As a family medicine physician and co-director of association member Boston Medical Center’s new combined family medicine and psychiatry residency program, I have seen firsthand the prevalence of chronic medical ailments in patients with mental health or substance use disorders.
According to the Substance Abuse and Mental Health Services Administration, 68 percent of adults with a mental illness have one or more chronic physical conditions, and individuals with both mental health or substance use issues and chronic conditions have a shorter life expectancy by almost 20 years compared with the average patient.
While a defining pillar of modern health care is that all patients should have access to quality, comprehensive care for physical and mental and behavioral health, this ideal is sometimes elusive.
Boston Medical Center (BMC) is helping to bridge the gap by training physicians through a combined program in family medicine and psychiatry. This will allow a single provider to attend to chronic conditions, mental health, and substance use disorders in one visit.
Our program launched in July. It is the sixth joint family medicine-psychiatry residency program in the country and the only one in New England. BMC has focused on the issues of substance use disorders and behavioral health in primary care for years, and this was a tremendous opportunity to help train physicians in two important care areas during their residency.
Medical residents will see what they are trained to see. When we emphasize treating behavioral health issues while residents are training in primary care, we highlight skills needed right now across the health system. Patients who struggle with mental health, substance use issues, and/or chronic health issues often have difficulty adhering to medications, but physicians who are cognizant and trained to work through barriers to treatment, such as medication adherence, are much more likely to improve outcomes.
For BMC’s family medicine-psychiatry residents, Eduardo Garza, MD, and Saikrishna Kugabalasooriar, MD, their long journey and training are just beginning. But they have hit the ground running and are bringing new perspectives to the hospital.
I hope that as Garza and Kugabalasooriar progress through the joint residency, they will provide two-way training for attending physicians through joint conferences and precepting, and that BMC’s family medicine physicians who are not psychiatrists will learn more psychiatry by being a part of the teaching process.
Garza, who grew up in Texas and Mexico, was first inspired to become a physician by his pediatrician. While Garza also was interested in psychiatry, he fell in love with family medicine during one of his clinical rotations at The Warren Alpert Medical School of Brown University.
Garza finds it fulfilling to become part of a patient’s life, and this comprehensive medical approach leads to a more well-rounded view of what it means to care for a patient.
Kugabalasooriar, originally from Maine and Massachusetts, entered Boston University School of Medicine with limited knowledge of family medicine and psychiatry. However, by engaging in activities that interested him, such as integrative medicine, clinical and communication skills training, and Healer’s Art, he already was headed down a path to family medicine. At Boston University, Kugabalasooriar also volunteered with the Outreach Van Project, which brings food, clothing, and care to the homeless population in East Boston.
It is encouraging to know that there are many more residents in training who will be more capable of caring for complex patients with a variety of mental health and chronic conditions. The health care community must think innovatively and creatively about caring for patients with comorbidities, support residents like Garza and Kugabalasooriar, and prepare to meet our challenges head-on.
For more information on family medicine-psychiatry resident programs, visit The Association of Medicine and Psychiatry’s website.