Can you expand on how you think internships discriminate based on applicants geographic location? I may have missed something in an earlier post, but I don't understand this.
She is able to move. She’s doesn’t want to. That choice has a cost. Same as choosing to go to grad school instead of working after undergrad.
Hypothetically do you think that could change (or would be more likely to change) if we switched to a post-doctoral internship + one year post-doc model? Historical issues aside of psych splitting out from "healthcare" I can understand just on the face why CMS would not want to be funding training for people who don't even have their terminal degree in hand.
It’s true, some people just have larger costs than others. Inequality is everywhere, but I think it’s helpful to acknowledge it to create space for those with worse circumstances
Would likely vary by insurance, but my hospital would not bill for this. Too much risk, not enough reward.
I do not think that and did not say that. Sanman thinks internship would discriminate based on geographic locations if there was no match by saying "If the match did not exist, programs would just take local candidates we like and ignore someone else." I was just asking why can't APA put regulations to prevent sites from doing that. Honestly, I think if sites want to do that they can (I'm not saying they are) regardless of whether we have the match.
You are missing the point here. What you are saying might be true. But how does having the match solve this problem? With the match system in place, site are still likely getting more local applications therefore would take more local applicants. I was simply saying the argument that the match system makes non-local applicants more likely to be considered is not valid.
? I thought we are talking about how the match makes it more equitable for non-local applicants? What you are saying has nothing to do with that. Going off topic and belittling other people's opinion do not make you more convincing. I'm going to stop responding to you so please do not ask me follow up questions. Thank you.
Thanks for humoring me, really. I appreciate the discussion. A few follow up questions, if you don't mind:
1. Wouldn't the attending just be the intern's primary supervisor? Aren't they already taking on risks by having a student?
2. What equity issues would pairing insured people with licensed providers create? I could see how it might create training issues if, say, an intern wanted to work primarily with psychotic patients, but because they had an LCSW/LPC they only had to see billable patients, which primarily didn't include psychotic patients. If this argument is that people with LPCs/LCSWs and psych degree are more experienced providers and therefore patients should have equal access to them, I'm flattered, but I still learned a ton on internship and clinical postdoc
I understand the third point (we fear x outcome therefore we won't do it). Tracks with much of my experience in managed healthcare.
Thanks for humoring me, really. I appreciate the discussion. A few follow up questions, if you don't mind:
1. Wouldn't the attending just be the intern's primary supervisor? Aren't they already taking on risks by having a student?
2. What equity issues would pairing insured people with licensed providers create? I could see how it might create training issues if, say, an intern wanted to work primarily with psychotic patients, but because they had an LCSW/LPC they only had to see billable patients, which primarily didn't include psychotic patients. If this argument is that people with LPCs/LCSWs and psych degree are more experienced providers and therefore patients should have equal access to them, I'm flattered, but I still learned a ton on internship and clinical postdoc
I understand the third point (we fear x outcome therefore we won't do it). Tracks with much of my experience in managed healthcare.
I'm really entertaining this discussion because I find it interesting. In reality my AMC doesn't hire LPCs so this would have to be a special thing just for our psychology interns. My hospital isn't about making special allowances for a small, low-revenue generating group.
When applying to PhD programs, I was waitlisted at program A ("you're our first alternate...") while simultaneously holding an offer from program B -- I ended up accepting the offer at program B after waiting a period of weeks-to-months to be told that all initial offers extended by program A had finally been accepted.
Ah- ok. I honestly don't think they were saying it's discrimination along the lines of "we're not going to offer you a position because of where you are from", but more along the lines of places looking to fill positions quickly getting applicants locally for practical reasons, rather than discriminating against non-locals. With all participating agencies and applicants in the country agreeing using APPIC as a centralized place for lists of internships as well as universal applications, it basically becomes and process with a nationwide scope. APA could certainly continue to mandate this process, but the universal notification day and rank listing hold it all together. Without the ranking lists and match day, you'd likely have a situation where top applicants would get multiple offers, holding out for the best ones, while other applicants (many of whom were also very qualified for the positions) would not get offers- at least until the top applicants had all made their decisions. The end result would be many more applicants not getting a position, and many more sites not filling their positions. From the site's perspective, doing all that work and not getting filling positions makes it a hard sell to continue to fund those positions. From the applicant's perspective, many more degrees are held hostage by factors outside of the control of the student or the degree granting institution. Long story short, if it's going to be a truly nationwide process overseen by a third party (e.g., APA or APPIC) the absence of match day and rank listings would make it much to cumbersome and unwieldy to be managed by the internship sites, and thus more difficult for applicants to match somewhere. As an applicant, a lot would come down to your negotiating and bargaining abilities.
Also happened to some extent within the match system when I was an internship faculty. Across our different rotations, we had about 6 intern spots. We new at least 4 of them would be going to students from specific graduated labs. The professors would let us know years in advance that they had a student coming down the pipeline for us, and we would meet that student at conferences and know of them and their work. Interview day was more for us to sell ourselves and our program sites, vs. determining if we wanted to offer that student a position. Regardless of the system, networking is the surest way to market yourself and get where you want to go. Another HUGE reason to attend a mentor-model program.
