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Key points
- A shortage of licensed professionals contributes to long waits for mental health treatment.
- The long-term commitment of time and money required for licensure can deter aspiring psychologists.
- One significant hurdle is the EPPP, the challenging professional examination required for licensure.
- The psychology profession can make changes to better support aspiring practitioners.
Many of my clients share with me their experiences with seeking mental health services. Typically, they ask, “Why is the wait time so long?” They stress the unfairness of waiting months to years for mental health services from licensed psychologists. My answer is, “There is a shortage of licensed psychologists.” The entire process from starting graduate education to obtaining a license can take a decade or more, requiring a long-term commitment, perseverance, and financial investment.
The path to becoming a licensed psychologist can deter individuals from entering the field. The shortage of licensed psychologists is a critical concern that affects mental health care access and quality. Several key factors contribute to the shortage; however, passing the Examination for Professional Practice in Psychology (EPPP) is often cited as the most rigorous and challenging aspect, especially for African-Americans and Hispanics.
Candidates must pass the EPPP, a comprehensive national exam that tests knowledge across multiple areas of psychology. Some states have additional exams that test knowledge of state laws, ethical practices, and specific areas of practice relevant to the state. By January 2026, the licensing process will include the EPPP (Part-2 Skills) assessment, an additional examination that will need to be passed to become a licensed psychologist.
Personal Narratives on the Path to Licensure
The cost of a graduate education in psychology and examination fees can be significant. Additionally, unpaid internships and supervised postdoctoral hours can increase financial strain. Add to that the cost of application and licensure fees to become a licensed psychologist, which many candidates have to pay repeatedly to pass. Not passing the EPPP can have significant implications for aspiring psychologists, affecting their career and emotional well-being. Here are just a few examples of these consequences, as expressed by licensed and aspiring psychologists:
- “It took me four tries to pass, thousands of dollars, and decimated my self-esteem.”
- “I lost out on so many professional and financial opportunities trying to pass this test.”
- “I invested thousands of dollars to pass this exam and have not been able to pass.”
- “Not passing the EPPP has been a major barrier to advancing my career in the field of psychology.”
- “I was fired, I have children.” “Why is passing this exam so hard for us?”
The Mental Health Journey
Failing the EPPP causes significant mental health concerns in aspiring psychologists, affecting their confidence and willingness to try to pass the examination. Repeated failures may lead to anxiety, depression, self-doubt, and questions about one’s competence and future in the field of psychology. Examples of these possibly career-ending frustrations include:
- “I have internal resistance to resume my study path and take the EPPP.”
- “I am beyond frustrated. I am leaving the field.”
- “My board would not approve my special circumstance; I was not allowed to sit for the examination again."
A practitioner can also be subjected to mental health concerns in the process of preparing for and retaking the exam. I asked licensed and aspiring psychologists to discuss how the licensing standards and passing or failing the EPPP have impacted their mental health. Here is what they had to say:
- “I attempted the EPPP two times.” “There are so many hurdles to jump in taking this test, but the additional layer of COVID-19 made the process much more difficult.”
- “I’ve lost hope. I have taken the exam two times and failed. The exam has made me depressed and I can clearly see that I no longer have confidence in myself while I worked so hard to obtain my doctorate."
- “I have to learn to channel my anger about this entire system.”
- “I passed, but I would not wish this process on anyone. I put my study time ahead of other commitments in my life. The EPPP needs reform, especially the financial piece."
- “There is no reason that we should go through this process, especially the way it currently stands.”
- “I am a licensed professional in this field, but not passing the EPPP has significantly impacted my mental health leading to feelings of inadequacy, low self-esteem, shame, and anxiety.”
- “I am crushed by my scores. I am changing fields. I will not spend thousands on this exam.”
Strategies to Move Forward
Equitable access to the profession of psychology is a needed change. Not passing the EPPP can be a significant setback with various negative impacts, including the shortage of licensed psychologists that has led to the public outcry for more immediate and long-term mental health care. The hardships in obtaining a license to practice do not fall solely on licensed or aspiring practitioners. Before 1992, the EPPP had different passing scores across jurisdictions. In 1983, the cut-off score for passing the EPPP was the 25th percentile. Between that time and now the cut-off has been changed to the 50th percentile. Watching peers progress in their careers while facing delays can be demoralizing and lead to feelings of inadequacy. Timely and effective public mental health care is important, as are proactive strategies that will positively assist aspiring psychologists to overcome this hurdle and eventually achieve their professional goals. Strategies can include:
- Engaging with mentors who have successfully navigated the licensure process.
- Connecting with peers who are also preparing for the EPPP.
- Forming or joining study groups to review material collectively.
- Practicing stress management techniques, such as exercise.
- Seeking support from a therapist or counselor to address any emotional and psychological challenges.
- Considering flexible work options that allow for dedicated study time without financial strain.
- Exploring alternative roles within the mental health field that do not require immediate licensure.
Explaining the reasons for the shortage of licensed psychologists to my clients when asked decreases their frustration about the field of psychology. Aspiring psychologists who face setbacks need the same conversations and support to remain in the field. Once licensed, psychologists enjoy stable career opportunities in various settings and make a significant difference in people's lives. It's important that aspiring psychologists not give up on their passion and career goals. The journey may be tough, but the rewards of helping others and contributing to the field are well worth the effort. Stay informed of any changes in licensure requirements or state regulations that might affect your path to licensure. The psychology field will overcome the obstacles in licensing standards to better support the public's mental health care needs.
