"And Mom … don't forget the Cheetos. You forgot my Cheetos today …" replied my 7 year-old daughter, when I called home to check in while working late. "I'll be home soon. Mommy had some extra homework, but it's done now. Did you eat dinner? How about your brother? Can I speak to Daddy, please?"
What do academic psychiatrists do? How would one describe a day in my professional life? Such questions raise awareness of my multiple roles that are intrinsic to a typical professional day and the diversity of the relationships that each of these roles bring. As a mother of two school-age children, wife, child psychiatry training director, and child mental health services researcher, my professional life is characterized by constantly working to balance the needs of those who are depending on me—whether it is for food, homework help, a confidential listener, administrative duties, career planning, research mentoring, reviewing preliminary data runs, editing research paper drafts, or writing grants. Yet, the dependency cuts both ways, as the development of the skills necessary to find such a balance seems constantly stimulated by the growth of those around me. It is the joy of raising children, maturing (hopefully) with my spouse, engaging in the clinical training and career decisions of residents, and working with talented research colleagues from multiple disciplines that sustains me.
In reviewing my calendar to find a typical day, I could neither operationally define it, nor could I locate a series of days that shared common elements. This was valuable data, as it raised the question of whether the dynamic nature of the life of an academic psychiatrist more closely approximated the "typical". Thus, t1 summarizes my work schedule during a randomly selected week during the past year and demonstrates a general trend to compartmentalize multiple tasks. Mornings are typically spent doing general administration. Replying to e-mails, following up with residents or attending physicians about a problem, and planning administrative tasks with my training program coordinator and research coordinator are just some of the "housekeeping duties" that have to be attended to. There are committee agendas to be finalized, phone calls to return, letter drafts to be edited, and schedules to be reviewed. Throughout the week, there are administrative meetings related to the training program, such as the Child Psychiatry Division faculty meeting, the Training Advisory Committee, the department's Steering and Clinical Coordinating Committees, and the Research Track Oversight Committee.
Teaching also plays a central role. These activities include weekly supervision with the program chief residents, coordinating a seminar in community consultation, updating materials for the research method seminar, preparing onetime lectures for other courses, and mentoring. At times, the mentoring needs of medical students and residents have a sense of urgency, as early career decisions seem pivotal. My work plans become quickly altered, but my day is enriched by their trust and passion to grow. In addition, administrative oversight of the didactic and clinical training for the child psychiatry residents warrants constant adjusting an "administrative fulcrum" to attempt to find the new balance point in meeting the needs of residents and faculty. With each new academic year, residents bring to the training program differences in training priorities, interests, and career goals. Similarly, the composition of the faculty and their training program roles shift a bit from year to year, bringing new strengths that merit integration into the training program. Across both groups, there are also developmental changes that promote change in the training program over time.
Likewise, a day doing research is typically atypical. My area of research is child mental health services. Child mental health services research is highly dependent on strong collaborative relationships with agency leaders, providers, and consumers. Their feedback enriches the work, as we seek together to conduct research that will produce findings relevant to improving care for children and their families in the community. This lofty goal also presents challenges, as priorities often differ and the development of new administrative infrastructure to support our collaboration takes time.
Our studies are at varying stages. Within a day, the application for Institutional Review Board approval for a study on mental health problems among recently arrested youths warrants revision. Together, we are working to develop a strategy that addresses the dilemma of how to safeguard the rights of research subjects who are minors, detained, and for whom informed written parental consent may not be feasible. An analysis of statewide data on quality of care for children is presenting analytic challenges, as we work to develop a data reduction for more than 110 quality indicators. What is acceptable care? How will we support selection of a particular cut-point? Since recommended care processes don't always clinically apply to all children, how should we handle missing data that is not randomly missing? We are also preparing to develop a high-risk pool sample of children enrolled in managed care Medicaid using two large agency administrative databases for a recently funded 5-year study. This first step is critical, and we are working to develop preliminary frequencies on selected variables in preparation for a meeting with our statisticians. Some of the assumptions for the sampling plan have not held true, and consultation to revise our sampling strategy is needed.
"Hello. … yes, I am coming home now. Where are you? The freeway is blocked where? No, … no sleepover tonight. The kids have got homework to do and then they need to practice … their lesson is tomorrow. Oh, I'm picking up some Cheetos on the way home … do we need milk?"