Psychology graduate students have far lower match rates into internships than medical school seniors have into physician residency programs, according to a recently published paper by Donna M. LaPaglia, PsyD, Assistant Professor of Psychiatry at Yale.
LaPaglia, a psychologist who directs the Substance Abuse Treatment Unit at the Connecticut Mental Health Center, studied the supply and demand imbalance of psychology internship and medical residency programs as part of a larger look at workforce shortages in health care. Her paper, "A Shortage of Medical Residency Positions: Parallels with Psychology," appears in the journal “Academic Psychiatry.”
More residency and internship opportunities have opened in recent years, however there remains a critical shortage of training venues, particularly for psychology graduate students, according to the paper.
In 2014, 20.2 percent of psychology graduate students failed to match to a one-year clinical internship, a program that must be completed before a doctorate is conferred. In contrast, only 5.6 percent of U.S. medical school seniors failed to match to a residency position.
“We believe that this is a forewarning of what could happen in medicine unless action is taken soon to ameliorate the training imbalance,” LaPaglia wrote.
The problem has been festering for decades. Beginning in 1991, according to the paper, the number of psychology students pursuing graduate degrees began to exceed the number of available internships. In 1980, a Graduate Medical Education National Advisory Council study revealed psychiatry had a larger deficit of practitioners than most other specialties.
The same pattern has been seen in medicine, where physician shortages have been documented for years, LaPaglia wrote.
The Association of American Medical Colleges predicts there could be a shortage of nearly 160,000 physicians in 10 years, but that the impact could be even more significant since more people are now being insured under the Patient Protection and Affordable Care Act.
Medical and graduate schools have increased their class sizes and are admitting more students, but the problem will persist unless more residency and internship opportunities are created for graduates, according to the paper.
“The key question is whether residency training opportunities will be sufficient to accommodate an increased flow of medical school graduates from all sources … . The answer is not reassuring,” LaPaglia wrote. “Despite modest increases in U.S. residency slots, and proposed efforts such as the Resident Physician Shortage Reduction Act, the number of U.S. residency positions has not been coordinated with the increase in … medical school enrollment. The effects of this uncoordinated effort are that the number of U.S. medical school graduates threatens to surpass the number of residency positions.”
Much has been written about the problem, but LaPaglia said she hopes her paper sparks more conversation between physicians and psychologists.
People have worked hard and tried to work across groups to increase opportunities for training at accredited (institutions). You want to keep the discipline strong.
Donna M. LaPaglia, PsyD, Assistant Professor of Psychiatry at Yale
“The reality is we’re peers and we can really help each other to problem solve,” she said. “Through various central meetings, this has been a topic for many years. People have worked hard and tried to work across groups to increase opportunities for training at accredited (institutions). You want to keep the discipline strong.”
Psychology still lags behind medicine when it comes to training opportunities, with the number of applicants outnumbering available internship positions.
According to LaPaglia’s research, there is disagreement in the field about how to remedy the imbalance. Some advocate for more training opportunities, while others say class sizes should shrink for doctoral programs.
“Though there has been a gradual increase in the number of internship slots, attempts to constrict the pool of trainees have floundered,” LaPaglia wrote. “There is no centralized oversight of the number or the size of psychology graduate programs and the number of students they enroll.”
Faced with decreased funding from the government and other sources, medical schools have struggled to grow their residency and internship programs. However at Yale, an additional training slot has been opened in the CMHC system, and there are now more postdoctoral training opportunities at the VA Medical Center in West Haven, LaPaglia said.
She predicts the imbalance will worsen unless the problem is addressed. When students don’t match to a program, they increase the size of the pool of residency candidates the next year, making it harder for that year’s graduates to find a training program.
LaPaglia said there are economic consequences to graduates who must begin to pay back student loans, but cannot get a job because they cannot complete their training.
Among other recommendations, she suggests members of Congress be lobbied to reconsider the 1997 Balanced Budget Act, which capped graduate medical education funding for training.
Doing nothing, she wrote, is not an option.
“The costs associated with securing better alignment between residency training slots and medical school graduates are vastly preferable to allowing the residency supply/demand imbalance to complicate medical education, threaten medical students’ futures, and undermine the capacity of the healthcare system to provide appropriate, accessible care,” she wrote. “Such adverse, broad-impact, disruptive consequences warrant urgent effort and resolve to overcome these challenges.”