Doctoral Internship Module

Daniel Michalski, MPA and Jessica Kohout, PhD
APA Center for Workforce Studies
June 2009

Main Report: 2008 APA Survey of Psychology Health Service Providers

Module A: Doctoral Internship
Module B: Insurance
Module C: Client Complexity and Provider Revenue
Module D: Information on Telepsychology, Medication, and Collaboration
Report Text

Introduction

The objective of the 2008 APA Survey of Psychology Health Service Providers was to gain a broad understanding of those psychologists providing health services in the United States. Prior research in this area has focused primarily on American Psychological Association members, which presents problems for generalizability of the data to nonmember providers. This study attempted to address these limitations by including non-APA member participants. Indeed, this was the first major effort undertaken by the APA Center for Workforce Studies (CWS) to include those outside of the association’s membership.

Specifically, this brief report or module focuses on the internship component of the educational and training pipeline as experienced by the current health service provider (HSP) workforce. While the vast majority of responses to this particular section of the survey came from APA member psychologists, the data gathered from this effort will be valuable to the association’s planning for the entire psychology workforce. As a whole, it is hoped that by researching the doctoral internship experiences, valuable glimpses of issues impacting the internship process may become apparent. Unlike previous efforts, the data in this report are drawn from the current population of HSPs, not simply new doctorates or recent interns, and thus present a picture of how the internship has changed over time.

Methodology

We included in the sample 34,289 members of APA identified as working in and/or trained as “health service providers” and holding a doctoral degree in psychology. In other words, the membership sample included members engaged in professional practice or potentially eligible to do so by merit of training or educational background sufficient for licensure in most jurisdictions.

Additionally, a roster of licensed, doctoral-level psychologists in the United States was purchased by CWS in April 2008, from a vendor able to compile a listing of individuals with state-issued professional licenses in psychology. The vendor culled duplicate entries across states and forwarded a list of 99,350 names and mailing addresses on to CWS. This list was then compared against the member sample of HSPs to remove duplicate records.

For the first wave in September 2008, an email invitation was sent to 23,818 members identified as licensed by one or more state licensing agencies/boards and having a valid email address on file with APA. Three follow-up reminders were sent to nonrespondents one week apart. The second email distribution was sent in October to 10,471 members with unconfirmed licensure status (names not appearing on the purchased list) and valid email addresses on file with APA. Nonrespondents from this distribution received three follow-up reminders also spaced one week apart.

Third, 10,000 randomly selected licensed psychologists (members and nonmembers) were mailed a paper version of the survey along with an URL address to access the online version from an internet accessible personal computer. The paper instrument did not include questions pertaining to the doctoral internship. However, 83 of the 5,486 online responses received for this effort were identified as originating from the general survey URL, meaning that by choosing the online version over the paper survey they could answer the internship items. As such, this small group of respondents consisted of APA members and non-members.

Only fully completed and submitted online surveys were included in analysis; data from partial or saved surveys were excluded. Four modules were randomly assigned to the 5,486 members of the sample. One thousand three hundred and four participants completed this doctoral internship module. This report focuses on the results from those chosen to participate in this section of the survey. The overall N for this report was 1,304. Measures of central tendency for values less than 10 in demographic categories are suppressed for purposes of confidentiality.

Given the exploratory nature of this study, only proportions and frequencies are reported; no distinction between members and non-members is implied beyond descriptive convenience.

Module Results

Participants answered several questions regarding their doctoral internship. All respondents were required to state whether or not their internship was obtained through the Association of Psychology Postdoctoral and Internship Centers (APPIC) Internship Match Program (Match). It is important to note that the current national computerized match began in 1999 but that APPIC has been active in placing interns since 1968. These data reflect the growth of APPIC internship placements through the 1970s and the subsequent decades.

In the analyses of the data from the internship module, we have found that the values for the demographic variables are contingent upon the different times at which the respondents were moving through the education pipeline. Thus, we see that women are more numerous among younger or more recent doctorates/interns, as are PsyDs, and ethnic minorities.

Table 1 summarizes general characteristics of those responding to the doctoral internship module by decade of internship. More than three fourths (77 percent) of respondents obtained their internship later than 1979. Eighty-seven percent received a stipend for their internship work and 84 percent obtained full-time placements. Within this group, ethnic minority representation is lower than that found in CWS studies of new doctorates. This is indicative of greater diversity in the early career population that has yet to be realized in the broader workforce. Women are in the majority in the HSP population by a ratio of 3 to 2, due to their increased representation in doctoral programs during the past 30 years. Nearly 80 percent of responding HSPs earned a PhD degree in psychology. Most of the remaining HSPs reported earning the PsyD. The representation of women and ethnic minorities among respondents is very close to that found among the APA members who are health service providers.

Table 2 reports demographic characteristics by year in which the respondents obtained their internships Of the 1,286 valid responses, the mean year for all respondents was 1988 (SD=11.49), the median was 1989, and the mode 1994. The respondents indicated a wide range of years, with the earliest year in 1950 and the most recent year reported was 2007. PsyDs reported more recent doctoral internship years when compared to PhDs and EdDs as expected due to the relative youth of the PsyD degree. Intern years for women were more recent due to their increases in participation in graduate education since the 1980s. Similar patterns were noted for persons of color as opportunities for historically underrepresented populations have grown steadily during the past 25 years. Results from APA’s Doctorate Employment Survey mirror these data by showing that the representation of women among doctorate recipients has increased from 33 percent to 72 percent, and for ethnic minorities it has increased from 8 percent to 19 percent in 30 years (APA, 2007).

In Table 2a, an analysis of the decade in which internship was obtained by degree and gender revealed that the largest proportion of PhDs obtained their internship in the 1980s while more than eighty percent of PsyDs did so later than 1989. The number of EdDs peaked in the 1980s. In the decades prior to 1980, men were the majority while women reached number parity during the 1980s and surpassed men in numbers during subsequent decades.

Most respondents (87 percent) received a monetary stipend while working in a doctoral internship placement (Table 3). Consistently, an overwhelming majority within each of the demographic categories reported a stipend, but EdDs reflected the smallest proportion (72 percent). It should be noted that this may be attributed to training and educational requirements that differ from those required of PhD and PsyD degree recipients from psychology departments.

Similarly, the majority (84 percent) worked full time at their internship placements (Table 4). As with internship stipends, most respondents reported full-time work across each of the demographic categories. EdDs reported the smallest proportion (64 percent) working full time in internships.

All participants were required to specify if their internship was obtained through the Association of Psychology Postdoctoral and Internship Centers (APPIC) Internship Match Program (Match). Although the current Match process was unveiled in 1999, it is reasonable to assume that most respondents interpreted this question as referring to past placement programs offered by APPIC and not necessarily the current Match structure per se. Half of respondents obtained their internship through APPIC (Table 5). Sixty- five percent of PsyDs stated that they obtained an APPIC internship compared to 48 percent of PhDs. As suggested previously, the low percentage for EdDs may reflect structural arrangements within EdD educational and training programs. By gender, more than half of women (54 percent) obtained an APPIC internship, while less than half of men (45 percent) did. Minority groups were more apt to obtain internships through APPIC than were Whites/Caucasians, with the exception of Native Americans (40 percent) and those with disabilities (35 percent).

For those that did obtain their internship through the Match, the vast majority (92 percent) placed in an American Psychological Association or Canadian Psychological Association (APA/CPA) accredited position (Table 6). The remaining participants described their internship as listed with APPIC (and not accredited by APA/CPA); as “Other”; or did not provide a response.

Table 6a breaks out selected characteristics of those that obtained an APA/CPA accredited internship through the APPIC Match program. As expected, distributions by decade reveal that more than 90 percent of these respondents obtained their internships after 1979 due to the relative newness of APPIC placement programs (1968) and the growth of the PsyD degree. Nearly all of the respondents received internship stipends (98 percent) and obtained full-time placements (99 percent) at proportions significantly higher than that reflected by the entire module population as shown in Table 1. In general, demographic distributions for this subgroup were similar to the full population in nearly every category. However, women constituted nearly two thirds (65 percent) of this group; a proportion slightly higher than the full population (60 percent) as shown in Table 1. Similarly, as with the full population, PhDs comprise a solid majority (77 percent) as well.

For respondents that obtained their internship outside the Match, slightly more than one third found their placement through a school/program based consortium (34 percent) (Table 7). The low number of responses for APPIC Clearing House (5 percent) most likely reflects a limitation with the instrument. Because respondents could not view questions subsequent to Question 9, they may not have distinguished “Clearing House” as a distinct option apart from the “Match” as they are both part of APPIC. In this regard, responses may be unclear and not fully reflect the programmatic differences between the two placement methods. Most notably, 43 percent reported that they obtained their internship outside of APPIC by “Other” means.

Table 7a breaks out the text responses offered by those that chose “Other” as the method for obtaining their doctoral internship outside of the APPIC Match. Thirty-seven percent of these responses indicated that they applied directly to an internship site while 16 percent obtained their internship prior to APPIC. Seven percent obtained an APPIC internship prior to the computer match while 9 percent worked through a school-based or school listing program. These data suggest that the current HSP workforce includes substantial numbers of practitioners that placed prior to either 1999 (the beginning of the Match) or 1968 (establishment of APPIC). As these people transition from the workforce we can anticipate less diversity of methods for obtaining internship placements provided that the Match meets demand. Efforts by organized psychology to tighten up the internship application process may also contribute in the future to less variability in how one obtains an internship and where that internship is located systemically.

For those that obtained their internship outside of APPIC, a solid plurality were placed in APA/CPA accredited programs (60 percent) (Table 8). Notably, nearly one quarter (22 percent) of those obtaining their internship outside of APPIC found placements that did not fit within the predetermined categories. Keeping in mind the permissibility of multiple selections for this item, many participants relied on the “Other” category to better explain and qualify the type of placement they obtained.

Table 8a summarizes the text responses offered those choosing “Other” as the type of internship they obtained outside of the Match. Thirty-two percent described their internship as not APA-accredited at the time of their internship but that it met other accrediting standards or was sufficient for licensure. School-based programs were selected by 18 percent of respondents.

Further analysis of those who were outside the APPIC Match revealed that those utilizing the APPIC Clearing House and a school/program-based consortium reported strong majorities in APA/CPA accredited placements: 67 percent and 53 percent respectively (Table 9). The type of internship for those that created their own placement varied greatly but nearly half either found one that was APA/CPA accredited or conforming to CDSPP guidelines (47 percent). Strikingly, slightly more than three quarters of those that obtained their internship outside of APPIC by “Other” means found APA/CPA accredited placements.

Module Conclusion

The past thirty years have witnessed an increase in the number of PsyD degree recipients and a greater representation of women and ethnic minorities in the HSP population among students in doctoral internships. These demographic and educational shifts are consistent with data from other studies such as APA’s Doctorate Employment Survey series as well as its Graduate Study in Psychology publication.

The proportion of current HSP providers that obtained an internship through the APPIC Match or similar program was nearly equal to those that did not. Variations occurred across demographic characteristics with the PsyD degree revealing the greatest differences. The EdD degree exhibits notably different participation in APPIC internships and likely can be attributed to structural rather than access issues.

In situations where doctoral students were unable to secure an internship through APPIC, the APPIC Clearing House and school based consortiums provided alternatives. Indeed, some obtained their own placements.

References
Wicherski, M. & Kohout, J. (2007). 2005 Doctorate Employment Survey. Washington, DC: American Psychological Association. Retrieved May 15, 2011 from http://www.apa.org/workforce/publications/05-doc-empl/index.aspx.
Appendices
Tables
Acknowledgments
The 2008 APA Survey of Psychology Health Service Providers is a product of the Center for Workforce Studies, a unit within the Science Directorate of the American Psychological Association. The authors are grateful for the continued support of Dr. Steven Breckler, Executive Director for the Science Directorate, and Dr. Norman Anderson, Executive Vice President and Chief Executive Officer of APA. We would also like to recognize the cross-directorate collaboration made possible by Dr. Lynn Bufka, Assistant Executive Director for Practice Research and Policy and Dr. Catherine Grus, Associate Executive Director for Professional Education and Training. Additionally thanks are due to Tanya Jacobsen, MAPP for her work developing the paper and online instruments and Victoria Pagano for text analysis. Special thanks to Marlene Wicherski for assistance on all aspects of this study but especially, methodology and sampling.