As a medical student, do you ever wonder what it’s like to specialize in psychiatry, especially focusing on the assessment, diagnosis, and treatment of mental health disorders during pregnancy and the postpartum period? Meet Alpa Shah, MD, a perinatal and reproductive psychiatrist and a featured physician in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in perinatal and reproductive psychiatry might be a good fit for you.
The AMA’s Specialty Guide simplifies medical students’ specialty selection process, highlight major specialties, detail training information, and provide access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.
Learn more with the AMA about the medical specialty of psychiatry.
“Shadowing” Dr. Shah
Specialty: Perinatal and reproductive psychiatry.
Practice setting: Health system.
Employment type: Employed by Marshfield Clinic Health System, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Years in practice: 25.
A typical day and week in my practice: I work about 3.5 days each week—I have some administrative work as well as clinical work. So, I have one designated day for clinic and that’s helped compartmentalize things to the extent that it can be. My clinical work primarily focuses on perinatal and reproductive psychiatry, so anything in the spectrum of women’s mental health, things that are gender-sensitive, gender-specific and the interface of psychiatry and ob-gyn and women’s health.
I see patients either face to face or through telehealth. I also do what is called integrated health care, so we have a nurse with behavioral health expertise who’s located in a primary care practice and then a psychiatrist will supervise a panel of patients through the nurse. This allows us to extend the reach of psychiatry into primary care and gives more timely access, particularly given the shortage of psychiatrists.
I am also involved in education of medical students, residents and allied professionals. Occasionally high school students will ask to shadow or observe my clinic and get a sense of what life in psychiatry is like. So, it’s a blend of teaching, clinical work and integrated care.
In my administrative side, I currently serve as chair of our physician and allied professional health committee. At Marshfield Clinic we are committed to improving the health and well-being of our staff. We have a committee structure for helping our physicians and allied professionals. Typically I will meet with either a physician or nonphysician provider who may be struggling with burnout or may have some health concerns or situations that may have come up administratively, raising concern for the well-being of the individual.
We know that our profession is a high-risk profession for depression, anxiety, substance use and suicide. One of the risk factors for these conditions is experiencing adverse clinical outcomes. When these situations happen, our committee reaches out to provide peer support, which can help the individual feel supported and not feel isolated in the stressful situation.
The most challenging and rewarding aspects of perinatal and reproductive psychiatry: The most challenging part is the misguided recommendations or information that patients have and then trying to correct it.
Previously I was an ob-gyn. I did my boards in ob-gyn back in India and then when we moved to the U.S. I switched over to psychiatry with a goal of doing what I’m doing now in my subspecialty practice. One of the things that I found challenging is patients will be told that because it’s mental health or emotional health, somehow the perception is that you can manage it on your own, you don’t need treatment or there’s a sense that medicines should absolutely not be taken because it affects the unborn child and will cause birth defects.
So, countering some of the information that is misguided and the misinformation is probably the most challenging part. The second part is that mental health tends to be stigmatized. It is about countering that stigma, normalizing mental health care and then helping put it in perspective that this is no different than any other medical condition.
Once you can have that conversation, the best thing for me in this field is when I can help women and even physicians understand that nuance, helping them understand that one of the most common complications during pregnancy is anxiety and depression. When people can make that connection and understand what the risks are of untreated maternal mental health conditions, then they can move forward with making a more educated decision, and they have a healthy pregnancy—which in turn helps with the health of the baby—this is very rewarding.
The impact burnout has on perinatal and reproductive psychiatry: The nature of psychiatry does make us more vulnerable to burnout. Day in and day out, you are looking at the struggling and some of the traumatic experiences that are the underpinnings of some of the mental health conditions patients experience.
This work does take its toll and can lead to professionals clinically backing off from practice or looking at early retirement due to burnout.
How Marshfield Clinic Health System is reducing physician burnout: We are bringing augmented intelligence (AI) tools for transcription support, which can help cut down the documentation time quite a bit.
In psychiatry, our notes in general tend to be longer and more descriptive than other medical notes, so a lot of times I feel like I’m regurgitating everything I told the patient and now I’m going to be spending more time documenting that same information into my note after the appointment. So, AI assistance is really helpful in cutting down documentation time.
The other thing Marshfield Clinic is doing is using Notable, which is a technology that helps reduce some of the paperwork burden for the staff. So, reducing burnout and workload not just for the physicians but also for our support staff.
How my lifestyle matches, or differs from, what I had envisioned: In medical school, I just expected to be busy. My father is a gynoncology surgeon who is retired, so I’ve seen his lifestyle and knew how busy he was and how much he had to do. So, I expected to be busy.
However, I also had a neighbor who was a mother of three girls, and she was an internist. She worked a very interesting schedule. In the morning, she had clinic until noon. Then she broke for lunch and three hours later she would go back to her clinic for another four or five hours. And one of the things she engrained in me was that you want to make sure you choose a specialty that gives you a good work-life balance so you can take care of your family as well as meet the needs of the profession. So, I have had that in the back of my mind.
Skills every physician in training should have for perinatal and reproductive psychiatry but won’t be tested for on the board exam: Psychiatry is unique in the sense that you have to be able to establish rapport and have therapeutic alliance. It’s not just going through a checklist of symptoms. You’re not going to get patients to talk with you and engage with you unless you can establish that alliance and rapport. Active listening and empathy are important in general in medicine, but more so in psychiatry and I’m not sure the board exams can really get to that.
One question physicians in training should ask themselves before pursuing perinatal and reproductive psychiatry: What draws you to this field and how do you feel you’re going to contribute to it?
Additional advice I would give to students who are considering perinatal and reproductive psychiatry: Resilience is even more important in this specialty and critical to develop. It is also important to figure out how you’re going to disconnect from work and not carry that home.
Having people to reach out to that you can confide in and share without feeling censured, and having ways to disconnect from work are important for all specialties, but even more so for us in psychiatry.
