In recent years, more psychiatrists have gravitated toward administrative positions as their primary function in an ever-changing behavioral health care environment. At the same time, many such psychiatrists have also wished to further establish, or preserve, professional identities as academicians. The ability to successfully combine these two pursuits often results in a very diverse, challenging and satisfying career path. The road to such personal career development takes considerable time, experience and significant effort on the part of the practicing psychiatrist, but, when successful, the results can be a career situation that meets many of an individual psychiatrist's most important personal and professional needs.
A Personal Perspective
After residency, like most young psychiatrists, I took a series of positions that served to bolster my clinical skills. I worked in the U.S. Department of Veterans' Affairs system, a hospital-based practice and community mental health care centers in two different states. I received valuable experience in both the public and private systems of psychiatric care and was exposed to a broad range of psychopathology and different models of behavioral health care. I also had the chance to embellish my clinical expertise in geriatric psychiatry, a subspecialty of particular interest.
Although I was happy spending all of my time providing direct patient care, certain needs were missing. I had always greatly enjoyed teaching and lecturing, plus I had hoped for more flexibility in respect to my time demands. Essentially, I wanted more balance -- in both my personal and professional life.
When a colleague offered me a medical administrative position in the Illinois state public mental health care system, I seized the opportunity. It had always bothered me that the most severely ill psychiatric patients often had the least access to the highest quality medical services. I viewed this career move not only as a challenge, but also as an opportunity to do some good for an underserved population and, quite frankly, a chance to better mold my own career. I agreed to that position just under five years ago, and there have certainly been ups and downs. However, the decision has been a good one, not only for me but also, I believe, for the systems of care in which I practice.
At present, I am associate medical director over psychiatric services at a 167-bed, state-operated psychiatric facility in suburban Chicago. In this capacity, I supervise physicians and other clinical staff, perform a variety of clinical administrative duties, and am a member of the facility's leadership team. When hired for the position, I was also told that part of my job would be to better cultivate the relationship with an academic affiliate, University of Chicago. For me this was an attractive bonus to assuming the clinical administrative role with the state hospital. I became a faculty member in the university's department of psychiatry, and I continue to serve as a liaison between the university and the state hospital. How far I wanted to go with this opportunity was really up to me.
Dealing with two large bureaucracies can be a challenge and must be seen as such right from the outset. However, if this bureaucratic "marriage" is supported by both administrations, everyone benefits. I have been very fortunate in that the administrators of both the state hospital and the university have been extremely supportive of this endeavor and my particular role in this process. Facilitating that support depends on being able to show each side the respective benefits from such a collaboration.
There are many benefits to a university affiliating itself with a public mental health care system. A state-operated psychiatric facility can provide a rich training ground for medical students, residents and other trainees. The public mental health care systems have large numbers of patients, some of whom suffer from the more interesting and severe psychopathologies.
In my administrator/academician role, I coordinate the medical student clerkships and psychiatry resident inpatient and outpatient public sector rotations for the university. This requires considerable time and effort, strong organizational skills, good communication and interpersonal skills, and the ability to identify and recruit good teaching psychiatrists into the public system. The result of this endeavor has been the development of clinical rotations in public psychiatry that the trainees consistently rate very favorably.
The university system further benefits by receiving financial support from the state system for resident and faculty stipends. In addition, the state hospital refers patients to the university for clinical services it may not be able to provide (for example, medical psychiatric services, electroconvulsive therapy, neuropsychological assessments and so on). Also, the public sector facility serves as a patient recruitment pool for clinical research trials that the university may have underway. From a community relations perspective, the university develops the reputation, deservedly so, of providing meaningful public service.
Conversely, the public mental health care system clearly benefits, since the academic presence and interactions with the university are stimulating, heighten the level of professionalism expected from its staff and give more credibility to the state hospital. It also allows for high-quality educational opportunities for the state hospital staff, such as grand rounds, visiting lecturers and on-site consultation from university faculty.
The state hospital psychiatrists who supervise the medical students and residents consistently report that this experience adds to their own professional growth, job satisfaction and clinical stimulation. The university affiliation is also a good recruiting tool to bring the best psychiatrists possible into the public sector. Most important, the patients being served by the public mental health care system benefit from access to a broader range of services, cutting edge treatments and an embellished level of clinical expertise from their providers. It is a "win-win-win" situation.
For me, such a merger has allowed for vast career development through a tremendous variety of professional experiences. In addition to coordinating the training rotations, my administrative position allows the flexibility to spend some time during the week providing direct clinical care and teaching in a university clinic setting. I run a geriatric psychiatry clinic at the university and supervise residents and medical students. The university department benefits by getting a clinical and teaching need filled by a board-certified geriatric psychiatrist, while I get the opportunity to keep my clinical skills sharp and satisfy my desire to teach. Maintaining at least a part-time clinical practice and teaching trainees enhances my performance as a medical administrator and supervisor in the public mental health care system.
Good psychiatrist-administrators must first be good practicing psychiatric clinicians. If they are good teachers, then they are truly in a position to succeed. The ability to have time dedicated to speaking and lecturing in the surrounding medical community is also enjoyable and rewarding. It benefits not just myself but serves as a valuable public relations tool for both the state hospital and the university.
Initial career opportunities in psychiatric administration often exist in the public systems of care (Veterans' Affairs, state hospital systems, community mental health care centers, the department of corrections and so on). Bringing competent, qualified psychiatrists into these systems as clinical administrators is necessary to elevate the quality of care. Enhancing the quality and delivery of mental health care -- especially for underserved groups -- can be personally gratifying. A 1999 survey of the American Association of Psychiatric Administrators (AAPA) revealed that psychiatrist administrators are among the most satisfied psychiatrists in respect to career choice.
An academic career in psychiatry may not offer a high income, but the benefits can be equally attractive -- and complementary -- to those of the psychiatrist administrator. Professional stimulation, the challenges of teaching, research endeavors and the chance to remain on the cutting edge of new clinical knowledge are all enticing reasons to be involved with a good academic institution.
Mixing an administrative career in psychiatry with academic pursuits seems in many ways to be a natural fit. Issues like conflict resolution, consensus building, decision making and navigating challenging organizational dynamics require a multitude of skills. A good clinical psychiatrist with an academic background should have a strong knowledge of group dynamics and is perhaps better suited for a position in administration than any other medical specialty.
At the 52nd American Psychiatric Association's Institute on Psychiatric Services, held in Philadelphia in October 2000, I had the privilege to chair a workshop on this subject. The workshop, affiliated with the AAPA, presented three psychiatrists, each a high-level medical administrator from a different mental health care system, who also maintain an active university faculty appointment with significant teaching and/or research responsibilities.
Marc D. Feldman, M.D., medical director of the Center for Psychiatric Medicine and professor of psychiatry at University of Alabama-Birmingham (UAB), described merging a career in expert-witness work (and research) with multiple administrative duties. Feldman is a nationally known expert in the areas of factitious disorders, Munchausen by proxy and malingering, having written three books on these subjects. While a full-time UAB faculty member, he served as regional medical director at a for-profit managed behavioral health care organization not affiliated with the university. He described the key to initial success as being the existence of a good working relationship between the respective administrative leaderships. An excellent relationship can lead to outstanding models of university and managed behavioral health care collaboration. Feldman pointed out that in the absence of such a solid relationship, it is difficult for the endeavor to prosper.
Mary Ellen Foti, M.D., is an area medical director in the Massachusetts Department of Mental Health. She merges that role with that of a principal investigator of a Robert Wood Johnson Foundation grant researching end-of-life care for people with serious mental illness. She described how, as a public mental health care administrator, it is necessary to maximize leadership skills to move an agenda from the hospitals and community. For the research side of her career, she discussed the leadership skills required to achieve maximal efficiency, direct personnel management and meeting set deadlines. Foti discovered that her skills in administration and her skills in research improved her performance in both areas. This is a common theme heard from those who have successfully combined administrative and academic roles.
The third panelist was Sy Saeed, M.D., chair of the department of psychiatry at University of Illinois College of Medicine at Peoria. He also serves as clinical director of the Comprehensive Community Mental Health Service NetWork of North Central Illinois. Saeed spoke of his research on the development and application of evidence-based treatment guidelines and algorithms. He anticipated that this academic pursuit will ultimately translate to real-world benefit in the community mental health care centers under his administration, thus adding value to both systems.
Administrative and academic careers in psychiatry often provide a nice mix for many psychiatrists. However, the success of such a merger depends on several issues. These factors include strong support by both administrative bodies, identifiable mutual benefit to the systems involved, and key clinical and administrative players who are highly supportive of your efforts and personal career development. There must be people at high levels in both systems who support the endeavor and respect the time demands placed on the individual psychiatrist who attempts to bridge these systems. A psychiatrist also needs to recognize and take advantage of the potential of various opportunities and situations that may meet their own personal needs. This must be done in such a way to clearly promote the resultant benefit to the systems that are being incorporated.
Creating such a career requires planning, time to develop the necessary clinical and leadership skills, and the building of relationships. The aspiring psychiatrist has to be open to challenges that will undoubtedly surface, embrace change and think creatively to arrive at such a destination. Some tasks may need to be taken on with little or no financial reimbursement at first, but if the individual psychiatrist is farsighted, the development of a career with time flexibility, intellectual stimulation, a respectable and stable income, lifestyle advantages, and professional satisfaction is certainly achievable.
No one is going to suddenly offer you the perfect job that immediately meets all your needs and desires. You must be proactive, envision your career and make it happen. In the end, it is the individual psychiatrist who is ultimately responsible for constructing a career that adequately meets their own personal and professional needs.