Working in primary care provides great opportunities and challenges for psychologists and other mental health providers. 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 percent of all mental health problems in the United States, without assistance from mental health providers. While psychologists are trained to provide the needed services they are often not trained to work in primary care or collaborate with PCPs.
Psychologists can provide important diagnostic services and information about the use of psychotropic medications for treatment. Successful collaboration with PCPs needs to be a win-win business relationship for everyone. From PCPs perspectives this includes solving a patient care problem, being given feedback and information about their patients’ status and progress, receiving referrals back from the psychologist and reducing their hassle with patient care.
Psychologists can provide important diagnostic information about the patient, recommend additional treatment options, provide information about progress of psychotropic medications and help increase compliance and satisfaction.
It is important to remember that PCPs are “over marketed” by pharmaceutical companies, medical supply companies and other specialists. Thus, a variety of contacts need to be made to establish and maintain an ongoing relationship with the PCP. Psychologists need regular contact – “once is not enough.”
Many PCPs welcome psychologists to practice in their offices either parttime or fulltime. In addition, arrangements to get through the physician’s staff or to rapidly contact the psychologist need to be established. Most PCPs take phone calls during sessions, while most psychologists usually do not. Establish ways to have regular meetings with the PCP to discuss patients (regularly scheduled breakfast, lunch, consultation time).
Other opportunities for seeing PCPs include joining the hospital staff at medical/surgical hospitals, joining hospital staff committees, providing continuing medical education seminars and providing patient education and prevention services. Be sure to market to the entire medical community, which includes physician assistants, nurse practitioners, nurses, medical staff and clerks.
PCPs strive to have long-term relationships with their patients and provide continuity of care that includes comprehensive, continuous services in sickness and in health. Thus, feedback on patient progress is essential to the PCP. Most PCPs only want a brief note (one to three paragraphs, no longer than one page) about your work with the patient. They want a diagnosis, a brief treatment plan explanation 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. The references below provide further information about working with PCPs.
James H. Bray, Ph.D., is director of the Family Counseling Clinic and associate professor in the Department of Family and Community Medicine at Baylor College of Medicine in Houston, Texas. He also maintains an active clinical practice focusing on children and families and behavior health.
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.
Haley, W. E., McDaniel, S. H., Bray, J. H., Frank, R. G., Heldring, M., Johnson, S. B., Lu, E. G., Reed, G. M., and Wiggins, J. G. (1998) “Psychological practice in primary care settings: Practical tips for clinicians,” Professional Psychology: Research and Practice, 29, 237-244.
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