psyD/PhD Questions

[Sanman]

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Originally Posted by docjohng
Well, even before the Internet was popularized in the mid-1990's, I began in my early days of graduate school to index mental health resources online. When I graduated, I moved into a career working entirely online, creating some of the world's first popular mental health and psychology websites. I do consulting for a number of well-known large corporations, grant reviews for the NIMH, and wrote the book, "The Insider's Guide to Mental Health Resources Online" in 1996 (Guilford). I also have run some very active online self-help support communities, including currently my own and have hosted a weekly live Q&A chat since 1995.

Good to be here!

-John

Hey,
It's good to have you here. I've actually checked out psych central and had ideas about similar websites myself. Its rare to find another person interested in using technology to further mental health.

 

[Forensic M.S.]

Agreed, for the most part. Though, I'd remember that generally these people (prof. grads) aren't going to be competitive with you for internship and postdoc spots (at least not the ones you want). What the numbers do in my opinion is lower the quality of the field. There aren't THAT many quality internships and postdocs. How do you enforce training standards when the current system does not support the numbers we have blitzing the gates? What consequence do the numbers have on the economics of the field (supply and demand)? Professional school advocates often say the market will decide. To that, I say that we (clinical psychology) are in a stronger position if we decide. By letting the market decide, we are essentially saying that once reimbursement and job stability/security plummet to levels that make professional school students uncomfortable (people that already apparently have poor economic sense given the choice to attend a prof. school), people will stop entering the field in as large of numbers. To me, that is a damaging perspective, one worthy of a beating or three.

that argument is bunk considering the low unemployment rate of psychologists...(unless you are talking about academic settings, in which who cares, go find a job elsewhere).

you act like the field some kind of god that is all-controlling, in which that is the most naive point of view i have ever heard. try telling that to other medical professions and see what they think.

 

[Forensic M.S.]

I agree professional school are churning out too many not-so-well trained people who think they are well trained. However they still have to pass the EPPP to do anything as a psychologist, and that is quite a chore. I am in favor of professional schools, AND I am in favor of strict exams as a gateway to licensure. I wish our field would follow medicine and adopt board certifications that are universal state to state and keep most out (statistically speaking) to allow only the top 10th percentile to practice at a higher level in a certain specialty than a licensed psychologist. I bet there are more PsyD/PhD's out there who can't get licensed as a psychologist than ever before.

i agree, that way people's concerns can be alleviated and redirected to the real source of the problem, not the fact someone's degree has something else written on it.

 

[docjohng]

What is the best training model for the field?

What is the best training model for the student?

How can clinical psychologists make more money?

How can clinical psychologists assure subspeciality expertise?

I believe that professional schools like NOVA (recall, both PhDs and PsyDs graduate from there) are bad for clinical psychology because they in GENERAL matriculate students that otherwise could not get into a good program (questionable abilities), that have huge debts, less faculty-student interaction (very inconsistent training), and less depth of training (because of inferior faculty and less research/theory emphasis along with farming out practical training to local clinicians and charging huge sums of money for it). I also believe that the professional schools saturate/steer students to complicated high pay subspecialties (e.g., neuropsychology) creating more supply (harming the ratio to demand) and lowering the quality of work in the subspecialty.

Nobody knows the best training model for this field is. Five decades worth of research hasn't answered that question.

We all know what generalizations are worth, but I'll say this in reply. There is no research, at least that I'm aware of and correct me if I'm wrong, that shows that a program like Nova is matriculating poor students (easy number to look at is how many of those students make it through the program and get into an internship: 80%? 90%?). That "huge debts" has no correlation to anything. People take on "huge debts" all the time, but the question is, are those debts worth it to the individual student -- it has no effect on the field in general.

I don't know about others at larger clinical programs, but I had as much faculty-student interaction as I pleased at Nova. At the time, there was something like 30-40 faculty, plus part-timers. I became friends with a few faculty members, some of whom I still keep in touch with. I pursued exactly the kind of interest that was of interest to me and actually found different members of the faculty that could mentor me in that interest (again, not beholden to a single faculty member whom I may or may not have gotten along with in a smaller program).

There is, in no way, "less depth of training" at a school like Nova. I was more experienced and better trained after 4 years than at least 75% of those on my internship. I knew diagnostics and assessment like the back of my hand, and had something over 2,000 clinical hours before internship. I was the norm in my program, not the exception in terms of my training.

I have no idea of what you're talking about farming out practical training to local clinicians. I did my practicums in three different locations during my three clinical practice years -- community mental health centers, a university counseling center (different university), and a VA hospital. I wouldn't call any of those "local clinicians" and I would say the diversity of my clinical training experience was about as rich as I could ask for. And, by the way, each one of those locations was my top pick for practicums. Each one taught me something different, and each one had top clinicians supervising and mentoring me. You know, the actual people who do the actual work day in and day out.

So you see why I object to such ludicrous generalizations, because they don't reflect the reality of the program I was in. Perhaps you should choose another school to generalize about, because Nova doesn't fit your characterization of their doctoral program one iota.

-John

PS - And quite frankly, psychology specializations is where the growth of the industry is in. As psychologists are learning, since there's very little clinical research to back up that better patient outcomes come from PhD-level psychologists versus Master's-level therapists trained in a wide variety of areas, psychotherapy is becoming less and less of the bread-and-butter of the profession. If you want to examine and understand why psychologists have a hard time making a living in psychotherapy today, look back at the late 1980's and early 1990's when managed care started turning to the mental health field as an area to cut costs. That's what started it, not established professional programs (Nova's doctoral program was founded in 1967, which, by my count, makes it almost 40 years old).

 

[docjohng]

... I recently spoke to a graduate of my pogram who did not match due to the fact that she overestimated her chances of a top children's spot. Well after she didn't match, affiliated clinical sites from my program were able to make accomodations for her. This is possible when only 8-10 people are in a class, but what are the chances are there for this in classes of 30,40, 50, 100? The greater the number of students, the less those connections stretch.

I think the key is that if a person doesn't match, perhaps that says something about that person, no? It's great that a school can make special accommodations for a student who doesn't match through the normal process the rest of the world has to go through. But that says nothing about the "quality" of that program.

For what it's worth since we're sharing old war stories here, I knew of at least 2 students who also didn't match from Nova. Guess what? Nova also found a way to get them into "affiliated clinical sites" and were able to make accommodations for them. If you're a larger program, chances are you have a much larger network to take advantage of as well.

-John

 

[docjohng]

However, that still doesn't address the raw numbers issue. Our field has a responsibility to manage supply. NOVA is a huge offender in this regard. It doesn't inspire much confidence in APA when the president of APA is/was a professor at a school like NOVA (why I picked it as an example).

"Our field"??

What, do you think this is some sort of communal society we live in? Sorry, it's not. It's capitalism and schools are a business, whether they are non-profit, state or private.

Our field has no such responsibility. People get into psychology to help others (whether directly, through clinical practice, or indirectly, through research). Not to try and change how the laws of economics or business work.

You don't think so? IF the norm is huge debt (let's say the professional school model takes over). . . IF supply continues to balloon because programs like NOVA profit from tuition. . . what will happen to the quality of people entering psychology? What kind of financial future will psychologists have?

Like I said, Nova's been doing this for 40 years now. If you can't measure "quality" of psychologists (and I'd like to see somewhere that you can), then you're arguing an issue with no reference point.

Your whole assertion that the quality of the field is going up or down has no basis -- there's simply no qualitative research in this area. It's great if you want to go out and do some, but until there is, all you have is baseless assumptions. I can make an equally baseless assumption -- that Ph.D. programs churn out clinicians who don't know the first thing about treating real people in the real world and expect the one-year internship to do all of their real training for them. Of course that's not true, but what's to stop someone from believing it?

. . . more useless statistics regarding relative training success at an internship no one here knows anything about. . . I can tell you people knew more tests than I did at my internship at the start. Tests are easy to learn. I knew more theory.

Theory is irrelevant when, according to research, most clinicians describe their approach as "eclectic." Theory is a good foundation, one which you can easily obtain in the first year or two of any decent graduate program. If you're still on "theory" in year 3, I suspect theory is taking on a larger role than it should in a program.

Keeping in mind the purpose of theory -- to give you knowledge and exposure to the broad numbers of *theories* about people's behaviors and motivations. Theories can give you guideposts to treatment, even techniques (for some of them, for some disorders, for some people, some of the time). But they can't replace real, live experience.

3 clinical practice years? God, why? I hope they weren't full time (or that one of those was an internship). Practical training is important, but it shouldn't be the primary focus in graduate school.

Not the primary focus, but one of a number of important foci in graduate school. If graduate school is about learning, isn't practical experience one way to acquire knowledge (especially about something as esoteric as psychotherapy)?

And why shouldn't it be one of those foci? The secret of doing good psychotherapy is that you only learn how to do good psychotherapy through practice, just as you learn how to get better at any activity you want to excel at. You can study aerodynamics all you'd like, but until you enter a cockpit and take the controls for the first time, all of that theory isn't going to get you off the ground.

There's a time and place for theory. But not 4 years, and not in clinical practice. Especially not when all the research shows there are virtually no significant differences in patient outcomes based upon a particular theoretical model.

It's funny to see how your argument appears to boil down to a numbers game. I never knew it was a bad thing to be doing something so well that you could do it for more and more people.

-John

 

[Sanman]

I think the key is that if a person doesn't match, perhaps that says something about that person, no? It's great that a school can make special accommodations for a student who doesn't match through the normal process the rest of the world has to go through. But that says nothing about the "quality" of that program.

Well, I believe that there are are many reasons a person does not match, the person I am speaking of only applied to programs like CHOP and Boston Children's and was probably aced out due to lack of ressearch/opportunities compared to child only programs. Should she have set her sites lower? Perhaps, but there are probably plenty of sites that would have taken her. Being incompetent isn't the only reason for not placing through the match. My point was that if two classmates, such as the two you mentioned both wanted child placements, it may not have been able to happen even at a larger program. Mypoint was not about quality, but connections for the student. I have a 4 to 1 faculty ratio, you have a 1 to 1 from what you have stated, ergo 4 times the connections per student. For example, my program has 2 neuropsych profs and two students specialize a year. If we had four students, they would have to try and place four students ergo maybe only one program would get a call asking to look at me instead of two. My argument isn't about "quality" per se. It is simply that fewer students generally means more investment in each one if you are at a good program.


In regards to APA internship match rates, the larger schools generally have lower rates, Argosy can be pathetically low. I know that the latest stats I had said that GW psyd students had a 45% match rate (2001-2002 stats at the time was the latest available I believe) that is really low. It should be at least 90% as in most trad programs. There are many Psyd programs that do so, baylor, the indiana programs, Va consortium, rutgers. Why should I not expect that from any good program?

I am not arguing quality, in my opinion that is in the individual. I am seeing how well programs are able to aid their graduates. That is what is important to me.

 

[positivepsych]

So apparently (from the other thread) the Rutgers PsyD program has recieved a whopping 650 applications this year. With 9 acceptances per class for the past two years, that puts it at a 1.4% acceptance rate, a selectivity that rivals most of the top clinical psych programs. The demand for quality and affordable Vail-Model programs is booming, if this is any indication.

Considering the fact that there are only three reputable PsyD programs in the country that I know of that don't require debt (I'm not familiar with the Indiana ones, so I won't speak for them), that means that there are probably around 27 spots in the entire US for bright, aspiring clinicians who want a Vail-Model education in psychology, without having to go into debt.

There is something wrong with this picture.

If funding is the problem in starting more university-based PsyD programs, then the APA should try to emulate MD and JD programs. Give no financial aid and require debt, but ban MSWs, MFTs, backdoor clinicians, etc. from practicing, therefore ensuring that students with doctorates in clinical psychology can make enough of a living to pay back debt.

You don't see any aspiring Psychiatrists shying away from Med School loans, because they know they can make a living to pay it back and then some.

 

[Forensic M.S.]

Yep, and in a capitalist society, how do business areas control themselves to be profitable? Hint: One way is not by flooding the market with more supply.

No, the argument becomes one consistent with trying to prove validity. It's a construct. There is no absolute empirical test of "quality." There are only proxies and constructed arguments. Incidentally, this is how we end up with nurses prescribing medications optometrists doing surgical procedures, etc. . . It's complicated research. So, what standard do we accept becomes the question.



It does, but it's an argument that is subject to criticism. The % of grads from professional schools increases yearly. The entrance requirements to professional schools are lower. The quality of student therefore is arguable lower. The quality of faculty, ratios of faculty to students, debt levels functioning as additional stressors, etc. .. can all be arguable detriments to the field. With more professional school students every year, these variables become more significant in terms of impact on the overall quality of clinical psychology.

. . . and isn't that a shame? That just tells me there are alot of talk therapists out there that don't particularly like to think.

Theory should never be neglected. Hence, by the way, part of the reasoning for CE credits.

you are basing your argument that the demand for psychology with be overflowed. that itself is a naive and dangerous assertion to hold. also you are acting as if the field will be overflowed and be forced to become more competitive....i find that ironic considering you are all about quality of psychologists. your argument is purely paranoid unsubstantiated claims that the market can't handle the flux of those entering the field. if that is so true,then other subdivisions would not be expanding and being created.

theory can only take you so far, that is the problem. following the same old methods for eternity dooms the field to the same problems and mistakes that will never able to be solved. there has to be room for growth, and it cannot always be scientific. clinical psychology is one of the most radical areas of psychology, there needs to be room for independence rather than dependence on funding and the politics of academia.

psychology must assimilate to society, not the other way around.

 

[Forensic M.S.]

So apparently (from the other thread) the Rutgers PsyD program has recieved a whopping 650 applications this year. With 9 acceptances per class for the past two years, that puts it at a 1.4% acceptance rate, a selectivity that rivals most of the top clinical psych programs. The demand for quality and affordable Vail-Model programs is booming, if this is any indication.

Considering the fact that there are only three reputable PsyD programs in the country that I know of that don't require debt (I'm not familiar with the Indiana ones, so I won't speak for them), that means that there are probably around 27 spots in the entire US for bright, aspiring clinicians who want a Vail-Model education in psychology, without having to go into debt.

There is something wrong with this picture.

If funding is the problem in starting more university-based PsyD programs, then the APA should try to emulate MD and JD programs. Give no financial aid and require debt, but ban MSWs, MFTs, backdoor clinicians, etc. from practicing, therefore ensuring that students with doctorates in clinical psychology can make enough of a living to pay back debt.

You don't see any aspiring Psychiatrists shying away from Med School loans, because they know they can make a living to pay it back and then some.

i couldn't agree more.

 

[Forensic M.S.]

Most naive point of view you have ever heard? Have you ever heard the one about how the earth is only 3000 years old? Your hyperbole is amusing. Regarding medical professions, I'm sure they could relate well to my arguments. The AMA has been a very successful all-controlling god. The medical field has, for the most part, succeeded in controlling their numbers quite well.

that was the point, you are trying to emulate the arrogance of the medical community, which is finally being confronted in regards to prescription privledges. as for relating to them, they'd just laugh in your face (as they are considered higher in the food chain)

 

[JatPenn]

sounds like from your plan, positivepsych, it makes much more sense just to do away with the Psy.D. degree altogether and direct those bright, aspiring clinicians to several excellent MSW, MFT, LCSW programs. This way they can do all the clinical work they want, without incurring too large of a debt due to the relative brevity of these programs.

 

[Forensic M.S.]

i think it would make more sense to give psych undergrads preference over other fields in my opinion, other majors are not so open and welcoming

 

[50960]

aagh this brings back memories. In the Right corner we have Dr. Snow, a talented neuropsych post-doc with Psy.D. wife, and in the left corner we have a new (to SDN), bright CLINICAL psychologist. 15 rounds, throw in the flag if you wish, winner will be decided by unanimous decision (me, me, me) jk🙂. I love this stuff...carry on!

PS. psychiatry forum is ramping up for a new sticky on differences between psychologists and psychiatrists..please go and give them your all. I have sworn off that group since my last tirade, but they are a good group all in all.

 

[JatPenn]

I'm not sure I understand your point, forensic, if that was directed at me.

Will someone answer this question: why is it that those who want to do only clinical work forgo something like a master's in social work to pursue a PsyD? Social workers do GREAT work and have been around for a long time.

 

[50960]

People pursure a doctorate over and MSW so they can be better trained, and have a much more liberal scope of practice.

😱

 

[JatPenn]

are they better trained? the research says maybe not...

 

[docjohng]

Yep, and in a capitalist society, how do business areas control themselves to be profitable? Hint: One way is not by flooding the market with more supply. [...] Right, which is why I think the position that market forces will solve the ills caused by professional schools is an erroneous argument.

You know, if the world were so simple as to point to one thing and say, with no data to actually support your position, mind you, "This is the cause of this problem!" there'd be little need for empirical research in the first place. We could just use our biases and opinions to form conclusions and bypass that whole messy data-collection and analysis phase altogether.

And yet, this appears to be exactly what you're doing here. You have no data, yet you're arguing as though it were an obvious point. The world is complex, and the minute we think we "know" something, it is proven that we didn't know nearly as much as we had thought. The minute someone starts telling me they know X causes Y, I do what any good psychologist does -- I ask for the data. Show me the data.

No, the argument becomes one consistent with trying to prove validity. It's a construct. There is no absolute empirical test of "quality." There are only proxies and constructed arguments. Incidentally, this is how we end up with nurses prescribing medications optometrists doing surgical procedures, etc. . . It's complicated research. So, what standard do we accept becomes the question.

And yet, here we are, 40 years later (from Nova's psychology program inception, anyways), and still, we have no data. No quality indicators. Nothing to tell you that X program is better than Y program (other than the dubious data point of "number of graduates," which is a fairly absurd datapoint to draw any conclusion from. Look at how the number of admissions into Harvard's MBA program have increased in the past two decades. Can I say they are now churning out lesser-quality professionals? Of course not, not unless I'm actually measuring that.).

It does, but it's an argument that is subject to criticism. The % of grads from professional schools increases yearly. The entrance requirements to professional schools are lower. The quality of student therefore is arguable lower. The quality of faculty, ratios of faculty to students, debt levels functioning as additional stressors, etc. .. can all be arguable detriments to the field. With more professional school students every year, these variables become more significant in terms of impact on the overall quality of clinical psychology.

I'd criticize the argument if it were actually a coherent argument. But it seems to boil down to "Well, since they're accepting more students, their entrance requirements must be lower, therefore the student quality must be lower, therefore the graduating students' quality must be lower, therefore more graduates are competing for less jobs, therefore all Psy.D. programs and students are bunk." All of this is easily and readily testable. But in the absence of data, most researchers I know wouldn't go out on a limb and say things they know they have no proof of.

There's an equally ridiculous opposite of your theory, but because I actually respect my colleagues with a Ph.D. and have no data to support it (outside of subjective reports), I won't verbalize it here.

-John

 

[docjohng]

There is something wrong with this picture.

If funding is the problem in starting more university-based PsyD programs, then the APA should try to emulate MD and JD programs. Give no financial aid and require debt, but ban MSWs, MFTs, backdoor clinicians, etc. from practicing, therefore ensuring that students with doctorates in clinical psychology can make enough of a living to pay back debt.

It's not up to the APA to say who practices psychotherapy and who doesn't. It's up to individual states to determine those licensing requirements and let me assure you, it is no easy or simple thing to stop a profession from doing what it's already been doing. It would decades and would likely be an unsuccessful effort.

It would be more successful, however, if we psychologists had data to show the public that psychologist do a better job (as shown by more positive patient outcomes) than other helping professions. The problem, of course, is that we don't have that data. It would be nice if we did. Studies show just the opposite -- that it generally doesn't matter what type of degree you have to affect patient outcomes.

What psychologists have to do is to try and find areas where their training, experience and background give them a lead or a place to grow. They're trying to do that with prescription privileges, but that's more to pursue autonomy and more money than it is because people believe psychologists have some unique insight into prescribing medications.

Things change, professions change, their scope and focus becomes refined. To expect that just because psychologists were, at one time, the leaders in providing psychotherapy and that it should always be that way is to be in denial (or to be a little naive). We lost the time when we could stop others from practicing this thing, so now we have to be more creative in figuring out ways to make our profession stand out in other ways.

-John

 

[50960]

There is no doubt psychologists are better trained than masters level therapists, and research doesn't support or refute this it is simply a matter of coursework and experience. MD are better trained than NP's who are better trained than RN's etc.

 

[docjohng]

The entrace reqs are lower. It may be related to accepting more students, but it's still the case. Student quality is a construct validity argument again. I'd say students with higher undergrad GPAs, higher GRE scores, more research experience, and so on are better quality (you might disagree).

Perfectly acceptable for you to believe that, it's a nice belief to have as it sustains your argument. But the evidence that we do have doesn't really support those conclusions, does it? Is there any evidence to suggest higher GPA/GRE correlates to better patient outcomes, or if you're a researcher, greater numbers of published articles or higher numbers of grants brought in?

For clinicians, at the end of the day, it all boils down to, "Do clients getter better, faster, than if left to their own devices, or paired with a different type of professional than me?" The answer is (what we know right now), no. There is no data to support that type of professional (or degree, or graduate program) correlates to better patient outcomes. Sorry.

More students are competing for less internships.

So you have three options:

1. Do nothing.
2. Reduce the number of students (understanding that students are a result of market forces and a demand curve, and an ever-increasing population. If you want to go against the market forces and demand curve, you're going to need to do it with regulatory action, not gentle requests).
3. Increase the number of internships. Look at why internships drop out of offering their programs (there are a number of well-understood reasons), and work to address those issues. There's certainly no lack of clients wanting to obtain therapy services.

-John

 

[docjohng]

On a side note, why is Harvard's MBA program so well regarded? Or rather, what are some indicators that it is a good program?

[...] entrace reqs. It is elite. The students are the best of the best.

[...] To make a sports analogy, success is often about the Jessies and the Joes, not the program, not the scheme, not the strategy.

So are you saying the public is best served by those coming from "elite" programs, not those coming from more mainstream programs?

People get a Harvard MBA because it's positively correlated with a high salary (from Day 1) and high salary potential. I doubt I could say the same thing of even the most presitigious psychology Ph.D. programs. Whether it relates to quality, I have no idea; I don't know that it does. The point of the analogy was to show that an increase in program size has no obvious relationship to any indicator in that program's quality.

-John

 

[docjohng]

Well, no it doesn't all boil down to that. It is a career. But, if we're going to argue along those lines. . . There is more to clinical psychology than therapy in the applied realm. What about subspecialties (e.g., neuropsychology)? What are the board cert rates for psyds vs phds? What about the match rate for PsyDs vs PhDs in the APPCN match?

You keep talking about statistics that are important to professionals. I keep talking about statistics that matter to people outside of school. Because if it doesn't affect your ability to garner good outcomes (yes, neuropsychologists want good outcomes too, don't they?), then what's the point?

These things may seem important to a student, because that's all a student has to go on early in their career. But once you start doing work in the field, you quickly forget those things because nobody cares about them. They are a means to an end, not an end in and of themselves. Here's a secret -- getting a good match isn't predestined based what program you're coming from. It comes from you -- as an up and coming professional -- to show the program that you're a *good fit* for that particular program. Your knowledge and skills complement that program's needs. That isn't shown by the degree you're trying to attain or what school you're going to to attain it. It's shown only by you and your abilities. And you can learn those abilities at any accredited school. There's no secret or magical formula to learning to do good therapy (or anything else in psychology). It's just a matter of learning and practicing that learning in an applied setting.

When I refer someone to another professional, I don't care where they scored on their GRE or ranked in their class. I care that they understand the complexity of the disorder and the person in front of them, and can bring about a good outcome for that client. It's that simple. Clinicians' careers are ultimately based upon whether they have a good word-of-mouth marketing network and a good, earned reputation in their community. Not from degrees, credentials, or what program they graduated from.

Everything else is just professional decoration.

-John

 

[docjohng]

The problem is that PsyD programs are not mainstream at all. They are basement level academic institutions, many little more than voc. type businesses (e.g., argosy). The PsyD could be great if it were supported by mainstream academia. It isn't.

And this is where I respectfully agree to disagree with your broad, sweeping generalizations and wish you well with this line of argument with others. It's a shame to see such ridiculous assertions coming from someone who apparently has a science background, but it's also clear that your arguing from religious grounds, not factual ones.

Good luck with that.

-John

 

[docjohng]

[...] Are there clear cut differences that have been measured right now for board certified clinical neuropsychologists vs. nonboard certified clinical neuropsychologists? I don't know. I do know that the board certified ones have gone through a fairly rigorous process and met reqs agreed upon by div 40. That's called oversight. In other words, while we don't know if board certified Npsychs are better than nonboard certified npsychs, we still are obligated to enforce and require standards of training and competence that are agreed upon in the field. [...]

Who cares? You're not even a member of the APA, so why trot out Division 40 standards? Why say you have no idea whether board-certification means anything in one breath, then make the assertion that they must mean something since Division 40 says they do (when, in fact, there's no research to back that assertion)?

Here's the deal... You're a psychologist or learning to become a psychologist, right? You have a hypothesis, right? What do psychologists do when they have a hypothesis that the current dataset can't and doesn't support? Do they continue to argue in a data-less vacuum, or do they go out and find the data to help support their hypothesis?

If you're not willing to test your hypothesis and have it supported or disproved by the data, then you're really tilting at windmills, aren't you? Anybody can express their opinion, but without proof, it just remains an opinion. So while it's fun to hit this back and forth, it's a religious argument without merit or function. You can't prove your assertion without an empirical study (or geez, go cheap and just do a survey). Not because it hasn't been tried (it has to some extent, go do your research), but because the data don't support it.

-John

 

[docjohng]

My contentions are supported well internally and, for the most part, unknown externally with respect to clinical outcome data. I am not dissuading anyone from researching that particular aspect further.

Ya know, that's exactly what my friend's psychic said -- since she believed it herself, she didn't need any "proof" that anything else existed.

Exactly what I'd expect from a psychic.

Exactly the wrong kind of response I'd expect from a psychologist or someone studying to become one. Too bad.

-John

 

[50960]

Snow....I think you lost this one.

 

[Forensic M.S.]

yeah actually it is

 

[Sanman]

You know it sounds to me as if you guys are arguing somewhat different points. The way I see it johng, you are arguing that the difference between phds, psyds, and even masters level individuals may not have a large impact on some forms of clinical treatment. While this view may or may not be correct, it only talks about the benefit to patients and says nothing of the impact on providers. I for one think psychologist salaries are low enough considering be spend about half a decade in school after college. If we continue to increase numbers without consideration, we could end up similar to academia in the inability to find jobs or well paying jobs. I didn't sign up to go to school for years just to end up making less than friends who went to work after college. If you think economic forces will even this out, just look at te record number of PhD's graduating every year to few jobs. As far as test such as the EPPP ensuring subpar clinicians do not practice, that is fine. However, if average scores of accepted individuals continue, you will end up accepting individuals who cannot handle the workload and pass such an exam. Is it not doing those individuals a disservice to force them to pay exorbitant fees to end up without a career? My goal is to try and take some action now before it reaches crisis level. As it is, PhDs are already being undermployed and underpaid all the time.

All are welcome to mock the medical model, but they have done a great job ensuring the future economic viability of their degree.

 

[Sanman]

An interesting discussion on economics and the PhD glut from an economist

www.lewrockwell.com/north/north427.html

 

[Neuro-Dr]

O.K., I'll trot the data out

Grad school
PhD - Applicants 161
Accepted 10% (9.8 students)
Enrolled 10%
PsyD - Applicants 156
Accepted 40% (34.9 students)
Enrolled 20%
Total Applied
PhD - 20,286
PsyD - 6,722

Total Enrolled
PhD - 1,217
PsyD - 1,502

Internship (2005)
Total Spots 2850
Total Appicants 3050
If you just had PhD programs, roughly 1500 spots per year would go unfilled. Since 80% of APPIC sites are also APA. that means roughly 1200 sites unfilled.

Average number of Post Doctoral sites available from APPCN per year (67)
Average number of NP graduating from APA-approved NP schools 361 (all PhD programs except 2). Thus, most PhDs will not go to an APPCN site (This is NP for Jon's benefit).

School with the highest number of ABCN members (Nova), second (Wright State) - source (neurolist)

Percentage of new board certified (ABPP) in Clinical Psychology holding PsyDs, 22%.

Enjoy

 

[Jon4PsyD]

Great data there--it just proves there is room in Clinical Psychology for the PsyD (Not that there was much doubt, the degree has sruvived 40 yrs and is only gaining respect/popularity).

Jon🙂

 

[LM02]

O.K., I'll trot the data out

Grad school
PhD - Applicants 161
Accepted 10% (9.8 students)
Enrolled 10%
PsyD - Applicants 156
Accepted 40% (34.9 students)
Enrolled 20%

Just curious - where are these data from?

I'm a firm believer in looking at things from non-extreme points of view. I hold a PhD, but I also see the utility in the PsyD degree. With that said, there are certain ways to ensure high levels of quality control in PsyD training - the university-based PsyD programs demonstrate this nicely (as do certain small private institutions such as the Wright Institute).

It is when certain programs operate from a business perspective (like Sanman said), that PsyD training becomes problematic. These programs have an inherent conflict of interest - utilize high standards for admissions and limit numbers (which, in turn, limits $$), or relax these standards and ensure that they have a very nice cash flow... personally, I see this as a recipe for disaster.

The numbers quoted above suggest that there are a number of internship slots that would go unfilled if not for PsyDs. So let's say we extract the number of PsyDs who come from these programs with higher admission standards and assume that they fill these slots. I wonder how many unfilled slots there would be after that?

Because as it is, many PsyDs coming out of these behemoth professional schools are not even vying for the APA internships, and are going outside the match to find non-accredited internships.

 

[Sanman]

Well for some reason I'm having trouble copying the quote, but everyone take a look at the 2005 internship stats. As it stands, 200 people are guaranteed not to match at all because there are not enough spots. This maybe good for internship sites but, is bad for applicants. And if enrollment in professional schools continues to increase and internship sites continue to remove spots or close due to the rising costs and smaller payouts of internship spots this will become a much larger problem. The only way to conrtol this is by limiting spots or creating more internship sites. Since internship sites are more likley to close than open in this financial climate that would only leave one option. For those who would say that there are sites outside the match, that is true and applicant already fill these as well. Also, these non-accredited sites make it difficult to get licensed. What we do not need in this field is a glut of psychologists w/out internships or who cannot get licensed. That is a big problem in my view.

 

[Sanman]

Duplicate post

 

[Neuro-Dr]

the data come from the Practice guide that is put out about every 5 years from the APA, a portion of this, which can be used to verify this data is in the Dec 2005 American Psychologist, but you can ask the APA for the entire study. Alliant and Argosy make up about 600 of the 1500 PsyD students, so there would still be about 600 APA internships left out. I'm not trying to push any particular agenda, but rather to illustrate that the belief that the production of a small number of psychologist and even smaller number of NP produced each year is more likely to lead to irrelevance of the field than to an increase in quality. Psychologist make up the smallest number of providers within any MH insurnace panel (around 5-15%). The only thing small is psychiatry (around 5%). Manay states are currently battling to keep MAs from providing psych testing and diagnosing patients. The continued view that there are enough psychologist with only the current PhD production is flawed and the belief that the fellowship or even board certification as a means to practice (which is currently going in FL within NP and if passed would mean folks like Jon Snow would be precluded from calling themselves a NP within that state until boarded) is flawed under the current system where only 13% of the entire field is boarded. (BTW - Jon, I'd love to hear your thoughts on this, I think they are often quite relevant).

My only motivation is to encourage a little out-of-the box thinking on these issues as to how a more dynamic field of psychology can emerge. Much of the PsyD movement was lead by psychologists who were concerned that a student could make it all the way to licensure without ever seeing a patient, hence the emergence of a bi-furcated (sp?') system in many states. Any other references for data or additional data wanted, I'll post.

 

[Neuro-Dr]

Psychiatrist are already experiencing this with us. One of the main positions put forward by RxP in psychology is the limited number of psychiatrists and the limited role they play in treatment. We have moved to gain their privledges in the same way that MA therapists have moved on testing. It is a possible hypocracy to say that we should be given more, but no one else should. I agree with the position we have taken, but worry about the complexities of RxP. If MA people, let's say school psychologists, say that we already give IQ, achievement, BASC, autism, aspergers and adhd measures - how far away are they from a PIC-2?

Can we afford to reduce the number of psychologists per year by half? Part of APA approval is a relieble cohort, if you leave 600 open spots, these places will close of lose accreditation or funding.

As for boards, 67% of psychiatrists are boarded, this is not what is happening in psychology - in order to require it, you have to demonstrate the relevance, I am not saying value. As a board-certified NP, I certainly appreciate the process andknow what it takes to get through it. What has happend with ABCN is that their willingness to pusue a more elitist stance has lead to 3 boards in NP, we could have avoided this with less of an attitude and frankly, I don't believe that the other board are lacking. Say what you want about ABPn not having a written exam, but 12/14 ABPP boards don't have one, so you can't say it is really a needed until ABPP comes back and says so.

I would not support your ban, but would say that the APA CoA should put guidelines for placement, coverage, retention, admission, faculty training in a more cogent manner - they are so wrapped up in diversity, gender and other issues, that while important are not the exclusive problems in the field. If they did this, the AU and Alliant numbers would drop in half or more and those comming out would be stronger.

 

[Neuro-Dr]

Good posts. Irrelevance from small numbers. Didn't think of that. Psychiatry is still relevant and they have substantially lower numbers than we do. I think irrelevance is more likely to occur with blurred boundries between disciplines (i.e., the supposed dumbing down of healthcare) and lower and lower standards for practioners.

I understand it isn't currently practical to require board certification to practice. But, I do think a phase-in system could potentially work. For example, like education, we might try a provisional license with a time limit to allow practice initially without board cert. I think board certification is one mechanism by which to fight the dumbing down of psychology
(e.g., masters level people diagnosing and assessing). We need to communicate strongly that what we do requires expertise and careful management (as it does). Allowing people with no training to interpret tests and perform as de facto psychologists is the true enemy in my opinion.

A shortage of applicants for internship slots, on the face of it, does not bother me. Internship slots are cheap labor for sites in any case. I don't see that as a problem. The issues are numbers, economics, relevance (as you've brought into the discussion), training quality, territory defense, and interspersed through all of that. . .ethics. I would support an immediate ban of alliant and argosy model programs.

Psychiatrist are already experiencing this with us. One of the main positions put forward by RxP in psychology is the limited number of psychiatrists and the limited role they play in treatment. We have moved to gain their privledges in the same way that MA therapists have moved on testing. It is a possible hypocracy to say that we should be given more, but no one else should. I agree with the position we have taken, but worry about the complexities of RxP. If MA people, let's say school psychologists, say that we already give IQ, achievement, BASC, autism, aspergers and adhd measures - how far away are they from a PIC-2?

Can we afford to reduce the number of psychologists per year by half? Part of APA approval is a relieble cohort, if you leave 600 open spots, these places will close of lose accreditation or funding.

As for boards, 67% of psychiatrists are boarded, this is not what is happening in psychology - in order to require it, you have to demonstrate the relevance, I am not saying value. As a board-certified NP, I certainly appreciate the process andknow what it takes to get through it. What has happend with ABCN is that their willingness to pusue a more elitist stance has lead to 3 boards in NP, we could have avoided this with less of an attitude and frankly, I don't believe that the other board are lacking. Say what you want about ABPn not having a written exam, but 12/14 ABPP boards don't have one, so you can't say it is really a needed until ABPP comes back and says so.

I would not support your ban, but would say that the APA CoA should put guidelines for placement, coverage, retention, admission, faculty training in a more cogent manner - they are so wrapped up in diversity, gender and other issues, that while important are not the exclusive problems in the field. If they did this, the AU and Alliant numbers would drop in half or more and those comming out would be stronger.

 

[docjohng]

Psychiatrist are already experiencing this with us. One of the main positions put forward by RxP in psychology is the limited number of psychiatrists and the limited role they play in treatment. We have moved to gain their privledges in the same way that MA therapists have moved on testing. It is a possible hypocracy to say that we should be given more, but no one else should. I agree with the position we have taken, but worry about the complexities of RxP. If MA people, let's say school psychologists, say that we already give IQ, achievement, BASC, autism, aspergers and adhd measures - how far away are they from a PIC-2?

This is one of the main reasons I'm against prescription privileges for psychologists. While true that there is not enough psychiatrists, I think the answer is best answered by professionals with existing medical training. Psychologist get little to no medical training, so it never made sense to me that they were an answer to this problem. If you want prescription privileges, there are many, many avenues open to you already for nearly the same amount of training.

As for boards, 67% of psychiatrists are boarded, this is not what is happening in psychology - in order to require it, you have to demonstrate the relevance, I am not saying value. As a board-certified NP, I certainly appreciate the process andknow what it takes to get through it. What has happend with ABCN is that their willingness to pusue a more elitist stance has lead to 3 boards in NP, we could have avoided this with less of an attitude and frankly, I don't believe that the other board are lacking. Say what you want about ABPn not having a written exam, but 12/14 ABPP boards don't have one, so you can't say it is really a needed until ABPP comes back and says so.

I'm not sure you have to demonstrate relevance or value of boarding. The only people who need to be convinced of its value are the professionals who pay for it. Consumers generally already understand its value in terms of exclusivity.

But psychologists already are, arguably, the most "exclusive" and highest-cost mental health practitioners. They are a minority of the psychotherapy caregivers on insurance panels, yet next to psychiatrists, are the highest paid. They are recognized for their specializations -- assessment, neuro, forensics, etc. -- yet psychology probably doesn't want to be marginalized as a profession of only specializations.

I'm not sure there are any obvious or easy answers to questions like these. Well, there's one -- prescription privileges -- and that's the one the profession is aggressively pursuing and will eventually obtain in most states.

John

 

[50960]

Docjon, write me about my Rx work. I manage drugs every day, order labs, and have done very well. It is possible, but YES we need good training to make it work well.

 

[Therapist4Chnge]

I understand it isn't currently practical to require board certification to practice. But, I do think a phase-in system could potentially work. For example, like education, we might try a provisional license with a time limit to allow practice initially without board cert. I think board certification is one mechanism by which to fight the dumbing down of psychology (e.g., masters level people diagnosing and assessing). We need to communicate strongly that what we do requires expertise and careful management (as it does). Allowing people with no training to interpret tests and perform as de facto psychologists is the true enemy in my opinion.

This is something I really support. I think NP is the perfect example of a place where boarding should be pushed. Of course...we need a unified board to do this, not a bunch of decorative board certifications.

-t