The PRMS Blog

Guest Blog: Mentorship in a Newly Established Psychiatry Residency Program


As a part of PRMS’ ongoing commitment to behavioral health we invited Ulrick Vieux DO, MS, Psychiatry Residency Program Director at Orange Regional Medical Center in Middletown, NY, to be featured as our guest blogger this month.

As the founding Psychiatry Residency Program Director at Orange Regional Medical Center in Middletown, NY, I wanted to ensure that the residents who have entrusted us with their training would have a program that would expose them to opportunities that more established programs have for their residents. My mentors have always taught me that it is important to understand your strengths, but is equally if not more important to understand your weaknesses. Hence, a way that new programs can expose their residents to the breadth that the specialty of psychiatry has to offer is by establishing relationships with outside organizations. The local district branches of the American Psychiatric Association provide an excellent opportunity to provide support for residents. Our local district branch, the West Hudson Psychiatric Society, has provided an excellent service to our residency by making mentors available to our residents.

Two of our residents who have taken full advantage of the program share their experience here:

Eric Jarmon, DO, Associate Chief Resident:

Last year, when the residents in our program were informed that we would be starting a mentoring program with our local chapter (West Hudson Psychiatric Society of the American Psychiatric Association), I had a few concerns. As a second-year resident, I felt I had enough on my plate. Trying to juggle the demands of my rotations, in addition to the mandatory meetings with my two supervisors from our program, seemed like enough responsibility. A mentoring program on top of this seemed a bit extraneous to me. But with the strong encouragement from our program director, I felt I had little choice but to participate.

Last fall, the administrator for the West Hudson Psychiatric Society sent questionnaires for the residents to complete. The questions asked about both our personal interests and our professional interests specific to psychiatry, such as pursuing fellowships in sub-specialties including child and adolescent psychiatry, forensic psychiatry, addictions, and geriatric psychiatry. As the representative resident/fellow for the West Hudson Psychiatric Society, I collected the completed forms and sent them back to the administrator. Within a few weeks, each resident was matched with a mentor, usually an executive board member for West Hudson. Once matched, the resident mentee was responsible for reaching out to the assigned mentor to arrange for future meetings.

I had concerns about this matching process, too. I didn’t know who my mentor was going to be, and I wondered if we would have anything to talk about. The first meeting was via Skype. This initial contact felt like a meet and greet, each sharing personal experiences of how we ended up in Psychiatry. We also talked about interests and topics for discussion of future meetings. Personally, I had a pressing issue that I wanted to discuss: office politics. I dove right in talking about my situation and the frustration I was feeling. To my surprise, he had a similar experience and provided some very helpful insights. I quickly began to realize that I had access to a seasoned professional who had a wealth of knowledge and experience to share. It was also a relief to have such a resource who wasn’t affiliated with work. I didn’t have to worry about saying something that might come back to “bite” me later, which also made having a mentor advantageous.

Over the course of the next few months, my mentor and I went from meeting once a month to every 2 weeks. I usually make the drive from Orange County to Rockland County after work on Fridays to visit his office after work. Skype wasn’t quite as personable as meeting face to face, so we usually meet for lunch or later at his office. The agendas for our meetings are less structured now, since we have gotten more comfortable with each other. Sometimes our sessions include discussing a book on problem solving that I read for the first time and my mentor re-read from his fellowship. Other sessions may focus on cases that I am seeing on my rotations. Another topic of discussion has been private practice and documentation. As a resident, what better resource to have than someone who has been in private practice for several years and who also works as a consultant reviewing medical records? Again, I cannot emphasize enough what a valuable experience mentoring has been for me.

Other residents in my program haven’t been as involved with the mentoring program. I can certainly empathize with them; residency can be challenging, stressful, and time-consuming. Having another item on your plate that isn’t required can feel like too much. Like me, they probably had doubts about what mentoring would look like, what to say, or what topics to discuss. After the first couple of meetings, I realized the benefit of having a mentor far outweighs concerns about time commitment or travel. What my mentor has offered me is a fresh perspective on daily struggles of residency that I wouldn’t have from someone working within my program. Scheduling and making time to meet is no longer a burden now that I realize what an asset the experience has been. I find myself looking forward to talking to my mentor. Whether the topic of discussion is patients, getting along with co-workers, documentation, private practice, travel, or where to get my new bike fitted, I can only hope my mentor finds our meetings half as rewarding.

Stephanie Kuntz, DO:

I am in a fairly new psychiatry program and it has been one of the best experiences of my life. The faculty has been very focused on my education and has made the process of caring for patients much more straightforward. However, there are always those lingering questions about my management of patients: “Did I ask all the right questions I could have asked?” and “Did I establish that therapeutic relationship?” From career goals to patient care, I have had so many questions, that at times, the thoughts were overwhelming.

During my second year of residency, I received a questionnaire that asked about what I looked for in a mentor. I was asked what my interests were, what I would feel comfortable discussing, and even about the distance I was willing to travel to speak to my mentor. I filled out the form, sent it out, and continued to question my clinical decisions until someone reached out to me and told me that there was a mentor for me from the West Hudson Psychiatric Society. Then, we were able to build a relationship that provided the guidance I needed.

Through my experience with this mentorship program, I am truly fortunate to be one of the residents that has an attending to speak to regarding my career as a psychiatrist. I was paired with an attending who worked with children, adults, and within the forensic psychiatry field. We had initially met face to face to discuss what major topics to delve into for future meetings. After that, although we have not met in person, FaceTime has been a great way to speak to each other and enabled us to meet more regularly, despite the distance.

There are so many ways in which this mentorship has benefited me. For example, my mentor has guided me in developing a further understanding of transference-counter-transference with some of my patients. Because of my lack of experience, I would always wonder what I did wrong if a patient had manifested either overt or covert aggression during the session. I would also find myself feeling uncomfortable with a patient and not understanding the reason for that emotion. My mentor allowed me the time to take a step back and re-evaluate the situation in a safe setting. My mentor enabled me to determine that something the patient had stated had resonated with something in me. As my mentor explained it, “this is a way of having you feel what they are feeling, that they cannot express for themselves.” Because of my mentor, I feel that I can more effectively use my own emotions in a clinic setting in order to build a better therapeutic relationship with my own patients. Having someone take that time to process a case with me, from beginning to end, has been very beneficial.

In addition to patient interaction, my mentor has enabled me to make more sense of where I want to go in my future career as a psychiatrist. Working with my mentor has enabled me to take a step back from those general questions that seemed so overwhelming before and really think things through. Those questions have ranged from deciding on whether or not to work with a select population (I have finally decided on children and adolescents), to deciding the environment in which I want to work (rural vs suburban vs urban), to whether I want to work in a private practice, an inpatient hospital, or the outpatient clinic setting. This last point is undecided; however, I’ve learned from my mentor through his many anecdotes about his experience and his words of wisdom, that I have time to decide and that choices are not set in stone. My indecisiveness was always a concern before, but my mentor has enabled me to feel more comfortable with the unknown.

The West Hudson Psychiatric Society has been a great example of how mentorship/supervision from an attending outside of the hospital can be an asset to the next group of doctors coming into practice. Through my mentor, I have been able to build a wonderful networking relationship that provides guidance and clarity. His anecdotes have helped me to learn what I want my future in the field to look like, as well as how to more appropriately process my clinical cases using both my medical knowledge and my growing knowledge of therapy. Above all, I have learned that, as a resident, I do not have to go through this next phase of medicine on my own. My mentor was very supportive when I came to him with frustrations and with triumphs, and I will always be grateful for that.

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The Life of PRMS: Megan Jones, Head of Strategic Product & Sales Analytics, Insurance Services


When I walked through the doors of PRMS for the first time, little did I know I would still be here 20 years later. PRMS staff tend to have a long tenure at the company. That’s probably because we enjoy not only the familial work environment but also the fantastic and caring client population that we serve. We would rather our clients concentrate on patient care then take time to worry about if their insurance is working for them.

Over the years, while my responsibilities grew, one line item on my job description always remained the same – Other duties as assigned. PRMS fosters an environment where we all pitch and do what needs to be done – all in the name of client satisfaction. From last-minute all-hands-on-deck envelope stuffing sessions to running across town to hand-deliver a new policy, you won’t hear us say, “it’s not in my job description.” It simply falls into “Other duties as assigned.”

In fact, I came on board when technology was changing rapidly. My job description could never have accounted for all the twists and turns of all the new advancements over two decades. I was given the opportunity to immerse myself into learning how to use new customer relationship management software, program websites in html, learn search-engine optimization and Google Analytics, integrate social media into our day-to-day activities, and how to code emails so that they don’t get sent back as spam. There is always an opportunity to learn something new.

Because the insurance industry is keen on risk avoidance and mitigation, we have also been trained to think a million steps ahead when something that could be an issue is lurking. Take for instance, Y2K. Remember when the world thought that after we partied like 1999, the computers were all going to shut-down and leave us in dire straits? Well, the PRMS Marketing Department was going to be prepared for whatever came our way. We printed out all our client names, addresses and contact information. We even had a stack of stamps in case email crashed and we needed to hand-type letters with a manual typewriter. The clock ticked midnight and the world kept turning. While a little chagrined that nothing happened, we were at least applauded by the Risk Management Department for preparing for the worst but hoping for the best. They trained us well. And, on the upside, we were able to use that inventory of stamps for at least another year saving some wear and tear on the postage machine.

From that first day oh so long ago, to present day, I have always considered PRMS to be an important foundation of my life. I have fabulous mentors who have taught me the ins and outs of insurance and I even was granted the flexibility to go up to Philadelphia to obtain my MBA from Wharton. For that, and more, I say “thank you” to PRMS and toast another 30 great years to this great organization.

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PRMS Endows Child Psychiatry Fellowship for GAP


Limited access to mental health care has far-reaching implications for children and adolescents with psychiatric illnesses or family dysfunction. Left untreated, mental illness in young people can lead to problems at school, at home and with peers, as well as changes in appetite or sleep and social withdrawal or self-destructive behavior.

PRMS recognizes this problem and as part of its continued investment in the future of psychiatry, recently teamed up with the Group for Advancement of Psychiatry (GAP), a think tank of leading psychiatric minds, to endow its first named child psychiatry fellowship, the PRMS GAP Fellowship in Child Psychiatry.  

GAP was founded in 1946. Over the years, its thoughtful analysis and recommendations have served to influence and advance modern psychiatric theory and practice. The organization is comprised of more than 300 members from across the United States and Canada. More than 30 working committees meet twice a year to focus on major issues and fields in psychiatry and publish content and research findings on pressing issues.

The work of GAP’s outstanding residents and fellows collaborating with leaders in the field also encourages discussion about the profession and promotes a public appreciation for the role of psychiatry within society. Because psychiatry is a multifaceted specialty encompassing the biopsychosocial paradigm, committees consider everything from psychopharmacology to addictions, the military, natural disasters and ethical and moral issues inherent in the field. 

“We are proud to work with such a prestigious group as GAP to fund this fellowship,” said Stephen Sills, Executive Chairman and Chief Executive Officer for PRMS. “The research and collaboration of GAP members and fellows who are leaders in their fields are substantive. We hope that this fellowship in child psychiatry will help produce a growing body of knowledge and innovative perspectives to help psychiatrists continue supporting the mental health needs of our country’s children and adolescents.”

Mental disorders are common among children in the U.S. and nearly five million have some type of serious mental illness that significantly interferes with daily life. According to the National Institute of Health, more than 20% of children either currently, or at some point during their life, have had a seriously debilitating mental disorder.

Not surprisingly, many psychiatric issues affecting children and adolescents often stem from abuse and neglect, as well as situations where parents or primary caregivers are using alcohol and other drugs, whether the children are suffering from abuse or neglect or not, according to GAP President John G. Looney, MD, MBA, a child psychiatrist of national stature and Professor Emeritus of Psychiatry and Behavioral Sciences at Duke University Medical Center.

Looney, who developed the first alcohol and substance abuse program for young people in a U.S. academic division of child psychiatry, said more focus is being put on earlier identification of children with “poor” psychological development who may end up being on the Autism spectrum or have another disorder. “The more we can focus on those things, the more we can help those kids,” Looney said.

GAP’s Fellowships cover everything from administrative psychiatry to psychiatry in the workplace. The GAP Fellowship is a two-year experience during which the Fellow attends four semi-annual meetings and works with a GAP committee on its current project.  Fellows contribute to the writing projects of their committees and develop a plenary presentation on a topic of their choice, presented to the general GAP membership at the Fellows’ final meeting. 

Every two years, GAP asks training directors at all Departments of Psychiatry in the U.S. and Canada to submit letters and CVs of potential fellows. The application process is competitive. GAP offers about 15 fellowships per class and typically gets more than 50 applicants for each fellowship. 

According to GAP Immediate Past President Steven S. Sharfstein MD, MPA, a practicing psychiatrist for more than 35 years and a GAP fellow in 1970, what makes GAP stand out is its ability to look at cutting-edge issues, the relationship of the profession to the rest of medicine and society by pulling together clinicians and academics to probe subject areas and produce independent studies and “a thoughtful product that’s the best thinking in the field on any particular issue,” said Sharfstein. Results can be anything from a book to a paper, a monograph, an op-ed piece, a professional article or even something for the general public.

Sharfstein, former president and CEO of the Sheppard Pratt Health System, Clinical Professor and Vice Chair of Psychiatry at the University of Maryland and a past president of the American Psychiatric Association, said the fellowship helped him develop relationships with mentors and peers that shaped his career. Many leaders in American psychiatry in their subspecialty or in general have had a GAP fellowship and the majority of GAP fellows go on to have esteemed careers in psychiatry. Membership in GAP is invitation-only, but many members have been fellows and leaders in the American Psychiatric Association and the American College of Psychiatrists.

“It’s part of the developmental process and something they remember as being critical in their career,” said Sharfstein, who’s best known for his research and writing on the economics of practice and public mental health policy.                                  

Looney said one reason the PRMS-endowed fellowship is so important is because child psychiatry remains one of the most underrepresented subspecialties in medicine. “Children are our future, that is self-evident,” said Looney. “But for children that we serve, the shortage of child psychiatrists gets pretty frightening.” One way to help deal with the shortage and increase access to quality mental health services is the use of telemedicine, or interactive, real-time videoconferencing, to deliver health care typically delivered in person. Telemedicine or telepsychiatry is not new but can be particularly useful when delivering psychiatric, mental health or behavioral health services to youth and their families over geographic distance and in certain settings, such as with children in rural areas whose parents may be addicted to drugs or in prison. 

“Our committee on child psychiatry tries to look at things like that – how we can improve service delivery as well as improvements in diagnostics and accuracy,” added Looney, whose primary interest is the mental health of college students and helping them develop management skills to succeed in college. 

Looney said he is excited about the PRMS-endowed fellowship: “PRMS is such a trusted partner with us in GAP and in the psychiatric field, and for many of us personally as our insurer. Our purposes and goals are so similar, and I just think this is a wonderful partnership.”

Sharfstein agreed: “I think it’s wonderful that PRMS is looking to the future of the field by engaging in this way with GAP. We’re only as good as our progeny, and what we pass on through our organizations and institutions is absolutely critical. And we’re very grateful for their help.”

In addition to support from PRMS, unrestricted grants from The Cotswold Foundation (Cotswold Looney Fellows), the Phillips Van-Buren Foundation (Dear Abby Fellow), Beacon Health Options (Beacon Health Options Fellow) and Ginsburg Fellowship also support individual GAP Fellowships. GAP encourages individuals, families, foundations and carefully selected corporate entities to provide support to help ensure the future of the fellowships.

“GAP fellowships are the lifeline of the organization, continuously bringing in new blood, fresh ideas and the energy of training,” said Frances Bell, GAP Executive Director. GAP is a 501(c)3 non-profit organization. Donations are tax deductible to the extent allowed by law. Anyone interested in supporting GAP should contact Bell at francesrotonbell@gmail.com, by calling (972) 754-2107 or visiting https://www.ourgap.org/donate

PRMS Executive Vice President Jackie Palumbo presents GAP President John Looney along with Susan Looney a letter of agreement for the PRMS endowment.

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The Life of PRMS: Jackie Palumbo, Executive Vice President, Chief Underwriting Officer


The insurance industry was the farthest thing from my mind when in 1976 I put my pursuit of becoming a teacher on hold and joined the workforce. I signed up with a temporary staffing service that placed me in a short-term clerical position with ISMIE, a newly created physician-owned medical malpractice company in Chicago. This temporary position shortly became a permanent underwriting position and 11 years later I was ready to spread my wings further and moved to Los Angeles where I joined The Doctors Company (TDC) as an underwriting manager. Next, my career path took me back to the Midwest where I became  Director of Underwriting at PIC-Wisconsin (now ProAssurance). A few years later, I was on the road again working with HealthCare Underwriters (now MLMIC), in upstate New York as their Director of Underwriting and Education.

Finally, I landed in Arlington, Virginia in 1996 joining the incredible team at Professional Risk Management Services, Inc. (PRMS) specializing in the management of a national program for psychiatrists and behavioral healthcare practices. I have learned from some of the best leaders in the medical professional insurance industry and worked with talented risk managers, claim adjusters, agents, brokers, actuaries, marketing and legal experts.  At PRMS, I have also had the opportunity to mentor and develop new underwriting talent through the years. It is a pleasure watching these underwriters develop skills and expertise,  become successful managers, serve as experts on industry panels, and participate in underwriting association leadership roles. Some might say my original dream to become a teacher has come true!

And most of all, I am grateful for the opportunity to be of service to psychiatrists including developing products that best serve their needs.

 

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The Life of PRMS: David Cash, Assistant Vice President, Risk Management


I started my legal career as an Assistant Public Defender in the Mental Health Division of Maryland’s Office of the Public Defender. Through my work and in my personal life, I had become friends with plenty of psychiatrists and, when I saw the job advertisement for a Risk Manager position with PRMS, I sought their feedback. It was all positive. “They’re a great company,” and “they put on really good seminars” was what I was universally told. I pushed aside my uncertainty about entering the corporate workforce and joined PRMS. That was almost 17 years ago, and it has turned out to be an awesome gig.

My absolute favorite part of working at PRMS is that I get to interact with psychiatrists. Our clients are an intelligent, insightful, and compassionate group. Whether I am assisting a client on the Risk Management Consultation Service, chatting at a reception, or fielding questions at one of our seminars, those qualities always come through. While I relish my role as a physician educator, I usually feel like I benefit more from our interactions than the clients that I speak with.

PRMS’ workplace diversity is a great strength. Staff at PRMS have hailed from almost every state in the nation from Alaska to Florida to California to New Hampshire – plus the District of Columbia and Puerto Rico. Additionally, we have been enriched by members of our team who have come from international backgrounds such as Iran, Afghanistan, Pakistan, France, India, Montenegro, Vietnam, Lebanon, Hungary, Trinidad, Taiwan, China, Philippines, Ukraine, Great Britain, South Africa and Jamaica. We learn from each other and we grow from shared and new experiences.

I especially appreciate the guidance and support – and significant freedom in doing my work – that Donna Vanderpool and Jackie Melonas, before her, have given me. They both are great colleagues. They even tolerated my “ponytail phase” with patience and grace.

Many years ago, I spoke at an event. Colleagues from Underwriting and Marketing were staffing a booth at the event and I visited the booth before my presentation. As we were all chatting, an exhibitor from a neighboring booth leaned over and said, “I want to work for your company. It seems like you guys have fun – like you really like each other.” We do.

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