Feature

Primary-care training

If the terms "medical home" and "patient-centered care" seem to crop up at every turn, it's not your imagination.

The 2010 Patient Protection and Affordable Care Act champions the concept: improving health-care quality and trimming health-care costs by coordinating patients' treatment through a team approach. The law channels new funding into primary-care settings, which serve as one-stop shops for all patients' health-care needs.

This model is creating new career opportunities for psychologists to work in interdisciplinary teams. The Department of Veterans Affairs is among those leading that charge. In April, the administration announced it would add 1,600 mental health clinicians, including psychologists, to its current mental health workforce of more than 20,000.

"Service delivery in the VA system has shifted," says D. Rush McQueen, PhD, training director of the Alaska VA Healthcare System's internship program. "Much of the care that would have traditionally taken place in a mental health clinic or psychiatric care unit is being placed in primary-care environments in the interest of lowering barriers and increasing access."

Students who want to prepare for this career path may find that psychology internships in primary care are less plentiful than specialized programs. But here are a few that can help future clinicians navigate the changing health-care landscape.

I Ola Lãhui Inc., Honolulu, Hawaii

I Ola Lãhui is a nonprofit training program that teaches psychology interns to provide chronic disease and mental health care to underserved native Hawaiians and rural communities in federally qualified health centers.

Stipend

Interns receive $20,000 plus health benefits, paid holidays and vacation for the one-year program. Travel and housing are covered for interns who will spend some of their time seeing patients on the island of Moloka'i.

Who you'll treat

About 60 percent of patients are native Hawaiian and about half of all patients need help making lifestyle changes to manage chronic illnesses such as diabetes, hypertension or heart disease. "And then we have the more traditional mental health patients with depression, anxiety, a lot of trauma issues and substance abuse," says training director Robin E.S. Miyamoto, PsyD.

What you'll learn

Psychology graduate students develop cognitive-behavioral and brief intervention skills to motivate patients to manage their medical conditions by eating a healthy diet, exercising more and monitoring their blood glucose or blood pressure, if needed. Interns also learn how to read lab work to see whether their patients are improving. "We're ahead of the curve," says Miyamoto, who has been working within a medical home model for 11 years. "I think psychologists are going to have to be able to interact with the primary-care provider to be relevant, now that everyone is moving to this model."

A typical week

Monday through Wednesday, the program's two interns work side by side with primary-care physicians at Waimanalo Health Center on Oahu or on Moloka'i, a tiny Hawaiian island with a population of 8,000. Interns see patients on their own or they accompany physicians, providing interventions when appropriate. On Thursday and Friday, interns work at the main office in Honolulu, participating in didactics and supervision and tracking patient demographics, diagnoses, the number of visits each patient makes and patient outcomes.

Who they're looking for

The staff at I Ola Lãhui aims to train interns who are interested in caring for native Hawaiians or rural communities and will stay in the state to practice psychology. Candidates should have experience with a broad population base or community-based psychology rather than in a specialized area such as residential treatment or forensics. Experience with cognitive-behavioral therapy is also desirable, says Miyamoto.

Alaska VA Healthcare System

This Anchorage-based program provides veterans with primary, specialty and mental health care at its outpatient clinics in four sites outside of Anchorage, the military hospital at nearby Joint Base Elmendorf-Richardson and some community hospitals.

Stipend

The one-year program pays $23,974. Interns are eligible for federal health and life insurance benefits and paid holidays and vacation.

Who you'll treat

While Anchorage's population is 70 percent white, the region is also home to Alaska natives, American Indians, Asian-Americans and Pacific Islanders. The veterans' needs are diverse, including diabetes management, weight counseling, smoking cessation, and treatment for anxiety and depression, McQueen says. Often, students work with veterans returning from tours in Iraq and Afghanistan. "There's a huge opportunity to be trained in caring for [veterans] with post-traumatic stress, in terms of combat as well as military sexual trauma," McQueen says.

What you'll learn

Students who join the residential rehabilitation rotation work in an interdisciplinary team to treat newly admitted veterans with mental health and medical conditions. In the outpatient mental health rotation, interns provide psychological assessments and conduct individual and group therapy sessions. The adult neuropsychology rotation helps interns learn to evaluate patients with comorbid neurological, medical and psychiatric conditions such as post-concussion syndrome, chronic pain, stroke, traumatic brain injuries and deployment-related adjustment difficulties.

A typical week

Depending on the rotation, the program's three interns spend four days a week performing assessments, conducting individual, group or couples' therapy, and attending meetings to discuss patient care. The remaining time is spent in individual and group supervision and in clinical-skills seminars. Meetings with McQueen, the training director, take place on Thursday afternoons. All interns can opt to spend up to four hours weekly on academics — wrapping up dissertations or collaborating with psychology faculty at the University of Alaska, Anchorage.

Who they're looking for

The Alaska VA seeks candidates who are interested in generalist training and are well suited to the program's scholar-practitioner training model. Candidates should be committed to empirically supported treatment and be sensitive to cultural diversity.

Eastern Virginia Medical School

This Norfolk, Va., medical school includes training at multiple local hospitals.

Stipend

The program's interns are paid $21,735 plus benefits for the one-year program.

Who you'll treat

About half of patients are from underserved and minority populations, says Barbara Cubic, PhD, co-director of the internship program. Most of the patients have both medical and psychological concerns. "The primary conditions the interns see are depression, anxiety, substance abuse and post-traumatic stress," she says. "They [also] address compliance issues with treatment regimens for problems such as diabetes, hypertension and cardiac illness."

What you'll learn

The majority of clinical training occurs within inpatient pediatric and adult medical settings, but opportunities are also available in a variety of outpatient settings within an academic medical center. For example, on the physical medicine and rehabilitation unit, interns learn to conduct cognitive assessments and provide interventions with patients coping with traumatic brain injury, spinal cord injury or other types of physical trauma. On the primary-care consultation liaison service, they also learn to help patients and their families "adapt to illnesses and cope with issues of death and dying," says Cubic. In the outpatient settings, interns learn how to develop treatment plans in such areas as medical treatment compliance, weight management, smoking cessation or mood disorders in collaboration with resident physicians. Participation in clinical research also is encouraged.

A typical week

Interns work three days a week with up to 14 patients a day in their major rotation — family medicine, pediatric behavioral medicine, physical medicine or rehabilitation, to name a few. Interns also help physicians improve their interpersonal skills in the school's simulated patient lab. One day a week, students work on their minor rotation — sleep disorders or neuropsychology, for example. Interns also spend half a day in seminars learning skills in areas such as advanced personality assessment, multicultural psychotherapy and psychopharmacology. Another half-day is spent in a traditional outpatient therapy clinic.

Who they're looking for

The medical school seeks four well-rounded students who are comfortable treating white, African-American and Hispanic patients of all ages. Intern candidates should have experience using empirically based treatments and brief interventions and assessments. "We want them to come in with skills like motivational interviewing, behavioral activation and cognitive restructuring and be able to implement the skills in hospital settings and clinics," says Cubic. Experience working with interdisciplinary teams or within integrated health care models is a plus, she adds.

Rebecca Voelker is a writer in Chicago.