Psychiatry is growing in popularity as a medical career: From 2015 through 2021, the specialty saw the second-highest rate of growth (26%) in first-year residents and fellows, according to the Accreditation Council for Graduate Medical Education.
Fueling the increase is a heightened awareness of the importance of addressing mental health problems, with one in five adults in America reporting a mental illness in 2019. Then the COVID-19 pandemic struck, which took its toll through higher rates of stress, insomnia, anxiety, and depression. That risk is magnified among people of color and those with fewer financial resources or who face housing insecurity, according to the National Institutes of Health.
The Class of 2024 started medical school just a few months into the pandemic, and its members are now graduating with nearly 10% entering the field of psychiatry—a 50% increase from recent years and the second-most popular specialty chosen by Albert Einstein College of Medicine graduates.
"I believe the increase reflects the humanistic and social justice orientation at Einstein coupled with our exceptional strength in the brain sciences,” says Jonathan Alpert, M.D., Ph.D., the Dorothy and Marty Silverman Chair in Psychiatry at Einstein and chair and professor of psychiatry and behavioral sciences at Einstein and Montefiore. “Our students see healthcare through a broader lens, and they understand that the practice of medicine includes mental health, community engagement, culturally responsive care, and the social determinants of health.”
Fourteen out of 19 Einstein students matched to programs in New York State, and most will be practicing in underserved communities. Here, four Einstein students from the Class of 2024 who chose careers in psychiatry share their stories and the reasons they chose the specialty.
Alexis Knisel: Advocating for the Voiceless
Giving voice to the voiceless has long been important to Alexis Knisel. Because of frequent moves, she was often the new kid in school and was reluctant to speak. Some teachers asked if she was mute.
“Being shy and moving around a lot, I knew what it was like to feel unseen and misunderstood,” says Ms. Knisel, 26. “I always wanted to help people whom I thought were feeling the same way or whom I saw as being neglected by society. That feeling only grew stronger as I got older.”
Finding her own voice so she could help others took years. A defining moment came after she reconnected with her father while she was in college. They hadn’t spoken in 14 years, but he called to tell her he had pancreatic cancer and did not have long to live. Uninsured and living in poverty, he had waited to see a physician until his pain was intense and his prognosis was poor. He and Ms. Knisel spent the next week sharing stories and reflections on daily calls. “Promise to help people like me when you’re older,” he said during one of their final conversations.
Her father’s death prompted Ms. Knisel to seek counseling and to work in her college’s mental health programs. As an outreach peer educator, she led educational activities and spoke to multiple student groups about self-harm, suicide, depression, anxiety, and self-care. She also found her calling: to become a psychiatrist.
Einstein became Ms. Knisel’s top choice after visiting campus and meeting students who were also passionate about working with people who have been historically marginalized. Starting in her first year, she volunteered at the Einstein Community Health Outreach (ECHO) free clinic and continued serving for three more years, helping to establish a permanent program to provide fresh groceries weekly to ECHO and enroll patients in a local food pantry.
Among the more memorable patient encounters she had during her clerkships was her experience with a man who was labeled as an intravenous drug user. She believes the time she spent listening to him led to hopeful outcomes, in part due to her persistence and advocacy: She researched treatment options, and the man eventually received the heart operation he was initially denied (due to previous drug use) and therapy for anxiety and depression.
Ms. Knisel matched at NYU Grossman School of Medicine, and will rotate among three hospitals, including Bellevue and a veterans’ hospital. Even if situations are uncomfortable and she’s not sure what to say, she plans to keep listening and engaging with patients.
“Through every experience and every clerkship, I gravitated toward patients who I felt weren't really having their voices heard,” she says. “When you use the proper language and truly get to know people, you learn a lot from them and they learn a lot from you. Seeing their confidence grow and having them find their voices is so inspiring.”
Alina Mitchell: Helping Others Navigate Tough Times
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Alina Mitchell
Alina Mitchell has had her share of difficulties, but she is a strong believer in finding the “light at the end of the tunnel,” even in the hardest of circumstances. As a toddler, Ms. Mitchell lost her mother, Lily, to breast cancer. She was lucky to have a loving father and extended family to raise her, preserve memories of Lily Mitchell’s work as a neonatal intensive care nurse in Malaysia, and provide her with a safe space to feel vulnerability and loss.
“It’s a vital thing I want to give other kids: space to listen to themselves and not feel guilty or bad about their feelings,” says Ms. Mitchell. “We can then come up with a plan for them to move forward, which can change how they approach the rest of their lives.”
One patient Ms. Mitchell met on her first rotation at a psychiatric clinic stands out: a young woman with suicide ideation who was emotionally guarded, hiding behind thick bangs during their first meeting. When Ms. Mitchell asked what she wanted to be as an adult when she got older, the girl told her that she didn’t plan on growing up. During their sessions, Ms. Mitchell discovered the girl’s interest in music. The two played songs and discussed lyrics, helping Ms. Mitchell gain hints of what was most meaningful to the teen.
“I really liked the process of understanding what made everything so difficult for her and then helping her see the other side of it,” says Ms. Mitchell, who will become a resident at Montefiore Health System. “The struggle she went through was terrible and traumatic, but it gave her lessons in resilience, and showed her what she is capable of doing for herself and others.”
While she was at Einstein, Ms. Mitchell became involved in Montefiore’s Art and Integrative Medicine program, an after-school initiative that provides a forum for young people in psychiatric care to use art, music, and other creative outlets to express themselves. And as part of Einstein Senior Leaders in Advocacy and Community Service, she mentored first-year medical students interested in mental health service-learning projects. She also worked with classmates and Bronx Helpers, an afterschool program for middle school students in the Bronx, to lead workshops for young people about stress management, common psychiatric conditions, and ways to find support.
Ms. Mitchell acknowledges the difficulty in overcoming structural barriers to care. “We are in a mental health crisis and a lot of kids are struggling,” she says. “Just growing up in an underserved area is a risk factor for mental health issues. So we're going to need to try to fight that at its root.”
For her, that means advocating for young people, particularly those in the criminal justice system. “It’s really important to address trauma and to help children recognize what they are struggling with,” she says. “I want to help them figure it out so that they can go into the world, contribute in positive ways, and feel good about themselves and their community.”
Jessica Juarez: Breaking Barriers to Care
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Jessica Juarez
When Jessica Juarez entered medical school, she thought she’d become a family medicine doctor, but changed her mind once she starting seeing patients.
“On the wards, we learned how to treat patients’ medical conditions, but then we realized that we’re not only working with the patient, we’re working with the community, the family, and different things that could be perceived as barriers,” says Ms. Juarez. “We know how to treat someone’s heart failure or diabetes, but how can we help people navigate depression, which prevents them from taking care of their physical health?”
Ms. Juarez was unsure of her career path after graduating from high school. She worked as a waitress and restaurant hostess before enrolling in community college. She later transferred to Hunter College. In 2017, a friend introduced her to Bronx Community Health Leaders (BxCHL), a pre-medical mentorship program that provides networking, community service opportunities, and leadership development for young people who want to pursue healthcare careers.
Ms. Juarez credits that pathway program, particularly its co-founder and director, Juan Robles, M.D., ‘11, associate professor of family and social medicine at Einstein and attending physician in the Family Health Center at Montefiore, with helping her get to and through medical school. Einstein was her “dream school,” in part because she felt she could relate to its mission of addressing healthcare for marginalized patients.
Having a family member with severe mental illness also helped propel Ms. Juarez toward a psychiatry career. The diagnosis came during her second year at Einstein, at the peak of the COVID-19 pandemic. She helped her family find the right care and talked with them about the need to discuss mental health and seek professional support.
At Einstein, she joined the Latino Medical Student Association and Einstein Future Advocates in Medicine, a student organization focused on empowering and mentoring students from diverse communities in the Bronx and the greater New York City area to pursue careers in health fields. “That was the rock—having that networking and connection with others during COVID,” she says.
In July, Ms. Juarez will begin working at Sunset Park (Brooklyn) Family Health Center at NYU Langone. “I hope to bring my experience of navigating mental illness and understanding the barriers to receiving care, including the stigma that people attach to being seen in a clinic or hospital,” she says.
She has spoken to Dr. Robles about another goal. “I want to establish a pathway program in Brooklyn. I’m already talking with him about how that can happen.”
Vincent Cali: Overcoming Mental Health Stigmas
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Vincent Cali
Vincent Cali was headed for a career filled with balance sheets and budgets. At Queens College, where he studied economics, he fulfilled a degree requirement in his junior year with an introductory psychology course taught by a neuroscience professor. Her engaging lectures about the brain prompted his change of heart.
Biology and neuroscience books replaced readings on economics, and he spent another three years in college to earn a biology degree. A medical shadowing experience led him to commit to a career in psychiatry. “I saw how important the role of a doctor is,” Mr. Cali says, recalling an elderly patient, retired and widowed, who broke down and spoke of feeling despondent during a checkup. The doctor later told Mr. Cali that the number one killer of his patients wasn’t diabetes or heart disease, it was loneliness and isolation. “I saw this vulnerability and the privilege that physicians have when patients share and confide in them,” he says. “Mental health became the cornerstone for the type of medicine I wanted to practice.”
Mr. Cali was already familiar with the mental health challenges he had observed while growing up in a working class immigrant neighborhood in Flushing, Queens. People avoided talking about mental health. Those who had disorders were sometimes labeled and shunned, he recalls, and there was little discussion on understanding their conditions or need for professional medical treatment.
Einstein was his first choice for medical school because he knew he would be able to train in an urban setting and work with diverse populations. Within months of starting classes, he became involved in two research projects on teenage depression and anxiety. He was awarded a fellowship and presented a poster at the American Academy of Child and Adolescent Psychiatry’s annual conference. He also co-led Einstein’s psychiatry student interest group and was selected to attend a national summer program run by the Substance Abuse and Mental Health Services Administration.
Mr. Cali says he is committed to carefully listening to patients he’ll see during his residency at New York Medical College-Metropolitan Hospital Center in Harlem. He recalls lessons learned during his addiction medicine elective and other psychiatry rotations at Montefiore, where acknowledging a patient’s autonomy and shared decision-making about treatment were key aspects of care.
“I hope to bring to my patients a sense of understanding, advocacy, and commitment to their mental and physical well-being and improvement,” he says.
“A lot of psychiatry is the art of navigating the nuances of the particular crises that our patients face—their difficulties, serious situations, complex presentations—and then applying the science of medicine and tailoring that for a patient’s unique circumstances.”
Mr. Cali recognizes how far he has come and is grateful to those who inspired him. When he was younger, he didn’t think he’d go to college. He envisioned working in a steady job like construction or sanitation to support a family.
“I’m proud of finding my passion and that with a lot of help, I was able to get to where I am,” he says. “I’m going to be doing a job that I know I’ll always love learning about, and I’ll always be humbled and appreciative. I never really thought that I could get that with work and a career. Psychiatry for me is the perfect combination of everything that I want to do.”
Posted on: Friday, May 17, 2024