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Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians

From the California Pacific Medical Center, San Francisco, CA (JAA), University of Maryland School of Nursing, Baltimore, MD (KS), University of Texas Medical Branch (VSS), and Center for Survey Research, University of Massachusetts, Boston, MA (BRC)

Correspondence: Corresponding author: John A. Astin, PhD, California Pacific Medical Center, 2300 California Street, Room 207, San Francisco, CA 94115 (E-mail: john{at}integrativearts.com)

Purpose: Examine physicians’ attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and identify barriers to the integration of evidence-based mind-body methods.

Method: Random sample of primary care physicians and physicians from selected non-primary specialties was drawn. A total of 1058 physicians completed a 12-page survey.

Results: The response rate was 27%. Although a majority of physicians seem to recognize the importance of addressing psychosocial issues, approximately one third believe that addressing such factors would lead to minimal or no improvements in outcomes. A minority reports their training regarding the role of psychosocial factors was effective, and relatively few indicate interest in receiving further training in these areas.

Males were less likely to believe in the importance of addressing psychosocial factors. Additional factors included perceptions that training was poor in these areas; feelings of low self-efficacy to address psychosocial issues and the perception that such factors are difficult to control; lack of knowledge of the evidence-base supporting the role of psychosocial factors; and lack of time and inadequate reimbursement to address the psychosocial domain.

Conclusions: These results suggest the need for more comprehensive training in the role of psychosocial factors in health. In addition, the finding that physicians identify lack of time and inadequate reimbursement as significant barriers suggests that the current health care delivery system may, in many respects, be antithetical to the biopsychosocial model.

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