Training issues at Postdoc Fellowship Program

[mind_over_matter277]

Hello,

I am currently a postdoc fellow at an APA-accredited postdoctoral residency program. I have been experiencing some training related issues at this site and I am wondering if anyone could offer some feedback or guidance on this matter.

I am a few months into the training program and I have not been receiving sufficient direct patient contact. My current therapy caseload is extremely small and I have been receiving less than 10 clinical hours per week. I have spent most of my days at the program sitting at my desk with nothing to do. On the bright side, I have spent a substantial number of hours preparing for the EPPP. However, I can only take so many practice tests before going crazy!

The lack of clinical experience has started to bother me, as I believe that I am not doing anything productive. I don’t think that the volume of clinical work that I am currently receiving will adequately prepare me for a career in any setting, as I imagine that most facilities would expect psychologists to manage a large caseload.

I have raised these concerns to my primary supervisor and training director 2 months ago but there has only been a slight level of improvement. I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work. Numerous referrals are generated each day to the clinic that I am assigned to and all of the providers schedules are booked out until January.

Usually, I have heard postdoc fellows say that they are overwhelmed with the amount of work given to them. However, it appears that I am underwhelmed. I was constantly busy during my internship year and had an average of 15-20 direct clinical hours every week. I used to cherish the days when I had significant free time available. Now, I find myself yearning for the days when I was an intern.

What might be the best way to proceed? At this point, it does not appear that the situation will change dramatically. There seem to be some systemic issues within the facility and problems with how the training program is being run that might partially explain the lack of clinical training opportunities.

I’m very frustrated now because I very much enjoy working with patients. The lack of clinical experience makes me feel like there’s no purpose for me here.

Any guidance would be appreciated!

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[summerbabe]

I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work.

Do you know why (or can strongly hypothesize) the reason(s) contributing to you being assigned less cases than other trainees?

It would be typical for a trainee’s direct supervisor to be solely responsible for managing their flow of patients, including screening for clinical appropriateness, gauging a patient’s willingness to be seen by a trainee, and making sure the trainee’s caseload is at a good number.

And lots of reasons that can contribute to this process not working smoothly, each with their own options for troubleshooting.

I have raised these concerns to my primary supervisor and training director 2 months ago but there has only been a slight level of improvement.

What helped slightly? Have you continued to bring this up or at least provided regular updates to your supervisor on your low caseload and desire to see more patients?

In some situations like this, maybe all it takes is more personal advocacy, especially if one’s supervisor is less organized/conscientious about details like caseload #s.

Or there could be significant systemic issues at play, which may require more effort.

Regardless, I’d encourage you to inventory reasons why you think this is happening and contrast it to efforts you’ve made to remedy this situation and see if any gaps are present and then formulate a new plan of action. The good thing is that you still have a majority of your training year left to meet your goals for postdoc and getting more patients when the overall facility is busy sounds resolvable. Good luck!

 

[mind_over_matter277]

Do you know why (or can strongly hypothesize) the reason(s) contributing to you being assigned less cases than other trainees?

It would be typical for a trainee’s direct supervisor to be solely responsible for managing their flow of patients, including screening for clinical appropriateness, gauging a patient’s willingness to be seen by a trainee, and making sure the trainee’s caseload is at a good number.

And lots of reasons that can contribute to this process not working smoothly, each with their own options for troubleshooting.

What helped slightly? Have you continued to bring this up or at least provided regular updates to your supervisor on your low caseload and desire to see more patients?

In some situations like this, maybe all it takes is more personal advocacy, especially if one’s supervisor is less organized/conscientious about details like caseload #s.

Or there could be significant systemic issues at play, which may require more effort.

Regardless, I’d encourage you to inventory reasons why you think this is happening and contrast it to efforts you’ve made to remedy this situation and see if any gaps are present and then formulate a new plan of action. The good thing is that you still have a majority of your training year left to meet your goals for postdoc and getting more patients when the overall facility is busy sounds resolvable. Good luck!

Yes, my supervisor is in charge of my entire schedule. She controls which intakes I get and the number of therapy cases. I know her schedule is packed and she gets referrals all the time but keeps them to herself.

 

[mind_over_matter277]

Do you know why (or can strongly hypothesize) the reason(s) contributing to you being assigned less cases than other trainees?

It would be typical for a trainee’s direct supervisor to be solely responsible for managing their flow of patients, including screening for clinical appropriateness, gauging a patient’s willingness to be seen by a trainee, and making sure the trainee’s caseload is at a good number.

And lots of reasons that can contribute to this process not working smoothly, each with their own options for troubleshooting.

What helped slightly? Have you continued to bring this up or at least provided regular updates to your supervisor on your low caseload and desire to see more patients?

In some situations like this, maybe all it takes is more personal advocacy, especially if one’s supervisor is less organized/conscientious about details like caseload #s.

Or there could be significant systemic issues at play, which may require more effort.

Regardless, I’d encourage you to inventory reasons why you think this is happening and contrast it to efforts you’ve made to remedy this situation and see if any gaps are present and then formulate a new plan of action. The good thing is that you still have a majority of your training year left to meet your goals for postdoc and getting more patients when the overall facility is busy sounds resolvable. Good luck!

I’m wondering if this is a power and control kind of issue?

 

[summerbabe]

Yes, my supervisor is in charge of my entire schedule. She controls which intakes I get and the number of therapy cases. I know her schedule is packed and she gets referrals all the time but keeps them to herself.

How many direct conversations have you had with your supervisor on this topic? How have they gone? Did she seem receptive and willing to work with you to increase caseload? Not so much? And if not, did she give any reasons for this rationale?

If the direct conversations have been minimal, I would start there, including thinking about the best way to clearly bring up your concern and invite problem solving on your behalf.

If this is something that you both are talking about every week with no resolution in sight, some other avenues for intervention (e.g., training director assistance) might be needed.

 

[mind_over_matter277]

I have had a few direct conversations on this topic with my supervisor. I believe they went well and she understood my concerns. I then went to my training director, who expressed my concerns to her. A plan was proposed a month ago but little to no change is evident.

I will say that she is incredibly detail-oriented. She goes through my notes and reports with a fine tooth comb. I imagine that takes a bit of time. Therefore, increasing the case load might be stressful for her?

 

[mind_over_matter277]

How many direct conversations have you had with your supervisor on this topic? How have they gone? Did she seem receptive and willing to work with you to increase caseload? Not so much? And if not, did she give any reasons for this rationale?

If the direct conversations have been minimal, I would start there, including thinking about the best way to clearly bring up your concern and invite problem solving on your behalf.

If this is something that you both are talking about every week with no resolution in sight, some other avenues for intervention (e.g., training director assistance) might be needed.

I don’t want to leave the fellowship program. I made a commitment and it was always my dream to complete a formal postdoc program. I would feel miserable and very much regret the decision later in my life.

I just think they aren’t willing to give much clinical work for a variety of reasons. Maybe, it looks bad if the waitlist is too short?

Would it be worthwhile to file a grievance? Any suggestions would be helpful.

 

[summerbabe]

I have had a few direct conversations on this topic with my supervisor. I believe they went well and she understood my concerns. I then went to my training director, who expressed my concerns to her. A plan was proposed a month ago but little to no change is evident.

Have you/how have you followed up regarding implementation of this plan, including discussion of barriers that have prevented that plan from being enacted/enacted more thoroughly? If the initial talks were well received, it sounds like more constructive discussions could be had that can now be even more action oriented.

I just think they aren’t willing to give much clinical work for a variety of reasons. Maybe, it looks bad if the waitlist is too short?

There can be all kinds of contributing factors but I thnk it's in your best interest to have frank discussions about what they actually are with your supervisor/TD and figure out specific, action-focused solutions for each of these barriers, rather than waiting for things to change, wondering and being unsatisfied.

I don’t want to leave the fellowship program..........Would it be worthwhile to file a grievance?

These sound like last resort type choices when all other reasonable options have been exhausted. Or when a single egregious violation has occurred, which this doesn't resemble.

Filing a formal grievance after what sounds like a couple of constructive conversations with minimal follow-up would reflect poorly on you, IMO, even if the program is creating barriers to you receiving appropriate clinical hours and following up on their training commitments.

Perhaps you could reflect on any internal barriers impacting the things that are 100% within your control (e.g., initiating continued discussions with your supervisor). Nobody enjoys difficult conversations that could create conflict and many of us struggle when our reasonable expectations are not being met.

If anything has prevented you from more effectively advocating for yourself so far, maybe you can talk with a trusted friend/family members/mentor and hash out a new plan of action and try to pick up these hours.

 

[mind_over_matter277]

Have you/how have you followed up regarding implementation of this plan, including discussion of barriers that have prevented that plan from being enacted/enacted more thoroughly? If the initial talks were well received, it sounds like more constructive discussions could be had that can now be even more action oriented.

There can be all kinds of contributing factors but I thnk it's in your best interest to have frank discussions about what they actually are with your supervisor/TD and figure out specific, action-focused solutions for each of these barriers, rather than waiting for things to change, wondering and being unsatisfied.

These sound like last resort type choices when all other reasonable options have been exhausted. Or when a single egregious violation has occurred, which this doesn't resemble.

Filing a formal grievance after what sounds like a couple of constructive conversations with minimal follow-up would reflect poorly on you, IMO, even if the program is creating barriers to you receiving appropriate clinical hours and following up on their training commitments.

Perhaps you could reflect on any internal barriers impacting the things that are 100% within your control (e.g., initiating continued discussions with your supervisor). Nobody enjoys difficult conversations that could create conflict and many of us struggle when our reasonable expectations are not being met.

If anything has prevented you from more effectively advocating for yourself so far, maybe you can talk with a trusted friend/family members/mentor and hash out a new plan of action and try to pick up these hours.

Yes, I think it’s good to continue to bring up the issue and advocate for myself. I may sound like a broken record but i need to be more proactive about getting my needs met instead of reactive.

 

[msc545]

Hello,

I am currently a postdoc fellow at an APA-accredited postdoctoral residency program. I have been experiencing some training related issues at this site and I am wondering if anyone could offer some feedback or guidance on this matter.

I am a few months into the training program and I have not been receiving sufficient direct patient contact. My current therapy caseload is extremely small and I have been receiving less than 10 clinical hours per week. I have spent most of my days at the program sitting at my desk with nothing to do. On the bright side, I have spent a substantial number of hours preparing for the EPPP. However, I can only take so many practice tests before going crazy!

The lack of clinical experience has started to bother me, as I believe that I am not doing anything productive. I don’t think that the volume of clinical work that I am currently receiving will adequately prepare me for a career in any setting, as I imagine that most facilities would expect psychologists to manage a large caseload.

I have raised these concerns to my primary supervisor and training director 2 months ago but there has only been a slight level of improvement. I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work. Numerous referrals are generated each day to the clinic that I am assigned to and all of the providers schedules are booked out until January.

Usually, I have heard postdoc fellows say that they are overwhelmed with the amount of work given to them. However, it appears that I am underwhelmed. I was constantly busy during my internship year and had an average of 15-20 direct clinical hours every week. I used to cherish the days when I had significant free time available. Now, I find myself yearning for the days when I was an intern.

What might be the best way to proceed? At this point, it does not appear that the situation will change dramatically. There seem to be some systemic issues within the facility and problems with how the training program is being run that might partially explain the lack of clinical training opportunities.

I’m very frustrated now because I very much enjoy working with patients. The lack of clinical experience makes me feel like there’s no purpose for me here.

Any guidance would be appreciated!

These people are sending you a message as isolating someone like this is a very hostile and unprofessional thing to do. Whatever has happened there between you and the powers that be is not good. I would suggest you look for a new setting elsewhere before they get rid of you. What they are doing now is designed to make you quit. Do so, but have an alternate plan.

 

[Cam_Chai19]

These people are sending you a message as isolating someone like this is a very hostile and unprofessional thing to do. Whatever has happened there between you and the powers that be is not good. I would suggest you look for a new setting elsewhere before they get rid of you. What they are doing now is designed to make you quit. Do so, but have an alternate plan.

This is jumping to conclusions in my opinion. There could be many reasons for not giving a trainee a full clinical load that have more to do with structural or supervisor-related factors rather than wanting to intentionally isolate someone and encourage them to quit. Maybe the supervisor is stretched thin and doesn't feel they have time to review more notes or expand the case load they are partially responsible for. Or maybe there is institutional pressure for them to increase their own caseload to improve their own job performance metrics rather than assigning additional clients to to their trainees if this site doesn't give supervisors credit for their trainees' caseload. I think it's completely reasonable to move forward with the hope that whatever barriers can be addressed with communication and time and the situation can improve.

 

[msc545]

This is jumping to conclusions in my opinion. There could be many reasons for not giving a trainee a full clinical load that have more to do with structural or supervisor-related factors rather than wanting to intentionally isolate someone and encourage them to quit. Maybe the supervisor is stretched thin and doesn't feel they have time to review more notes or expand the case load they are partially responsible for. Or maybe there is institutional pressure for them to increase their own caseload to improve their own job performance metrics rather than assigning additional clients to to their trainees if this site doesn't give supervisors credit for their trainees' caseload. I think it's completely reasonable to move forward with the hope that whatever barriers can be addressed with communication and time and the situation can improve.

Apparently, they have no problem doing it for everyone except the OP. This is not coincidence:

"I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work. Numerous referrals are generated each day to the clinic that I am assigned to and all of the provider's schedules are booked out until January."


If it were me, I would walk the hell out of there on Monday. Tolerating abuse leads to more abuse.

 

[Cam_Chai19]

Apparently, they have no problem doing it for everyone except the OP. This is not coincidence:

"I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work. Numerous referrals are generated each day to the clinic that I am assigned to and all of the provider's schedules are booked out until January."


If it were me, I would walk the hell out of there on Monday. Tolerating abuse leads to more abuse.

There are many reasons different trainees in the same program might have different experiences or caseload sizes depending on their rotations, supervisors, or training goals. Or different luck with how many referrals pan out. In my training I've had supervisors that had me take on a case load similar to staff psychologists to have the experience balancing a full caseload, and I've had others who wanted me to build up a caseload very gradually to make sure the quality of my training wasn't coming at the cost of quantity. The certainty that this person is being personally targeted and abused based on the information we have is confusing to me.

 

[smalltownpsych]

Is there a financial aspect of this? I don’t understand why they would not want you to work when there is work available. If the supervisor is too stressed to give you more cases then maybe you could get some cases with a secondary supervisor? The fact that there has been a slight improvement is good and I wouldn’t be in a hurry to leave. Number one on your agenda at this point is get the license so you can work independently. Use some of the xtra time to start exploring job opportunities. I just had an interview with someone in the middle of their internship. It was a good chat and probably helpful for them as they think about some of their next steps and the possibilities out there career wise. Training sites are a small slice of where we can work so we often don’t know what’s going on outside of that realm during training so good opportunity to invest that time wisely.

 

[mind_over_matter277]

These people are sending you a message as isolating someone like this is a very hostile and unprofessional thing to do. Whatever has happened there between you and the powers that be is not good. I would suggest you look for a new setting elsewhere before they get rid of you. What they are doing now is designed to make you quit. Do so, but have an alternate plan.

Now, I’m getting scared. I spoke to the previous fellow who completed the program last year. The individual stated that the caseload consisted of 10-12 clients per week. Although this is double what I have now, it still seems low in my opinion.

 

[mind_over_matter277]

There are many reasons different trainees in the same program might have different experiences or caseload sizes depending on their rotations, supervisors, or training goals. Or different luck with how many referrals pan out. In my training I've had supervisors that had me take on a case load similar to staff psychologists to have the experience balancing a full caseload, and I've had others who wanted me to build up a caseload very gradually to make sure the quality of my training wasn't coming at the cost of quantity. The certainty that this person is being personally targeted and abused based on the information we have is confusing to me.

I’m getting very nervous now. Are they trying to phase me out?

 

[mind_over_matter277]

Is there a financial aspect of this? I don’t understand why they would not want you to work when there is work available. If the supervisor is too stressed to give you more cases then maybe you could get some cases with a secondary supervisor? The fact that there has been a slight improvement is good and I wouldn’t be in a hurry to leave. Number one on your agenda at this point is get the license so you can work independently. Use some of the xtra time to start exploring job opportunities. I just had an interview with someone in the middle of their internship. It was a good chat and probably helpful for them as they think about some of their next steps and the possibilities out there career wise. Training sites are a small slice of where we can work so we often don’t know what’s going on outside of that realm during training so good opportunity to invest that time wisely.

I don’t think it’s financial, per se. I think I might be caught in the brunt of systemic issues. There are definitely other rotations and clinics at this site. I’ve expressed interest in gaining some experience in other settings. The supervisors and training director don’t seem to open about this. They keep saying they want to focus on getting specialized and focused training that’s consistent with the fellowship position. Something seems up?

 

[mind_over_matter277]

This is jumping to conclusions in my opinion. There could be many reasons for not giving a trainee a full clinical load that have more to do with structural or supervisor-related factors rather than wanting to intentionally isolate someone and encourage them to quit. Maybe the supervisor is stretched thin and doesn't feel they have time to review more notes or expand the case load they are partially responsible for. Or maybe there is institutional pressure for them to increase their own caseload to improve their own job performance metrics rather than assigning additional clients to to their trainees if this site doesn't give supervisors credit for their trainees' caseload. I think it's completely reasonable to move forward with the hope that whatever barriers can be addressed with communication and time and the situation can improve.

Something just doesn’t seem right in my opinion. Are they trying to get rid of me? If so, I’d rather quit. Do you think I could experience backlash as a result of bringing this issue up?

 

[WisNeuro]

Something just doesn’t seem right in my opinion. Are they trying to get rid of me? If so, I’d rather quit. Do you think I could experience backlash as a result of bringing this issue up?

My advice is to talk to someone you trust locally who knows the details of the program and can better understand the issues going on. Ignore the rantings of some of the alarmist members here as it is the opposite of helpful to your situation. And, as always, document everything, and get conformation and summaries of things in e-mail format. Paper trails are nice.

 

[mind_over_matter277]

My advice is to talk to someone you trust locally who knows the details of the program and can better understand the issues going on. Ignore the rantings of some of the alarmist members here as it is the opposite of helpful to your situation. And, as always, document everything, and get conformation and summaries of things in e-mail format. Paper trails are nice.

I mean the fact that they are giving me much less than what’s expected for a postdoc fellow makes me feel very dispensable.

 

[AcronymAllergy]

If the program is APA-accredited, they can't just phase you out or get rid of you. I'm certain they have formal disciplinary and grievance processes, and if they deviate from those, that's a big "no no." They can't just suddenly decide they don't want a postdoc anymore. And if they are planning to dismiss a trainee, they'll need to have taken and documented attempts at remediation up to that point, unless the trainees does something egregious that would warrant immediate dismissal. So if they had concerns about you as a trainee, they would've (or at least should've) spoken with you about those.

I'm not sure why you're consistently getting less work than other trainees and prior fellows, but it's worth another talk with your supervisor and/or the DCT. And as WisNeuro said, document everything, just in case. To include keeping an ongoing document detailing when you've talked to people, to whom you spoke, and what you discussed.

 

[mind_over_matter277]

If the program is APA-accredited, they can't just phase you out or get rid of you. I'm certain they have formal disciplinary and grievance processes, and if they deviate from those, that's a big "no no."

I'm not sure why you're consistently getting less work than other trainees and prior fellows, but it's worth another talk with your supervisor and/or the DCT. And as WisNeuro said, document everything, just in case. To include keeping an ongoing document detailing when you've talked to people, to whom you spoke, and what you discussed.

Yes, they have not taken any formal disciplinary actions against me. There seems to be a protocol for such actions outlined in the training manual. They have said that they have “rarely disciplined a trainee.”

I guess it would be more of a red flag if I was getting less work as a staff member.

I know for a fact that the neuropsych fellows are swamped with work and they are very much enjoying the experience. The other fellows are also very satisfied with what they are getting.

 

[AcronymAllergy]

Yes, they have not taken any formal disciplinary actions against me. There seems to be a protocol for such actions outlined in the training manual. They have said that they have “rarely disciplined a trainee.”

I guess it would be more of a red flag if I was getting less work as a staff member.

I know for a fact that the neuropsych fellows are swamped with work and they are very much enjoying the experience. The other fellows are also very satisfied with what they are getting.

Yeah, being APA-accredited, they need to have their disciplinary and grievance procedures documented in their training materials. And they, like you, are bound by those procedures. You could read through it if you're curious, but it certainly doesn't sound like this is a performance- or discipline-related issue.

It doesn't make a whole lot of sense to me as to why it might be happening, but definitely worth another talk with the powers that be.

 

[mind_over_matter277]

Yeah, being APA-accredited, they need to have their disciplinary and grievance procedures documented in their training materials. And they, like you, are bound by those procedures. You could read through it if you're curious, but it certainly doesn't sound like this is a performance- or discipline-related issue.

It doesn't make a whole lot of sense to me as to why it might be happening, but definitely worth another talk with the powers that be.

I don’t want to experience any backlash from bringing this issue up, especially if it’s part of a deeper problem.

 

[mind_over_matter277]

Have you/how have you followed up regarding implementation of this plan, including discussion of barriers that have prevented that plan from being enacted/enacted more thoroughly? If the initial talks were well received, it sounds like more constructive discussions could be had that can now be even more action oriented.

There can be all kinds of contributing factors but I thnk it's in your best interest to have frank discussions about what they actually are with your supervisor/TD and figure out specific, action-focused solutions for each of these barriers, rather than waiting for things to change, wondering and being unsatisfied.

These sound like last resort type choices when all other reasonable options have been exhausted. Or when a single egregious violation has occurred, which this doesn't resemble.

Filing a formal grievance after what sounds like a couple of constructive conversations with minimal follow-up would reflect poorly on you, IMO, even if the program is creating barriers to you receiving appropriate clinical hours and following up on their training commitments.

Perhaps you could reflect on any internal barriers impacting the things that are 100% within your control (e.g., initiating continued discussions with your supervisor). Nobody enjoys difficult conversations that could create conflict and many of us struggle when our reasonable expectations are not being met.

If anything has prevented you from more effectively advocating for yourself so far, maybe you can talk with a trusted friend/family members/mentor and hash out a new plan of action and try to pick up these hours.

I followed-up with my supervisor. She attempted to obtain more cases indirectly but it was only slightly successful. It seems like there’s a combination of factors at play right now.

 

[mind_over_matter277]

Perhaps you could reflect on any internal barriers impacting the things that are 100% within your control (e.g., initiating continued discussions with your supervisor). Nobody enjoys difficult conversations that could create conflict and many of us struggle when our reasonable expectations are not being met.

If anything has prevented you from more effectively advocating for yourself so far, maybe you can talk with a trusted friend/family members/mentor and hash out a new plan of action and try to pick up these hours.

I think I still feel very vulnerable as a trainee. I was always taught to keep quiet and just take what is given. This issue goes against that mindset.

 

[msc545]

There are many reasons different trainees in the same program might have different experiences or caseload sizes depending on their rotations, supervisors, or training goals. Or different luck with how many referrals pan out. In my training I've had supervisors that had me take on a case load similar to staff psychologists to have the experience balancing a full caseload, and I've had others who wanted me to build up a caseload very gradually to make sure the quality of my training wasn't coming at the cost of quantity. The certainty that this person is being personally targeted and abused based on the information we have is confusing to me.

You can imagine all sorts of reasons that this might conceivably occur, but an application of Occam's razor yields the conclusion that this is abuse. Stop rationalizing.

 

[msc545]

I’m getting very nervous now. Are they trying to phase me out?

Yes, they probably are. In a real work situation, this would be constructive termination. You need to respond to this coherently and properly with good self-care and by finding another position right away.

 

[mind_over_matter277]

Yes, they probably are. In a real work situation, this would be constructive termination. You need to respond to this coherently and properly with good self-care and by finding another position right away.

Wow! Idk what to do?!

 

[mind_over_matter277]

This is really freaking me out now? I mean Ocaam’s razor tends to be the best way of making sense of a complex and ambiguous situation?

 

[PsychPhDone]

Uhhh this thread really took a turn since I last looked at it. OP, there's lots of reasons your caseload might be lower than it could be but I'd like to think of it had anything to do with your performance it would have been brought up already. Have you ever had performance issues before? Even if so, the site owes you honest feedback. They had a meeting with you, agreed to work on it, and there's been a little progress. Schedule another meeting and request a plan to get your caseload up and identify the barriers to it happening. That's...it. That's all you need.

 

[WisNeuro]

Wow! Idk what to do?!

First step is to not listen to irrational advice.

 

[summerbabe]

I know for a fact that the neuropsych fellows are swamped with work and they are very much enjoying the experience. The other fellows are also very satisfied with what they are getting.

It's not uncommon for trainees in the same cohort to have different experiences when they have different rotations and supervisors. I don't see any reason to believe the catastrophic options being thrown around such as you are being phased out and should consider quitting hold water short of other concrete info or future developments.

From the perspective of maintaining accreditation (which I assume this facility wants to do), losing interns does not support this mission. It's kinda like how PhD programs sometimes make mistakes with admissions but rather than cut students loose at the first sign of trouble, they instead make painstaking efforts to help these students finish, even if they struggle a lot and probably won't turn out to be assets for our field, because the progam values self-preservation more.

I followed-up with my supervisor. She attempted to obtain more cases indirectly but it was only slightly successful. It seems like there’s a combination of factors at play right now.

This is really freaking me out now? I mean Ocaam’s razor tends to be the best way of making sense of a complex and ambiguous situation?

I am a supervisor and like others who posted, can think of a bunch of reasons that have nothing to do with your competence/program standing such as your supervisor being overwhelmed with all of her work demands and putting your training needs secondary because they did make some initial effort which produced some results that were not maintained.

To me, that sounds like more attention is needed in some specific areas, rather than something drastic, like quitting before you're fired (which doesn't even make sense from a postdoc perspective given APA rules and your program guidelines).

I think I still feel very vulnerable as a trainee. I was always taught to keep quiet and just take what is given. This issue goes against that mindset.

It's totally reasonable to feel this way. And some PhD programs reinforce this standard in not so good ways. But you definitely have agency in this situation.

Ask on Monday to schedule a meeting with your supervisor. Be professional and ask specific questions such as the current status on getting more cases assigned and barriers that have popped up. Offer assistance in troubleshooting those barriers. Make sure to leave the meeting with some mutually agreed upon concrete goals and timelines (e.g., x cases assigned by the end of this week, x cases assigned by the end of the following week, etc).

My guess is that despite whatever systemic issues might be going on, your supervisor will be receptive, which means it's largely a matter of follow-up throughout the rest of this rotation. While that sucks for you since this might be happening smoothly for other trainees, solutions are likely to be found.

 

[AbnormalPsych]

Does the state you will eventually practice in require a specific number of F2F hours? If not and checking the postdoc box off is all that is between you and this large milestone of fully independent practice, sometimes you just gotta keep your head down and check boxes, then move on to the next thing, whatever that be for you.

 

[mind_over_matter277]

Does the state you will eventually practice in require a specific number of F2F hours? If not and checking the postdoc box off is all that is between you and this large milestone of fully independent practice, sometimes you just gotta keep your head down and check boxes, then move on to the next thing, whatever that be for you.

I think if it’s APA-accredited, they automatically accept the hours. If it’s not, the state requires a full breakdown of the clinical hours including supervision, direct care, admin, etc.

 

[mind_over_matter277]

It's not uncommon for trainees in the same cohort to have different experiences when they have different rotations and supervisors. I don't see any reason to believe the catastrophic options being thrown around such as you are being phased out and should consider quitting hold water short of other concrete info or future developments.

From the perspective of maintaining accreditation (which I assume this facility wants to do), losing interns does not support this mission. It's kinda like how PhD programs sometimes make mistakes with admissions but rather than cut students loose at the first sign of trouble, they instead make painstaking efforts to help these students finish, even if they struggle a lot and probably won't turn out to be assets for our field, because the progam values self-preservation more.


I am a supervisor and like others who posted, can think of a bunch of reasons that have nothing to do with your competence/program standing such as your supervisor being overwhelmed with all of her work demands and putting your training needs secondary because they did make some initial effort which produced some results that were not maintained.

To me, that sounds like more attention is needed in some specific areas, rather than something drastic, like quitting before you're fired (which doesn't even make sense from a postdoc perspective given APA rules and your program guidelines).

It's totally reasonable to feel this way. And some PhD programs reinforce this standard in not so good ways. But you definitely have agency in this situation.

Ask on Monday to schedule a meeting with your supervisor. Be professional and ask specific questions such as the current status on getting more cases assigned and barriers that have popped up. Offer assistance in troubleshooting those barriers. Make sure to leave the meeting with some mutually agreed upon concrete goals and timelines (e.g., x cases assigned by the end of this week, x cases assigned by the end of the following week, etc).

My guess is that despite whatever systemic issues might be going on, your supervisor will be receptive, which means it's largely a matter of follow-up throughout the rest of this rotation. While that sucks for you since this might be happening smoothly for other trainees, solutions are likely to be found.

Thanks for your support! My supervisor does feel overwhelmed and I have a feeling that the facility actually measures the amount of work that each provider does. So, they can’t just assign work to a trainee and collect RVU’s.

I also feel bad for the interns in this rotation. They aren’t getting much experience here. However, the lack of opportunities are being offset by their other rotations. It’s hard because I’m just stuck in this one setting for the full year.

 

[mind_over_matter277]

Uhhh this thread really took a turn since I last looked at it. OP, there's lots of reasons your caseload might be lower than it could be but I'd like to think of it had anything to do with your performance it would have been brought up already. Have you ever had performance issues before? Even if so, the site owes you honest feedback. They had a meeting with you, agreed to work on it, and there's been a little progress. Schedule another meeting and request a plan to get your caseload up and identify the barriers to it happening. That's...it. That's all you need.

No, they haven’t brought such concerns up to me.

 

[mind_over_matter277]

Is it an APA issue if they aren’t providing enough clinical experience for a postdoc resident?

 

[futureapppsy2]

So, as a faculty member, I can say that trainee talk about these things can sometimes misconstrue things or miss broader structual issues, individual trainee differences, or other concerns. Talk to your faculty--see if there's a reason for this (performance issues, they want you to be doing research, they are trying to block time for a speciality population, etc).

 

[mind_over_matter277]

So, as a faculty member, I can say that trainee talk about these things can sometimes misconstrue things or miss broader structual issues, individual trainee differences, or other concerns. Talk to your faculty--see if there's a reason for this (performance issues, they want you to be doing research, they are trying to block time for a speciality population, etc).

It’s not performance issues. I have been receiving good feedback in this regard. I think they just aren’t willing to give more therapy cases out. Maybe, the facility is encouraging them not to?

I am concerned that the skills that I have spent years acquiring will just go to waste.

 

[foreverbull]

It’s not performance issues. I have been receiving good feedback in this regard. I think they just aren’t willing to give more therapy cases out. Maybe, the facility is encouraging them not to?

I am concerned that the skills that I have spent years acquiring will just go to waste.

They aren’t going to waste if you’re seeing clients and getting training and supervision. I’d be extremely concerned if you got zero hours of clinical contact, but that isn’t the case, and your postdoc hours should be fine based on what you said before about it being APA-accredited.

Maybe I’m on my own here, but is this lowish hours issue really as much of a problem as you think it is? It sounds like you’re uncomfortable and that the low hours are due to organizational factors that have nothing to do with you. Then can you be okay with accepting the situation as is and focusing on doing great work with your caseload? Or slowly working your way up to a bigger caseload throughout the year but not focusing too much on it?

You’ll be swamped with work once licensed. I’m just wondering if this is something you need to worry about this much at this stage. You’re about to be licensed and probably have several practice years under your belt. You are not a novice trainee in your first year getting few clients and painstakingly counting those hours for APPIC/internship apps.

If you bring up the concern over hours regularly to your supervisor, I also wonder how this will play out in evaluations and how you’d be perceived. I’d keep the requests clear & reasonable, but tactful, few and far between, and after that, you may need to read between the lines and accept the reality if it doesn’t change too much (unless it bothers you enough that you want to leave your postdoc before your contract is up, which may present its own challenges).

 

[msc545]

It's not uncommon for trainees in the same cohort to have different experiences when they have different rotations and supervisors. I don't see any reason to believe the catastrophic options being thrown around such as you are being phased out and should consider quitting hold water short of other concrete info or future developments.

From the perspective of maintaining accreditation (which I assume this facility wants to do), losing interns does not support this mission. It's kinda like how PhD programs sometimes make mistakes with admissions but rather than cut students loose at the first sign of trouble, they instead make painstaking efforts to help these students finish, even if they struggle a lot and probably won't turn out to be assets for our field, because the progam values self-preservation more.


I am a supervisor and like others who posted, can think of a bunch of reasons that have nothing to do with your competence/program standing such as your supervisor being overwhelmed with all of her work demands and putting your training needs secondary because they did make some initial effort which produced some results that were not maintained.

To me, that sounds like more attention is needed in some specific areas, rather than something drastic, like quitting before you're fired (which doesn't even make sense from a postdoc perspective given APA rules and your program guidelines).

It's totally reasonable to feel this way. And some PhD programs reinforce this standard in not so good ways. But you definitely have agency in this situation.

Ask on Monday to schedule a meeting with your supervisor. Be professional and ask specific questions such as the current status on getting more cases assigned and barriers that have popped up. Offer assistance in troubleshooting those barriers. Make sure to leave the meeting with some mutually agreed upon concrete goals and timelines (e.g., x cases assigned by the end of this week, x cases assigned by the end of the following week, etc).

My guess is that despite whatever systemic issues might be going on, your supervisor will be receptive, which means it's largely a matter of follow-up throughout the rest of this rotation. While that sucks for you since this might be happening smoothly for other trainees, solutions are likely to be found.

"Make sure to leave the meeting with some mutually agreed upon concrete goals and timelines (e.g., x cases assigned by the end of this week, x cases assigned by the end of the following week, etc)."



At least this sounds like a reasonable approach in contrast to people encouraging him to basically just put up with it and/or making excuses for the treatment he is receiving.

 

[msc545]

Uhhh this thread really took a turn since I last looked at it. OP, there's lots of reasons your caseload might be lower than it could be but I'd like to think of it had anything to do with your performance it would have been brought up already. Have you ever had performance issues before? Even if so, the site owes you honest feedback. They had a meeting with you, agreed to work on it, and there's been a little progress. Schedule another meeting and request a plan to get your caseload up and identify the barriers to it happening. That's...it. That's all you need.

It could also be something as simple as one or more people above him have decided they dislike him and while they cannot point to any performance issues or find any rational reasons to actually fire him, they can find ways to make him miserable and possibly quit. I've seen this happen to people more than a few times and in fact, in a large school district where I live, it is the preferred method for getting rid of people administrators dislike but cannot find a reason to fire.

 

[AcronymAllergy]

Thanks for your support! My supervisor does feel overwhelmed and I have a feeling that the facility actually measures the amount of work that each provider does. So, they can’t just assign work to a trainee and collect RVU’s.

I also feel bad for the interns in this rotation. They aren’t getting much experience here. However, the lack of opportunities are being offset by their other rotations. It’s hard because I’m just stuck in this one setting for the full year.

Odds are the supervisors have their productivity tracked, yes. However, depending on the nature and setup of the program, the supervisors may also receive credit for wRVUs performed by trainees.

I would also second what was said above about different types of trainees having different experiences. As a neuropsych fellow, the experiences of myself and the other neuropsych fellow were at times markedly different than other fellows at the same program. Given the bolded portion, it sounds like it's something specific to your particular setting/rotation. I agree with everything summerbabe said, particularly regarding ways to approach the meeting with your supervisor.

I personally would not be worried about being dismissed. Your program has processes to which they must adhere in that regard. If they haven't spoken with you about any issues, you aren't on some sort of remediation plan, and you haven't done anything ethically egregious, they will not (and likely cannot) dismiss you. And they gain essentially nothing from trying to get you to resign, even if that were allowed. And if the situation started to move in that direction, it would likely need to go through both APA and your facility's training leadership, including potentially having one or both of those groups talk with you directly about the situation. In this case, the situation as a trainee is pretty different than if you were a "regular" employee, in which case I might be more concerned.

 

[futureapppsy2]

It could also be something as simple as one or more people above him have decided they dislike him and while they cannot point to any performance issues or find any rational reasons to actually fire him, they can find ways to make him miserable and possibly quit. I've seen this happen to people more than a few times and in fact, in a large school district where I live, it is the preferred method for getting rid of people administrators dislike but cannot find a reason to fire.

In the context of a formal training program, this doesn’t really work like that. For one, trainee attrition is expensive and looks bad; for another, the requirement of a formal remediation process means that if they were quietly trying to force the OP out, which I don’t think they are, this wouldn’t be the way to do it.

In my postdoc, another fellow was initially unhappy with the clinical hours they were given, and that frustration led them down the initial, understandable road of “this whole program is broken.” But when they talked to the program faculty about it, it became more clear that it was an issue of “we gave you these hours because they were the most immediately available; if you can help us come up with a way to get you different hours that are more in line with what you want, we are happy to work with you on that.” It took a bit of leg work, but the trainee ended up finding a way to get clinical hours that fit what they wanted and having an overall good experience with the program.

As faculty now, I’ve seen issues of informal “peer advising” turning into a game of telephone, where students pass along information about their own experience as though it is program policy and other students get upset or confused when they have or perceive themselves to have different experiences, not realizing that there were often times other factors at play.

 

[msc545]

In the context of a formal training program, this doesn’t really work like that. For one, trainee attrition is expensive and looks bad; for another, the requirement of a formal remediation process means that if they were quietly trying to force the OP out, which I don’t think they are, this wouldn’t be the way to do it.

In my postdoc, another fellow was initially unhappy with the clinical hours they were given, and that frustration led them down the initial, understandable road of “this whole program is broken.” But when they talked to the program faculty about it, it became more clear that it was an issue of “we gave you these hours because they were the most immediately available; if you can help us come up with a way to get you different hours that are more in line with what you want, we are happy to work with you on that.” It took a bit of leg work, but the trainee ended up finding a way to get clinical hours that fit what they wanted and having an overall good experience with the program.

As faculty now, I’ve seen issues of informal “peer advising” turning into a game of telephone, where students pass along information about their own experience as though it is program policy and other students get upset or confused when they have or perceive themselves to have different experiences, not realizing that there were often times other factors at play.

All of that is a plausible but unproven hypothesis that may or may not apply to this program - we can all create such scenarios with a little thought which does not make them valid. What DOES apply is that he has been singled out and is being treated poorly and differently than all of his peers by his own account - that is the real evidence.

I continue to contend that that is not a coincidence and that it has meaning. The OP said:

"I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work. Numerous referrals are generated each day to the clinic that I am assigned to and all of the provider's schedules are booked out until January."

 

[WisNeuro]

 

[smalltownpsych]

OP needs to not catastrophize. Even if people in organization were dissatisfied with their performance and wanted to underwork them, so what? Complete the postdoc and get licensed. I doubt from what they describe that is the case. If anything it sounds like the supervisor might be in more trouble than they are. It also sounds like their model of specialization is leading to this problem as well since it limits what they can do to be flexible.

My first 4 months of my business, I was lucky to get 10 clinical hours a week. This led to an average gross revenue of 7k and with expenses of 3k, clearly not enough to pay the bills. I’m at about 20 clinical hours a week now and pay myself a salary of 4K a month and health insurance and now am hitting over 20k a month with about 18k in expenses (includes some of the money that goes to me as mentioned above). During those four months, I used the low clinical demand to put energy into other aspects of business.

Learning how to channel non-clinical time onto productivity is a skill that psychologists should have imo. Put 5 hours a week into turning your dissertation into a book or developing more expertise in area of interest. Do the legwork for starting your own business. Most of that can be done with minimal investment. Get a class to teach at the local college which is actually something I did during my own postdoc.

Learning how to deal with adversity and the work environment is part of the training experience. If you wanted I could regale you with all of the ”learning experiences“ during my internship and postdoc. Short version is primary supervisor during internship was placed on administrative leave and during postdoc my supervisor was deployed to Iraq. In retrospect, these adverse situations tend to stand out as where I learned the most about the work part. Kind of like how my most difficult cases taught me the most about the clinical part.

 

[Dazen]

All of that is a plausible but unproven hypothesis that may or may not apply to this program - we can all create such scenarios with a little thought which does not make them valid. What DOES apply is that he has been singled out and is being treated poorly and differently than all of his peers by his own account - that is the real evidence.

I continue to contend that that is not a coincidence and that it has meaning. The OP said:

"I don’t think that there is a lack of opportunities available as the majority of psychologists, interns, and practicum students are receiving plenty of work. Numerous referrals are generated each day to the clinic that I am assigned to and all of the provider's schedules are booked out until January."

Except they might not be, given that the same thing is happening to everyone in that particular area of the site...

"I also feel bad for the interns in this rotation. They aren’t getting much experience here. However, the lack of opportunities are being offset by their other rotations. It’s hard because I’m just stuck in this one setting for the full year."

 

[mind_over_matter277]

I was expecting postdoc to serve as a bridge between internship and a staff job. As such, I anticipated starting with a decent number of hours and gradually build up to the caseload of a staff psychologist. This hasn’t happened and it is disappointing. Less than 10% of the hours that I have spent here have been clinical contact. I’m starting to think I don’t have a purpose here and would have wasted a precious year of my career doing next to nothing. Seems similar to just taking a year off before returning to school?