Journal of Clinical Psychology in Medical Settings, Vol. 11, No. 2, June 2004 ( C  2004) Training Primary Care Psychologists 1 James H. Bray 2 Primary care psychology is a new area that provides exciting opportunities for the field. This paper discusses the definition of primary care and the role of psychologists in primary health care. Educational programs developed by the author for pre- and postdoctoral training in primary care psychology are described. KEY WORDS: primary care psychology; family medicine; primary healthcare. INTRODUCTION Primary care psychology is an exciting new area for the profession. The opportunities in primary care psychology necessitate additional knowledge of primary care and different skills in caring for primary care patients. This expansion of knowledge and skills reflects the evolution of psychology from being a mental health profession to a full partner in the health professions (Bray, 1996; Bray, Frank, McDaniel, & Heldring, 2003). For many years psychologists have collaborated with physicians and other healthcare providers, but this has been mainly in the mental health arena. Work in primary care has been more recent. This paper describes training opportunities for psychologists in primary care that were devel- oped in the Department of Family and Community Medicine at Baylor College of Medicine. Primary Care Primary care providers are usually the point- of-entry for patients and families into the healthcare system (Rakel, 2002). They provide continuous and comprehensive medical care for patients over a period 1 This paper is based on an invited address at the 2003 Annual Convention of the American Psychological Association, Toronto, Canada. 2 Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, 6th Floor, Houston, Texas 77098; e-mail: jbray@bcm.tmc.edu. of time, both in sickness and in health, and coordi- nate all the healthcare needs of patients (American Academy of Family Physicians, 1994; Rakel, 2002). Further, primary care practitioners assume contin- uing responsibility for individual patient follow-up and community health problems. Providing this kind of care requires that primary care providers develop productive relationships with their patients and fami- lies over time. These components are incorporated in the Institute of Medicine’s definition of primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for address- ing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community” (Donaldson, Yordy, & Vanselow, 1994, p. 15). Primary care physicians evaluate and treat a broad range of illness and disease that ranges from minor self-limiting problems to severe or life- threatening disease (Crabtree, Miller, & Stange, 2001; Kroenke & Mangelsdorff, 1989; Miller, McDaniel, Crabtree, & Stange, 2001). Patients present with un- differentiated symptoms that are often vague and may involve various bodily systems (“I don’t sleep well and I’m tired all of the time,” or “My stomach hurts a lot”). Twenty-five diagnoses account for 50% of office visits to primary care providers (Schappert, 1999). Included among these diagnoses are conditions frequently treated by psychologists, such as depression, anxiety, obesity, and chronic pain. A common indication that a clinician is functioning as a primary care provider is that the clinician takes care of undifferentiated 101 1068-9583/04/0600-0101/0 C  2004 Plenum Publishing Corporation