1) Importance of "reputations" of internship sites in postdoc/future career? 2) The ratio of private practice income to Cost of Living in a city?

[studentdoctorsnetwork123]

1) "Reputation" of internship sites on postdoc/future career?

Love to hear folks' thoughts on how the "reputation" of internship sites might impact one's post-doc / future career opportunities. For example, Boston VA, Palo Alto VA, Houston VA, Seattle VA -- They seem to carry some weight. For folks who work in the VA, how do you perceive the reputation of sites when you receive applicants?

2) The ratio of private practice on income : Cost of Living in city

Love to hear from folks who have been some experiences with private practice in the big cities or observed some: Do you think the ratio of (Income : the cost of living) is greater in places like SF than in non-SF areas like Seattle/Boston? Is it worth being in the super expensive city in terms of how much we can make in private practice? Or does the high CoL of these major cities win out the income..? 🙁 Some examples would be very helpful to have a tangible reference point.

Thank you all.

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[cara susanna]

As someone who applied to "big name" VA research sites for both internship and post doc, post doc was less competitive than internship overall. I'm sure it helps to come from a bigger name internship, but I doubt it makes a huge difference. My internship wasn't amazing but I got a post doc at a very reputable VA.

 

[Pragma]

I can’t recall being asked about my internship after postdoc interviews.

 

[deleted1129370]

I went to a least known VA for internship in Ohio, secured my first job as a staff psychologist with the Columbus VA right out of internship, spent a year there. At the same time I had my own LLC private practice I did on the side doing clinical and forensic work. Then moved to Houston where I've been at the VA and serve as an assistant professor at an AMC. I went to a sub-par PsyD program with most of my background leading up through internship being in neuropsychology. I did not complete a post-doc, and I currently work in the SUD department.

As far as private practice, I have been scaling/growing my new LLC here in Houston and so far, business is looking good. Much more demand for what I offer. I typically provide therapy for chronic pain, insomnia, trauma, addiction/SUD, depression, burnout, and anxiety. My assessments for now focus on typical diagnostic clarification, ADHD, academic/professional accommodations, and on the forensic side I do IME, workers' comp., disability, and law enforcement/public safety evals. I am looking to expand into pre-surgical and competency evals in the near future. The moment I started to actively market (about 2 weeks ago), I started getting 2-3 referrals for testing, so I am hopeful.

I should also add that I had interviews with top-notch VAs and AMCs for both post-doc (in neuro and rehab psych) and some GS-11 spots.

 

[Therapist4Chnge]

I matched to a solid but not elite VA Consortium. I ranked based on fit which bumped down the “big name” places that largely overworked their interns. My Uni mentor knew my (eventual) internship mentor, and I trusted his judgment for ranking sites. They both opened some doors for me for fellowship.

Program name/reputation mattered very little once I started fellowship. My first faculty job only really cared about fit bc I already checked the other boxes by publishing, presenting, fellowship, & having the right LORs. Some AMCs and VAs tend to draw from the same pools bc they know they can trust the training, others will look widely.

Internship only mattered bc of my internship mentor. Neuropsych loves to look at lineage of training. Coming from a VA internship def helped when interviewing for VA staff positions bc I knew what to ask about, but plenty of VA staff didn’t train in the VA before working in one. VAs can also vary quite a bit bc of leadership and location.

Having a brand-name fellowship was very helpful for me bc I came from a meh Uni-based PsyD program. I think it’ll vary by person bc at this point you should be known by some in your niche area already from conferences, internship interviews, etc.

No idea about your 2nd question other than to say for the very high COL areas, I’d prob suggest going PP if you already have a solid CV. It’ll be easier to earn more to afford the high COL unless you are a baller researcher w great funding who makes bank.

 

[summerbabe]

For folks who work in the VA, how do you perceive the reputation of sites when you receive applicants?

My 2 cents based on my particular set of VA experiences.

Right now, staff jobs seem quite plentiful with departures and increased veteran demand for mental health appointments greatly outpacing new hires at many facilities around the country. So getting your foot in the door is likely much easier today than pre-pandemic and way easier than many years ago, when VA careers were more desirable.

So if you're looking for a standard clinical job, it probably doesn't matter too much. For facilities with openings who are eager/desperate to hire (and then overburden those clinicians immediately), a warm body that can pass a background check is good enough so having some VA experience/training is a cherry on top. For facilities experiencing minimal turnover and steady mental health service demands that don't require new positions to be created, there will be limited opportunities for any employment. There's a sweet spot of well-run facilities who can choose to be picky and have some openings, where your background would be more relevant. I would put my current facility in this category but we rely a lot on word of mouth recommendations and poach providers from other VAs for our remote positions.

For jobs with research centers like MIRECC or COEs, academic lineage and research output likely matters a lot more (but I don't have firsthand exposure).

When it comes to advancement and leadership opportunities, who you know and how much they like you and if they would enthusiastically recommend or hire you for future positions is probably more important than where you've been. Some of the people that I know who advanced quickly through VA don't necessarily have the most 'impressive' backgrounds on paper but they impressed the right people at the right times (and happily drink the VA kool-aid). And many of them also sought out professional development opportunities like mentoring via AVAPL and involvement that gets their name out there in positive ways.

As for internship, I think prioritizing fit rather than prestige might be the way to go. Some people go into internship/postdoc thinking they will work in VA forever but have negative experiences and then leave the system (and that's probably the right call for many). I never had intentions of a VA career but really enjoyed my internship and postdoc so staying on when I had the chance made a lot of sense and I don't regret that choice.

 

[cara susanna]

Good point: if you don't mind being on site, VA psychologist jobs are plentiful right now.

 

[ClinicalABA]

When looking to hire psychologists (into a private, toddler-assessment-focused group practice currently, but other clinical positions in the past), where you did your internship is not a huge consideration UNLESS you did one of the few that directly prepare you for the type of work we do. We certainly don't expect- or even anticipate applicants from these sites, but bonus if you are! Realistically, primary concern in that you are licensed/license eligible (quickly!) and with some history of clinical work with children. Secondary is that you did not attend one of the hereabouts oft-mentioned "graduate training programs of questionable quality." The highly variable quality of graduates of these programs is just not worth the risk (particularly with early career applicants who don't have successful clinical experience to "counter" the name on their "diploma").

TL/DR- In regards to landing clinical positions in the future, big name internships might help in certain places, but decent-sounding APA approved internships elsewhere are not likely to hurt.

 

[AcronymAllergy]

I'll add to the chorus that by and large, the reputation of your internship site doesn't matter much beyond postdoc. If it affects things later, it'll usually be based on the connections you formed with people while on internship rather than the name of the site itself. Although every now and then, you might meet another provider who trained at the same facility, which can help with networking.

This is all assuming the internship is APA-accredited. If it's non-accredited, it's more of a crapshoot--many places will care, some will not.