This limited podcast series is brought to you by APA's Women Psychiatrists Caucus and hosted by Anjali Gupta, MD, President of APA's Women Psychiatrists Caucus. Dr. Gupta is an Assistant Professor in the Department of Psychiatry at the Georgetown University School of Medicine. She has led a number of wellness and equity initiatives at Georgetown and was selected to be a Gender+Justice Initiative Faculty Fellow for her research on The Experiences of Women in Medicine. She is active with APA's Committee on Women's Mental Health and is Chair of the AMWA Literary Committee. In this series, Dr. Gupta will interview women psychiatrists across the country who lead in a variety of ways. These conversations will uncover insights from guests' journeys in psychiatry on a range of topics, including work-life integration, mentorship, gender equity, and more.

In this episode, Dr. Gupta is joined by Carol A. Bernstein, MD, Dr. Bernstein is Professor and Vice Chair for Faculty Development and Wellbeing in the Departments of Psychiatry and Behavioral Science and Obstetrics and Gynecology and Women's Health at Montefiore Medical Center and the Albert Einstein College of Medicine. She is also a consultant and Senior Scholar for the Accreditation Council for Graduate Medical Education (ACGME). She was previously Vice Chair for Education and Director of Residency Training in Psychiatry at NYU. From 2001-2011, Dr. Bernstein also served as the Associate Dean for Graduate Medical Education and the Designated Institutional Official for ACGME accredited training programs at NYU. Dr. Bernstein is a Past-President of the American Psychiatric Association and served the Association as Vice-President, Treasurer and Trustee-at-Large and as the chair of multiple committees. She has served as a spokesperson for the American Psychiatric Association on many occasions and received the 1997 exemplary psychiatrist award from the National Alliance for the Mentally Ill (NAMI). She is the recipient of the APA/NIMH Vestermark Award in Psychiatric Education and the APA Alexandra Symonds Award for contributions to the advancement of women in leadership and in women’s health. In 2018, Dr. Bernstein received a special Presidential commendation from the APA for her work in educating the public about mental illness through her role on Sirius/XM Doctor Radio. In 2019, she received the John Gienapp Award for notable contributions to Graduate Medical Education from the ACGME and the Distinguished Service Award from the American College of Psychiatrists.

Transcript

Dr. Carol Bernstein (00:00) I think I would want to have reached out more. Your generation in women I see now, they're much more apt to say, can I come and talk to you? Can you help me out? I mean, I never had those kinds of mentoring experiences or sponsorship experiences until later in my career. I just didn't have it. So I would encourage young people to reach out to mentors, to reach out to people they admire and respect.

Dr. Anjali Gupta (00:30) Welcome to season two of the Women Leaders in Psychiatry podcast by the American Psychiatric Association's Women Psychiatrists Caucus. I am Dr. Anjali Gupta, president of the Women Psychiatrists Caucus, and I will be interviewing women psychiatrists across the country who lead in a variety of ways so that we can hear their stories and learn from their insights. I have the pleasure of being here today with Dr. Carol Bernstein. Dr. Bernstein is professor and vice chair for faculty development and wellbeing in the departments of psychiatry and obstetrics and gynecology at the Albert Einstein College of Medicine. She has held a number of leadership roles, including director of residency training in psychiatry, associate dean for graduate medical education, and past president of the American Psychiatric Association. She is active in many national psychiatric associations in addition to the APA. which include the American College of Psychiatrists, the Group for the Advancement of Psychiatry, and the American Board of Psychiatry and Neurology. Thank you so much, Dr. Bernstein, for being here today.

Dr. Carol Bernstein (01:41) My pleasure.

Dr. Anjali Gupta (01:43) So I thought we would get started just trying to understand what, how did you get here? What inspired you to pursue the field of psychiatry?

Dr. Carol Bernstein (01:55) Well, it's, do you want the conscious or the unconscious reasons? I'll give you both. So I was a late starter to medicine. I was out for seven years between college and medical school. And when I entered, I had actually had some experience in psychiatry, but I was not planning to pursue a career. In fact, I didn't like my rotations. I started in internal medicine and in the middle of my internship,

I got depressed as many people do and started to talk to some of my mentors at Columbia where I'd been a medical student and decided I'd apply to two programs. So I did and I got, and by the time I was accepted, I was ambivalent. I was really loving medicine. I wasn't depressed anymore. I was feeling better. But the real reason I think that I went into psychiatry had to do with the fact that my mother had bipolar illness.

and that I really needed to understand what happened to her. So that was the unconscious motivation. It took me a long time to really talk about this. And I actually regret that I didn't make more of a statement about my own experience when I was president of the BAPA. I think it was an opportunity lost to help stigma.

Dr. Anjali Gupta (03:17) So I appreciate you sharing something so personal. How did you understand it before you came into the field? What was your understanding of what of it all?

Dr. Carol Bernstein (03:29) my mother's illness. I had no idea what had happened to her. It happened after I started college. It was very abrupt. She became a person I didn't know. I mean, in fact, I think she was probably chronically depressed most of her life. There is actually also a big ⁓ family history on her side of the family of bipolar illness that people didn't know what it was. ⁓

And I believe that when I started college, my recollection is that my dad finally got her to see a psychiatrist and he put her on antidepressant medication. This was in the sixties. And I suspect that that triggered a manic episode. But when she was in a manic episode, was something I had never seen before. And in retrospect, I've come to also understand the impact of depression on children, you know, when you have a mother who's depressed. So.

That was all after the fact.

Dr. Anjali Gupta (04:28) Yeah, and again, probably so enlightening to make sense of something that you had experienced. ⁓ So then you started at Columbia and you're still in the New York area. How has the field changed in your time since you've entered? What are some of the bigger changes that you've seen?

Dr. Carol Bernstein (04:57) It's been dramatic in that the, remember, it was probably in the nineties, it may have even been in the eighties when Paul Fink was president of the American Psychiatric Association. And his theme for his meeting was stigma. And I was very involved in, I wanted to reduce stigma. One of my early roles with the APA was on the public affairs committee. I wanted to talk.

and to educate people about it. And the shift in public perception and certainly among medical students has been dramatic. I mean, you know, mean, I COVID was contributory, but this was happening anyway. And of course there was the greater understanding that this sort of, don't wanna say the movement away from psychoanalysis, but the understanding of how the fact that many of these disorders are brain disorders.

as well, mean, you they're multifactorial as everything else is in medicine. And I think the world's understanding of the significance of mental illness has really improved dramatically since I began in the field. And I remember in the early nineties when I chaired the APA committee on medical student education, everybody was all upset because there were so few students going into psychiatry. And now,

you know, it's quote the new derm, you know, anyway, I mean, I'm just, laughing, but now the, you know, I'm working at Einstein and you know, the Dean of Students is telling students who are applying in psychiatry that maybe they want to consider double applying because they may not get in. This is unbelievable to me. And some of it's lifestyles, some of it's the fact that we can spend time with our patients. I think as primary care has gotten successively squeezed,

psychiatry has become much more appealing that way. I think the advances in our understanding of the brain have really helped in understanding all of that, but it's been quite amazing. And of course, the brain is the final frontier of medicine. So that also, you know, and also many medical students are coming into medicine having majored in cognitive neuroscience when they were in undergraduates. So there are a lot of factors that are involved.

Certainly the pandemic, you know, put this information all on steroids, if you will.

Dr. Anjali Gupta (07:29) Yeah, and what do you see as some of the most effective strategies in reducing stigma?

Dr. Carol Bernstein (07:35) ⁓ I think stories are really important. I think authentic stories are important. I think having leaders, as I was saying to you earlier, even my disclosing my own depression, my family's experience with mental illness, that as we talk about that and as people hear about it from people that they admire and respect, that that will do a lot to reduce stigma, ⁓ probably more than anything else.

And I think we have to bring mental illness still out of the shadows. And certainly in medicine, we know there's still an enormous amount of shame and embarrassment about having to admit to a psychiatric illness.

Dr. Anjali Gupta (08:20) Yeah, which ⁓ actually brings me to another topic that I know you have been really invested in, which is well-being ⁓ of the healthcare workforce. So as we consider faculty well-being, what are your thoughts? What are the hurdles that remain?

Dr. Carol Bernstein (08:41) ⁓ Unfortunately, I think there are still a lot of hurdles. I actually came to Einstein from NYU where I had been working in GME to try to focus on the faculty and their wellbeing because I saw that we were protecting medical students. We're still even protecting house staff. But when it came to the faculty, it was a different story. And I think unfortunately, the corporatization of American medicine is a big contributor to why the faculty

are so burned out and so disconnected from the meaning and importance of their work. It's not an easy answer to say that the system has to change, but the system really does. And to the extent that institutions are focused on profit over people, that's gonna continue to be a big problem. Now, the good news, the good news is, if we can look at it that way, is there are potential opportunities with AI

I think like that we could even, you and I could have this conversation on a podcast and an AI could extract the information that was most significant and lay it out for us as much the way that we could do that with notes with our patients so that we're not treating the chart, so that we're not caught up in Epic and other ⁓ electronic health record issues. And so that we can really spend the time with our patients that we want to and that we think is so important

to the health and wellbeing, not just of the workforce, but of the people we treat.

Dr. Anjali Gupta (10:14) Well, and you know, as we think about wellbeing, I think in the past, there's been a lot of focus on kind of the individual and, you know, the individual factors and resilience. But as we think about this more and talk about this more, there's also a number of systemic factors that are contributing that are trickier to address. ⁓

Right now I know there's a lot of talk about efficiency in the government, but as we extrapolate that and think about efficiency in our work environments and what would that look like to shake them up, ⁓ because a lot of that inefficiency produces longer work hours and increased workloads for faculty, which directly we know affects wellbeing.

Dr. Carol Bernstein (10:49) Thank

think that you're correct about that and that to the extent that we can use AI to help with those inefficiencies, to help with the bureaucracy, to help with the regulations, that will dramatically improve the wellbeing of our workforce who really want connection, meaning, value in their work. I mean, that's really the difference. I always bring up this analogy of Navy SEALs, my fantasy, you know,

They work together as a unit, as a community. The work that they do is really important and valued. And their hours and their challenges are enormous. And medicine is not for sissies, shall we say. And I often say to my house staff and medical students, working in medicine is not the same as working at Google. It just isn't. We're not gonna have fancy.

places to work and free meals and all of that. It's not gonna happen. And dealing with people who are sick is taxing. So we do need the individual, there's a Yerkes-Dotson curve that I often talk about that plots ⁓ stress against performance. We need to sort of get up there and maximize performance. We don't wanna send people over the edge. So that's the individual part. ⁓ But on the other hand,

As you mentioned, there are all of these issues within the system, the focus on the dollar, churning out more visits. My own PCP, this is not mental health, but my own PCP just left the faculty practice because he couldn't see his patients the way he wanted to. Of course, it's now a concierge practice, which is not great, but I decided I'd try it, just see if it was worth the money.

I can write to him and in two minutes I get a response, you know, because he's not tied up with all the miscellaneous, not relevant work, you know, the non-physician work that we talk

Dr. Anjali Gupta (13:17) Yeah, so, you know, I know you've also been super involved with medical students, with education, with residency training. And we know that our trainees are at highest risk ⁓ when it comes to burnout and in terms of thinking about wellbeing. What?

For that group specifically, do you think have been some of the advances and what is the work that remains for the residents in particular?

Dr. Carol Bernstein (13:54) Well, I think the destigmatization of mental health is really important. My colleague, Laurel Mayer and I have often choked about maybe we should really put all of the house staff on a little dose of SSRIs, maybe. It'd be interesting to do an RCT on that, but I don't think we ever could, a randomized control clinical trial. ⁓

But I think to the extent that there's reduced stigma and there's much more conversation about reaching out when you feel overwhelmed and need help, I think that's all really good. On the negative side, I worry that things become cut and paste and that people don't have ⁓ agency over their work and the meaning with their patients. We did work terrible hours when I was an intern, it was awful, ⁓ but...

The care that we gave to our patients really mattered and we felt responsible for them. And that helped reduce burnout, even though the hours were really bad. So I think we've over-corrected a bit and we need to back it up some because what's happening is these kids are graduating from residency training and they take one look at the workplace. Then they say, I'm out of here. I don't wanna stay in academic medicine. I don't wanna work in a system.

I'm gonna open my own office and not accept insurance. I mean, that's what's happening. And I'm very concerned about that because our healthcare systems that are attached to medical schools are really the places for our marginalized and underserved patients. And they're not gonna get any services if everybody goes and opens an office and sets up a concierge practice.

Dr. Anjali Gupta (15:41) So what do you think is important for students and trainees starting out to know about pursuing a career in mental health?

Dr. Carol Bernstein (15:50) Well, first of all, that I think it's a different time. So it's great. People won't be saying, why did you choose psychiatry? That's gonna be important. And as I said earlier, as the brain is the last frontier in medicine, think that they should, I mean, one of the things I used to say about psychiatric practice was the more you do it, the more interesting it gets because you'll see how unique each patient is.

I think that may be a little bit different with especially procedurally oriented specialties where proficiency in getting the procedure right is really important and consistency and our universe is much more open than that. And of course the time and the knowledge that we have of our patients.

Dr. Anjali Gupta (16:39) So another leadership role that you held was being past president of the American Psychiatric Association. What do you remember as being one of your biggest challenges you faced in that role?

Dr. Carol Bernstein (16:52) ⁓ It's very clear what my biggest challenge was there. I had invited Desmond Tutu to be our convocation speaker. And much to my shock, ⁓ there were members of the APA community who were very upset about this because they perceived him as being anti-Semitic. They didn't know him. This is all sort of, and this was, you know, 10 years ago before we had

all of the fake news out there that exists today. I mean, this was before. And I was, I had always prided myself on being able to communicate with people. And I would talk to people and I would say, but don't you understand? He's a Nobel laureate. Have you ever met him? And eventually they, people, they took out ads in psych news and said, he should be disinvited. We're gonna boycott the meeting.

And I was horrified. And ⁓ one of my friends said to me, Carol, you really have to address this. I kind of didn't want it to explode in the media. And I remember thinking, I felt for Obama, you see what distortions can happen. And that was again, early on. so I wrote a piece explaining my viewpoint and he ended up coming and it was a remarkable event and a wonderful experience, but it was...

it was very telling to me about how when you put yourself out there in leadership, become the, know, transference is pretty powerful and you get a whole lot of things dumped on you that you don't control. And I think it's, you know, it's probably why I'm happy. You know, I've sort of been there, done that now. And I want to go back and to do the real stuff and work on the ground, for example, with the students where I feel I can have a much more authentic and meaningful

role, which is what may be gravitate towards graduate medical education and medical training in the first place.

Dr. Anjali Gupta (18:58) So, you know, knowing what you know in that leadership role and you've held a number of other leadership roles with the APA, as the organization continues to think about relevance in these changing times, what do you think are some of the important key issues to consider?

Dr. Carol Bernstein (19:17) Well, I think it's challenging now because everybody's concerned about money and joining all of these professional organizations is costly. And in the old days, academic medical centers used to pay for people to belong to things and they don't anymore. So it's really a question of how important do you think it is for medicine and psychiatry in particular to have a voice, if you will, in the

public health, the public and the political arena to talk about the importance of mental health, to educate people about this, to advocate for our patients who are still the most marginalized in all of the patients that we see and to continue to work hard to make sure that there's appropriate reimbursement for services. mean, just, you know, there was a hole to do in New York.

just today over the person who ⁓ had a choke hold on a psychiatric patient who then died and he was acquitted. That was the jury decision, but mentally ill people need a lot of services and we need to be able to advocate for them and we need to be able to do it in a meaningful, political and outspoken way. And we need the national organization. Even our subspecialty organizations, which is what people join the.

you know, consultation liaison, child psychiatry, et cetera, they're smaller. know, there is really strength in numbers, which is why actually the AMA is important as well. I mean, I think doctors and psychiatrists in particular really need to have a voice ⁓ in how we take care of our patients.

Dr. Anjali Gupta (21:06) So as you've held a number of leadership roles, what have you learned about yourself as a leader?

Dr. Carol Bernstein (21:14) Well, I actually took this leadership course, executive leadership in academic medicine, ELAM, which is for women, which is, the best leadership thing I ever did. And I like to say that it's the gift that gives, that keeps on giving because at this stage of my career, I really do understand the different roles, the different strategies that

you know, what things work and what things don't. I can, and I've lived it. And for me, it's important for me to live these experiences as opposed to just read about them. ⁓ And I think that that's really important to do going forward, that we have to share our experiences about this and move on.

Dr. Anjali Gupta (22:07) In what ways do you think we can support more women in leadership?

Dr. Carol Bernstein (22:13) Women need to be in leadership. I mean, what I was saying before about strength in numbers with the AMA, unfortunately, there's still this academic pyramid. I think there are more women than men in medical school these days, or if not, it's certainly even. It's really even. But somehow, there is still this pyramid where people at the top are not, women are not at the top, women and minorities are not at the top.

And what you really need though is enlightened leadership. And I think there are women and people and minorities who are not support, who are not, you know, don't have ⁓ a way to look at things from a new perspective. And there are white men who are allies, who can do good things. And it really does have to do with changing our understanding of power structure. And I think that a big problem for women is that

we're still in these dual roles that even though men are much more involved in childcare and in the home than they used to be, no question, hugely better. And I know a lot of women who are chairs of departments, deans who have house husbands, know, somebody's kind of got to do that. But our system is not set up to help people with issues of childcare and elder care that we all face at some point.

one way or the other. And we don't have guaranteed ⁓ maternity, paternity time off. We don't have time for family time off in general. All of those things are important for the society. And I think because women have traditionally had those roles that until that system really changes, it's gonna be very hard to have more women in power. And I think...

that women in general, and these are generalizations, are more collaborative, they're less hierarchical, which doesn't mean to say that there aren't hierarchical women and that there aren't collaborative men, but in general, if you look at the hunter gatherer issues from the distant past, that's where biology does play a role.

So I think until that changes, it's going to be very hard and that women will not move up the leadership ladder because they're going to say it's not worth it. I don't want to give up the time. My family is important. My personal life is important. And these roles demand that I give all of that up. So we have to do a better job with that before I think it's going to be possible for women to really. Women need to, we're half the sky. We need to.

you know, we have to help change the world.

Dr. Anjali Gupta (25:05) So as you consider your journey, what, like, kind of knowing what you know now, what would you tell your younger self?

Dr. Carol Bernstein (25:16)

⁓

I I would tell myself to pay attention to how other people see you because we often, think women more than men have a tendency to ⁓ not value our contributions as much, not value the assets and the strengths that we bring to situations. People have always perceived me in a certain way that,

You need therapy, you need to understand how your outer self and your inner self need to come together better. I think I would want to have reached out more. Your generation in women I see now, they're much more apt to say, can I come and talk to you? Can you help me out? I mean, I never had those kinds of mentoring experiences or sponsorship experiences until later in my career. I just didn't have it.

And I think I was reluctant to even to reach out to men in power, men who could have supported me and could have helped me. just sort of stay, you know, I got, I managed to still advance, but I don't think I got as much support as I could have if I had reached out. So I would encourage young people to reach out to mentors, to reach out to people.

they admire and respect. Everybody likes to be approached for giving support and help. I love to really help my students and my residents move forward in their careers. And now fortunately, I'm in a position where I can do that. People will, and I will also say not, ⁓ you know, as I mentioned earlier, transference is really important and the fact.

that I was president of the APA, as opposed to the experience itself has helped me later on. It's given me a greater sense of security about my own abilities. And it's made people look at me differently. I keep saying I'm the same person. I don't get it. Why are you, you know, just because I held this position, you think I have something to offer, but I had something to offer before. But it is true that as you move up in leadership, you know, there's a...

There's an aura that comes around you that you can use for the benefit of others if you want to do that.

Dr. Anjali Gupta (27:46) Well, and I think a few things that you said just resonated with me and made me ⁓ think about kind of the course of people's journeys, right? I think sometimes as you move forward and you have these experiences and you do different things, you get more comfortable reaching out to people, right? But I think sometimes in those,

early parts of a career when you don't yet really maybe have that same confidence, reaching out to someone seems like a very daunting task. And of course, you know, I graduated medical school in the 90s, know, pre social media. reaching out really meant like going up to someone. And I think these days one of, you know,

The great things about social media is that there is this accessibility to reach out to people, not only at your institution, but across the country in a way that seems, ⁓ you know, you can do it on your time. You can do it 24 seven. You can do it in a very non-threatening way to, you know, to reach out. ⁓to someone, I think it's a real advantage.

Dr. Carol Bernstein (29:12) I'm gonna put in a Luddite plug here. Part of the way that I advanced was that I got involved in national organizations and that's how I met people. And while you're right about social media, we are so flooded that it may be difficult for someone to pay attention to you on social media. And that's where the in-person connections that we lost during COVID that are coming back now are so important.

because you meet face to face at and that that was really I mean I got involved in the APA assembly and I got to go to Washington and so I met people and that then just played on itself. So I would encourage people to do that and to look for people who can be in sponsorship roles. I had a ⁓ lovely young woman from Canada came up to me at the.

Association for Academic Psychiatry meeting, someone had encouraged her to talk to me because she was doing wellbeing work in Toronto. And she was afraid to come, you know, oh my God, can't, how can I come up? And we met and I said, oh, this is great. And why don't you come to this ACGME Symposium on wellbeing? She was so grateful, but I'm like in this position now where I can do that. And I will do that for your listeners. I mean,

It's really what I feel I can contribute at this stage of my career. And I have enough knowledge and enough connections to be able to do that.

Dr. Anjali Gupta (30:48) Amazing. ⁓ So you've done so much in the course of your career. Are there boxes that remain unchecked? The things that you still like have on your list to do?

Dr. Carol Bernstein (31:04) It's probably a little late for the have on the list. I never did seek out being a chair or being a dean. I probably could have done it if I were a little bit more confident, although I'm not sure. don't know ⁓ really what, you know, I don't know whether I could have made a difference in that way. I like to think that I would be able to have done that. ⁓

there was something else that you made me think of that just sort of flew out of my head about, ⁓ boxes unchecked. That's probably some of ⁓ it. ⁓ it's just, I'm trying to focus on what I have done and the fact that I want to continue to do it. That for me, retirement isn't a thing. I don't think I want to do that. I think other people do.

Maybe if I had developed more hobbies when I was younger, I haven't. I work was sort of what it was. And I like people and I like interacting. So ⁓ that's been really important for me. And just understanding that there's no right way you really have to find your own path. know, pay attention to your inner self.

You know, the things that matter to you, the things that you enjoy. I like to say to people, if you really enjoy doing something, if you really get gratification out of it, you're probably gonna be good at it. You know? So true. And I'll say one other thing. I used to think my life was just a series of serendipitous events. Serendipity does play a role, but it's not the only thing.

It's the combination of serendipity with what your own talent and your own work is all about. You can't control the serendipity part, but you can take advantage of things when they come their way. And that's important to do. And that was an interesting lesson. mean, when I spoke, when I won the Alexandra Simmons award and I had to think about what I wanted to talk about. And I thought, well, people want to know about my career. How did I get there? And I was like,

Well, it was just luck. I was just the right person in the right place at the right time. Well, some of that, but not all of it. So it's really both things.

Dr. Anjali Gupta (33:32) Well, thank you so much, Dr. Bernstein. It's been so fabulous to have you on and to hear your words of wisdom. sure I really enjoyed it and I'm sure everyone else will learn a lot from you as well.

Dr. Carol Bernstein (33:46) Well, I hope so. And I'm really out there to try and help the next generation. So pass that along.

Dr. Anjali Gupta (33:54) Thanks

Dr. Carol Bernstein (33:55) The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other... ⁓

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