By the time psychiatry residents and fellows are ready to graduate from their programs and start the next exciting chapter in their careers, most have had years of education and training in human anatomy and physiology, psychotherapeutic modalities and strategies, and psychopharmacology. While these early career psychiatrists (ECPs) may be ready to tackle the clinical aspect of their work, many continue to be confounded by the intricacies and variables that govern other aspects of their employment and job satisfaction. There are also significant knowledge gaps in the understanding of leadership roles and importance in advocacy, which are not often addressed over the course of residency and fellowship training.

As a third-year psychiatry resident, I attended the Resident-Fellow-Medical Student track at this spring’s American Psychiatric Association annual meeting. Experts shared their valuable insights with the common opportunities and pitfalls faced by ECPs – from mentorship, to leadership, to advocacy. Here’s what I took away from the sessions.

Tips and Advice for Early Career Psychiatrists

Panel – “What to Do With the Rest of My Life? Career Tips for Launching Psychiatrists” with Jessica L.W. Mayer, MD, Margo Christiane Funk, MD, James Shore, MD, Eric Williams, MD, Maryland Pao, MD

In this session, panelists shared their career journeys, discussing the pros and cons of various career opportunities, lessons learned from navigating positions and job transitions, and the importance of work-life balance. Their advice may be summarized as such:

Clinical Mentorship is Key

Great mentorship is likely one of the most valuable things for trainees and ECPs to develop. For psychiatry residents, there are likely supervising and attending psychiatrists who can serve as excellent mentors. For trainees who are pursuing fellowship training, fellowship directors and other faculty members may serve as excellent mentors as well. Looking beyond the usual suspects, there are also plenty of mentorship opportunities in different professional organizations. ECPs may consider looking at supervisors from previous employment for mentorship opportunities.

Great mentors are important for a variety of reasons. For some, mentors have led them to excellent career prospects and leadership opportunities. For many, mentors represent a calming and reassuring source of advice when issues arise. For example, if you are running into problems in your current job and may be considering a transition to a different position, mentors may provide useful advice on how to navigate these difficult and stressful situations.

Aside from support and reassurance, it is also important to have mentors who would push and challenge you. Dr. Funk shared her experience with being offered an excellent opportunity but feeling apprehensive and guilty about having to relocate her family with three young children across the country. One of her mentors challenged her and asked if she would have the same hesitancy if she was the father in the family. Shortly after, Dr. Funk decided to pursue this opportunity and she said she could not be happier with her decision.

It is also important to keep in mind that your mentorship should evolve along with your career. Different mentors are beneficial for different stages of your career, and it is important to continue cultivating relationships and look for mentors who may be more suitable for your current activities and needs.

See also, mentorship in clinical psychology and evolving digital mental health care models are reshaping private practice, with clinical psychologist Julie Kolzet. 

Finding Your “Bliss” in Psychiatry Practice

As Dr. Williams put it succinctly, “You get one life – live that life for yourself.” It is important to understand what you love doing and do what you love in your career. Due to the continued need for mental health services in this country, there is no shortage of employment opportunities for psychiatrists. It is particularly crucial for ECPs and budding psychiatrists to understand their worth and pursue opportunities that are personally rewarding.

It is common for psychiatry trainees to have questions about working in the public sector vs. private sector, inpatient settings vs. outpatient clinics, etc. Keep in mind that this is a matter of personal preference and no one can provide you an answer that suits you 100%. Looking back at your psychiatry training and your experiences in working with different patient populations and within various clinical settings, ideally, you can identify the environments and opportunities that you have enjoyed most.

See also, how to start a private practice.

For ECPs and other psychiatrists who have been practicing for a few years, it is important to continue identifying and re-evaluating your interests and to make sure that you continue to feel fulfilled by your work. The need to assess and re-assess your career leads to the next takeaway – your colleagues.

Colleagues in Psychiatry: Work with Great People

A key contributor to job satisfaction is the people that you work with. You need to work with people who believe in your abilities and value your work, and you want to work with people whom you admire and respect. It is also important to evaluate your work culture and environment. A sudden shift in leadership or administration may further enrich a great work culture, or turn a previously welcoming environment into a toxic workplace.

In the process of evaluating your work and interests, as well as your work environment, be sure not to make any hasty decisions based on one bad day or week. If you find yourself thinking about leaving your workplace consistently, then it may be time to transition out. As noted, having great mentors can be immensely beneficial in these moments.

When considering transitioning to a different employment opportunity, it is common to feel guilty. Hopefully, if you have done well in your current role, there may be colleagues and supervisors who will try to convince you to stay and become upset if you do not. It is important to keep in mind that no matter how important you are, your organization will always replace you when you leave.

Dr. Williams cited this great analogy – “If you really want to know how important you are, stick your finger in a bucket of water, and observe the hole when you pull it out.” It is great to acknowledge the good work that you have done and be proud of what you have accomplished, but once you have decided to move on, do so with conviction and without hesitancy.

Timing and Opportunity – Career Transitions in Psychiatry

Different opportunities will come knocking over the course of your career. Even if you may be actively seeking a transition, it is always important to maintain your work ethic and integrity. There will also be many occasions when you are assigned committee duties or administrative responsibilities. While some work may seem tedious at first, your dedication and reputation will pay off in the long run, and you will put yourself in much more competitive position when better opportunities arrive in the future.

With respect to timing, there will be occasions when a great opportunity falls on your lap. You may be presented with a difficult choice to make if you are already satisfied with your current position. In these instances, try to think about how much you would regret missing out on this opportunity. Having an open mind and seizing the right opportunities will open doors for you. However, do not despair if you have decided to let an opportunity pass at the moment – a better prospect may be just around the corner.

Work-Life Balance in Psychiatry

Dr. Pao noted that the commonly used term “work-life balance” assumes “there’s balance” and suggests instead that “the proper term is organized chaos or entropy.” A better way of looking at work-life balance may be to consider “work integration into life,” he said.

It is important to evaluate what you value in life and be able to create a career that allows you to enjoy those things. Identify what brings you joy, and learn how to say “no” to things that will preclude you from doing things that you love the most.

See also, two other psychiatry residents’ take on avoiding burnout.

Psychiatry Leadership Roles: Benefits and Challenges

Panel – “The Benefits and Challenges of Assuming Leadership Roles: A Workshop for Residents, Fellows and Early Career Psychiatrists” with Tobias Diamond Wasser, MD, Luming Li, MD, James Rachal, MD, Victor J.A. Buwalda, MD, Manish Sapra, MD, Xiaoduo Fan, MD

In this American Psychiatric Association 2021 annual meeting session, presenters discussed leadership opportunities within the field of psychiatry and the benefits and challenges of assuming roles.

ECPs may be offered a host of employment opportunities within various settings, including the public sector and private sector. The type of positions may vary and each job may contain multiple roles and additional responsibilities including clinical, administrative research, and education. Within each job description, there may be further specifications on how a clinician is expected to split up their time or how their productivity will be measured. It is important, therefore, for prospective candidates to understand what they are looking for in a job, and be able to evaluate what they are being offered in each position.

Dig into the Roles Behind the Job Titles

It is crucial to look for the “identifiable gems,” said Dr. Li. Identifiable gems may include mentorship/supervision opportunities, development opportunities, and other benefits. ECPs should also be aware that fancy leadership titles often do not equate to career development. “Assistant,” “Associate,” and “Deputy” often refer to the same level on an organizational chart, and “Medical Director” is often a non-specific title. Ask questions about the day-to-day expectations when applying for these roles.

An organization that values investment in career development should be treasured over one that hands out titles for free. Ideally, you can find an opportunity that offers the best combination of compensation and identifiable gems.

In considering early leadership positions within psychiatry, it is perhaps somewhat paradoxical that medical leaders may at times have very little actual authority, noted the panelists. Such personnel do not always make direct employment or financial decisions, and often have no ability to allocate resources. Therefore, being a clinician leader often means that one needs to lead without actual authority. To get others to follow, a leader commands respect and needs to have the ability to influence, motivate, and contribute towards an organization’s success.

Use Your Voice as an Early Career Psychiatrist

That said, there are often leadership opportunities at different levels, and you can get started early by looking at committee roles or discussing prospects with your mentors.

Ultimately, it is important for early career psychiatrists to develop leadership skills and become leaders within their field. Clinicians are often positioned well to effect policies and changes that impact the healthcare system, as they make frontline decisions that determine the quality and efficiency of care, and have the technical know-how to make sound strategic choices.

Studies have previously shown that healthcare organizations with higher clinician participation in leadership and management have better performance. However, some clinicians may be hesitant to take up leadership positions. Some physicians may prefer to spend their time doing clinical work, while some may find the benefits of leadership less tangible, and others simply feel uncomfortable or inadequately prepared for leadership roles. To that end, there has been increasing effort from certain organizations, including the American Association for Psychiatric Administration and Leadership (AAPAL), to provide education and training for psychiatrists to become leaders.

Advocacy in Psychiatry

Panel – “The Time for Justice Is Always Now! Engaging in Advocacy as an Early Career Psychiatrist” with Mary C. Vance, MD, Katherine Gershman Kennedy, MD, Ilse R. Wiechers, MD, Uchenna Barbara Okoye, MD, Corey Williams, MD

Presenters at this virtual session discussed the importance of advocacy in psychiatry and how psychiatrists can become involved in public advocacy.

In the 2020 book, A Psychiatrist’s Guide to Advocacy, co-authored by several of the panelists from this session, advocacy is defined as “public voicing of support for causes, policies, or opinions that advance patient and population health.” Physician advocacy encompasses a wide range of actions and is conducted in the best interest of a patient, community, or patient population; advocacy should be done in partnership with those that are most affected.

Many ECPs may not know that advocacy is a core professional responsibility for psychiatrists. The American Psychiatric Association supports the American Medical Association (AMA) Declaration of Professional Responsibility, which states that physicians should commit themselves to “advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.”

Advocacy Versus Activism

It is important to understand the differences between advocacy and activism.

  • Advocacy is traditionally conducted within an institution and centers on medical identities.
  • Activism is conducted outside of institutions and centers on non-medical identities.

An example of activism would be the Black Panther Party’s establishment of free medical clinics in the late 1960s/early 1970s, in part due to the systemic discrimination against African American patients in hospitals and clinics. A more recent example of activism may be seen widely on the news and social media when physicians and other healthcare staff protest against racial inequality and social injustice.

Both advocacy and activism are important in generating lasting institutional changes.

You can use your own clinical experience to identify patterns of inequality and injustice. You may recognize disparities in healthcare that are the results of laws and legislations, social and structural determinants, or insurance/managed care regulations. Notably, you should look within yourself to recognize and address any implicit bias that you may have so that you can hope to achieve equitable and culturally informed care to your patients.

See also, provider bias regarding borderline personality disorder in LGB patient populations and cultural sensitivities in ADHD diagnoses.

Advocacy – Getting the Good Work Done

Advocacy work comes in many different shapes and sizes. It is beneficial to understand the different types of advocacy and the settings where advocacy can be conducted, as described by the panelists:

  • Clinical Advocacy –aimed at individual patients or groups of patients. The simplest example may be a physician who is advocating for a patient in order to get authorization from an insurance company to prescribe a nonformulary medication.
  • Teaching – as an example, teaching healthcare laws and policies to trainees and honing their advocacy skills.
  • Research –conducted with a clear understanding of the issues at play and the underlying factors that are contributing to the status quo. Research and publications are powerful forms of advocacy.
  • Community –aimed at communities. An example, as suggested by Dr. Okoye, may be the establishment of a community clinic in a medically underserved area with the goals of providing not just medical care but culturally and linguistically concordant care.
  • Communication – publishing in popular media outlets, podcasts, blogs, social media outlets, and interviews are all examples of critical forms of advocacy.
  • Legislative Reform – keeping informed with local, state, and federal laws and regulations; working with lawmakers on reforms is an impactful way to make system- or country-wide changes to the healthcare system.

As budding clinical advocates, you should recognize that advocacy involves a set of skills, including communication, collaboration, and research. Effective advocacy takes continued education and practice. It is also important to understand that advocacy is a team sport, and you should utilize the power of collaboration and enlist help from allies and mentors whenever possible.

After you have identified an issue that you are passionate about, research the topic on hand and identify the advocacy work that you want to engage in. It is especially important to understand the organization or system in question, and recognize the mechanisms and processes that can effect changes. At this point, focus on translating your advocacy work into compelling messages that you can distribute. These messages should be clear and concise, with a clear messenger and a well-defined audience, noted the panelists. They should also include an “ask” to engage and encourage an audience to amplify and propel your advocacy work.

Advocacy is hard work, as it often takes effort and time to build the knowledge base and skills required to become an effective advocate. You will also be confronted with setbacks and barriers, such as institutions that are resistant to change. However, advocacy can be immensely rewarding as you may be able to effect the changes that you want to see in the world; and when that happens, remember to celebrate your successes!

My Reflections as a Psychiatry Resident

As I prepare to start my fourth year of psychiatry residency, my co-residents and I are quickly confronting the stresses of additional clinical and leadership responsibilities that come with being a senior resident. However, we are also excited by the possibilities of our graduation and the opportunities that lie beyond residency.

Our excitement is particularly compounded by the constant barrage of psychiatrist job openings and career opportunities, many with grand promises of great salaries and excellent work-life balance. However, it soon dawns on me that, despite our years of clinical training and education experiences, most of us do not have the slightest idea about career building and job selection in our supposed field of expertise. I was therefore very excited to see that the APA annual meeting created a series of sessions aimed specifically for trainees and ECPs, as these serve to address an important knowledge gap that exists within residency training.

I certainly agree with the importance of great mentorship, as I have been the fortunate beneficiary of greater mentors both inside and outside my psychiatry program. In addition to the advice provided by the session’s panelists, I would suggest it is very important to find mentors who connect with you and understand what makes you “click.” Further, I believe that the key to a successful career, or maybe even the key to happiness in life, is to find what you love doing the most and keep on doing that for as long as possible.

The importance of leadership and advocacy is understated in residency training. I have only begun to gain a deeper appreciation for them as I progress through residency and begin noticing the institution-level and system-level factors that govern healthcare. When I consider the clinical environment that I work in – the amount of time I am allocated to spend with patients, the scope of my clinical practice, and the healthcare organization and structure that I work in – all these things are easy to take for granted.

However, it is important to keep in mind that they are the results of healthcare leaders who have advocated for all the big and little things that make up the foundation of the mental health care field. It is a duty for psychiatrists to become leaders and advocates, and to continue fighting for changes that better the world for everyone.

See also, our psychiatry residents’ corner on burnout and versatility, and more highlights from the American Psychiatric Association 2021 annual meeting.

Last Updated: Jun 15, 2021