PhD/PsyD Unpaid internships (meaning unpaid practica)

[Shiori]

As to grad students advocating for higher stipends, doing so haphazardly or in an unorganized manner ("lets's protest at the Student Union, then go get some beers!") is unlikely to lead to much. On the other hand, start a unionization campaign and secure the right to collective bargaining, then you will have more say. While it's certainly tough times for universities, those endowments are shrinking, not disappearing.

Fortunately, it was organized enough for their progress to make the news in higher education publications. That probably reveals a little about where I'm located, but I'm proud of their achievements.

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[ClinicalABA]

Fortunately, it was organized enough for their progress to make the news in higher education publications. That probably reveals a little about where I'm located, but I'm proud of their achievements.

Making the news in higher ed publications is not the same as making the news in the pages of "Solidarity." Publicly, with the way things are now, grad students with low stipends are not a very sympathetic group, relative to everything else that is going on. As PsyDr alluded to above, the real work gets done at the bargaining table and in the legislative halls. There is still, unfortunately, a large group of people in charge who see grad student protests as nothing more that a bunch of lazy, whiny, hippies with no real world knowledge.

 

[ccpsych16]

I guess I'm not sure why practica should be paid if the program is providing funding to the students already. As mentioned, wouldn't that be considered part of the training provided by the program?

I’m sure it varies by site, but in my program and many programs I’m aware of, funding is provided in exchange for teaching/TA services. Still paid MUCH less than minimum wage (dividing pay by hours per week), but I imagine programs include the tuition waiver in the total “pay”. So, while yes it can be argued that it’s training and therefore shouldn’t be paid, it is not part of what students are already paid for.

 

[bcliff]

I trained in a state that allowed PhD/PsyD students to earn a mid-level license, and where services rendered by licensed trainees could be billed to insurance. It was not uncommon in my program for trainees to supplement their departmental funding with funding provided by an external clinical training site. I think this model (i.e., allowing trainees to pursue midlevel licensure, allowing sites to bill for supervised services, and ultimately compensating trainees for rendering those services) might be the most viable way to circumvent the issue of unpaid externships.

 

[Shiori]

Making the news in higher ed publications is not the same as making the news in the pages of "Solidarity." Publicly, with the way things are now, grad students with low stipends are not a very sympathetic group, relative to everything else that is going on. As PsyDr alluded to above, the real work gets done at the bargaining table and in the legislative halls. There is still, unfortunately, a large group of people in charge who see grad student protests as nothing more that a bunch of lazy, whiny, hippies with no real world knowledge.

The fight went to our state supreme court where they sided with the students.

 

[WisNeuro]

The fight went to our state supreme court where they sided with the students.

Can you link to the decision? I'd be interested to read the language of the decision.

 

[Sanman]

Some opinions.

1) Federal labor laws prohibit using unpaid interns for a job that a paid person usually does. Because one has to prove that the unpaid person is doing the work of a paid person, the issue of being licensed comes into play. Medicine has solved this by granting licenses before residency.

2) CMS is part of the Department of Health and Human Services. CMS was created in the 1960s. Like a lot of bills, the law creating CMS had a bunch of other things. One of these things was the creation of a fund to pay for medical residencies salaries (i.e., Direct Graduate Medical Education funds). That Graduate Medical Education fund is administered by CMS. Because CMS is paying a flat fee for resident's salaries, they created rules to prevent double dipping (i.e.,, paying for resident's salaries, and then also being billed for each thins done by a trainee).

3) It gets a bit more complicated. CMS has both medicare and medicaid. Every year, CMS is given an annual budget. Then they have to divide up how that pool of money is distributed. Medicare is administered at the federal level (i.e., same rules in each state). Medicaid is federally funded, but administered by each state (e.g., CMS gives Delaware $500MM to run their medicaid program for a year, Delaware's medicaid office makes up their own rules). So why medicare might not pay for stuff billed by trainees, some states' medicaid programs might allow training institution to bill for trainees work.
4) When psychology is added, it gets even more complicated. Psychology doesn't get any of that sweet sweet CMS Direct Graduate Medical Education funding. Instead, the Department of Health and Human Services gives us some funding under a different branch (i.e., Health Resources and Service Administration). This pays a lot less than CMS.

5) Ready for it to get more complicated? By default, ALL providers in the USA are CMS providers. You literally have to write CMS a letter saying "I do not want to be a CMS provider". So we are bound by CMS rules.

6) Now we add in private insurance companies. So long as there is a licensed professional that is supervising, they can allow trainees to bill or not.

7) The VA gets their own funding for trainees, and they have their own laws. I don't know how that works.

8) Putting it all together: Psychologists are usually governed by CMS rules, but we don't get CMS money for training. Usually we cannot bill for trainees services. Unless they are in a state where medicaid says they can. Or if they are in a state where the state law supervisors can bill for trainee services, and the insurance contracts say they can do that. But usually that isn't the case. In order for a trainee to fix this problem, they would have to prove the supervisor is billing for their services, and that the trainee has replaced a paid person.

If someone was serious about lobbying for better pay during training, I would start with CMS and getting access to GME funds. This would give programs the pot og money they need to offer stipends and better salaries at the intern/post-doc level. Graduated licensing at earlier levels would also help.

 

[PikminOC]

You aren't supposed to bill insurance or clients for services you do not provide. If a supervisee does the work, billing it at a psychologist rate or under a psychologist billing code is fraud. In private pay cases, if you are billing doctoral level rates for supervisee's work, you better have a long paper trail where you can prove that the client knew EXACTLY what they were paying for (and in that case, a savvy private pay client would just find a licensed/experienced provider at the same rate as the trainee?).

In my practice. If the supervisee (e.g. postdoc) does the work independent of me (I'm NOT in the room/zoom AND actively participating), we either attempt to bill under an appropriate billing codes for their credentialling level or we don't bill at all. If I'm sitting in the room working on a report for another client while the trainee does the assessment, that doesn't allow me to bill (and it shouldn't count as a direct supervision hour, either).

This private practice I know isnt telling the patient any of that

 

[PikminOC]

Are you asking if supervisors can bill trainees for providing supervision or if supervisors can bill patients for their trainees' services?

Either way I treated exactly zero patients in a setting who paid for treatment during any of my training. Maybe very very few of my VA patients had the copay? There was little in the way of PP practica at my grad program. We were all fully funded on merit based fellowships, research assistantships, or teaching assistantships.

In private practice this is exactly what I'm seeing. They are billing as if the person was licensed or maybe under the supervisor id. And they take only bcbs.
They don't let the patient know they aren't licensed and still very their hours...

 

[PikminOC]

I trained in a state that allowed PhD/PsyD students to earn a mid-level license, and where services rendered by licensed trainees could be billed to insurance. It was not uncommon in my program for trainees to supplement their departmental funding with funding provided by an external clinical training site. I think this model (i.e., allowing trainees to pursue midlevel licensure, billing for their services, and being compensated for providing those services) might be the most viable way to circumvent the issue of unpaid externships.

The therapists I'm seeing in pp don't have licenses

 

[WisNeuro]

In private practice this is exactly what I'm seeing. They are billing as if the person was licensed or maybe under the supervisor id. And they take only bcbs.
They don't let the patient know they aren't licensed and still very their hours...

I'm curious as to what info you are making this assertion on. Do you have the consent forms and billing claims?

 

[AcronymAllergy]

In private practice this is exactly what I'm seeing. They are billing as if the person was licensed or maybe under the supervisor id. And they take only bcbs.
They don't let the patient know they aren't licensed and still very their hours...

The insurance they're using may allow the supervisor to bill for services provided by trainees.

State licensing laws may (and, in my experience, universally do) require that supervising psychologists inform patients that trainees are working under their supervision. This ideally is discussed/reviewed with the patient, but may also just be included in intake documents and consent forms/packets. I suspect it's possible the patient(s) may have been informed but weren't sure what it meant or just don't remember that part. If the state board requires it and the psychologist isn't providing that information, it could warrant a call to the provider and/or a board complaint, but you'd want to be certain.

 

[ClinicalABA]

The insurance they're using may allow the supervisor to bill for services provided by trainees.

Yep- we have some insurers where we can bill for services provided by non-licensed trainees (post-docs), but it is at a lower rate than if we did it.

State licensing laws may (and, in my experience, universally do) require that supervising psychologists inform patients that trainees are working under their supervision. This ideally is discussed/reviewed with the patient, but may also just be included in intake documents and consent forms/packets. I suspect it's possible the patient(s) may have been informed but weren't sure what it meant or just don't remember that part. If the state board requires it and the psychologist isn't providing that information, it could warrant a call to the provider and/or a board complaint, but you'd want to be certain.

In every setting I've been in, both as a licensed psych and trainee, there was a specific consent form for treatment by a trainee. It expressly stated the nature of the work to be done, the name of the trainee and name/contact information for the supervisor, and the right to decline treatment from a trainee. Regardless of state law, I would not even consider being involved in any trainee experience without such a document,

 

[ClinicalABA]

This private practice I know isnt telling the patient any of that

Then they may be a) practicing psychology without a license; and b) committing billing fraud.

Under state regs/board policies, the trainee themselves may be subject to discipline and sanctions for such behavior. It may be legally (and it is definitely ethically) required for the trainee to state the nature of their position/credentialing at the outset of the relationship.

 

[Ollie123]

Yep- we have some insurers where we can bill for services provided by non-licensed trainees (post-docs), but it is at a lower rate than if we did it.

Exact rules are going to vary by state. For private insurance we're required to be physically in the room for the intake, but can bill at normal rate for trainees in subsequent visits as long as the supervising psychologist is available on-site (but can be with another patient in a different room). Whether it should be that way or not is a separate question and I suspect our hospital system has jumped through major hoops to make that happen.

 

[foreverbull]

Then they may be a) practicing psychology without a license; and b) committing billing fraud.

Under state regs/board policies, the trainee themselves may be subject to discipline and sanctions for such behavior. It may be legally (and it is definitely ethically) required for the trainee to state the nature of their position/credentialing at the outset of the relationship.

Yes indeed. In my postdoc, in the very first meeting with the new client/family, I always stated that I was Dr. Z, a psychological assistant working under Dr. X, a licensed psychologist. My consent form also included my supervisor’s contact info (in addition to mine) in case of concerns. This was in a nonprofit organization, and somehow they were able to bill for my services and those of master’s graduates. It was done by the book, so my state allowed that.

 

[WisNeuro]

Exact rules are going to vary by state. For private insurance we're required to be physically in the room for the intake, but can bill at normal rate for trainees in subsequent visits as long as the supervising psychologist is available on-site (but can be with another patient in a different room). Whether it should be that way or not is a separate question and I suspect our hospital system has jumped through major hoops to make that happen.

Yeah, there was some of that in a prior state I was in (supervisor had to be physically present). Which, goes back to our earlier comments that it's still a huge time and revenue sink for many, as well as being contraindicated in certain situations (TPO for evals).

 

[PikminOC]

These are msw doing this. Maybe their rules are more lax?

 

[Grenth]

It seems somewhat common in my area for doctoral students to get mid level license (typically mental health counselor associate) and to bill/be paid at that rate for any hours above what the school required per week for practicum. I did this for any non-governmental pracs and made twice as much on practicum than I'm making on internship. Unfortunately the best pracs in my area are governmental and so when I did those they were very unpaid. For the federal practicum the only thing I got the entire time was a free prison made paper date book. The state was a bit more generous and we sometimes got free food.

 

[WisNeuro]

It seems somewhat common in my area for doctoral students to get mid level license (typically mental health counselor associate) and to bill/be paid at that rate for any hours above what the school required per week for practicum. I did this for any non-governmental pracs and made twice as much on practicum than I'm making on internship. Unfortunately the best pracs in my area are governmental and so when I did those they were very unpaid. For the federal practicum the only thing I got the entire time was a free prison made paper date book. The state was a bit more generous and we sometimes got free food.

Non SW midlevels can't bill for certain services independently, some of this varies by state.

 

[Grenth]

Non SW midlevels can't bill for certain services independently, some of this varies by state.

Absolutely. In my state with my license (MFT) I was pretty unrestricted but neighboring states are more strict. More cohesive regulations would be great for lots of reasons including this but also for scope creep etc. I know in some states mid levels can do some pretty suspect stuff especially regarding assessment.

 

[singasongofjoy]

Seconding @WisNeuro 's comment above about advocating for funding. The state and the hospital's funding for my program (which is part of a large AMC) has been cut year over year. Considering we're one of the only places around that accepts Medicaid in this specialty area, that's at LEAST 80% of my billing. So Medicaid reimburses 1/3 of what the actual charge is, state / other funding is cut and cut, I/we can't bill for student time, and it takes at least as much time and often more to train & supervise students, edit reports etc.... yes, I really wish that there was budget to give students some kind of pay, even minimum wage, but if the money isn't there, it isn't there. And yet though psychologists in my program are paid considerably less than they would be elsewhere, many folks stick around for other reasons, and most essentially volunteering time to train students because they like training students (Plus - if they're going to eventually be colleagues in this field, we certainly want them trained well- and this is a program that does a really good job of it.) But our program is most certainly not adding to students' bank accounts in the least until some major systemic issues get sorted out first. Those issues need to be addressed first and urgently.

 

[WisNeuro]

So, to summarize what a lot of us as saying. We get it, we were there. There are lots of us who had no financial help from family. It's hard, and you have to make some sacrifices to go this route. And, part of that process is unpaid practica for a lot of people. Now, may of us are on the other side. We've spent countless unreimbursed hours supervising and mentoring. So, you can imagine our frustration when we're accused of exploiting students for our own financial gain, when most of the time it's the exact opposite.

It's been a good discussion, so let's continue to have these discussions, here and within your state to advocate for funding to do something about it instead of sniping at each other in the future. It's easy to have grand ideas about how things should be, but once you see how the sausage gets made, you start to see how hard it is to implement change in some situations.

 

[roryportman]

Thank you to everyone that spent time in explaining what the other side looks like. There are clearly many systemic problems, with no easy fix, that go way beyond #unpaidinternships. I agree with whoever said programs with large cohorts and little funding should be nixed, and @WisNeuro provided a helpful summary above.

@Shiori mentioned the heart of what I was originally trying to get at. I am also a POC, and I fought my way tooth and nail to get into a fully funded program, and receive some external scholarships that make financial means even a possibility in nyc. While I was exaggerating when I said that many students I know are super wealthy (I also know many typical PhD students of average means), I just wish that diverse students could have a better shot. It's just not possible for many Black and Latinx people due to many barriers like finances and even GRE (I know, GRE would be a whole other debate).

After landing a post-doc, I finally have some breathing room to think about the experience of becoming a psychologist. I can't help but worry about the fairly homogeneous group of people who make it through this process. I am heartened that there are efforts to expand opportunities for trainees by examining the reimbursement of services. I am often the only African American in the room at this level, and I have regularly been asked for my feedback on how to recruit and keep more diverse trainees. The financial commitment is daunting. I have been a TA pretty regularly and have had undergrads of colors ask about the process of becoming a psychologist. Many of them don't have access to financial resources that would make psychology a viable option. It's frustrating, and it's an expensive problem to fix. I'm definitely going to commit more of my energy to doing what I can.

Sorry for the random new post! I joined when I was panicking about getting into a PhD program. It was a wild ride, and now I'm closer to the other side of the process.

In any case, my perspective has definitely expanded thanks to this discussion.

 

[Sanman]

Thank you to everyone that spent time in explaining what the other side looks like. There are clearly many systemic problems, with no easy fix, that go way beyond #unpaidinternships. I agree with whoever said programs with large cohorts and little funding should be nixed, and @WisNeuro provided a helpful summary above.

[B]@Shiori mentioned the heart of what I was originally trying to get at. I am also a POC, and I fought my way tooth and nail to get into a fully funded program, and receive some external scholarships that make financial means even a possibility in nyc. While I was exaggerating when many students I know are super wealthy (I also know many typical PhD students of average means), I just wish that diverse students could have a better shot. It's just not possible for many Black and Latinx people due to many barriers like finances and even GRE (I know, GRE would be a whole other debate).[/B]


In any case, my perspective has definitely expanded thanks to this discussion.

Both psychology graduate programs and medical school are historically upper middle class professions and the programs reflect this reality. As I have said before, both nursing and SW are more accessible professions with rungs on the ladder that you can climb throughout your career. I have worked with a number of minority NPs that started out as nursing assistants or LPNs and worked their way up the profession slowly. Much more feasible for those of a lower SES level.

 

[foreverbull]

Thank you to everyone that spent time in explaining what the other side looks like. There are clearly many systemic problems, with no easy fix, that go way beyond #unpaidinternships. I agree with whoever said programs with large cohorts and little funding should be nixed, and @WisNeuro provided a helpful summary above.

@Shiori mentioned the heart of what I was originally trying to get at. I am also a POC, and I fought my way tooth and nail to get into a fully funded program, and receive some external scholarships that make financial means even a possibility in nyc. While I was exaggerating when many students I know are super wealthy (I also know many typical PhD students of average means), I just wish that diverse students could have a better shot. It's just not possible for many Black and Latinx people due to many barriers like finances and even GRE (I know, GRE would be a whole other debate).


In any case, my perspective has definitely expanded thanks to this discussion.

SES barriers to higher education are stark (which also intersects with ethnicity). I was one of two people in a program with maybe 30-ish people total who came from around poverty-level or thereabouts at times and it was a different world for the two of us vs. everyone else. We were literally the only two people whose family couldn’t afford to help us out financially if we had an emergency (any uptick in monthly expenses, car breakdown, higher energy bill, tuition increase, travel/moving for internship and after, or health situation resulted in more student loans). To contrast, a colleague of mine from a different SES lived in their own swanky place during grad school (paid for by family) and their time was freed up so that the person had time to pursue many different fellowships and other scholarship-type opportunities, as well as networking more professionally (and of course, travel during internship apps time and going to APA every year and other conventions regularly to network). Their last year before internship, the colleague got paid to do their dissertation research as a “job“ because they secured a relatively lucrative fellowship. The irony of seeing someone from the upper class secure funding that others needed but weren’t even aware of was frustrating to say the least. This is an extreme example, because most folks did struggle financially in grad school, but it was eye-opening to me that one of the richest students got paid to work on their dissertation while the rest of us had to find the time to write ours outside of classes, practicum, and assistantships. There’s no system of need-based financial award at the graduate level, which is unfortunate, I think.

My colleagues from the middle class would complain that they were poor in our grad program but their parents had paid for their undergraduate education and were there for them financially if they were in a bind. I had a roommate throughout grad school and lived simply and budgeted, so it wasn’t that I was trying to live outside of my means, but debt is a reality for many folks from lower SES who pursue higher education.

The farther you achieve education-wise, the fewer low SES folks you see (and folks of color), and it is very frustrating to see how few have the opportunity to make it to the doctoral level. This is systemic, starts early in life in our society, and is common in most white-collar professions, unfortunately.

 

[mypointlesspov]

Both psychology graduate programs and medical school are historically upper middle class professions and the programs reflect this reality. As I have said before, both nursing and SW are more accessible professions with rungs on the ladder that you can climb throughout your career. I have worked with a number of minority NPs that started out as nursing assistants or LPNs and worked their way up the profession slowly. Much more feasible for those of a lower SES level.

How often do we come across social workers that have become psychologists late in their careers? I don't think this is comparable to LPN going to NP, but if there's any data to back it up I would like to see it. SW, counseling, and the other mid-level mental health professionals are trained differently. We all know that good psychology doctoral programs look for research experience, not necessarily professional experience (especially in a different field). Who is a quality doctoral clinical psych program more likely to take: A person in their mid-20s who has some posters after spending two years in an unpaid research position or a person in their mid-40s with 15 years of social work experience but no research experience because they couldn't afford to work for free? It's BS that a low SES person should have to effectively settle for a master's level profession and hope against the odds that they can work their way up later on.

A lot of people in psych go on and on about the importance of diversity, but if they really wanted to promote diversity in this field, there would be more opportunities for people from lower SES backgrounds.

 

[Sanman]

How often do we come across social workers that have become psychologists late in their careers? I don't think this is comparable to LPN going to NP, but if there's any data to back it up I would like to see it. SW, counseling, and the other mid-level mental health professionals are trained differently. We all know that good psychology doctoral programs look for research experience, not necessarily professional experience (especially in a different field). Who is a quality doctoral clinical psych program more likely to take: A person in their mid-20s who has some posters after spending two years in an unpaid research position or a person in their mid-40s with 15 years of social work experience but no research experience because they couldn't afford to work for free? It's BS that a low SES person should have to effectively settle for a master's level profession and hope against the odds that they can work their way up later on.

A lot of people in psych go on and on about the importance of diversity, but if they really wanted to promote diversity in this field, there would be more opportunities for people from lower SES backgrounds.

People don't go from SW to Psychology. They are different professions. However, you can work your way up from case manager with a bachelors degree or some college, to LGSW, to an LCSW therapist, to a DSW professor and be working the entire way. I know people who have done it.

As I said, psychology and medical school are largely set up for middle to upper middle class people.

 

[Shiori]

It may be set up that way, but we can fight to change it. I am definitely committed to doing just that! I think it ultimately strengthens the clinical work and research to have more perspectives. I know I have helped people rework some of their questionnaire questions to be less alienating.

 

[singasongofjoy]

With respect to making it possible for more POC to enter the profession- that is a really important point and it has been an issue for a long time. I've been heartened the past few years to see more and more programs setting aside more (both in frequency and in amount) money in various programs/grants specifically for students who bring diversity (of various sorts, but very often that is racially) to the program. Still a loooooong way to go. I wonder how many people just never even consider large categories of careers that they might would otherwise have been interested in because they write them off due to financial burden.

 

[Sanman]

It may be set up that way, but we can fight to change it. I am definitely committed to doing just that! I think it ultimately strengthens the clinical work and research to have more perspectives. I know I have helped people rework some of their questionnaire questions to be less alienating.

From a longer term perspective, there are absolutely things that can be done. From the perspective of a low SES person with limited family help that may need to self fund an education today, it may be something to consider if the person would also be happy as a psych NP or LCSW therapist.

There is also the issue of limited POC mentors in the field. During my entire undergrad/graduate training process, I encountered a total of 2 male POC psychologists and none in a clinical capacity (both professors at an HBCU). I did have a few female POC mentors. It certainly was a challenge for me coming up, but it continues to improve with each generation and I currently work with an ethnically diverse group of clinicians male and female.

 

[Shiori]

When I had undergrads in my lab, I would put up different professions on the board and tell them how much education they did or didn't need. They found it really helpful. That steered several toward a masters level program. When one still wanted to go to a PhD program after the chat, I helped her get a real publication under her belt. She's off doing fancy things now.

The mentorship problem is real. My DCT actually reached out broadly to the community to see if she could help me find someone because I was kind of a mess. A lot of the unarmed shootings were happening, and I felt out of place in my program. No one was specifically unwelcoming, but I could tell that things were not set up with me in mind. The microaggressions were pretty prevalent too. Then there were a few just flat out aggressions. I found a therapist on campus who was a POC and he also helped connect me to the right people. I finally got my footing. It was a rough couple of years, but was more manageable with support. I mentor other POC whenever I can. It's a lot of emotional labor, but it was instrumental to me still being here. I'll be glad as more of us are in these spaces and we can share the load.

 

[AlmostaPhD]

I'm willing to be told I am wrong about this but I have been under the impression that many people take out some student loans for graduate school. I went to a funded program but also took out loans, partly because the stipends are abysmal and partly because I wasn't great with money in my 20s and didn't think it through. Is it the general impression of folks here that many clinical psych students have sources of support outside of stipends and loans? I know there's been talk of programs in places like NYC having students that might fit that profile, but a lot of the people I know well enough to know about their finances had some level of student debt from not just undergrad but graduate school. I would never advocate for the 150k in loans folks take out for unfunded programs, but it seems to me like lower income students who qualify for federal loans (I think this would be most US citizens?) ought to be able to make ends meet in college towns with stipends + some modest loans (10s of thousands, not 100s of thousands). Not every university is in a low cost of living area, etc. but many R1s (most likely to have funded programs) are.

Am I off base? I did have some family help (a car I drove until it fell apart, not cash) and volunteered as an RA in undergrad but have otherwise not done research or clinical activities outside of course requirements for free. I wasn't paid to write any specific papers and might have been TAing that semester or whatever, but I was financially supported throughout training. It seemed like a doable path for a single person (different if you are supporting others) regardless of family SES but again, interested to hear if I have a skewed perspective.

 

[WisNeuro]

I'm willing to be told I am wrong about this but I have been under the impression that many people take out some student loans for graduate school. I went to a funded program but also took out loans, partly because the stipends are abysmal and partly because I wasn't great with money in my 20s and didn't think it through. Is it the general impression of folks here that many clinical psych students have sources of support outside of stipends and loans? I know there's been talk of programs in places like NYC having students that might fit that profile, but a lot of the people I know well enough to know about their finances had some level of student debt from not just undergrad but graduate school. I would never advocate for the 150k in loans folks take out for unfunded programs, but it seems to me like lower income students who qualify for federal loans (I think this would be most US citizens?) ought to be able to make ends meet in college towns with stipends + some modest loans (10s of thousands, not 100s of thousands). Not every university is in a low cost of living area, etc. but many R1s (most likely to have funded programs) are.

Am I off base? I did have some family help (a car I drove until it fell apart, not cash) and volunteered as an RA in undergrad but have otherwise not done research or clinical activities outside of course requirements for free. I wasn't paid to write any specific papers and might have been TAing that semester or whatever, but I was financially supported throughout training. It seemed like doable path for a single person (different if you are supporting others) regardless of family SES but again, interested to hear if I have a skewed perspective.

Depends on program. In my program, most of us were scraping by, budgeting, and living with roommates. Some us did it without loans at all, but that required some side hustles. Anecdotally, I had no family financial support throughout undergrad and grad.

 

[foreverbull]

I'm willing to be told I am wrong about this but I have been under the impression that many people take out some student loans for graduate school. I went to a funded program but also took out loans, partly because the stipends are abysmal and partly because I wasn't great with money in my 20s and didn't think it through. Is it the general impression of folks here that many clinical psych students have sources of support outside of stipends and loans? I know there's been talk of programs in places like NYC having students that might fit that profile, but a lot of the people I know well enough to know about their finances had some level of student debt from not just undergrad but graduate school. I would never advocate for the 150k in loans folks take out for unfunded programs, but it seems to me like lower income students who qualify for federal loans (I think this would be most US citizens?) ought to be able to make ends meet in college towns with stipends + some modest loans (10s of thousands, not 100s of thousands). Not every university is in a low cost of living area, etc. but many R1s (most likely to have funded programs) are.

Am I off base? I did have some family help (a car I drove until it fell apart, not cash) and volunteered as an RA in undergrad but have otherwise not done research or clinical activities outside of course requirements for free. I wasn't paid to write any specific papers and might have been TAing that semester or whatever, but I was financially supported throughout training. It seemed like a doable path for a single person (different if you are supporting others) regardless of family SES but again, interested to hear if I have a skewed perspective.

The vast majority DO take out loans in PhD and School psych programs (77%). I think 75k is the median debt for PhDs/school psych. This was almost a decade ago, so I’d love to hear if those numbers have gone up since then.

Got debt?

A look at solutions for students who face formidable loan repayments.

www.apa.org

https://www.apa.org/apags/resources/debt.pdf

My overall point is that lower SES students are more likely to take out more debt to get by, at least anecdotally and relative to peers of higher SES. Are there stats about this for grad programs and SES one grew up in?

 

[Shiori]

Yeah, a lot of people take out loans. I was also able to live carefully and bring in other sources of income like fellowships that kept me afloat. I also had savings before I went to school. The debt forgiveness conversation has highlighted some of the disparities that occur all along the process of needing loans, securing loans, and paying them back. It's a lot easier to sift through the research now that it's a hot-button issue.

 

[Sanman]

I'm willing to be told I am wrong about this but I have been under the impression that many people take out some student loans for graduate school. I went to a funded program but also took out loans, partly because the stipends are abysmal and partly because I wasn't great with money in my 20s and didn't think it through. Is it the general impression of folks here that many clinical psych students have sources of support outside of stipends and loans? I know there's been talk of programs in places like NYC having students that might fit that profile, but a lot of the people I know well enough to know about their finances had some level of student debt from not just undergrad but graduate school. I would never advocate for the 150k in loans folks take out for unfunded programs, but it seems to me like lower income students who qualify for federal loans (I think this would be most US citizens?) ought to be able to make ends meet in college towns with stipends + some modest loans (10s of thousands, not 100s of thousands). Not every university is in a low cost of living area, etc. but many R1s (most likely to have funded programs) are.

Am I off base? I did have some family help (a car I drove until it fell apart, not cash) and volunteered as an RA in undergrad but have otherwise not done research or clinical activities outside of course requirements for free. I wasn't paid to write any specific papers and might have been TAing that semester or whatever, but I was financially supported throughout training. It seemed like a doable path for a single person (different if you are supporting others) regardless of family SES but again, interested to hear if I have a skewed perspective.

This was my experience with loans differing based on how lean you want to live. However, there were several times where family/spousal help was needed that loans would not cover:

1. Getting a used car for grad school to get to class and practica
2. Security deposit, moving expenses, etc. when starting grad school/internship/practica
3. Internship/Post-doc interview costs
4. Unforeseen car repairs
5. Costs related to binding dissertation, graduation fees, obtaining initial malpractice insurance, fees for psych associate/initial licensing
6. Small loans when financial aid check was delayed

If you don't have some sort of benefactor that can give you cash or a loan during these start-up periods it can make life a lot more difficult.

 

[AlmostaPhD]

This was my experience with loans differing based on how lean you want to live. However, there were several times where family/spousal help was needed that loans would not cover:

1. Getting a used car for grad school to get to class and practica
2. Security deposit, moving expenses, etc. when starting grad school/internship/practica
3. Internship/Post-doc interview costs
4. Unforeseen car repairs
5. Costs related to binding dissertation, graduation fees, obtaining initial malpractice insurance, fees for psych associate/initial licensing
6. Small loans when financial aid check was delayed

If you don't have some sort of benefactor that can give you cash or a loan during these start-up periods it can make life a lot more difficult.

That makes sense. I had savings when I started so that helped with the move and as I mentioned I had a car from my family. For the other things, as far as I remember, I used loans. I took out more loans than I thought I’d need and treated the extra like an emergency fund. This was extra expensive during the internship year when I didn’t qualify as a FT student and had to dip into unsubsidized or maybe even private loans but I knew with moving costs, the delay in getting your first check, and my biweekly pay I wasn’t actually going to be able to make rent on the first of the month basically the whole year.

I also had first a roommate and then a partner to split rent and other expenses with, so that helped with the day to day and I could have asked my family if I needed to, so I know I’m lucky in that respect.

 

[AlmostaPhD]

The vast majority DO take out loans in PhD and School psych programs (77%). I think 75k is the median debt for PhDs/school psych. This was almost a decade ago, so I’d love to hear if those numbers have gone up since then.

Got debt?

A look at solutions for students who face formidable loan repayments.

www.apa.org

https://www.apa.org/apags/resources/debt.pdf

My overall point is that lower SES students are more likely to take out more debt to get by, at least anecdotally and relative to peers of higher SES. Are there stats about this for grad programs and SES one grew up in?

That seems like a huge amount of debt to me. In the article it's not clear if this is undergrad + grad? Or are some of these PhD programs that are not funded? That would be like an extra $1,000/month every month for 6 years of graduate school, which seems high.

You're right that lower SES folks without a safety net probably end up taking out more than people who can get help with deposits, cars, or emergencies. I wonder if those data are out there.

 

[WisNeuro]

That seems like a huge amount of debt to me. In the article it's not clear if this is undergrad + grad? Or are some of these PhD programs that are not funded? That would be like an extra $1,000/month every month for 6 years of graduate school, which seems high.

You're right that lower SES folks without a safety net probably end up taking out more than people who can get help with deposits, cars, or emergencies. I wonder if those data are out there.

You'd have to control for funded vs. unfunded programs to have a meaningful comparison.

 

[AlmostaPhD]

You'd have to control for funded vs. unfunded programs to have a meaningful comparison.

Right. I also wonder if the unfunded programs skew toward lower SES students as they are less competitive (require less preparation) and based on anecdotal experience they do sales pitches that might convince students who are first gen or otherwise disadvantaged that they are a smarter option than they are. I feel like we'd need to know information about students and programs to make the kinds of conclusions we're talking about.

I found this: Sci-Hub | Graduate debt in psychology: A quantitative analysis. | 10.1037/tep0000112. They do not divide up by funded vs. not programs or first gen status, even though they did collect the latter. They say they found no debt load differences based on race/ethnicity or sex but I don't see family SES as one of their variables.

A couple of quotes that I think are useful:

"Across all graduate students and ECPs in the current sample, 43.1% reported owing debt from their undergraduate training. Average levels of undergraduate debt were $28,905.96 (Mdn $20,000.00, SD $22,330.70)." 20-30k (median to mean) of the 75k figure might actually be from undergrad, which still has to get paid back but I think that distinction is important when we're talking about graduate school financial issues specifically.

"Graduate students and ECPs attributed 75% and 68.5% of their loan debt, respectively, to direct educational costs (tuition and fees)." This seems like an important statistic. A lot of folks in this sample (1300 people out of 10k invited, probably this selects for people who have something to say about debt depending on how invitation was worded) took out loans to cover tuition and fees. This means that they did not attend funded programs so that's how the results end up with awfully high medians, in my opinion.

 

[Shiori]

I know my school has had fluctuating offers to incoming students due to budget cuts. I came in with it being pretty stable regarding funding. We weren't totally guaranteed a funded position, but it almost always happened. We took a pretty big hit with state budget cuts. The incoming students were offered much less than we received. I was probably in the last cohort of the "good times." They slashed stipends, raised student fees, and did away with internal funding sources. We started out a funded program, but it didn't stay that way. I'll be curious to see how the numbers change in the coming years.

 

[foreverbull]

That seems like a huge amount of debt to me. In the article it's not clear if this is undergrad + grad? Or are some of these PhD programs that are not funded? That would be like an extra $1,000/month every month for 6 years of graduate school, which seems high.

You're right that lower SES folks without a safety net probably end up taking out more than people who can get help with deposits, cars, or emergencies. I wonder if those data are out there.

Are there a lot of completely unfunded counseling PhD, clinical PhD, and school psych programs out there?

They separated PsyDs from PhDs for clarification ($200k was the median for PsyD program debt, with 91% of PsyD students graduating with debt).

Also, this is PURELY graduate debt. So 3/4 of grad students in counseling, clinical, and school psych doctoral programs are taking out graduate loans, even if they’re funded, with a median of $75k of graduate school debt.

This was data from 2013-2014.

https://www.apa.org/apags/resources/debt.pdf

 

[Ollie123]

I might be misremembering, but I thought there was data showing traditional programs were actually equally or more diverse than unfunded programs? Logically, that makes sense to me. Anecdotally, the local Argosy definitely drew on a very different demographic than my funded program but it was kind of all-over-the-place (people switching mid-career, fresh out of undergrad mommy-and-daddy-are-paying, spouses of wealthy folks arguably doing it for fun, etc.). Racial/ethnic diversity seemed negligible but I obviously only knew a very small subset of students so take that with a grain of salt.


Even in funded programs, I do think plenty of people take out loans. I think many do just for improved QoL even when its not 100% necessary. That said, there is a world of difference between 10k a year to "boost" your salary to a more manageable 30k/year versus 50k/year in tuition + 30k/year in living expenses. One is a car payment, the other is a house payment.

 

[AlmostaPhD]

Are there a lot of completely unfunded counseling PhD, clinical PhD, and school psych programs out there?

They separated PsyDs from PhDs for clarification ($200k was the median for PsyD program debt, with 91% of PsyD students graduating with debt).

Also, this is PURELY graduate debt. So 3/4 of grad students in counseling, clinical, and school psych doctoral programs are taking out graduate loans, even if they’re funded, with a median of $75k of graduate school debt.

This was data from 2013-2014.

https://www.apa.org/apags/resources/debt.pdf

Where I went to grad school (R1) Counseling and School Psych were in College of Education and not funded. There might have been some funding opportunities but it was not standard. I don't know how typical that is across the country, but I do know of another school where APA site visitors complimented the Counseling PhD program on providing financial support and criticized the Clinical PhD program for having low levels of support. They both offer tuition waivers and the same stipend but were being compared to different sets of peers/expectations.

I think the infographic you linked to uses the same data as the study I linked to, which should be viewed with a grain of salt because of what I noted about it including undergrad debt and seeming to include a lot of people in unfunded programs who are using loans to pay tuition.

 

[foreverbull]

Where I went to grad school (R1) Counseling and School Psych were in College of Education and not funded. There might have been some funding opportunities but it was not standard. I don't know how typical that is across the country, but I do know of another school where APA site visitors complimented the Counseling PhD program on providing financial support and criticized the Clinical PhD program for having low levels of support. They both offer tuition waivers and the same stipend but were being compared to different sets of peers/expectations.

I think the infographic you linked to uses the same data as the study I linked to, which should be viewed with a grain of salt because of what I noted about it including undergrad debt and seeming to include a lot of people in unfunded programs who are using loans to pay tuition.

In the study you linked, counseling psychology actually reported lower graduate debt than clinical subfields, although unfortunately, as you mention, unfunded vs. funded was not assessed, and PsyDs were included in the subfields with PhDs, it appears. It seems that we need more research to capture some of the nuances at play.

I’m glad to see that they asked about family support (53.3% had some). It’s interesting to me to see that slightly more than half of doctoral students had to rely on family financial support in the sample. Of course ideally they’d break it down further into type of program and include SES next time, but clearly, graduate debt is an issue for the majority of doctoral graduates in psychology regardless of type of degree and subfield.

Of course, there are methodological issues with this study (abysmal response rate, for example), but I hope that this continues to spur more research that can create a more clear picture.

 

[cara susanna]

I was fortunate enough to have outside support, both from a relative who passed away and made my mother swear on her deathbed that she'd make sure I got through grad school, and from my partner who worked a full time job until we had to move for my internship. I also adjunct instructed at a local community college, which made a surprisingly decent amount of money since we were unionized. Additionally, I had saved money by living at home during undergrad, which I know is another option that I was fortunate enough to have.

I want to be clear that, when I say that I'm not sure about paid practica, that doesn't mean I think people should have to finance themselves or take out loans. I think that is the program's responsibility to make sure that students have enough funding, and that the funding should come from them instead of practica. And I agree that stipends are generally not adequate.

On that note, my clinic currently has an MSW trainee and apparently this person is getting paid. So, yeah, it does happen in other fields.

 

[Mojito_15]

Where I went to grad school (R1) Counseling and School Psych were in College of Education and not funded. There might have been some funding opportunities but it was not standard. I don't know how typical that is across the country, but I do know of another school where APA site visitors complimented the Counseling PhD program on providing financial support and criticized the Clinical PhD program for having low levels of support. They both offer tuition waivers and the same stipend but were being compared to different sets of peers/expectations.

I think the infographic you linked to uses the same data as the study I linked to, which should be viewed with a grain of salt because of what I noted about it including undergrad debt and seeming to include a lot of people in unfunded programs who are using loans to pay tuition.

I went to a partially funded school psych program in a college of ed- which is to say there were funded positions we could apply to around campus and a few TA positions available in the department. I had funded positions for the first 3 years that covered tuition + a small stipend. After that, I applied for and got in-state tuition and then worked full or part-time off-campus every year for the rest of the 9 years it took me to go from B.A. to Ph.D. 2 of the years I just worked as a part-time school psych, which with in-state tuition and benefits paid better than the funded on-campus positions. While ABD I worked full time as a professor. In retrospect- working made me take 2-3 years longer than a lot of people in my cohort, but I did not take out any graduate loans nor did I rely on family support.