The Register Report, Fall 2008 The Integration of Psychology Services at Hurley Medical Center in Flint, Michigan: The Benefits of Parallel Training for Physicians and Psychologists by:  Kirk Stucky, Psy.D., ABPP, Christine Chew, Ph.D., and Shannon McIntosh, Ph.D. Return to Table of Contents

Hurley Medical Center (HMC) is a 493-bed, university affiliated, urban teaching hospital for Michigan State University (MSU) and maintains cooperative affiliations with the University of Michigan and Henry Ford Health System. HMC is the primary provider of subspecialty care in the region and also a Level One trauma center in the tri-county area it services. It houses an NICU, PICU, Regional Burn Unit, and CARF accredited rehabilitation program, in addition to medical units in cardiology, oncology, psychiatry, pediatrics, obstetrics-gynecology, renal, and family practice. As a teaching hospital it sponsors numerous postdoctoral fellowship and residency programs.

THE PSYCHOLOGY DEPARTMENT

Since 1995 HMC has had an independent Department of Psychology in which all members are part of the medical staff and the department chairperson is a voting member of the Medical Executive Committee. A more thorough description of the department’s history and development can be found in a companion article (Lechner & Stucky, 2000). Department members currently participate in hospital governance and various hospital committees including credentials, ethics, and graduate medical education. By sitting at the decision making table with other physician colleagues, psychologists have been able to influence hospital policy and procedure, control the provision of services, and earn the respect necessary to practice collaboratively in a large medical setting. One of the most important by products of this involvement has been the medical staffs increased awareness that psychologists can provide a great deal more than just psychotherapy.

Postdoctoral Health Psychology Program

HMC originally started a medical psychology postdoctoral fellowship program in 1991. The Department of Graduate Medical Education (GME) has long recognized the need to maintain doctoral level training programs, including psychology, in the same department. Thus, the attending psychology staff receive their contract through the same entity that employs physician faculty. The fellowship program director is a voting member of the GME Committee, which includes all of the residency program directors, senior hospital administrators, and other selected teaching faculty and residents. This centralized administrative structure supports and emphasizes the fellowships primary purpose as a postdoctoral level training program. The importance of this broad based administrative and physician support cannot be overemphasized. Without this, aspects of the fellowship, which historically have primarily provided value added services and do not pay for themselves, would not have survived during fiscally challenging times at HMC.

Currently, HMC is one of the three hospitals within the Consortium for Advanced Psychology Training (CAPT), a collaborative postdoctoral fellowship in clinical health psychology offered by the combined resources of four sponsoring institutions: Genesys Regional Medical Center (GRMC), Hurley Medical Center (HMC), McLaren Regional Medical Center (MRMC), and the Michigan State University College of Human Medicine: Flint Area Medical Education, Inc. (MSU/FAME).

MSU/FAME serves as a vehicle whereby all three area hospitals come together as a consortium to create and implement programs in medical education and other allied health care fields in conjunction with MSU. In 1999 the consortium was the first program in the nation to receive 5-year specialty accreditation from the American Psychological Association (APA) as a postdoctoral training program in clinical health psychology. In 2002 HMC was the first hospital in the United States to obtain Center for Medicare / Medicaid Services (CMS) funding for fellowship training. More detailed information regarding this milestone accomplishment for psychology training can be found in a recently published article (Stucky, Buterakos, Crystal, Hanks, 2008).

Since the program’s inception the incoming psychology fellows have been members of the residents union and have received salary and benefits commensurate with the other medical residents. The Department of Graduate Medical Education supports the postdoctoral fellows’ salaries and receives supportive funding from a variety of service lines including obstetrics-gynecology, pediatrics, rehabilitation, and behavioral medicine. Fellows and faculty are intimately involved in the provision of medical education for medical students and physician residents. Simultaneously, psychology trainees and faculty are integrated members of various healthcare teams and participate in rehabilitation teams, medical staff rounds, trauma conferences, and other physician related training. Consequently, psychologists are typically able to collaboratively follow patients from their initial hospitalization through outpatient care.

SERVICES PROVIDED

Over the years, the practice of psychology at HMC has evolved and recreated itself several times, but has consistently maintained a strong base in medical education and direct patient care. In many ways these two activities are interlaced and occur simultaneously, but we have provided separate discussions of them for explanatory purposes. The reader will probably note that both activities are in many ways mutually dependent and compliment one another to ensure a well-rounded experience. Essentially, psychologists and physicians learn from one another on a daily basis while providing patient care. This unique and cooperative venture blends the best of both worlds – a university environment and a community setting to produce an excellent learning situation for students, residents, and fellows.

Medical education: The provision of medical education services has been a cornerstone activity throughout the fellowship program’s history. HMC is one of seven teaching hospitals for MSU and all psychology faculty and fellows have appointments in the MSU College of Human Medicine. Furthermore, Graduate Medical Education has five core programs: Internal Medicine, Combined Internal Medicine-Pediatrics, Obstetrics Gynecology, Pediatrics, and Transitional Year. There are three affiliated programs: Pediatric Dentistry, Diagnostic Radiology, and Emergency Medicine. In addition to the Psychology Fellowship program three additional fellowship programs are offered in Geriatric Medicine, Pediatric Emergency Medicine, and Trauma. A rotation in behavioral medicine is required for all residents in pediatrics, medicine-pediatrics, and obstetrics gynecology. During these block rotations faculty and fellows take residents to see patients, conduct lectures, and provide precepting during the residents various activities in order to enhance their effectiveness in patient communication and use of techniques such as motivational interviewing. A more detailed description regarding the integrated interface between medical education and patient care is provided in the section below.

Clinical Service and patient care: Relative to the other hospitals in CAPT, psychologists at HMC maintain a more intense workload with regard to patient care. Psychologists treat and evaluate patients on a variety of medical surgical units, which provides diverse training opportunities. Consequently, trainees have an opportunity to work with a variety of clinical problems that range from pediatric illness and injury, stroke, traumatic brain injury, spinal cord injury, psychological complications of acute or chronic illness, psychosomatic disorders, adjustment disorders, primary mental disorders, disorders of childhood and adolescence, and a variety of neurologic issues. Currently there are two postdoctoral fellows and three full time faculty. One fellow spends a significant amount of time interfacing with the pediatric and medicine pediatric residency program while providing clinical services to pediatric service lines. The other postdoctoral fellow provides services to adult and adolescent patients who have been admitted to various medical units or require inpatient rehabilitation. Psychologists in rehabilitation, pediatric, and trauma related services act as full-time members of the team and attend various meetings or formal rounds. Both postdoctoral fellows provide brief neuropsychological assessment, psychotherapy, crisis management, family interventions, behavioral management, non-pharmacologic pain management, and other interventions under the direct supervision of the attending psychologist. The psychologists also provide a variety of interventional skills beyond psychotherapy and assessment including team building, staff training and support, and hospital governance work.

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