APA is moving towards an Integrated Healthcare focus beginning in 2017. Understanding how to work within a medical setting or learning how to work with physicians is the future of graduate school training and clinical practice. There are many avenues for working as a health psychologist such as providing medical education in the area of psychology to physicians in training, working alongside physicians in a hospital setting, or developing an outpatient health psychology practice like I’ve done, just to name a few. Starting your own health psychology practice may feel daunting but if you are thoughtful and strategic about your academic work and clinical training, it is a very do-able and rewarding career path!
During my graduate training, I completed coursework in Health Psychology and completed a 2,000 hour internship in Pediatric Psychology, spent mostly on the hospital based outpatient pediatric oncology clinic. I also worked on the inpatient neonatal unit with the parents of premature infants. Additionally, I completed evaluations in the multi-handicapped clinic, saw clients in the then newly developed ADHD assessment clinic, and treated individuals in the outpatient mental health clinic who suffered from chronic health issues along with psychosocial overlays. Lastly, I participated in resident and medical school student training to teach residents and students about mental health issues in a primary care setting. These experiences allowed me to develop relationships with primary care physicians, internists, and pediatric specialists in my geographic area. It also provided me with a foundation for working as a health psychologist.
Using that foundation, I co-located my office with a primary care physician (PCP) and have been working as a health psychologist in this setting for over 20 years. But what does it mean to co-locate? In a nutshell, The PCP and I set up a clinic where the whole person can receive help and treatment under one roof. The co-location allows for conversations about cases and allows me to teach her psychology and for her to teach me more about medicine. Together, we address the biopsychosocial needs of mutual clients. However, our practices are not legally entwined. At the start of the practice, I set up my own corporation to ensure the confidentiality of my client’s personal protected health information. Consequently, mutual clients need to sign release of information documents allowing for the two providers to confer. Both practices have standard release of information forms available to clients who see both of us. Not all clients allow me to communicate with their PCP, but most do.
One important bonus of the co-location is that since the beginning of our relationship, my PCP colleague has used screening tools for depression, anxiety, ADHD, and Bipolar Affective Disorder. Doing so has enhanced her awareness of mental health issues and increased the number of appropriate referrals for psychotherapy to me and to other mental health providers. Another benefit of the co-located practice is that as word spread in the community, other PCPs, internists, and specialty physicians (Obstetricians, Pediatricians, Cardiovascular) also began to inquire about our model and my services. Brief, result-oriented presentations were done for these groups focusing on how a health psychologist could augment their services and improve medical outcomes. The result– more referrals.
Typical referrals include persons who are not compliant with their medical regime (inconsistent with taking medications, not following protocol for an illness such as diabetes), people with chronic health diseases such as Multiple Sclerosis, chronic pain, fibromyalgia, and cancer. Frequent goals of treatment are to motivate and educate the client toward better management and self-care of their illness, as well as to help clients with chronic conditions stay in charge of their lives and not be defined by their illness.
When working in primary care medicine, the health psychologist needs a broad understanding of the typical medical referrals that may come his or her way. When I branched out in to pain management and post-cardiac care, I attended seminars and sought out supervision. Working as a health psychologist requires continual learning and updating information in the professional psychology and medical worlds. It also means working to help clients overcome their skepticism and lack of understanding as to why their PCP has sent them to a “head doctor” when clearly they have a medical problem. A psychologist’s basic training in developing rapport, empathizing with the client, and responding in a genuine, warm way, often opens the door for further meetings and a chance to show the clients how a health psychologist can help.
Doug Callan, PhD, MSP faculty member