As I entered my final year of residency, I was not sure what trajectory my career path would take. I enjoyed working with outpatients, so in addition to the approximately 16 hours per week of patients I was seeing, I elected to spend time at my program’s Student Mental Health Clinic where I saw an additional 20 hours a week of students. For one of my fellow residents, this experience convinced him that he wanted to go into private practice. For me, the opposite occurred. While I still enjoyed the patient contact, I had trouble remembering all my new patients and I felt emotionally exhausted at the end of each day.
I decided to postpone a career decision by entering a 2-year Robert Wood Johnson Clinical Scholars Fellowship where I had an opportunity to study clinical research methodology and medical ethics. After a clinically intense residency, the chance to become a student again with only a one-half day per week of clinical responsibility was a welcome opportunity to study. It was during my fellowship that I decided upon an academic career.
Twenty-five years later, I have never regretted that decision to try academia. I have directed our residency training program for the past 17 and one-half years and our continuing medical education (CME) programs for the past 15 years. What I have enjoyed most is that each day brings new challenges and problems to be solved and a variety of tasks to be completed. The following is a typical day.
7 a.m.: Drive my daughter to school and head to grand rounds. Directing grand rounds has permitted me the opportunity to work with residents to schedule people who have fascinating stories to tell. In addition to the usual psychopharmacology updates, we have heard topics ranging from Native American healing to psychiatric perspectives on ground zero to genius found in the Savant Syndrome, and I cannot wait to hear about magnetic resonance imaging (MRI) studies on Tibetan monks.
9:15 a.m.: Attend a managers meeting at the local community mental health center. This is one of our major training affiliates, and I attend this twice-a-month meeting to represent the training perspectives as the administrators deal with inpatient census loads, staffing issues and funding shortages.
10:20 a.m.: Attend seminar on resident bioethics. I have taught this course for over 20 years and still enjoy sorting through the ethical dilemmas of various clinical situations. Today we review the issue of double "agentry," where psychiatrists have competing and conflicting responsibilities such as working for the military or in Student Mental Health Clinics.
11:10 a.m.: Make phone calls. Some are to refill patient prescriptions. Others are to Program Directors of different specialties to confirm their attendance at an Accreditation Council for Graduate Medical Education/American Board of Medical Specialists (ACGME/ABMS) Quadrad meeting. These are part of my tasks as Chair of the Organization of Program Directors Associations.
Noon: Attend lunch meeting of the Mental Health Disaster Task Force. This committee is composed of members of the public and private mental health community, meeting to plan a coordinated response for the mental health aspects of any manmade or natural disaster in the post 9/11 era.
1:30 p.m.: Catch up on e-mail and phone calls.
2 p.m.: Attend meeting on our department’s Health Outreach, Partnering and Education initiative. We have received grant funding to develop more community outreach programs.
3 p.m.: See patients. I generally see about 12—15 hours of outpatients each week with about 6 weekly psychotherapy cases, 1 weekly intake and the rest medication follow-up. Today, for the first time in decades, I actually prescribed low-dose imipramine (starting at 10 mg. per day) on a patient who had side effects to a whole range of current antidepressants.
6:45 p.m.: Dinner with a visiting professor who is giving a workshop in town the following day. I invite him to speak at next summer’s Door County Summer Institute.
8:30 p.m.: Return to the office to complete my day’s clinic notes, catch up on other paperwork and work on a draft of a presentation to be given in a week.
10:30 p.m.: Head home physically exhausted, but emotionally charged as some ideas have come together for the talk.
Not all days are this frenetic, but because I was away for a couple days, the remainder of this week got jammed. Last week I ended a day at 4 p.m. in order to watch my daughter’s track meet. It is the variety of the day/week’s activities that makes academic life interesting and fun for me.
Dr. Chan is affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin, Milwaukee, WI.