Post-Licensure: What first

[bmedclinic]

So, as I've stated in one EPPP thread and alluded to in others, I've passed my EPPP and should be licensed any day now. Long term career goal is health psych related; maybe primary care as a BHC. Currently have a pretty decent job in a state hospital. I want to get from here to there in the next few years, and I'm looking for the "best way" to do things. CAQH? ABPP (clinical health psych) in the near future sounds fun, but my current work environment doesn't really qualify- I probably need to be spending more time in a medical hospital or primary care for that to qualify, I'd think.

FWIW My boss is cool with me eventually going to 4 x 10's to work a day in primary care. I've done primary care before, and I enjoy it. And no: I have no interest in the VA system at all, not in the slightest. To be quite frank, I'm not really a "big system" kind of person- I'd work for a smaller healthcare system, but only to facilitate me eventually working for myself unless I was given the autonomy I desire.

So, is the next step to be "credentialed" by some insurance company after getting licensed? I was recently offered to work for a group practice, but they seemed like only an "ok" deal, not a great business model and I dont want to jump into bed with a practice so soon.

---

Members don't see this ad.

 

[PsyDr]

Get on as many insurance panels as you can. Start learning how billing works. Call up a local hospital and ask about getting credentialed. Start networking. Prove you provide a value added service.

That should take a few years.

 

[bmedclinic]

Get on as many insurance panels as you can. Start learning how billing works. Call up a local hospital and ask about getting credentialed. Start networking. Prove you provide a value added service.

That should take a few years.

How do I go about getting on insurance panels? Good one to start with? Cost?

 

[erg923]

To be quite frank, I'm not really a "big system" kind of person- I'd work for a smaller healthcare system, but only to facilitate me eventually working for myself unless I was given the autonomy I desire.

I dont think think doing primary care psych as sole practitioner is: 1. very doable early on. 2. a good investment in the long term, as the pattern over the past decade has been in bringing more and more services "in-house" vs contracting out. ACOs, etc.

 

[erg923]

How do I go about getting on insurance panels? Good one to start with? Cost?

Start with the bigboys. Anthem, Optum, Beacon, etc. Valueoptions and Beacon just merged, by the way. Then your states medicare/medicaid vendor. Usually credentialing info is on their website.

 

[bmedclinic]

Start with the bigboys. Anthem, Optum, Beacon, etc. Valueoptions and Beacon just merged, by the way. Then your states medicare/medicaid vendor. Usually credentialing info is on their website.

Thanks, Erg re: big boys.

 

[deleted343839]

Long term career goal is health psych related; maybe primary care as a BHC. Currently have a pretty decent job in a state hospital. I want to get from here to there in the next few years, and I'm looking for the "best way" to do things. CAQH? ABPP (clinical health psych) in the near future sounds fun, but my current work environment doesn't really qualify- I probably need to be spending more time in a medical hospital or primary care for that to qualify, I'd think.

ABPP is a respected credential but I'd wait a few years to see where you end up before deciding which certification to pursue. For the ABPP in clinical health, you need to have several years of relevant experience if you didn't complete formal training in health psychology. In meantime you might consider joining Society of Behavioral Medicine and/or APA Division 38 (you don't have to belong to APA at large). If you're not geographically bound these groups are good resources for job leads.

Primary care psychology is tricky to enter without any prior training or mentoring because it's such a different model of practice than how most of us are trained. The field is getting a little more organized with a growing number of formal postdocs in primary care psychology and related areas. There are still plenty of opportunities, but I think over time the qualifications for these positions will become more specific.

 

[erg923]

ABPP is a respected credential but I'd wait a few years to see where you end up before deciding which certification to pursue. For the ABPP in clinical health, you need to have several years of relevant experience if you didn't complete formal training in health psychology. In meantime you might consider joining Society of Behavioral Medicine and/or APA Division 38 (you don't have to belong to APA at large). If you're not geographically bound these groups are good resources for job leads.

Primary care psychology is tricky to enter without any prior training or mentoring because it's such a different model of practice than how most of us are trained. The field is getting a little more organized with a growing number of formal postdocs in primary care psychology and related areas. There are still plenty of opportunities, but I think over time the qualifications for these positions will become more specific.

I would be less concerned about that, although its a good point, and more concerned about not not being "a big systems kind of person." While nobody likes organizational dysfunction, working within systems (usually fairly sizable ones) is actually part of the job when attempting to maintain true integration of primary care and mental health services. The "autonomy" of the typical PP psychologist is not applicable here because that is based on a consultation service model, which is the exact opposite model of practice used by primary care psychologists.

The conduction of primary care mental health services is also made markedly easier when one has many options (preferably "in-house") for ancillary or more specialized or intensive mental health services. There is no shortage of serious psychopathology and dysfunction coming through a typical primary care office, and practitioners who are essentially in private practice will need to be very well connected to other providers in their community in order to offer adequate service referrals. You will certainly not be able to treat or address everything that comes through your door.

 

[deleted343839]

I would be less concerned about that, although its a good point, and more concerned about not not being "a big systems kind of person." While nobody likes organizational dysfunction, working within systems (usually fairly sizable ones) is actually part of the job when attempting to maintain true integration of primary care and mental health services. The "autonomy" of the typical PP psychologist is not applicable here because that is based on a consultation/liaison service model, which is the exact opposite model of practice used by primary care psychologists.

Great point. I overlooked the OP's mention about autonomy. Definitely not part of the formula for a BHC in primary care!

 

[Ollie123]

Truthfully, I'm a little uncertain what "primary care" outside a larger setting would even look like. Is the idea to be in PP with a physician (or small group) somewhere? I'm not sure such positions are economically viable at present - seems like it would be a difficult thing to pull off. I won't claim to know what things will look like 10 years down the road, but I know medical groups also seem to be consolidating right now so if anything it seems like it will be more difficult to be outside the system while working in that setting moving forward. There may certainly be more creative/consultation type roles that touch on primary care that emerge, but I don't see integration of direct service provision by psychologists into the corner doctor's office happening anytime soon.

Wish I could offer specific advice, but I'm curious if the OP could clarify a bit more what they are hoping to do. This is a bit removed from where I am going, but tangentially related and I'm interested to hear what others are thinking about...

 

[erg923]

Truthfully, I'm a little uncertain what "primary care" outside a larger setting would even look like. Is the idea to be in PP with a physician (or small group) somewhere?

I dont know. Practices that small have no need for integrated primary care mental services of course, because...whats the point? From their perspective. The consultation model (refer out to well established community practitioner) often serves them just fine. Part of the challenge of primary care psych practice is that, frankly, the older model is so entrenched, most primary care physician care little about MH and have even less desire to help coordinate its treatment with you.

Is the idea to be in PP with a physician (or small group) somewhere? I'm not sure such positions are economically viable at present.

There are people doing this in a PP, fee for service type model, but they are embedded within larger health systems, not some small 2 doc practice. The people who are able to make this economically viable for both themselves and the practice aren't newbies, either. The one person I've know personally who does this for a large healthcare system in CO, is well published, well known, and nearing retirement actually.

 

[Ollie123]

There are people doing this in a PP, fee for service type model, but they are embedded within larger health systems, not some small 2 doc practice. The people who are able to make this economically viable for both themselves and the practice aren't newbies, either. The one person I've know personally who does this for a large healthcare system in CO, is well published, well known, and nearing retirement actually.

See - that's the model I'm more familiar with and how I'm used to seeing it. Makes perfect sense to me that a large hospital/major clinic with a couple dozen docs and various other in-house services would benefit tremendously from a psychologist to provide consultation, brief behavioral interventions and help with MH triage. Seems completely workable. Just from a purely numbers perspective, I'm trying to figure out how it would work within a smaller system with fewer providers - the number of patients the PC provider would see sets the limit on the number the psychologist could possibly see. While most individuals with MH concerns will go to a primary care office at some point (why its critical for us to be integrated), that doesn't mean most of the patient load will also have significant MH concerns. Coupled with relatively low reimbursement and a smaller patient base than you would get in a larger hospital with a big clinic (as well as the issues that you mentioned - decrease opportunities for "warm handoffs", etc.), I'm just not sure how it could be a viable primary income source. Happy to be proven wrong...just confused how that would work.

 

[erg923]

See - that's the model I'm more familiar with and how I'm used to seeing it. Makes perfect sense to me that a large hospital/major clinic with a couple dozen docs and various other in-house services would benefit tremendously from a psychologist to provide consultation, brief behavioral interventions and help with MH triage. Seems completely workable. Just from a purely numbers perspective, I'm trying to figure out how it would work within a smaller system with fewer providers - the number of patients the PC provider would see sets the limit on the number the psychologist could possibly see. While most individuals with MH concerns will go to a primary care office at some point (why its critical for us to be integrated), that doesn't mean most of the patient load will also have significant MH concerns. Coupled with relatively low reimbursement and a smaller patient base than you would get in a larger hospital with a big clinic (as well as the issues that you mentioned - decrease opportunities for "warm handoffs", etc.), I'm just not sure how it could be a viable primary income source. Happy to be proven wrong...just confused how that would work.

In true primary care psych, there should be also be a large focus on drumming up business for health coaching and more nontraditional services such as treatment of chronic pain from psych perspective, smoking cessation, lifestyle managements issue such as diabetes adherence/edu, "coping" with chronic disease, etc. I recently did a desensitization protocol for a perfectly psychologically healthy dude with a raging case of insulin dependent DM and a profound needle phobia.

You are essentially correct though, there is no financial benefit to the practice offering this if its just a small doc owned practice with a handful of physicians. H&B codes dont pay much more than the more traditional psychotherapy CPTs by most insurers anyway.

 

[bmedclinic]

Guys,
I'm sorry if I wasnt clear. I have quite a bit of experience in primary care, and in varieties of primary care (pediatrics, family medicine) and even in sleep medicine, though that's not primary care. That's not the issue. I am even well versed on the different models of doing it. The issue for me was now that I'm done, how to best eventually move from where I am to where I want to be. Also I didnt clarify my role in the system- I was thinking more of working for a healthcare system in one of their offices, potentially as a contract employee either part time or full time (though my own LLC), not being a W-2 employee of said company. That's all trivial to some extent, my original question was what to do first. Perhaps I should have explained I have the required experience and skill to do what I'm talking about doing, but I figured that was kind of a given.

I do appreciate the help and feedback however.

 

[bmedclinic]

The one person I've know personally who does this for a large healthcare system in CO, is well published, well known, and nearing retirement actually.

FWIW There are plenty of people that do this in a variety of ways and make it economically viable for themselves and for the physicians they work for.

 

[erg923]

FWIW There are plenty of people that do this in a variety of ways and make it economically viable for themselves and for the physicians they work for.

This is growing area. I am not disputing that. What I am disputing is that this is service model that is still largely confined to larger health systems, which you seem to strangely against for someone interested in integrating two largely disparate health services.

 

[AcronymAllergy]

My generic response might be--networking? Heck, even cold-calling/cold-emailing local hospitals (who don't have a PCMHI team/provider) to let them briefly know what you do and how you could be of service to them might help...? It's very possible that there are still plenty of systems out there (particularly that are more moderate rather than large in size, are more rural, etc.) that have only a vague understanding of/exposure to the concept of primary care mental health integration.

I'd imagine this might be where ABPP could be particularly useful. Even if you're talking with docs/administrators who've had limited experience with PCHMI, most all of them will appreciate the concept of boarding.

I have no direct experience in that area, though, so I unfortunately can't offer more specific suggestions.

 

[deleted343839]

Guys,
The issue for me was now that I'm done, how to best eventually move from where I am to where I want to be. Also I didnt clarify my role in the system- I was thinking more of working for a healthcare system in one of their offices, potentially as a contract employee either part time or full time (though my own LLC), not being a W-2 employee of said company. That's all trivial to some extent, my original question was what to do first.

My impression has been that private health systems tend to favor hiring salaried employees for integrated behavioral health roles. Embedding an independent psychology practice within a private healthcare organization strikes me as an unusual arrangement. But I'm going to work on the assumption that people have been able to pull this off, as you've suggested.

Regardless of how much experience you might have gotten in your training, physicians and administrators are still going to see you as "green." You need a strong reputation and a track record of successful collaboration with PCPs as an independent clinician. It sounds like you're trying to establish that by working a day a week in primary care. Also, keep track of your clinical outcomes using endpoints that are familiar and relevant to healthcare administrators. You may not need data to land a salaried job, but to land a contract or service agreement it could come in handy. Beyond that, you will eventually need some sort of business plan to define exactly what you're selling, how it meets the organization's needs, and how you will evaluate your performance and evolve over time.

The best sources of information are the people who are actually running the kind of practice you'd like to have. You seem to be aware of this group of people, so find them and network like there's no tomorrow. Listen to their stories.

 

[smalltownpsych]

I am thinking that a good next step could be to get a job working for a hospital. The position that I have now would lend itself to experience as a health psychologist if that was what I wanted. I just turned down the opportunity to be the go-to psychologist for the pain clinic as I am more interested long-term in owning a residential treatment center for either the generic anxious and depressed adolescents or perhaps more specifically even sexual abuse survivors. Nevertheless, I can work with primary care as much as I would like and I field a variety of consults from the medical staff.

 

[Goobernut]

1. Bdmedclinic -- can I ask what area of the country you are in? You don't have to give me specifics. I'm asking because I'm a mid-level mental health provider in primary care and the areas that I'm familiar with are not hiring psychologists (or contracting for them) for primary care work, but instead are hiring mid-levels. Please don't flame me, I'm sure this could just a regional difference. It is also a speciality difference, as I sometimes see psychologists doing primary care work but for pediatric care, rather than adult primary care.

2. I personally have not seen a true medical private practice contract a psychologist for their services, so I have no idea where to direct you. But, my best guess would be that if you are wanting to serve as a contractor, you are going to need to set yourself up as a private practice clinician to start. So perhaps talking to PP psychologists in your area and asking them which panels are the best to start with in your state. Other than you'd probably have an easier time of the whole thing if you got hired on by a group, but you stated you weren't looking for that haha.

 

[smalltownpsych]

So, as I've stated in one EPPP thread and alluded to in others, I've passed my EPPP and should be licensed any day now. Long term career goal is health psych related; maybe primary care as a BHC. Currently have a pretty decent job in a state hospital. I want to get from here to there in the next few years, and I'm looking for the "best way" to do things. CAQH? ABPP (clinical health psych) in the near future sounds fun, but my current work environment doesn't really qualify- I probably need to be spending more time in a medical hospital or primary care for that to qualify, I'd think.

FWIW My boss is cool with me eventually going to 4 x 10's to work a day in primary care. I've done primary care before, and I enjoy it. And no: I have no interest in the VA system at all, not in the slightest. To be quite frank, I'm not really a "big system" kind of person- I'd work for a smaller healthcare system, but only to facilitate me eventually working for myself unless I was given the autonomy I desire.

So, is the next step to be "credentialed" by some insurance company after getting licensed? I was recently offered to work for a group practice, but they seemed like only an "ok" deal, not a great business model and I don't want to jump into bed with a practice so soon.

Who is the biggest insurer in your area? Which physicians are on that insurance? Take some of those physicians to lunch to talk about what they could use from a psychologist. Find out what the health psychology needs are in your community and then come up with a plan to meet those needs.

 

[AcronymAllergy]

1. Bdmedclinic -- can I ask what area of the country you are in? You don't have to give me specifics. I'm asking because I'm a mid-level mental health provider in primary care and the areas that I'm familiar with are not hiring psychologists (or contracting for them) for primary care work, but instead are hiring mid-levels. Please don't flame me, I'm sure this could just a regional difference. It is also a speciality difference, as I sometimes see psychologists doing primary care work but for pediatric care, rather than adult primary care.

2. I personally have not seen a true medical private practice contract a psychologist for their services, so I have no idea where to direct you. But, my best guess would be that if you are wanting to serve as a contractor, you are going to need to set yourself up as a private practice clinician to start. So perhaps talking to PP psychologists in your area and asking them which panels are the best to start with in your state. Other than you'd probably have an easier time of the whole thing if you got hired on by a group, but you stated you weren't looking for that haha.

This is strictly within the VA, but here (at least in the hospitals in which I've worked), it's largely psychologists who fill PCHMI roles (along with psychiatrists or NPs as the assigned prescribing providers). Social workers are also embedded in primary care, but largely in roles that support primary care physicians re: resource location and related functions (e.g., homelessness, low-cost medical supplies, completion of durable power of attorney/living will documents, etc.), completion of psychosocial evaluations, and occasionally follow-up therapy (although to my knowledge, all patients are first seen by a psychologist and/or psychiatrist).

I'd imagine it varies heavily from hospital to hospital, though.

 

[erg923]

1. Bdmedclinic -- can I ask what area of the country you are in? You don't have to give me specifics. I'm asking because I'm a mid-level mental health provider in primary care and the areas that I'm familiar with are not hiring psychologists (or contracting for them) for primary care work, but instead are hiring mid-levels. Please don't flame me, I'm sure this could just a regional difference. It is also a speciality difference, as I sometimes see psychologists doing primary care work but for pediatric care, rather than adult primary care.

2. I personally have not seen a true medical private practice contract a psychologist for their services, so I have no idea where to direct you. But, my best guess would be that if you are wanting to serve as a contractor, you are going to need to set yourself up as a private practice clinician to start. So perhaps talking to PP psychologists in your area and asking them which panels are the best to start with in your state. Other than you'd probably have an easier time of the whole thing if you got hired on by a group, but you stated you weren't looking for that haha.

If the job description is simply triage and brief therapy, there is probably little incentive to pay a Ph.D level wage when you can get the same services and pay masters level wages. Although I would argue that, on average, we are much better trained in the evidence based treatment that primary psych necessitates. But with a lack of much difference in outcome between the two, Docs and HR specialists are not likley to take that into much consideration when hiring or writing hiring annoucements.

My job in PCMHI at the VA is much more than what I stated above, which I why I think the VA sticks with psychologists for primary care psych rather than mid-levels. I dont think thats the case in many places that are researching bringing on primary care mental health practitioners though.

Psychology really is threatened by midlevel takeover, I would argue. And it is also why I support the developing vision of how APS and clinical science programs see/conceptualize psychologists. It is also why I have contemplated getting out of traditional clinical service all together.

 

[deleted343839]

If the job description is simply triage and brief therapy, there is probably little incentive to pay a Ph.D level wage when you can get the same services and pay masters level wages.

This. Find a job ad for a primary care BHC outside VA/DoD. Most of these positions are open to master's level clinicians.

 

[Goobernut]

I have a few more questions and comments about BHCs in Primary Care, but I don't want to derail this thread anymore than I already did. I'll just start another thread for those questions. Sorry Bmedclinic. My advice to research the main players in your state still stands, as the insurance panels vary by region. Also you mentioned the clinic that would contract you, I suggest talking to the folks who credential for that clinic and find out what commercial providers are key for them. Worst case scenario you could contact that insurance company directly and ask how you would go about becoming a provider -- they can direct you to the panels necessary. Most likely. I could give you advice on who to contact in my state, but more than likely it will not be helpful for you as everything is regional Also medicaid is (obviously) a state thing, and I'd have no idea who to contact in your state.

 

[bmedclinic]

Goobernut,
No flame from me. Also, feel free to PM if you dont want to derail. That said, as far as I'm concerned, I've gotten what I need from this thread so I dont care at this point if it gets derailed.

I was already approached by a pp, and I'm holding off on that because there's not too much incentive that I see (long term) to quickly jump into practice with them. Shorter drive, flexible hrs, Also, I'm somewhat uncomfortable with their business model as it seems less efficient than I'd prefer- hence my looking into going at it on my own. I have checked with those who have been successful going at it on their own, and their general consensus was that it may be a step back for me to work for that pp as a contractor in primary care as opposed to getting myself paneled and doing it on my own. However, there's still a lot of unknowns and I dont want to lean too heavily on those who have been willing to help me so far and require excessive amounts of time on their part which is why I actually thought I could get advice from this board. Because of this thread though, I am now planning to get credentialed asap. So I greatly appreciate that advice. FWIW I'm located on the east coast currently. "Mid-Atlantic".

Who is the biggest insurer in your area? Which physicians are on that insurance? Take some of those physicians to lunch to talk about what they could use from a psychologist. Find out what the health psychology needs are in your community and then come up with a plan to meet those needs.

Smalltown, very much considering doing this. I have a practice in mind (that's part of a larger health system) and I've been toying with the idea recently of taking them to lunch, and having such a conversation.

 

[Goobernut]

Oh since you don't care if it's derailed, I have several comments/questions on behavioral health in the primary care setting. I was too lazy to make my own thread...

Erg, could you expound on the following?

Although I would argue that, on average, we are much better trained in the evidence based treatment that primary psych necessitates.

I know you aren't saying that mid-levels aren't trained in evidence based practices, but it still kinda makes me feel like I need to come to the defense of my profession I will always recognize and admit that a PhD has that additional skill level, that I will never have, unless I get a PhD. But to clarify, we at the mid-level are trained in evidence based therapies (i.e. CBT) and skills (i.e. MI) that are useful in the primary care environment. Just in case some of the readers are confused by erg's above statement haha.

I also think how psychologists vs mid-levels are used in the VA vary by team and VA. I have been avoiding the VA personally because I've heard people other than erg describe the teams in just the way he did. I really don't want to get relegated to case management work. But despite what I've heard, I recently found a job opening on usajobs.gov that asked for a "licensed clinical social worker OR psychologist" to fill the "integrated behavioral clinician" role on a PACT.

As a mid-level provider in the primary care setting, I would looooove to have a psychologist in the clinic for assessments and for clients that I feel would benefit from just that next level of care. But hey, I'm all about inclusion Some of us mid-levels just want to do our mid-level job and do it well. That does mean having a place, rather than "PhD for all clients all the time in all instances" which sometimes seems to be the standard answer on these boards. Unless someone with poor writing skills post, then many posters (except maybe smalltown who has made a concerted effort to continue recruiting for psych are all about referring to a mid-level program haha.

Despite the fact that my state prefers mid-levels in primary care, I'm not going to get to work in the primary care setting again until I'm licensed. Fun times. I'm being advised to go spend two years in a CMHC and then come back to primary care when I can bill. That's the world of primary care for you though. They want people who can bill for their services and add income to the clinic.

 

[smalltownpsych]

Oh since you don't care if it's derailed, I have several comments/questions on behavioral health in the primary care setting. I was too lazy to make my own thread...

Erg, could you expound on the following?



I know you aren't saying that mid-levels aren't trained in evidence based practices, but it still kinda makes me feel like I need to come to the defense of my profession I will always recognize and admit that a PhD has that additional skill level, that I will never have, unless I get a PhD. But to clarify, we at the mid-level are trained in evidence based therapies (i.e. CBT) and skills (i.e. MI) that are useful in the primary care environment. Just in case some of the readers are confused by erg's above statement haha.

I also think how psychologists vs mid-levels are used in the VA vary by team and VA. I have been avoiding the VA personally because I've heard people other than erg describe the teams in just the way he did. I really don't want to get relegated to case management work. But despite what I've heard, I recently found a job opening on usajobs.gov that asked for a "licensed clinical social worker OR psychologist" to fill the "integrated behavioral clinician" role on a PACT.

As a mid-level provider in the primary care setting, I would looooove to have a psychologist in the clinic for assessments and for clients that I feel would benefit from just that next level of care. But hey, I'm all about inclusion Some of us mid-levels just want to do our mid-level job and do it well. That does mean having a place, rather than "PhD for all clients all the time in all instances" which sometimes seems to be the standard answer on these boards. Unless someone with poor writing skills post, then many posters (except maybe smalltown who has made a concerted effort to continue recruiting for psych are all about referring to a mid-level program haha.

Despite the fact that my state prefers mid-levels in primary care, I'm not going to get to work in the primary care setting again until I'm licensed. Fun times. I'm being advised to go spend two years in a CMHC and then come back to primary care when I can bill. That's the world of primary care for you though. They want people who can bill for their services and add income to the clinic.

Hey, I doesn't wanted to recruit posters with pore writing skills. Just those who say, "I hate researches but want to be therapits."