Thoughts on the Match Process?

[R. Matey]

It is a private practice. And I have a client that was transferred to me from a masters level clinician because their insurance switched to Medicare. The majority are Medicaid but there are at least 1 or 2 that are medicare.

Wis is right--this could be fraud. You may want to clarify with your supervisors and training director at your home program that you are legally able to see Medicare patients since we don't know how your practice would be able to skirt federal law. When I getting my clinical hours for licensure in a large healthcare system, some of the master's level triage clinicians didn't understand that I couldn't take Medicare patients so it was a constant battle to keep them off my caseload.

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[WisNeuro]

Wis is right--this could be fraud. You may want to clarify with your supervisors and training director at your home program that you are legally able to see Medicare patients since we don't know how your practice would be able to skirt federal law. When I getting my clinical hours in a large healthcare system, some of the master's level triage clinicians didn't understand that I couldn't take Medicare patients so it was a constant battle to keep them off my caseload.

There is a very small subset of situations that can actually do something like this, so it's not theoretically impossible, but it is very rare. But what happens much more often is either intentional or unintentional billing fraud.

 

[R. Matey]

There is a very small subset of situations that can actually do something like this, so it's not theoretically impossible, but it is very rare. But what happens much more often is either intentional or unintentional billing fraud.

I was wondering if that provisional license allowed them to somehow, but that wouldn't take care of the trainee issue. I couldn't find a satisfying answer in the minute I devoted to googling it.

 

[WisNeuro]

I was wondering if that provisional license allowed them to somehow, but that wouldn't take care of the trainee issue. I couldn't find a satisfying answer in the minute I devoted to googling it.

It is tenuous and a lot of things have to align, one being the provisional license issue, which most states do not have. There are also some other things that have to be true for this to be allowable. Generally speaking, there are a lot of practices that think what they are doing is legal, until they get audited, and learn a very expensive mistake.

 

[Sanman]

It is tenuous and a lot of things have to align, one being the provisional license issue, which most states do not have. There are also some other things that have to be true for this to be allowable. Generally speaking, there are a lot of practices that think what they are doing is legal, until they get audited, and learn a very expensive mistake.

True. The other option if it is just a few cases,as mentioned, is that they are just writing it off as an LPC can't bill Medicare yet either.

 

[AcronymAllergy]

Unfortunately, it seems/sounds like we have a ways to go in terms of getting the political/legislative support to chance CMS policy on paying interns. Although it's on APA's radar and they've been working at it, as far as I know, for some time. Postdocs may be easier, especially because policy could change at the state level to eliminate the need for a postdoc year to be licensed. They also already have their degree, so the work isn't really part of a training program so much as it is fulfilling specific state requirements. I don't think student time on medical clerkships (which is kinda sorta the best medical training equivalent to a psych intern) is billable, unless perhaps the licensed physician is present when the services are performed. So that might be the best psychology can hope for.

Psychologists also are pretty stingy when it comes to financially supporting legislative efforts. In my state, we contributed less than half of what NPs and psychiatrists did, and about 2/3 of what OTs did.

As for the match itself, personally, I enjoyed the process, even though it was expensive (I think I traveled to something like 10-12 sites, but it's a blur). I do think the switch to primarily virtual interviews helps the economic aspect. I appreciated that everything was done all at once. For fellowship, the interviews were more enjoyable just given the nature of the situation, but I still opted to apply to mostly match sites and participated in the match rather than accept other offers. I don't know that there's a way to make the process administratively (and economically) feasible for sites if applications and admissions occur on a rolling basis. I also agree with PsyDr that sometimes, patterning our system after physicians is a net benefit.

 

[PsyDr]

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

I’m not sure if this exists, but are there ways for students struggling financially to get reimbursement or aid for apps/relocation expenses/other costs of the process? I feel like I read something about a scholarship on the APPIC doc…

I have no idea what "create space" means. If it refers to "saying everyone has challenges", sure. If it means, "other people need to compensate for your decision to have kids”…. Not my actions, not my consequences.

 

[psychologynbooks]

I have no idea what "create space" means. If it refers to "saying everyone has challenges", sure. If it means, "other people need to compensate for your decision to have kids”…. Not my actions, not my consequences.

By making space, I just mean validating that it’s a hard part of the process for some and offering support. I don’t have a good solution on how to change the system. I’ve seen some comments on here that there are initiatives being worked on as part of DEI to support parents who are also interns. On the appic discord this year, there was a chat just for parents because of the extra stressors it adds to the process

 

[Spydra]

I'm glad you brought that up--I was thinking earlier in the thread about how a rule change that allowed for interns to bill wouldn't necessarily stop some sites from pocketing the extra money instead of passing it on to the trainees. Ideally, there would be a separate training license (or designation) for psychology interns that covers the full range of services that they provide, but also capped to reduce abuse. Likely though, in such a scenario, it would take enforcement from accrediting bodies to ensure that trainees were protected.

More importantly, that's a heavy load for an intern to carry. You deserve to be paid more.

And you're right, some sites do pocket the extra money. I interned at a site that required I get a provisional license so I could bill insurance. The amount they received did cover my stipend, but supervisors were not compensated for all of their supervision work. The extra just went to the agency and none of it was invested in training-related supports. They could have paid me more and invested more in training-related resources.

The upside to being able to bill was that I learned about insurance much earlier than I probably would have otherwise. I learned why so many hate Medicaid and how it frequently was a huge pain to get things approved with them that were almost effortless with other carriers. About half my caseload had Medicare so I was very involved in the murderous Incident To process, but without it my opportunities would have been less diverse and my expectation of internship was that it was to be a generalist year. I also never had to deal with not getting direct hours because I could bill. Friends in other settings complained about not getting enough hours due to a lack of referrals or other reasons and some of that had to do with not accepting insurance. I never had an issue having plenty of patients and getting direct hours.

The downside to being able to bill was frequently the agency "forgot" that trainees are not intended to be profit sources. There was a lot of pressure to accept the heavy caseloads of the independently licensed and to meet the same deadlines and timeframes. I worked really hard to learn and do things correctly and the pressure to not need that time and just be faster was unfair and exhausting. I was lucky to have a supervisor that understood that the burden of learning and seeking supervision required more time than the profit driven deadlines and timeframes allowed and advocated for me. Those who didn't have that were exhausted and overworked. So yes more oversight here to make sure all trainees are equally protected makes sense.

 

[PsyDr]

It’s hard for everyone. Some people have it easier, some people have it harder. Some of those difficulties are self induced, some of the amelioration is unearned. It’s fine to acknowledge that.

However, it is unfair to say “One person has to do this undesirable thing, because the other person has a kid”.

 

[LM02]

I'm old enough to remember what internship applications were like before the match. As some have shared here, it created a massive bottleneck of people holding onto offers while waiting for spots to open up at their preferred sites, while the people who preferred to have a spot at the site whose spot the others were holding then also got stuck waiting. Once offers opened, people were in positions of having to make decisions in very tight time frames (I remember a grad student struggling with this when I was an undergrad), and it was pretty chaotic and much more stressful than just being "a regular hiring process." There was a reason that the match was instituted, and it provides scaffolding and structure to a system that is not ideal, but what we are working with - at least for the time being.

 

[haRtwin]

I'm surprised this thread is focused on pros and cons of the match system. I always found the process of applying for internship to be outlandish.

In my clinical psychology program, faculty get students to start reviewing internship brochures in June and think about potential sites. Students then wait for the finalized brochures to be released so that they can write essays, tailor cover letters, and interview at as many as 15 sites until January of the next year.

What strikes me about the internship process more broadly is that many students are highly vetted and then spend all their time applying for a low paying job that lasts one year. There has to be a better way to reduce burden on students and internship sites.

 

[WisNeuro]

I'm surprised this thread is focused on pros and cons of the match system. I always found the process of applying for internship to be outlandish.

In my clinical psychology program, faculty get students to start reviewing internship brochures in June and think about potential sites. Students then wait for the finalized brochures to be released so that they can write essays, tailor cover letters, and interview at as many as 15 sites until January of the next year.

What strikes me about the internship process more broadly is that many students are highly vetted and then spend all their time applying for a low paying job that lasts one year. There has to be a better way to reduce burden on students and internship sites.

Why wait to write essays? The prompts are the same and those really shouldn't change much between programs?

 

[haRtwin]

Why wait to write essays? The prompts are the same and those really shouldn't change much between programs?

If they're smart, then they don't wait to write the essays. But my experience is that average student is too anxious to think clearly during this process.

 

[WisNeuro]

If they're smart, then they don't wait to write the essays. But my experience is that average student is too anxious to think clearly during this process.

I wouldn't say the average student, or maybe our program was just fairly well adjusted. As discussed in the psychotherapy fad thread expectancy has a lot to do with this. Even in the "crisis" days of the match, most university based programs were sitting at or near 100% match rates over time. It just wasn't that big of a deal.

 

[cara susanna]

I wouldn't say the average student, or maybe our program was just fairly well adjusted. As discussed in the psychotherapy fad thread expectancy has a lot to do with this. Even in the "crisis" days of the match, most university based programs were sitting at or near 100% match rates over time. It just wasn't that big of a deal.

Speak for yourself - I was terrified of not matching. My program had a good match rate, but there were still 1-2 students who didn't match each year. I knew I could be one of them.

 

[Sanman]

Honestly a lot of the headaches have been removed through the use of technology. The students today do not have to drive to the airport to get their application postmarked by the application deadline. They also do not have to double check envelopes to make sure the correct materials are in the correct envelope. Things are much more streamlined and if we moved to virtual interviews, a lot people would be happier to save on time and travel expenses. The rest is a lot of effort trying to make things slightly easier.

 

[haRtwin]

I wouldn't say the average student, or maybe our program was just fairly well adjusted. As discussed in the psychotherapy fad thread expectancy has a lot to do with this. Even in the "crisis" days of the match, most university based programs were sitting at or near 100% match rates over time. It just wasn't that big of a deal.

When I look back on the internship experience, I agree it wasn't a big deal. That's not how I felt when I was in it though. I was very anxious about the process despite being a strong applicant and whether I admitted that to myself or any of my peers. For context, our program has maintained 100% match for over 10 years now, and I was a strong candidate with over 800 face to face hours. I ended up matching to my top site, and I had a fantastic training experience.

I still find the application process to be too much work, and I wonder what the process actually predicts. From what I remember, the only reliable predictor of finishing an internship is dissertation progress.

 

[ClinicalABA]

Speak for yourself - I was terrified of not matching. My program had a good match rate, but there were still 1-2 students who didn't match each year. I knew I could be one of them.

Agreed! We had a great match rate in the program as a whole and my lab specifically, with no real evidence that we wouldn't match. It was still a major and frequent topic of discussion from first year onward, and there was a lot of fear about not matching.

 

[Sanman]

Speak for yourself - I was terrified of not matching. My program had a good match rate, but there were still 1-2 students who didn't match each year. I knew I could be one of them.

When I look back on the internship experience, I agree it wasn't a big deal. That's not how I felt when I was in it though. I was very anxious about the process despite being a strong applicant and whether I admitted that to myself or any of my peers. For context, our program has maintained 100% match for over 10 years now, and I was a strong candidate with over 800 face to face hours. I ended up matching to my top site, and I had a fantastic training experience.

I still find the application process to be too much work, and I wonder what the process actually predicts. From what I remember, the only reliable predictor of finishing an internship is dissertation progress.

Part of this is individual anxiety, goals, etc. I know people that were more nervous than me with far more interviews. A few of them had every right to be nervous as they did not interview well. Once I got the interview, I was less nervous as I tend to do better in person than on paper. All of us trying to go back to a major city were also more nervous than those that wanted to stay close in our smaller southern city.

 

[WisNeuro]

Speak for yourself - I was terrified of not matching. My program had a good match rate, but there were still 1-2 students who didn't match each year. I knew I could be one of them.

I dunno, it just wasn't a source of anxiety for most of us. The whole time that I was at my program, we had one non-match, and it wasn't a surprise. I just think that about 75% of the issue is how much applicants amp themselves up for what is a fairly straightforward process.

 

[Shiori]

Wise, you also weren't all that stressed about the EPPP, if I remember correctly. You might just not be a worrier.

 

[haRtwin]

I dunno, it just wasn't a source of anxiety for most of us. The whole time that I was at my program, we had one non-match, and it wasn't a surprise. I just think that about 75% of the issue is how much applicants amp themselves up for what is a fairly straightforward process.

I agree with you that the issue is about how much applicants amp themselves up. I also think that many programs and other academic environments (e.g., academic Twitter) amp up the anxiety for applicants too. But I think it's naïve to say that internship was not a source of anxiety for your cohort mates or the average student. Surely it's an empirical question.

 

[WisNeuro]

Wise, you also weren't all that stressed about the EPPP, if I remember correctly. You might just not be a worrier.

I am definitely not a worrier, personally. But, the general vibe in our program was also pretty relaxed around this.

I agree with you that the issue is about how much applicants amp themselves up. I also think that many programs and other academic environments (e.g., academic Twitter) amp up the anxiety for applicants too. But I think it's naïve to say that internship was not a source of anxiety for your cohort mates or the average student. Surely it's an empirical question.

There is general, normal anxiety. Then there's the seemingly "crippling" anxiety in some people that seems to be pervasive around this subject. Our program had a little bit of the former, none of the latter.

 

[AcronymAllergy]

I do agree that going through the entire process for "just" one year is cumbersome, although I'd take that over requiring a longer internship. I also think there's something significant to be gained from a full-time, one-year clinical experience (particularly given the variability not just in the quality of training programs, but also in the amount and type of clinical experiences gained across programs) that's separate from the doctoral program. I don't know a good alternative.

I also don't know if the APPIC data has information on if/to what degree applicants found the process anxiety-provoking. But as a hypothesis, I think it's fair to say the modal applicant experiences some amount of anxiety, as is the case with most major life changes (especially when one has limited direct control on the outcome). I don't know if the modal applicant experiences substantial anxiety. There may be a pub out there somewhere; I haven't looked in a few years. I also don't know if there's a viable way to reduce this, or if it needs to be reduced. I do think that addressing the imbalance provided some progress in that regard.

 

[Sanman]

I do agree that going through the entire process for "just" one year is cumbersome, although I'd take that over requiring a longer internship. I also think there's something significant to be gained from a full-time, one-year clinical experience (particularly given the variability not just in the quality of training programs, but also in the amount and type of clinical experiences gained across programs) that's separate from the doctoral program. I don't know a good alternative.

I also don't know if the APPIC data has information on if/to what degree applicants found the process anxiety-provoking. But as a hypothesis, I think it's fair to say the modal applicant experiences some amount of anxiety, as is the case with most major life changes (especially when one has limited direct control on the outcome). I don't know if the modal applicant experiences substantial anxiety. There may be a pub out there somewhere; I haven't looked in a few years. I also don't know if there's a viable way to reduce this, or if it needs to be reduced. I do think that addressing the imbalance provided some progress in that regard.

I do think that it may be helpful to many people to combine the internship and post-doc match into a "residency" match for those planning on post-doc. While, for some, this happens informally anyway it may help to reduce the number of moves required.

 

[WisNeuro]

I do think that it may be helpful to many people to combine the internship and post-doc match into a "residency" match for those planning on post-doc. While, for some, this happens informally anyway it may help to reduce the number of moves required.

A combination would be helpful for general clinicians. For some of the specialty people (e.g., neuro), some applicants need that internship year to set up a quality postdoc. I will wager that a not insignificant number of people actually want a different postdoc site. Especially for the two year postdocs.

 

[Sanman]

A combination would be helpful for general clinicians. For some of the specialty people (e.g., neuro), some applicants need that internship year to set up a quality postdoc. I will wager that a not insignificant number of people actually want a different postdoc site. Especially for the two year postdocs.

It depends. I would have preferred a single move for internship and a two year post-doc (and likely should have just stayed at the AMC affiliated with my program a few more years). Dissertation completion becomes a huge hurdle in combining matches though and can throw everything off.

 

[R. Matey]

I agree with you that the issue is about how much applicants amp themselves up. I also think that many programs and other academic environments (e.g., academic Twitter) amp up the anxiety for applicants too. But I think it's naïve to say that internship was not a source of anxiety for your cohort mates or the average student. Surely it's an empirical question.

Agree with this and even if the match rate is 100% for a given program, students seem to believe their entire career hangs on where they go for internship (it doesn't) thereby contributing to anxiety. This was the case for both clinical and counseling folks at my alma mater. Also, your average psychology graduate student is probably 0.50 +SD from the national mean on trait anxiety. So there's that.

 

[PsyDr]

Agree with this and even if the match rate is 100% for a given program, students seem to believe their entire career hangs on where they go for internship (it doesn't) thereby contributing to anxiety. This was the case for both clinical and counseling folks at my alma mater. Also, your average psychology graduate student is probably 0.50 +SD from the national mean on trait anxiety. So there's that.

Scales 6 & 7 are predictors for internship success. Maybe they are watching you.

 

[R. Matey]

Scales 6 & 7 are predictors for internship success. Maybe they are watching you.

Yeah, but you got to account for my interpretation of the blank TAT card.

 

[cara susanna]

When I look back on the internship experience, I agree it wasn't a big deal. That's not how I felt when I was in it though. I was very anxious about the process despite being a strong applicant and whether I admitted that to myself or any of my peers. For context, our program has maintained 100% match for over 10 years now, and I was a strong candidate with over 800 face to face hours. I ended up matching to my top site, and I had a fantastic training experience.

I still find the application process to be too much work, and I wonder what the process actually predicts. From what I remember, the only reliable predictor of finishing an internship is dissertation progress.

Right? It's just such a hassle for ONE YEAR. I wish they could make it less dramatic and cumbersome, more like prac applications. Technology has helped in that respect with virtual interviews, at least.

 

[Sanman]

Right? It's just such a hassle for ONE YEAR. I wish they could make it less dramatic and cumbersome, more like prac applications. Technology has helped in that respect with virtual interviews, at least.

I didn't really have prac applications. Just rankings for where I wanted to be placed.

While captive internships have a downside, they are convenient.

 

[WisNeuro]

I didn't really have prac applications. Just rankings for where I wanted to be placed.

While captive internships have a downside, they are convenient.

We kind of had applications, but for the neuro folk, it was more of a formality, the AMC in town always took our students preferentially.

 

[Sanman]

We kind of had applications, but for the neuro folk, it was more of a formality, the AMC in town always took our students preferentially.

Ours were a bit of a formality too as the program generally took small classes with different clinical interests. Only became an issue if someone had a sharp change in interest during school.

 

[AcronymAllergy]

Not to completely derail, but I never even knew programs had formal practicum application/selection processes until talking with trainees from other programs at least a few years into my time at grad school. We kinda just said, "yeah, I'd like to work there next year, is that cool?" And/or we had some set practicum suggestions or requirements from our advisors.

 

[smalltownpsych]

Just wanted to add that dealing with the stress and challenges of the match were part of the training in my mind.

 

[WisNeuro]

Not to completely derail, but I never even knew programs had formal practicum application/selection processes until talking with trainees from other programs at least a few years into my time at grad school. We kinda just said, "yeah, I'd like to work there next year, is that cool?" And/or we had some set practicum suggestions or requirements from our advisors.

This was essentially what we had, they just wanted an application on file for policy reasons.

 

[Dazen]

Not to completely derail, but I never even knew programs had formal practicum application/selection processes until talking with trainees from other programs at least a few years into my time at grad school. We kinda just said, "yeah, I'd like to work there next year, is that cool?" And/or we had some set practicum suggestions or requirements from our advisors.

From talking to friends in other programs, it seems like it’s primarily in big cities where prac sites are choosing between students from different programs rather than than internal

 

[Shiori]

Yeah, we definitely had to apply, interview, and be selected by our prac sites. There were people who wouldn't get selected for any prac sites and would have to problem-solve with the DCT. Some people ended up leaving Clinical Psych due to the prac process essentially screening them out.

 

[ClinicalABA]

Not to completely derail, but I never even knew programs had formal practicum application/selection processes until talking with trainees from other programs at least a few years into my time at grad school. We kinda just said, "yeah, I'd like to work there next year, is that cool?" And/or we had some set practicum suggestions or requirements from our advisors.

We had some regular practicum sites with multiple students applying to and being selected for each year. We could also seek out and create our own practica that met certain programmatic standards. Also, if we wanted a tuition reimbursement, we had to receive a minimum salary from the the practicum This was part of our union CBA, and the union (United Auto Workers affiliate!) really frowned on grad students working for free or low salary. The process wasn't as competitive as internship, but still some sires were highly coveted.

 

[cara susanna]

Yeah, we had a fairly formal application and interview process for prac. But our practica were paid (that's how we were funded during our 3rd and 4th years). We weren't competing against other programs, just each other.

 

[AcronymAllergy]

Always interesting to see/hear how it's handled at different programs. Ours was a very informal process. If multiple students wanted to work at the same site, either additional funding was picked up somehow, or some kind of compromise was worked out (e.g., you work here next year and I'll go the year after, or we'll work there two years, with me being part-time and getting funding the first year and vice-versa).

We also hardly heard anything about internship until preparing to apply, and even then, it was mostly from other students. I think that may have since changed a bit.

 

[PsyDuck90]

I was in the NYC-metro area, and with so many programs and practicum sites, we had an organized match process every year. I did feel very prepared for internship interviews since I had been writing cover letters and interviewing for sites for 3 years prior at that point (as there were only so many practicum spots for all the big name hospitals like NYU, Mt. Sinai, Columbia, etc.). It was stressful each year, especially on match day (which worked like the uniform notification date), but there was also a huge breadth of training opportunities, so I got experiences that the average prac student did not, which many sites commented on during internship and post doc interviews.

 

[Sanman]

Speaking of match problems... Just had a conversation about the poor fill rate on post-docs both locally and nationally. So, it is becoming a problem for facilities.

 

[deleted1147464]

Speaking of match problems... Just had a conversation about the poor fill rate on post-docs both locally and nationally. So, it is becoming a problem for facilities.

That’s very interesting. I heard it was much less competitive than applying for internship, but didn’t realize this was an issue. Is this problem likely due to more recent graduates going straight into job positions that offer supervision or non-clinical roles?

 

[cara susanna]

Speaking of match problems... Just had a conversation about the poor fill rate on post-docs both locally and nationally. So, it is becoming a problem for facilities.

Yup, we had trouble filling out post doc recently.

 

[Sanman]

That’s very interesting. I heard it was much less competitive than applying for internship, but didn’t realize this was an issue. Is this problem likely due to more recent graduates going straight into job positions that offer supervision or non-clinical roles?

A combination of things mot likely. More jobs available with higher pay, more tele-health options, and we don't have the in demand post-docs like neuropsych. I think more people are choosing general outpatient psych and remote jobs. That is certainly the trend with licensed folks.