Promote the creation of new internship sites?

[Mein Traum]

---

Members do not see this ad.

Hello,

I have been watching and reading, I haven't seen this question addressed. Forgive me if I somehow missed it.

Let me frame the question a bit:

As a private practitioner, time is money. Any time taken to train or supervise a student takes away from time seeing a client.

At the medicare rate (90834 is the new 90806) that is 81.00 per hour. This is a low average when considering the private insurance reimbursement rates. If you only meet with the intern one hour a week this is $4,212 over a year.

Then, you also have to pay the intern ($18,000) and some locations provide medical insurance or other benefits.

The intern will need an office in which to see clients. This is an office that a licensed person could be using and billing from which makes that a potential loss of $71,500 (30 hrs week x 50 weeks x 81 per hour = 121,500) minus the salary of the licensee (50,000) = 71,500.

The intern is seeing clients and is not licensed, therefore every client that the intern sees is billed at a lower rate and some cannot be reimbursed at all. At a guess this is a potential loss of approximately half what a licensed person would produce or around 35,000 giving the benefit of the doubt. So, 71,500-35,000=$36,500.

We need to add various APA related fees that total over $2,000.

Without even considering any number of other issues (computer, testing supplies, staff to interview, time to complete the paperwork, time to complete paperwork asking for help with costs, etc) we are at a conservative estimate loss of well over $60,712.

Also, the person we train could potentially set up an office next door and be our competition.

1. Please, help me understand why any practitioner would want to provide an APA accredited internship?

Yes, I have read the APA internship toolkit and supposedly we should be wanting to do this for altruistic reasons, etc and yes, grant money is available but, not to the level that covers the expenditures.

2. So, would you do it?

3. How many of you will host an intern after you graduate?

4. How many that went through the match imbalance in the last ten years have finished and then decided to host an intern?

I think that this is such a systemic problem and the efforts to address it fall very short of what is needed. I do not want to offer a problem without a possible solution. I could be very wrong but, I think they need simply to change the internship requirements to post-grad and then with a professional or learner's license an intern could justify the cost of their own training.

Ideas, thoughts, etc. Tell me where I am wrong and how I might potentially convince someone to host an intern.

Best,

M.T.

 

[neuronic]

As a private practitioner, time is money. Any time taken to train or supervise a student takes away from time seeing a client.

True, but depending on the type of practice, you could do group supervision of several interns which would allow you to see multiple patients. For example, consider neuropsych, where one supervisor could have 3 interns see patients a day. This would greatly enhance revenue compared to seeing one patient per day.

[/QUOTE] Then, you also have to pay the intern ($18,000) and some locations provide medical insurance or other benefits.[/QUOTE]

You should pay, but nothing mandates that and it is part of the reason why so many students will seek unpaid internship and post-doc positions. [/QUOTE]

{/QUOTE]The intern will need an office in which to see clients. This is an office that a licensed person could be using and billing from which makes that a potential loss of $71,500 (30 hrs week x 50 weeks x 81 per hour = 121,500) minus the salary of the licensee (50,000) = 71,500. [/QUOTE]

What would your cut be if you worked with another licensed practicioner? Likely nothing, since they would see those patients. At least with an intern, you can take a larger share home.

[/QUOTE]The intern is seeing clients and is not licensed, therefore every client that the intern sees is billed at a lower rate and some cannot be reimbursed at all. At a guess this is a potential loss of approximately half what a licensed person would produce or around 35,000 giving the benefit of the doubt. So, 71,500-35,000=$36,500. [/QUOTE]

It is not like these patients would be seen by you and you would collect all 71,500. 36,500 is much greater than ZERO if those patients are never seen.

[/QUOTE]Without even considering any number of other issues (computer, testing supplies, staff to interview, time to complete the paperwork, time to complete paperwork asking for help with costs, etc) we are at a conservative estimate loss of well over $60,712. [/QUOTE]

You of course will have costs of training. Every job does (salary, office space), but so long as you can make profit from the intern, what is the problem. In other words, your intern needs to eclipse the $61,000 to make it beneficial. All jobs are like that. In hospitals, if providers do not prove their worth, they get fired.

[/QUOTE]Also, the person we train could potentially set up an office next door and be our competition. [/QUOTE]

Or they could join you and make your practice larger once licensed.

 

[Mein Traum]

Neuronic,

Thank you for helping me to consider and possibly address these points.

It is not like these patients would be seen by you and you would collect all 71,500. 36,500 is much greater than ZERO if those patients are never seen.[unquote]

My rationale is that although a practitioner/owner of the clinic would not see those clients personally, they would install someone in that office for whom they could bill the highest amount possible thus, my scenario.

This means that it really is more than 60,000 that an intern must produce in order to be cost effective for a private practitioner. I agree that the group of interns scenario would help with this issue.

I also wish that the practitioners would look at the intern as a possible future colleague however, from the neuropsych perspective, I have discussed this with a couple of practitioners and they are very real in their desire to remain the primary practitioner (masters and techs provide services with them in the building). I can't blame them for not wanting to share this bounty. They do not need another psychologist to grow the practice, they just need more techs or master's level therapists.

These are some valid things to consider, thank you.

M.T.

 

[neuronic]

It is a good discussion to have, and I think the implications are completely different for larger academic health settings/VAs than for private practice. A lot of the overhead costs (e.g., space, comps) are much more easily written off by hospitals than in private practice, and I myself would be less inclined to add interns in a private practice due to all the considerations you mentioned. Like yourself, I would also think that individuals would try to bill as high as possible and likely do so myself to find the person who can make that happen. Again, I think this is a large reason why there are many post-docs which are unpaid. As such, your business can grow without fiscal reductions, whereas the trainee gets supervision needed for licensure which is a fine commodity these days. However, at the end of the day, if you want your practice to survive, it is about who/what can bring in the most revenue. Sometimes interns who are worked unfairly to the max, other times licensed providers. Regardless, it is likely much easier to add internship slots to established training programs, than to start from the ground up, especially with regard to APA accreditation.

 

[Mein Traum]

It is a good discussion to have, and I think the implications are completely different for larger academic health settings/VAs than for private practice. A lot of the overhead costs (e.g., space, comps) are much more easily written off by hospitals than in private practice, and I myself would be less inclined to add interns in a private practice due to all the considerations you mentioned. Like yourself, I would also think that individuals would try to bill as high as possible and likely do so myself to find the person who can make that happen. Again, I think this is a large reason why there are many post-docs which are unpaid. As such, your business can grow without fiscal reductions, whereas the trainee gets supervision needed for licensure which is a fine commodity these days. However, at the end of the day, if you want your practice to survive, it is about who/what can bring in the most revenue. Sometimes interns who are worked unfairly to the max, other times licensed providers. Regardless, it is likely much easier to add internship slots to established training programs, than to start from the ground up, especially with regard to APA accreditation.

Neuronic,

Sadly, I think that I have to agree with you and I was so hopeful. The idea of a group of interns is a good selling point that I was able to take from this discussion. I am considering how I might package that idea and shop it around. I will have to give it more thought.

I agree that there are a limited number of locations who can absorb these costs and that will continue to limit the number of professionals unless the process changes. What do you think of the idea of requiring more practicum hours before graduation and then internship occurring exclusively in a post-doc situation?

M.T.

 

[graduatingsoon]

Neuronic,

Sadly, I think that I have to agree with you and I was so hopeful. The idea of a group of interns is a good selling point that I was able to take from this discussion. I am considering how I might package that idea and shop it around. I will have to give it more thought.



M.T.

Hey guys:

I believe there is one other consideration that will make this situation untenable. From what I recall, to meet minimum qualifications for APA/APPIC, each intern needs a minimum of 2 hours of individual supervision, and at least another 2 hours of group supervision. I had 6 hours of training at my internship. You need to show that you are a training site and are not using the intern for profit. APA Accreditation protects the intern. You also have to provide a reasonable stipend that is in line with geographic cost of living.

It is hardly ethical to work the intern 40-50 hours per week and only provide group supervision (I don't know if this was your intent). This is not a reasonable solution to the internship crisis.

 

[Mein Traum]

Hey guys:

I believe there is one other consideration that will make this situation untenable. From what I recall, to meet minimum qualifications for APA/APPIC, each intern needs a minimum of 2 hours of individual supervision, and at least another 2 hours of group supervision. I had 6 hours of training at my internship. You need to show that you are a training site and are not using the intern for profit. APA Accreditation protects the intern. You also have to provide a reasonable stipend that is in line with geographic cost of living.

It is hardly ethical to work the intern 40-50 hours per week and only provide group supervision (I don't know if this was your intent). This is not a reasonable solution to the internship crisis.

Graduatingsoon,

Thank you. Again, my perspective is in promoting this idea. I will (of course) research this more before (or if) I propose it however, I really do appreciate your quick feedback and assistance.

I can understand that the APA wants to protect interns and that in some situations it may be necessary. However, when we look at this from a cost benefit perspective it does look grim.

After having participated in the previous sections of this discussion, I reviewed the information in The APA Internship Toolkit again. It contains an example cost benefit analysis based upon the use of four interns. www.apa.org/education/grad/internship-toolkit.pdf

It is well done and interesting however, taking on four new staff members each year may not be realistic for private practitioners who might be able manage that task for one or two interns. However, it is as if the APA is telling us that they couldn't make the figures work with less than four interns and based upon our discussion, I can see why.

This is more to think about.

M.T.

 

[cara susanna]

Here is the issue. Adding more APA internship sites is a band-aid. Right now, the internship crisis serves as a bottleneck for the field. If you add more APA internship sites and more people match, great, but then that bottleneck moves into post-docs and jobs. We need to move the bottleneck to before people even start doctoral programs.

 

[Rivi]

Mein Traum,

I appreciate your discussion points. This has given me a lot to think about. The good news is that the APA is working on setting up a special type of billing code for interns that can minimize costs as part of the internship stimulus package. I think we need to start looking at what medical schools are doing for their internships/residencies, and model that as much as possible. BTW, does anyone know how other professions handle this issue (the cost of training interns, etc.).

I agree with Cara, if we want to reasonably address the internship imbalance, we need to limit the students entering into the field by holding schools accountable for internship match rates. The internship imbalance is a symptom of a larger problem.

 

[AcronymAllergy]

Mein Traum,

I appreciate your discussion points. This has given me a lot to think about. The good news is that the APA is working on setting up a special type of billing code for interns that can minimize costs as part of the internship stimulus package. I think we need to start looking at what medical schools are doing for their internships/residencies, and model that as much as possible. BTW, does anyone know how other professions handle this issue (the cost of training interns, etc.).

I agree with Cara, if we want to reasonably address the internship imbalance, we need to limit the students entering into the field by holding schools accountable for internship match rates. The internship imbalance is a symptom of a larger problem.

I believe medical residents can bill for their services, as they have their degrees (similar to how they can also moonlight).

 

[Mein Traum]

Mein Traum,

I appreciate your discussion points. This has given me a lot to think about. The good news is that the APA is working on setting up a special type of billing code for interns that can minimize costs as part of the internship stimulus package. I think we need to start looking at what medical schools are doing for their internships/residencies, and model that as much as possible. BTW, does anyone know how other professions handle this issue (the cost of training interns, etc.).

I agree with Cara, if we want to reasonably address the internship imbalance, we need to limit the students entering into the field by holding schools accountable for internship match rates. The internship imbalance is a symptom of a larger problem.

Rivi,

This is interesting. So, are you saying that the APA would be paying the bill out of the funding they have set aside? I can't see insurance companies doing it...

As far as the medical profession, they had some concerns with their match rates also.

I know that as an LPC-intern, I worked for the CMHC and paid a supervisor 50.00 a week for one hour of supervision a week. I can't imagine that anyone wants to pay for supervision. However, this internship was post-master's. If we look at this we can see a basis for a post-doc internship for Psychologists.

M.T.

 

[psychRA]

4. How many that went through the match imbalance in the last ten years have finished and then decided to host an intern?

Others have touched on a few of the issues, but I wanted to add to the list of reasons that you can't just up and "host an intern" if you want to offer an accredited internship opportunity. Of course, in addition to paying a salary, you need to have an actual training program in place, with didactics, multiple hours of supervision, and mandatory trainings on a bunch of key topics (depending on your state). All of those things seem completely prohibitive to someone in private practice. In addition, you can't just take one intern - I can't recall whether this is an APA requirement, or just a requirement in my state, but in order to be licensed, you need to come from an internship program that includes at least 2 interns per cohort. The rationale is that working and consulting with peers is an important part of training, and if you're the only intern at your site, you're missing that component.

I might argue that private practice (if that's what you're referencing) is not an ideal setting for internship in any case. All of the sites I applied to were in large hospitals that offered a range of rotation options, including inpatient, outpatient, substance abuse, SMI, neuropsych, PTSD, etc. I don't think there's any way I could have gotten the same breadth of clinical experiences within a single practice.

 

[graduatingsoon]

Rivi,

This is interesting. So, are you saying that the APA would be paying the bill out of the funding they have set aside? I can't see insurance companies doing it...

As far as the medical profession, they had some concerns with their match rates also.

I know that as an LPC-intern, I worked for the CMHC and paid a supervisor 50.00 a week for one hour of supervision a week. I can't imagine that anyone wants to pay for supervision. However, this internship was post-master's. If we look at this we can see a basis for a post-doc internship for Psychologists.

M.T.

In terms of medical school, there is a near 100% match rate for those that attend US medical schools actually. One of the only reasons why MD's continue to command a high salary is because the AMA has managed to keep the supply of MD's low and does not accredit for profit professional schools like the APA. This is really a supply side issue. We don't need to lower standards or eliminate the internship year. The APA just needs to hold for profit schools accountable.

 

[Ollie123]

I would agree. I don't know that offering an internship being completely unmanageable for a private practice is a bad thing! I'm hard-pressed to believe the average private practice could offer an internship of even middling quality (assuming that is what is being suggested), just like joe blow psychologist shouldn't be able to open an APA accredited graduate program operating out of his basement. The fact that there are people without access to care (and lots of people who want to go to graduate school) doesn't change that. A full caseload with an hour of supervision a week isn't an internship - there is a whole lot missing from that picture.


As others have said, we don't want to further the "race to the bottom" in our solution to this problem. To me, this sounds like an attempt to provide really awful training and graduate some folks with pretty crummy training just in the interest of resolving the problem. Letting folks with crummy credentials get into programs that provide crummy training GET to the internship phase is the problem we need to be addressing.

 

[Mein Traum]

Others have touched on a few of the issues, but I wanted to add to the list of reasons that you can't just up and "host an intern" if you want to offer an accredited internship opportunity. Of course, in addition to paying a salary, you need to have an actual training program in place, with didactics, multiple hours of supervision, and mandatory trainings on a bunch of key topics (depending on your state). All of those things seem completely prohibitive to someone in private practice. In addition, you can't just take one intern - I can't recall whether this is an APA requirement, or just a requirement in my state, but in order to be licensed, you need to come from an internship program that includes at least 2 interns per cohort. The rationale is that working and consulting with peers is an important part of training, and if you're the only intern at your site, you're missing that component.

I might argue that private practice (if that's what you're referencing) is not an ideal setting for internship in any case. All of the sites I applied to were in large hospitals that offered a range of rotation options, including inpatient, outpatient, substance abuse, SMI, neuropsych, PTSD, etc. I don't think there's any way I could have gotten the same breadth of clinical experiences within a single practice.

psychRA,

I absolutely agree with you. But, I think that if the money made sense, there would be an incentive for the training, etc. to be developed and provided. Yes, I do think that two interns is the minimum except that places have used the formation of consortiums to avoid that issue. With that said, I would love a placement in a large (or small) hospital.

M.T.

 

[futureapppsy2]

Here is the issue. Adding more APA internship sites is a band-aid. Right now, the internship crisis serves as a bottleneck for the field. If you add more APA internship sites and more people match, great, but then that bottleneck moves into post-docs and jobs. We need to move the bottleneck to before people even start doctoral programs.

This, so much. I really think the problem could be pretty close to resolved by shutting down FSPS or capping class sizes, but APA is very unlikely to do that.

 

[Mein Traum]

I would agree. I don't know that offering an internship being completely unmanageable for a private practice is a bad thing! I'm hard-pressed to believe the average private practice could offer an internship of even middling quality (assuming that is what is being suggested), just like joe blow psychologist shouldn't be able to open an APA accredited graduate program operating out of his basement. The fact that there are people without access to care (and lots of people who want to go to graduate school) doesn't change that. A full caseload with an hour of supervision a week isn't an internship - there is a whole lot missing from that picture.


As others have said, we don't want to further the "race to the bottom" in our solution to this problem. To me, this sounds like an attempt to provide really awful training and graduate some folks with pretty crummy training just in the interest of resolving the problem. Letting folks with crummy credentials get into programs that provide crummy training GET to the internship phase is the problem we need to be addressing.

Ollie,

I don't think that anyone wants to sacrifice quality. At this point, I agree that it is probably not supportable however, it doesn't hurt to ask how else something might be done. This is especially true if the current system is broken.

So, what are your thoughts on post-graduation internships?

M.T.

 

[Mein Traum]

This, so much. I really think the problem could be pretty close to resolved by shutting down FSPS or capping class sizes, but APA is very unlikely to do that.

Futureapppsy2,

Why do you think the APA will not close down the FSPS's. (Does anyone have a list of these schools because I am not sure that they are all the same.) What do you think of a post-doctoral internship?

M.T.

 

[futureapppsy2]

Futureapppsy2,

Why do you think the APA will not close down the FSPS's. (Does anyone have a list of these schools because I am not sure that they are all the same.) What do you think of a post-doctoral internship?

M.T.

Because they get a lot of money from FSPS, not only in accreditation fees but in conference sponsorship money, like for the national convention. I think there are some kinks that would have to be worked out, but overall, I think post-doc internship would be a good move and might make having interns more lucrative and therefore appealing. That said, I still think that the primary changes need to take place in shutting down or capping problematic programs that flood the job and internship markets,

 

[Mein Traum]

In terms of medical school, there is a near 100% match rate for those that attend US medical schools actually. One of the only reasons why MD's continue to command a high salary is because the AMA has managed to keep the supply of MD's low and does not accredit for profit professional schools like the APA. This is really a supply side issue. We don't need to lower standards or eliminate the internship year. The APA just needs to hold for profit schools accountable.

Graduatingsoon,

http://chronicle.com/article/In-Record-Setting-Match-Day/137969/

Percentage-wise, it isn't a lot. However, for each of these 1,097 students, it was a problem.

Best,

M.T.

 

[Mein Traum]

Because they get a lot of money from FSPS, not only in accreditation fees but in conference sponsorship money, like for the national convention. I think there are some kinks that would have to be worked out, but overall, I think post-doc internship would be a good move and might make having interns more lucrative and therefore appealing. That said, I still think that the primary changes need to take place in shutting down or capping problematic programs that flood the job and internship markets,

futureapppsy2,

Well, I guess that makes sense but, if these programs were really just diploma-mills, the APA would have no choice. It seems that the real focus is on limiting/restricting the number of people admitted to the profession. With the talk of the bottleneck being a good thing, I wonder if the imbalance is by design. If that is the case, are the FSPS's red herrings or scapegoats?

M.T.

 

[Ollie123]

I agree post-doctoral internships is a move in the right direction. However, I think it needs to be accompanied with additional quality control efforts. The problem with simply making it post-doctoral is that right now internship is one of the few quality control measures we have left. Yes, lots of good students are getting caught in the middle and that sucks. However, there is a pretty clear break in APA match rates. Many of the schools many of us wouldn't mind seeing disappear have utterly atrocious match rates. Even if these folks are still getting doctorates, it at least limits their ability to obtain certain jobs. Unfortunately, the jobs they are able to get are often those with the most vulnerable populations. These often have lower funding and are in less of a position to be picky about training standards for their providers.

I think any solution to this will need to be multifold. I'd support moving internship post-doctoral only if we TRULY make APA a minimum standard. Mostly though, I think the problem is on the supply side. Sure, some additional internships won't hurt. However, we have dramatically increased the number of folks we are graduating and this has largely come from programs that have the lowest requirements for graduation. I've said before that these schools are basically just slapping a doctorate sticker on a master's degree. Why not just "call a spade, a spade" and make them into master's programs. Problem pretty much solved right there. People can still enter the field and contribute to alleviating suffering, but are no longer artificially inflating their credentials. We've dramatically reduced the strain on the internship system. Seems a fairly simple solution once we remove the political/financial motivations from the equation.

 

[Mein Traum]

I agree post-doctoral internships is a move in the right direction. However, I think it needs to be accompanied with additional quality control efforts. The problem with simply making it post-doctoral is that right now internship is one of the few quality control measures we have left. Yes, lots of good students are getting caught in the middle and that sucks. However, there is a pretty clear break in APA match rates. Many of the schools many of us wouldn't mind seeing disappear have utterly atrocious match rates. Even if these folks are still getting doctorates, it at least limits their ability to obtain certain jobs. Unfortunately, the jobs they are able to get are often those with the most vulnerable populations. These often have lower funding and are in less of a position to be picky about training standards for their providers.

I think any solution to this will need to be multifold. I'd support moving internship post-doctoral only if we TRULY make APA a minimum standard. Mostly though, I think the problem is on the supply side. Sure, some additional internships won't hurt. However, we have dramatically increased the number of folks we are graduating and this has largely come from programs that have the lowest requirements for graduation. I've said before that these schools are basically just slapping a doctorate sticker on a master's degree. Why not just "call a spade, a spade" and make them into master's programs. Problem pretty much solved right there. People can still enter the field and contribute to alleviating suffering, but are no longer artificially inflating their credentials. We've dramatically reduced the strain on the internship system. Seems a fairly simple solution once we remove the political/financial motivations from the equation.

Ollie,

In places where I have seen the post-doctoral internship proposed, it was in conjunction with the students being required to pass the EPPP before graduating. Does that sound more palatable? Would something else need to be required? IF so, what?

M.T.

 

[Ollie123]

Significantly more, in my view. The EPPP should also not be the sole gatekeeper. It was never intended to be. Certainly that helps too - I find it quite telling that many of our threads about how unreasonably difficult the EPPP is come from graduates of questionable programs. Nearly everyone I know has basically framed it as "Yeah, its kind of a pain in the butt to find time to study for it but its no big deal". Heck some master's programs require people to pass it (in states that allow independent practice at the master's level). That said, its a start.

Mostly, I think we just need to focus on increasing the requirements for graduate school. Students should be coming out with real research experience. A 100 page rant about ravens shouldn't fly as a dissertation. Doing administrative work for someone's private practice shouldn't fly as a practicum. Other professions hold schools accountable for providing some assurance their graduates meet a minimum standard. I'm not sure why we can't do the same. I hate to think we need to make our accreditation standards this specific and am reluctant to do so because their are always exceptions, but perhaps it is necessary. I'm a big fan of how PCSAS is approaching things (even though there are some problems with it) so I'm hoping it becomes a new standard.

 

[Pragma]

Ollie, how about a 10 page rant about Ravens? I think you are being too generous about the lack of rigor in these programs.

I agree with Ollie. This is a front end problem that has to do with low standards and large class sizes. Expanding internships does more harm for the profession than good in my view, so I don't even consider it a bandaid. We need to grow appropriately with demand.

Like Ollie, I am not against modeling things more like med school where the degree comes, then internship and postdoc. But I am in no way a supporter of that without drastically regulating admissions practices, which I don't think is going to happen.

 

[Mein Traum]

Significantly more, in my view. The EPPP should also not be the sole gatekeeper. It was never intended to be. Certainly that helps too - I find it quite telling that many of our threads about how unreasonably difficult the EPPP is come from graduates of questionable programs. Nearly everyone I know has basically framed it as "Yeah, its kind of a pain in the butt to find time to study for it but its no big deal". Heck some master's programs require people to pass it (in states that allow independent practice at the master's level). That said, its a start.

Mostly, I think we just need to focus on increasing the requirements for graduate school. Students should be coming out with real research experience. A 100 page rant about ravens shouldn't fly as a dissertation. Doing administrative work for someone's private practice shouldn't fly as a practicum. Other professions hold schools accountable for providing some assurance their graduates meet a minimum standard. I'm not sure why we can't do the same. I hate to think we need to make our accreditation standards this specific and am reluctant to do so because their are always exceptions, but perhaps it is necessary. I'm a big fan of how PCSAS is approaching things (even though there are some problems with it) so I'm hoping it becomes a new standard.

Ollie,

This was new to me so, I went and looked at it. This is what I found:

"Only doctoral programs in psychological clinical science that grant Ph.D. degrees and that are integral units within non-profit, research-intensive universities are eligible to apply for PCSAS accreditation. Programs with a chief mission of training psychologists for specialized careers in applied clinical work—no matter how science-based such applied training may be—are not appropriate candidates for PCSAS accreditation." Retrieved from: http://www.pcsas.org/principles.php

Ok, I can agree that they can set any standards that they want but, that last sentence is somewhat arbitrary.

However, I can admit that I had happy chills when I read, "Whereas some graduates of clinical science programs may pursue careers devoted primarily to practice, the programs judged to be of highest quality will be those that demonstrate convincingly that the majority of their students contribute significantly to advancing scientific knowledge".

I mean really, Woo Hoo!

So, like anything, some good and some bad.

I agree that standards should be upheld. I just wonder sometimes how rigid they must be and still allow for variety.

M.T.

BTW....Ravens...fly...cute.

 

[Mein Traum]

Ollie, how about a 10 page rant about Ravens? I think you are being too generous about the lack of rigor in these programs.

I agree with Ollie. This is a front end problem that has to do with low standards and large class sizes. Expanding internships does more harm for the profession than good in my view, so I don't even consider it a bandaid. We need to grow appropriately with demand.

Like Ollie, I am not against modeling things more like med school where the degree comes, then internship and postdoc. But I am in no way a supporter of that without drastically regulating admissions practices, which I don't think is going to happen.

Pragma,

These programs...I'm still not sure that I know exactly which programs, however I can understand a hesitancy to name them. (maybe) But, I don't really feel qualified to comment because I am not sure what I might be commenting about.

I can see low standards being a problem. But, I don't know how that compares to large class sizes. Many universities have huge classes and the MOOC is becoming a popular model.

I think (and apparently the APA agrees) that not expanding internships is problematic also.

Regarding the idea of growing with demand, I addressed that in the other thread with the OOH statistics.

I like trying to understand the different sides to issues. I think that if I only absorb the ideas of those around me, I am not allowing myself to look at the entire issue. I may not always agree with you but, I respect your beliefs.

M.T.

 

[Sanman]

Because they get a lot of money from FSPS, not only in accreditation fees but in conference sponsorship money, like for the national convention. I think there are some kinks that would have to be worked out, but overall, I think post-doc internship would be a good move and might make having interns more lucrative and therefore appealing. That said, I still think that the primary changes need to take place in shutting down or capping problematic programs that flood the job and internship markets,

It always makes me chuckle that an organization that considers monitoring the ethics of members as an important task cannot see the conflict of interest and associated unethical decision making that might come from taking vast sums of money from organizations/businesses that you are tasked with policing.

 

[Ollie123]

Oh I fully agree that their "mission" isn't optimal. We've discussed it here before at great length. I view it as highly problematic and serving to further increase the gap between science and practice, and I say that as someone planning to pursue a scientific career.

I was more referring to their focus on output rather than input with regards to accreditation. They aren't saying "You have to have these classes, cover these topics, etc." as APA does. Instead they are making the case that one should look at at their graduates are doing. Admittedly somewhat easier to do with research where there is a tangible output that is easily shared (grants, pubs), but I think the general approach has a good deal of merit for clinically-oriented programs as well, albeit with somewhat greater challenges for implementation. The boarding process seems an attempt to do this clinically and I suspect it will continue to grow (albeit very slowly, barring some major changes to the field).

With regards to large class sizes - again, I don't think its by chance that the worst schools have huge classes. Though it isn't a perfect measure. I'm not sure universities having huge classes holds much water, as I assume you are referring to the undergraduate level. That is a very different ballgame than grad school (or at least should be - the fact that its not at some schools is a big part of the problem!).

 

[cara susanna]

Haha, I always love raven references.

 

[futureapppsy2]

Haha, I always love raven references.

Best thread ever. Heck, best dissertation ever. 😀

 

[DinoBar]

I'd like to know what magic wand you used to become licensed because as far as I'm concerned we ALL need to be supervised before becoming licensed. It is also my believe that people that go into the psychology field are in it to help society not for the money. But heck who am I to judge others beliefs!

Hello,

I have been watching and reading, I haven't seen this question addressed. Forgive me if I somehow missed it.

Let me frame the question a bit:

As a private practitioner, time is money. Any time taken to train or supervise a student takes away from time seeing a client.

At the medicare rate (90834 is the new 90806) that is 81.00 per hour. This is a low average when considering the private insurance reimbursement rates. If you only meet with the intern one hour a week this is $4,212 over a year.

Then, you also have to pay the intern ($18,000) and some locations provide medical insurance or other benefits.

The intern will need an office in which to see clients. This is an office that a licensed person could be using and billing from which makes that a potential loss of $71,500 (30 hrs week x 50 weeks x 81 per hour = 121,500) minus the salary of the licensee (50,000) = 71,500.

The intern is seeing clients and is not licensed, therefore every client that the intern sees is billed at a lower rate and some cannot be reimbursed at all. At a guess this is a potential loss of approximately half what a licensed person would produce or around 35,000 giving the benefit of the doubt. So, 71,500-35,000=$36,500.

We need to add various APA related fees that total over $2,000.

Without even considering any number of other issues (computer, testing supplies, staff to interview, time to complete the paperwork, time to complete paperwork asking for help with costs, etc) we are at a conservative estimate loss of well over $60,712.

Also, the person we train could potentially set up an office next door and be our competition.

1. Please, help me understand why any practitioner would want to provide an APA accredited internship?

Yes, I have read the APA internship toolkit and supposedly we should be wanting to do this for altruistic reasons, etc and yes, grant money is available but, not to the level that covers the expenditures.

2. So, would you do it?

3. How many of you will host an intern after you graduate?

4. How many that went through the match imbalance in the last ten years have finished and then decided to host an intern?

I think that this is such a systemic problem and the efforts to address it fall very short of what is needed. I do not want to offer a problem without a possible solution. I could be very wrong but, I think they need simply to change the internship requirements to post-grad and then with a professional or learner's license an intern could justify the cost of their own training.

Ideas, thoughts, etc. Tell me where I am wrong and how I might potentially convince someone to host an intern.

Best,

M.T.

 

[Mein Traum]

I'd like to know what magic wand you used to become licensed because as far as I'm concerned we ALL need to be supervised before becoming licensed. It is also my believe that people that go into the psychology field are in it to help society not for the money. But heck who am I to judge others beliefs!

DinoBar,

Your question makes no sense. Are you trying to be funny or are you really asking something?

M.T.