Paid Practicum Experiences

[CheckYourHead]

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Hello All,

During a recent meeting with faculty, the grad students in my PhD program brought up the idea of the program working to obtain more paid practicum placements. One of the faculty's counterarguments was that it just doesn't happen, or at least not without some serious strings attached (i.e. you will work with little flexibility/time off, like a real job).

Part of the reason this was brought up is that a PhD program near us boasts all paid practicum for their students (even if they are at the same site for which we are unpaid in our program). I am aware of paid practicum placements being more common in some geographic areas than others (I've heard they aren't unusual in TX or FL), but wanted to throw this up on the forum to see if I could get some feedback/discussion going from the StudentDoctor community.

Please post if your program (or you are aware of others) have paid practicum placements, and, if possible, list the type of program (Clinical/Counseling/etc., PhD/PsyD), geographic location (state & region, if you don't want to name your specific program or city), and nature of the practicum (clinical/assessment/neuro/etc). Your responses will really help us gauge whether this is a worthwhile issue to pursue.

Thank you!

-Check

 

[Ollie123]

Southeast Clinical PhD in an urban area. Have a variety of paid practicums - therapy and assessment. They have become increasingly rare though thanks to another local "school" flooding the market with hordes of students willing to work for free. Most of those that remain are through organizations with which we have very close ties or internal (i.e. school clinic, faculty grants for clinical research).

 

[AcronymAllergy]

Like Ollie, I attended a clinical PhD program in the southeast. We had a variety of paid clinical externships. The settings include community mental health, academic/teaching hospitals, and various state-run facilities.

Edit: Forgot to mention that the pay was almost exactly the same as for TA/RAships.

 

[ResearchGirlie]

West coast urban area clinical program and have never heard of paid practicums. Like the faculty member you mentioned, my guess would be that the faculty would say absolutely not because it would likely take more time away from research. Plus, if you are funded by NIH, NSF, or NIMH I don't think you can make money on the side. I know NSF has tightened up their restrictions on grad students teaching 1 semester a year while in the graduate fellowship program.

How much do these paid sites tend to pay? Is it by hours or some general amount per semester?

 

[Ollie123]

I believe ours are generally administered through the school and thus come as a stipend just like anything else, though could be wrong (never done one). They're generally meant as an alternative to teaching/TAing that some students take for a year or two. I'm not entirely sure where the concern regarding it taking time away from research comes in - I don't think my program is an outlier among clinical science programs in that it expects people to be engaging in clinical work throughout the program and accrue at least a modest number of hours for internship. It perhaps takes up a bit more time than teaching alone but the difference is not enormous, and it is substantially less time than teaching AND an unpaid practicum would be (which is really the only viable alternative for those not on grants).

If the concern is that its an hourly wage and students will just fit in as many hours as possible to make money and ignore research, than I get it - but that's not how it works here.

 

[ResearchGirlie]

I believe ours are generally administered through the school and thus come as a stipend just like anything else, though could be wrong (never done one). They're generally meant as an alternative to teaching/TAing that some students take for a year or two. I'm not entirely sure where the concern regarding it taking time away from research comes in - I don't think my program is an outlier among clinical science programs in that it expects people to be engaging in clinical work throughout the program and accrue at least a modest number of hours for internship. It perhaps takes up a bit more time than teaching but the difference is not enormous, and it is substantially less time than teaching AND an unpaid practicum would be (which is really the only viable alternative for those not on grants).

If the concern is that its an hourly wage and students will just fit in as many hours as possible to make money and ignore research, than I get it - but that's not how it works here.

Ok, that makes a lot more sense. I was thinking it was entirely separate from school so you'd basically have a part-time job on top of graduate school. If the department could maintain some control I can see why they would allow it.

 

[AcronymAllergy]

Ok, that makes a lot more sense. I was thinking it was entirely separate from school so you'd basically have a part-time job on top of graduate school. If the department could maintain some control I can see why they would allow it.

Ours were generally the same as those at Ollie's program--the funding went to the university first, and then the university paid the students just as if it were a TA or RA position. I believe one placement might've handled things differently, and this had been worked out with the DCT ahead of time.

 

[cara susanna]

Midwestern clinical PhD program, balanced focus. We have external placements outside of the department and we're funded on these third and fourth year. Usually the pay is terrible, but the clinical experiences are good. Some positions are through the university and these tend to pay better.

 

[Doctor Eliza]

We didn't have any outside placements. All practica were done at our departmental clinic.

Dr. E

 

[erg923]

What did internship sites think of this? There is no way you get much breath of experience this way (no primary care, no multidisciplinary teams, no inpatient, no residential treatment, no hospital services or experience working with physicians, no homeless, no vets). Honestly, what did you talk about on internship interviews?

 

[Doctor Eliza]

What did internship sites think of this? There is no way you get much breath of experience this way (no primary care, no multidisciplinary teams, no inpatient, no residential treatment, no hospital services or experience working with physicians, no homeless, no vets). Honestly, what did you talk about on internship interviews?

It didn't seem to be a huge deal, honestly. My school had nearly a 100% placement rate for APA accredited internships every year. The clinic was sliding fee scale so that provided a fair amount of diagnostic variability. We did do a few assessments at a home for vets and did a good number of child and college student LD evaluations. And most of us had a good number of total face to face hours.

I do think it probably influenced the settings where we got our internships though. For example, I had my heart set on a counseling center internship due to several sites' emphasis on gender and cultural issues. However, they wouldn't look at me because I didn't have counseling center experience (which seem ridiculous, but common). I actually know this to be true because I had the DCT follow up for me. I ended up interning at a CMH, which was a pretty similar population to what I saw in grad school. My neuro friends were pretty successful in getting in with VA's although their only experience with this population was some assessment. I suspect that the quality neuro research that they were involved with helped convince sites that they knew their stuff.

Best,
Dr. E

 

[Pragma]

This has come up before. These don't exist in my major city because of the competition. But I also wouldn't have wanted them...I think when people are getting paid for research, it is easier to keep it as a primary focus. I felt not being paid for practica helped me to prioritize more easily.

 

[ClinPsychEnthus]

This has come up before. These don't exist in my major city because of the competition. But I also wouldn't have wanted them...I think when people are getting paid for research, it is easier to keep it as a primary focus. I felt not being paid for practica helped me to prioritize more easily.

My situation is very similar to Pragma. I get paid for research through my university (stipend), but in my area no-one gets paid for practica, even at major (R1) settings where clinical and research duties are a part of the training. My understanding is that this can be seen as distinguishing between work and training experience. Thankfully, my practicum sites have been such wonderful training opportunities that I would have chosen to be there without pay anyway... it does help that no sites would have paid me, though.

 

[cara susanna]

What sucks about paid practica is that they're almost always all assessment because you can't reimburse for therapy conducted by prac students. So it's difficult to get therapy experience through these.

 

[AcronymAllergy]

What sucks about paid practica is that they're almost always all assessment because you can't reimburse for therapy conducted by prac students. So it's difficult to get therapy experience through these.

The clinical externship I was on for my final year was actually funded via a training grant, which was nice in that it allowed us not to have to worry about reimbursement. It also let the supervisor "throttle" the referrals to better suit our training goals (e.g., more assessment, more therapy, more research).

 

[Psychadelic2012]

What sucks about paid practica is that they're almost always all assessment because you can't reimburse for therapy conducted by prac students.

Here's one for having a licensable masters when you enter a doctoral program, so you can get reimbursed and benefit both you and your supervisor 👍!! Also, I disagree that a paid practica suck because they're assessment 😕. Sounds great to me!

 

[cara susanna]

The assessment part doesn't suck, what sucks is that it's harder to get therapy experience through them. You can do additional unpaid pracs but it's a huge strain on your time to do a 20 hour/week assessment prac and then add on an 8 hr/week therapy prac, in addition to research, classes, and other grad school duties.

 

[Psychadelic2012]

Oh, ok. Well, I guess I'm coming from a place where official practica are ALL therapy, plus I have master's (therapy) hours, so I can't relate to that scenario...

 

[MBellows]

What sucks about paid practica is that they're almost always all assessment because you can't reimburse for therapy conducted by prac students. So it's difficult to get therapy experience through these.

The agency that I work for offers paid practica for therapy. They receive funding for therapy through a county mental health program funded (poorly) by the state, and if you've seen my many of my posts you'll know what state and just how ****ty the funding is.

 

[CheckYourHead]

Thank you for your responses so far, everyone. It sounds like their are quite a few varied experiences and I wanted to ask a bit more about one particular aspect. To give more perspective on why this is an issue of concern for my program (which is in the Midwest in an urban setting), the assistantships in our program are almost exclusively for teaching. We are expected to do our research on our own time, in addition to our unpaid clinical practicum (though for practicum we are capped at 20 hrs/wk and are expected to be doing as much as necessary to be competitive for internship, with research being a little more based on your own interests, thesis/dissertation notwithstanding). It sounds like a lot of the people here with assistantships have those for research, which would understandably make priority for clinical hours a bit different. Is having only teaching assistantships and doing the research/practicum unpaid and on your own time that unusual?

 

[paramour]

Midwestern Clinical Psych PhD program and all of our practicum (outside of the 1.5-2 years of "required" clinic time) are paid positions. Unfortunately, we are nearish enough to a large city, overflowing with students (both master's and PsyD's), that we have been losing many of our positions over the years as sites have started to recognize that they can receive free labor from folks willing to travel. And then we have lost sites simply because everyone's hurting financially in general and they're no longer able to afford to pay us. We managed to pick up a few new sites (primarily child/adolescent) in the last year or two. Some "disgruntled" folks have started to work voluntary practicum, either on top of their current work or in place of their dept offers, in an attempt to obtain additional hours and/or more diversity in experiences. It's a pain in the rear to get this approved, however.

If a student receives a paid practicum position, this IS their source of funding for the year (i.e., 20 hours per week of clinical work). Otherwise, they would either have a teaching gig (20 hours per week teaching) or research spot (20 hours per work in someone's lab). Students obviously participate in research outside of their "paid" work; this paid work is usually involvement in their advisor's research and grants or even another individual's lab if they have the funding available. Other research work is voluntary (either for your advisor or someone else's lab) in addition to your thesis/dissertation (required) or any additional independent projects (again, voluntary). Most folks are involved in voluntary research in one form or another.

What did internship sites think of this? There is no way you get much breath of experience this way (no primary care, no multidisciplinary teams, no inpatient, no residential treatment, no hospital services or experience working with physicians, no homeless, no vets). Honestly, what did you talk about on internship interviews?

It didn't seem to be a huge deal, honestly. My school had nearly a 100% placement rate for APA accredited internships every year. The clinic was sliding fee scale so that provided a fair amount of diagnostic variability. We did do a few assessments at a home for vets and did a good number of child and college student LD evaluations. And most of us had a good number of total face to face hours.

I do think it probably influenced the settings where we got our internships though. For example, I had my heart set on a counseling center internship due to several sites' emphasis on gender and cultural issues. However, they wouldn't look at me because I didn't have counseling center experience (which seem ridiculous, but common). I actually know this to be true because I had the DCT follow up for me. I ended up interning at a CMH, which was a pretty similar population to what I saw in grad school. My neuro friends were pretty successful in getting in with VA's although their only experience with this population was some assessment. I suspect that the quality neuro research that they were involved with helped convince sites that they knew their stuff.

Best,
Dr. E

I actually find this interesting. We had a few students who did not match last year, and some of the feedback they received was a lack of diversity in their experiences. Their primary site was our university clinic (and it sounds comparable to your exposure). Everyone is supposed to have at least *one* external practicum but the clinic will not guarantee anything beyond this. These students who did not match, unlike a select few other students, actually had multiple sites under their belts. But because they had "most" of their experience at our clinic and because their external experiences were not deemed "diverse" or broad enough, they were not evaluated as favorably (reportedly). Our dept adamantly denied this feedback could be true and that it was the presentation/packaging of the applicants themselves.... but then everyone resorted to pointing fingers instead of attempting to resolve anything (as usual). :thumbsdown:

 

[ResearchGirlie]

Thank you for your responses so far, everyone. It sounds like their are quite a few varied experiences and I wanted to ask a bit more about one particular aspect. To give more perspective on why this is an issue of concern for my program (which is in the Midwest in an urban setting), the assistantships in our program are almost exclusively for teaching. We are expected to do our research on our own time, in addition to our unpaid clinical practicum (though for practicum we are capped at 20 hrs/wk and are expected to be doing as much as necessary to be competitive for internship, with research being a little more based on your own interests, thesis/dissertation notwithstanding). It sounds like a lot of the people here with assistantships have those for research, which would understandably make priority for clinical hours a bit different. Is having only teaching assistantships and doing the research/practicum unpaid and on your own time that unusual?

It tends to vary a lot by lab based on funding situation. There are several labs that routinely have students TA every semester on top of unpaid research and practicum. The department heavily encourages students to apply for external funding to avoid this situation and to open up your time for more research.

 

[AcronymAllergy]

It tends to vary a lot by lab based on funding situation. There are several labs that routinely have students TA every semester on top of unpaid research and practicum. The department heavily encourages students to apply for external funding to avoid this situation and to open up your time for more research.

I was funded as a TA, and later instructor, for my first few years in grad school, so the above was the norm for perhaps the first half of my training (i.e., 20 hours/week for teaching/TAing, approximately 15-20 hours/week for clinical work, and research wherever I could fit it on top of that).

My last couple years I was funded via clinical externship, so my teaching responsibilities were nil. I felt a lot less pressured time-wise, as could be imagined. I was also more productive research-wise as a result.

 

[paramour]

I was funded as a TA, and later instructor, for my first few years in grad school, so the above was the norm for perhaps the first half of my training (i.e., 20 hours/week for teaching/TAing, approximately 15-20 hours/week for clinical work, and research wherever I could fit it on top of that).

My last couple years I was funded via clinical externship, so my teaching responsibilities were nil. I felt a lot less pressured time-wise, as could be imagined. I was also more productive research-wise as a result.

Our program seems to run similarly. Most students are funded as TAs/instructors in the first few years; and then the latter part of the program tends to be funded by clinical positions (so no teaching at all). Paid research gigs are few & far between although there are some for a few students in the first year or two (often depends on your advisor) and then again near the latter part of the program.

 

[AcronymAllergy]

Our program seems to run similarly. Most students are funded as TAs/instructors in the first few years; and then the latter part of the program tends to be funded by clinical positions (so no teaching at all). Paid research gigs are few & far between although there are some for a few students in the first year or two (often depends on your advisor) and then again near the latter part of the program.

Pretty much how my program was as well, yep. It was highly advisor-dependent (i.e., who had grant money coming in), although overall, I believe most people were still funded via TAships.

 

[ResearchGirlie]

Pretty much how my program was as well, yep. It was highly advisor-dependent (i.e., who had grant money coming in), although overall, I believe most people were still funded via TAships.

We're about 70 / 30 research to TA funding. Research includes being funded off an advisor's grant, training grants, or NRSA/NSF etc.

 

[CheckYourHead]

Our program seems to run similarly. Most students are funded as TAs/instructors in the first few years; and then the latter part of the program tends to be funded by clinical positions (so no teaching at all). Paid research gigs are few & far between although there are some for a few students in the first year or two (often depends on your advisor) and then again near the latter part of the program.

What sort of clinical positions were people funded for? Part of our problem also seems to have been the recent changes that result in anyone not already licensed (at the Master's level) not being able to bill for things like Medicare.

 

[paramour]

What sort of clinical positions were people funded for? Part of our problem also seems to have been the recent changes that result in anyone not already licensed (at the Master's level) not being able to bill for things like Medicare.

Our current paid positions are as follows:
- child development clinic at the local community hospital: 2 positions
- school district: 2 positions
- MR/DD sites: 3 positions across 3 sites
- nonprofit agency providing services for children/adolescents with developmental disabilities: 1 position (primarily assessment)
- probation: 1 position (assessment)
- counseling center: 1 position
- private clinic/day tx program for child/adolescents: 1 position (primarily group tx)
- our univ clinic: 2 positions

We've had other positions, including placements at a CMHC, a nonprofit PAIP, and a few different private clinics that focused primarily on forensic work and the like--but these have fallen through over the years.

Some of the above placements do require that students have their master's degree, which is why many of them are reserved for students a few years into the program. Others seem not to care or it does not matter as much.

I understand the Medicare issue, as I currently work at a CMHC and I am limited in who I can see. But it has yet to be a problem with keeping my caseload full. As there seems to be limited services available in the area, combined with an overabundance of folks who are self-pay/Medicaid, then they still bill for my services. I can request a waiver for grant money to cover cases outside of self-pay/Medicaid, but, again, I usually have enough referrals without needing it.