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Regular Article | December 01, 2005

Early Career Professional Development Issues for Military Academic Psychiatrists

Christopher H. Warner, M.D.; William V. Bobo, M.D.; Julianne Flynn, M.D.

Academic Psychiatry 2005;29:437-442. 10.1176/appi.ap.29.5.437

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Received February 3, 2005; revised April 14, 2005; accepted April 28, 2005. Dr. Warner is affiliated with Walter Reed Army Medical Center, Department of Psychiatry, Washington, DC and the Malcolm Grow Medical Center, Department of Psychiatry, Andrews Air Force Base, Maryland. Dr. Bobo is affiliated with Uniformed Services University of the Health Sciences, Department of Psychiatry, Bethesda, Maryland. Dr. Flynn is affiliated with the Wilford Hall Medical Center, Department of Psychiatry, Lackland Air Force Base, Texas. Address correspondence to Dr. Warner, Division Mental Health, Bldg. 601 E, Fort Stewart, GA 31314; christopher.h.warner@us.army.mil (E-mail). Copyright © 2005 Academic Psychiatry.

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Abstract

OBJECTIVE: Academically motivated graduates of military psychiatric residency programs confront serious challenges. METHOD: In this article, the authors present a junior faculty development model organized around four overlapping domains: mentorship, scholarship, research, and career planning/development. Using these four domains as a platform for discussion, the authors focus on challenges facing academically oriented early-career military psychiatrists and provide guidance. CONCLUSION: The authors believe that a proactive stance, skillful mentoring, self-awareness through conscious planning and effort, ability to capitalize on existing opportunities for growth, and attention to detail are all vital to the junior military psychiatrist.

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Significant challenges exist for recent graduates of psychiatric residency training who wish to establish successful academic careers (1). These challenges, at best, may hinder the full development of aspiring faculty or, at worst, lead to high junior faculty attrition (2). Given this information, the importance of ongoing professional and career development of junior psychiatrists is a matter of little debate, though it is not always easy to arrive at a precise definition of what those efforts should entail (3). As an initial guide, the medical literature consistently defines factors predictive of success in academic medicine. These include clearly defined career goals, sound time management practices, mentorship, and a focused research plan (4).

Many academic psychiatry departments feature an infrastructure that promotes scholarship, especially for medical faculty who teach in medical schools or teaching hospitals (5). However, the literature provides little direct guidance concerning the fostering of professional academic skills outside of these settings, and almost no guidance specific to early career military psychiatrists. In this article, we build upon a junior faculty development model described by Pololi et al., whose conceptual framework is organized around four overlapping domains: mentorship, scholarship, research, and career planning/development (6). Using this as a platform for discussion, we focus on challenges facing academically oriented early career military psychiatrists and provide what we hope will be useful guidance.

The Challenges of Psychiatric Practice in the Military

Routine psychiatric training and practice in the military are not that dissimilar from what is seen in nonmilitary settings. Military psychiatrists practice in a variety of clinical settings including general adult, geriatric, child-adolescent, and forensic populations. However, there are several features that are fairly unique to Military Psychiatry. Early career psychiatrists in the military are expected to rapidly master a number of unique additional skill sets. These are outlined in Appendix 1. The challenge is to remain academically focused in the face of the time demands necessary for acquisition and ongoing development of necessary military-specific skills in an environment whose primary mission—unlike the university setting—is not academic medicine. Appendix 2 summarizes some practical tips we suggest could be utilized to overcome these challenges by early career psychiatrists in the military who are interested in academia.

Aside from military-specific issues, these suggestions would also be put to good use by junior faculty in rural training programs or in programs with many hospitals far from one another. These individuals face similar challenges and obstacles to remaining academically focused in the face of increasing time demands from patient care and administrative duties.

Keys To Success

Mentorship

The medical literature consistently documents a strong relationship between a positive mentoring experience and career progression, higher career satisfaction, perception of increased professional academic skills, and willingness to remain involved in academe (7—14). These findings were reported regardless of medical discipline and remained consistent even in the face of increased emphasis on economic forces such as cost containment and provider productivity, factors that have also become prominent in military medicine (7—14). Successful physician mentoring has been associated with enhanced organizational alignment and positive impact on provider satisfaction, productivity, retention, and morale even during times of administrative reorganization and limited resources (15, 16). These are principles that are highly valued in military organizations.

For junior military physicians, it is imperative that mentoring relationships be solidified during residency training. This ensures the longest possible exposure to senior faculty whose clinical and military administrative skills may be emulated via direct interaction and observation. Beyond this more traditional model of mentorship, another type of relationship—one that is more "portable"—is necessary for individuals who are assigned to ships or remote duty stations where senior mentors may be in very short supply. These individuals remain available to junior psychiatrists via electronic or other communications technologies for ongoing guidance and feedback after graduation (17). We believe that both types of relationships must be specifically sought, at the earliest possible point in training, in order to establish a pattern of regular contact, shared academic interests, and the expectation of periodic future guidance. Especially for the second type of mentoring relationship, several individuals should be approached. We recommend that selected mentors have varying clinical and academic interests (perhaps even outside of psychiatry), but that they all possess superior military administrative skills and organizational knowledge.

Because mentorship is so crucial, we recommend beginning the process of choosing mentors with a brief introspective exercise designed to clarify personal career goals and what interactive styles enhance motivation to work and learn (Appendix 3). Most senior faculty who make the "final list" of candidate mentors probably value and enjoy such interactions with junior faculty. However, it is helpful if the junior member enters the relationship with something to offer, such as collaboration on a scholarly project or related activities. In addition, the mentor relationship may be especially productive if the mentor believes he or she can also learn from the one mentored.

Scholarship

Consistent efforts to expand one’s knowledge base and hone one’s teaching skills are requisites of academic and clinical success, no matter what the setting. These efforts are referred to as scholarship, the development of which is easily facilitated, on one hand, by postdoctoral fellowship training. For those who choose not to pursue a postdoctoral fellowship, simply teaching others may be the best method of developing these skills.

The military provides ample opportunities to teach others. For instance, some smaller military community hospitals are host to training programs in primary care specialties such as family practice. These programs typically welcome offers from specialists to join their teaching faculty. Placed in such a setting, one may take fullest advantage of the natural role of specialty consultant. In addition to traditional patient care and teaching functions, military psychiatrists provide administrative "command consultation" to military leaders. Effective command consultation requires an ability to make complex mental health issues understandable to a lay audience and to integrate clinical and administrative matters in order to make appropriate recommendations. Many small departments offer interservice training opportunities where all interested hospital staff are invited to attend formal lectures or case discussions that can be academically invigorating given the wide sampling of clinical disciplines represented. Nonphysician mental health providers and paraprofessional staff in small departments usually appreciate planned academic exercises, since all medical commands require that hospital staff receive a specified number of educational hours.

Finally, funds are often set aside by most medical commands specifically for travel to academic conferences and similar programs. The availability of these funds may vary widely from duty station to duty station, and the feasibility of attending lengthy conferences may also vary substantially with the availability of clinical cross-coverage, especially on remotely located bases. For instances of low travel fund availability, "in-house" educational opportunities are even more valuable.

General recommendations begin with devising and executing a planned program of study and maintenance of required continuing medical education (CME) credits. Because we believe that teaching and learning are indivisible processes, it is vital that junior psychiatrists take the fullest advantage of whatever opportunities for teaching—and therefore learning—are available at their local commands.

Research

Early mentored research experience appears to translate to increased academic productivity over the course of a career (18—20). Currently, all military psychiatry residency programs require completion of a scholarly project; however, the challenge is in continuing research activities after residency training. From a research perspective, the military is a potentially fruitful study population that is relatively young, healthy, ethnically diverse, uniformly employed, and universally covered in terms of access to health care (21). Large automated data collection systems closely track clinical diagnoses, pharmacy use, medical appointment types, demographics, laboratory and radiographic results, insuring the availability of vast amounts of population health and accurate denominator data (22). Junior military psychiatrists will make contact with a large number of first episode cases and follow individuals exposed to multiple stressors including significant psychological trauma, prolonged geographic separation from family, and frequent relocation (23, 24).

For junior military psychiatrists interested in continued research efforts, investigating research questions of interest to military commanders can optimize time constraints and foster local support. This also holds true for nonmilitary psychiatrists interested in developing research projects related to their current positions, whether they are in the state or community mental health system. Most military leaders are interested in data concerning the health and welfare of individuals under their command, as well as their families, especially if the information can be used to improve the care of patients (25). Using this as a guideline, researchable issues that may be of interest to all stakeholders include the incidence, prevalence, severity and risk factors for common mental disorders in military populations; the economic impact of mental disorders in terms of health care costs, occupational functioning and work productivity; postdeployment health care concerns; the burden of substance use disorders and other high risk health behaviors; posttraumatic vulnerability and resiliency factors; and suicide prevention.

Finally, we believe that consistent effort at academic oriented writing is an effective use of time for accomplishing several missions, including increasing knowledge, earning Category 2 CME credit, and developing publication potential (26).

Career Planning and Development

It is widely held that all early career psychiatrists should develop short and long range career plans based on personal values and academic goals, a review of which is beyond the scope of this brief paper (27). In practice, goals and personal priorities may change over time and are significantly influenced by practice setting, location, and the needs of the military. Frequent relocation and other factors inherent to military practice outlined above make this point especially salient. Devoting time to formulating career plans for academic development, periodically reviewed with mentors and departmental leadership, should certainly be a high priority. Devoting equal time to developing a military career pathway must also be a part of this process for those intent on remaining in the military beyond the end of their service obligation, as advancement in rank will depend on having demonstrated both a variety of assignments and increasing levels of administrative responsibility over time.

Several short term challenges will also require added attention and/or constant monitoring. These can divert the focus from academic pursuits, and one must be aware of this tendency. These short term challenges include scheduling time to prepare for board certification despite multiple clinical and administrative duties, staying on top of stringent fitness standards and requirements, maintaining the required array of personnel and readiness files, and the possibility of experiencing a lengthy deployment in the midst of a research project. Short suspense taskings can also pull one away from research, teaching, or writing activities, and the lack of research infrastructure (such as the absence of departmental or hospital biostatisticians, or research assistants) in some of the more remote locations can be yet another challenge in pursuing academic work in military psychiatry.

Conclusion

Within the relatively small literature that addresses needs of early career physicians, early career psychiatrists in the military appear to be an especially understudied group. This article was an attempt to reconcile a lack of study with the need for practical advice concerning how best to meet these early career needs in the rapidly evolving military health care system. Additionally, we hoped to address military specific challenges involved in career planning, management, and utilization. Finally, we also hoped to open the matter to further discussion. Military psychiatrists as a matter of occupation must be clinicians, administrators, advisers, and leaders. Each role is, in and of itself, difficult to master and requires a substantial time investment which at first glance may appear to be at odds with development of academic skills. However, there are as many opportunities for academic and professional growth as there are challenges to these endeavors in a system that assigns positions of such responsibility relatively early in one’s career. We believe that a proactive stance, skillful mentoring, self-awareness through conscious planning and effort, ability to capitalize on existing opportunities for growth, and attention to detail are indispensable in these matters (28, 29).

ACKNOWLEDGMENTS

The views stated in this article are those of the authors and do not represent the views or the policy of the U.S. Department of Defense.

No grants or financial support were used to fund this study.

APPENDIX 1. Unique Challenges to Military Psychiatrists

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APPENDIX 2. Practical Considerations for Academically Oriented Early Career Psychiatrists in the Military

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APPENDIX 3. Guidelines for Selecting Career Mentors

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