ORIGINAL RESEARCH
Brooke Ike, MPH; Brennan Keiser, MSW; Ajla Pleho, MPH; Kris Pui Kwan Ma, PhD; Annie Koempel, PhD, RD; Madeline Byrd, MEd; Andrew W. Bazemore, MD, MPH; Sebastian T. Tong, MD, MPH
Corresponding Author: Brooke Ike, MPH; University of Washington, Department of Family Medicine.
Email: bike2@uw.edu
DOI: 10.3122/jabfm.2025.250109R1
Keywords: Family Medicine, Family Physicians, Integrated Delivery of Health Care, Mental Health Services, Primary Health Care, Private Practice, Qualitative Research
Dates: Submitted: 03-19-2025; Revised: 07-28-2025; Accepted: 09-02-2025
Status: Volume 39, Issue 1 (Publishes March 2026)
INTRODUCTION: Mental health and substance use diagnoses are increasing, and many patients cannot access behavioral health (BH) care. One-third of family physicians work in independently owned practices, but only a minority work collaboratively with BH clinicians. Our study sought to describe barriers to implementing integrated BH in independently owned family medicine practices and the alternate approaches family physicians are using to offer BH care services to their patients.
METHODS: We recruited eligible family physicians who completed the American Board of Family Medicine 2021-2022 Continuous Certification questionnaire. We interviewed 16 family physicians working in independently owned family medicine practices. Interviews were analyzed using a qualitative exploratory design guided by the Framework Method.
RESULTS: Participants identified cost, staffing, and space as principal barriers to implementing and sustaining integrated BH at independent practices. In the absence of integrated BH, participants reported that they provide BH support to their patients in the form of assessment and diagnosis, basic medication management, coaching on BH skills, and referring to outside resources.
CONCLUSIONS: This study highlights that barriers to integrating BH at independent family medicine practices align with those at larger health systems, but that the nuances of those barriers differ based on the smaller practice context. Family physicians at independent practices are filling in BH services gaps to the best of their abilities but are constrained by training and resource limitations. Targeted strategies, particularly addressing cost, staffing, and clinical space limitations, are needed to support independent family physicians in achieving sustainable access to integrated BH care.