{"id":45038,"date":"2014-03-22T11:25:12","date_gmt":"2014-03-22T15:25:12","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=45038"},"modified":"2014-03-22T12:02:16","modified_gmt":"2014-03-22T16:02:16","slug":"not-define-it","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/03\/22\/not-define-it\/","title":{"rendered":"not define it…"},"content":{"rendered":"
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Cultivating the Next Generation Of Psychiatrist<\/a>s<\/div>\n
PsychiatricNews<\/font><\/strong><\/div>\n
by Carolyn Rodriguez, M.D., PH.D.; Jonathan Amiel, M.D.; and Jeffrey Lieberman, M.D.<\/div>\n
March 20, 2014<\/div>\n

The beginning of a psychiatrist’s career after residency or fellowship is an exciting, but daunting, time. Whatever career path he or she is pursuing—clinical practice, academics, public sector, or industry—the transition from trainee to professional is critically important and often stressful. There is the challenge of having primary responsibility for one’s own patients. The desire to become comfortable in a new work environment and with new colleagues. The understanding that no matter how thorough our training has been, there remain difficult situations that arise in practice, testing our knowledge and mettle. APA well understands the need to support psychiatrists at this stage of their development and even has a special name for them: early career psychiatrists [ECPs]. Every psychiatrist and member of APA has faced this juncture in their careers. Consequently, we recently reviewed APA membership survey data to learn what special needs and services applied to this important constituency of our profession. <\/p>\n

We were surprised to see that while resident-fellow members saw value and were pleased with APA membership, many weren’t continuing their membership as they entered the field and the professional workforce. We wondered whether this may be due to the fact that, in a changing and challenging environment, we may too often focus on the challenge of the moment over our longer term professional needs and enrichment. This problem was particularly concerning since APA membership is especially helpful early in one’s career for educational and mentoring resources. And more importantly, young members strengthen APA and shape the Association now and for the future. <\/p>\n

To examine this issue, we co-chaired a work group of ECP members and two senior APA advisors to find out what APA was — and wasn’t — doing to support the needs of psychiatrists just starting in the field and what could be done better. Based on the work group’s recommendations, APA, with the full support of the Board of Trustees, is focused on making sure that the needs of psychiatrists just starting their careers are optimally addressed…<\/div>\n<\/blockquote>\n
Conflict of Interest Statement<\/font><\/strong><\/em><\/u>: One’s view of recent history at large is irreconcilably bound to one’s own personal experience. And the study of history often involves a critical review of what the people of the time said about the period under the microscope. I had been an Early Career Physician<\/em> already in the field of Internal Medicine. For me, being an Early Career Psychiatrist<\/em> was the second time around. And what a time to enter the fray – in the middle of what is now called "the crisis of the 1970s<\/em>". To say psychiatry was changing is beyond an understatement.<\/div>\n

In some ways, I was lucky. I was torn between two compelling interests – the hard science of medicine and the human experience of illness. I had already had my identity crisis before arriving in psychiatry training and made my choice, so I was running on my own motor towards the latter. I had no idea that psychiatry itself was about to go the other way, and during my Early Career Psychiatrist<\/em> days, it did. But I didn’t. And again, I was lucky. I was able to have a rewarding career doing what I chose to do, even though it was isolated from mainstream of psychiatry. I have a thought about what Dr. Lieberman et al are saying in this article, but it’s idiosyncratic, biased by my own path.<\/p>\n

Cultivating the Next Generation Of Psychiatrists<\/font><\/strong><\/em><\/u>: People talk about the neoKraepelinians [Robins and Guze etc.] or the DSM-IIIs Robert Spitzer as the movers and shakers of the changes in psychiatry in 1980, but that credit really belongs to Mel Sabshin, the Medical Director of the American Psychiatric Association from 1974 to 1997. His book, Changing American Psychiatry: A Personal Perspective<\/a>, tells the story from his front line perspective. He was a strong and beloved leader who did what he set out to do – change American Psychiatry.  I didn’t even know he existed at the time. The APA under Sabshin took the reins of the direction of psychiatry and lead the radical changes we all already know about, some of which were positive and long needed, some of which were either ill-considered or had inadvertent negative consequences.<\/p>\n

The above article is really about the APA’s continued waning membership roles, and why young psychiatrists see APA membership as superfluous. I wasn’t so young when I let my APA membership expire. At that time, the APA was leading psychiatry in a particular biomedical direction that had little to do with my life and practice. In contrast, I didn’t see the APA taking leadership at all in areas that were of interest to me, but rather following Managed Care and PHARMA who were shaping and redefining psychiatry in their own image. So the APA was more than superfluous. It was a negative force that I couldn’t do anything about, but I sure wasn’t interested in supporting.<\/p>\n

The way the story’s told, psychiatry needed a Melvin Sabshin to consolidate power to motivate change, and that may well have been absolutely true. I wasn’t around for that so I don’t really know the answer. But there were some unaddressed consequences that linger. The first was that the APA hadn’t read Bion’s books about groups and became lethal – extruding the psychoanalysts and the psychologically minded almost en mass [exception: Aaron Beck’s CBT], actually assigning us to the status of scapegoats. That attitude unfortunately bled over into the APA’s relationship with the other mental health professions. So people like me didn’t actually withdraw from the APA, we were marginalized. But more importantly, the APA under Sabshin consolidated and centralized the power, and never gave it back. History is filled with similar stories – a strong leadership that brings off a coup d’etat as a reform movement, creating the environment for a future oligarchy in the process. Sometimes, that’s the only way to get the job done [by revolution], but the wise know that a subsequent restoration of balance is essential.<\/p>\n

The APA didn’t do that, and continued to hold the reins tightly – going on to became a power base for a biomedical ideology that seems primarily allied with the forces of industry. In the last decade, the ideologically driven APA attempted to "do it again<\/em>" by using the revision of the Diagnostic Manual to further change psychiatry to fit a particular view just as Sabshin and Spitzer had done [but with a different agenda]. But the "second coming<\/em>" fell very flat. Even the title of this article contains the problem – Cultivating the Next Generation Of Psychiatrists<\/font><\/strong>. It implies a centrality that exists primarily in the minds of the APA leadership, but apparently not in the minds of the majority of psychiatrists or its newest arrivals. A professional organization is meant to represent and serve that profession as a whole, not define or even cultivate it…<\/div>\n","protected":false},"excerpt":{"rendered":"

Cultivating the Next Generation Of Psychiatrists PsychiatricNews by Carolyn Rodriguez, M.D., PH.D.; Jonathan Amiel, M.D.; and Jeffrey Lieberman, M.D. March 20, 2014 The beginning of a psychiatrist’s career after residency or fellowship is an exciting, but daunting, time. Whatever career path he or she is pursuing—clinical practice, academics, public sector, or industry—the transition from trainee […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-45038","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45038","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=45038"}],"version-history":[{"count":22,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45038\/revisions"}],"predecessor-version":[{"id":45060,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45038\/revisions\/45060"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=45038"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=45038"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=45038"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}