Feature

For the past several years, about one-quarter of psychology graduate students who have gone through the internship match process have not secured an internship. APA and its student arm — the American Psychological Association of Graduate Students (APAGS) — have been working to find solutions to the mismatch between the number of qualified graduate students and the number of available internship slots. Now, it looks as if their efforts may be paying off.

More students matched to internships this year compared with last year (see below for the latest numbers). But the even better news is that solutions are in the works to address the internship crisis in ways that are expected to boost match rates even more.

"We're anticipating some big changes," says Ali Mattu, PhD, APAGS's past chair. "The players are talking, the wheels are turning."

The changes emanate from a meeting last year attended by APAGS, the Association of Psychology Postdoctoral and Internship Centers (APPIC), APA's Education Directorate, and five doctoral training councils: the Council of Combined Integrated Doctoral Programs in Psychology, the Council of Counseling Psychology Training Programs, the Council of Directors of School Psychology Programs, the Council of University Directors of Clinical Psychology and the National Council of Schools and Programs in Professional Psychology.

Each attending group made at least one commitment that it promised to fulfill to ameliorate the internship shortage, along with one "ask" — a request to the other training councils to fill a particular need.

The most significant ask to come out of the meeting is likely to affect the internship match for years to come: APAGS proposed that all groups agree that completing an accredited doctoral training program and an accredited internship become the standards for entry into health service psychology. This essentially means that all groups would work toward phasing out nonaccredited training experiences. These changes, which would ultimately affect both graduate programs and internships, are no small undertaking, but when they do begin to happen, the hope is that they'll streamline the system and benefit the field.

"From APAGS's perspective, this is a matter of ensuring quality," says Mattu.

Other health-care professions are adopting more rigorous standards, he says, and requiring accreditation would more closely align psychology with these evolving norms. "We're moving toward health-care reform and standards are going up. Employers, and the public, need to know that our training is up to par."

In March, APPIC revealed its plan for rolling out one of the relevant changes. Beginning in 2017, the match will be limited to students from accredited graduate programs: This means that students from programs not accredited by the APA or CPA (Canadian Psychological Association) would be ineligible to participate in the match program. Mattu says everyone was surprised to see this change happen so quickly, but many of the councils believe it will benefit the field tremendously.

There are some provisions in place to ensure that no one who's already in the middle of graduate training is negatively affected by the change. For example, students who are currently in nonaccredited doctoral programs will be grandfathered in and will not be excluded from participation from the internship match. However, students beginning study in nonaccredited graduate programs in fall 2013 or later will not be eligible to take part in the internship match.

To support accreditation as a standard of entry into health service psychology, the psychology community has been working to create more accredited internships, which will improve one's chances of matching to an accredited internship. Last year, for example, APA launched an up to $3 million Internship Stimulus Program to develop more accredited programs.

There are also changes happening that will streamline the process internship programs must go through to gain accreditation. Mattu explains that the accreditation process has different phases, which until recently must all be completed before the program is granted accreditation.

"In the new system," says Mattu, "as long as they complete each step along the way, and that material is approved by the Commission on Accreditation, they'll have ‘contingent accreditation' and will be fully accredited when the last phase is completed and approved by the CoA." In other words, the program will be able to function as an accredited program while it is still in the process of completing the requirements for accreditation.

"All of this will help create new internships and newly accredited ones, which will shift us away from the old two-tiered model," says Mattu. He adds that for accreditation to be truly required for entry into the field, licensure laws would need to change, and this is a difficult and lengthy undertaking in its own right. The Association of State and Provincial Psychology Boards, which organizes licensing, doesn't have jurisdiction over the states. Also, individual states may be hesitant to reevaluate laws, since "every time you open up license laws, there is a fear that scope of practice might get attacked and things will get taken away," says Mattu. So, though we're moving toward the valuable one-tiered model, it certainly won't happen overnight.

More help

Another important change is in the works: APAGS has committed to educate applicants to psychology graduate programs about how the programs stack up in such key areas as the number of students accepted, the attrition rate, internship match rates and more. Such information is publicly available but can be difficult for applicants to find and interpret, according to Nabil Hassan El-Ghoroury, PhD, associate executive director of APAGS.

"The data are hard to understand for people who know what to look for, let alone people who don't," he says. "So we're hoping to make it easier for applicants to decipher."

El-Ghoroury hopes that, armed with better information, students will be able to make more informed decisions about programs before committing, based on the career they envision for themselves in the future.

"Know what you're getting into," he advises. "Look for the numbers. If your program has a 10 percent match rate, know that. And know that if you take an unaccredited internship, you many never work at a VA in the future."

APAGS also asked the graduate councils to call for graduate programs to provide financial support for unmatched students who find themselves in school for another year — and accruing the associated costs. Being in grad school, especially for that extra year, comes with tuition, housing costs, loans and the absence of a salary. Providing assistance in various ways could ease the significant financial burden, says Catherine Grus, PhD, deputy executive director of APA's Education Directorate.

"Financial support could take a lot of different forms," she says. "Schools might allow an extra year of funding through teaching assistantships or reduce the amount of tuition an individual has to pay."

Schools that cover the cost of tuition for their graduate students would agree to continue to do so for an extra year. For schools that don't, programs might reduce the tuition a student has to pay in that final year and keep the students registered as full time, so loans would remain in remission.

All the experts agree that offering financial assistance to unmatched students would greatly relieve some of the stress that they find themselves facing when they are unable to move into an internship.

Looking ahead

As these changes go into effect, students should keep in mind that if they don't get an internship, it's not a reflection on the quality of their work; it's just simple math, says Grus.

"Students coming out of grad school are prepared," she says. "There are just not enough spots. And I'll say it again — it's very important for students to know that the larger psychology community is concerned and working hard. Training councils in particular are all working together to fix this problem."

El-Ghoroury suggests that in the meantime, students should read the APAGS internship workbook, and attend workshops, such as the APAGS Internship Series coming up in August, if possible.

There will surely be some kinks to iron out in the beginning of these changes, but ultimately these transitions should benefit the match system and the field itself, says Mattu.

"There will be some growing pains and consequences," he says. "But all of the changes that are happening are going to affect far more than our generation of psychologists and their students; it's going to change the next 30, 40, 50 years of what we do. We have to do what's right for the field and for our patients."

Stats on the internship mismatch

In 2012, 915 students remained unmatched by the end of the second phase of the APPIC match. In 2013, the number was 788. This slight improvement was also reflected in the total percentages of students who were unmatched (including those who withdrew or didn't submit ranks) relative to the total number that applied.

All in all, in 2012, 29 percent did not match, and in 2013, the number was slightly lower, at 26 percent.

For the full data set, go to APPIC.