February 5, 1999

by Ann S. Maloney, M.D.

Early career psychiatrists have lots of interesting real life stories to be told. I'm going to tell you mine in hope that someday you'll let us know yours.

I'm three years out of residency and 47. How did this happen?

Psychiatry is my third career. I'd always wanted to be a doctor, but it took me a long time to get here. I started out my professional life as a medical technologist. As the supervisor of Michael De Bakey's open heart surgery lab in Houston, I soon learned the kinds of medicine I didn't want to do but had yet to find my true calling. In the meantime, I embarked on another occupation-training in decorative arts and then running my own profitable interior design business. Even then, I wasn't satisfied. I still wanted to become a physician. I just didn't know what kind.

And then, in 1980, I found myself in a life crisis and thus in the office of one of Houston's most effective clinical psychiatrists. And all at once everything fell into place for me. As I found myself, I found my profession and my passion. I looked at Dr. C and said, "This is it. This is the medicine for me."

It's 18 years later: medical school in Houston, the move to New York, a residency at NYU culminating in my appointment as super chief resident, two-and-a-half years so far of psychoanalytic candidacy at the Columbia Center, five years of involvement in APA (one as the charter chair of the Assembly Committee of Early Career Psychiatrists), and a 50-hour practice in psychiatry (individual and group psychotherapy, psychopharmacology, and psychoanalysis). I really can't believe it. Me-the jock from Michigan who raced slalom and who, as a St. Mary's coed, cheered the boys of Notre Dame. But it's true. I've become the doctor I always wanted to be.

I'm sure lots of you have stories like mine. Lots of you have struggled to make viable and rewarding professional lives for yourselves. We, your representatives, would like to read about them in this column. But first let me tell you a little bit more about my more recent experience setting up shop.

In fact, it wasn't easy changing careers and becoming a student again. After 10 years as a trainee living close to the bone, I found myself in my 40s itching to become a grown-up again, with an adult's lifestyle and income. So, informed by business experience and aided by my involvement in APA, I set about taking the necessary steps to build a successful practice. En route to this I, like many of you, took on a lot of jobs to support myself and to gain experience in the field as a whole before striking out completely on my own. While I was a resident in a costly analysis, I moonlighted, of course-a 17-hour shift every other week in the Bellevue "up wards." When I graduated from residency, and while I built up my patient load, I became the medical director of a private substance abuse center. I still work as a consultant for this clinic as well as for a computer company that's trying to develop the definitive software for mental health.

But what I'm most fulfilled by is the day-to-day work in my office with psychiatric patients-the work I wanted to do ever since that fateful encounter in Houston nearly two decades ago. And how did I do it?

First, there's the need to learn what people are all about. Psychoanalytic training has honed my skills in a whole array of therapeutic modalities, including the management of medications. Of course, not everybody can or would choose to embark on this demanding course of post-postgraduate training. Still there are courses on psychodynamic therapy that numbers of analytic schools are offering psychiatrists deprived of this in their residencies. The best way to keep patients is to understand them.

Then there is the need to get them into your office, to generate the patients themselves, to network. Referrals have come to me through my former training director, internists with whom I did my internship, my teachers and colleagues at the psychoanalytic center, and the district branch patient referral service.

Now, my colleagues and I on APA's Early Career Psychiatrist committees have drawn from our experience to help our peers develop practices of their own. Bill Callahan, the current chair of the Assembly Committee of ECPs and a man with his own interesting story, and I have developed an ECP workshop, "How to Launch a Successful Private Practice" sponsored by Professional Risk Management Services Inc., the administrator of APA's Professional Liability Insurance Program. First done at the annual meeting last spring in Toronto, it's become an annual APA event. What's more, we've taken the show on the road, offering it in each of APA's seven Areas. In these meetings, Bill and I share our personal experiences with the participants, our peers. We concentrate not only on the practicalities involved in making psychiatry work for psychiatrists and the challenges posed by the economic stresses of this era, but also on the new clinical opportunities we have-our exponentially expanding ability to help our patients as never before.

Bill and I look forward to meeting you at a future workshop.