We, the undersigned, call on the Association of Psychology Postdoctoral and Internship Centers (APPIC), American Psychological Association (APA) and the broader psychology training community to take immediate and meaningful action to address a structural inequity that has gone unaddressed for decades: the absence of any formal accommodation for applicants with significant, documentable geographic constraints.

Add your name to stand with trainees with disabilities, student caregivers, and all applicants for whom the current match system was not designed.

The precedent for change already exists; the couples match acknowledges that applicants do not exist in isolation, that their real-life circumstances affect their training access, and demonstrates that the match system can be modified to reflect personal circumstances without compromising its integrity. The accommodation we propose addresses one layer of an inequitable system, but the field must also reckon with the structural shortage that underlies it.We call for an analogous mechanism, or equivalent structural solution, for applicants whose geographic constraints are a matter of necessity

Who Is Being Left Behind?

The populations most likely to face immovable geographic constraints include applicants with physical disabilities who depend on specialized healthcare systems, durable medical equipment suppliers, accessible housing, and established support networks that are often state- or region-specific; single parents and primary caregivers of dependent family members; and applicants with serious financial constraints that cause relocation to be, even temporarily, impossible.

These are not hypothetical concerns. A 2009 APA gradPSYCH report documented students already navigating this reality: one doctoral candidate restricted her search to 11 sites within driving distance of her ill father, knowing she might not match at all; another applied to only six sites near her home as a mother of three, most of which fell outside her training interests (Novotney, 2009). APPIC leadership acknowledged the problem even then, yet the structural response has remained unchanged: applicants are advised to apply broadly, with the implicit burden placed on individuals to resolve circumstances the system declines to accommodate.

When Relocation Isn't an Option

For applicants with physical disabilities in particular, relocation is not just inconvenient. It can mean losing access to treating physicians, disrupting care coordination for complex conditions, risking lapses in insurance coverage tied to state Medicaid systems, and abandoning community-based infrastructure that may have taken years to build. The costs are medical, financial, and in some cases, life-altering. Yet disability is one instance of a broader pattern: the match system routinely treats geographic restriction for any reason as an applicant’s individual shortcoming rather than a structural constraint.  

In a qualitative study of doctoral student mothers navigating the APPIC match, LaFollette (2016) documented the same dynamic playing out across a different population. The prevailing advice to "cast a wide net" and "be willing to move" is delivered as universal wisdom, with what LaFollette describes as “an almost palpable note of condescension” toward those who cannot follow it. Training directors in that study cited geographic limitations as the primary reason students fail to match (61%), yet the structural forces producing those limitations, whether caregiving demands, disability-related immobility, or financial precarity, were largely treated as personal failings rather than systemic problems requiring systemic solutions. And this framing has deep roots: the current psychology training model has not been substantially revised since the 1947 Boulder Conference, when the overwhelming majority of graduate students were White men without the constraints that now characterize a far more diverse applicant pool (Hutchings et al., 2007, cited in LaFollette, 2016).

In a comprehensive analysis of the internship imbalance, Hatcher (2014) noted that unaccredited placements have historically functioned as a de facto safety valve for geographically constrained students, including those with health conditions, family obligations, and financial limitations. Because unaccredited sites are not required to follow APA regulations, including standards regarding intern stipends, this informal workaround is neither equitable nor reliable. Geographically constrained applicants pushed toward unaccredited settings face training of uncertain quality, placements potentially outside their specialty, and compensation that falls below APA standards, all without the regulatory protections that accreditation affords (Hood et al., 2024). The fact that the system has long accommodated geographic constraints informally and inequitably is precisely the argument for formalizing and standardizing that accommodation.

The Data on Disabled Applicants & Match Disparities

The empirical record on disability and match outcomes is unambiguous. In a multiyear analysis of APPIC applicant survey data from 2008 through 2016, Lund (2021) found that applicants with disabilities consistently matched at lower rates than their non-disabled peers across all disability types studied. The disparities were particularly pronounced for applicants with physical and orthopedic disabilities, whose mean match rate was approximately 71% compared to roughly 83% for applicants without disabilities, a gap of 12 percentage points with a very large effect size (Cohen's d = 3.17). These differences represent a consistent, structural disadvantage spanning nearly a decade of data.

It is important to note that these figures reflect pre-COVID match cycles. There is no reason to assume that conditions have improved in the years since; in fact, pandemic-related disruptions to healthcare infrastructure, housing, and support services may have made geographic mobility even more prohibitive for disabled applicants. As such, updated data collection and reporting by APPIC on disability-disaggregated match outcomes is long overdue.

The causes of these disparities are multifactorial, including direct ableism in the interview and selection process (Lund, Andrews, & Holt, 2016), the cumulative "disability tax" of navigating inaccessible training environments prior to internship application (Lund et al., 2021), and the structural penalty imposed on applicants who cannot apply nationally. These are not separate problems. They interact and compound. A system that already disadvantages disabled applicants through direct bias and institutional barriers then further penalizes them for the geographic immobility that disability itself often produces.

Specialty Training Compounds on Geographic Restriction

Geographic limitation interacts with specialty training in ways that further narrow the pool for constrained applicants. An applicant whose doctoral training has focused on pediatric psychology, rehabilitation psychology, or neuropsychology cannot simply apply to any site within their accessible radius. They must identify sites that (a) fall within their geographic constraints, (b) offer adequate specialty training in their area of emphasis, and (c) are a reasonable fit for their clinical background. In many regions, the intersection of these three criteria produces a very small number of viable sites. 

The current system offers no recognition of this compounded constraint. An applicant who limits their applications to specialty sites within a single area due to disability-related geographic immobility is penalized in exactly the same way as someone who limits their applications out of preference. The match algorithm cannot distinguish between these cases, and no accommodation pathway exists to address them.

The ADA legal standard of "reasonable accommodation" is instructive here. The existence of internship slots in a given region does not, on its own, constitute a meaningful alternative for all applicants. An applicant with a specialized training background in a major metropolitan area may appear to have abundant options, yet find that only a small number of sites offer training consistent with their area of emphasis. When specialty training requirements and geographic immobility intersect, the pool of genuinely viable options can shrink dramatically, to the point where no reasonable alternative exists at all. The question, then, is not how many sites exist in a region, but how many are both accessible and appropriate for this applicant, and whether that number is truly comparable to the options available to someone who can apply broadly across the country?

APPIC's Own Record Reflects the Urgency

In 2011, APPIC published applicant feedback comments and no subsequent compilation of applicant feedback on structural barriers has been made publicly available since. The field has continued to accumulate evidence of disparities, in disability match rates, in the experiences of student parents, in the documented barriers facing caregivers and low-income applicants, while the formal channels for applicants to communicate these experiences to APPIC have gone quiet for over a decade. We call on APPIC and APA to restore and expand transparent mechanisms for applicant feedback, stratified by disability status, caregiver status, and geographic constraint.

We invite readers to visit these comments directly and read the testimonials. If this is what the experience looked like for applicants fifteen years ago, the human cost of inaction today is difficult to overstate: https://www.appic.org/Internships/Match/Match-Statistics/Comments-about-Imbalance

Addressing Anticipating Concerns
We recognize that APPIC and internship training directors may raise legitimate implementation questions, and we take those concerns seriously.

How would geographic constraints be documented or verified?

 We acknowledge this is a meaningful question, and we propose a documentation standard analogous to what exists in other accommodation contexts: attestation through medical documentation (for disability-related constraints), state Medicaid or insurance records (for insurance-related geographic restrictions), SSDI documentation (where applicable), or tax residency and dependent care records (for caregiver-related constraints). Notably, the existing couples match requires no formal proof that applicants are a couple, as it operates on self-attestation. A geographic constraint pathway could adopt a similar or more modest verification standard.

Would this compromise the integrity of the algorithm? 

The couples match demonstrates that constraint-based modifications to the match algorithm are both feasible and compatible with the integrity of the broader system. The proposed geographic constraint pathway, or an equivalent structural solution, would require building an opt-in category with its own constraint parameters, much as the couples match already does.

Would too many applicants claim geographic constraint to gain an advantage? 

This concern assumes applicants would misrepresent their circumstances for strategic gain. In our view, this assumption is both empirically ungrounded and cynical. More importantly, the current system's failure to accommodate genuine constraints is not justified by the speculative possibility of misuse. The solution is an appropriate documentation standard, not refusal to adapt.

Does this pathway solve the internship imbalance?

We recognize that a geographic constraint pathway alone does not resolve the broader internship imbalance. The fundamental problem remains that there are not enough accredited internship positions to meet the demand of applicants for whom an internship is a requirement to graduate. The accommodation we propose addresses one layer of an inequitable system, but the field must also come to terms with the structural shortage that underlies it. 

A Call to Action

We urge APPIC & APA to take the following concrete steps:

Establish a geographic constraint match pathway. Convene a working group (inclusive of applicants with disabilities, student parents, and trainees with caregiving responsibilities) to design a formal geographic constraint accommodation pathway or equivalent structural solution for the APPIC match.

Restore and expand public reporting on match outcomes. Resume transparent and publicly available reporting of match outcomes disaggregated by disability status, with updated data collection that reflects post-2016 match cycles and includes caregiver status as a reported variable.

Examine ADA obligations. APPIC and APA should jointly engage legal and disability policy expertise to assess whether the current match structure, as applied to applicants with physical disabilities, is consistent with the spirit and requirements of the Americans with Disabilities Act.

Acknowledge geographic immobility as a disability-related barrier in training and match guidance. APPIC should partner with the APA Committee on Disability Issues in Psychology and the APA Office on Disability Issues to make this acknowledgement formal and actionable.

The field of psychology has consistently articulated a commitment to diversity, equity, and inclusion. Disability is a critical dimension of that commitment. The internship match, as currently designed, imposes real and measurable costs on applicants whose geographic constraints reflect a necessity. These applicants are not less qualified. They are not less committed. They are navigating a system that was not built with them in mind and has not been updated to include them. That is a problem with the system, not with the applicants, and it is one we have the knowledge and responsibility to correct.

Psychology is not alone in relying on a centralized match infrastructure. Other health professions using the National Matching Services, including medicine, pharmacy, and social work, face structurally similar constraints, and the precedents APPIC sets here may carry broader implications. If successfully implemented in psychology, a geographic constraint accommodation pathway could serve as a model for match reform across health professions.

If you believe that training systems should work for everyone, please add your name.

Every signature sends a message to APPIC and APA that the time for structural change is now.

We thank you for reading. Please sign and share widely.

The Coalition for Disability & Neuropsychology (CDN)

Instagram: @CDNVoices | Email: cdnvoices@gmail.com

References:

1. Novotney, A. (2009, January). When family comes first. gradPSYCH Magazine. https://www.apa.org/gradpsych/2009/01/family
2. LaFollette, J. R. (2016). Matching moms: Understanding how doctoral student mothers in professional psychology programs experience training and the APPIC match [Doctoral dissertation, Indiana University]. ProQuest Dissertations & Theses. https://www.proquest.com/openview/3f5867079d12dc98e65123001ac03531/1?pq-origsite=gscholar&cbl=18750
3. Hutchings, P. S., Mangione, L., Dobbins, J. E., & Wechsler, F. S. (2007). A critical analysis of systemic problems with psychology pre-doctoral internship training: Contributing factors and collaborative solutions. Training and Education in Professional Psychology, 1, 276–286. https://doi.org/10.1037/1931-3918.1.4.276
4. Hatcher, R. L. (2014). The internship imbalance in professional psychology: Current status and future prospects. Annual Review of Clinical Psychology, 10, 53–83. https://doi.org/10.1146/annurev-clinpsy-032813-153737
5. Hood, C. O., Schick, M. R., Cusack, S. E., Fahey, M. C., Giff, S. T., Guty, E. T., Hellman, N., Henry, L. M., Hinkson, K., Long, E. E., McCoy, K., O'Connor, K., Wilborn, A. P., Reuben, A., Sackey, E. T., Tilstra-Ferrell, E. L., Walters, K. J., & Witcraft, S. M. (2024). Short-changing the future: The systemic gap between psychology internship stipends and living wages. Training and Education in Professional Psychology, 18(1), 49–58. https://doi.org/10.1037/tep0000449
6. Lund, E. M. (2021). Psychology predoctoral internship match rates by disability type. Rehabilitation Psychology, 66(3), 311–316. https://doi.org/10.1037/rep0000386
7. Lund, E. M., Andrews, E. E., & Holt, J. M. (2016). A qualitative analysis of advice from and for trainees with disabilities in professional psychology. Training and Education in Professional Psychology, 10(4), 206–213. https://doi.org/10.1037/tep0000125
8. Association of Psychology Postdoctoral and Internship Centers. (2011). Internship supply & demand imbalance: Comments from 1,076 students who participated in the 2011 APPIC match. https://www.appic.org/Internships/Match/Match-Statistics/Comments-about-Imbalance