Internship imbalances strike again!

[Neuropsych2be]

Y'all might want to take a look at this Washington Post article. The internship imbalance we face is soon to occur in medicine as the number of med school graduates increases and the number of residency slots remains relatively stagnant.


http://www.washingtonpost.com/blogs...thing-for-premed-students-to-freak-out-about/

---

Members don't see this ad.

 

[Ollie123]

Is this due to substantially increased enrollment in US med schools though, or an increased number of applicants from overseas programs? I'd heard about this but was under the impression it was driven more by the latter.

 

[PHD12]

As of now, this is just drama. I read that over 95% of students from US med schools match for residency. This was confirmed by my med school/physician friends as well. Its tough for foreign students.

Unfortunately, the internship imbalance in our field gets no press. Why aren't we publishing an article in the washington post about how 50% of our students are not completing apa internships and face many restrictions? Law/medical fields have been really great at generating media attention for their causes, including debt levels. This has led to increased funding for medical school and some proposals to change medical school to a 3 year process (NYU started this already). Committees are also working on changing law school to a 2 year program because of all the recent press about the job market.

 

[cara susanna]

That's actually the exact thought that I had, PHD12. This hasn't even happened yet for med students and they already get an article about it. It's been going on for years in our field and we've had barely any press coverage.

 

[KillerDiller]

To be fair, there was an article in the NYT about our imbalance last February.

 

[AcronymAllergy]

To be fair, there was an article in the NYT about our imbalance last February.

Yep, I believe I remember seeing that. Plus, there are more medical students and physicians than psychologists and psych grad students, and their overarching field as a whole is a bit more well-known than ours, so when things are set to effect them, it makes a louder "splash."

But hey, if someone wanted to set aside some time to write up a sketch (complete with an initial set of sources/citations) of either the internship imbalance or any other problems facing our field, I'm sure a news org somewhere might be interested in picking it up.

 

[Psychadelic2012]

and some proposals to change medical school to a 3 year process (NYU started this already). Committees are also working on changing law school to a 2 year program because of all the recent press about the job market.

Interesting, because the reaction around these parts, regarding psychology, is that longer is better. I guess it depends on what you're focused on--cost, profits, competition? How much worse can a so-called "midlevel" be if they have been in school about the same time as someone with a doctorate??

 

[Pragma]

Yep, I believe I remember seeing that. Plus, there are more medical students and physicians than psychologists and psych grad students, and their overarching field as a whole is a bit more well-known than ours, so when things are set to effect them, it makes a louder "splash."

But hey, if someone wanted to set aside some time to write up a sketch (complete with an initial set of sources/citations) of either the internship imbalance or any other problems facing our field, I'm sure a news org somewhere might be interested in picking it up.

In theory, one would think that our professional organization would spearhead this type of effort. but unfortunately, the APA is so interested in taking money from FSPS that it is a joke of an organization when it comes to these types of strategies (you know, the ones that protect the integrity of the field).

 

[AcronymAllergy]

In theory, one would think that our professional organization would spearhead this type of effort. but unfortunately, the APA is so interested in taking money from FSPS that it is a joke of an organization when it comes to these types of strategies (you know, the ones that protect the integrity of the field).

No argument here. I'm guessing the APA doesn't want to draw any more attention than is necessary to a situation that it played a large part in creating. And, as you've mentioned, it likely doesn't want to risk alienating some of the programs from which it may obtain a substantial portion of its financial support.

 

[kyril]

Yep, I believe I remember seeing that. Plus, there are more medical students and physicians than psychologists and psych grad students, and their overarching field as a whole is a bit more well-known than ours, so when things are set to effect them, it makes a louder "splash."

But hey, if someone wanted to set aside some time to write up a sketch (complete with an initial set of sources/citations) of either the internship imbalance or any other problems facing our field, I'm sure a news org somewhere might be interested in picking it up.

The APAGS statement on the Internship crisis is a good starting point

 

[PHD12]

Here is information on the new 3 year MD. This is one way in which other professions are dealing with debt problems. The 3 year NYU program includes entry into NYU's residency program.

http://communications.med.nyu.edu/m...-school-medicine-debuts-three-year-md-program

I don't see our field getting shorter.

 

[Pragma]

I don't see our field getting shorter.

It already got shorter when they introduced the Psy.D. - most of those programs have a full year less of minimum requirements than most Ph.D. programs.

I don't see how we can go any shorter than that.

 

[PHD12]

It already got shorter when they introduced the Psy.D. - most of those programs have a full year less of minimum requirements than most Ph.D. programs.

I don't see how we can go any shorter than that.

The 4 year PsyD only exists in theory though because there is no way you can match for an internship these days without the 5th or even 6th year. PsyD students are still paying for 5+ years in tuition.

I don't think it needs to be shorter. I'm just saying that with the MD possibly moving to a 3 year model, JD into a 2 year model, MBA is now 1.5-2 years, and now you can get a BA and MA/MS degree in 4 years (e.g., Stanford), we are not going to be attracting the best and brightest students. PsyD is actually the longest professional degree out of these (in terms of # of years in which students are paying tuition).

 

[cara susanna]

I attend a PhD and not a PsyD program, but a lot of people in our program match during their fourth year. It can be done even if it's getting more rare.

 

[PHD12]

I attend a PhD and not a PsyD program, but a lot of people in our program match during their fourth year. It can be done even if it's getting more rare.

Did these students come in with a Master's degree?

 

[cara susanna]

No--in fact, one student who entered with their Masters is applying as a third year right now.

I have noticed a general trend though that the people who tend to not match are applying in their fourth year. As of yet, to my knowledge we haven't had anyone applying during their fifth year not match (knock on wood, and I'm even more hesitant to write this because I will be applying in my fifth year).

That said, we usually have about two to three students per year who go on internship after being in the program for four years. That rate is decreasing and I imagine will continue to decrease as the imbalance worsens, however.

 

[PHD12]

No--in fact, one student who entered with their Masters is applying as a third year right now.

I have noticed a general trend though that the people who tend to not match are applying in their fourth year. As of yet, to my knowledge we haven't had anyone applying during their fifth year not match (knock on wood, and I'm even more hesitant to write this because I will be applying in my fifth year).

That said, we usually have about two to three students per year who go on internship after being in the program for four years. That rate is decreasing and I imagine will continue to decrease as the imbalance worsens, however.

I meant 4 years including internship is rare. Taking that extra year and applying in the 5th year can really increase your chances.

 

[cara susanna]

Oh, sorry, I misunderstood. Yeah, I don't regret my decision to wait, although it is a little sad to be left out of the exciting process as most of my cohort is going through it.

 

[Pragma]

The 4 year PsyD only exists in theory though because there is no way you can match for an internship these days without the 5th or even 6th year. PsyD students are still paying for 5+ years in tuition.

I don't think it needs to be shorter. I'm just saying that with the MD possibly moving to a 3 year model, JD into a 2 year model, MBA is now 1.5-2 years, and now you can get a BA and MA/MS degree in 4 years (e.g., Stanford), we are not going to be attracting the best and brightest students. PsyD is actually the longest professional degree out of these (in terms of # of years in which students are paying tuition).

It might be more rare, but the minimum requirements are different. If you look at APA accredited programs with both PhD and PsyD degrees, you'll notice it. I recall a program trying to sell me on a PsyD because it was "shorter than a PhD"

They may not match and stick around longer, but they still have less required of them.

 

[Ollie123]

I love that the proposed solution to there being more lawyers than legal jobs is to make it faster and cheaper to get a law degree. Am I the only one who sees a problem with this plan?

 

[pearible]

With match rates for APA internships so low, I'm wondering when/if we'll see a change in the work-force requirements recognizing this? Will we reach a point where "APPIC" rather than "APA" will be the standard?

 

[AcronymAllergy]

With match rates for APA internships so low, I'm wondering when/if we'll see a change in the work-force requirements recognizing this? Will we reach a point where "APPIC" rather than "APA" will be the standard?

I don't say this in a mean-spirited or "elitist" way at all, but I truly hope not. A further watering-down of our standards (even if it's just from APA to APPIC) is exactly what we don't need right now.

 

[NeuroTrope]

With match rates for APA internships so low, I'm wondering when/if we'll see a change in the work-force requirements recognizing this? Will we reach a point where "APPIC" rather than "APA" will be the standard?

Probably not. There's still heavy competition for the good positions.

 

[kyril]

I don't say this in a mean-spirited or "elitist" way at all, but I truly hope not. A further watering-down of our standards (even if it's just from APA to APPIC) is exactly what we don't need right now.

I agree. it is not like APA standards are so incredibly high. they are more like a minimum level

 

[PHD12]

I agree. it is not like APA standards are so incredibly high. they are more like a minimum level

Exactly. I'm starting to see APA internship as the minimum criteria to apply for most postdocs. I'm also seeing it on some job postings these days.

 

[pearible]

So if you didn't match for an APA accredited internship, you'd just reapply next year (and the next year - and in some cases around here, the *next* year) - instead of matching at an APPIC non-APA internship?

 

[AcronymAllergy]

So if you didn't match for an APA accredited internship, you'd just reapply next year (and the next year - and in some cases around here, the *next* year) - instead of matching at an APPIC non-APA internship?

I honestly can't say what I personally would've done in that situation. Our program requires that we attend an APA-accredited internship, so that essentially took the decision out of my hands when I applied.

I was fortuante enough to match during my first go-round. However, if I hadn't matched during that first Phase I, I likely would've only looked at APA-accredited sites in Phase II. If that didn't pan out, I again likely would've applied to only APA-accredited sites the next year for Phase I. However, if I again didn't match, at that point, I probably would've seriously considered petitioning to see if my program would've been open to an APPIC site. VA has been a top career goal of mine, though, so that would've been a tough call to make had it come down to it.

 

[cara susanna]

I dunno, I could see APPIC becoming the standard instead of APA. Maybe not for the profession as a whole (like VA gigs), but for the second tier that is developing thanks to professional schools and CAPIC.

 

[Pragma]

I dunno, I could see APPIC becoming the standard instead of APA. Maybe not for the profession as a whole (like VA gigs), but for the second tier that is developing thanks to professional schools and CAPIC.

So the rest of us would lower our training standards to accomodate the poor souls who chose to go to for-profit schools (and not to mention the schools that happily took their loan money)? Meh.

 

[kyril]

I dunno, I could see APPIC becoming the standard instead of APA. Maybe not for the profession as a whole (like VA gigs), but for the second tier that is developing thanks to professional schools and CAPIC.

I can see it happening, all too clearly, but it would be no good for the profession.

 

[cara susanna]

Yeah, I agree that it'd be bad for our field, but I can see it happening. Especially if the internship crisis isn't solved soon.

 

[pearible]

So the rest of us would lower our training standards to accomodate the poor souls who chose to go to for-profit schools (and not to mention the schools that happily took their loan money)? Meh.

The problem is, Pragma, that it's not just those "poor souls" - good students from good, non-profit, non-professional schools are also some of those "poor souls."

This is my 1st year going through the match process, but I've seen posts on this list from folks in their *third* go-round... and I don't know what I'd do if I were in their shoes.

The match imbalance isn't just affecting "those people" - those people are "us."

 

[PHD12]

I dunno, I could see APPIC becoming the standard instead of APA. Maybe not for the profession as a whole (like VA gigs), but for the second tier that is developing thanks to professional schools and CAPIC.

The second tier is already developed. We have CAPIC postdocs for people who complete CAPIC internships. California has many unpaid postdocs at several institutions and clinics. UCSF (not the research postdoc), non-profit clinics, and some county organizations (san mateo county takes 60-70 trainees each year without a stipend unless they speak spanish and then it goes up to 5,000) have unpaid postdoc positions. I ran across these positions when i was doing my post-doc search. Its become the norm in CA for someone with an MFT to work in an unpaid role for 2 years in order to accrue his/her hours. Its going to move in this direction for doctoral level graduates who did not complete accredited internships.

 

[bmedclinic]

Yeah, I agree that it'd be bad for our field, but I can see it happening. Especially if the internship crisis isn't solved soon.

BTW, my supervisor is a TD at an APPIC site and a few weeks ago when we met for supervision, she brought an article for me to read on the internship crisis. Target audience, obviously was training directors as it was in a training director APA journal.

Anyways, the article suggested that no matter how you slice it, the imbalance will not be able to be "fixed" in under 10 years. Even the "let's eliminate professional schools" argument wont "fix" the problem.

Here it is: http://psycnet.apa.org/journals/tep/6/4/249/

 

[PHD12]

Anyways, the article suggested that no matter how you slice it, the imbalance will not be able to be "fixed" in under 10 years. Even the "let's eliminate professional schools" argument wont "fix" the problem.

Here it is: http://psycnet.apa.org/journals/tep/6/4/249/

That's not really the take home message I got from this article (I can't get the full article online). Even reducing enrollment at professional schools (without eliminating professional schools) would lead to a sustainable reduction in the internship imbalance. Sounds like a great start to me.

"In contrast, methods to reduce enrollments of doctoral training programs were estimated to produce sustainable reductions in the internship imbalance over the same time period. I argue that a plan to reduce enrollments of all doctoral training programs, coupled with implementing a policy to limit access to the annual internship match to students from accredited programs, represents an effective and relatively palatable strategy to solve the internship crisis by the decades' end."

There is another article published that found that 15 programs (all but one were PsyD programs) were responsible for 32% of unmatched applicants. Here is one fact they found: All told, the 15 programs sent 4,808 students into the match from 2000 to 2006 — 22 percent of all internship applicants during that time frame.

Let's say APPIC took really drastic measures for 2013 and did not allow anyone from these 15 programs to apply for the APPIC match. Even doing this (and this is only a small portion of professional programs) would eliminate the surplus of applicants by reducing the applicant pool by about 25% (that's the number of unmatched applicants). This wouldn't lead to 100% match for 2013, but it would be significantly higher and noticeable immediately.

 

[Pragma]

The match imbalance isn't just affecting "those people" - those people are "us."

I recognize that. But how do you solve the problem? Lower standards?

It is a competitive field, and it is the responsibility of students and their doctoral programs to make a student competitive for accredited internships. I personally don't view watering down the standards as an acceptable solution to the problem.

 

[mrfox1]

only allow as many Doctoral candidates as their are internship opportunities from the previous year. Problem solved.

 

[AcronymAllergy]

only allow as many Doctoral candidates as their are internship opportunities from the previous year. Problem solved.

Some of the proposed solutions have suggested similar actions (e.g., limit incoming class sizes to the average number of applicants matched to accredited internships over the past X number of years). Unfortunately, enforcing such a restriction is the hard part.

 

[Pragma]

Some of the proposed solutions have suggested similar actions (e.g., limit incoming class sizes to the average number of applicants matched to accredited internships over the past X number of years). Unfortunately, enforcing such a restriction is the hard part.

Well making it a rule would be a good start. But then of course, who does the enforcing? If it is a program that is avoiding APA accreditation, then the APA has no say.

 

[mrfox1]

then don't allow non-APA accredited internships to count towards the hours required for licensure.

 

[PHD12]

Some of the proposed solutions have suggested similar actions (e.g., limit incoming class sizes to the average number of applicants matched to accredited internships over the past X number of years). Unfortunately, enforcing such a restriction is the hard part.

US medical schools have been successful at this so far. They have been able to limit the number of professional schools and cap class size to equal the number of residency spots (match rates are higher than 95% as long as you attend a US school). We should find out how they were legally able to do this. This has kept salaries and demand for MD's pretty high. At some of my previous training places, they were dying to hire psychiatrists and were unable to fill the positions for months despite paying over 200K (they actually ended up hiring psychiatrists from foreign medical schools to fill spots).

 

[Pragma]

then don't allow non-APA accredited internships to count towards the hours required for licensure.

Easy fix - just pass that through every individual state legislature

Then of course, people will just add another postdoc year of hours and avoid your limit anyways.

 

[mrfox1]

Easy fix - just pass that through every individual state legislature

Then of course, people will just add another postdoc year of hours and avoid your limit anyways.

never going to happen because University is treated as a business here (even if they claim to be 'non-profit'). Welcome to the USA.

 

[bmedclinic]

The answer isnt the state legislature-- its getting some officiating body (APPIC, APA, etc) to actually do something.
It turns out that it's likely every person in this thread is involved with those bodies at some level. All we need is enough support to begin to create change. Those 30 or so schools might complain and complain, but I actually think the way to do this is not via the law. It's through psychologists advocating for themselves- something we all know that we suck as a whole at doing.

 

[PHD12]

then don't allow non-APA accredited internships to count towards the hours required for licensure.

It may be more efficient for the APA to put programs on probation that have poor match rates (maybe less than 60%). You could give them a grace period to comply with the new requirements. APPIC should then change the requirements for participation in the match to programs that are APA Accredited and are in good standing. APPIC could easily do this. CAPIC only allows students from specific california schools to participate in their match process.

 

[Pragma]

The answer isnt the state legislature-- its getting some officiating body (APPIC, APA, etc) to actually do something.

Sure, it was a response to the post about licensure (which is governed by state laws).

 

[Pragma]

APPIC should then change the requirements for participation in the match to programs that are APA Accredited and are in good standing. APPIC could easily do this.

Would love to see it, but not sure what their incentive is.

 

[PHD12]

Would love to see it, but not sure what their incentive is.

They do have an ethical incentive. In 2006, APPIC members voted to only allow paid internships and postdoctoral fellowships to participate in the match from a purely ethical standpoint:

"APPIC understands the financial difficulties facing many programs across the country and is hesitant to lose quality member programs. However, we believe that the field benefits from raising the bar in this area. ....The payment of a stipend is a concrete acknowledgment that a trainee in the agency is valued and emphasizes that the primary task of the year is educational in nature."

 

[bmedclinic]

I just went and looked at their board-- everyone on there is at a prominent post. No one I saw stood out to me as representing one of "those" schools. I'd think every one of those people (and the majority of the members of APPIC for that matter-- both schools and internships) would be in favor of making all of these changes.

 

[PHD12]

Match day is around the corner. I'm sure the match rates will not get any better.

We should send a letter via email to the APPIC Board Members urging them to consider some changes that would help reduce the match imbalance. The letter last year was excellent and can include some recommendations for APPIC specifically. Their reputation is also at stake if they continue to contribute to this problem.

APPIC Board:

Chair
Arnold Abels, Ph.D. (2013)
UMKC Counseling Center
4825 Troost, Suite 206
Kansas City, MO 64110-2499
(816) 235-1635
[email protected]

Vice Chair & Chair Elect
Jason Williams, Psy.D. (2015)
The Children's Hospital
Denver, CO
(720) 777-6152
[email protected]