February 10, The duty published an article in which doctoral students in psychology express their reluctance to do their internships in the public sector (“Graduating students in psychology issue a cry from the heart not to work in the public sector”). This article has stirred up negative criticism in some media, notably in a column by Mr. Ferrandez on Paul Arcand’s program (FM 98.5), which concludes that these doctoral students are showing selfishness. Our letter aims to provide a nuanced perspective on the desire of psychology doctoral students to practice in the public health care system. We ourselves doctoral students in psychology, we rather consider that the disinterest of some of our colleagues for the public sector is symptomatic of a weakened public health system, which requires more than a simple influx of interns in psychology to respond to the problems affecting him.
Note that the majority of psychology doctoral students want to work within the public healthcare system. To tell the truth, according to an internal report by the Interuniversity Federation of Doctoral Students in Psychology (FIDEP) carried out in 2020, 75% of us have this intention. Why ? Because we believe it is essential to improve the public’s access to psychological services, free of charge. In addition, the public system offers us the privilege of working with diverse clienteles, in vulnerable situations and sometimes presenting complex disorders that require the support of a multidisciplinary team. Working in such an environment represents for us an incomparable source of learning and enriching experiences. As future psychological practitioners, this is exactly what we are looking for.
A set of factors can, however, dampen the motivation of doctoral students to continue their training in the public sector. First, let’s note the growing lack of internships in the public sector, due to the lack of psychologists working in this environment. Doctoral students are therefore in competition for a limited number of internships, which encourages the exodus of many to the private sector to do their studies.
Then, when we are able to land an internship in the public sector, we have the opportunity to apply for a $25,000 scholarship to complete 1600 hours of supervised practice. Note that as interns, we carry out 80% of the tasks of a psychologist and that an unpaid internship of 700 hours precedes our internships. This scholarship is granted to us on the condition that we agree to work for two years in the public network after our graduation.
However, the job assigned sometimes does not correspond to the expertise developed by the doctoral students during the internship. Accepting to practice with a clientele having difficulties for which we have not been trained raises ethical issues. It is even more demoralizing to work within a system that does not value the profession of psychology. Indeed, the profession of psychologist does not receive the recognition, professional autonomy and salary that four to seven years of doctoral studies should provide. The psychologist’s pay scale starts at $25.05 per hour, while a family physician may charge $57.05 for 30 minutes of psychotherapy, then $28.55 for each additional 15 minutes of psychotherapy ( which totals $114.15 per hour) (general practitioner billing manual, p. 224).
If we refuse the assigned position, we have the obligation to reimburse the scholarship. This reimbursement is then added to an average debt of $24,764, which 66% of doctoral students report having accumulated during their university studies. Demanding such reimbursement is a concrete demonstration of the lack of consideration the government gives to the work of psychology interns in the public network. In his column, Mr. Ferrandez even suggests that psychology doctoral students who decide not to work in the public sector reimburse their tuition fees. However, doctors who complete their studies do not have to reimburse the salary earned during their residency or their tuition fees, if they choose to work in private practice or leave the province.
As Quebec is going through an unprecedented crisis and mental health needs are glaring, we consider it essential that the government recognize the undeniable contribution of both interns and psychologists within the Quebec public health system. Such recognition should, among other things, be reflected in working conditions and a salary commensurate with their expertise. The sustainability of psychological services in the public network depends on it.
* This letter is supported by more than 260 signatories.