Not enough integrative behavioral health pediatric experiences for internship?

[ninim]

Hi,

I’m a rising 4th year doctoral student in clinical psychology and just finished applying to externship sites. I’m spiraling a bit because I am recognizing I might have set myself up a bit for a rough road ahead.

My past clinical experience pre doctorate include mostly work with adults. I worked at a research lab that focused on child and family work, and when entering graduate school I worked with a mix of adults and child/adolescents with anxiety and mood disorders, I wanted a solid training in CBT/ExRP as well as psychodiagnostic assessment experiences and the site was wonderful for that. I have also completed 8 integrated neuropsychological reports (4 adult/4 child). For my 3rd year I went the inpatient adult route because of the programs focus on a modality I wanted training in and ny strong interest in interdisciplinary work.

My goal is to work in pediatric integrative integrative behavioral health, more specifically in medical inpatient. I naively thought I could wait until internship to get more training in this area and therefore only applied to 2 pediatric IBH sites for next years externship cycle, the remainder of the sites I applied to are eating disorder and adult IBH/oncology sites. It was always my goal to broaden my training before internship, but I’m very much noticing that based on what I have heard it’s going to be extremely hard to break into the IBH peds world for internship should I not receive offers from these two sites for my 4th year externship. I know there is always still post doc but I don’t get the impression it would be any easier at that point. I am also bound to NYC because of my kids/husband, which doesn’t make it less competitive. I realize I’m jumping ahead here but I’m in a bit of a spiral and would love advice from people who may have more knowledge of this. I even considered adding on a year should it not work out but I DEF don’t want to do that 🙂

I’m going to speak to my advisor and our DCT next week too but this forum seems incredibly helpful for these things.

Thank you so much!

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[psych.meout]

Hi,

I’m a rising 4th year doctoral student in clinical psychology and just finished applying to externship sites. I’m spiraling a bit because I am recognizing I might have set myself up a bit for a rough road ahead.

My past clinical experience pre doctorate include mostly work with adults. I worked at a research lab that focused on child and family work, and when entering graduate school I worked with a mix of adults and child/adolescents with anxiety and mood disorders, I wanted a solid training in CBT/ExRP as well as psychodiagnostic assessment experiences and the site was wonderful for that. I have also completed 8 integrated neuropsychological reports (4 adult/4 child). For my 3rd year I went the inpatient adult route because of the programs focus on a modality I wanted training in and ny strong interest in interdisciplinary work.

My goal is to work in pediatric integrative integrative behavioral health, more specifically in medical inpatient. I naively thought I could wait until internship to get more training in this area and therefore only applied to 2 pediatric IBH sites for next years externship cycle, the remainder of the sites I applied to are eating disorder and adult IBH/oncology sites. It was always my goal to broaden my training before internship, but I’m very much noticing that based on what I have heard it’s going to be extremely hard to break into the IBH peds world for internship should I not receive offers from these two sites for my 4th year externship. I know there is always still post doc but I don’t get the impression it would be any easier at that point. I am also bound to NYC because of my kids/husband, which doesn’t make it less competitive. I realize I’m jumping ahead here but I’m in a bit of a spiral and would love advice from people who may have more knowledge of this. I even considered adding on a year should it not work out but I DEF don’t want to do that 🙂

I’m going to speak to my advisor and our DCT next week too but this forum seems incredibly helpful for these things.

Thank you so much!

This is going to be a far bigger issue than what you're worried about here. You have some research and clinical experience with peds and could frame your internship apps that your training goals are to get more peds experiences. And if you're flexible, there are lots of ways to get peds experience on internship that will achieve your career goals, e.g., a generalist AMC site with peds rotations. The problem is that if you can't/won't move for internship you're going to seriously limit your competitiveness and options. There are many applicants who are limited to the area and many others who want to move to the area for internship and the rest of their careers. You'll be competing with all those applicants and they may be more competitive than you, at least for the sites you want. So, you're already limiting your competitiveness with geographic restrictions (which is consistently the #1 reason people don't match for internship) and on top of that you're looking for a very specific career and are somewhat more limited in your CV in that area.

 

[ninim]

This is going to be a far bigger issue than what you're worried about here. You have some research and clinical experience with peds and could frame your internship apps that your training goals are to get more peds experiences. And if you're flexible, there are lots of ways to get peds experience on internship that will achieve your career goals, e.g., a generalist AMC site with peds rotations. The problem is that if you can't/won't move for internship you're going to seriously limit your competitiveness and options. There are many applicants who are limited to the area and many others who want to move to the area for internship and the rest of their careers. You'll be competing with all those applicants and they may be more competitive than you, at least for the sites you want. So, you're already limiting your competitiveness with geographic restrictions (which is consistently the #1 reason people don't match for internship) and on top of that you're looking for a very specific career and are somewhat more limited in your CV in that area.

Thank you. I’m fully aware of the geographic limitations - unfortunately that is a non negotiable for many reasons. I wish it were an option. That’s exactly what I’m worried about (all that you mentioned). I’m seriously considering adding another year but I don’t know if it would make any difference. I spoke to our DCT and she’s not worried, she thinks I’m very competitive and our school has a good reputation but I’m pretty concerned. Thanks for your insight on this. Here’s to hoping I’ll get an offer from one if the two sites. If not I guess I’ll have to reconsider.

 

[psych.meout]

I don't know how much another year might help with the geographic considerations. Not that it won't help at all, but rather that you might have to be more flexible and open to more kinds of sites than you'd like, even if they don't have the training opportunities you want (e.g., ones that don't have peds medical inpatient, any peds at all). The most important thing is matching to an accredited site and completing internship. I'd rather meet those goals and try to get the training I wanted (but missed out on) during post doc and early career training than risk not matching, which would be far worse for your career.

 

[ninim]

I don't know how much another year might help with the geographic considerations. Not that it won't help at all, but rather that you might have to be more flexible and open to more kinds of sites than you'd like, even if they don't have the training opportunities you want (e.g., ones that don't have peds medical inpatient, any peds at all). The most important thing is matching to an accredited site and completing internship. I'd rather meet those goals and try to get the training I wanted (but missed out on) during post doc and early career training than risk not matching, which would be far worse for your career.

For sure. I would only apply to accredited programs my school does not allow us to apply to non accredited internships anyways. I think it makes sense to do an half and half approach and be more flexible in what sites I am applying to in terms of training while also aiming for some that provide a more specialized peds IBH training, whether it works out or not. It’s encouraging to hear that post doc is still an opportunity to get more specialized training too.. I always feel that people are so funneled into their areas at that point but I’m also not even close to that yet. Also, the eating disorder sites I applied to are adolescent heavy and isn’t too far removed from peds IBH.. we shall see. Thanks for all your thoughts on this! Very much appreciate it

 

[summerbabe]

My goal is to work in pediatric integrative integrative behavioral health, more specifically in medical inpatient.

As an adult generalist with primarily VA experience, I haven’t the slightly clue about this sub area.

But broadly speaking, are these jobs competitive? Competitive in NYC? And job competitiveness may have nothing to do with externship/internship/postdoc (or be very strongly correlated in certain regions).

If you’re not really sure how to answer this, you might benefit from some networking/mentoring by people who work in this field so you can get a better idea of what is needed to secure these types of jobs (and it’s very possible that the barriers to entry are actually lower than you think).

And would you be satisfied doing other types of things in psychology if you couldn’t find such a job?

If these jobs aren’t super competitive such as there being plenty of positions in NYC, plenty of turnover or open positions or you’d be happy to other types of things in psychology, then I would try to match to the best possible accredited internship and get as much relevant experience as possible.

But if these jobs are super competitive, you genuinely wouldn’t be happy working in other settings and you are also restricted to NYC for internship/postdoc/work, that’s tough.

Perhaps applying narrowly during internship (like only places that will provide the exact type of training that would be needed to secure a future job) and being open to the possibly of an extra year in school should you not match to one of those places could be one of the options on the table.

Not saying this is the best option since there are lots of potential drawbacks.

 

[Sanman]

As an adult generalist with primarily VA experience, I haven’t the slightly clue about this sub area.

But broadly speaking, are these jobs competitive? Competitive in NYC? And job competitiveness may have nothing to do with externship/internship/postdoc (or be very strongly correlated in certain regions).

If you’re not really sure how to answer this, you might benefit from some networking/mentoring by people who work in this field so you can get a better idea of what is needed to secure these types of jobs (and it’s very possible that the barriers to entry are actually lower than you think).

And would you be satisfied doing other types of things in psychology if you couldn’t find such a job?

If these jobs aren’t super competitive such as there being plenty of positions in NYC, plenty of turnover or open positions or you’d be happy to other types of things in psychology, then I would try to match to the best possible accredited internship and get as much relevant experience as possible.

But if these jobs are super competitive, you genuinely wouldn’t be happy working in other settings and you are also restricted to NYC for internship/postdoc/work, that’s tough.

Perhaps applying narrowly during internship (like only places that will provide the exact type of training that would be needed to secure a future job) and being open to the possibly of an extra year in school should you not match to one of those places could be one of the options on the table.

Not saying this is the best option since there are lots of potential drawbacks.

I will add a bit to this. What are your plans post-internship? If you want to be competitive for this type of job, you will need a post-doc and NY requires a year for license. How many spots are available? Then, one of the few pediatric inpatient jobs on NYC has to open up for you to be employed. What happens if it is not? Each year you stray from that goal is another year away from getting the job. If your dream job opens up 6 years post-license, what have you been doing those 6 years vs the competition? It is your decision, but given the limitations you have placed on yourself, it might be better to broaden options than keep extending your training.

 

[ninim]

As an adult generalist with primarily VA experience, I haven’t the slightly clue about this sub area.

But broadly speaking, are these jobs competitive? Competitive in NYC? And job competitiveness may have nothing to do with externship/internship/postdoc (or be very strongly correlated in certain regions).

If you’re not really sure how to answer this, you might benefit from some networking/mentoring by people who work in this field so you can get a better idea of what is needed to secure these types of jobs (and it’s very possible that the barriers to entry are actually lower than you think).

And would you be satisfied doing other types of things in psychology if you couldn’t find such a job?

If these jobs aren’t super competitive such as there being plenty of positions in NYC, plenty of turnover or open positions or you’d be happy to other types of things in psychology, then I would try to match to the best possible accredited internship and get as much relevant experience as possible.

But if these jobs are super competitive, you genuinely wouldn’t be happy working in other settings and you are also restricted to NYC for internship/postdoc/work, that’s tough.

Perhaps applying narrowly during internship (like only places that will provide the exact type of training that would be needed to secure a future job) and being open to the possibly of an extra year in school should you not match to one of those places could be one of the options on the table.

Not saying this is the best option since there are lots of potential drawbacks.

That’s a really good point. I am going to start reaching out to some people in my network who are also past post doc. I haven’t even considered that possibility in terms of staying a year after that process but was just thinking in terms of pushing it back.. if one were to do that, would people apply to externships concurrently at the same time as internship since the timelines broadly align.

 

[summerbabe]

That’s a really good point. I am going to start reaching out to some people in my network who are also past post doc. I haven’t even considered that possibility in terms of staying a year after that process but was just thinking in terms of pushing it back.. if one were to do that, would people apply to externships concurrently at the same time as internship since the timelines broadly align.

Networking is a great idea. I went to school and live in a rural area so I’m able to piece together a pretty good idea of what types of institution-based jobs are available locally for psychologists since there aren’t that many options to start with.

Not sure how realistic that is for NYC but it would be great to figure out how many of these jobs theoretically exist period in NYC (or within a travelable distance).

If it’s only a handful, you’d literally need to wait for somebody to retire or voluntarily give up a position AND be qualified, which could take years theoretically and would warrant having some Plan Bs. Versus if there are a ton of these inpt units and many are struggling to retain their psychologists (eg., we’ll take anybody with a license, pulse and clean background check).

And having worked in adult inpt/medical settings, it’s not uncommon for duties to be split (like you’re half time doing something else) or for psychologist positions to be cut when hospital funding is tight since it’s a lot easier to get rid of the psychologist (and figure out ways to get coverage for absolutely needed tasks like assessment) than it is to cut the nursing staff needed to sustain unit.

If you end up finding some not so promising info, it will be ok. What I’m doing in the 4th year of my career after postdoc isn’t what I thought I would be doing when I started internship and WAY different than when I started grad school so if pivots may be needed, you have plenty of time (if willing). Good luck!

Also, as for applying to both internship and externship together, I don’t know much about the NYC externship system but think about people who end of not matching or withdraw and then need something to do for the next academic year but figure something out. Your TD would likely have some info on how to navigate the NYC externship process specifically if you go this route.