Career Development for Integrated Primary Care: An Early-Career Psychologists’ Perspective

Cerissa L. Blaney, PhD, University of Central Florida

Any Society of Behavioral Medicine (SBM) member who seeks to understand how to develop a strong professional identity in the health service sector and deliver behavioral medicine interventions in clinical settings, needs to read this personal journey of an early career psychologist. Given SBM’s focus on “translating science to policy and practice,” this brief summary of one professional’s experiences provides great support for the work we need to do more of.

Ten months ago, I started my first job as an academic psychologist within a patient centered medical home (PCMH). I am the first and only psychologist at the University of Central Florida to be financially supported by the Department of Psychology but function primarily in the College of Medicine’s physician practice. In this joint appointment, I am charged with developing integrated care services, for primary and specialty care, and preparing the next generation of psychologists for the unique and diverse roles within integrated primary care (IPC). 

The expectations from the College of Medicine and the Psychology Department are not always compatible. In the PCMH, I am director of Behavioral Health Services and I primarily provide direct patient care; in psychology, I train eight onsite graduate students. In one brief year, I have learned that assertiveness, flexibility, and patience are essential for success as an IPC provider. 

I was fortunate as a graduate student at the University of Rhode Island, and as an intern and post-doctoral fellow at Brown University, to have trained in well-developed integrated settings, including primary care. Often, IPC training opportunities are centered on providing direct care as part of an interdisciplinary team. However, many trainings are limited in other important skills in this field: developing competence in program development, billing in IPC, electronic health record (EHR) development and regulations, provider engagement, funding streams, systemic challenges, training development (provider and students), and quality improvement.

Although I built appropriate confidence during my internship and post-doctoral training, I soon experienced the return of self-doubt and the dreaded “imposter syndrome”. Regardless, I pushed forward to take the necessary steps to establish joint appointments, memoranda of understandings, HIPAA compliance procedures for integrating into an EHR and documentation of behavioral services, training guidelines, service setup, intercollegiate expectations, and dozens of workflow processes. 

Throughout this process I learned that – even given strong training -- early career success in IPC requires two more factors:  (1) tolerance of uncertainty, and (2) perseverance. While establishing myself as a new leader in an organization, I have learned how important it is to be comfortable functioning and making decisions within the context of ambiguity.  I also learned how to persevere without on-site mentorship or colleagues of similar background. However, feedback from trainees, clients, colleagues and clinical teams fueled my motivation for continued growth as an individual professional and development as a clinical service.

As often recommended by leaders in IPC, having a physician champion who is invested in the integrated behavioral health service is crucial to our growth and development. Specifically, having my medical director’s consistent support and encouragement has been an indispensable factor in establishing my role and maintaining appropriate expectations for programs. In discussing physician perceptions and experiences with our services, Maria Cannarozzi, MD, medical director, stated that, “Our physicians have learned so much regarding how to care for patients' behavioral needs. We have learned how effective brief interventions can be and how wide the scope of intervention can be. Prior to having onsite [behavioral health] BH services, we would refer patients for psychology/psychiatry services with no knowledge of the type of care they were receiving, how we could effectively partner with them during treatment, even if indeed they were pursuing the care we recommended!  Now we are co-managing illness and wellness together, while learning from one another during each shared patient encounter.  It’s been fun to be a part of the IPC program development and see the positive effects for our patients and staff."

Even with this support, it continues to be challenging to juggle advocacy roles across various teams and departments. I often need to clarify the complex role of behavioral health services in IPC settings.  A few IPC-naive colleagues have a difficult time fully understanding my IPC role and its accompanying responsibilities. Many presume that behavioral health services are simply a physically relocated form of the traditional mental health paradigm. Further, medical providers and their teams may also share this misunderstanding, and dated models of training are likely to contribute to this type of thinking.  Changing professionals’ beliefs and expectations while simultaneously developing services and training experiences for the next generation of IPC psychologists has been quite a unique learning experience.

Finally, I must emphasize that early career mentorship is invaluable for support and continued training within the rapidly evolving field of IPC. I have benefitted immensely from the support of great IPC mentors across a wide variety of organizations. Specifically, I would like to thank Justin Nash, PhD; Susan McDaniel, PhD; Jared Skillings, PhD; Cheryl Brosig Soto, PhD; James Anderson, PhD; Christine Runyan, PhD; and Barbara Cubic, PhD. along with their mentoring organizations: APA, Collaborative Family Healthcare Association, Association of Psychologists in Academic Health Centers, Council of Clinical Health Psychology Training Programs, SBM, and the Society for Health Psychology.

I hope that the IPC field continues to expand its embedded training opportunities for the continued development of early career and future psychologists. Specifically, we should focus on broad training for our various functional roles in these positions and mastery of IPC program development and management within organizations that have yet to experience the benefits of a behavioral health team.