With a thriving private practice in northern New Jersey, 51-year-old Linda Busch, PhD, wasn't interested in a career change. But while searching for new office space a year ago, she met some local primary-care doctors looking for a psychologist to join their practice. Intrigued by a new challenge, she signed on.
Despite longer days and a "runaway train" of a caseload—she sees some 300 patients semi-regularly—Busch loves the fast pace and steady salary of her new practice, where she collaborates with physicians on the mental health of people with disabilities, chronic pain and serious mental health issues. She says it would have been a tough transition if she had not first taken an online certification course on primary care designed especially for behavioral health practitioners.
"There's a whole host of medical conditions that you have to become familiar with," Busch says. The course helped her learn about how certain illnesses and medications affect mental health and the best ways to talk with physicians about these issues.
Like Busch, most psychologists looking for a midcareer transition to primary care will need additional training, says Mark Vogel, PhD, program director of the primary-care health psychology fellowship program at Genesys Regional Medical Center, adding, "It takes a lot of expertise."
New setting, new skills
Perhaps most challenging is acquiring the skills to work on a team with doctors, nurses and other health-care providers.
"It's learning how to function as a truly integrated clinician and not just as the mental health provider down the hall," says Jennifer Ferrand, PsyD, who works for Hartford Hospital, a health-care system in Connecticut.
Though Ferrand studied health psychology during her internship and fellowship, an online course at the University of Massachusetts Medical School (UMMS) helped her become more efficient when she started working in the setting. "I learned about the philosophy of integrated primary care and how to function as a member of a collaborative team," she says.
Another skill gap may be providing therapy on a tight turnaround. "If a doctor gives you a warm handoff of a person who's just been diagnosed with insomnia, can you simply teach them to put themselves to sleep within a half hour?" asks Alexander Blount, EdD, professor at Antioch University, who developed the UMMS course.
Providing primary-care services also involves such nuts-and-bolts issues as getting credentials from managed-care organizations and learning how to complete electronic health records (EHR), including diagnosis codes and confidentiality regulations, which are different than for a solo psychology practice. "With an EHR, half of learning is how to use it and the second is knowing the important pieces to put into notes for primary physicians," Vogel says.
Virtual ed
There are ways for psychologists to learn these skills without going back to graduate school, though most are through distance-learning courses. UMMS's Primary Care Behavioral Health course, for example, is a self-paced series of lectures and tests on such topics as medical care of chronic pain, psychotropic medications, and working with children and the elderly. The University of Michigan's School of Social Work also offers a 40-hour certificate program of webinars and podcasts. It delves into such topics as the medical aspects of behavioral health, how to do assessments in integrated care and how patient-centered medical homes work.
In August, the National Register of Health Service Psychologists launched a free CE video training series for its members and affiliated doctoral students that includes lectures from primary-care experts. The talks cover such concepts in integrated health care as the "triple aim" of improving patient experience, improving population outcomes and reducing costs; how common conditions are treated in primary care; and how to collaborate with other team members.
For other free webcasts, check out the offerings from the APA Online Academy. They cover primary-care competencies, an overview of how to do assessments and the biopsychosocial foundations of behavioral health.
For those who want in-person training, Cherokee Health Systems, an integrated community health center in Knoxville, Tennessee, offers the two-day Behavioral Health Consultant Academy for professionals looking to move into primary care. It provides didactic training on job roles, skills and competencies, and offers opportunities for role-playing and feedback. Another two-day training at Cherokee, the Primary Behavioral Health Integrated Care Training Academy, gives an overview of the model's administrative, operational and financial infrastructure.
Another option is to evolve your integrated-care practice over time, says Nancy Ruddy, PhD, vice president of patient engagement at McCann Health in Parsippany, New Jersey. Many practitioners develop relationships with primary-care providers by working collaboratively. For example, you can start by talking more with the medical providers of current patients. Psychologists who routinely obtain a release of information from patients' physicians often discover a number of shared patients. That makes it easier to send a brief note or call to suggest a more extended conversation, something like "Hey, we share a bunch of patients and it would be helpful to talk about a referral relationship. How about if we get together?" Ruddy says.
Ruddy also encourages psychologists who are interested in primary care to seek a mentor in addition to training. One way to do that is through the APA Div. 38 (Society for Health Psychology) Health Psych Connections program, which connects members with integrated-care practitioners.
Psychologists can also look for local medical residencies in family medicine and pediatrics, which often have faculty who specialize in behavioral health, Ruddy says. Connecting with such residencies can help psychologists learn about the ways they will need to change their practice patterns to succeed in primary care.
It's also important to stay on top of research in areas you're likely to encounter in primary care, especially issues that have strong ties to mental health, such as pain, insomnia and cancer. Busch says she reads medical journals to "learn to speak a doctor's language. You're in somebody else's neighborhood now. You're in the medical model."
