Psych 101: How to become a psychiatrist

[00:00:00] Bruce Bassi: Hi, my name is Dr. Bassi. I’m an adult psychiatrist based in Florida. I was recently contacted by an undergraduate from the University of Buffalo to discuss what it’s like being a psychiatrist. We discussed my recommendations for pre-meds, who are looking to go into psychiatry and some encouragement if you feel like parts of your application could use some work. We also discussed a bit about how engineering relates to psychiatry. And what I would do differently if I was an undergrad. We decided to record the interview in case it would be helpful to anyone else. I hope you enjoy it.

[00:00:30] Marcella McDowell: Okay, so I just have some questions for you. What did you major in?

[00:00:40] Bruce Bassi: So, I majored in biomedical engineering. I knew I wanted to do some engineering, and I also wanted to do medicine too. So that was the only one that really had the ability to do the prerequisites for med school.

[00:00:51] Marcella McDowell: So you went into med school after, what was it?

[00:00:56] Bruce Bassi: I did a master’s program after undergraduate. I took, I took a little bit of time off, so I always really thought about medicine I didn’t know– I wasn’t a hundred percent in on, I actually felt very discouraged because a lot of people talked down about medicine and said it was starting to change and not be what it typically was, and there’s a lot of dissatisfied physicians and they’re unhappy, and that was very discouraging because I felt like I wanted to be a doctor, but nobody really sounded like always a very good career path at the time. And so that, that led me down to a PhD route. So I applied for a PhD program in biomedical engineering at Columbia, started it, and I realized I was just too so removed from the clinical aspect. I was, could spend days without really even talking to people just on my computer coding or working on a project or something like that, and it felt really not fulfilling. So I said, I, you know, I’m always gonna regret not going to med school and just doing it.

And so I did and ended up loving it. I actually, I’ve really enjoyed my career. It’s really fun, I don’t feel like it’s work to me. I’m working like all hours of the day. I don’t, I don’t like keep track of my hours because it doesn’t really feel like work. It feels like kind of a hobby or a art, and it just feels so, so enjoyable to to see patients and help out practice too, and to help teach and supervise other people in the practice. So then I, after my master’s program, which was really a PhD program, just abbreviated. I went to med school and I had quite a bit of exposure to psychiatry from the master’s program.

I had done a master’s in a psychiatric lab, essentially, the biomedical engineering, program was– my advisor was in a psychiatric lab. So it was a TMS lab. I don’t know if you’re familiar with TMS.

[00:02:57] Marcella McDowell: What does that, what?

[00:03:00] Bruce Bassi: Magnetic stimulation used primarily to treat depression, but other types of illnesses. And we were programming the actual device for different paradigms of delivery of the magnetic stimulation. And so I had, I had about two and a half years of exposure to a psychiatric research clinic essentially. patients were coming into the clinic to enroll in research studies at Columbia University. And so I knew what psychiatry was all about, and that was really helpful going into medical school. I talked about that a lot in my interviews and personal statements.

And then I thought I wanted to go into emergency medicine. I really liked it as a student. I was very interested in the pace and helping people with acute issues that was very hands-on. You can do a lot procedures, work with your hands. It was fun. I really got along quite well with a lot of emergency medicine physicians and other residents, individuals in the residency, they were cool down to earth, easy to talk to normal people. So I went into that career path and then I’ve realized, no, I actually really like psychiatry. So, decided, you know, psychiatry as a career path, is a lot more attractive me, though emergency medicine was fun a student I didn’t like it as a career path.

[00:04:31] Marcella McDowell: So you did your bachelor’s and then you did your master’s and then PhD.

[00:04:38] Bruce Bassi: I didn’t do my PhD. It was a PhD program where you get your master’s first, then you do your PhD. I left after I got my master’s.

[00:04:45] Marcella McDowell: Okay, so then you went into med school after your master’s?

[00:04:49] Bruce Bassi: Yep. Exactly. Mm-hmm.

[00:04:52] Marcella McDowell: And where did you get your degree?

[00:04:55] Bruce Bassi: I did my undergraduate, University of Connecticut, my master’s at Columbia, Med School at University of Michigan, so I’ve been bouncing around a lot. And then I did my residency at University of Florida in Gainesville.

Marcella McDowell: Oh, you practice in Florida, right?

Bruce Bassi: Yep. I’m in Jacksonville.

Marcella McDowell: And what is your position at your company that you’re at?

Bruce Bassi: So I’m the medical director, meaning I oversee any sort of medical or psychiatric issues and I’m the owner of the practice, so I, I have a private practice that’s only owned by me. I fully own it and therefore, you know, there’s a employees that work with me. And we all see patients and do therapy and medication adjustments, medication management.

[00:05:43] Marcella McDowell: Okay. And what are some core skill sets do you feel the best prepares for a current college student to have if they’re pursuing a career in your field?

Bruce Bassi: So I’m a psychiatrist, so I went to med school and then did a psychiatry residency. If somebody’s interested in mental health, they can obviously be a psychologist where they have a PhD, they can be a licensed clinical social worker. They can go into marriage and family therapy. So if somebody wants to work in mental, that is a huge, very general term.

And some, if somebody to go specifically into psychiatry, that means that they have to do all the pre-med requirements and go to med school first, and then they’re gonna be exposed to different rotations within medicine, and then they’ll have to continue to pursue psychiatry after medical school for another four years.

So when somebody is thinking about psychiatry, they have to be geared toward going to med school first and getting all the pre-med requirements done, taking the mcat, getting letters of recommendation, getting exposure to medicine in general. I think it, fine if you know that you want to go into psychiatry, right from the get go. It’s, it’s pretty rare that you know, only about 15% people go into psychiatry from med school, and of those 15%, not all of them knew that they wanted do that right off the bat. It’s not a very popular field if you think about all the other ones out there. So somebody who goes into psychiatry obviously loves talking to other people and getting to know how they think, that’s really what it does come down to. But if to exceed and excel, I mean, and do well in med school, you have to liken and enjoy human biology and pharmacology, physiology, those are the, the main coursework. Biology, pharmacology and physiology, I would say is what it comes down to when excelling in med school.

[00:07:42] Marcella McDowell: Okay. And what are some experiences do you feel that a current college student should be interested in when they’re pursuing a career in your field? Like, what do you think they should expect?

[00:07:53] Bruce Bassi: So I review a lot of applications and resumes for people who are interested in employment with practice. I would say it’s very, almost stereotypical for people to say that they’ve had their own personal trials and tribulations in mental health, mental health issues, and that’s how they got interested in it.

It’s, it’s kind of like a, a very old experience that I keep reading time and again. I would say somebody should have more than just personal experience within the field. They should have a lot of professional experience in the field too, hopefully, where they’ve done volunteer work and maybe like a clinical setting where they’ve helped patients do various tasks or advocated for patients.

There’s a huge need for that, and plus can get quite a very good ground there, foundation of how medicine works in general. And also talk about those experiences both in your personal statement and your interview. I wish I did more of that when I was applying to med school. I did a lot of research and I very strong on the research front of things, but I shadowed a bit, but I don’t think it was nearly enough that it should have been.

So I shadowed maybe for like four weeks and it maybe one, one two hour session per week. So it was very, very minimal. I would say somebody should do shadowing or volunteer work or being a scribe is actually also like huge, huge way of growing and learning about medicine and getting experience exposure.

Because eventually you’re gonna have to make that decision. Is this the right thing for me? Once in med school, you’re like, do I want to do psychiatry? And so if you’re a scribe, you’ve probably been exposed to other aspects of medicine in, in depth and therefore can make a, a very sound decision and articulate that to somebody that it’s like a very well thought out decision that you wanna make and you’re completely dedicated to the field.

[00:09:53] Marcella McDowell: What were some specific experiences or courses that you took in college that you feel helped, that helped you succeed in your career right now?

[00:10:03] Bruce Bassi: Maybe it sounds a little cynical or sad, but I don’t, I can’t really recall very many of them that are something I use right now. I took coding classes and I took engineering classes, biomedical engineering classes, biomaterials classes. I took civil engineering classes there’s a requisite for that too. And then all the basic education requirements.

I was in the pre-med club, so that was, that was fun and a good experience to meet and talk to other individuals too about what their goals were, what, how they’re approaching the mcat, what their timeline is, if they’re gonna take a gap year.

I feel like a gap year is very common these days, and you can really set yourself up for, for a nice application by having a little bit extra experience in, in that gap year. So in, in undergraduate, I would say, you know, focusing on your classes in doing maybe some clinically oriented volunteer work and taking the MCAT is like, quite a bit to put on your plate already. That’s like asking a lot already. So I wouldn’t say I used any of my orgo or, or biology physiology. I mean, probably do, and I don’t even realize Maybe, maybe I’m using some physiology in there that I don’t even realize that was in that class back then. So I graduated in 2006, from, from undergrad. So it was, I don’t know what, 15, 16 years ago or so. So it’s hard to like think back on what coursework was in that class and then figure out if I’m utilizing it. Mostly stuff I learned in residency, quite honestly my, my day to day clinical experience. What I draw from is, is a lot the patients that I worked with in residency, know, have worked with people with depression, anxiety, schizophrenia, bipolar, OCD, personality disorders. So that’s the main a lot of the, the main foundation of medicine itself for me.

[00:17:07] Marcella McDowell: And I just have another, just a question that I thought of. How does engineering relate to psychiatry? Like where does engineering come in?

[00:17:16] Bruce Bassi: Well, that’s, that’s a really good question. So in a different few different ways, but the way that I’m familiar with is the delivery of electronic stimulation to the brain to help reregulate circuitry in the brain. Depression and anxiety can, and even schizophrenia can be thought of as a miswiring misfiring of particular circuit in the brain, meaning a pathway of neurons to different parts of the brain.

So if, generally speaking and very putting it very basically, for depression, for instance, if there’s a slowing of that circuitry, you can use external factors such as external stimulation ECT, electronic electrical convulsive therapy, TMS, which is magnetic stimulation to start to up-regulate that circuitry that was now artificially like kind of slowed down because of depression. And same with things like OCD, so you can use deep brain stimulation where you implant an electrode into a particular area of the brain to start to reregulate that, that location and then at, at the effects are like surprisingly miraculous. It happens like almost instantaneously when a patient is coming to follow up and they press the button and certain thoughts and feelings, they just like get eliminated immediately. So those devices, the biology behind where it’s going, all of that people work with engineering teams to, to help improve those things. So bio tech companies in healthcare, they have teams and teams of engineers. that help work on these things.

And that’s, that’s from the biomedical side of things. And then there’s computer science where you could be programming an app. You could be programming a VR device, so that, that would be a computer science type of individual who can maybe help out in psychiatry and mental health. We didn’t get into pain, electronic stimulators of the spinal cord to help treat pain. And there are some psychiatrists who, who do that pain, pain, management. Trying if others in regard to psychiatry and mental health.

Pharmacology medication delivery systems. There’s new versions of Suboxone and Abilify and they’re basically trying to come up with ways of delivering the medication. in a way that is bioavailable, meaning available to the body, but in ways to reduce side effects. So depending on how it’s getting into your body and the rate in which it’s delivered to the, to the body and yourself you could either have very high side effects or very low side effects. And so that is another aspect of how engineering can relate to psychiatry is the delivery of medications.

[00:20:29] Marcella McDowell: Okay. Thank you. I didn’t know any of that, so thank you for that.

[00:20:34] Bruce Bassi: It’s a cool field. I mean, if you’re interested in engineering and mental health, then there’s definitely a lot of overlaps there.

[00:20:44] Marcella McDowell: There’s such a wide range of things you can do in mental health and, and you really don’t know until you talk to so many different people. So it’s just interesting to see all the different aspects of mental health and what you can do in mental health.

[00:20:56] Bruce Bassi: Oh, totally. You know, I wanted to to mention that too, because even when it sounds like you’re being pigeonholed into psychiatry, oh my gosh, I’m going to psychiatry. The field of psychiatry so broad. You can do corrections, you can do outpatient, you can do academic medicine, you can do child and adolescent, you can do addictions, you can do forensic psychiatry. you could do geriatric psychiatry and all of them, like their day is so much different. Like if you look at, you want just one person to compare their day to a person in a different aspect of psychiatry. It’s just night and day different as to like what their day is like. So, and even those fields, depending on the place of service, like inpatient versus outpatient versus in a jail setting versus in a facility versus an IOP program, like an intensive outpatient program. Those are all different environments too.

[00:21:58] Marcella McDowell: It’s interesting.

[00:22:00] Bruce Bassi: Yeah, it is.

[00:22:03] Marcella McDowell: Okay, so I have another question. Please explain the importance of effective writing skills in your career.

[00:22:11] Bruce Bassi: Writing, communication, verbal communication without it, you’d be disabled in our career path. I mean, you, I, I remember I had laryngitis, and I didn’t call out because it’s my private practice and I really wanted to see people, but I was so hard to speak and just really hard to see patients and treat them without the ability to speak. Was there a reason you wanted to know about written communication versus oral communication?

[00:22:41] Marcella McDowell: Well, this specifically is for writing class, so that’s why they asked. But , I feel that oral communication will probably weigh more important in your field.

[00:22:51] Bruce Bassi: Yeah, well, we’re in communication, so when am I writing things? Writing prescriptions, if you make an error in that, that could be, it could be life and death, first of all. It could be very confusing to the pharmacist or the patient, and there’s a very specific way to write a prescription.

The notes themselves. So we’re writing notes quite a bit and they could be helpful for me, the patient and the insurance company, and any subsequent treating clinicians. So you have, you have many audiences to your note, clinical note that I’m writing, and that makes it very difficult because of my writing list for myself versus the patient. It could be like different, the way I would speak it, the way I would explain it, you know?

[00:23:34] Marcella McDowell: Yeah.

[00:23:35] Bruce Bassi: You, you tend to find your style in residency because you’re, you’re seeing a lot of other people’s notes and people are also giving you feedback on your notes too. And so there’s, there’s definitely a lot of improvement when you’re first writing a note versus like when you’ve done it for a few years. There’s a lot of abbreviations. And there’s a lot of different styles that people have. So, when you’re in residency, because you are often on consulting services and you’re seeing other people write their notes, you can kind of see what is a, a nice, clear way to communicate this to another clinician? So that’s all, that’s all I can think of in regard to written communication.

There’s, there’s some marketing aspect to being in private practice, and you need to be a good written communicator too.

Often a lot of our communication with patients is written if I’m patients, patients can email me, they can send me a message through our, our patient portal well. So we are often communicating with patients in written format too.