Unpaid externships and free labor

[cat22]

A NYTimes article last week on unpaid internships and the abuse of free labor (http://www.nytimes.com/2010/04/03/business/03intern.html) got my fellow doctoral classmates and I thinking about externships. I'm not sure how it works on other parts of the country, but almost all externships in NYC are unpaid. Students were beginning to spend so much time at their externships that the a new rule went into effect mandating that externship sites require no more than 16hours/2days from their externs in 2010-2011.

At one outpatient hospital externship (unpaid, of course), the program can not operate without externs. Externs outnumber full-time staff and the program practically shuts down for one month in the summer when there are no externs. The hospital bills over $200 for each weekly therapy session a patient has with an extern.

It also seems that the anxiety over securing a psychology internship has made conditions worse for students in externships. First, students feel they need their externship supervisor to write them a letter or rec for internship so the students avoid doing anything that could "jeopardize" a good letter (e.g. requesting less hours, speaking up when their caseloads are becoming unmanageable, etc). Second, students feel they need to "accumulate more hours" for internship and keep trying to fit more externships into their graduate training.

Student research obviously suffers when a student is largely consumed with clinical work. It just seems wrong that externships can become a way for clinics/programs to get free clinical labor to the point of giving externs the kind of caseload that is more appropriate for paid staff.

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[docma]

This is an important issue in the field. I'd like to add the perspective though that while your labor is uncompensated, it is not "free" for a training site and if it became a requirement that all students be paid many public health sites would simply have to stop training (therefore decreasing training options and services to the poor.) You are getting value if you are getting good-enough supervision and meeting programatic requirements to complete your program

If you actually add up the costs of supervision (when staff are not able to draw revenue), overhead (office space, utilities), training time provided by staff (also a revenue loss) and maybe insurance costs--and recognize that agencies and hospitals almost never get "paid" $200 even if Medicare/Medicaid is billed that amount, it is not quite as dire a deal as you suggest.

Many internship directors have an annual fight to keep training programs in place because it can be seen as a logical place to "save"money by discontinuing the staff-time costs, liability hazard and focus on a service (eg individual psychotherapy) that is becoming less and less of a priority in many settings as budgets get tighter.

Traditionally, practicum students were never paid. It is the rising cost of school that is driving some of this and it is equally important that that issue be addressed.

 

[IT514]

I'm usually a moderate when it comes to most issues, but for this one I am totally against being paid during externship. My main point comes down to the fact that there are always going to be strings attached to anything you get paid to do...which, in a clinical setting, could lead to the educational experience being compromised, not to mention reduced quality of patient care. This is the main reason why med students do not get paid while they are in med school and the same logic holds true for us. I would trade the 10 bucks an hour any day for the hours of great supervision I get in return. Getting paid during externship is totally unethical in my opinion. Its also true that some sites may be unethical in the way they treat their students, but that needs to be addressed by the DCTs at each program.

 

[cat22]

Yes, free was the wrong word to use given the costs of supervision, etc. I think the problem has been the escalation of clinical work expected to be done by the externs. It's become just another expectation of graduate training even though externs are now doing work that is comparable to paid staff. I've seen this at a few places in NYC so I'm curious about others experiences.

I think an important question is, can an externship site operate/function without externs? If not, that says a lot about the kinds of demands that are placed on externs and the resulting quality of training.

 

[justme08]

I think it says something about the funding for mental health programs in general. I'm only a lowly volunteer, yet I am allowed to do a lot. I know I'm included for census/supervision. I also know the facility keeps experiencing budget cuts.

 

[Ollie123]

I have mixed feelings. A decade or two ago my school used to have tons of paid clinical placements that could be taken instead of teaching/RA positions that would cover a full stipend and tuition expenses. These have dwindled in number over the years, in large part due to an Argosy opening and saturating the area with students, driving down prices.

I don't know that I would assume the training quality would be reduced - I think this is where the school comes in, something that certain schools are probably more responsible about than others. Paid or unpaid, students here aren't allowed to work for sites that don't provide adequate supervision, provide services that aren't strongly evidence-based, etc. There has been some tension created between certain sites when they were told they were being dropped for reasons like those you stated. I don't know that it would inherently lead to a decrease in quality, though it does allow the site to dictate more about what you will do...at the same time, the school should be tracking these things and not let students work there if it is a problem.

The downside to expecting pay is it may limit opportunities. It was only in recent years that we were even ALLOWED to work places that didn't pay us, but with the market saturation students were no longer able to find paid work in areas they wanted experience in. I'm planning on doing mostly unpaid placements because I have other sources of funding (i.e. I'm in a lab with tons and tons of grants).

I'm wondering how much of those problems are a function of NYC. I can't imagine anyplace here demanding a practica student work like that. If its volunteer, how could that be required? Are the sites that competitive to get into that people NEED to do it? At least here, pretty much anyplace I want to work its just a matter of asking. For example, I might work in the substance abuse program at the local VA next year. I know a few folks there, so getting that experience was just a matter of emailing someone and saying "Hey, can I do a practica here" and them saying "Sure, when do you want to start?". Assuming the school approves it, I'm good to go. I'm not sure if it is that easy in NYC, but if for some reason the VA starts acting ridiculous (they won't, but if they did...) I'd just leave and find someplace else.

I'm actually going to intentionally try not to get the paid clinical placements because I like the flexibility, which is why I find it odd that it sounds like students feel "stuck" in these abusive situations. At least here, since I'm doing work for free, I actually get a lot of control. I can dictate how many hours I work so I can spread things across multiple sites. I can say what experiences I want to get at that site...group, individual, assessment, etc.. If I don't feel I'm getting adequate supervision I can ask for more. If the experience isn't what I want, I can say "Screw you" and walk away whenever I want without any reprecussions (although my program might not be happy if I was that rude). I thought this was how it worked everywhere, but maybe not?

 

[erg923]

Ollie:
We have to apply and interview for external practicums here, and I assumed that the way it was everywhere, to some extent at least.

So I'm curious, has anyone ever argued that the huge downside here is that your schools process gives one litttle experience about what its like to be in the real world (where people actually have to interview for jobs) and provides no real experiences/training in writing cover letters/essays and the nuances of interviewing skills? By the time we exit our program, every single one of us is a seasoned interviewee. We have practiced and been given feedback for years by our mentors on writing good, succinct cover letters and the nuances of professional interviewing. I have been told that this really shows during the predoc interview process as well.

Frankly, I much preferred it this way, rather than just calling up a place and being handed it on a proverbial silver platter. That not that way things really operate and I am happy that i got solid training/exposure to the real working world while in grad school.

 

[Ollie123]

Absolutely yes, a number of us have made that argument including myself - particularly when it comes to internship interviews. We're trying to find ways to convince faculty to provide more training/guidance when it comes to interviewing, particularly for clinical settings. It is a pretty big downside, though I'm not certain that job interviews in those type of settings are seen as a critical skill for students possess...for the majority of us, internship is probably the last time we will ever be interviewed for a clinical position. We get all kinds of training in how to talk about our research, prepare for the academic job market, etc.. In part, I think the clinical side is de-emphasized because the program isn't designed for students who want to work in those settings, but at least for internship I think it would be helpful, as well as for the students who do decide to seek a primarily clinical career afterwards.

I was perhaps a bit misleading, there are SOME sites that interview and paid ones certainly do - I did just have one at another nearby VA where there were even essays I had to write, though the general consensus is that it is ridiculous to require essays on case conceptualization for a practica. I also have to wonder what the standards are because I absolutely crapped mine together at the last minute and still got an interview offer. I'm going to figure out which VA would be better for me based off what they offer, but I actually was interested in doing it just for the practice.

I can certainly see the merits to having a more formal application process (though I'm not sure it is the only way to adequately prepare students for applying for jobs in clinical settings), but at the same time I'm not sure it relates to the broader point of this thread that as a student if you are working for free you should get some control over what your experience is like. Even at the place I had to write the essays, I was able to ask for lower hours, tell them what I wanted to do there, etc., and if they are abusive/crazy I can just leave and find another place, even if I had to interview there too.

PS - I'm not convinced that knowing people and saying "Hey, can I come work for you" isn't how it works in the real world It certainly seems that it is how post-doc works based off what I've heard from recent graduates!

 

[psychmama]

I'm wondering how much of those problems are a function of NYC. I can't imagine anyplace here demanding a practica student work like that. If its volunteer, how could that be required? Are the sites that competitive to get into that people NEED to do it?

Incredibly, it IS that competitive at most externship sites in NYC. Sometimes these sites get as many as 15 applications for every extern slot they have. The hospitals and clinics often have a lot of leverage, and sometimes they take advantage of their externs, who are worried about not getting enough hrs, good recommendations, and "prime" externships before applying for internship. My program is in NJ, and I saw a major difference in terms of competitiveness between the practicum placements in NJ and those just 30 miles away in NYC.

 

[Wapote84]

Well, sometimes, you actually are paid in someway or another. For example, at my (future) institution the externships are actually paid, and that is what sets our stipends at $18,000 per year. So even though we aren't being paid hourly wages, my university is getting a financial incentive for us which is then reflected in our stipends. I think this is more the exception to the rule in most cases though.

 

[LM02]

I have mixed feelings. A decade or two ago my school used to have tons of paid clinical placements that could be taken instead of teaching/RA positions that would cover a full stipend and tuition expenses. These have dwindled in number over the years, in large part due to an Argosy opening and saturating the area with students, driving down prices.

This is really interesting, as something similar happened in my graduate program. But it wasn't a professional school, but rather a university-based PsyD program in a nearby city, that essentially saturated the area. I had a program director of a local site tell me that explicitly - the PsyD students were "cheaper," and therefore they no longer accepted students from the PhD program. It was disappointing, as it really limited the number of external placements that were available to us.

With that said, my strategy was really similar to what Ollie suggested. I found a few unpaid opportunities over the years, but was very clear about setting limits on my time. At one point, one site offered to hire me on an hourly basis, and I actually declined. It gave me more flexibility to pick and choose my hours, and to not worry about things like finding someone to cover for me if I couldn't go in. As a "free" extern, I was always a bonus person - and they had to deal with regular staffing independent of me. It was nice, but I also had an NRSA which gave me a nice stipend, benefits, no teaching responsibilities, and a lot of flexibility.