Want to move into primary care? Think in terms of a flexible schedule for starters, said John C. Linton, PhD, of the West Virginia University School of Medicine, at a session on practicing in primary-care settings at APA’s Annual Convention.
The physicians you collaborate with will page you or hunt you down to pull you in for a consult, even when you’re busy with another client, he said.
“You give up control of your time,” said Linton.
It’s an adjustment some psychologists find difficult, he said, but it is essential to thriving in fast-paced, primary-care settings. Psychologists who want to work in these settings also need to adapt to having less time to bond with clients. “Patients that come to family medicine don’t expect 50 to 60 minutes with their physician; they expect in and out,” he said. “They expect you to do the same thing.”
Psychologists who want to work in primary care also need to put aside their specializations, said Linton. Instead, primary-care psychologists need to be generalists who can move easily from pediatrics to geriatrics and everything in between, and vary their clinical techniques from case to case.
“You may lose some of your autonomy” in such settings, Linton said. “But you have an opportunity to broaden your influence in the health-care system.”
Indeed, working as part of a health-care team brings the opportunity to help a greater number and more diverse mix of clients, since many Americans still go to their primary-care physicians first for anxiety, sleep problems, weight management, depression and other problems psychologists can help with, said panelists at the session. Becoming more integrated into the nation’s health-care system is also part of APA’s strategic plan and important for the field’s long-term survival as the nation moves toward a more integrated system, said Randy Phelps, PhD, APA’s deputy executive director for professional practice.
Other tips for moving your practice into a primary-care setting shared at the session include:
Create a contract between you and the primary-care practice or clinic. Hire a lawyer with health-care experience to help you create a document that protects you and the practice and spells out expectations, said Helen Coons, PhD, of Women’s Mental Health Associates in Philadelphia. Include specifics on what the office space will cost if you’re buying space, what office resources and technology you can use, and a draft schedule of the hours you’ll be on-site. The contract should also address how staff will manage confidential patient records, and such details as whether the receptionist will bring back your clients or call you to come greet them, said Coons.
Be brief and specific. Learn to write short, jargon-free progress notes and to make a treatment recommendation to the physician about a patient rather than simply describing a diagnosis, Linton said. A referring physician will likely want immediate feedback, he added, so don’t take four days to think about your case in detail before reporting back to him or her.
Promote your services. If you want to integrate into a family medicine practice, get your foot in the door by offering to do a free referral for a local physician, said Nancy Ruddy, PhD, of Mountainside Family Practice in Mountain Lakes, N.J. If you’re a prescribing psychologist, talk to physicians about how your expertise could help their patients in ways they may not have thought of, such as working with patients who need help managing their medications, said Elaine LeVine, PhD, an independent practitioner in Las Cruces, N.M.
Request an introduction. Ask the nurse or physician colleague who refers you to a patient to introduce you personally, said Linton. Such introductions lend weight to your expertise in the patient’s eyes, he said.
Respect your co-workers. Be sure to develop strong working relationships with administrative staff. “Physicians value their support staff colleagues’ opinion of the care setting,” Linton said. “If you’re aloof and ignoring or discounting the staff, their informal feedback to the physician could be along the lines of ‘We really don’t like that psychologist, and doubt our patients will either.’”
Respect your physician colleagues’ training as well, he added. If a patient asks you to talk to the physician about a treatment they are unhappy with, it’s unwise to agree to intervene on his or her behalf. “Don’t struggle for control,” he said.
For psychologists like Linton who are willing step out of a traditional practice mindset, working in primary care can be extremely rewarding, said Ruddy.
“I’ve yet to meet anyone who has transferred into this type of work who didn’t just love it,” she said.
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