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Working in primary care provides great opportunities and challenges for psychologists. Changes in medical practice due to managed care have put tremendous pressure on primary care physicians (PCPs) to diagnosis and treat a broad spectrum of biomedical and psychosocial problems. PCPs treat over 60% of all mental health problems in the United States, without assistance from psychologists or other mental health providers. While psychologists are trained to provide the needed services, they are often NOT trained in working in primary care or collaborating with PCPs.
Psychologists can provide important diagnostic services and information about use of psychotropic medications for treatment. PCPs are often less familiar with various mental disorders and psychotropic medications. Successful collaboration with PCPs needs to be a win-win business relationship for both providers. PCPs want psychologists help in solving a patient care problem, being given feedback and information about their patients’ status and progress, and receiving referrals back from the psychologist. This type of help reduces their hassle with patient care. Psychologists can provide important diagnostic information about the patient, recommend additional treatment options, provide information about the progress of psychotropic medications and help increase patient compliance with medical treatments. All of these often improve patient satisfaction (Bray & Rogers, 1995).
PCPs are “over marketed” by pharmaceutical companies, medical supply companies, and other specialists. Thus, a variety of contacts will need to be made to establish and maintain an ongoing relationship with the PCP. As we found in our research, “once is not enough,” and the psychologist needs to arrange for regular contact (Bray & Rogers, 1995). Many PCPs welcome psychologists to practice in their offices either part-time or full-time. Many patients prefer this arrangement, since they can go to one place for their health care, they may feel less stigma about obtaining treatment for their mental health problem, and appreciate the collaboration between PCP and psychologist.
Physicians usually have a different practice style than psychologists. It is important to make arrangements to get through the doctor’s staff to the physician or for the PCP to be able to rapidly contact the psychologist. Most PCPs take phone calls during sessions, while most psychologists do not. Establish ways to have regular meetings with the PCP to discuss patients (regularly scheduled breakfast, lunch, consultation time). There are a variety of other opportunities for seeing PCPs. These include joining the hospital staff at medical/surgical hospitals, joining hospital staff committees, providing continuing medical education seminars to local medical societies and provide patient education and prevention services. Be sure to market your services to the entire medical community, which includes physician assistants, nurse practitioners, nurses, and medical staff and clerks.
PCPs develop long-term relationships with their patients and provide continuity of care that includes comprehensive, continuous services in sickness and in health (Rakel, 2002). Feedback on patient progress is essential to the PCP. Most PCPs only want a brief note (1 to 3 paragraphs, no longer than one page) about your work with the patient. They want a diagnosis, a brief explanation of your treatment plan, and any recommendations you may have to improve patient care. It is also important to help the patient return to his/her PCP for follow-up visits. Arranging for follow-up visits is a way of continuing to market your services to the PCP. Working with PCPs is a great way to expand your practice.
Further information about working with PCPs can be found in:
Bray, J. H., & Rogers, J. C. (1995). Linking psychologists and family physicians for collaborative practice. Professional Psychology: Research and Practice, 26, 132-138.
Bray, J. H. & Rogers, J. C. (1997). The linkages project: Training behavioral health professionals for collaborative practice with primary care physicians. Families, Systems, & Health, 15, 55-63.
Frank, R. McDaniel, S. H., Bray, J. H., & Heldring, M. (Eds.) (2004). Primary care psychology. Washington, DC: American Psychological Association.
Haley, W. E., McDaniel, S. H., Bray, J. H., Frank, R. G., Heldring, M., Johnson, S. B., Lu, E. G., Reed, G. M., & Wiggins, J. G. (1998). Psychological practice in primary care settings: Practical tips for clinicians. Professional Psychology: Research and Practice, 29, 237-244.
Rakel, R. E. (Ed.) (2002). Textbook of family practice 6th Edition, Philadelphia, PA: W. B. Saunders.
James H. Bray, Ph.D. is a candidate for President of the American Psychological Association. He is Director, Family Counseling Clinic and Associate Professor in the Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX 77098, (713) 798-7751, jbray@bcm.edu. He maintains an active clinical practice focusing on children and families and behavioral health.
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