Hi I'm looking for some input if anyone has experience or opinions about the pros/cons of an integrated primary care psychiatry job. I have the opportunity for a new part time position. This is not a job where I have a psych clinic located in a primary care doctor's office. Instead, the job would be essentially very little patient contact. The majority of the work is reviewing clinical notes and coordinating with social workers and RNs from a primary care clinic. Patients are tracked and monitored on a registry which includes tracking of depression screening scores, along with information about medication duration, dose, and response. The goal of this system is to identify patients with depressive disorders and get them better engaged in care by increasing frequency of appointments, encouraging/facilitating short term psychotherapy, and having psychiatric oversight of medications. The hope is this will be superior to the typical PCP appointment every 3-6 months, with better depression outcomes and hopefully better medical outcomes because the depression is being treated more effectively.
My role as the psych consultant is to coordinate with SW/RN about specific patients they are concerned about, and these would be patients who have not had improvement in depression symptoms despite being on antidepressant medication and being in therapy. The psych consultant would make recommendations about changes to medication dose or changing medications entirely; the recommendations get sent to the PCP who would then implement the changes if they agree. There would likely be hundreds of patients being tracked in each clinic, but I would focus on the fraction of patients who are not improving. My recommendation would go into the medical record, but there would be a caveat that the recommendations are not based on direct patient evaluation. Though, at times it sounds like a 1 time consultation might be appropriate for certain challenging patients. And being available by telephone to the PCP would be expected as well.
Overall it sounds like an interesting job. My main concern is liability because it's a novel treatment model (no patient contact for the most part). But I know Mayo Clinic and some other large academic centers (Univ of Washington) have been doing this for several years and from what I've read there haven't been any liability issues so far.
If anyone works in such a clinic or has thoughts, I'd be very interested in concerns, recommendations, warnings, etc, about what to watch out for and appropriate boundaries to be set for the new position.
My role as the psych consultant is to coordinate with SW/RN about specific patients they are concerned about, and these would be patients who have not had improvement in depression symptoms despite being on antidepressant medication and being in therapy. The psych consultant would make recommendations about changes to medication dose or changing medications entirely; the recommendations get sent to the PCP who would then implement the changes if they agree. There would likely be hundreds of patients being tracked in each clinic, but I would focus on the fraction of patients who are not improving. My recommendation would go into the medical record, but there would be a caveat that the recommendations are not based on direct patient evaluation. Though, at times it sounds like a 1 time consultation might be appropriate for certain challenging patients. And being available by telephone to the PCP would be expected as well.
Overall it sounds like an interesting job. My main concern is liability because it's a novel treatment model (no patient contact for the most part). But I know Mayo Clinic and some other large academic centers (Univ of Washington) have been doing this for several years and from what I've read there haven't been any liability issues so far.
If anyone works in such a clinic or has thoughts, I'd be very interested in concerns, recommendations, warnings, etc, about what to watch out for and appropriate boundaries to be set for the new position.
