Dr. White is also correct that in the practice-based collaborative care intervention arm of our study, depression treatment was delivered by an on-site primary care provider and an on-site care manager, without the involvement of a consulting psychiatrist. This comparison group was chosen for three reasons. First, most primary care practices do not have access to an on-site psychiatrist. Second, two high-quality randomized trials had previously demonstrated that depression outcomes can be improved in small primary care clinics lacking on-site mental health specialists by training depression care managers (without psychiatric supervision) to support primary care providers (1, 2). Third, this comparison group replicated the Depression Health Disparities Collaborative that was being disseminated in federally qualified health centers by the Health Resources and Services Administration (HRSA). For the depression collaborative, HRSA specifically recommended: “Establish linkages with key specialists to assure that primary care providers have access to expert support,” and our practice-based care managers were encouraged to use mental health resources available in the community (e.g., community mental health centers). However, for federally qualified health centers located in medically underserved areas, access to psychiatric care is challenging, and obtaining psychiatric consultation and care manager supervision is especially difficult.