Leaders in Medical Education

Dr. Paul Summergrad, American Psychiatric Association

Osmosis Team
Jul 23, 2014

Dr. Paul Summergrad serves as president of the American Psychiatric Association and Psychiatrist-in-Chief at Tufts Medical Center. He is also a Dr. Frances S. Arkin Professor and Chairman of the Department of Psychiatry and a Professor of Medicine at Tufts University School of Medicine. His impressive leadership roles caught our eye at Osmosis, and we were thrilled to speak with him about his experiences in psychiatry and medical education.

How did you decide on a career in medicine?

I was thinking about what to do after I finished college in the early 1970s. I had considered going to medical school when I was a teen, but in the post-Vietnam era, I wasn’t sure. As I considered my options, I thought medical school was an opportunity to help people and it was connected closely to human biology, which I really liked. I wasn’t quite sure I would do psychiatry at the time, but it was an interesting possibility. I would say it kind of found me at a certain point. I was a substitute teaching after I graduated from college, and, in my class, one of the kids’ father was the Chair of Family Medicine at the University of Rochester. They invited me over for dinner and then I spent a summer working in the Family Practice Center with them. This opportunity pushed me in the direction of medical school.

What made you pick psychiatry as your specialty?

I was always interested in psychiatry. I was interested in the philosophical questions about human nature as well as human biology and the brain sciences. I was curious about what allowed people to be conscious. It just seemed to be a natural focus for me and one that I kept coming back to. I actually resisted it for a long time - I trained in internal medicine first. I did my residency at Boston Hospital and a lot of people had complex medical psychiatric illnesses. At every turn, I was interested in the neuropsychiatric complications of those illnesses. I decided that I needed to train in psychiatry at that point, so I continued and did my psychiatry residency at Mass General.

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 had been working at Mass General after my residency and I became involved in how to respond to contracting  requests for my inpatient service. To do so, I put together a whole team. It was something I had never done before, but I found it interesting and I enjoyed what I was doing. I became passionate about wanting to do things in a better way for my patients and it just kind of took off from there. Looking back, it seems to have just happened. I’m not sure I pursued it and it has evolved into a major part of my career. It is interesting and important and as long as it stays focused on the core values and the mission, it is great. If it becomes about the money or authority or power, it is no longer worth it. But if it is about doing something that is good, it is satisfying.

What are the top two or three things you would change about the way we train our physicians?

Medical students, particularly in their third year, often jump from one hospital to another. There are very intense experiences taking care of patients and very few opportunities for them to sit back and reflect. When you’re doing training in medicine at the student level or resident/fellow level, you need to become immersed in it and you need to have an adequate amount of clinical experience to identify patterns of illness. William Osler, one of the founding professors of Johns Hopkins Hospital, said, “ The study of the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all”. I think it would be beneficial if there was a longitudinal group so that med students could come back and have a relationship with someone. This would prevent them from becoming overly callous to the suffering they see around them.

I remember the first day I went to anatomy and they showed us a film about how to do an autopsy. The autopsy was being done on a young woman. I had never in my life had an anxiety attack, but for about 5 minutes I couldn’t get over the fact that this woman was dead and they were cutting her open. She looked like she could have been the woman sitting next to me. There is no place to metabolize these types of experiences.

Another thing is that I think we need to be very careful that our resident experiences are intensive enough and there is enough continuity of care so that people learn what it is to become a confident physician. There is a recent article in the Wall Street Journal about the training that Navy Seals go through. They are really trying to train people in leadership under great stress. Not that doctors should have the same training, but we need to think about the developmental and transformational role of residency training as well.

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Much of your work revolves around mental health and society. What changes do you think need to be made to overcome the stigma associated with mental health?

I think it is really hard because these are complicated illnesses. Some of it has to do with the way we talk about these things in the media and the tendency to use disparaging language. Secondly, there is an association in people’s minds between violence and mental illness, though it has been shown to be statistically untrue. The third piece is that  these are  illnesses which affect our most intimate sense of self, and it is hard to overcome an internalized stigma. In addition, there are a wide range of illnesses and not all of them are stigmatized. People with anxiety disorders might not be as stigmatized as people who have schizophrenia . PTSD is generally less stigmatized but it may also be associated in people’s minds with having difficult experiences and recurrent nightmares. These are things that are potentially scary for people because they affect our most human functions. I think we need better education and improved language when we talk about mental health. Fortunately, there has been a change in the last 20-30 years.

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 think people should ignore it. Most of the physicians that I know are actually very happy practicing medicine and, while there may be some that are burnout, it happens to people in every type of field - lawyers, architects, teachers, cab drivers, etc. The opportunity to be a physician is an unbelievable one. You are able to use scientific knowledge to benefit people who are hurt and suffering and you are able to be with people at difficult times but also at wonderful ones, such as when a baby is born or a loved one is cured from an illness. I see people who come in depressed and not sleeping, and in a little while, they are back at work and satisfied with life. Don’t worry about the money, just do what you are passionate about and the rest will take care of itself.