We present here a series of short essays, written by several of our very dedicated colleagues, on why they like (love!) being academic psychiatrists. We hope that readers will be as interested as we have been to understand what these special individuals have discovered about themselves and about our field through their careers in academia.
Laura Weiss Roberts, M.D., M.A.
Two concepts that appeal to me in appreciating academic psychiatry are convergence and progress.
Convergence, or the bringing together of disparate elements to make a whole, is exemplified by the integration of biological, psychological, and social components in patients’ illnesses (operationalized as the biopsychosocial formulation). There is convergence among various biological systems in illness-generation (e.g., mood symptoms may follow disorders of metabolism, CNS degeneration, or lesions, or pharmacological influences). Understanding psychiatric illness requires mastery of the pathology of several different organ systems. Our clinical interventions are often a convergence of psychopharmacology, psychotherapy, and other interventions. Thus, in academic psychiatry, we must be “multiply-convergent.”
Progress is an advance toward the ideal. In clinical medicine, constant improvement and refinement is central to our clinical existence. In our specialty, the rate of progress in understanding the origins of illness, the development of psychopharmacological and other somatic interventions, and refinement of psychotherapy models are but three examples of the “constancy of change.” So, in academic psychiatry, we must make “progress at the task of progress.”
Academic psychiatrists are charged with managing and making sense of multiple channels of “convergence and progress.” The opportunity to be in the midst of such dynamic change brings out the best in us. The constant expectation of studying the past, understanding the present, and looking to the future is appropriately never-ending, humbling, yet gratifying.
The appeal of a career in academic psychiatry is precisely that it can never be completely mastered, will not be routine, and can never stagnate. While embracing this point of view requires acknowledgment that one will never be “finished” or “know it all,” the resulting pursuit of such mastery forces one to excel. It is a privilege to be here. I hope that those who follow us pick up these challenges and go to the next level, as we are all a part of a great continuity in the pursuit of elusive mastery of the ultimately unknowable.
Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton Ontario Canada
• Never having to say you’re sorry
My nonpsychiatry teachers, colleagues, and friends in other fields often looked down on those opting for psychiatry. Somehow, making it clear that I was planning to be an academician focusing on research and scholarship adequately justified a psychiatric career in their eyes. They understood that psychiatric research issues matter and that psychiatry has much to learn.
• Participating in diverse activities
Friends and associates in clinical practice often report that, after awhile, their daily activities start to feel routinized. For me, the diversity of teaching, research, clinical, and administrative roles and frequent prospects for change-of-focus assure ongoing novelty.
Opportunities to connect with large numbers of colleagues at my own institutions, nationally and even internationally, have been extremely rewarding. I’ve not only developed many wonderful friendships, but all of this has somehow resulted in publications written with nearly 300 different collaborators—locally, nationally, and around the world. Many are on my joke lists.
• Having a multiplier effect
Over the years, I’ve been the privileged recipient of many bits of academic and clinical wisdom, perspective, and rules-of-thumb bestowed by scores of mentors and teachers. I’m fortunate to follow in this oral tradition, passing these good words and others that I’ve generated, in turn, along to other students, residents, and colleagues. Some of these “memes” seem to have sticking power, and will continue to disseminate through future generations.
Early on, I learned that I didn’t enjoy being a lab scientist as much as I had thought I would, but that psychiatry still offered a huge range of other opportunities to contribute to new knowledge, teaching, and patient care. And for me, that’s what it’s all about.
Dept. of Psychiatry, University of Colorado School of Medicine, Aurora, CO
Correspondence: Joel Yager, M.D.; e-mail: Joel.Yager@ucdenver.edu
I love being an academic psychiatrist.
For over 12 years, I practiced psychiatry (including psychotherapy) in the community—in my very own, 500-square-foot office, complete with leather sofa, oriental rugs, and soft lighting. The only background noise came from the gentle splash of a Zen fountain. And, for awhile, I was in Nirvana. What a welcome respite from 4 years of residency training in an intense urban “war zone,” followed by a challenging forensic fellowship. So, why did I ever leave the oasis of private practice?
Don’t get me wrong. I loved my patients and still do. Being part of a healing relationship allows me to express my respect and compassion for those in need, and I’m forever grateful and humbled by the privilege of being a part of their lives. But, as meaningful as clinical work is, it wasn’t enough for me. I wanted to be a part of a bigger humanitarian mission, in a place where rich intellectual discourse occurs daily. So I joined a clinical psychiatry department at a research university.
As an academic psychiatrist, I am able to conduct empirical scientific investigations and develop innovative educational interventions, while still taking care of patients and teaching. These scholarly projects nurture my own personal growth, especially my curiosity and creativity. Like a “kid in a candy store,” I’m in awe at all the opportunities for discovery surrounding me. I hope my enthusiasm inspires a similar openness to experience in my students and residents, so that they, too, may come to embrace the wonder of academic psychiatry.
Margaret Smith Chisolm, M.D.
Dept. of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Last Monday began with a meeting with our multidisciplinary Physician Suicide-Prevention Committee, a group of faculty, house staff, students, and staff dedicated to enhancing physician well-being, identifying and treating depression, and preventing suicide. We all feel gratified with the impact of our efforts and the privilege of working together—from there, to a Clinical Service Chiefs meeting to gather with the department’s clinical leaders, many of whom I had helped train and who were now my colleagues on the faculty—next, a Strategic Planning Committee meeting with the department’s leaders to problem-solve short- and long term strategies to maintain excellence in all of our academic, educational, community, and clinical missions. This was a morning spent closely interacting with some of the most altruistic, compassionate individuals I know (the first meeting), former trainees who were now budding stars in clinical psychiatry (the second), and academic giants and thought leaders who also happen to be among my closest friends (the last).
In the afternoon, I supervised a brilliant undergraduate who was initiating an interesting cross-cultural study on bereavement; a medical student who was studying differences in burnout and suicide risk factors between premedical and non-premedical undergraduates; another medical student completing a project comparing medical students with faculty on burnout and depression and associated features; a chief resident, on administrative conundrums; and a second-year resident, on a challenging clinical dilemma. In each of these encounters, I believe I learned more than I taught. At the end of the day, I answered calls from long-time friends and colleagues from around the country, saw two patients (½-hour each) who were also participants in my four-site Complicated Grief Treatment study (also with life-long friends and colleagues from around the country), and began preparing for a symposium on treatment-resistant depression scheduled for later that week (yes, again, with long-term friends and colleagues from other medical schools).
Where else can a day like that happen? In one busy-but-typical day, I was able to rub shoulders with bright, inquisitive, always stimulating students at multiple career levels—undergraduates, medical students, residents, and former residents—and seasoned leaders in the field. I was focused on topics of great interest to me: physician well-being, suicide-prevention, bereavement, mood disorders, and training. And I functioned as a teacher, clinician, investigator, mentor, administrator, and friend. I can’t think of a more stimulating, gratifying, and fulfilling professional life!
Dept. of Psychiatry, UC San Diego and VA San Diego Healthcare System.
In what other profession do you actually get paid to help patients and families feel better and do better, and occasionally, very specifically, save someone’s life? Where patients come to your university because of the reputation, the history of service, and the quality of care they expect and deserve to receive... and where you are carrying that commitment for excellence every time you see a patient? What other career allows you to feel respected and valued in teaching and training students from so many disciplines—medicine, psychology, social work, and nursing? And if you are interested in clinical research or administration, what other type of institution provides for the opportunity to take courses and self-improve, and gives you the infrastructure to develop these areas of interest? And, if all that weren't enough, each day, we academics have the incredible good fortune to work with other colleagues, students, and staff who are inquisitive, generous, and who equally want to learn and be helpful to one another?
Choosing an academic career provides the ability to have a balanced quality of life. There are usually set hours, coverage for emergencies on evenings and weekends that is spread among a large faculty, and terrific administrators who help make sure that funds are flowing in the right directions. There are opportunities in academia to develop and grow in a number of professional organizations that are geared to your area of specialty and where you can travel and present your scientific work.
As academic psychiatrists, we are always faced with new challenges and ways to rethink how we understand and work with patients and families in an interdisciplinary manner, how we train our students, and contribute to exciting areas of science.
Each day, I deeply appreciate the opportunity to be an academic psychiatrist… and, at every chance, I try to encourage others to join this amazing, wonderful career path.
Michelle Riba, M.D., M.S.
Professor and Associate Chair for Medical and Psychiatric Services, University of Michigan; Director, PsychOncology, University of Michigan Comprehensive Cancer Center; Associate Director, Michigan Institute for Clinical and Translational Health Research ((MICHR)); Associate Director, University of Michigan Depression Center.
When I began psychiatry residency I envisioned my future career to be that of a clinician. Now, 40 years later, I still identify myself as a clinical psychiatrist who practices both psychotherapy and medication-management. But it only took a few years post-residency for me to realize that I needed something more if I was going to have a fulfilling career. I required the intellectual and interpersonal aspects of a hospital-based academic environment to challenge me and stimulate my creative juices.
Scholarly activity as defined by ACGME is much more than publication alone. It includes discovery, dissemination, and application along with participation in activities that promote a spirit of inquiry and scholarship. My academic route has been through the field of psychiatry education. I am now celebrating my 30th year as a Training Director. Developing innovative curriculums, organizing clinical rotations, teaching classes, providing clinical supervision, and mentoring residents, medical students, and junior faculty provides me with challenges and rewards on a daily basis. The personal satisfaction that I feel when one of my patients is relieved of their painful symptoms and demonstrates recovery in functioning is only matched by the joy I experience when one of my mentees “gets it” and goes on to treat or teach someone else.
The unanticipated opportunity I have received as an academic psychiatrist has been the personal relationships I have been able to establish with my colleagues locally and around the country. As an active member and former president of the American Association of Directors of Psychiatric Residency Training (AADPRT), I’ve been fortunate to work with some of the most dedicated, intellectually gifted, and nicest psychiatrists in this country. What could be a better career bonus than that?
Associate Professor of Psychiatry, Director, Education and Training, Hofstra North Shore-Long Island Jewish School of Medicine, and The Zucker Hillside Hospital.
In over 35 years of teaching, my approach to psychiatric/medical education has been enhanced by student observation. I feel fortunate to have met and taught insightful, appreciative students. In addition to didactics, I have emphasized the importance of humanity and empathy in clinical practice. I have found that putting students at ease seems to promote active learning and enhanced involvement in their work. For example, students have often shared my interests in sports psychiatry and music. At times, we have established rapport with patients using these interests. I have been impressed by how interested students are in learning about the doctor–patient relationship and how much they appreciate the significance of compassion, respect, and authenticity in treating patients. What has surprised me has been students’ strong interest in and appreciation of the teacher–student relationship and the importance of that relationship in fostering learning. I am gratified that many of my students have chosen to enter the field of psychiatry.
I have learned that my practice of academic psychiatry is generally on par with that of my peers at other programs. In directing our weekly Grand Rounds/CME program for 18 years, I have invited 500 speakers and learned a great deal from those speakers. I have enjoyed meeting with the presenters and developing friendships with many of them. Their enthusiasm and knowledge infused my own teaching. In return, I have spoken many times at other schools and meetings. Over the years, I have become more comfortable with the experts, the “superstars” of the profession, and they have graciously welcomed me into what I regard as a cherished club. I am honored to know and to be considered as a peer by such distinguished psychiatrists. The vast network has been very beneficial in my capacity to help my students and residents move forward.
Chief, Dept. of Psychiatry, Cooper University Hospital, RWJMS-Camden, Camden, NJ.
Cultural psychiatry focuses on how membership in various social groups—such as family, race, ethnicity, and religion—relates to personal identity and mental illness. An academic cultural psychiatrist advances cultural psychiatry through original contributions in didactics, clinical care, and research. As an academic cultural psychiatrist, I occupy a unique niche in the department of psychiatry.
For instance, residency programs organize syllabi around diagnostic classification, psychopharmacology, and psychotherapy. Cultural psychiatry seminars can introduce real-world considerations of these subjects in actual practice. How do we understand patients who present with accepted cultural syndromes without corresponding DSM diagnoses? Moreover, how do we account for cultural variations in the acceptability of medications or psychotherapy for psychiatric illness? Residents appreciate such insights in our increasingly multicultural society.
Cultural psychiatrists can also influence clinical care. Trainees find that the DSM-IV Outline for Cultural Formulation systematically addresses cultural issues. Case presentations clarify how to integrate cultural information within diagnostic and treatment planning. Analyzing the strengths and weaknesses of using the Cultural Formulation makes cultural psychiatry dynamic and relevant.
Finally, academic cultural psychiatrists can encourage original research. The NIMH, SAMHSA, and other agencies consistently issue announcements to improve mental health for underserved ethnic and racial minorities. Cultural psychiatrists can promote science through research on reforming education, closing service gaps, and improving patient outcomes such as treatment retention and adherence. In sum, the academic cultural psychiatrist can offer a distinct, important perspective on the effects of social and cultural contexts to mental health and illness.
Neil Krishan Aggarwal, M.D.
The author is supported by a Minority Fellows Program grant administered through the American Psychiatric Association and the Substance Abuse and Mental Health Services Administration. The author is currently a National Institute of Mental Health T32 post-doctoral fellow. There is no conflict of interest to declare.
Dept. of Psychiatry, Columbia University, New York, NY; e-mail: firstname.lastname@example.org, email@example.com
By the end of the first day of the first year of medical school, I had ruled out a career in surgery. We had started the dissection of the upper extremity, and I knew that if I was having that much trouble differentiating brachialis from brachioradialis (or even nerve from tendon), it was probably in my—and my future patients’—best interests if my practice didn’t involve deciding which bits of them to cut off. That said, 2 years later, I still thoroughly enjoyed my rotation on surgery for one simple reason: everything was new. Every procedure and exam that was deemed “routine” by my residents and attending physicians was an undiscovered country for me. That stimulation of novelty is what kept me rolling out of bed in the wee hours of the morning for rounds throughout medical school. My choice to stay in academia is in many ways an attempt to maintain that level of excitement—I get to experience every patient presentation through the eyes of someone seeing it for the first time. Working with third-year medical students on their psychiatry clerkship allows me to constantly relive the thrill and satisfaction that I felt the first time I saw a catatonic patient awaken after a dose of lorazepam or a delirium patient calmed after a dose of haloperidol. As long as I’m surrounded by that eager and fresh curiosity and that crisp sense of newness, I know that a career in teaching is my inoculation against ever feeling that my work is “routine.”
Chair of Psychiatry, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ.
Correspondence: e-mail: firstname.lastname@example.org
Lately, interestingly, I have been frequently asked, by students, residents, patients, and younger colleagues, whether I like what I do and why I like what I do. Some of them want just to be reassured that they are dealing with someone who likes his work. Some wonder why I still like what I do, knowing that I grumble about it at times. True, I do occasionally grumble—about those mundane rules and regulations—we all do. However, as I tell those asking, I love doing what I consider my core academic work. I also emphasize that one should love what one does, otherwise life could be pretty boring.
So, what specifically do I like about what I consider the core academic work? First, I like the ability to do and to participate in various things: seeing patients, teaching students and residents, mentoring younger colleagues, participating in research, writing, debating with colleagues, going to conferences, learning and being forced to keep studying and absorbing new things. Second, coming from a culture (Central Europe) where being in academia used to be the most valued thing to do in medicine, being an academician has a special meaning for me. As I fulfilled my father’s dream, maybe there is some dynamic in it, too? To summarize: it is being in an environment of constant intellectual stimulation, in which I keep expanding my knowledge, an environment that I value very much and that gives me joy.
Wayne State University, University Psychiatric Center, Detroit, MI.
I like being an academic psychiatrist because I am regularly prompted to change the way I work. Two years ago, the LCME told our school of medicine that we were relying too heavily on passive learning (traditional lectures). This prompted our faculty to reinvent our curriculum and create new ways to promote learning. We designed assignments that required students to apply the information and concepts that we presented in our shortened lectures, as they developed presentations, individually and in groups, to deliver to the class. Consciously or not, the students were now “playing” with the information and ideas that they had merely memorized before our active-learning initiative. Feedback from students indicated greater satisfaction in this new learning environment. In some cases, it was even expressed as joy. Fortunately, performance on standardized exams improved, as well.
We teachers, also, changed in this process. No longer could we lean on our well-seasoned lectures. We had to imagine ways to engage students in their own learning, rather than tweaking our PowerPoint presentations. In fact, lecture time and content had to be reduced in order to open space for the student presentations. We also had to prepare ourselves to respond to what they found in their research and the challenging questions that arose from these exercises.
I like being an academic psychiatrist because the renewal process that it continually demands is rejuvenating and satisfying. If I had chosen a career in private practice, I would have been forced to adapt and change in response to challenges from my patients. The difference is that, in addition to those opportunities for growth in clinical care, I am also prompted to innovate by these bright, creative students who represent the next generation of physicians.
Dept. of Psychiatry, University of Missouri-Kansas City, Kansas City, MO.
Academic psychiatry for me has always been about multi-tasking: teaching residents and medical students, providing clinical care, conducting research with colleageus, and performing administrative roles. What keeps me going and my enthusiasm constant is the underlying principle: teaching and learning. I have a passion for asking questions and finding answers. My patients and my students, of any age, never cease to teach me and grant me the gift of allowing me into their lives. As clinicians, we all share our role of helping patients. As an academic psychiatrist, my life is also filled with undergraduates, medical students, nurses, social workers, psychologists, pharmacists, doctors, and administrative staff that I have worked with who went on to pursue new academic interests and degrees after we worked together. This, most of all, is the gift of being an academic psychiatrist.
The explosion of research knowledge, whether the advances be biologic, clinical, epidemiological, or in health-delivery system, has helped to emphasize that we are not alone in asking questions and that we can solve them better by working together. The concept of “translational” medicine is the new “buzz-word” for bringing what we discover to the care of our patients. In the last 25 years, we have gone from a handful of genetic markers across a tiny portion of our genome to being able to read the full 3 billion base-pair sequence for each individual. This transformation is the product of a vast team of investigators committed to sharing what we learn. This is not work to be done alone. I needed collaborators in the lab, in informatics, and statistics, among other disciplines, to ask the right questions and get meaningful answers. Academic psychiatry brings many experts together and encourages the life-long process of learning. For me, it is the ability to be generative (à la Erik H. Erikson), while continuing to learn, that is the drive that keeps me going.
Dept. of Psychiatry & Behavioral Sciences, Keck Medicine of USC, Los Angeles, CA.