An open letter to the American Psychological Association,

The internship imbalance continues to be an increasingly arduous hurdle for aspiring psychologists. During the 2011 match cycle, more than 20 percent of those who entered the match process did not match to an APPIC member internship (including both phase 1 and 2 of the match process). Further, only 56% matched to APA/CPA accredited sites. Last year, a petition was submitted with more than 500 signatures requesting that APA address several of the contributing factors to this problem. Although some groups (e.g., APAGS, CCTC, APPIC) have made strides toward resolving the imbalance, the current petition reiterates that the imbalance remains the single most important issue in the training of psychologists and that we, the signers, are not satisfied with the actions taken by the APA and demand this issue receive the attention and action that it deserves.

As demonstrated by the many signatures from professional psychologists last year, this is not just a student issue. The problem is a symptom of a more systematic deterioration of doctoral level psychology. Specifically, the problem is largely due to the expansion of doctoral training sites in number and enrollment. Concurrently, APA/CPA accreditation as a standard of training for doctoral sites does not represent an acceptable standard of program outcomes. If this trend continues, psychology will be marginalized as a legitimate science and as an important facet of integrated patient care.

Accreditation of doctoral training programs must be revised to include internship match rates and student enrollment. Although such policies are “on the books” in the accreditation system, the findings of Parent and Williamson (2010) as well as APPIC’s data (APPIC, 2010) clearly indicate that these policies are not enforced across all doctoral training program accreditation reviews, as many programs demonstrate large student numbers, weak match rates, and large contributions to the number of unmatched students before, during, and after accreditation review.

Contrary to opinions expressed in some commentaries, use of relevant student outcome data in accreditation does not constitute restraint of trade or violation of antitrust law (Stedman et al., 2009).

There are now far more psychology graduate students applying for internship every year than there are positions (APPIC, 2010). In 2011, 4199 applicants entered the match, and only 2339 APA/CPA-accredited internship positions were available. The imbalance and erosion of standards appear to be the product of rapid expansion of graduate schools in professional psychology (Parent & Williamson, 2010). The inflation in number of students over the past decade has not been matched by the number of available APA/CPA accredited internship slots. Further, it far exceeds estimates for social need or market demand for clinical psychologists in the workforce (Robiner & Crew, 2000). Students from professional schools now comprise over 50% of new clinical psychology graduates, though professional schools represent a minority of doctoral level psychology programs. Parent and Williamson’s (2010) analysis clearly indicated that the imbalance is not equally distributed among training programs, as 3% of doctoral programs produced over 30% of unmatched internship applicants between 2000 and 2006. While it is clear that a few programs are responsible for much of these problems, we do not believe the "weeding out" process should be conducted on the back-end, after huge amounts of time and money have been invested. Rather, the APA needs to intervene to inform consumers of doctoral programs on the front-end. Students entering into professional schools of psychology are at a particularly vulnerable period in their lives, most not yet having the economic savvy to understand the ramifications of debt, nor education in the realities of the field with respect to what it takes to be competitive, to secure quality internship and postdoctoral training, and to attain a professional level job (not one that is occupied just as easily by social workers or other masters level providers).

There are clear ethical issues with allowing programs that enroll large numbers of students and demonstrate consistently weak APA/CPA internship match rates to continue to market doctoral psychology to whoever they can convince to attend, while saddling consumers of this educational model with six figure debt, poor internship prospects, and, following, poor post-doc and job prospects (students that complete a non-APA/CPA accredited internship are at a serious disadvantage in an increasingly challenging marketplace). In addition to the burden placed on our future colleagues, this is a public health threat.

1. By accrediting these programs, the APA is condoning their unethical behavior with regard to admissions.

2. Debt creates stress. This impacts the mindset/situation of our professionals. As more of our professionals are saddled with debt, this creates a potential public health risk for individuals to practice outside of their competencies in order to maintain a reasonable income. By not requiring information on factors such as graduate debt, and by not referencing this or other outcome data to national norms, applicants are not adequately informed about their likely outcomes for training at particular sites.

3. By having subjective, nonstandardized criteria in APA accreditation, we (psychology as a field) are losing control over what it means to be a psychologist. We cannot ensure quality or even minimum competency.

The current situation creates an environment ripe for a cascade effect that could be ruinous to the livelihood and happiness of many of our workforce and to the quality of the product that we offer as psychologists. As it stands, this situation is akin to other predatory loan schemes and should fall within, at least, morally, the concept of usury laws.

We, the undersigned, endorse the following:

1. We request that the APA sanction programs that do not match students to APA/CPA internships sites at an acceptable rate; this is particularly a problem for sites that take very large cohorts of students each year. These programs do a disservice to their students and are not good citizens of the psychology professional community. We strongly suggest that APA place these programs on probationary accreditation status, and remove accreditation from these programs if they do not improve their match rates to APA/CPA accredited internship sites and/or lower their contributions to the number of unmatched internship applicants.

2. We request that APA amend the Accreditation Guidelines and Principles so that all doctoral training programs must publicly disclose the 25th percentile, median, and 75th percentile of educational debt upon graduation for their students. These data MUST be presented in a standardized format and MUST be presented along with resources for potential applicants to better understand what internships are, average incomes for psychologists (i.e., the APA’s salary survey data), and potential career limitations for enrolling in a training site with a history of poor APA/CPA internship match rates. Such a required document would constitute informed consent only if linked to such informative resources. Current presentation of outcome data (i.e. C-20 data) is obscure and likely meaningless to most applicants.

3. We request that APA accreditation be examined for revision. Current accreditation guidelines (available online at http://www.apa.org/ed/accreditation/) allow for the potential for accreditation teams to make inconsistent, subjective judgments about doctoral training programs, leading to inconsistent training standards and to the continued accreditation of programs that produce weak student outcomes and stress the internship match system. The accreditation system may be replaced by a point-based system that takes into account relevant student factors (e.g., enrollment, faculty-student ratio, average debt load of graduates, APA/CPA internship match rates, graduate EPPP scores, etc.). Such alterations would also make site self-studies easier and simpler.

These suggestions would serve many important goals for our field. 1) It would be the single largest positive event in relation to the internship imbalance. 2) It would limit the amount of debt our professionals are saddled with upon graduation. 3) It would improve the quality of internship opportunities by alleviating the burden of review that all sites face as they are bombarded with 100s of applications; reducing the number of doctoral students would allow sites to conduct a more thorough evaluation of candidates. 4) It would improve the quality of internship programs that students select (e.g., many programs in California encourage students to attend non-APA/CPA accredited sites, many unfunded; many students now match to non-APA/CPA accredited sites). 5) It would protect the public from overly-stressed and poorly educated professionals. 6) it would facilitate the informed consent of doctoral training program applicants, who currently are not adequately informed about the realities of graduate training in psychology.

We request a response from APA, including the Board of Directors, the Board of Educational Affairs, the Committee of Chairs of Training Councils, APPIC, the National Council of Schools of Professional Psychology, and the American Psychological Association of Graduate Students, on this topic, and invite responses from other boards and committees in APA and CPA.

Sincerely,

The undersigned.

References

APPIC (2010). APPIC match: 2000 - 2010: Match rates by doctoral program. Retrieved from http://www.appic.org/Portals/0/downloads/APPIC_Match_Rates_2000-10_by_Univ.pdf

Parent, M. C. & Williamson, J. B. (2010). Program disparities in unmatched internship applicants. Training & Education in Professional Psychology, 4,116-120.

Robiner, W. N., & Crew, D. P. (2000). Rightsizing the workforce inhealthcare: Trends from licensing boards, training programs, and managedcare. Professional Psychology: Research and Practice, 31, 245–263.

Stedman, J. M., Schoenfeld, L. S., Carroll, K., & Allen, T. F. (2009). The internship supply-demand crisis: Time for a solution is now. Training & Education in Professional Psychology, 3,135-139.

Occupy the Imbalance

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