Leaders in Medical Education

Dr. Deborah Hales, American Psychiatric Association

Osmosis Team
Published on Jul 16, 2014. Updated on Invalid date.

Dr. Deborah Hales is committed to advancing the field of psychiatry. She is the associate director of the American Psychiatric Association's Division of Education, Minority, and National Programs. Dr. Hales also served as the chair of the continuing medical education program at the San Mateo County Mental Health Services. Her research focuses on the destigmatization of psychiatry and the recruitment of medical students into the specialty. We had the pleasure to speak with Dr. Hales about her career in medicine and how she wishes to see medical education improve.

How did you decide on a career in medicine?

My father was an oncologist, and I wanted to be a doctor since about the fifth grade. I never really thought about anything else, which wasn’t necessarily the greatest thing. Medicine was it for me from a very early age.

What made you pick psychiatry as your specialty?

When I was in medical school, I was involved in research with two pediatricians on mother-infant attachment. I was interested in psychiatry, but there was a lot of stigma attached to going into it, including from my own father. As a result, I went into pediatrics and I finished the whole residency. I never liked clinical pediatrics; I liked the child development research. If I hadn’t picked up the stigma about psychiatry, I would have gone into child psychiatry. Instead, I went into pediatrics. When my husband had to move to California for his job, I thought the time was right to do my psychiatry residency at Stanford and I was very happy with the clinical work of psychiatry.

It seems that more medical students are pursuing interdisciplinary careers and degrees (MD/MPH, MD/MBA, etc). Can you describe how you managed to combine your career in medicine with your interest in leadership?

I took a job when I finished my psychiatry residency as a part-time Residency Training Director. At this point, I was involved in education but I also had time to practice. That was a wonderful split for me because my kids were little and my private practice was really small.  Many psychiatrists have a salaried job and a part time clinical practice.  Medical schools also need volunteer supervisors in psychiatry. This is valued by local medical schools, and keeps the practitioner up to date. It is a wonderful way to volunteer your time and allows you to stay involved in teaching, even if  you are full-time in private practice.

What do you think is the most important aspect of designing curriculum for medical students?

One thing is that all doctors need to know a fair amount about psychiatry and behavioral health because they touch every part of medicine. I think medical students need to understand the relationship between psychiatry and the rest of medicine in order to provide excellent patient care.

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I noticed that you oversee the Office of Career Development and Women’s Programs. How do you foresee women’s role in medicine, specifically in psychiatry, changing over the next few years?

Right now, psychiatry is about half men and half women. However, more and more women are going into medicine and even more are going into primary care. One of the things that I noticed even 10-15 years ago was that in psychiatry women gravitated more towards psychotherapy and men gravitated more towards psychopharmacology. I would like to see a 50-50 split between men and women in the kinds of specialities that they enter, where women aren’t gravitating towards the lowest paid part of a specialty. The change depends partly on the women themselves and partly on the environment that encourages and/or discourages women from entering these areas of medicine.

What is the biggest obstacle to recruiting medical students into psychiatry?

I think it is stigma. I think the worst stigma comes from schools where other faculty “put down” psychiatry. There are times when well-known and popular internal medicine faculty tell students not to pursue psychiatry, which is a huge barrier for students. We are doing research here at the APA about what schools are doing to beat the odds, as the average medical school has only 9% of their students going into psychiatry. There is a combination of factors that affect that statistic. One of them is how much primary care medical schools emphasize and whether or not schools offer joint/combined residency programs. It also depends on whether the faculty respect the psychiatry department or if they criticize student interest in psychiatry. When the medical school faculty in general respects psychiatry and their school’s psychiatry department, more student go into psychiatry.

Psychiatry has so many things to offer students - students have more control over their lifestyle than other specialities, yet there is still the opportunity for individual practice. My friends who went into primary care years ago now wish they were psychiatrists, especially now that they’re getting older. It is a field that gets more and more interesting every year. If you like understanding people, talking to your patients and having an interpersonal relationship with them, psychiatry is the place.

Every few weeks there appears to be a new report discussing burnout rates of physicians and the fact that many would decide not to pursue medicine if given the chance. In this somewhat disheartening environment, do you have any advice for current medical students about avoiding burnout? Or more general advice?  

I would have to say become a psychiatrist! You can practice psychiatry for much longer than other specialties and you never get bored. For example, my mother-in-law is a psychiatrist and she works part time. She has an office in her home and as she gets older, it is really nice for her to control her schedule and earn a living without having to work full-time. There are many advantages to psychiatry that make it more appealing and allow students to avoid burnout.