Finding Your First Clinical Practice Position

Stuart C. Tentoni, Ph.D.
Coordinator & Training Director
University of Wisconsin-Milwaukee
Norris Health Center
Counseling and Consultative Services
Milwaukee, Wisconsin

Job-hunting in the clinical practice sector requires one to first determine in which state they would like to practice. It is sage advice for new graduates to go wherever the jobs are, whenever possible, to launch their careers. The job and place might not be ideal, but it is much easier to find another job when you have one than when you do not. With the proliferative explosion of activity via the Internet, it is now possible to do a job search from the comfort of one's computer. There are a number of web sites that can be searched for both clinical and academic positions:

1. The Chronicle of Higher Education (http://chronicle.merit.edu/.ads/.links.html)
2. The Catapult Job-Web (http://www.jobweb.org/catapult/jfield.htm)
3. Pioneer Jobs (http://pioneer.lib.ut.us/employment.html)
4. National Business Employment Weekly (http:// jobsearch.monster.com/)
5. American Psychological Association (http://www.apa.org)
6. American Counseling Association (http://www.aca.org)
7. American Psychological Society (http://www.psychologicalscience.org/jobs/jobs.html)
8. “Colleges Colleges” (http://www.collegescolleges.com/), a directory of colleges and universities in the United States, in which one can make contact with campus personnel or human resources departments
9. Higher Education Jobs (http://www.higheredjobs.com), a site listing college/university jobs by position or search by state

Once an interesting position is found, a curriculum vita needs to be developed. As a recruiter of psychologists, the most frequent mistake new graduates make in the job application process is to send out a variant of their pre-internship vita. This style of vita can go 12 pages or more and most of the information is superfluous. It is vital to cut the vita in length and to format the information in the order of importance to the reader(s). Suggested major headings for the clinical practice vita are:

1. identifying information (name, address, phone, e-mail)
2. educational background (list most recent degree and date first)
3. licenses/certificates
4. internship experience
5. professional experience (to include any practical experience you have in the field)
6. teaching or administrative experience (if any)
7. publications (if any)
8. presentations (if any)
9. honors, achievements, and organizations

I would also add that you follow the position listing directions to the letter when submitting a vita to a prospective employer. Many will ask for a cover letter, a vita, and a specified number of professional references. Submit exactly what is asked for: no more and no less. For most clinical practice positions, one should be able to get by with a two page minimum, or three page vita at somewhere between a 12- or 14-pitch font. Many clinical practice positions can get between 30 and 60 vitae submitted and either an individual or a team may review all of these to narrow down the field of candidates. The most important thing to remember where vita review is concerned is chances are strong the reviewer will be doing the same kind of work duties as listed in the position listing. And for many practitioners, time is at a premium. If applying to a group clinical practice, the practitioner(s) may be giving up either free time, or billable time, in order to review your application materials. Therefore, the more direct and organized your vita is, the higher it may end up rating out during the initial screening phase.

It is also advised to keep cover letters short, unless the position listing calls for a short essay in the letter. The reason cover letters can be kept short is because a submitted vita may be going to a central collection point, such as a personnel or human resources department. In large institutions/agencies, it is not uncommon for human resources to only pass along the vita to the department listing the position vacancy. A good cover letter can be done in just two paragraphs. The first paragraph should indicate what materials you are submitting, in response to seeing a job listing (and indicate exactly where this listing was seen, especially if it was seen on the internet, as employers like to know their advertising works), and a desire to be formally considered for the position. The second paragraph should indicate the reader can contact you if any additional information is needed to assess your eligibility and/or candidacy for the position, and that the reader may feel free to contact your references for more information, or to verify the authenticity of their letters.

Where reference letters are concerned, only use university professors and internship supervisors until you get your first professional job. After that, quickly phase your university contacts out. Your references should use the official letterhead of their agency/institution, and hopefully will use different fonts and pitch in word processing their letters. Ask your references if they would be willing to write letters for you in a “To Whom it May Concern” format that you can send out with your job application materials. Let your references know you will be applying for a large number of jobs and your intent is to minimize the impact upon them in having to provide an original reference letter for you every time you apply for a job. You should only send copies of your original reference letters, saving the originals for possible future inspection during an interview.

The most frustrating aspect of job searching is sending a vita somewhere, then sitting and waiting to see what happens. Private institutions and agencies generally respond quicker to job applications and will screen applicants, interview them, and make an offer to someone much sooner than what one should expect if applying to a state institution or agency. Many state agencies are unable to even list a position as available until such time that the incumbent leaves it. State agencies tend to allow for between four and six weeks for applicants to submit their materials. If a human resources or personnel department is used as the drop point for the applications, someone in human resources will do an initial screening to make sure all applicants meet the minimum educational, experiential, and certification requirements as listed in the position announcement. This can take several weeks for someone to do. Those not meeting minimum requirements will get a rejection letter from the human resources/personnel department. Those meeting all requirements in the position announcement will have their materials forwarded to the department looking to hire someone. Once the material arrives to the department, it can take up to another month or more before all members of the screening committee are able to review all the materials just to begin the initial screening. Many clinical practice sites utilize screening committees to review applicant materials and then narrow the candidate pool to around 10% of the total applicants and to invite that 10% to a formal interview. The next step will be to do a reference check on those who make it to the interview stage. It should not come as a surprise that by the time the initial review, initial screening, getting down to a list of finalists, and reference checks are done, up to four months, or more, can pass between submitting an application and finally getting a call to arrange an interview.

There are some essential things for to bring to an interview so that you are ready for every eventuality. All of these items can be contained in a standard expanding file folder that you can use like a mini-briefcase. This type of folder can be bought at any office supply or university bookstore, and they come in two sizes: 1.875 inches and 3.5 inches deep. Inside of this expanding file, include the following:

1. Several clean copies of your curriculum vita - just in case they are needed.
2. Official copies of any and all college transcripts - for review, if needed, and make sure the Registrar's seal is clearly visible/evident.
3. Original letters of reference - for review to attest to their authenticity. If you work in a university setting and have gotten any cards or letters of appreciation from student clients, make xerox copies of those and black out the client last name for confidentiality purposes.
4. If you worked in preparing any special documents or projects, such as “Policies & Procedures”, “Scope of Care”; or were have any professional publications other than your dissertation, etc., bring copies of those items.
5. If you have given any presentations, especially anything you have done at an American Psychological Association convention, bring copies of those too.
6. Any evaluations of your work performance either as an intern, or in a professional capacity.
7. A tablet of paper. The paper may be needed for you to take notes during the interview as to salient aspects of the position, etc., however, make sure you ask if it is all right with the interviewer(s) if you to take some brief notes.

All of these items should fit neatly into your expanding file folder. Be sure to organize the file folder in such a way that you can find what you are looking for in a matter of seconds. Above all else, do not show up late for an interview !! Make every effort to know where you need to be ahead of time and show up between ten and fifteen minutes early, if possible.

Clinical practice interviewers typically open up the interview in a more projective fashion, asking the applicant to “tell something about yourself that is not on your vita”. This line of questioning tends to throw many new graduates out of synch. Other projective questions an applicant can expect are “What do you see as your greatest strength and your greatest liability ?”, and, “If I called your present supervisor about you, what would I be told ?”

During the interview process, there comes a time for applicants to ask questions of the interviewer. However, there are some questions applicants should ask, and don't, such as “What is your management/supervisory style ?”; and “How many applicants were there for this position and how many will be interviewed ?” The first question will give you an idea what the interviewer will be like to work with, or work for. The second question may tell you where you placed in competition for this position. For example, some interviewers may answer that question by stating, “We received 40 applicants, and are interviewing 4, and you are the last person we are talking with.” This information suggests you are the top candidate for the position (if it is with a federal, state, county, or other governmental agency, as they tend to interview the best candidate last); or you are the bottom candidate for the position (if it with a private for-profit, or even non-profit agencies, as they tend to interview the best candidate first).

Personal Appearance

This is one area that I do not typically like to address, having been a former “longhair” during the 1960's ! I am all for as much individuality as the next person. But, you need to remember the people most likely to hire you may look something like me. Or, they will be much taller, thinner, and more chic ! You may have to set your individuality aside temporarily in order to get your first professional position. Therefore, you will have to look the part if invited for an interview, and you cannot afford to have a bad hair day ! Men, ditch the earring(s), polish your shoes, and make sure there is no sideways crease in your pants from being on a hanger too long.....! Women, disguise any “body art”, and no more than two earrings in each ear!

What an Interviewer May Ask You

You may find the interview experience to be longer, more structured, and more focused on behavior than it was in the past. The interview experience is also likely to involve several interviewers. You should be prepared to meet between three and six interviewers, either separately, or in a panel. The interviewers will have already reviewed your vita long before you arrive for an interview. Many interviews may typically start the interview in a more projective fashion, asking applicants to “tell us something about yourself that is not on your vita”. This line of questioning tends to throw many new graduates out-of-synch. Other projective questions applicants may be asked are, “What do you see as your greatest strength and greatest liability ?”, and, “If I called your present supervisor about you, what would I be told ?” My own favorite question to use is, “Medical scientists are going to announce a breakthrough discovery: a pill that will cure all physical and emotional ills. As of midnight tonight, the practice of psychology will cease. What will you look back on as your most significant achievement while you were in the field ?”

Many interview candidates are just not ready for this kind of questioning. It is advised that you realistically assess what your greatest strength and liability is and to possibly have both of these being the same thing. For example, a person could say their strongest point is their “dedication to duty”, for obvious reasons. However, this could also be used as the liability, telling the interviewer your dedication is such that you may need to be told when to go home, or when to take time off work. The strength cannot be too strong, and the liability cannot be so bad that someone questions why they would hire you. With respect to being asked what your present supervisor would say about you, indicate that you aren't sure what s/he would say right this moment, but pass a copy of your last written performance evaluation to the interviewer to show what the supervisor wrote about you, which is why bringing a copy of a recent performance evaluation in your expanding file folder is strongly advised.

However, be prepared for interviewers to pose a series of predetermined questions designed to discover if you have the skills and necessary characteristics to succeed in the position. This line of questioning is based upon the old behavioral dictum, “The best predictor of future performance is past performance”. Questions for this more behaviorally-based interview are developed by analyzing the job and deciding what skills and personal characteristics are needed to perform it well. In this type of interview, you may be asked to describe in detail a prior job or placement, including responsibilities, accomplishments and failures, most and least enjoyable aspects of the job, and reason for leaving. The most difficult aspect of this type of interview is in predicting the questions, and up to half the questions may be somewhat negative in connotation (“Please tell me a specific incident where you had to work under stress”; “Could you relate a project you worked on in which the results did not turn out too well ?”, etc.).

What You Ask of an Interviewer

Toward the end of a typical interview, there comes a time where the applicant is given the opportunity to ask questions of the interviewer(s). This is also a tough area for most interviewees. In the desire to make a good impression on the interviewer, many interviewees will either ask no questions, or only ask about salary and benefits for the position. As a job hunter, you must remember that any prospective job must be a two-way fit, meaning not only should you fit the job dimensions, but the job should also fit you. Not fitting the job dimensions will lead to the employer becoming dissatisfied with you. The job not fitting you will lead to you becoming dissatisfied with the job.

However, there are some questions applicants should ask, and do not, such as “What is your management philosophy and supervisory style ?”. This question will give you an idea what the interviewer will be like to work with, or work for. You may also want to find out what form the supervision will take, so that you know what degree of autonomy exists, if any. If the position requires, or may require a license to practice, you will need to know if the employer is willing to provide the post-doctoral supervision necessary to qualify for licensure. A good follow-up to this question is to inquire about the staff turnover rate. As you have already experienced in this job search, jobs in the mental health field are difficult to find. Learning about staff turnover rates may give you some clues as to how well the management philosophy and supervision style has worked at that particular agency/institution. A number of years ago, I interviewed for a position in the Veterans' Administration system. The only interviewer was the department chief, who was late for the interview. He happened to be alone in his office behind closed door at the time I arrived, and the interview did not take place immediately before or after a lunch hour. When he finally opened the door and greeted me, I saw a huge pile of case files on the desk. Sandwiched between the files were three issues of Playboy magazine, which now has a flat binding to allow the title of the magazine to be easily read. The interviewer apologized for being late because he was “busy”, and gestured at the files, unaware that I could see the magazine bindings. When it got to my turn to ask questions, I asked this person about his supervisory style, and was told, “My door is always open......”. My next question was, “How do I know when I need to come through that door ?”. The interviewer had no reply. It should come as no surprise that the staff turnover rate under this department head was 300% over an eight-year period for the particular position I applied.

Another important area to explore is how many applicants there were for this position and how many will be interviewed. This question may tell you where you placed in competition for this position. For example, some interviewers may answer that question by stating, “We received forty applicants, and are interviewing four, and you are the last person we are talking with.” This information can potentially suggest you are the top candidate for the position (if the position is with a federal, state, county, or other governmental agency, as they tend to interview the best candidate last); or you are the bottom candidate for the position (if the position is with a private for-profit, or even non-profit agencies, as they tend to interview the best candidate first).

You may need to know what the funding source is for the position and how stable that funding might be. There are a number of university practice positions that are funded either by outside grants, internal grants, or fees generated by clients. There are also a number of clinical positions in private settings where one is paid on a straight percentage-basis on billings collected, or situations in which your income may be based upon the percentage of billing collected and an advance on anticipated collections. This kind of situation can lead to wild fluctuations in monthly income. Where advances on anticipated collections are concerned, you could start each month technically owing the practice money until collections offset the advanced portion of “salary”. In addition, it is up to the employee to pay estimated quarterly state, federal, and Social Security “self-employment” taxes.

Another area worth exploring is if this position has a probationary period, and if so, the length of that probation. Your follow-up question in this area should involve discovering what role the supervisor takes to help you get through the probationary period. Probationary periods can range anywhere from six months to three years (Veterans' Administration system). In the event you are applying for a position in the Veterans' Administration system, you may want to inquire as to employee success rates at making it through the probationary period. In the example already cited above with the Veterans' Administration system position I had applied for, when pressed, the interviewer indicated that in his eight years, no employee ever made it off probationary status. Needless to say, I did not accept this position when an offer of it was made.

The last area you may want to explore is to ask the interviewer(s) what aspect(s) of the practice they find difficult or had difficulties in adjusting, which will give you a better idea what you might be getting yourself into and what potential problem areas may exist.

Summary

To summarize, your best chances of a successful job hunt will involve:

1. Being willing to use every source available to find out about job openings, with special emphasis upon using the internet to locate job related web sites, as well as being able to check out the classified ad section of newspapers around the country. You must be willing to go where the jobs are.
2. Your vita must be designed in a way to be clear and concise, and do not use a pre-internship vita. All information on the vita must be verifiable and presume attempts will be made to verify anything you choose to list.
3. Keep your cover letter short. Cover letters might not ever get in the hands of those who will be screening applications.
4. The screening process for a number of jobs may take time. Do not get concerned if you do not hear anything for a couple months after your materials were received.
5. If you are invited to an interview, bring a file folder with vita; official transcripts; original copies of references; any special projects and/or presentations you may have done; any work performance evaluations you received on any prior position you held; and a tablet of paper upon which to take notes.
6. Arrive at the interview site early, if possible, and pay attention to your personal appearance.
7. Be prepared for a long interview, possibly with a panel of interviewers. Be yourself. Resist the urge to be eager to please. The job hunt involves a two-way fit. The job must fit you, too.
8. Ask some relevant questions of the interviewer(s) about their management and supervisory styles; funding sources for the position; probationary periods (if any); how many applicants there were for the position; and what aspects of the practice the interviewer find difficult.