Patients with psychosocial issues: The referral practices of family physicians

Over the past twenty years, there is growing concern that primary care physicians worldwide medically treat most psychosocial complaints of their patients with little or no referrals for psychotherapy. This study has contributed to the void in the literature and offers insight as to which mental health professionals are used by family physicians when referring patients with psychosocial issues. A quantitative online survey was designed and made available to the current members of the National Research Network of the American Academy of Family Physicians. The questions inquired as to the participants' familiarity with six mental health providers as well as which of these is most preferred and considered most effective in assisting their patients. These mental health professionals included: counselors, psychiatrists, marriage and family therapists, psychologists, social workers, and psychiatric nurse practitioners.

The members who completed the survey (n = 80) comprised 37.6% of the total NRN listserv (N = 213). The majority of participants who completed this survey were M.D.s (95%) and male (78.8%) with an average of 21.6 years of experience in practice. All of the participants (100%) reported that they prescribe psychotropic medications. Descriptive statistics found the overall rankings of the different mental health providers. Psychologists ranked highest as a first choice for psychotherapy referral and were seen as most effective in assisting patients as well as being among the most familiar to these physicians. Psychiatrists were noted to be most familiar to these physicians but ranked third as a preferred referral choice and were considered second to last as effective with these patients.

Coming from the perspective of marriage and family therapy, the study found that licensed marriage and family therapists (LMFTs) are mental health professionals who are among the least chosen and the least known to family physicians when referring their patients for psychotherapy. Yet, family physicians consider LMFTs among the top choices of psychotherapists who are highly effective. Since family physicians are the medical specialists most likely to hear first about a person's mental or emotional distress, these findings provide important implications, especially for LMFTs. Recommendations for both practice and further research are presented.