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CFHA Facebook Debate #1: Generalists versus Specialists

Posted By Administration, Thursday, February 9, 2012

CFHA has hosted a number of debates on our Facebook page ("like" CFHA today to participate!). This post is the first in what we hope will be a series of debates that went viral on facebook and were brought here for further commentary. Please add your perspective to today's debate.

You're starting an integrated team from the ground-up. Would you hire 3 mental health clinicians who view themselves as generalists (e.g. 3 LPC's or LCSW's) or would you prefer to have clinicians with some form of specialty focus (e.g. 1 MedFT, 1 psychologist, 1 addictions counselor)?

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Comments on this post...

Benjamin Miller says...
Posted Thursday, February 9, 2012
I would want a team that had skills that could generalize across the population. I don't want someone who just gets depression, but would rather have a provider who understood that there exists a range of mental health need in primary care. There are enough "partialists" in healthcare, why promulgate another in the largest platform of delivery, primary care? Additionally, I don't think that looking at degrees makes sense when integrating mental health providers. It is really much more who can accomplish what function. Communities may all have varying needs, and having someone who can address those needs will likely trump their degree or "specialty".
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DeAnna Harris-McKoy says...
Posted Thursday, February 9, 2012
I would want a psychiatrist, a social worker, and a family therapist. A multitude of services could be delivered with that team.
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Randall Reitz says...
Posted Thursday, February 9, 2012
This is Randall Reitz. My answer would depend a little on the setting. If it were a pediatric office, I'd want to have MedFT's and perhaps a child psychologist, but if it were a family medicine office I would want to have generalist clinicians who match the skill set and patient panel of generalist physicians.

My experience with people of numerous backgrounds is that our field attracts generalists, and like Ben suggests, the actual credential is less important than the personality and the commitment to learning the primary care ropes. I blogged on this exact topic at the Growing MedFT blog this morning: http://bit.ly/sbk3gz

A psychiatrist would be fantastic, but mostly if we had a large practice. A part-time psychiatrist who could see patients along with the primary care docs (and/or perform chart reviews with them) would be a luxury in a smaller clinic.
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Paul D. Simmons says...
Posted Thursday, February 9, 2012
I want whatever Benjamin Miller wants and the opposite of whatever Randall Reitz wants.
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Gonzalo Bacigalupe says...
Posted Thursday, February 9, 2012
Does the potential clinician understand issues of equity?

Does the new hire believe being accountable to their community is core to the role and not an addition?

Does the potential clinician believe equity is not about political correctness?

Is the clinician willing to have her work being monitored and open to others to review?

Does this clinician think that the work is about the patients, families, and their communities rather than some preconceived idea about confidentiality, close doors?

Does this clinician know how to assess and intervene thinking systemically?

Does this clinician knows what she/he doesn't know (and therefore think that leaning on others is a plus and not a deficit)?

Does this clinician think that using or learning how to use social media is not an option but a necessity?

Should he/she be generalist would be an issue only after the previous questions have been answered.
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Randall Reitz says...
Posted Thursday, February 9, 2012
Gonzalo, those are all excellent questions related to characteristics that would make a person to being a good primary care team member. They are the types of questions that lead some to believe that collaborative care is a separate discipline in need of its own credentialing process.

While I share your enthusiasm for social media, I don't see it as a core clnical function for collaborative care. I have a number of colleagues who are excellent integrated therapists who have never tweeted and who don't maintain a facebook account. Perhaps our field will evolve clinically to where this question would need to be asked, but I don't see it within the era of my career.
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Gonzalo Bacigalupe says...
Posted Thursday, February 9, 2012
P, those yes definitely, was trying to be provocative. In respect to SOME, no doubt there are great clinicians who don't FB or Twitt, but the requirement of needing to relate different with gathering data and sharing it with communities of practice is necessity if clinicians are to keep with speed of evidence development. Not that candidate needs to know but at least open to question the not need to assumption. Starting with being able to handle electronic records and on. Integration won't happen just because someone is flexible or caring: need to but not sufficient... Will have to write a blog entry on this.
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Randall Reitz says...
Posted Thursday, February 9, 2012
I would love for it to be the person(s) with the most skill but unfortunately traditions of hiring certain professions (combined with lack of parity in reimbursement among mental health professions) into these positions outweigh actual experience and competency in integrated care.
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Peter Fifield says...
Posted Thursday, February 9, 2012
If that is the case...where is the talent?
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Kate Feifar says...
Posted Thursday, February 9, 2012
As someone said, competency and experience with a variety of issues and clients is important (diversity, for example). I would prefer clinicians with specialities. As an MFT student, I suppose I am inclined to say that... But I would definitely consider hiring one generalist, and 2 different specialists to start with. : )
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