They call it “the match.” Every year, thousands of graduate students in clinical psychology pick the hospitals and clinics where they would like to do yearlong internships. They rank their choices. The internship programs also rank the applicants.
A computer algorithm then digests the lists in an attempt to link mutually desired applicants and programs. But in recent years the process has broken down: In psychology, there are simply not enough internships to go around.
The issue is on the minds of many graduate students in psychology right now, with the application season for next year’s internships in full swing. Last year, 937 students, or 24 percent of those who applied, were not accepted by any of the sites they had chosen — and students must complete internships to earn their degrees and venture out into the workplace.
“These results are unacceptable,” Melba J. T. Vasquez, the president of the American Psychological Association, wrote in April.
Students who do not match must hunt for unaccredited internships, positions that can hobble their careers. Almost half end up without an internship at all and must try again the next year. According to a 2007 study by researchers at the University of Texas, 44 percent of graduate students who did not match were not able to find a program placement, and many if not most of them had to put off graduation by a year.
“It means that there are people who are taking student loans and spending years in this training who could go out and provide a service to the public, and they’re stuck,” said Robert E. McGrath, director of the doctoral program in clinical psychology at Fairleigh Dickinson University in New Jersey.
In some smaller cities and towns, counseling programs for the elderly, the poor and children do not have enough intern psychologists to see all the patients who need treatment, even as a weak economy and high unemployment drive up demand for the programs’ services. The American Psychological Association recommends that students select a doctoral program with high match rates. (Schools are required to publish them.) Nevertheless, even top students at highly regarded schools sometimes do not match because they did not include enough of the less competitive programs in their list or did not rank those programs highly enough to convince the admissions officers of their enthusiasm.
Joanna Wolfson was an A student “with distinction” at Fairleigh Dickinson, which, along with her essays, recommendations and unpaid clinical experience, made her a top prospect from a highly regarded graduate program. Nine internship programs called her in for interviews, and then she went through the match.
“By the terms of the internship, I felt very prepared,” Ms. Wolfson said. “I was applying with an application I was proud of.”
Yet she failed to find a match. “When it sunk in, I just felt it was the end of the world for 24 hours,” Ms. Wolfson said. “I went through all the emotions, being disappointed, being very upset, though in time I accepted it more.” She had to put off graduation by a year, hoping to gain more experience while working on her dissertation.
Psychology students who do not match endure a free-for-all known as “the scramble,” a high-speed process in which, over a few days, they reapply to programs with unfilled positions. In 2011, there were just 1,138 unfilled psychology internship positions in the country.
The problem stems from another kind of mismatch — between the number of students in the nation’s 373 psychology programs and the number of internship slots. The number of enrolled students is growing twice as fast as the number of internships.
“You can’t cram 4,100 students into 3,100 positions,” said Greg Keilin, the director of psychology training at the University of Texas and the coordinator of the national psychology matching program.
The problem has been mounting for years, with the number of unmatched applicants increasing 117 percent since 2002.
Several training directors say part of the problem is that schools, particularly in California and Florida, are composing entering classes of 50 to 75 students, even though enough nearby internships may not be available.
The imbalance is less severe in New York, where clinical psychology programs accept only a dozen or so new students every year. Cynthia D. Belar, the A.P.A.’s executive director for education, said graduate programs could ameliorate the problem by authorizing their own internships, even if they’re not accredited.
Unaccredited internships can be high-quality programs, said Mitchell L. Schare, the director of clinical psychology at Hofstra University. Often the administrators of these programs simply do not want to go through the expense or long commitment of getting accredited by the A.P.A.
But many postdoctoral fellowships and university teaching positions, as well as jobs at veterans’ hospitals, are open only to psychologists trained in accredited internships.
Creating an internship can be expensive. A psychology intern who works 40 hours a week seeing both hospitalized patients and outpatients is paid a salary — $20,000 to $30,000 is the average in New York — and the psychologists who supervise them may lose face time with patients. In some states, including New York, hospitals cannot bill patients for visits to interns.
Susan M. Sussmann, the director of psychology education at NewYork-Presbyterian/Columbia hospital, which has 10 internships a year, said her hospital had explored increasing internships. But, she added, “if it gets too big, we won’t give out stellar training.”
Still, the problem with the way the matching process works out, according to experts like Barry A. Farber, a professor of psychology and education at Teachers College at Columbia University, is that it weeds out “not just marginal students but terrific students.”
“How can these students not have matched?” he asked.