Shirah Vollmer MD

The Musings of Dr. Vollmer

Graduation Time

Posted by Dr. Vollmer on June 7, 2013


Tonight the UCLA Child Psychiatrists are marking the end of their fourteen year journey to professionalism. There are eight 30ish men and women who will begin careers for the first time, without the mandatory supervision of faculty members. Many folks see this as a prolonged adolescence in that despite their age, they have yet to experience the responsibilities of adulthood. Although they are licensed physicians, and perhaps board certified in adult psychiatry, they have never had the experience of being an employee. Thus far, they have been in this in-between land in which they are working under supervision, similar to an apprentice, while still learning their trade. They are graduating at a time in which the Affordable Care Act will soon change the landscape of medical practice. Access to mental health care will explode, leading to a high demand, but at the same time, the providers of this care will likely be primary care physicians and nurse practitioners. Psychiatrists, the experts project, will be consultants, helping those on the front lines deal with the issues of mental distress. Yet, their training has not been embedded in primary care so the jobs they jump into will not resemble their apprenticeship. This reminds me of my training where psychotropic medications were yet to explode, so I launched into a world of “psychopharmacologists” thinking that word was for those with PhDs in psychopharmacology and not clinicians. As I have often said in these posts, I was caught in a world in which my younger colleagues became great enthusiasts for the wonders of medication, whereas  my older colleagues had deep skepticism, and I could see both sides. This is the dynamics of medical training, where the embryonic development is so long, that the field one enters is not the field one exits. Excitement and apprehension ensue. These folks have had multiple graduations, from college, medical school and residencies, but “this is the one that matters” I tell my students. “This graduation means you are entering into a world in which you are now responsible for your own career.” I say, remembering the weight of this crossroads.

2 Responses to “Graduation Time”

  1. Shelly said

    So how do your students cut their teeth on real life patients with nobody looking over their shoulders, telling them what to do? I realize that they’ve had supervisors aplenty during their residency, but are they ready to do it on their own? Do they feel like they can handle everything that real life throws their way?

    • You ask, as usual, a very good question. There is no standard way to teach psychotherapy, so the skill set of the graduating resident is highly variable. How one grows into being a psychotherapist is a very intriguing question, to which I do not have a good answer. I need to ponder.

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