Page 15 - Mar_Apr 2022 Newsletter.pub_Neat

Adventures with Adversity Series - Navigating
Multidisciplinary Team Environments
By: Robin Bitner, MD

For the last five years, I have been a psychiatrist and medical director for an adult partial hospital and
intensive outpatient program (PHP/IOP). I have found working as a psychiatrist in this setting to be
rewarding and challenging. What I have loved most working in the PHP/IOP is seeing the tremendous
recovery patients can make in a short amount of time and working closely with a multi-disciplinary team.
However, for too many reasons to describe here, our clinical team dynamic had begun to fray, and many
of the most experienced therapists became unhappy at work. When the pandemic hit, issues that were
germinating exploded, and six excellent therapists who are my trusted colleagues and friends left within a
two-month period.

It was challenging being in the psychiatrist/medical director role while the therapists are employed by the
hospital and not our physician group. I sought support from my peer psychiatrists and tried to problem
solve as best I could with hospital management to improve the situation for our therapists. Often, I found
myself caught in the middle advocating for change and became a sounding board for staff who did not
work directly for us. I also became unhappy working in a demoralized and negative milieu. Looking back, I
absorbed a lot of the feelings without being able to make much of a direct impact.
After nearly a year of the pandemic with all its stresses (Zoom kindergarten, need I say more?), and with
conditions at work continuing to decline, I began to seriously consider stepping away from my role in the
program. At first it was not clear what our group could do to cover my position, and I did not want any of
my partners to have to carry my burden. I carefully approached the hospital administration to ask for
support and, gratefully, was offered a locum tenens doctor to fill my spot while I took a break. While away,
I have helped my partners by taking inpatient shifts and have maintained my private practice but have
worked less overall.
It has been almost a year since I left PHP/IOP. Since then, I enrolled in a mindful leadership training
program with the intention of learning skills that would help me better navigate my position if I decided to
return. Working less allowed me to reconnect with hobbies and self-care and spend more time with my
family. In addition to enjoying more free time, stepping away helped me see what parts of the work I
really missed. Taking a break showed me how much I would miss regularly seeing colleagues, feeling
productive and helpful to others, and being intellectually engaged with the work I love. PHP/IOP is back up
and running now in-person with some new staff and a fresh dynamic. I am planning to return in 2022.
Learning more about myself and shifting my perspective helped me make the decision to return.
On an organizational level, multidisciplinary teams are dependent on each other and can be a powerfully
supportive work environment. Also, different leadership structures working together can both help and
hinder each other. Just being more aware of this tension can help. On a relational level, I really enjoy
having strong relationships with the team. Working with such high clinical acuity brings us close together
and generates trust. The flip side to this is that stress and negativity can sometimes be contagious. On a
personal level, when I feel very stressed or even burned out, solutions can start to look very black and
white. I was afraid to ask for a change and was amazed when it was much easier than I thought it would
be to get help.

Going forward, I hope to remember that it is human to have stressful, unfulfilling days sometimes. As a
leader (all be it with limits) of a team, my intention is to move forward with realistic optimism to help

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NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 15 March/April 2022