Could the internship shortage help the profession?

[edieb]

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I was wondering what all of you think about the internship shortage and its eventual impact on the profession, especially in regards to professional schools that are pumping out phds and psyds.

A friend and I were talking about APPIC and how phoney they are. Greg Keilin, one of the heads of APPIC, talks about how concerned he is about the shortage; however, he had to see this coming. I wonder why he did nothing about it: could it be that APPIC makes money on every person who registers for the match, whether he/she matches or not? In any other profession, those responsible for this debacle would be fired but in psychology they are likely to get a promotion, lol

 

[Therapist4Chnge]

The increased number of applicants, combined with the limited number of APA-accredited internships, is forcing grad students to take APPIC and non-APPIC sites (state-acred, no acred). As an aside, there are some great APPIC-accredited sites, but lack of APA-accreditation seems to bite the student later.

I think the overflow of students will eventually create a 2-tier system....those with APA-accredited internship training, and those without. The VA is the most well known place that limits applicants, but in reality most medical centers do, as well as other competitive positions.

 

[ClinicalTrainee]

*Of course* the people at APPIC know about the internship imbalance! It's not new news, and a LOT of people are concerned about this, APPIC included. From what I've been told, CUDCP (Council of University Directors of Clinical Psychology) devoted it's meeting last year to discussing the internship imbalance, and the other training councils (NSCPP, APPIC, etc.) are discussing it as well. There are MANY articles about this issue that have been published lately (example: see special issue of Training and Edcuation in Professional Psychology in 2007). Check some of them out if you want more information.

Greg Keilin, Karen Taylor, and all the other people at APPIC, cannot individually DO anything about it. The entire field has been brainstorming solutions and has yet to come up with anything feasible. Add more internship sites? Sure, nice idea, but (lack of) funding often gets in the way. Plus, as T4C points out, some students are restricted to APA or APPIC accredited programs. Help more sites get APA-accredited? They're working on that.

Other solutions proposed involve limiting who can enter the match (but based on what: size of incoming graduate class? readiness for internship?) or who can enter doctoral programs in the first place. But who decides these things? Who is responsible for enforcing them?

This is a HUGE issue for psychology and one that is being worked on feverishly, but it's also not one that is going to be addressed overnight. APPIC isn't out to con graduate students out of money.

 

[edieb]

I disagree -- at the very least, APPIC turned a blind eye to this shortage while it was in the process of happening. APPIC is a business and businesses are out there to make profits. Why would they do anything other than pass resolutions that make them look like they are trying to address the problem.

I am wondering what percentage of applicants are expected to not obtain internships this year.

 

[Therapist4Chnge]

*Of course* the people at APPIC know about the internship imbalance! It's not new news, and a LOT of people are concerned about this, APPIC included.

The issue I have is that it has been a known issue for the better part of a decade, and psychology as a profession (APA, APPIC, and its membership) has done nothing but accredit more programs and fail to address the scores of students who continue to not match.

I still go back to my proposal to only allow programs to accept as many students as it can place into accredited internship spots (averaged over 3-5 years). Make this a requirement for accreditation, and any program that does not comply gets their accreditation pulled. I think programs would do what is needed to meet this requirement, as they'd risk faculty and student unrest if their accreditation disappeared in the middle of a student's training.

 

[positivepsych]

I still go back to my proposal to only allow programs to accept as many students as it can place into accredited internship spots (averaged over 3-5 years). Make this a requirement for accreditation, and any program that does not comply gets their accreditation pulled. I think programs would do what is needed to meet this requirement, as they'd risk faculty and student unrest if their accreditation disappeared in the middle of a student's training.

I second this. The problem is not internship sites, we don't need more, because we don't need more psychologists. We need to curtail the number of students applying to internship in the first place from professional schools. Most of them are even discouraged from applying to APA internships since their chances are low, and most only want to go into private practice anyway.

Quite frankly, I'm glad many employers only take people who went to APA-approved internships. It helps keep the riff-raff of our field out, though I don't think they should have gone to grad school in the first place. I meet people from Psy.D. programs who had below a 2.5GPA from college a long time ago, and argue that they weren't focused back then, and it's irrelevant for being a grad student. I'm sorry, but that would preclude you from medical school, unless you got a 4.0 in a master's program and proved you were up to snuff. I hate to be elitist here, but we shouldn't lower our standards, just because someone is willing to pay $200K for grad school.

 

[erg923]

Thats what i cant stand when reading articles on the internship crisis in grad psych and APA monitor. Its alwasys framed as "shortage of sites"....well hasnt anyone looked at the problem differentlly and said well maybe its "surplus numbers of applicants".....

Never once a mention of that in the APA publications, always "as increasing numbers of grad students enter match"......but thats a far as it goes. Isnt anyone over there curious about the "increasing number of grad students" issue"?

 

[Neuropsych2be]

I second this. The problem is not internship sites, we don't need more, because we don't need more psychologists. We need to curtail the number of students applying to internship in the first place from professional schools. Most of them are even discouraged from applying to APA internships since their chances are low, and most only want to go into private practice anyway.

Quite frankly, I'm glad many employers only take people who went to APA-approved internships. It helps keep the riff-raff of our field out, though I don't think they should have gone to grad school in the first place. I meet people from Psy.D. programs who had below a 2.5GPA from college a long time ago, and argue that they weren't focused back then, and it's irrelevant for being a grad student. I'm sorry, but that would preclude you from medical school, unless you got a 4.0 in a master's program and proved you were up to snuff. I hate to be elitist here, but we shouldn't lower our standards, just because someone is willing to pay $200K for grad school.

There are some problems with this. The APA can not simply pull accreditation that easily. The APA functions under the authority of the Department of Education and its decisions can be reviewed and overturned by the DOE. Furthermore, as an accrediting agency opertaing under federal jurisdiction, its actions may be reviewed by the court system. Removing accreditation from programs is a process fraught with legal requirements and difficulties. Removing accreditation due to factors like the internship shortage that is beyond the control of an educational institution could be regarded as arbitrary and capricious by the DOE and/or the court system. The point could be made that the APA only has the legal authority to remove accreditation for educational reasons not professional/guild reasons. Attempts to limit the number of students entering the profession by re-engineering the admission system could be construed as a violation of antitrust laws and the imposition of a guild based monopoly. That would be illegal and probably a violation of racketeering laws. The court system and the federal government would likely squash such a system. We live is a free society and attempting to limit the number of people who can enter a profession violates that freedom. Under our laws and the regulations of the DOE, the APA must create and enforce accreditation standards that are equitable and achievable by all educational institutions whether they are traditional or professional schools. Furthermore, in a free society people have a right to pursue the educations and training they wish. This may be causing problems for the profession, but this is the price we pay for living in a free society.

 

[erg923]

Furthermore, in a free society people have a right to pursue the educations and training they wish. This may be causing problems for the profession, but this is the price we pay for living in a free society.

Well..no, they dont......Thats why we have admissions standards...to limit the people entering....

 

[Neuropsych2be]

Well..no, they dont......Thats why we have admissions standards...to limit the people entering....

Well that is not the point I was making. Educational institutions have the right to set academic standards and admission standards. However, the APA and the profession of psychology do not have that authority. In terms of it being an accrediting body, the power of the APA is quite limited.

 

[Therapist4Chnge]

The APA had a chance to protect the profession when it worked with various states and state licensing boards on what constitutes "adequate" training.

 

[aagman01]

Couldn't APA just not permit for-profit institutions (i.e. the Argosy's, etc.) to get accredition.

Sort of a hypocratic oath thing? Are there for-profit medical schools out there? I doubt it. Could not whatever standards/regulations prohibit for-profit medical colleges from forming could be included to prevent accredition of professional for-profit schools?

On a slightly different note, perhaps APA could put a cap size on an entering cohort (sort of like APPIC does, though in reverse, regarding a having minimum number of interns employed for a site to get internship accredition). I doubt very few university training programs have more than 10 individuals in any one cohort (mine is no more more than half of that) - why not just cap an entering cohort at 10 or 15 --- the Argosy's would have a difficult time making a profit with a max of 10 or 15 students per class while also meeting APA requirements regarding the number of trainers at a program. APA could sort of make some structural requirements that university training programs meet but that for-profit institutions would have a very difficult time meeting the standards of.

Just a few musings.....

The APA had a chance to protect the profession when it worked with various states and state licensing boards on what constitutes "adequate" training.

 

[psychmama]

I still go back to my proposal to only allow programs to accept as many students as it can place into accredited internship spots (averaged over 3-5 years). Make this a requirement for accreditation, and any program that does not comply gets their accreditation pulled. I think programs would do what is needed to meet this requirement, as they'd risk faculty and student unrest if their accreditation disappeared in the middle of a student's training.

I agree.

 

[psychmama]

There are some problems with this. The APA can not simply pull accreditation that easily. The APA functions under the authority of the Department of Education and its decisions can be reviewed and overturned by the DOE. Furthermore, as an accrediting agency opertaing under federal jurisdiction, its actions may be reviewed by the court system. Removing accreditation from programs is a process fraught with legal requirements and difficulties. Removing accreditation due to factors like the internship shortage that is beyond the control of an educational institution could be regarded as arbitrary and capricious by the DOE and/or the court system. The point could be made that the APA only has the legal authority to remove accreditation for educational reasons not professional/guild reasons. Attempts to limit the number of students entering the profession by re-engineering the admission system could be construed as a violation of antitrust laws and the imposition of a guild based monopoly. That would be illegal and probably a violation of racketeering laws. The court system and the federal government would likely squash such a system. We live is a free society and attempting to limit the number of people who can enter a profession violates that freedom. Under our laws and the regulations of the DOE, the APA must create and enforce accreditation standards that are equitable and achievable by all educational institutions whether they are traditional or professional schools. Furthermore, in a free society people have a right to pursue the educations and training they wish. This may be causing problems for the profession, but this is the price we pay for living in a free society.

Yes. I've heard this argument before...that limiting the accreditation could be viewed as restraint of trade. I've always wanted to ask an antitrust lawyer about this -- whether this is so.

 

[cara susanna]

Oh, really? I didn't think of that.

I think T4C's idea is good.

 

[positivepsych]

The restraint of trade issue is only in theory, the medical profession has been purposefully limiting the number of licensed physicians for years. Do you think Dermatologists make $300K+ for <40/week of work, because their services are more valuable than other providers? No, its because there are an artificially limited number of dermatology residencies and spots, which keeps supply/demand in balance, and private practices full. This is also true of pharmacy, dentistry, and nursing. The demand for nursing is HOT right now (their salaries are topping ours), and still some nursing schools have waiting lists that are 1-2+ years long.

I don't believe in limiting supply just to increase salaries, but it is justified to reduce unemployment. A profession should only graduate the number of students as there are jobs for. Research-oriented clinical psychology Ph.D. programs generally do this: taking only 3-15 students because there are only so many assistant professor jobs. Academia learned its lesson when too many students got PhDs in the 60s (thanks to draft dodging and the GI Bill), and couldn't find employment as professors.

I have read 1 or 2 published articles show that major California cities have already reached a saturation point of licensed psychologists, and that demand in CA may actually decrease in the coming years. Thus, the APA has an ethical responsibility to manage supply/demand, even if it means lobbying or legal action, and there is certainly precedents by similar professions.

 

[ClinicalTrainee]

Yes. I've heard this argument before...that limiting the accreditation could be viewed as restraint of trade. I've always wanted to ask an antitrust lawyer about this -- whether this is so.

Yes, it is.

I am not an anti-trust lawyer, but I do know that CUDCP consulted one and discussed a host of possible solutions to the internship imbalance and most of them violated anti-trust laws.

Part of the problem is the diffusion of responsibility. As was pointed out earlier in this thread, APA does not have that much authority. Yes, APA could change it's accreditation rules, but that won't stop for-profit programs springing up that aren't accredited.

Because every state has it's own rules for licensure, it's the states that really control entrance into the profession. Should the licensing laws be changed so only people from accredited programs are eligible for licensure? I could see the merit in that.

My original point, btw, wasn't to say that "increase the number of internship slots!" is the ideal solution, only one that gets tossed around a lot, and is advocated by some factions of the profession.

The ultimate issue for me isn't even about saturation of the field (admittedly a problem, yes) but about the quality of the profession. There are students from for-profit schools who don't bother to go through the match or do any kind of accredited (APPIC, APA/CPA or whatever) internship and just cobble one together based on practica opportunities. What are these students learning? What are they passing on to clients?

 

[Therapist4Chnge]

....who don't bother to go through the match or do any kind of accredited (APPIC, APA/CPA or whatever) internship and just cobble one together based on practica opportunities. What are these students learning? What are they passing on to clients?

This is my concern also. The standard should be APA-accredidation, but the horse is out of the barn for "other" accredidations. California's psychology association pushes their own accredidation so that students in California can come from "an accredited" internship, though there has already been issues of students not being able to be licensed in other states.

I don't understand the rationale (other than $$) to allow students to be eligible in some states and not others. A lot of students don't understand the implications of the various accredidations at the program and internship level, in addition to not understanding what it means to take an unpaid internship at that point of training.

I applied to programs back in 2003, and the main thing I took away from my search was, "APA only". My mentor wasn't up on the latest issues, as he had graduated before there was a real "match". I didn't know what APPIC was, that some people who go through clinical/counseling doctoral programs couldn't be licensed afterwards, etc. This was all pre-SDN (clinical forum), so there wasn't really a place to go to find out. Unfortunately, not much has changed since then in regard to the pitfalls that are out there for students. I was able to find my way to a decent program, APA-accredited internship, etc.....but I'm concerned that other students who don't really do the necessary leg work, will be in for a rude awakening when they can't get licensed certain places....or not at all.

 

[Neuropsych2be]

Yes, it is.

I am not an anti-trust lawyer, but I do know that CUDCP consulted one and discussed a host of possible solutions to the internship imbalance and most of them violated anti-trust laws.

Part of the problem is the diffusion of responsibility. As was pointed out earlier in this thread, APA does not have that much authority. Yes, APA could change it's accreditation rules, but that won't stop for-profit programs springing up that aren't accredited.

Because every state has it's own rules for licensure, it's the states that really control entrance into the profession. Should the licensing laws be changed so only people from accredited programs are eligible for licensure? I could see the merit in that.

My original point, btw, wasn't to say that "increase the number of internship slots!" is the ideal solution, only one that gets tossed around a lot, and is advocated by some factions of the profession.

The ultimate issue for me isn't even about saturation of the field (admittedly a problem, yes) but about the quality of the profession. There are students from for-profit schools who don't bother to go through the match or do any kind of accredited (APPIC, APA/CPA or whatever) internship and just cobble one together based on practica opportunities. What are these students learning? What are they passing on to clients?

I am strongly opposed to "for-profit" graduate schools. It dilutes the educational mission of the school. However, this same issue plagues medicine. Since the Flexner report came out 100 years ago, the medical profession has been able to shut down and prevent the opening of "for profit" medical schools. However, recently a for profit osteopathic medical school has open up and been given provisional accreditation by the relevant osteopathic board. I think it is called Rocky Vista and is located in Colorado. More for profit medical schools may soon be developed. One of the reasons given for this is the tremendous shortage of primary care physicians whose roles are being taken over by nurse practitioners. Limiting entry to the profession of psychology may lead to greater penetration of social workers and LPC's into the marketplace.

I see the ultimate solution for psychology to be the creation of new applied roles beyond that of psychotherapist. Our sister social sciences of sociology and anthropology are continually developing new applied roles for their Ph.D. graduates outside of academe and they certainly are not doing therapy. Indeed, some of their Ph.D. programs are explicitly applied in nature. I believe that the University of South Florida has a Ph.D. in Applied Anthropology which prepares their graduates to fill a variety of roles. I ultimately think those psychologists who will do best are those of us who continually seek out new professional roles instead of suckling on the teat of the insurance companies for a tiny sip of financial milk.

I am not optimistic about this however. God forbid that psychology look to another social science for inspiration of any kind. Psychology is too narcissistic and self-involved for that 😀 Just look at what passes for "multicultural" psychology and you will see that we utterly ignore the sister social science devoted to the study of culture and instead insist on re-inventing the wheel. We arrogantly call ourselves "the science of behavior" when we are one behavioral discipline among others.

 

[edieb]

I am strongly opposed to "for-profit" graduate schools. It dilutes the educational mission of the school. However, this same issue plagues medicine. Since the Flexner report came out 100 years ago, the medical profession has been able to shut down and prevent the opening of "for profit" medical schools. However, recently a for profit osteopathic medical school has open up and been given provisional accreditation by the relevant osteopathic board. I think it is called Rocky Vista and is located in Colorado. More for profit medical schools may soon be developed. One of the reasons given for this is the tremendous shortage of primary care physicians whose roles are being taken over by nurse practitioners. Limiting entry to the profession of psychology may lead to greater penetration of social workers and LPC's into the marketplace.

I see the ultimate solution for psychology to be the creation of new applied roles beyond that of psychotherapist. Our sister social sciences of sociology and anthropology are continually developing new applied roles for their Ph.D. graduates outside of academe and they certainly are not doing therapy. Indeed, some of their Ph.D. programs are explicitly applied in nature. I believe that the University of South Florida has a Ph.D. in Applied Anthropology which prepares their graduates to fill a variety of roles. I ultimately think those psychologists who will do best are those of us who continually seek out new professional roles instead of suckling on the teat of the insurance companies for a tiny sip of financial milk.

I am not optimistic about this however. God forbid that psychology look to another social science for inspiration of any kind. Psychology is too narcissistic and self-involved for that 😀 Just look at what passes for "multicultural" psychology and you will see that we utterly ignore the sister social science devoted to the study of culture and instead insist on re-inventing the wheel. We arrogantly call ourselves "the science of behavior" when we are one behavioral discipline among others.

Medicine has had for-profit schools for a long time, almost all of them in the Caribbean.

 

[Neuropsych2be]

You mean like Ross, AUC, St. James .. don't they splash ads all over SDN??🙁