Over time, I’ve noticed more PCBH job postings recruit only for LISW/LPCC/LMFT (or equivalent). From my experience, many psychologists would love to work in PCBH, but they never get the chance. Many job postings don’t even list psychologists as an option, and when contacted, organizations often can’t offer pay that fits the level of training and responsibility psychologists bring to the role. This is especially true in the setting where I work, federally qualified health centers (FQHCs; Pathman et al., 2025).

I don’t think this is an intentional exclusion. I think it’s a practical issue where leaders are trying to manage limited funding. But it’s worth asking what gets lost when we write roles in ways that unintentionally filter out psychologists.

The American Psychological Association brief on hiring psychologists in integrated care points to a set of contributions that show up repeatedly in real clinics (American Psychological Association, 2025). Psychologists often provide value in three areas:

1. Managing complexity: Primary care is where overlapping mental health symptoms, chronic medical illness, trauma, substance use, and social stress often occur in the same patient. These are areas where psychologists typically have more training and experience (Pathman et al., 2025; Serrano, 2024).

2. Enhancing capacity: Psychologists enhance the team through ‘curbside’ diagnostic consultations and providing high-level supervision that elevates the skills of the entire behavioral health staff (Nash et al., 2012). This impact is amplified by initial clinical credibility stemming from their doctoral-level training (Serrano, 2024).

3. Driving sustainability: Rather than relying on external consultants to fix workflows, an embedded psychologist provides the in-house expertise needed to evaluate the program, troubleshoot implementation gaps, and ensure ongoing quality improvement (Nash et al., 2012; Robinson & Reiter, 2025; Serrano, 2024).

Empirical work also suggests psychologists’ role matters. Staab and colleagues (2022) examined integrated care implementation in 77 Midwestern community health centers and found that clinics reporting at least one psychologist on staff had substantially higher (about sevenfold) odds of being in a maintenance phase (i.e., sustaining integrated care) rather than still building implementation. In addition, workforce research suggests psychologists and other doctoral-trained clinicians may be more likely to stay in place over time, which can reduce the costly turnover that may destabilize integrated care (Adams et al., 2019; Pathman et al., 2025).

Taken together, these findings connect back to the funding issue: while psychologists often command higher salaries (Collaborative Family Healthcare Association, 2024), their sustainment and retention advantages may offset the added labor cost (Staab et al., 2022; Adams et al., 2019; Pathman et al., 2025).

While these findings highlight the unique value of psychologists, they do not diminish the essential contributions of master’s-level colleagues who remain the primary drivers of patient access and continuity. Instead, they underscore a clear fiscal and clinical trade-off: though doctoral-level salaries require a higher initial budget, the gains in program stability, reduced turnover, and advanced clinical capability offer a significant return on investment.

The Path Forward: When designing future PCBH roles, I encourage organizations to explicitly include psychologists in job postings and adjust compensation to match their doctoral expertise. By intentionally inviting psychologists to the table, we ensure our integrated teams have the full range of expertise necessary to meet the complexity of primary care.

References

Adams, D. R., Williams, N. J., Becker-Haimes, E. M., Skriner, L., Shaffer, L., DeWitt, K., Neimark, G., Jones, D. T., & Beidas, R. S. (2019). Therapist financial strain and turnover: Interactions with system-level implementation of evidence-based practices. Administration and Policy in Mental Health and Mental Health Services Research, 46(6), 713–723. https://doi.org/10.1007/s10488-019-00949-8

American Psychological Association. (2025, October). Why hire a psychologist? A case for psychologists in integrated care. https://www.apa.org/topics/health-care/why-hire-psychologist

Collaborative Family Healthcare Association. (2024). 2024 Career survey data. https://www.cfha.net/career-survey/

Nash, J.M., McKay, K.M., Vogel, M.E. et al. Functional Roles and Foundational Characteristics of Psychologists in Integrated Primary Care. J Clin Psychol Med Settings 19, 93–104 (2012). https://doi.org/10.1007/s10880-011-9290-z

Pathman, D. E., de Saxe Zerden, L., Konrad, T. R., Shafer, A. B., Harrison, J. N., Fannell, J., & Lombardi, B. M. (2025). Job assessments and the anticipated retention of behavioral health clinicians working in U.S. Health Professional Shortage Areas. BMC Health Services Research, 25(1), 592. https://doi.org/10.1186/s12913-025-12698-6

Robinson, P. J., & Reiter, J. T. (2025). Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-72150-2

Serrano, N. (Ed.). (2024). The Implementer’s Guide To Primary Care Behavioral Health, Second Edition (1st edition). Collaborative Family Healthcare Association.

Staab, E. M., Wan, W., Li, M., Quinn, M. T., Campbell, A., Gedeon, S., Schaefer, C. T., & Laiteerapong, N. (2022). Integration of primary care and behavioral health services in midwestern community health centers: A mixed methods study. Families, Systems, & Health, 40(2), 182–209. https://doi.org/10.1037/fsh0000660

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