Thoughts on removing the predoctoral internship?

[NeuroObsessed]

I’ve seen some talk about removing the internship requirement for doctoral students. As someone who’s about to start their 1st year in a clinical psych program, I’m curious as to what people think about such a change. Are there any actual benefits for students completing pre-doctoral internships vs possibly combining it with their postdoc training?

I think the idea of combining the internship with postdoc seems to make a lot more sense for psych students. Psych students wouldn’t have to move for internship, split their attention 3 months in as they begin applying for postdocs, and then move again a year later for whatever postdoc they are accepted to. Patients and clients are then working with doctoral providers in training rather than a student who’s super close to getting their doctorates. Residency for med students is postdoctoral and for the students who choose to complete their residency, they become board eligible in their field. I think a similar model would do well in Psychology for those who wish to practice. Instead of a 1 year internship and 2 year postdoc in possibly two different locations to become eligible for licensure and board certification, we would just have a 3 year post doc in one location for the same end result. Similar to medical residents and dependent on the state, we could become eligible for licensure at some point throughout the 3 year postdoc or after completing the entire thing. With this, those who wish to pursue careers in research can avoid further moves and clinical training, and if they choose to, they can pursue postdoctoral experiences in research. I’m sure there is more to it than just changing the requirements and it is somewhat difficult to change the system, but it seems like such an obvious change that makes the road to becoming a psychologist a little easier.

---

Members don't see this ad.

 

[TrackCPD]

Is there a problem with internship? If not, why change it?

Personally, I learned a great deal on internship and I think the opportunity for a new experience postdoc would be lost if the expectation is someone stays at the same location for three years after a little practicum training.

I say keep it the way it is.

 

[LurkerNow]

California already does not require a predoc internship. One can accrue all 3000 of the clinically supervised hours required for licensure as a postdoc.

 

[NeuroObsessed]

Is there a problem with internship? If not, why change it?

Personally, I learned a great deal on internship and I think the opportunity for a new experience postdoc would be lost if the expectation is someone stays at the same location for three years after a little practicum training.

I say keep it the way it is.

I think a lot people just have an issue with how compacted it all is. We apply, start internship, shortly after begin applying for postdocs, then doing interviews, and then moving again for said postdoc.

 

[TrackCPD]

That’s a bit misleading. While the hours can be accrued postdoc, the vast majority of doctoral programs (all of the ones I’m aware of) require an internship for your degree. Without an internship, no doctoral degree, no postdoc.

Unless things have changed since I was in grad school.

 

[jdawg2017]

Is there a problem with internship? If not, why change it?

Personally, I learned a great deal on internship and I think the opportunity for a new experience postdoc would be lost if the expectation is someone stays at the same location for three years after a little practicum training.

I say keep it the way it is.

There are tons of problems with internship that frankly do not outweigh the benefits of a two year post-doc for general folks or a three-year post doc for specialists (e.g., Neuropsych). These have been outlined by Palitsky et al. (2022) and numerous others. Edit, forgot to include the link: https://psyarxiv.com/5y6eb/

I acknowledge that I learned a great deal from amazing internship supervisors and co-interns, but making two cross-country moves in two years to then move to post-doc is financially straining (understatement), but something I had to do personally. At the same time, this would not have been financially possible for me if I didn’t have a partner with a flexible and high-paying job and family support. I know many friends who either needed to take out massive credit card debt to make these moves and just live a basic life or intentionally limit internship sites to their local city because of the costs that will be imposed by moving (sometimes resulting in a non-match).

If physicians can do their residency after they get their degree (and thereby make more money on residency), why can’t and shouldn’t psychologists? We don’t need to martyr our trainees for the sake of being different or because this “is the way it’s always been.” When I talked to a family friend who is in their 80s and a neuropsychologist and explained Internship to her she was baffled by the concept of the middle ground of training that is internship (she’s been unplugged and in PP for many years, so not up to speed on the training world).

 

[jdawg2017]

That’s a bit misleading. While the hours can be accrued postdoc, the vast majority of doctoral programs (all of the ones I’m aware of) require an internship for your degree. Without an internship, no doctoral degree, no postdoc.

Unless things have changed since I was in grad school.

To acknowledge this point, this would require a system-wide change led at the APA level.

 

[NeuroObsessed]

California already does not require a predoc internship. One can accrue all 3000 of the clinically supervised hours required for licensure as a postdoc.

That is true, however APA accreditation requires programs require a predoctoral internship prior to granting their doctoral degree.

 

[NeuroObsessed]

To acknowledge this point, this would require a system-wide change led at the APA level.

Exactly, I’m sure it’s a little more complicated then we know for the APA to enact such a change, but I think the burden it removes from students would be well worth it.

 

[NeuroObsessed]

If physicians can do their residency after they get their degree (and thereby make more money on residency), why can’t and shouldn’t psychologists?

Yeah, I think having the degree would at least be somewhat of a talking point when figuring out the salaries for postdoctoral training even without having the predoctoral internship.

 

[TrackCPD]

There are tons of problems with internship that frankly do not outweigh the benefits of a two year post-doc for general folks or a three-year post doc for specialists (e.g., Neuropsych). These have been outlined by Palitsky et al. (2022) and numerous others. Edit, forgot to include the link: https://psyarxiv.com/5y6eb/

I acknowledge that I learned a great deal from amazing internship supervisors and co-interns, but making two cross-country moves in two years to then move to post-doc is financially straining (understatement), but something I had to do personally. At the same time, this would not have been financially possible for me if I didn’t have a partner with a flexible and high-paying job and family support. I know many friends who either needed to take out massive credit card debt to make these moves and just live a basic life or intentionally limit internship sites to their local city because of the costs that will be imposed by moving (sometimes resulting in a non-match).

If physicians can do their residency after they get their degree (and thereby make more money on residency), why can’t and shouldn’t psychologists? We don’t need to martyr our trainees for the sake of being different or because this “is the way it’s always been.” When I talked to a family friend who is in their 80s and a neuropsychologist and explained Internship to her she was baffled by the concept of the middle ground of training that is internship (she’s been unplugged and in PP for many years, so not up to speed on the training world).

Trust me, I interned as the sole income for my household with two children. I can relate to the financial and personal burden internship and postdoc can have.

But part of grad school and becoming a professional is about making personal sacrifices to attain that higher level of training. I’m more concerned about the possibility of having poorly trained clinicians simply because we want to avoid adverse financial impact.

That being said, if studies can be done showing the efficacy of restructuring internship in such a way to enable adequate training while simultaneously easing financial and personal burden on the trainee, I’d be all for it. I haven’t seen any such studies and am unaware of any proposed proven solutions. It’s one thing to complain about something but another thing entirely to propose proven alternative solutions.

 

[jdawg2017]

Trust me, I interned as the sole income for my household with two children. I can relate to the financial and personal burden internship and postdoc can have.

But part of grad school and becoming a professional is about making personal sacrifices to attain that higher level of training. I’m more concerned about the possibility of having poorly trained clinicians simply because we want to avoid adverse financial impact.

That being said, if studies can be done showing the efficacy of restructuring internship in such a way to enable adequate training while simultaneously easing financial and personal burden on the trainee, I’d be all for it. I haven’t seen any such studies and am unaware of any proposed proven solutions. It’s one thing to complain about something but another thing entirely to propose proven alternative solutions.

I totally agree that more data would be helpful on this the matter. I think, however, it’s impossible to obtain without shifting the training model and then seeing how it’s going. We already know that internship poses a huge financial barrier to training. Forcing people to “choose” to defray income or significant life milestones while adding up 1-2 moves in 1 year is not conducive to diversifying our field in terms of SES.

I disagree that internship is integral to fully trained clinicians if we move to a 2-year minimum post-doc. Residency in medicine serves the same gate-keeping function in practically, provided that we continue to keep the term “clinical, school, counseling psychologist” protected and contingent on completing the post-doc. I do see concern, in theory, with people getting the PhD, bailing out, and “practicing” outside of their scope without doing the fellowship.

I’m not sure why the medical residency
model can’t be a “proven solution.” There’s no reason to really reinvent the wheel when we already have a clear model that functions well.

 

[NeuroObsessed]

Trust me, I interned as the sole income for my household with two children. I can relate to the financial and personal burden internship and postdoc can have.

But part of grad school and becoming a professional is about making personal sacrifices to attain that higher level of training. I’m more concerned about the possibility of having poorly trained clinicians simply because we want to avoid adverse financial impact.

That being said, if studies can be done showing the efficacy of restructuring internship in such a way to enable adequate training while simultaneously easing financial and personal burden on the trainee, I’d be all for it. I haven’t seen any such studies and am unaware of any proposed proven solutions. It’s one thing to complain about something but another thing entirely to propose proven alternative solutions.

Medicine has been doing a postdoctoral training model. Obviously psychologists aren’t the same as physicians, but I believe right now psychology is the only healthcare profession that requires a year long full-time internship. Medicine, Dentistry, Podiatry, Optometry, etc. all have their full-time training available via postdoc.

I feel like it would be the same if an intern stayed at the same site for postdoc without adding on another application process. I know you said you gained valuable experience at your internship and that we would be losing the experience that comes with going to a new site for postdoc, but in the grand scheme of things I’m not sure how moving between two sites can be more beneficial than staying at just the one.

 

[NeuroObsessed]

I do see concern, in theory, with people getting the PhD, bailing out, and “practicing” outside of their scope without doing the fellowship.

In this case, such a situation could be applied to how things are setup now. In some states, California is the only one I know of offhand, you still need postdoctoral hours for licensure, so what would stop them from completing their internship, receiving their PhD/PsyD, and practicing outside of their scope without completing the required postdoctoral hours for licensure? In either route, there’s a point where we have degrees but lack the necessary postdoctoral training, which then leads to the situation you presented.

 

[AcronymAllergy]

Medicine has been doing a postdoctoral training model. Obviously psychologists aren’t the same as physicians, but I believe right now psychology is the only healthcare profession that requires a year long full-time internship. Medicine, Dentistry, Podiatry, Optometry, etc. all have their full-time training available via postdoc.

I feel like it would be the same if an intern stayed at the same site for postdoc without adding on another application process. I know you said you gained valuable experience at your internship and that we would be losing the experience that comes with going to a new site for postdoc, but in the grand scheme of things I’m not sure how moving between two sites can be more beneficial than staying at just the one.

Training at different sites allows you to potentially work in different settings, with different supervisors, and in different capacities. You also get to see how the same types of patients are assessed and managed at different clinics/hospitals. The sticking point is whether those additional experiences offset the costs.

 

[AcronymAllergy]

In this case, such a situation could be applied to how things are setup now. In some states, California is the only one I know of offhand, you still need postdoctoral hours for licensure, so what would stop them from completing their internship, receiving their PhD/PsyD, and practicing outside of their scope without completing the required postdoctoral hours for licensure? In either route, there’s a point where we have degrees but lack the necessary postdoctoral training, which then leads to the situation you presented.

I suppose the biggest difference is that they wouldn't have a degree in one situation whereas they would, even if unlicensed, in the other.

As for scope of practice more broadly, there's generally nothing other than the provider's judgment stopping someone from practicing within vs. outside their competence, at least in most states, and until a board complaint is made.

 

[futureapppsy2]

There was talk of this during the height of the internship imbalance, but it was turned down, IIRC, in large part because it would be difficult to find a way to replicate the depth of clinical experiences received on internship in a practicum-like setting. Personally, I've been a fan of coupling internship and post-doc (e.g., when you match to site for internship you can also choose to non-competitively stay there as a post-doc) simply because the current system basically makes people start applying for post-docs as soon as they start internship anyway. Now that the imbalance has subsided, I've stopped seeing much discussion around changing internship.

 

[AcronymAllergy]

I think one of the biggest challenges is that doing away with the pre-doctoral requirement and pushing it to postdoc essentially requires changing laws in pretty much every state, and doing so in a direction opposite to what the recent trend has been of doing away with postdoctoral requirements.

Just in my opinion, given how onerous that would be and as the field has finite/limited resources (particularly legislatively), I think psychology has other things it needs to focus on at the moment.

One thing APA could do to ease the burden and that wouldn't require legislation would be encouraging, or even helping, more grad programs develop their own internship sites so students wouldn't have to move. While of course also maintaining at least the current level of quality standards.

 

[ClinicalABA]

Seems that getting rid of the post-doc requirement for licensure is a more common and less complicated (regardless of effects on training) change.

My biggest problem with the pre-doc model is that it makes your degree dependent to a large extent on ~1/5 of your training time being done at a by an agency that is outside the control of the degree granting institution. May not seem like to big a deal now, but back in the imbalance days, many otherwise qualified and on-track students had there degrees held hostage by a lack of resources outside of the university/college.

 

[PsyDr]

1) Convenience is a VERY BAD justification for this argument. Once you open the door, to say, "it's hard to XYZ, so we shouldn't do it", it's a downward slide towards online education. A face to face profession isn't amenable to online only education, and the in person setting weeds some people out. There is a reason that University of the Flaming Bird doesn't have an online medical school.

2) It is a VERY BAD idea to make ourselves different than medicine. The medical field controls how healthcare is run (e.g., how billing is done, how insurance works, how treatment should look like, how legal requirements are made, etc). Our profession tried to say that we are different, thanks to Carl Rogers. We said that we don't treat mental illness, we help people grow. Insurance said, "great, we only pay for treating illness. So you get zero dollars and zero cents.". It almost ended the profession.

 

[jdawg2017]

Agr

1) Convenience is a VERY BAD justification for this argument. Once you open the door, to say, "it's hard to XYZ, so we shouldn't do it", it's a downward slide towards online education. A face to face profession isn't amenable to online only education, and the in person setting weeds some people out. There is a reason that University of the Flaming Bird doesn't have an online medical school.

2) It is a VERY BAD idea to make ourselves different than medicine. The medical field controls how healthcare is run (e.g., how billing is done, how insurance works, how treatment should look like, how legal requirements are made, etc). Our profession tried to say that we are different, thanks to Carl Rogers. We said that we don't treat mental illness, we help people grow. Insurance said, "great, we only pay for treating illness. So you get zero dollars and zero cents.". It almost ended the profession.

Agree with #2 - we really shot ourselves in the foot on that one.

R.E. #1 - there is a different argument for internship being made. It’s not that internship is “inconvenient.” Internship is another major financial barrier on top of the difficulties that are already appropriately in place for doctoral training. I am not sure if I agree with the slippery slope that changing the model to mirror medical education will somehow result in online programs being acceptable. I’m not seeing an online physicians out there…

 

[Therapist4Chnge]

The only way it makes sense to change models is if that also came with changes to the reimbursement model. Med Interns and med residents can bill for their time and collect bc they are post-degree. They also have hospitals subsidized for their training. If psych could negotiate the same setup, then making a major change to post-doc years could make sense. Otherwise, we are hurting the field bc we already get short-changed, literally.

 

[Sanman]

No point in getting rid of predoctoral internship. I would argue that the thing most people want to get rid of is the national match for predoctoral training. If one were allowed to complete a generalized clinical internship at a home institution and participate in the match for specialized post-doctoral training, it would make the logistics simpler for some students. That said, I am not sure graduate programs want this responsibility and it would delay moving for those looking to leave the area of their doctoral training.

 

[PsyDr]

Agr

Agree with #2 - we really shot ourselves in the foot on that one.

R.E. #1 - there is a different argument for internship being made. It’s not that internship is “inconvenient.” Internship is another major financial barrier on top of the difficulties that are already appropriately in place for doctoral training. I am not sure if I agree with the slippery slope that changing the model to mirror medical education will somehow result in online programs being acceptable. I’m not seeing an online physicians out there…

Which things in clinical psychology education should we modify because it is a barrier, and to what degree?

SDN gets a regular influx of people who say they want to go to a top program, but they will not move, have a horrible GPA and can't tolerate completing a MA program to remediate that, can't stop working full time at any point in a program, etc. Should we change those barriers?

 

[Shiori]

I think it makes sense to examine the gatekeeping role of each barrier. For internship, does it make sense as a field that we ask people to move, sometimes across the country, for training? Is that "uprooting" a part of the experience of becoming a psychologist, or are we hoping that by uprooting they are gaining something else like cultural and regional awareness? If some people do not have that experience, do we feel like something is missing from their training? Is it foundational or a "nice to have?"

Is it less about training and more about keeping out poorer quality applicants? Is it just that we've put a lot of things together that make the journey difficult, and we don't want to take any away in fear that it'll open up the floodgates? What if some of the approaches we're using as gatekeeping tools are actually exacerbating the problem? We could easily be attracting monk-like scholars who can indefinitely delay gratification and we can be attracting people uninformed about the psychology process to the point that they will spent hundreds of thousands of dollars to become a psychologist. We might be scaring away the more practical-minded folks who want to make a comfortable living with a comparable level of effort to other, similar fields. I honestly have no idea.

I would love to see a training dismantling study, but that sounds like a beast of a project.

 

[Ollie123]

I don't necessarily know that we need a change. Removing it does not seem wise as I think doing full-time clinical work is an important step.

If we are going to make a change, I think it makes more sense to embed into the graduate program itself. Everyone is already there so it saves a move completely. Programs should have relationships with local practica sites that could be extended to full-time roles, the structural supports are already in place, etc. You don't get the degree until after anyways...it just makes more sense for this to be under the auspices of the graduate program. You finish school and then move where you want. My main hesitation is that I don't trust certain programs to do a good job on this front and am hesitant to give them even more power to potentially shuffle large numbers of unqualified providers out the door. Note that I'm not saying we "should" do this - just that I think this would be a more logical approach than merging it with post-doc.

Making post-doc part of internship doesn't do much to help folks on the academic side of things. Only a handful of internship sites will have appropriate research fellowship positions.

 

[jdawg2017]

Which things in clinical psychology education should we modify because it is a barrier, and to what degree?

SDN gets a regular influx of people who say they want to go to a top program, but they will not move, have a horrible GPA and can't tolerate completing a MA program to remediate that, can't stop working full time at any point in a program, etc. Should we change those barriers?

Again, this is a slippery slope argument. I do not think the issue of asking people to potentially move 1-2 times and sometimes make significantly less on internship than in their program (this was my case) is equivalent or will lead to the acceptability of online education or throwing the whole training model out the window.

The captive internship model is definitely interesting. I know of at least one program that does that and has mixed reviews in terms of the psychologists they produce.

 

[NeuroObsessed]

I feel like the only people that benefit from having a predoc internship are the schools that we are attending. More than likely, we are shipped out for internship, never touching campus for the year, and yet are still charged several grand for tuition. If we were to move the internship to after having our degree, combined with two years of postdoc as well, making it one long “residency,” I’m sure we wouldn’t be able to really say there would be a difference in practitioner preparation.

As for how far this “easing” of training would go, I’m not really sure that makes too much sense as people aren’t asking to remove an entire year of training. The idea would be just to consolidate it to one site for 3 years. Unless your stance is that we are missing out on life experiences with having to move, or somehow there would be a training difference, I haven’t seen much in terms of how doing so would harm practitioners training.

I guess the better questions would be, why do we feel, to be competent psychologists, we need a full year of training before receiving the degree vs doing that training after? Why do our peer physicians, dentists, etc. not feel the need to do a year-long internship prior to graduating? Forget easing up on financial barriers or anything like that, is there actual justification for us being the only healthcare field, that I know of, to do the predoc internship?

 

[Sanman]

I feel like the only people that benefit from having a predoc internship are the schools that we are attending. More than likely, we are shipped out for internship, never touching campus for the year, and yet are still charged several grand for tuition. If we were to move the internship to after having our degree, combined with two years of postdoc as well, making it one long “residency,” I’m sure we wouldn’t be able to really say there would be a difference in practitioner preparation.

As for how far this “easing” of training would go, I’m not really sure that makes too much sense as people aren’t asking to remove an entire year of training. The idea would be just to consolidate it to one site for 3 years. Unless your stance is that we are missing out on life experiences with having to move, or somehow there would be a training difference, I haven’t seen much in terms of how doing so would harm practitioners training.

I guess the better questions would be, why do we feel, to be competent psychologists, we need a full year of training before receiving the degree vs doing that training after? Why do our peer physicians, dentists, etc. not feel the need to do a year-long internship prior to graduating? Forget easing up on financial barriers or anything like that, is there actual justification for us being the only healthcare field, that I know of, to do the predoc internship?

This then assumes that every site that can field and internship would be able to field an equivalent number of post-doc spots. This is not necessarily the case.

Not really sure how any decent program benefits much from pre-doc internship. I think my program charged us around $800 in fees for the year? Hardly making them rich.

 

[WisNeuro]

I feel like the only people that benefit from having a predoc internship are the schools that we are attending. More than likely, we are shipped out for internship, never touching campus for the year, and yet are still charged several grand for tuition. If we were to move the internship to after having our degree, combined with two years of postdoc as well, making it one long “residency,” I’m sure we wouldn’t be able to really say there would be a difference in practitioner preparation.

As for how far this “easing” of training would go, I’m not really sure that makes too much sense as people aren’t asking to remove an entire year of training. The idea would be just to consolidate it to one site for 3 years. Unless your stance is that we are missing out on life experiences with having to move, or somehow there would be a training difference, I haven’t seen much in terms of how doing so would harm practitioners training.

I guess the better questions would be, why do we feel, to be competent psychologists, we need a full year of training before receiving the degree vs doing that training after? Why do our peer physicians, dentists, etc. not feel the need to do a year-long internship prior to graduating? Forget easing up on financial barriers or anything like that, is there actual justification for us being the only healthcare field, that I know of, to do the predoc internship?

Not my experience, nor any colleagues that I've heard of. We just had to pay the University's base level matriculation fee to technically stay enrolled. $150 if I remember correctly.

 

[jdawg2017]

Not my experience, nor any colleagues that I've heard of. We just had to pay the University's base level matriculation fee to technically stay enrolled. $150 if I remember correctly.

I think this is worse at for-profit schools and some programs that are behind the times. I’ve heard anywhere from 0-$4000 for the year. I was fortunate that my program was $0, but that was after a protest at our program a decade or so ago where the whole cohort didn’t pay the fees and basically played chicken with the registrar. The students won, thankfully.

 

[jdawg2017]

This then assumes that every site that can field and internship would be able to field an equivalent number of post-doc spots. This is not necessarily the case.

Not really sure how any decent program benefits much from pre-doc internship. I think my program charged us around $800 in fees for the year? Hardly making them rich.

The “sites not being able to support trainees for two years” argument is the most valid one I’ve heard, since moving the internship to year 1 of post-doc would essentially double current costs for salaries.

Maybe a mid-ground is the current UCSF model - a guaranteed post-doc at the site if you meet certain basic milestones the intern year and want to stay. Lots of sites have “pseudo-guaranteed” post-docs assuming the funding and recruitment cycles align correctly the year you are an intern. I actually used the percentage of retained folks at the site for post-doc as one of my criteria for selecting internship site ranks. Too bad I loved my site but absolutely hated the city haha.

 

[WisNeuro]

I think this is worse as for-profit schools and some programs that are behind the times. I’ve heard anywhere from 0-$4000 for the year. I was fortunate that my program was $0, but that was after a protest at our program a decade or so ago where the whole cohort didn’t pay the fees and basically played chicken with the registrar. The students won, thankfully.

I don't doubt it's worse at for-profit diploma mills. But that's likely a drop in the bucket compared to the tuition money those students were already scammed out of. I think the takeaway is that programs and universities did not create the internship system as a cash grab. There are legitimate criticisms of the system, but that is hardly one of them.

 

[PsyDr]

Again, this is a slippery slope argument. I do not think the issue of asking people to potentially move 1-2 times and sometimes make significantly less on internship than in their program (this was my case) is equivalent or will lead to the acceptability of online education or throwing the whole training model out the window.

The captive internship model is definitely interesting. I know of at least one program that does that and has mixed reviews in terms of the psychologists they produce.

It's not a slippery slope fallacy, at all. Again, I am not arguing against the idea. I am arguing against the justification for the idea.

The proposition is "X should change because of Y". In this case X= internship, Y=hardship.

If one accepts that "hardship" is a good reason to change things, then it is reasonable to establish the boundaries of the application. What should change because of hardship?

 

[AcronymAllergy]

I feel like the only people that benefit from having a predoc internship are the schools that we are attending. More than likely, we are shipped out for internship, never touching campus for the year, and yet are still charged several grand for tuition. If we were to move the internship to after having our degree, combined with two years of postdoc as well, making it one long “residency,” I’m sure we wouldn’t be able to really say there would be a difference in practitioner preparation.

As for how far this “easing” of training would go, I’m not really sure that makes too much sense as people aren’t asking to remove an entire year of training. The idea would be just to consolidate it to one site for 3 years. Unless your stance is that we are missing out on life experiences with having to move, or somehow there would be a training difference, I haven’t seen much in terms of how doing so would harm practitioners training.

I guess the better questions would be, why do we feel, to be competent psychologists, we need a full year of training before receiving the degree vs doing that training after? Why do our peer physicians, dentists, etc. not feel the need to do a year-long internship prior to graduating? Forget easing up on financial barriers or anything like that, is there actual justification for us being the only healthcare field, that I know of, to do the predoc internship?

With the current setup of training programs, it's rarely the case that folks make it through training with no clinical experience. But I've definitely seen folks who, even in more balanced programs, made it through with a pretty limited breadth and depth of clinical experience. IMO, I don't know that I would've said it's sufficient to grant a degree. I suppose it depends on what we envision as being required before granting the degree.

Physicians do clerkships during their last two years in medical school. I could be wrong, but I believe the students may be training for 60-80 hours/week during those years. So they get a decent amount of exposure prior to earning their degree.

 

[WisNeuro]

With the current setup of training programs, it's rarely the case that folks make it through training with no clinical experience. But I've definitely seen folks who, even in more balanced programs, made it through with a pretty limited breadth and depth of clinical experience. IMO, I don't know that I would've said it's sufficient to grant a degree. I suppose it depends on what we envision as being required before granting the degree.

Physicians do clerkships during their last two years in medical school. I could be wrong, but I believe the students may be training for 60-80 hours/week during those years. So they get a decent amount of exposure prior to earning their degree.

This was pretty much the case for my spouse.

 

[Sanman]

It's not a slippery slope fallacy, at all. Again, I am not arguing against the idea. I am arguing against the justification for the idea.

The proposition is "X should change because of Y". In this case X= internship, Y=hardship.

If one accepts that "hardship" is a good reason to change things, then it is reasonable to establish the boundaries of the application. What should change because of hardship?

jdawg2017 said:
Again, this is a slippery slope argument. I do not think the issue of asking people to potentially move 1-2 times and sometimes make significantly less on internship than in their program (this was my case) is equivalent or will lead to the acceptability of online education or throwing the whole training model out the window.

The captive internship model is definitely interesting. I know of at least one program that does that and has mixed reviews in terms of the psychologists they produce.

I think the bigger question is what is the motivation to change things? To make things easier for students? Because enough people are not applying to be psychologists? Don't think so.

 

[NeuroObsessed]

I think this is worse at for-profit schools and some programs that are behind the times. I’ve heard anywhere from 0-$4000 for the year. I was fortunate that my program was $0, but that was after a protest at our program a decade or so ago where the whole cohort didn’t pay the fees and basically played chicken with the registrar. The students won, thankfully.

That’s great for your cohort! Maybe my own cohort can take notes for the future. Even for more credible programs like PGSP-Stanford, their internship is almost $5k.

 

[clausewitz2]

With the current setup of training programs, it's rarely the case that folks make it through training with no clinical experience. But I've definitely seen folks who, even in more balanced programs, made it through with a pretty limited breadth and depth of clinical experience. IMO, I don't know that I would've said it's sufficient to grant a degree. I suppose it depends on what we envision as being required before granting the degree.

Physicians do clerkships during their last two years in medical school. I could be wrong, but I believe the students may be training for 60-80 hours/week during those years. So they get a decent amount of exposure prior to earning their degree.

Depends on which specialty they are rotating with but yes generally the idea is for medical students to be keeping close to resident hours, often including on-site call or working weekends for appropriate services. Wildly variable from service to service, sometimes; my neurosurg rotation had me at morning sign-out at 5:30 AM and leaving around 4-5 PM, while the very next rotation in ophtho was a much more civilized 8-3. But then, what do you expect from eye dentists?

Most medical schools also now arrange for some kind of longitudinal shadowing experience at the very least starting from first year of medical school, but it is a far cry from shadowing to being an (even very junior and relatively unimportant) member of the team.

 

[jdawg2017]

Depends on which specialty they are rotating with but yes generally the idea is for medical students to be keeping close to resident hours, often including on-site call or working weekends for appropriate services. Wildly variable from service to service, sometimes; my neurosurg rotation had me at morning sign-out at 5:30 AM and leaving around 4-5 PM, while the very next rotation in ophtho was a much more civilized 8-3. But then, what do you expect from eye dentists?

Most medical schools also now arrange for some kind of longitudinal shadowing experience at the very least starting from first year of medical school, but it is a far cry from shadowing to being an (even very junior and relatively unimportant) member of the team.

Is this daily for the clerkship, or how many days per week? I am curious how much (or not) this mirrors practicum experiences in clinical psychology.

 

[clausewitz2]

Is this daily for the clerkship, or how many days per week? I am curious how much (or not) this mirrors practicum experiences in clinical psychology.

Certainly 5 days per week at least with all of them; lighter outpatient sometimes got weekends off consistent, heavier inpatient generally had one day off per week or the occasional 12 days straight.

EDIT: Later in the year during residency interview season we might get released for a day (or two, if far away) at a time to go attend interviews (back pre-pandemic, so all interviews still in person). Merciful services wouldn't count this against the amount of time we were allowed to take off during the clerkship but I heard plenty of horror stories of students being made to use up their allowable time off for just that purpose.

Most med schools also seem to allow you to set up a largely nonsense elective month with very low expectations at some point in 4th year to facilitate interviewing, but I had interviews running from late September into December so a month wasn't going to cut it.

 

[WisNeuro]

Certainly 5 days per week at least with all of them; lighter outpatient sometimes got weekends off consistent, heavier inpatient generally had one day off per week or the occasional 12 days straight.

EDIT: Later in the year during residency interview season we might get released for a day (or two, if far away) at a time to go attend interviews (back pre-pandemic, so all interviews still in person). Merciful services wouldn't count this against the amount of time we were allowed to take off during the clerkship but I heard plenty of horror stories of students being made to use up their allowable time off for just that purpose.

Consistent with my spouse's training as well. How we met during this period and eventually married is beyond me

In general, physicians are getting far more contact hours of very wide varieties of clinical work than psychologists. Big difference being that psychologists are probably getting more focused clinical contact, and (at least in the non-diploma mills) spending a good deal of time conducting research (thesis, dissertation) as well as teaching (unless you are grant funded). So, hours-wise, there may be some overlap in time spent, just depends on the focus of that time.

 

[cara susanna]

Seems that getting rid of the post-doc requirement for licensure is a more common and less complicated (regardless of effects on training) change.

My biggest problem with the pre-doc model is that it makes your degree dependent to a large extent on ~1/5 of your training time being done at a by an agency that is outside the control of the degree granting institution. May not seem like to big a deal now, but back in the imbalance days, many otherwise qualified and on-track students had there degrees held hostage by a lack of resources outside of the university/college.

Yup, and internship became increasingly something where, instead of being a generalist training experience, you are now expected to have specialized experience in that specific area to even be competitive for said internship. Like, your program doesn't have a VA nearby? Good luck getting a VA internship.

Moving cross-country for a year to even get your degree, especially when you're still finishing up an important research project (your dissertation)_, is ridiculous. I don't know of a better solution but there HAS to be one.

 

[futureapppsy2]

The only way it makes sense to change models is if that also came with changes to the reimbursement model. Med Interns and med residents can bill for their time and collect bc they are post-degree. They also have hospitals subsidized for their training. If psych could negotiate the same setup, then making a major change to post-doc years could make sense. Otherwise, we are hurting the field bc we already get short-changed, literally.

Actually, BCBS now allows mental health providers to bill for their supervisees' work.

 

[WisNeuro]

Actually, BCBS now allows mental health providers to bill for their supervisees' work.

Nationally, or regionally?

 

[futureapppsy2]

Nationally, or regionally?

This was shared on a national listserv--don't know if it extends to other states:

Provider News

 

[WisNeuro]

This was shared on a national listserv--don't know if it extends to other states:

Provider News

I'll keep an eye out, but this hasn't passed our legislative staff yet and we usually get stuff pretty quickly.

 

[MAClinician]

I'll keep an eye out, but this hasn't passed our legislative staff yet and we usually get stuff pretty quickly.

This is also allowed by BCBS in MA, and a few other commercial insurance providers allow “incident to” billing here (and I think RI but not 100% positive).

 

[WisNeuro]

This is also allowed by BCBS in MA, and a few other commercial insurance providers allow “incident to” billing here (and I think RI but not 100% positive).

If it's becoming more widespread, good. Until Medicare makes the change, doesn't help a lot of neuropsychology practices just yet.

 

[bcliff]

Yup, and internship became increasingly something where, instead of being a generalist training experience, you are now expected to have specialized experience in that specific area to even be competitive for said internship. Like, your program doesn't have a VA nearby? Good luck getting a VA internship.

I've found the hype around getting a VA internship without prior VA experience to be a little overblown - Maybe it holds true for more generalist applicants? I think for neuropsychology, at least, a strong foundation in the specialty is way more important of a factor than whether that training was or was not completed at a VA.

Moving cross-country for a year to even get your degree, especially when you're still finishing up an important research project (your dissertation)_, is ridiculous. I don't know of a better solution but there HAS to be one.

I encourage trainees to strongly consider local sites when applying to internship for this reason - I work in an area with several well respected AMCs, VAs, and large hospital systems with a mix of solid generalist and specialist training programs (that's also not particularly desirable geographically), so this is likely more feasible to recommend than in LA, NYC, or Chicago. Still, though, I find peers / colleagues of mine routinely encouraging trainees to (somewhat condescendingly) "see the world!" on internship, which always strikes me as not helpful and disingenuous; e.g., it implies that doing internship locally is somehow "less than" doing it out of state. I counter that it is less... less expensive and less stressful. It also implies that most people didn't already move for their doctoral training.

RE: The original post, the Yale Child Study "requires" (allows? not sure how enforceable of a requirement this would be) interns to complete fellowship training there, too - I believe the training program is designed as a 2y curriculum (i.e., "all interns remain with the Psychology Training program for a second year to complete their Postdoctoral Fellowship and, therefore, do not need to apply for a postdoc during their internship year.") - There's at least one other site I can think of that previously advertised themselves as offering something similar (e.g., we consider our interns for fellowship before considering external applicants), but I just checked their internship site and couldn't find this language.

I would like to see more training programs offering this model; e.g., moving for a 2-3y position is more palatable (to me) than moving first for a 1y position followed immediately by moving *again* for another 1-to-2y position. It also wasn't clear to me, as a trainee, how normal it is for relocation assistance, etc., to be on the table when negotiating a faculty position, so staying local for training *and then* moving makes good sense. FWIW, I don't know of any APPCN fellowships that advertise this, so I wonder if there are any rules / regulations specific to that organization (and/or others involved in fellowship training) that prevent sites from prioritizing internal applicants over external ones. I also wonder if sites have gotten burned by this before and are hesitant to commit themselves to this model.