Questions on intern year and the development of fellowship/post-doc

[jadedphysiotherapist]

Hi,
I wanted to know if I could get any feedback on the development of intern year, fellowship, and post-docs in psychology practice.

Do PhD grads complete them as well as PsyD grads and what was the historical timeline for development for fellowship and post-doc....say for example, neuropsychology?

How are the programs structured? Is a generic supervised "hour" count with mentorship or are diagnoses, interventions, and outcomes measured and tracked prior to graduation?

Does the field reserve certain CPT coding for fellowship and post-doc students to provide pay incentive and create competition, are there usually legalities for psychological testing administration that are obtained postgrad that differentiates a board certification from lack of one, or is it a pathway to work at an institution that highly encourages it following a mandatory training component?...Or a combination?

Finally, has the field ever needed or wanted to change the training pathway for PsyD students to decrease student debtload? Is there talk about it?

Just looking for more information on the field and comparisons of training models. Anything is greatly appreciated.

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[WisNeuro]

These questions would take like several book chapters to answer. Any one of these you'd like answered more than others, in a more specific sense?

 

[erg923]

Hi,
I wanted to know if I could get any feedback on the development of intern year, fellowship, and post-docs in psychology practice.

Do PhD grads complete them as well as PsyD grads and what was the historical timeline for development for fellowship and post-doc....say for example, neuropsychology?

How are the programs structured? Is a generic supervised "hour" count with mentorship or are diagnoses, interventions, and outcomes measured and tracked prior to graduation?

Does the field reserve certain CPT coding for fellowship and post-doc students to provide pay incentive and create competition, are there usually legalities for psychological testing administration that are obtained postgrad that differentiates a board certification from lack of one, or is it a pathway to work at an institution that highly encourages it following a mandatory training component?...Or a combination?

Finally, has the field ever needed or wanted to change the training pathway for PsyD students to decrease student debtload? Is there talk about it?

Just looking for more information on the field and comparisons of training models. Anything is greatly appreciated.

Thanks for your zillion part question. Why dont you narrow it down and we can assist.

Until then: Clinical psychology - Wikipedia

 

[PsyDr]

Hi,
I wanted to know if I could get any feedback on the development of intern year, fellowship, and post-docs in psychology practice.

Do PhD grads complete them as well as PsyD grads and what was the historical timeline for development for fellowship and post-doc....say for example, neuropsychology?

How are the programs structured? Is a generic supervised "hour" count with mentorship or are diagnoses, interventions, and outcomes measured and tracked prior to graduation?

Does the field reserve certain CPT coding for fellowship and post-doc students to provide pay incentive and create competition, are there usually legalities for psychological testing administration that are obtained postgrad that differentiates a board certification from lack of one, or is it a pathway to work at an institution that highly encourages it following a mandatory training component?...Or a combination?

Finally, has the field ever needed or wanted to change the training pathway for PsyD students to decrease student debtload? Is there talk about it?

Just looking for more information on the field and comparisons of training models. Anything is greatly appreciated.

1) yes
2) about 9 years (5-7 grad school, 2 for neuropsych or 1 for general)
3) fairly rigorously
4) the latter
5) no
6) depends on state, but the ending of your question isn't correct
7) sorta. Some people care, some don't. There's a bunch of issues wrapped into this including quality of training, attempts to keep the field small as some method of idealized reduced competition which ignores that cpt valuation is more important than the number of providers for income, people seeking to enter the field for their own emotional purposes that keep them from any logical discussion, sharks who are happy to charge people whatever they can possibly get out of them, interaction between newer educational laws interfering with the previous educational modes, etc.

 

[deleted343839]

Eh, I'll bite. Quickest answer I can muster:

When it comes to internship and beyond there are no functional distinctions between PhD and PsyD students. The internship year is a critical component of training for all doctoral trainees. The postdoc year(s) can refer to an organized fellowship program or an informal period of supervised practice. Licensure requirements for postdoctoral training vary between states and will probably continue to vary for the foreseeable future. Though some states have done away with the requirement of a postdoc year for licensure purposes, many if not most psychologists still consider this important for training and professional development. In most practice specialties, but especially neuropsychology, a postdoctoral fellowship is regarded as essential preparation for entry-level practice.

The field (if by that you mean APA, state psych associations, etc.) advocates for policies that are favorable to trainee billing, but billing and reimbursement practices are ultimately determined by other entities (governments and payers). Again, these vary by state.

Finally, has the field ever needed or wanted to change the training pathway for PsyD students to decrease student debtload? Is there talk about it?

Once upon a time, huge student debt loads were not as common as they are now. The growing burden of debt can be traced to policy changes favorable to proliferation of for-profit graduate programs. It is widely known that for-profit schools, which disproportionately offer the PsyD degree, tend to have larger class sizes and poor to mediocre outcomes relative to traditional, university-based programs. In other words, it's not the training pathway that needs to change. Personally, I am of the opinion that the PsyD model was an answer to a problem that no longer exists. Possibly the biggest myth out there among people interested in psychology doctoral programs is that PsyD = practitioner and PhD = academic.

I know that doesn't answer all your questions, but you are welcome to look up detailed standards for education and training on the American Psychological Association web site.

 

[jadedphysiotherapist]

These questions would take like several book chapters to answer. Any one of these you'd like answered more than others, in a more specific sense?

Sure. How competitive are post doc fellowships and are they a requirement in that you cannot treat a population without it...or are they more encouraged due to developing practice patterns and passing off expertise?

Basically, if you are in one state, are your job prospects very low compared to a post doc even if post doc isn't required for entrylevel?

Thanks for your zillion part question. Why dont you narrow it down and we can assist.

Until then: Clinical psychology - Wikipedia

Literally made me lol.

How about this....what fellowships and postdocs exist outside of neuropsych and does your field have different assessments used in your evaluations, specific to each one, that you become competent in, following completion?

1) yes
2) about 9 years (5-7 grad school, 2 for neuropsych or 1 for general)
3) fairly rigorously
4) the latter
5) no
6) depends on state, but the ending of your question isn't correct
7) sorta. Some people care, some don't. There's a bunch of issues wrapped into this including quality of training, attempts to keep the field small as some method of idealized reduced competition which ignores that cpt valuation is more important than the number of providers for income, people seeking to enter the field for their own emotional purposes that keep them from any logical discussion, sharks who are happy to charge people whatever they can possibly get out of them, interaction between newer educational laws interfering with the previous educational modes, etc.

I'm surprised ppl don't care more honestly. We're flipping out quite a bit.....but that may just be generational.

Eh, I'll bite. Quickest answer I can muster:

When it comes to internship and beyond there are no functional distinctions between PhD and PsyD students. The internship year is a critical component of training for all doctoral trainees. The postdoc year(s) can refer to an organized fellowship program or an informal period of supervised practice. Licensure requirements for postdoctoral training vary between states and will probably continue to vary for the foreseeable future. Though some states have done away with the requirement of a postdoc year for licensure purposes, many if not most psychologists still consider this important for training and professional development. In most practice specialties, but especially neuropsychology, a postdoctoral fellowship is regarded as essential preparation for entry-level practice.

The field (if by that you mean APA, state psych associations, etc.) advocates for policies that are favorable to trainee billing, but billing and reimbursement practices are ultimately determined by other entities (governments and payers). Again, these vary by state.



Once upon a time, huge student debt loads were not as common as they are now. The growing burden of debt can be traced to policy changes favorable to proliferation of for-profit graduate programs. It is widely known that for-profit schools, which disproportionately offer the PsyD degree, tend to have larger class sizes and poor to mediocre outcomes relative to traditional, university-based programs. In other words, it's not the training pathway that needs to change. Personally, I am of the opinion that the PsyD model was an answer to a problem that no longer exists. Possibly the biggest myth out there among people interested in psychology doctoral programs is that PsyD = practitioner and PhD = academic.

I know that doesn't answer all your questions, but you are welcome to look up detailed standards for education and training on the American Psychological Association web site.

It is the same job at the end of the day with the same license then? Tho a PhD can more easily transition into academia?




Thanks for the responses everybody

 

[WisNeuro]

Sure. How competitive are post doc fellowships and are they a requirement in that you cannot treat a population without it...or are they more encouraged due to developing practice patterns and passing off expertise?

Basically, if you are in one state, are your job prospects very low compared to a post doc even if post doc isn't required for entrylevel?

Depends on the specialty. Neuropsych fellowships are easy to get if you come from a reputable background. Those from diploma mills may struggle, or will be forced to take "postdocs" where the are essentially a glorified psychometrist there to pump up billing numbers. As for job prospects, if you do not have a neuropsych fellowship, you are ineligible to work in probably 90% of institutional settings (caveat with older neuropsychs trained before the HCG were set up). I have yet to see a job posting that hasn't at least required it, with most of those requiring board eligibility or board certification as well. I'm sure you can set up a PP somewhere, but good luck finding referral sources.

 

[Therapist4Chnge]

Fellowships are being pushed outside of neuropsych..rehab, health, etc.

 

[PsyDr]

Fellowships are being pushed outside of neuropsych..rehab, health, etc.

but who would want to go into rehab.....

 

[psych.meout]

Depends on the specialty. Neuropsych fellowships are easy to get if you come from a reputable background. Those from diploma mills may struggle, or will be forced to take "postdocs" where the are essentially a glorified psychometrist there to pump up billing numbers. As for job prospects, if you do not have a neuropsych fellowship, you are ineligible to work in probably 90% of institutional settings (caveat with older neuropsychs trained before the HCG were set up). I have yet to see a job posting that hasn't at least required it, with most of those requiring board eligibility or board certification as well. I'm sure you can set up a PP somewhere, but good luck finding referral sources.

Can you and anyone else discuss this a bit more?

What would constitute a "reputable background?" How easy is "easy?" How plentiful are these fellowships?

 

[WisNeuro]

Can you and anyone else discuss this a bit more?

What would constitute a "reputable background?" How easy is "easy?" How plentiful are these fellowships?

Going to a reputable clinical psych program. Having decent practica during grad school. Actually doing research in the neuro realm. Going to an accredited APA internship. In my view, the fellowships are very plentiful, although a exact number is hard to get due to many spots being outside of the match.

 

[jadedphysiotherapist]

Going to a reputable clinical psych program. Having decent practica during grad school. Actually doing research in the neuro realm. Going to an accredited APA internship. In my view, the fellowships are very plentiful, although a exact number is hard to get due to many spots being outside of the match.

Do you still have a supply issue with less sites than students?

 

[jadedphysiotherapist]

Depends on the specialty. Neuropsych fellowships are easy to get if you come from a reputable background. Those from diploma mills may struggle, or will be forced to take "postdocs" where the are essentially a glorified psychometrist there to pump up billing numbers. As for job prospects, if you do not have a neuropsych fellowship, you are ineligible to work in probably 90% of institutional settings (caveat with older neuropsychs trained before the HCG were set up). I have yet to see a job posting that hasn't at least required it, with most of those requiring board eligibility or board certification as well. I'm sure you can set up a PP somewhere, but good luck finding referral sources.

Fellowships are being pushed outside of neuropsych..rehab, health, etc.

but who would want to go into rehab.....

Thank you for the responses

 

[WisNeuro]

Do you still have a supply issue with less sites than students?

I am not aware of a match issue in neuropsych fellowships. Those numbers are not easily accessible. We have numbers for the APPCN match, but the non-match sites do not have any kind of central compilation of stats. All I have are my anecdotes. I have never met anyone who did not match/get an invite to a non-match site their first go round. That being said, as someone who has reviewed postdoc apps for years, there are most likely students who do not get a spot. That's not a bad thing. We got a not insignificant number of apps from people who had no business applying to postdocs.

 

[Therapist4Chnge]

As mentioned, the neuro match is even fuzzier now with more legit sites choosing to forego the match (often bc of needing a solid research match, to poach top candidates early, etc).

The bottom line is that someone who attends a quality APA-acred university-based program, gets exposure the neuro training and mentorship, and attends an APA-acred internship should be able to match/secure a fellowship spot.

The students that struggle to secure interviews and offer(s) tend to be from sub-par programs and/or are restricted geographically. Unlike the internship match over the past decade or so, I haven't seen quality students get locked out of a training spot. A handful may scramble outside of the match, but students with quality training backgrounds tend to land on their feet.

 

[Therapist4Chnge]

but who would want to go into rehab.....

...clinicians who realize that they want to do differential diagnosis AND intervention.

 

[deleted343839]

It is the same job at the end of the day with the same license then? Tho a PhD can more easily transition into academia?

Same license, yes. Same job, not necessarily.

 

[psych.meout]

I am not aware of a match issue in neuropsych fellowships. Those numbers are not easily accessible. We have numbers for the APPCN match, but the non-match sites do not have any kind of central compilation of stats. All I have are my anecdotes. I have never met anyone who did not match/get an invite to a non-match site their first go round. That being said, as someone who has reviewed postdoc apps for years, there are most likely students who do not get a spot. That's not a bad thing. We got a not insignificant number of apps from people who had no business applying to postdocs.

Huh, I wasn't aware of this at all. Is there any stigma or practical difficulties resulting from getting a neuropsych fellowship at a non-APPCN match site or any difficulty getting jobs and/or boarding afterwards?

 

[cara susanna]

Speaking as an early career psychologist, it seems that there's kind of this inflation going on where everyone's now doing post docs. Although you can get a job without one, it probably will become more difficult because you'll be competing for jobs with people who've completed them.

That being said, I had a training director at an internship where I interviewed tell me that post docs are a scam and not to do one. Haha. Although I should add that I did a post doc (and I'm not neuropsych or anything where it's expected) and it really helped me feel prepared to become an independently functioning psychologist. I don't regret it at all.

 

[WisNeuro]

That being said, I had a training director at an internship where I interviewed tell me that post docs are a scam and not to do one. Haha. Although I should add that I did a post doc (and I'm not neuropsych or anything where it's expected) and it really helped me feel prepared to become an independently functioning psychologist. I don't regret it at all.

Yikes, looks like someone has an ax to grind. Even outside of neuropsych, I fail to see where having a steady paycheck, while getting guaranteed supervision, didactics, and hours needed for licensure is a terrible thing. Now, there are some "postdocs" out there that truly are scams. Stay away from those.

 

[AcronymAllergy]

Huh, I wasn't aware of this at all. Is there any stigma or practical difficulties resulting from getting a neuropsych fellowship at a non-APPCN match site or any difficulty getting jobs and/or boarding afterwards?

Depends very heavily on the fellowship. Some non-match sites provide solid training at very "name brand" medical centers. Some are cobbled together at a private practice, either because the practitioner wants to be involved in training but perhaps has limited nearby training networks/opportunities for integration, or (more nefariously) they're looking for ways to increase income without having to pay the trainee as much.

In the case of the former, there will likely be few, if any, hurdles for jobs or boarding. May have to fill out a few extra sections of the boarding application. For the latter, the hurdles can be significant to insurmountable. Probably less so for finding some type of job, but possibly substantial when it comes to boarding.

 

[Therapist4Chnge]

Non-match programs have included UCLA, Johns Hopkins, and Columbia...but there could also be Bob's Assessment Mill & Coffee Shop...so quality varies greatly. It's been at least 4-5 years since I looked at the neuro match site, so YMMV with particular programs.

 

[jadedphysiotherapist]

Yikes, looks like someone has an ax to grind. Even outside of neuropsych, I fail to see where having a steady paycheck, while getting guaranteed supervision, didactics, and hours needed for licensure is a terrible thing. Now, there are some "postdocs" out there that truly are scams. Stay away from those.

Has the clinic been around long enough that it has excess funds to allocate for a yearly salary to invest in someone? Also, is the trainee invested in with a slight hope that they will become a partner or staff within the practice?

We have these as well and they are encouraged but the market is so hot and loans are such an issue that almost everyone just forgoes it. You also have the argument that with self discipline, continuing education and self study outside of work hours, you can produce the same outcomes.

In your experience have you seen an inflation of sorts with these, in that some have made training a resume filler race even though there aren't necessarily demonstratable outcome differences? Or would you argue that the field is self regulated well at the graduate school acceptance level?

As a negative example, pharmacy has postgrad training. It's actually been pushed as the jobs have been drying up from school over proliferation. Yet, students keep applying as it's become a norm for clinical positions.

Non-match programs have included UCLA, Johns Hopkins, and Columbia...but there could also be Bob's Assessment Mill & Coffee Shop...so quality varies greatly. It's been at least 4-5 years since I looked at the neuro match site, so YMMV with particular programs.

Ya but their coffee is fire. Haters gonna hate.

 

[WisNeuro]

Funding varies by type of institution (VA vs AMC vs private hospital vs PP). Trainee can be invested at times, really depends on if that placement is expanding their services to need another full-time staff member at that time or not. As for the medicine aspect, I guess it's all semantics, but I work in medical field. Call it medicine, mental health, or whatever, it's arbitrary. I don't know what you mean by "inflation, or filler" for my specialty, it's a requirement. Similar to residency for a physician. And, psychology doesn't regulate itself at the grad school level very well at all, which is why we have diploma mills popping up all over the place.

 

[jadedphysiotherapist]

Funding varies by type of institution (VA vs AMC vs private hospital vs PP). Trainee can be invested at times, really depends on if that placement is expanding their services to need another full-time staff member at that time or not. As for the medicine aspect, I guess it's all semantics, but I work in medical field. Call it medicine, mental health, or whatever, it's arbitrary. I don't know what you mean by "inflation, or filler" for my specialty, it's a requirement. Similar to residency for a physician. And, psychology doesn't regulate itself at the grad school level very well at all, which is why we have diploma mills popping up all over the place.

Thank you for the response.

Inflation was meant to describe training pathways that have become required due to the job market with there not being enough fulltime positions, rather than the fellowship etc. actually providing legit continuing education that is significantly more in depth from an academic or supervised clinical perspective, from school....and your practice patterns following completion wouldn't change much had you just acquired a job. Pharm is pretty bad. Medical uses the fellowship system following residency to do this for subspecialties.

I like to just say "medicine" to distinguish nonphysician but I understand what you mean.