Mental Health Counseling is one of the most important, yet possibly one of the most underutilized, resources in primary care patient treatment. As a 15+ year experienced primary care Physician Assistant (PA) for a very busy family practice in Clearwater, Florida, I can see where the irreplaceable benefits exist in this valuable resource.
I treat a wide variety of patients of all ages. Most with a number of complicated disease states, such as hypertension, diabetes, heart disease, chronic pain syndrome, and morbid obesity. A great majority of these comorbid patients are also stricken with serious mental health conditions. Especially variations of Major Depression, Anxiety, OCD, ADHD, and PTSD. Those of us in primary care spend a lot of time managing very complicated comorbid disease states. However, what I always tend to continually remind myself, treating such patients, is that their physical ailments cannot be managed properly if their mental ailments are not. I place a lot of effort in educating these patients as to the importance of the management of their mental health. And, why it must be taken as seriously as every other disease state they harbor. Without the mind, there cannot be a body.
Referring Patients The Right Way
Since I do refer a lot of my patients to mental health counselors and psychologists, I am well aware of how important it is to get it right the first time. Often times, if a patient has an unfavorable experience with a mental health counselor, they are far more resistant to being referred to another one for fear that every experience will end the same for them. This is precisely why I am very selective as to who I tend to refer my patients to. While many primary care doctors and PAs are advised to direct the patients to call the number on the back of their insurance card to get a list of who they may see, I do not like that impersonal approach.
For one, the patients are less likely to take that kind of initiative in the first place. It tends to feel like a lot of work for them to call a 1-800 number, obtain a list of nearby providers, and then begin calling random numbers hoping to get an appointment. Secondly, my patients trust me as a provider to lead them in the right direction. I build a trusting relationship with them, over time, and they look to me to guide them in every aspect of their care. I would much rather give them a name that I have had positive feedback about, or someone who I know or have met personally. My patients are far more likely to follow through on such a referral if I can recommend the right counsellor for them.
How To Find Counsellors To Refer To
The counsellors I tend to prefer referring to are those who make a positive connection with a majority of their patients. As a provider, you can’t just know this right out of the box. It takes networking and word of mouth, largely from patients who have seen these providers firsthand.
When a patient has a really positive experience with a counsellor and they tell me, I ask them if they can get the counsellor to send me some of their business cards. Often times, the patients will bring the business cards to me themselves in their subsequent appointments to see me. Currently in my practice, I have two to three counsellors who I strongly prefer. This is based on their interactions with different patients of mine over the years. They often send me thank you cards for all the referrals, which I feel is a nice touch on their part.
Insurance companies have made the process a bit more complicated. This by not being accessible enough to primary care offices to permit our referral coordinators an easy way to assist the patients in finding out if our preferred counsellors are on their network lists. This is why it is good to have at least three preferred counsellors with diverse insurance plan participation.
Three Tips To Get Doctor Referrals
While I certainly may have my favorites in my region, this doesn’t mean I am not open to having more to choose from for my patients. I’m sure there are many other very capable and fantastic mental health counselors out there. Including new ones who are just waiting for the opportunity to prove how excellent they are. New counselors can get more referrals from primary care physicians and PAs like myself by going out into the community and asking to meet the physicians, PAs, and NPs at various offices. Those of us in our line of work are often busy and are less likely to have time to chit chat for several minutes. So, here is a good approach that I feel is almost always going to be a successful one if you are a new counselor coming to introduce yourself to a primary care office:
- Be super polite to the front office receptionists. These folks are the gate keepers of the office and protect their primary care providers seemingly with their lives. We always hope our receptionists are polite. But, sometimes they get fatigued from the never ending flow of incoming pharma reps and product peddlers. And, they may give you a look of exhaustion and exasperation when they see you at the window. Be patient and be friendly. They will respond better to that.
- Make sure you use the words “brief” and “real quick”. This can get you access much easier in our world. Example: “I just wanted to real quick introduce myself as a new counselor in the area. Here are my cards. Can I just briefly say hi to one of your providers, I promise I will just say hello and that’s it”. If you are lucky, the provider might strike up a convo. Or, they may even ask you to come back to chat in his/her office. Or maybe they really will be brief and take your cards and run. But, allowing them to place a name with a face is more invaluable than you realize.
- Don’t be too persistent. Repeated visits to the same office may begin to antagonize staff and will work against your goals. A good idea, rather than revisiting the office, would be to send the doctor or PA a postcard. Include a couple more cards and a brief note to the tune of “Thank you for giving me the chance to meet you the other day. I really hope you can give me an opportunity to help some of your patients in the near future”.
These pointers seem too simple perhaps. But, you would be surprised at how rarely they are used, at least in my region. In my nearly 16 years of family practice, my office has only been visited twice by mental health counsellors to introduce themselves. TWICE. And both of them ended up getting some referrals from me. Know your community and know the providers. And, don’t forget, other professionals work in primary care, not just physicians. In fact, it is quite likely that PAs and NPs make up a greater proportion of patient care visits than their physician counterparts.
Most physicians see fewer patients and work fewer hours because they can hire these advanced practice PAs and NPs. If you go to an office and only ask to meet the doctor, you are likely missing a huge opportunity for a provider that is more likely to use your skills. In fact, my experience has been that PAs and NPs are usually MORE likely than their physician counterparts to refer patients for mental health counseling. There are some studies to back that up, but that is for another article.
Those of us practicing family medicine are keenly aware of the importance of mental health counsellors. We are all greatly appreciative of all you do to help our patients right their minds so that we can be more successful righting their bodies.
Eric S. Smith, MMS, PA-C is a family practice physician assistant (PA) operating since 2001 in Clearwater, FL. He is a Bachelor of Science graduate of Florida State University and a Master of Medical Science Physician Assistant graduate of Nova Southeastern University.