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My Journey into the Integrated Workforce

Posted By Natasha Gouge, Thursday, February 27, 2014

This is part of an ongoing blog series by early career professionals and trainees. Check back each month for a new post by up and coming professionals!

I grew up in a rural community where the only exposure I had to “psychology” was through local churches where it was described as being equivalent to “witch craft”.  (I’m not joking.) In college I was exposed to the psychological “witch craft”, and I learned very quickly that I liked it and that I seemed to excel with the material (gasp!).  This didn’t exactly gain me any prestige among the local pastors, but my professional atlas had finally begun to narrow in direction.

I was naïve going into the field of psychology as a first generation college student.  First, I thought psychologists got training in everything from palm reading to forensic profiling (both of which sounded like fun!).  And second, I assumed you were a “psychologist” when you graduated college with your four-year degree and you left graduation on Saturday to enter the workforce on Monday.  Needless to say, my professional atlas was missing a few pages.  


A few months before completing my undergraduate degree a professor began encouraging me to apply to graduate school and my eyes were opened to another world of possibilities (and to the fact I had spent four years working on a degree that didn’t make me a “psychologist”!)  In exploring graduate school options, I had my first exposure to primary care psychology—I believed I had finally found my professional direction.  What took place over the next half decade was a combination of quality course work and training, excellent mentorship (shout out to Jodi Polaha!), innovation, and probably some serendipity that resulted in the creation of my dream job in the integrated workforce. 

Appreciate it’s not just busy work

I truly believe the graduate training program at East Tennessee State University (ETSU) set many of my successes in motion because of its mission, focus, and commitment to training and preparing students for the integrated workforce.  Among the mass of reaction papers, article reviews, and assigned research projects (at times seeming like “busy work”), I was exposed to viewpoints and curriculum through nursing, pharmacy, medicine, social work, anthropology, and public health.  I had classes that were incredibly innovative and pragmatic that allowed me to see standardized patients in real time with evaluations based on patient contact, case formulation, chart documentation, and debriefing the referring primary care provider.  I had courses that required multiple business pitches about integrated care to a variety of audiences: physicians, office managers, insurance companies, etc.  Through this I became energized around the idea of creating a position in an integrated setting close to home, but I found with each business model pitch I completed I was met with the same general response:  “integrated care sounds wonderful—now how do we pay for it?” 

Integrated care
sounds wonderful—
now how do
we pay for it?
Develop a professional mantra

That question would haunt me in my sleep.  I mean, I am passionate about what I do, but I’m also passionate about making enough money to eat, play, do fun things with my husband and our kids, and dare I mention the S-L words?  (student loans!)  So working as a behavioral health provider (BHP) for free just wasn’t going to cut it, but how do we pay for it?!  This question became the driving force for my dissertation research. 

Put on your business hat

I believe it is important to explore the indirect ways in which having a BHP onsite can impact clinic revenue.  Through studying a pediatric primary care practice that offered a one-day-a-week integrated model, I found that even in the absence of direct billing from the BHP the clinic was able to generate over $1,000 average in extra income on days that a BHP was providing services on site.  How was this possible?  Mostly through time savings benefits.  As the providers handed off behavioral health concerns to the BHP, they were able to see (and bill) for additional acute visits which came in the form of extra walk in appointments and additional double-booking strategies on integrated care days. 

This data, along with many other nuanced findings, tied together nicely for the development of a business pitch—a business pitch in which I could finally offer some current, real-life suggestions to answer that reimbursement question that always comes at the end.  And even more exciting, a way to answer that question without relying on direct BHP billing and the barriers therein.

Throw it out there

Because of my training experiences through ETSU, I was well connected with some pediatricians who I met at my practicum placement.  I sent a text message out inquiring about where they were working and whether their current offices were interested in hearing my business pitch.  Guess what?  They all were interested!  And the first clinic I pitched to offered me a full time position! 

I’ve been at my current job now close to 6 months and we continue to rely on time-savings rather than direct billing to offset my salary and benefits.  Although my ongoing data collection and program evaluation is still underway, (stay tuned friends!) I can report that recently a provider told our finance manager that my service allowed her to see at least 6 additional acute patents a day.  Those visits add up folks!  If you haven’t compared the reimbursement rates for what a physician might bill for 6 acute patients versus what a BHP might bill for 6 sessions, I encourage you to do so!

To make a short story long, my blog post is an early career professional’s story about ways to get in the integrated workforce.  Surely there is no one right way.  After all, my journey began with “witch craft”.  


Natasha Gouge, PhD currently works as the full time BHP with Mountain States Medical Group Pediatrics in Kingsport, TN.  Dr. Gouge graduated from East Tennessee State University, Department of Psychology, within the Clinical PhD Program and completed her internship through the East Tennessee South West Virginia Psychology Internship Consortium.  Dr. Gouge is passionate about integrating behavioral health among primary care settings, prevention of and early intervention for behavioral health problems, and research and consultation regarding the development and sustainability of integrated health care programs. She appreciates a good dose of competition and sarcasm, as well as being outdoors, traveling, participating in sports, and spending time with her husband, son, and step-son.

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