The 4,139 psychology doctoral students who participated in 2021’s APPIC match accumulated a mean debt of $99,488 during their training (Keilin, 2021b; Keilin, 2021a). U.S. applicants reported a mean debt of $103,198 and a median debt of $80,000 associated with graduate school, while Canadian students accumulated virtually no debt (Keilin, 2021b). In the United States, average pre-internship debt increased 8.4% in 3 years and 14% over 13 years (Association of Psychology Postdoctoral and Internship Centers, 2008; Keilin, 2021b).  

Hatcher et al. (2012) estimated that in the U.S. approximately 12,000 psychology graduate students are engaged in practicum training each year. As these numbers indicate, practicum training is as ubiquitous as it is vital. The American Psychological Association (APA) requires programs to include practicum training of various levels and duration as criteria for accreditation, yet makes no provisions regarding compensation for graduate student labor (APA, 2015). Many programs allow their students to be paid, but only 4% require it, and some programs prohibit trainee compensation (Hatcher et al., 2011). Many of these policies have remained constant in recent decades and have not been revisited with consideration of the student debt crisis, the COVID-19 pandemic, or the rise in the cost of living nationwide.  

In addition to increased cost of living and stagnant early career wages, graduate psychology trainees endorse high levels of stress throughout their education and often describe persistent financial stress and taking on additional debt to afford living expenses (Doran et al., 2016). While increasing debt burdens affect all trainees, Black, Indigenous, and People of Color (BIPOC) trainees are disproportionately affected by debt accumulation (Malcom & Dowd, 2012). Unpaid trainee labor is also highly gendered and racialized. Professions that are construed as male-dominated and traditionally White often pay trainees, while professions traditionally held by marginalized people or construed as female-dominated regularly require hundreds or thousands of hours of unpaid labor prior to employability (Caldararu, 2019).  

As Doran et al. (2016) noted, the debt trainees accumulate likely exacerbates barriers to increasing the representativeness and diversity of the field. These new concerns and challenges require significant adaptation from the profession. This article attempts to explore the issue of unpaid graduate labor and equity in the profession from a perspective grounded in the APA Ethics Code (2017). 

The 1938 Fair Labor Standards Act (FLSA) is the legal basis for unpaid practicums, permitting employers to pay a lower wage to apprentices and learners, and was followed by a series of legal battles which distinguished between training and employment (Burke & Carton, 2013). The U.S. legal system uses the “primary beneficiary test” to assess the quality of a trainee-employer relationship by reviewing several factors to determine whether the trainee gains more from their placement than the employer (United States Department of Labor, 2018). In a psychological context, the test would measure the clarity of practicum expectations established by sites and the cost to provide training in comparison to the monetary value of services provided by trainees. Graduate programs and practicum coordinators routinely define expectations and rules for trainees, which must be agreed upon prior to the start of these placements, thus meeting the legal system’s standard for clarity of expectations (Burke & Carton, 2013; Hatcher et al., 2011, 2012).  While trainee informed consent to unpaid training is required, trainees participate in larger systems that constrict their choices. In addition, unpaid trainees are also likely to have fewer legal protections than they would in an educational context or as an employee (Burke & Carton, 2013). Scholars noted that this arrangement creates a difficulty to meet the need for standardization of the quality of practicum training and university monitoring of trainee experiences (Burke & Carton, 2013; Hatcher et al., 2011, 2012). Practicum coordinators who are charged with these duties value their work and seek to provide quality training (Hatcher et al., 2012). Yet they also endorse varying degrees of institutional support. Most coordinators indicate that their organizations emphasize training as part of their mission statements while only 39% reported the inclusion of practicum expenses in organizational budgets (Hatcher et al., 2012). Coordinators endorsed concerns about trainees being adequately prepared prior to begin their placements (Hatcher et al., 2012). The authors also identified supervision as a concern indicating that prior to the COVID-19 related shift to telehealth, less than 20% of practicum sites conducted direct observation of students (Hatcher et al., 2012). In addition, most practicum placements are unpaid and student services may not be eligible for insurance reimbursement (Hatcher et al., 2012). Seventy-two percent of responding coordinators indicated that they do not pay students and that stipends are of little importance for training quality; 81% of sites also had no travel stipends which were also regarded as minimally important (Hatcher et al., 2012). These data accentuate the misalignment between institutional priorities and trainee financial strain as current social, economic, and political conditions make the situation increasingly untenable. This misalignment further highlights the value of upholding the profession’s ethical principles through action.  

The Ethics Code does not require compensation for trainees’ labor, but its general principles and sections offer space for ethical consideration of the current system (APA, 2017). Principle A, Beneficence and Nonmaleficence, guides psychologists to “safeguard the welfare and rights” of people in professional contexts and to cultivate an awareness of how their health affects their ability to serve others. Principle B, Fidelity and Responsibility, encourages psychologists to work with professionals and organizations as necessary to serve the best interests of those within their sphere of influence. Principle E, Respect for People’s Rights and Dignity, highlights the importance of psychologists’ recognition of individuals’ right to self-determination and dignity. Section 3.04, Avoiding Harm, advises psychologists to take reasonable steps to prevent harm to their students and supervisees. In combination, these guidelines suggest that psychologists strive to respond to a wide range of situations that represent a threat to trainee welfare and the diversity and equity of the profession. While trainee welfare and equity are broad concerns, scholars recently identified financial strain as a factor for specific concern. Doran and colleagues’ (2016) work exploring the numerous impacts of financial strain and the rapid surge of APPIC applicant total debt highlights financial stress and debt burden as significant impediments to trainee welfare and the potential impact of this strain on their work and career outlook. 

Trainees in both PhD and PsyD programs often take on additional debt to afford living expenses, although many receive a combination of tuition remission, research assistantships, teaching assistantships, grants, and other financial support (Doran et al., 2016). Starting salaries for new psychologists have not grown as quickly as these costs (Doran et al., 2016). Rising costs of living and education without practicum stipends or equivalent increases in early career salaries negatively affect the health of trainees, newly licensed psychologists, and potentially the profession (Doran et al., 2016). 

Psychologists in training, like other healthcare workers, regularly face significant anxiety, stress, depression, burnout, and chronic physical health difficulties prior to their internships, graduation, and licensure (Bhurtun et al., 2019; Kaeding et al., 2017; Richardson et al., 2018; Rummell, 2015; Zhou et al., 2020). Researchers have often investigated personality-level characteristics to understand and predict burnout (Kaeding et al., 2017; Richardson et al., 2018). However, systems level approaches can provide a helpful departure point for additional ethical observations. Zhou et al. (2020) found that trainee physicians facing workplace stress, like negative work-life balance or negative work environments, were twice as likely to endorse burnout compared to trainees struggling with non-work-related factors like self-efficacy or physical health. They also demonstrated that perceived poor salary, debt, or financial problems contributed to burnout stress to a lesser extent than work stress and emphasized the importance of organization-level intervention.  

These systemic, organization-level interventions require consideration of the material conditions from which they originate. Caldararu (2019) urged examination of the sociopolitical construction of graduate training as a site of conflict between policies emphasizing individual responsibility and those prioritizing the common good. Practica offer trainees opportunities to develop competencies, obtain gradually increasing responsibility, and receive supervision to enhance their work while attempting to prevent unprepared professionals from causing harm in the communities they serve. Yet trainee labor and growing competency occur within a market-oriented economic system. Trainee labor thus produces increasing value across their studies, which can allow organizations to bill for services or, in some contexts or professions, shift labor from paid workers to trainees (Caldararu, 2019). Caldararu’s “hidden curriculum” refers specifically to the social construction of mandatory unpaid practicums operating within a neoliberal framework that privileges service-delivery, and capital generation, over trainee development or questioning established power hierarchies of class. In his formulation, educational institutions nationwide contribute unpaid labor to private sector or non-profit organizations, teaching students the hidden lesson that they must pay for career opportunities by accumulating debt, sacrificing their personal lives, or seeking paid employment after hours.  

While trainee psychologists experience exponential growth in their abilities during practicum training, the profession’s “hidden curriculum” creates innumerable barriers to entry for trainees facing the most systemic discrimination. Principle D, Justice, (APA, 2017) asks psychologists to ensure equitable access and benefit from the field’s advances, which is threatened when systemic barriers limit equitable access to membership in the profession. Furthermore, differing priorities of training coordinators, their organizations, and practicum trainees often lead to unintended conflicts and organizational standards that are out of alignment with the Ethics Code.  

Pietrantonio and Garriott (2017) offered valuable steps the profession can take to address this issue in their response to Doran et al.’s (2016) article on the graduate psychology debt crisis. Their plan emphasizes:   

(a) transparency and guidance for undergraduate psychology students, (b) financial-informed consent in graduate training, (c) ensuring financial literacy and creating a culture of safety around discussing student debt, (d) post-graduation financial resources, (e) increasing funding opportunities for clinical training, (f) federal advocacy for student debt concerns, and (g) APA advocacy for higher wages for entry-level positions (Pietrantonio & Garriott, 2017, p. 94). 

These steps provide a holistic approach to addressing the structural inequality inherent in the current practicum model by addressing the potential harms of the system at the level of their causes while also increasing the equity of the profession.  

An ethics-oriented approach to the dramatic increases in graduate psychology trainee debt, financial stress, and tension between the profession’s ethical principles and common institutional and organizational constraints can provide helpful suggestions for future action. Psychologists must critically assess the “hidden curriculum” of unpaid trainee labor and determine whether it aligns with the profession’s ethical aims. The full impacts of the COVID-19 pandemic’s influence on living costs and the long-term course of the student debt crisis remain uncertain. Yet, the financial burden of joining the profession clearly requires a broad response guided by its ethical principles. Page Break 

References 

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