Latest / The Medical Mind / Women Psychiatrists Caucus Chats: Leading Forward with Dr. Rashi Aggarwal

Transcript

Women Psychiatrists Caucus Chats: Leading Forward with Dr. Rashi Aggarwal · The Medical Mind

• 0:00
  being a leader is always thinking about who are the people you are impacting and are you impacting them in a positive way and supporting them or not.
• 0:10
  you
• 0:16
  Welcome to season two of the Women Leaders in Psychiatry podcast by the American Psychiatric Association's Women Psychiatrists Caucus.
• 0:25
  I am Dr.
• 0:26
  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
• 0:36
  their stories and learn from their insights.
• 0:40
  Today I have the pleasure of being here today with Dr.
• 0:42
  Rashi Agarwal.
• 0:43
  Dr.
• 0:44
  Agarwal is the Chair of Psychiatry and Behavioral Sciences at Northwell Staten Island University Hospital.
• 0:52
  Before joining Staten Island, Dr.
• 0:54
  Agarwal was Professor of Psychiatry at Rutgers New Jersey Medical School, where she was Director of the Residency Training Program and Vice Chair of Education.
• 1:04
  Dr.
• 1:05
  Agarwal is a national leader in medical education, physician wellness, and consultation liaison psychiatry, and has held numerous leadership positions, including deputy editor
• 1:16
  for academic psychiatry, chair of APA's Council on Medical Education and Life-Long Learning, and secretary of adpert.
• 1:25
  Welcome, Dr.
• 1:26
  Agarwal, and thank you so much for being here today.
• 1:29
  It's a pleasure to be here, Anjali.
• 1:32
  So I thought we would start out going to the very beginning.
• 1:36
  How did you decide to go to medical school and eventually into the field of psychiatry?
• 1:45
  For me, medical school, you I trained in India.
• 1:47
  So you make a decision of when to go to medical school in high school.
• 1:51
  So it's not as thought out as it is here, but I wanted to go to med school because I just wanted to heal.
• 1:57
  Like, you know, this vague feeling of I want to help people.
• 2:00
  um When I landed in medical school, I remember feeling a little bit frustrated where I didn't feel that we were doing that much healing.
• 2:10
  um
• 2:13
  somehow it didn't feel like we were making as much of an impact as I would have liked to make.
• 2:17
  And felt a little bit lost till I started my clerkship year.
• 2:24
  And then I think for me, I had no idea about psychiatry as a field, but till I started my psychiatry clerkship and it was almost like love at first sight.
• 2:35
  And the way I knew it was love at first sight is that honestly, I was a mediocre medical student actually.
• 2:42
  So, you know,
• 2:43
  You have a group of 20 students and are doing a clerkship and the ones that hide in the back, was sort of, I was happy hiding in the back.
• 2:51
  But in psychiatry clerkship as the preceptor or the attending asked questions or discussed cases, I saw myself naturally raising my hands, being interested.
• 3:03
  And which leads to a positive cycle of that made me read more and actually be not just a mediocre.
• 3:11
  I actually ended up
• 3:12
  really enjoying that.
• 3:13
  that was a start.
• 3:14
  ah And then as I started thinking more formally about it on what I should do uh after med school, uh you know, I reflected on the fact that uh friends and people would come with
• 3:28
  problems and I love listening to them.
• 3:29
  So I'm like, oh, it seems like psychiatry might be something I'm really passionate about.
• 3:35
  So you mentioned that you trained in India and that you decided in high school.
• 3:41
  Did you know uh doctors or you mentioned healers or how did you kind of get there?
• 3:50
  I had a lot of doctors in the family.
• 3:54
  So, and a lot of like, I feel like my family was divided into professors who are like sort of teaching college doctors and then business.
• 4:04
  So out of those, to me, medicine seemed to be the most appealing, but I didn't really know what people, what they actually do.
• 4:11
  It was more like, you know, I want to do something meaningful in society.
• 4:15
  I want to make a difference.
• 4:16
  I want to help people.
• 4:17
  So it sort of came from there, but there were no psychiatrists.
• 4:20
  at all in the family.
• 4:22
  And in fact, when I did make the decision to go into psychiatry, there was a lot of informal and formal sit down sessions on why it might not be the best thing for me to do.
• 4:33
  There was a lot of stigma against psychiatry.
• 4:37
  That time, and I think it still persists, but it was definitely choosing psychiatry as a woman at the time I did, I did have to go against the stream to do so.
• 4:49
  And then how did you decide to come to the United States or at what point did you come here for your training?
• 4:59
  wow, that sort of goes into a little bit of a personal history of Sakyan's and also cultural, I guess.
• 5:06
  um So I was looking for psychiatry residency in India, um which is also people might not realize that as competitive as it is getting into residency here, getting into
• 5:19
  postgraduate training in India is pretty competitive because
• 5:22
  Not all physicians are expected to do post-graduation like here.
• 5:25
  You can practice as an independent physician right after med school.
• 5:28
  You don't have to do post-graduate training.
• 5:31
  So I was applying for psychiatry.
• 5:33
  At the same time, it was time for me to think about marriage and family.
• 5:37
  And for me, at that point, um I didn't have somebody I wanted to get married to.
• 5:45
  even the traditional route, is arrange marriage route.
• 5:50
  I wasn't really planning on sharing this, but.
• 5:52
  em And one of the calmest things that came up during, so arranged marriage is a little bit like, if you were interviewing for a job and both sides are interviewing each other and
• 6:04
  thinking about how they like the other person.
• 6:09
  So it's not as what people think here sometimes.
• 6:12
  When you think of arranged marriage, people in US think that it's, you're being told what to do.
• 6:17
  It's not exactly like that.
• 6:18
  Families decide and meet and then the person and what people involved, the female and the male, they meet and they decide too.
• 6:29
  At least a few times I heard this thing, this would be a great match, but are you willing to change your field?
• 6:36
  What about pathology?
• 6:38
  ah That's a nice field for women.
• 6:41
  It's family-friendly, things like that.
• 6:45
  I had no plans to come to US uh till that time.
• 6:51
  these conversations sort of helped me sort of rethink my plan of where I wanted to do my psychiatry training.
• 6:58
  And then of course, uh the lure of good psychotherapy training that US has combined with these experiences made me decide to actually uh get married to somebody in US and do my
• 7:13
  psychiatry residency here.
• 7:15
  So that's how I ended up coming to US.
• 7:19
  So it was really because of psychiatry, though I did come through because I had an arranged marriage with someone in the United States.
• 7:28
  Yeah, so let's talk a little bit about that.
• 7:31
  you were, know, what is sometimes so common for women, were juggling this new professional life and then also your new personal life.
• 7:43
  How was that transition in terms of being an international medical school graduate and coming into the US?
• 7:53
  For it wasn't as challenging as I think IMGs are finding it now.
• 8:00
  Though I also think I'm a glass half full person.
• 8:04
  So I sometimes tend to dismiss the struggles I had because, you know, it all turned out, you know, everything is for the best in the end kind of a thing.
• 8:14
  I had always, because my interest in psychiatry was also very psychotherapy focused interest.
• 8:20
  I moved to California and
• 8:24
  before I even started applying for residency, you know, studying for your semilies, took them and then I'm like, okay, I want to learn more about psychotherapy and also build my
• 8:34
  research portfolio before I apply.
• 8:36
  So, and as luck would have it, uh you know, I lived close enough to Stanford where there was the steady on-group psychotherapy.
• 8:44
  And I had always found this fascinating that psychotherapy could have an impact on breast cancer patients and their quality of life.
• 8:52
  So, so I
• 8:54
  literally just walked into David Spiegel's and Katherine Klaassen's lab saying, hey, I'm interested in your work and I work.
• 9:01
  And so I ended up like, couldn't work with David Spiegel himself, but with Katherine Klaassen, who was doing group psychotherapy studies.
• 9:07
  So I ended up doing research work there.
• 9:09
  uh So
• 9:12
  I didn't find the journey as hard, though it was longer.
• 9:15
  uh remembering my glass half full propensity, uh I did match the first time I applied, but not necessarily in the program that I would have liked to match uh geographically.
• 9:32
  We had to move from California to New York because of, I'm delighted with where I trained, but I had to move and my family had to move.
• 9:42
  because which would not have been our first choice.
• 9:45
  And I remember somebody telling me very clearly because I was working at Stanford as a researcher at that time that they wouldn't say it formally, but you're an IMG.
• 9:58
  We don't usually take IMGs.
• 10:00
  And California was much harder for IMGs then.
• 10:03
  And I'm not sure what the status is now, but it's still hard.
• 10:07
  So there were challenges definitely.
• 10:11
  Also, you it was enjoyable.
• 10:13
  Learned a lot in that journey.
• 10:15
  And I know you've been a residency training director yourself.
• 10:21
  Are there certain practices or ways that you could support IMGs in their training as you think through your own experience?
• 10:33
  I think the biggest way to support is really acculturation.
• 10:37
  So it really depends.
• 10:39
  For me, when I started residency, I was already in United States for five years and ah had a lot of friends and people who were not just IMGs or international visitors.
• 10:54
  So when you start residency, there is a lot of cultural things that one can...
• 11:01
  oh
• 11:02
  The common advice of watching shows doesn't really work because that's not really always reflective of what happens in day-to-day life here.
• 11:11
  So the best advice is really to, know, the comfort zone is to sort of fall in groups where you feel most comfortable, right?
• 11:19
  So you, a group of IMGs or a group of people with your ethnic background.
• 11:24
  But what really helps is when you sort of mingle, when you truly acculturate, right?
• 11:29
  Where you are actually making friends with people from all.
• 11:32
  kinds of backgrounds.
• 11:33
  So in some ways, the way we have in residency sometimes where a particular residency program will have only IMGs or only US medical graduates, that's not the best model.
• 11:46
  Like if you have both in the natural group formation, the natural friendships, we all learn from each other.
• 11:52
  And I think that is the easiest way to accumulate.
• 11:55
  um Other than that, like, you know,
• 12:00
  I come from a country where we train in English, so that made my journey easier.
• 12:05
  So if English is not your language of medicine and you have to learn a whole, so that is definitely a challenge that people have to sort of work on.
• 12:14
  And if that's a struggle, training programs can support their residents in that.
• 12:19
  But the other one is just acculturation and sort of being more aware that when somebody is saying something or doing something, is it reflective of a cultural background or is it
• 12:30
  When we say, quote unquote, problem residence, what is the context?
• 12:34
  And to have a little bit of a more growth mindset.
• 12:39
  But that is true if you're doing your job as a residency training director.
• 12:45
  That is true for all residents.
• 12:47
  So IMGs, don't think, need anything special.
• 12:49
  They just need what all residents need, which is a growth mindset and being aware of the individual's background.
• 12:58
  Yeah, and it sounds like what you're saying in openness to really understand their experience um and if there are things that could benefit them no matter what the resident
• 13:11
  but.
• 13:12
  And you know, we learn from each other.
• 13:14
  As a training director, there are things I've learned from my residents.
• 13:17
  So it's not that the teaching is unidirectional.
• 13:21
  We really do learn from everyone.
• 13:24
  Yeah.
• 13:26
  And then you got drawn to CL psychiatry.
• 13:30
  Was that from these initial psychotherapy groups or how did you land there?
• 13:37
  Yeah, you know, for CL, was always, uh for psychiatry, psychiatry was my love.
• 13:44
  CL was a little bit more cognitive decision than falling in love.
• 13:51
  I was good at liaison aspect of it, good at, you know, I had developed a reproductive psychiatry elective for myself in my fourth year, just because I was interested in the
• 14:01
  topic and I could reach out to somebody in OB instead of health.
• 14:06
  create a new rotation where there was none.
• 14:07
  um I was not planning to go for fellowships, but my program director said that being an IMG, it would be good for you to go and do a fellowship in a uh more established academic
• 14:21
  program.
• 14:21
  um And then when I thought about which fellowship to do, CL made the most sense because of that.
• 14:27
  And honestly, in retrospect, I can't imagine doing any other fellowship.
• 14:32
  I loved it.
• 14:34
  It's fast-paced.
• 14:36
  It has elements that I like.
• 14:38
  It's not, and I laugh at that.
• 14:40
  It's definitely not a psychodynamic psychotherapy kind of work, which is what had initially drawn me.
• 14:47
  But you know, you do end up doing a lot of CVD in small pieces and mindfulness.
• 14:55
  But the fun part of it is sort of working with other teams, which can also be, by the way, the non-fun part of it.
• 15:02
  But.
• 15:02
  uh
• 15:04
  you sort of end up being the ambassador for psychiatry.
• 15:10
  There is stigma against psychiatric patients, against psychiatrists, sometimes among other specialties.
• 15:16
  And the best way to encounter that stigma is by doing a great job when you are in CL and really showing our competence and what we bring to the table.
• 15:28
  So uh CL has been a, I'm so glad I did it, but you know,
• 15:33
  Sometimes when people say, you should only do what things you love, sometimes you can make decisions that are more cognitive.
• 15:38
  So it all works out.
• 15:39
  um So I was lucky that way.
• 15:44
  From the point that you entered consultation liaison psychiatry to where we are now, what changes have you seen?
• 15:52
  Have there been any advances or how has it changed in your mind?
• 15:58
  So in some ways, it hasn't changed dramatically.
• 16:03
  But in other ways, I think stigma is definitely less.
• 16:07
  um There is much more acceptance.
• 16:11
  In fact, if anything, I've seen a dramatic increase in the volumes wherever I worked in CL.
• 16:17
  And part of it is that there is a much higher awareness um of
• 16:25
  what the needs are in the awareness for depression and anxiety.
• 16:30
  So people are catching that and calling us.
• 16:32
  uh The other aspect of this is like there's been growth in like CL can be a complicated field sometimes to do research in, but the number of studies that have been done on
• 16:42
  delirium patients and things like that.
• 16:44
  So there has been an actual development of literature that supports what we are doing.
• 16:50
  ah from that perspective, there has been a lot of growth.
• 16:55
  you've done some work with stigma with mental illness and you mentioned stigma both in the cultural context in India as well as here in the US.
• 17:07
  What strategies do you believe are most effective in reducing stigma?
• 17:14
  Um, I think the thing that works the best is familiarity and normalization.
• 17:20
  So, you know, we keep talking about education, about like, let's teach people about depression, anxiety, and that will decrease the stigma.
• 17:27
  I don't think that decreases the stigma.
• 17:30
  I think stigma, like stigma is such a normal part of being human, actually.
• 17:37
  Like, I think we put a group of five of us together and we'll find something.
• 17:44
  that will make the sixth person a little bit out of the group kind of a thing, right?
• 17:47
  Like there is just, we tend to be biased, you know, as humans.
• 17:52
  So we fall into those traps.
• 17:54
  So it's easy to say a particular group is like that, but when you put a name to an individual, then you don't say those things.
• 18:03
  So, you know, the more we hear stories about people or having a psychiatric analyst, right?
• 18:10
  Like that normalizes it.
• 18:12
  And
• 18:13
  And the more people see us as psychiatrists, as the same professionals as others are in different specialties, the more stigma is handled.
• 18:24
  exposure, like when we when we're thinking about bias or stereotypes, this idea of exposing people to people who have are suffering from a variety of mental illnesses so
• 18:37
  that they understand these are just illnesses, know, physical illnesses, mental illnesses, these are all there's a biological basis and
• 18:48
  And we see that movement now, I think, you know, from the time when the that movie, the ECT movie, the one flew over the cuckoo's neck.
• 18:58
  Like it was so stigmatizing in so many ways.
• 19:02
  And now you look at how sometimes a psychiatrist is not even the central theme.
• 19:07
  It's just as a site that the main character in a show or a movie has something.
• 19:13
  Right.
• 19:13
  And you go to Tiktok like, are you here?
• 19:17
  all these famous celebrities sharing.
• 19:20
  So the more we normalize, the same way as we talk about breast cancer or HIV or any other illness, the more it gets accepted and less stigmatized.
• 19:34
  So I know that I mentioned you've been a residency training director.
• 19:39
  You've also uh done work on wellbeing and medical education.
• 19:46
  What has gotten better for resident wellness and what work remains?
• 19:53
  uh It's always we have come a long way in the last 10 years on well-being.
• 19:58
  uh First of all, these are not considered taboo words in medicine anymore.
• 20:04
  People actually talk about wanting to be well and prioritizing it.
• 20:08
  uh It has become parts of, because of ECGME requirement, every program at least does something, at least talks about it.
• 20:17
  uh There are retreats, there are activities.
• 20:23
  People have started, and people have been talking about organizational intervention.
• 20:27
  So well-being is one thing.
• 20:29
  The opposite side, though it's not the same coin, but uh the whole reason you're talking about well-being in medicine is because of the recognition that there was burnout and
• 20:39
  severe burnout in medicine, Which sort of hurts me sometimes, Anjali, because I think well-being should be its own priority, not just because we were doing so bad, but we can
• 20:50
  talk about that for an hour.
• 20:51
  um
• 20:52
  Yeah, and it's not simply the absence of burnout.
• 20:55
  It's also how to, you know, have each person fulfilled and flirt.
• 21:01
  Yeah.
• 21:02
  Yes, exactly.
• 21:03
  You and I are completely aligned on developing.
• 21:06
  So it does hurt me a little bit to talk about burnout, but burnout is so prevalent.
• 21:10
  So people are talking about individual interventions, and I think there is a broader awareness that there should be organizational interventions.
• 21:19
  But I think that part is much more challenging and harder.
• 21:23
  And that's not just for the residents.
• 21:25
  Residents at least get some attention.
• 21:27
  But if you think about
• 21:28
  faculty, people like you and me, uh we are not really supposed to be thinking about our well-being at work, right?
• 21:35
  Those are really check-marky things even now because that sort of brings us, it's not even an institution or a department, it's really the system of medicine and the culture of
• 21:47
  medicine and ah will bring us against other thorny topics like ah the medical system in our country and how is it serving
• 21:57
  not just the patients, but also all of us who are part of the system.
• 22:01
  Our current system doesn't serve any of us that well.
• 22:06
  Well, and our crucial part of this is one could argue if there is no system without the healthcare workers.
• 22:16
  But yes, I think the organizational parts are harder because it's not just, know, they're not going to be a quick fix and they do require kind of overall strategy and buy in at a
• 22:34
  number of levels, right?
• 22:36
  home.
• 22:37
  which is a hard one because...
• 22:42
  you know, because we are not, we are a business in United States and businesses run with a very different principle and the financial incentives and all.
• 22:54
  Like it is a very challenging and complex problem to solve, to truly solve like small things, small, you know, we'll have a well-being lunch or a retreat.
• 23:06
  Those are easier to do and that's why those are the easier fixes, but the actual fix is much more complicated.
• 23:13
  Yeah, that's a whole podcast in itself.
• 23:18
  em So I wanna shift a little bit to one of your leadership roles em as I know you're deputy editor of academic psychiatry.
• 23:31
  As you think about kind of the forefront of cutting edge research and topics in the field, what do you see to be some of the most critical challenges to academic psychiatry
• 23:41
  currently?
• 23:44
  I think the biggest challenge is, and it's not just for academic psychiatry, it's for academic, many other specialties probably too, but for us, it's really the question and
• 23:58
  the training we are providing makes good psychiatrists.
• 24:01
  But the training we provide is that leading to, how's that serving our society as a large, our patients as a large, the needs of
• 24:12
  the patients.
• 24:13
  And so in some ways, the workforce access issue that we have in psychiatry causes us to think about, we training in a way that makes the most effective psychiatrists from that
• 24:30
  perspective, not just from a traditional way of thinking of what makes a good psychiatrist?
• 24:35
  And I'm not aware that we are evaluating in any way, like,
• 24:42
  you know, asking our new graduates when they go and work in the field on what aspects of their training they could have done less of or more of now that they are in the real out
• 24:55
  world or what they wish they had learned.
• 24:58
  So there's no such evaluation and there's no such thinking.
• 25:02
  And though, again, nationally, there are conversations that are ongoing about this, but I think that's the biggest challenge.
• 25:08
  And psychiatry, uh
• 25:12
  ACGME requirements are going to have a major revision coming up soon.
• 25:17
  And I think these will be things that will be discussed there.
• 25:23
  And if we make changes that are adequate to answer some of these issues, it will be difficult for all of us because we have all been trained in a different way of thinking.
• 25:33
  And if we don't make enough changes, then it won't be as challenging for us, but it won't address meeting the needs of the public at large.
• 25:45
  So I want to delve into this a little bit.
• 25:49
  on the one hand, when I hear that, think of the curriculum, kind of the topics and the design in terms from a curricular perspective.
• 26:06
  Another thing that comes to mind is just this idea of
• 26:15
  where residency is in terms of um a lifeline, a timeline.
• 26:22
  And um so as women and men are starting families, just the way that the residency falls and usually people are in that kind of 30s, 30ish timeframe.
• 26:44
  What do you think in terms of structurally, are there things we can be doing to support women and men?
• 26:54
  We've talked for years about this idea that at the time that people are delving into their new professional identity, it often correlates with those same years that they are.
• 27:11
  delving into perhaps a marriage or you know motherhood or fatherhood.
• 27:17
  I love any thoughts you have on that.
• 27:21
  It is a complex problem to solve because on one hand, you do want people to take.
• 27:30
  And it's not even time.
• 27:32
  It's so interesting because anytime we have these conversations, we get fixated on the maternity leave.
• 27:36
  And we should say maternity and paternity leave at the same time because I really like the way you framed it.
• 27:43
  So first of all, it's not just about that leave time.
• 27:47
  Right, it is about the new time and and like.
• 27:51
  uh It's a broader concept.
• 27:53
  think you're exactly right that I think sometimes we get caught up on that time, which is important, right?
• 28:00
  That is important that people feel that they get some guilt-free time, but it's something broader than that because the return to work following the leave em is also worth looking
• 28:14
  at if we're talking about structural changes in those years.
• 28:21
  So I think one solution is just the way you framed it.
• 28:25
  If we stop thinking about maternity leave and started sort of thinking about maternity and paternity leave, and if it became a norm that both the fathers and the mothers take the
• 28:39
  same amount of time, oh in probably not the same time, so it actually brings both parents into
• 28:50
  equal as equal partners and you're taking care of kids and it normalizes in the society.
• 28:54
  then it's not about, know, actually it's, it's interesting.
• 28:58
  I remember doing a workshop at ABA long time ago on women in medicine and academic medicine and somebody from the support staff just sat in.
• 29:10
  So it wasn't not a psychiatrist, but somebody from general public just sitting in that and they made a comment about, but women go on maternity leave.
• 29:18
  And we're talking about academic promotions and things like that.
• 29:21
  And it sort of just brings to like, if everybody went on a maternity paternity leave, then it's expected for the struggles some of the younger women faculty have in balancing their
• 29:36
  roles or in their growth paths.
• 29:39
  every person in the field has the same uh similar challenges, then it's not a challenge anymore because that becomes the expected part of your growth.
• 29:48
  Well, and then there's buy-in
• 29:52
  But to do that, we go back into the system of Madison because uh as much as I completely support this, but as a training director when you're covering cause and you have one
• 30:06
  person out and it really depends on the programs and on what your resources are.
• 30:12
  If one person will be out, how much the burden will it put on the rest?
• 30:19
  versus it's sort of expected that one in four will be out at any given time.
• 30:25
  So are you staffing appropriately for that?
• 30:29
  Inpatient units staff their nurses accordingly.
• 30:33
  But we don't.
• 30:35
  We staff to capacity.
• 30:37
  Every psychiatrist has to, every resident has to do X amount of work.
• 30:41
  We don't ever say, well, if we have 20 residents, we have to sort of staff to 18, because two should be out at any given time.
• 30:50
  It's that kind of a thinking.
• 30:51
  So we as a society, it's not even about Madison.
• 30:54
  uh Our American culture, like I think the only place you can really contrast to is like European culture where you stop accordingly.
• 31:04
  So then we come back to the tricky system of what is our system of Madison.
• 31:11
  Right, I was just thinking that as you were saying that, that, you know, this goes back to how much is on the individual and how much is on the system.
• 31:19
  I mean, so, you know, this idea of being guilt free as you ask for those days is really hard if the system can't accommodate for it and you feel like you're, you know, that that
• 31:39
  is going on to your peers, it changes kind of how you feel about it.
• 31:47
  But if the system could accommodate for a way to structurally understand that, you know, this is a necessity, then it would take it off the individual to feel that burden of
• 32:02
  guilt.
• 32:04
  So, yeah, another systemic...
• 32:07
  uh
• 32:10
  thing to continue to ponder.
• 32:12
  ah So you have held numerous leadership roles.
• 32:17
  uh What has been a challenge for you as a leader and how have you overcome it?
• 32:27
  you know, every stage of leadership, I've learned so much.
• 32:30
  there was like just so many, um, I think the biggest challenge for me is I personally am a problem solver.
• 32:40
  So that really served well when I was in more junior leadership roles.
• 32:48
  but, and, and I will not say that I've mastered it.
• 32:51
  I am still working on it, but you know, when there are problems,
• 32:56
  And my brain starts coming up with, can we do this and that or not?
• 33:00
  And it's like, no, the job of the leader is to help other people grow and help them problem solve.
• 33:09
  And then the difficult task of helping them not just come up with an idea, that part is still easy.
• 33:17
  uh Even that can be complicated, but then taking an idea and sort of figuring out
• 33:24
  how to actually make it happen.
• 33:26
  And then sitting with them and their frustration when things take a long time to change.
• 33:33
  So it helps to, like once you've been in the field for a longer time or gotten the well-deserved gray hair, can sort of, you can see the changes do happen, but changes take
• 33:46
  patience and persistence.
• 33:48
  And that can be very challenging for younger leaders.
• 33:53
  So for me, that has been the biggest challenge to not jump with solutions and periodically I will fall into the trap and then try to retreat and oh but really help others come up
• 34:06
  with solutions and then also to help them implement it.
• 34:10
  Well, yeah, and we talk about wanting more women in leadership and more women chairs, and congratulations to you for being a chair.
• 34:22
  You said in October?
• 34:24
  Yes, thank you.
• 34:26
  Yeah, it's been fun.
• 34:27
  I'm really enjoying it.
• 34:29
  So what advice do you have for younger generation of women and men as they think about leadership?
• 34:37
  So the common advice is, you know, leadership is not just about getting a better title or a better salary or a better office.
• 34:46
  Leadership is really, it's as simple as whatever task you're doing, whatever your job is currently, it's almost like figuring out a way to excel at completely and going a little
• 35:01
  bit beyond on what is.
• 35:04
  So I'm going to say two contradictory things.
• 35:08
  First, I'll say the general thing and then I'll make a little bit of contradiction when it comes to women in particular.
• 35:13
  So you want to do a little bit more than what your job title says.
• 35:20
  when you see, you know what, you are at max capacity and you're doing everything and now you're bored because it's coming easy, because you have figured out how to be excellent at
• 35:33
  whatever that is, whether that's being
• 35:36
  a CL psychiatrist or an educator or supervisor, whichever aspect of your role.
• 35:44
  Don't be in a rush to the next, don't just look upwards or outwards.
• 35:51
  Look at have you really excelled at all the roles you want to excel at.
• 35:56
  And each role will have, like I've never had, when you're in attending, you're also a teacher.
• 36:01
  So you just have to think about what are all the roles.
• 36:04
  And when you have excelled at them and getting bored, then you should really think of, okay, what's the next role?
• 36:09
  Because then you will get that steep learning curve and you learn new skills.
• 36:13
  And once you've done that, then you move on.
• 36:15
  At least that has been my personal philosophy.
• 36:18
  I have never sought a title because of a title.
• 36:22
  For me, it has always been about how will that lead to my growth?
• 36:25
  Because to me, that's the whole purpose of life, right?
• 36:29
  It's a lot about how am I growing now?
• 36:34
  So that's a general advice.
• 36:35
  um And also, as a person walking into a situation, you see a problem.
• 36:45
  There's a tendency to jump in and create.
• 36:46
  But before you do that, listen in and find out what the situation is.
• 36:53
  There might be more nuances than we think when you walk into.
• 36:59
  So the contradiction part of this is for women in general, because what I've learned over time is that we as women, when we will judge ourselves to be excellent, like I think there
• 37:12
  is a gender difference between how men and women look at things.
• 37:18
  And we're talking about only two kinds.
• 37:19
  And again, you know, it's not that strict.
• 37:22
  will be men who fall into what I'm saying and women who fall into the other category.
• 37:26
  it's not.
• 37:27
  But in general, we tend to under evaluate ourselves.
• 37:33
  I think there is a saying that women will ask for a promotion, or at least I've heard this and I'm not sure, women will ask for a promotion when you've been doing something 100 %
• 37:44
  already and already doing that job.
• 37:47
  And now you're just saying, hey, this is what I'm doing.
• 37:50
  I should have the title that goes with it.
• 37:52
  Where it men might say, hey,
• 37:56
  I know I can do that job, so I'll ask for it.
• 37:58
  So there is a degree of, and I don't know if it is a gender related thing or a cultural society related thing or an interaction of both, but I've definitely observed it.
• 38:10
  I've at least observed it in myself and many of my mentees where we ask for things that we already deserve.
• 38:21
  Men ask for things in which they can grow into.
• 38:25
  So that is the.
• 38:27
  And I think the research supports that in terms of women being over qualified for jobs and then feeling like they can apply and women and, know, like having more than the criteria
• 38:40
  um necessary and uh men having half or, you less and feeling like they are qualified for the same job.
• 38:52
  And you know, I'm feeling very conscious that you're talking about gender in such a binary way, like not all women are like that, not all men are like that, and it's gender is not
• 39:00
  just so starkly binary, but there is these elements that I have definitely observed in myself and have seen in many others.
• 39:13
  But yeah, leadership is not something one should aspire just because you feel it's fancier.
• 39:19
  I think it's a little bit more about what does that mean, that particular job.
• 39:24
  And if that excites you, that's the best way to approach it.
• 39:29
  Yeah, and I think there's also just so many different ways that leadership looks.
• 39:37
  uh And so I think it is really important to have more women in the top leadership roles in terms of deans and chairs, and that is so crucial.
• 39:53
  At the same time, I think there's so many ways within a day that you can see
• 40:00
  people leading, you know, and I try to always remind people when they're leading teams and leading projects and leading task forces and all these different ways that, you know,
• 40:13
  being in tune with your leadership even in those roles is important.
• 40:18
  You know, being a leader is always thinking about who are the people you are impacting and are you impacting them in a positive way and supporting them or not, right?
• 40:29
  you can be a leader and as a physician, you are a leader somewhere or the other.
• 40:33
  Like you can't get out of it, right?
• 40:37
  Yeah, so true.
• 40:39
  Well, thank you, Dr.
• 40:40
  Argoil.
• 40:41
  Thank you so much for being here.
• 40:42
  It's been a pleasure to talk to you today.
• 40:44
  uh
• 40:46
  Thank you so much for having me, Anjali.
• 40:50
  The expressed in this podcast are those of
• 40:53
  only and do not necessarily represent the views of the American Psychiatric Association.
• 41:00
  Content of this podcast is provided information purposes only not for medical or any other type of professional advice.
• 41:10
  If you are having a medical emergency please contact your local emergency response number.