohort sizes *cough*), but there's been so many indications that the APA is so tierd up with FSPS financially and lobbying wise, I doubt they'd do that. Thus, everyone just keeps going around in circles.

I have heard rumors about this, APA & FSPS "in bed" with each other so to speak, things like APA needing the money from FSPS because APA is losing money due to a decrease in memberships and FSPS needs the APA to ensure accreditation for their schools...is this what you mean? If any of this is true, then yeah, everyone will just keep going around in circles unfortunately.

 

[OneNeuroDoctor]

APA accreditation is optional and not required for doctoral psychology training programs. However, each state has different requirements or accreditation standards. Some state psychology licensing boards have requirement for APA accredited programs or equivalent standards.

A good number of psychologist are not members of APA and I think APA has no power over programs unless they are APA accredited and Free Trade laws allow for these programs to open as FSPS private schools. Are you going to close all private schools?

Part of the problem for the imbalance is due to agencies being restricted for reimbursement of services for trainees. Another factor is required individual and group supervision hours during the internship year and this reduces billable hours for agencies. Additionally, supervisors normally do not receive additional income for supervising interns so they choose to not supervise.

Now that I have worked for close to two years, I hear colleagues say they will not supervise interns and they do not seem to care that they need the experience for licensure. I have heard statements there are way too many psychologist and that licensing should be harder with EPPP score of 80% or above required. Many seem resentful when LMSW and LPC receive the same rate of reimbursement. Many seem angered towards APA as membership cost is to high and they feel APA does not represent psychologist, but it is just a political bureaucracy.

 

[Rivi]

I am not a fan of this video, at all. The issue is mostly an oversupply of students, particularly from Psy.D. schools. Why create more internships to meet the demands of students, if there isn't an increased demand for psychologists? This just shifts the "bottleneck" from internship to post-doc, to the job market, etc.

What is going on with the Committee for Accreditation, btw? Aren't they supposed to be implementing some sort of internship/EPPP cutoff into APA-accreditation?

 

[Ollie123]

No need or practical way to "close all private schools", but there are many perfectly legal ways to render it difficult/impossible for these schools to become accredited, render it difficult/impossible for students at these schools to participate in the match and likely in the end render it difficult/impossible for graduates of these programs to become licensed, effectively driving them out of business (or forcing them to dramatically alter their ways to avoid the above).

Agree with the issues regarding billing for services. If interns could bill, I imagine agencies would be more willing to absorb the hit from supervision costs. Though admittedly, I do think its important to strike a balance here as taking interns SHOULD be an educational commitment for the agency. Agencies with extremely limited resources may not be able to provide the necessary experiences to warrant accreditation, which I think is unfortunate but reasonable. There are already too many practicums/internships that are more interested in cheap labor than providing training and that is part of the problem.

I'd be all for adding (meaningful) hurdles to licensure. Not the artificial, input-focused "You need more classes in X and another 1000 hours", but I'd be all for raising the bar and more outcome-focused requirements.

 

[erg923]

APA accreditation is optional and not required for doctoral psychology training programs. However, each state has different requirements or accreditation standards. Some state psychology licensing boards have requirement for APA accredited programs or equivalent standards.

A good number of psychologist are not members of APA and I think APA has no power over programs unless they are APA accredited and Free Trade laws allow for these programs to open as FSPS private schools. Are you going to close all private schools?

1. I dont understand this logic of this sentence. 2. who said anything about closing "private schools?

Part of the problem for the imbalance is due to agencies being restricted for reimbursement of services for trainees. Another factor is required individual and group supervision hours during the internship year and this reduces billable hours for agencies. Additionally, supervisors normally do not receive additional income for supervising interns so they choose to not supervise.

Just to clarify:
These are explanations for why some sites do not form internships. I agree. However, Its NOT a cause of the mismatch between applicants and sites (ie., imbalance). The number of predoctoral applicants went up dramatically between 200o and present with no consideration for the training infrastructure. Too much supply, not enough demand. Simple economics.

Now that I have worked for close to two years, I hear colleagues say they will not supervise interns and they do not seem to care that they need the experience for licensure. I have heard statements there are way too many psychologist and that licensing should be harder with EPPP score of 80% or above required. Many seem resentful when LMSW and LPC receive the same rate of reimbursement. Many seem angered towards APA as membership rate is to high and they feel APA does not represent psychologist but it is just a political bureaucracy.

Im sure this depends on settings and likely if they are affiliated with academic institutions. Our facility happens to have staff that is committed to students training, even though we don't have an internship yet. We do have active practicum and journals clubs for grad students though.

I agree that there are too many psychologists given the current market demand for services.

 

[MCParent]

In the video, it's mentioned that $3 million will be given by the APA to help sites get accredited. Which is great, and I'm glad they are doing something. Will this money go towards the fees involved in sites getting accredited? Which sites would get money? How much does it cost for sites to get accredited?

Interestingly, I've recently learned that some of the "stimulus package" money has gone to internships that have formed captive internships with particular sites (i.e., FSPS). If you think that is a problem, I'd suggest posting to the APAGS/APA message boards or coming to this at convention: http://www.apa.org/convention/programming/presidential/index.aspx (Saturday at 4)

 

[Rivi]

Interestingly, I've recently learned that some of the "stimulus package" money has gone to internships that have formed captive internships with particular sites (i.e., FSPS). If you think that is a problem, I'd suggest posting to the APAGS/APA message boards or coming to this at convention: http://www.apa.org/convention/programming/presidential/index.aspx (Saturday at 4)

 

[MCParent]

That sums up my reaction pretty well.

That and this.

 

[OneNeuroDoctor]

No need or practical way to "close all private schools", but there are many perfectly legal ways to render it difficult/impossible for these schools to become accredited, render it difficult/impossible for students at these schools to participate in the match and likely in the end render it difficult/impossible for graduates of these programs to become licensed, effectively driving them out of business (or forcing them to dramatically alter their ways to avoid the above).

Agree with the issues regarding billing for services. If interns could bill, I imagine agencies would be more willing to absorb the hit from supervision costs. Though admittedly, I do think its important to strike a balance here as taking interns SHOULD be an educational commitment for the agency. Agencies with extremely limited resources may not be able to provide the necessary experiences to warrant accreditation, which I think is unfortunate but reasonable. There are already too many practicums/internships that are more interested in cheap labor than providing training and that is part of the problem.

I'd be all for adding (meaningful) hurdles to licensure. Not the artificial, input-focused "You need more classes in X and another 1000 hours", but I'd be all for raising the bar and more outcome-focused
requirements.

Irony here is that when people do not get licensed as a psychologist they can usually get licensed as an LPC or LCSW and make as much or more money. There is not national uniformity among states requiring Psychologist licensed for positions so they will hire LPC or LCSW at the
same rate of pay.

 

[futureapppsy2]

Irony here is that when people do not get licensed as a psychologist they can usually get licensed as an LPC or LCSW and make as much or more money. There is not national uniformity among states requiring Psychologist licensed for positions so they will hire LPC or LCSW at the
same rate of pay.

Yeah, no. No psychology PhD/PsyD program is going to prepare anyone for LCSW licensure--seeing as it's an entirely different field--and most programs won't fulfill the requirements for LPC/LMHC licensure, either. It's not that simple.

 

[AcronymAllergy]

The problem, it seems, isn't going to get solved without more than a few feathers getting rustled. And setting aside money for more internship spots isn't ruffling feathers.

 

[PsychBiker]

If I had only taken my PsyD programs required courses, I would have never have gotten my LPC. I took maybe four more courses to meet my state's LPC requirements.

 

[OneNeuroDoctor]

That is what I meant....some folks never pass the EPPP and they have to move on so they take some extra courses for LPC or LMSW license. Some LPC or LMSW boards allow PsyD/Phd Clinical Psychology students to take something similar to respecialization abbreviated program to gain licensure as an LPC or LMSW.
Some very competent PsyD/PhD graduates in clinical/counseling psychology must resort to gaining only master's level licensure. I attended one of the EPPP workshops and there was indication that they would continue to work with students who do not pass the EPPP and that some students have taken it 7 or more times and sadly some students never pass the EPPP and they are not licensed as psychologist but are LPC or LMSW.

For some reason doctoral level psychology programs under current model may accept ten to 20 students per cohort expecting 20 to 30 percent of each cohort to not make it through and then towards the end or final outcome, an all or none outcome measure (EPPP) determines licensure rather than prior performance in Practicum, Internship...etc.... It needs to be reversed where passing an exam such as the EPPP is earlier on in the program so you don't end up having people never gaining licensure. From talking with friends who are MD, this is the way MD is set up in that you take qualifying exams second year but the Boards are more specialty exams rather than broadly based as the EPPP. My supervisor has indicated that numerous PhD/PsyD students who have not passed the EPPP have filed lawsuits against ASPPB and the whole licensing process but no one has won their case. I have taking both the NCE and the EPPP for my master's level license and passed both, with the EPPP at the masters level or above 450 with a score of 485. I am scheduled to take the EPPP again in September for doctoral level licensure. From looking at the raw score for a 485, I just needed to pass three more questions to pass the EPPP at the doctoral level or 500. I did not study much the first time but I am studying more intensively this time around.

 

[Therapist4Chnge]

For some reason doctoral level psychology programs under current model may accept ten to 20 students per cohort expecting 20 to 30 percent of each cohort to not make it through and then towards the end or final outcome, an all or none outcome measure (EPPP) determines licensure rather than prior performance in Practicum, Internship...etc....

Can you cite some programs? Any halfway decent APA-acred. university based programs I've seen has a licensure rate of 85%-90%. A 5-10% attrition rate can still happen, but that is quite low compared to many other types of programs.

As for EPPP pass rates....the exam isn't perfect, but I really wonder about the people you mentioned who failed 7+ times. I know at least one of my former supervisors failed her first time, as she didn't think she needed to study....so it does happen, but 7 times...

 

[OneNeuroDoctor]

I have not reviewed the APA site regarding cohort size, internship match, and licensure recently. I was surprised when I reviewed it awhile back to discover that some of the programs I was familiar with that were highly respected were not doing so well in these areas. Seems that TWU, TAMU, SMU, UNT and other programs near where I was were not doing all that great.

I guess what I am trying to specify is that completion of such a broadly based exam should be in the front end rather than the back end. Have the EPPP or similar exam the third year of the program rather than at the end for licensure. Another option is to make the EPPP exam a specialty exam rather than a broadly based exam. Most of the EPPP is stuff learned in general psychology rather than in clinical psychology. Another suggestion is to have the doctoral degree completed before internship so internship program may receive reimbursement for training of interns. Have you ever subscribed to the EPPP listserv? Some of these stories make you wonder if this is all worth it considering the income most psychologist earn when having the title of Doctor. I joined the EPPP listserv to get all of the information from the Goldmine files, but I can't bear listening to these stories of people taking it three or four times without passing, and paying all of this money for different programs. It is really depressing so I don't read the listserv anymore.

 

[erg923]

What you said is like saying there are plenty of great lawyers who can't pass the bar exam. We'll, yea, maybe. But we can't really say that with any confidence because the can't pass the exam. Lol

 

[erg923]

And to clarify yet again, traditional funded, phd programs do NOT admit with an expectation of 70% attrition. That would be irresponsible use of federal grant money and university resources. Thus why admission standards are so high in traditional programs ...to minimize the risk of ANY attrition.

Also, you are actually earning a doctorate in "psychology." The concentration within that doctorate is the clinical application of psychological knowledge/science. Thus, a test measuring comprehensive knowledge of psychology, not just clinical applications, seems pretty fair. I will agree that some of the content and wording is rather silly. But, unless you have absolutely paralyzing test anxiety, if you can't pass the test after multiple tries, your training was just not up to snuff or you didn't review. Period. Most all the content should be familiar at the least, so not being able to pass after brushing up on each domain means you were probably not exposed to that content.

 

[OneNeuroDoctor]

Hah... Yes some never pass the Bar exams and become great history/political Science teachers. The EPPP passing does not make a psychologist competent. These are people who have severe test anxiety and may freeze up on the EPPP as many of the questions and answers are not clear or straightforward.

 

[WisNeuro]

There are things we can do about test anxiety. It's not an excuse for failing 7 times.

 

[Ollie123]

There are things we can do about test anxiety. It's not an excuse for failing 7 times.

I agree that seems quite extreme and not exactly the sort of thing that should concern most people. Its unfortunate for those it impacts but between treatment (and possibly accommodations?) this hardly seems the sort of thing that warrants some sort of systemic change. The national pass rate is what ~65%? My eyeballing of the data suggests its typically more like 85-100 among legit programs. That doesn't seem a major cause for concern to me...I'm certainly not worried about it for when my turn comes. Though I'd be all for moving it earlier in training if that facilitates acquisition of licensure prior to internship. The exam could certainly be improved, but I worry that some of the dialogue surrounding the EPPP seems to imply we should be eliminating the relatively few hurdles that remain like the EPPP because some people can't pass it. Its far from a perfect exam, but some people shouldn't be passing it...I don't think that's necessarily bad. We WANT some hurdles in place for licensing. I'm all for making those as meaningful as possible...but "easier" shouldn't be the way to go.

I agree wholeheartedly with erg surrounding the relevance of the material. I think it speaks to the broader issue of people conflating "psychologist" with "therapist" and expecting all training and any hurdles to align with their desire to only ever do the latter. Given the direction the field is going, it doesn't seem wise to cater to those with an overly narrow definition of what a clinical psychologist does...in fact, we should probably be moving in the other direction. Heck, I'm waist-deep in the IO leadership and organizational change literature right now as part of my clinical internship...these sorts of things DO come into play as a clinical psychologist.

 

[Menolly]

APA accreditation is optional and not required for doctoral psychology training programs. However, each state has different requirements or accreditation standards. Some state psychology licensing boards have requirement for APA accredited programs or equivalent standards.

A good number of psychologist are not members of APA and I think APA has no power over programs unless they are APA accredited and Free Trade laws allow for these programs to open as FSPS private schools. Are you going to close all private schools?

Part of the problem for the imbalance is due to agencies being restricted for reimbursement of services for trainees. Another factor is required individual and group supervision hours during the internship year and this reduces billable hours for agencies. Additionally, supervisors normally do not receive additional income for supervising interns so they choose to not supervise.

Now that I have worked for close to two years, I hear colleagues say they will not supervise interns and they do not seem to care that they need the experience for licensure. I have heard statements there are way too many psychologist and that licensing should be harder with EPPP score of 80% or above required. Many seem resentful when LMSW and LPC receive the same rate of reimbursement. Many seem angered towards APA as membership cost is to high and they feel APA does not represent psychologist, but it is just a political bureaucracy.

These are valid points. I have also observed many colleagues that refuse to supervise interns or postdocs. I have not heard them say that licensing should be harder, but I have heard them say they don't want to because they are not reimbursed for providing the supervision and they don't get credit for their interns' caseloads. If I could change this system, I'd make it more like medical doctors. Get your degree in 3-4 years (replace second doctoral exam with the EPPP maybe), then continue your clinical training at a decent pay grade in specialty residency programs. Provide funding (APA? federal initiatives?) for the specialty residency programs so that there are enough opportunities. I remember on internship being looked down upon by the medical residents because they assumed an intern had no clinical experience. Just some musings.

 

[smalltownpsych]

I agree that seems quite extreme and not exactly the sort of thing that should concern most people. Its unfortunate for those it impacts but between treatment (and possibly accommodations?) this hardly seems the sort of thing that warrants some sort of systemic change. The national pass rate is what ~65%? My eyeballing of the data suggests its typically more like 85-100 among legit programs. That doesn't seem a major cause for concern to me...I'm certainly not worried about it for when my turn comes. Though I'd be all for moving it earlier in training if that facilitates acquisition of licensure prior to internship. The exam could certainly be improved, but I worry that some of the dialogue surrounding the EPPP seems to imply we should be eliminating the relatively few hurdles that remain like the EPPP because some people can't pass it. Its far from a perfect exam, but some people shouldn't be passing it...I don't think that's necessarily bad. We WANT some hurdles in place for licensing. I'm all for making those as meaningful as possible...but "easier" shouldn't be the way to go.

I agree wholeheartedly with erg surrounding the relevance of the material. I think it speaks to the broader issue of people conflating "psychologist" with "therapist" and expecting all training and any hurdles to align with their desire to only ever do the latter. Given the direction the field is going, it doesn't seem wise to cater to those with an overly narrow definition of what a clinical psychologist does...in fact, we should probably be moving in the other direction. Heck, I'm waist-deep in the IO leadership and organizational change literature right now as part of my clinical internship...these sorts of things DO come into play as a clinical psychologist.

I especially agree with the benefit of the IO stuff. I had very little education prior to test so it was helpful to learn some of that info and I was able to apply that in my position as a clinical director. I also want to second the "we are more than just therapists". We are experts in the field of mental health and that includes psychotherapy, law, ethics, supervision, education, assessment, research. I probably left quite a few out! Oh consultation, program development, leadership.

 

[Dr_lost]

I think it's because colleges/Universities/Technical Schools are a business. They all want to lure in as many students as possible. The down side is that once those students graduate you now have to deliver on your promises of getting them those lucrative jobs/internships.

I do agree, the real problem is the degree factories. But they'll never stop taking Federal money for students, therefore their will be a lot of Millennial's with Bachelors, Masters and PhD Degrees that can't even get their foot in the door.