Integrating Behavioral Medicine Into Primary Care GME: A Necessary Paradigm For 21st Century Ambulatory Practice

Limited access to child and adolescent, adult, and geriatric psychiatry, as well as other mental health providers, has a large impact on the capacity of our health care system to address mental health needs, particularly in underserved urban and rural areas. A major determinant of this limited access is an under-supply of mental health providers. The recently developed Teaching Health Center Graduate Medical Education (THCGME) program provides a promising resource to address this problem because of its unique educational setting, which could facilitate integration of behavioral medicine into primary care graduate medical education (GME).

In this post we describe the workforce crisis limiting access to mental health providers, and we outline a new primary care GME paradigm addressing this crisis through integration of behavioral medicine into primary care GME. We explain the multiple advantages of this integration and how it could be implemented in conjunction with the recently established THCGME program. We specifically describe how this integration could be accomplished by its inclusion in the three-year THCGME program of the three medical primary care disciplines.

Finally, we describe how the proposed THC “whole person” approach represents a continuation of the curricular emphasis of colleges of osteopathic medicine and makes THCs an ideal GME setting for the high percentage of their graduates who pursue primary care.

Additional innovations that would support this role and which have, to varying extents, been piloted, include: 1) embedded mental health providers (psychologists) who work within the medical home to provide evaluation services, act as a bridge to ongoing care, and provide support for minor-to-moderate problems; 2) strongly-linked home visiting services which extend, enhance, and augment the reach of the anticipatory guidance and other advice provided in the clinic; and 3) consulting psychiatry models, involving psychiatrists who provide expert evaluation, diagnostic clarification, and medication recommendations to be implemented by the primary-care provider.