Description

The Division of Medical Psychiatry in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine is seeking a psychiatrist with background or interest in primary care mental health integration to join our Integrated Behavioral Health (IBH) Program as a psychiatric consultant. Working within an IBH model, the psychiatric consultant collaborates with licensed clinical social workers, primary care providers (PCPs), other psychiatric providers, and additional clinical staff to deliver mental health care in the primary care setting. The consultant supports the IBH care team through regular consultation on an assigned caseload. The consultant advises the prescribing medical provider on medication selection and other treatment strategies. The consultant also provides the care team with educational support on diagnosing and managing behavioral health conditions.

This position is under the Clinician Educator (CE) Service Line. The Clinician Educator role is defined by engagement in clinical care and teaching that advances clinical medicine. Clinician Educators are also encouraged to engage in scholarly activity and to perform in an administrative role. This position is funded by Stanford Health Care and is therefore not reliant on RVUs for position maintenance.

AREAS OF FOCUS

The IBH program serves patients across the lifespan and across several care settings. The areas below reflect current program needs. Applicants are not expected to cover all four, and the final scope of the position will be built around the candidate’s training, board certification, and clinical interest. Applicants should indicate in their cover letter which of these areas they are prepared to support. 

• Child and Adolescent Psychiatry. Pediatric and adolescent patients make up a meaningful share of the behavioral health need identified in primary care, and the program currently has no dedicated child psychiatric consultation capacity. This focus involves caseload consultation on youth presenting with depression, anxiety, ADHD, and behavioral concerns. The consultant advises on medication initiation and monitoring in minors, risk assessment, family engagement, and thresholds for referral to specialty child and adolescent services. Board certification or eligibility in Child and Adolescent Psychiatry is preferred for applicants interested in this area.
• Geriatric Psychiatry and Senior Care. Older adults in primary care present with cognitive complaints, behavioral symptoms of dementia, late-life depression and anxiety, and questions of decision-making capacity. Polypharmacy and deprescribing are recurring consultation questions. This focus involves caseload consultation on the senior population, support for caregivers through the IBH team, and coordination with primary care and geriatric medicine colleagues. Board certification or eligibility in Geriatric Psychiatry is preferred for applicants interested in this area, though equivalent clinical experience will be considered.
• Express Care. Stanford’s Express Care sites are an area of growth and see a substantial volume of behavioral health presentations, including acute anxiety, agitation, substance-related presentations, and suicidal ideation. Behavioral health integration in this setting is at an early stage. This focus involves real-time consultative support to Express Care clinicians, guidance on disposition and on which patients can be managed in place rather than referred to an emergency department, and development of triage pathways connecting Express Care patients into IBH or specialty care. The consultant will help design the model rather than staff an established one.
• Adult Primary Care Integration and Program Development. The program will continue to optimize and expand adult IBH services across Stanford primary care sites. This focus involves registry-based population health management, refinement of the e-consult and co-visit pathways, measurement-based care, and expansion to additional clinic sites. There is room to develop and evaluate new models of care delivery. Applicants with interest in program design, quality improvement, or implementation scholarship are encouraged to describe that interest.

DUTIES AND RESPONSIBILITIES

The duties below reflect the range of activities within this position. Depending on program need and the consultant's areas of focus, the role may include some, but not necessarily all, of the following.

1. Provide regularly scheduled (minimum weekly) caseload consultation to the IBH Licensed Clinical Social Workers (LCSWs). Case review consultations focus primarily on patients who are new to the caseload or who are not improving as expected under their current treatment plan. The consulting psychiatrist will review referral cases with the LCSWs after initial triage and assessment to determine appropriate treatment plans.
2. Work with the IBH LCSWs and the IBH Care Coordinator to oversee the status and population health of the assigned patient caseload. The psychiatric consultant and other IBH team members will use a registry to monitor individual patients and the caseload as a whole.
3. Provide regularly scheduled caseload consultation to a group of PCPs with additional mental health training. These PCPs act as IBH PCP champions and see referred patients for direct evaluation and brief treatment. Case review consultations focus primarily on patients who are new to the caseload or who are not improving as expected. The psychiatric consultant and PCP champions will also use a registry to monitor patient cases and overall caseload.
4. Liaise with PCPs to recommend treatment adjustments, including medication recommendations and other interventions, within 24 hours of consulting with IBH team members. Recommendations will be relayed both as notes in the electronic medical record and through direct PCP engagement.
5. Advise on treatment for patients who may need more intensive or more specialized mental health care. This includes bridging treatment recommendations until patients can be engaged in specialized care.
6. Complete e-consults from PCPs to assist with non-urgent medication, diagnostic, and other intervention questions. Initial e-consults are expected to be completed within three business days. The psychiatric consultant will continue to discuss patient management with the PCP after the initial e-consult.
7. Provide telephone consultation to medical providers for very complex patients or challenging clinical situations. Respond to calls from medical providers and behavioral health care managers within one business day. Respond to urgent calls within one hour when available.
8. Develop and deliver in-service training for primary care providers and staff on the recognition and treatment of behavioral health conditions in primary care. At sites where capacity allows, this may include recurring group consultation ("pod") sessions, in which a group of PCPs brings behavioral health topics and specific patients to a dedicated consultation block. This extends population-level consultation and management support to the broader empaneled primary care patient population, beyond patients on the IBH registry.
9. Participate in direct patient evaluation through one or both of the following mechanisms, with the specific mix determined by site need and program stage:
   1. co-visits, in which a patient is seen in tandem with a PCP during a primary care visit. The PCP retains responsibility for prescribing.
   2. one-time evaluations of patients identified during IBH case discussions as needing psychiatric evaluation.

RANK AND SALARY

Rank and salary will be commensurate with experience. Base pay ranges are listed below.

This position commands a competitive salary enhanced by an attractive benefits package, including but not limited to generous housing assistance and home purchase programs, bonus programs, paid vacation time, paid personal time, health, dental, and vision benefits, paid malpractice, and 403(b) plans.

Stanford is an equal employment opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Stanford also welcomes applications from others who would bring additional dimensions to the University’s research, teaching, and clinical missions.

Requirements

Eligible candidates must hold an MD or DO degree (or equivalent) and be ABPN board-certified or board-eligible in Psychiatry. Subspecialty certification or eligibility in Consultation-Liaison, Child and Adolescent, or Geriatric Psychiatry is preferred, depending on the focus areas the applicant wishes to support. A demonstrated record of interest or training in integrated behavioral health models such as the Collaborative Care Model is preferred. Experience with primary care psychiatry or consultation-liaison psychiatry is desired.

Candidates should have a demonstrated ability to collaborate effectively in a team setting and excellent communication skills. A positive, flexible, and solution-focused approach is important, as is the ability to synthesize medical and psychiatric data quickly and formulate evidence-based clinical recommendations. Comfort with remote work and strong organizational skills are needed.