9. Choosing Child Psychiatry

I had mentioned in V, Moving into Residency, that one choice I had considered was pediatrics because I liked being with children. At the time though, as I also explained further, my over-arching interest was in families and ultimately the communities they lived in. Therefore, I had reasoned that I could get my share of working with children in Family Practice, which is indeed the case. When it came to going into psychiatry, I really never thought about the Child and Adolescent subspecialty. All my experience had been with adults and even psychogeriatrics.

What really set the ball rolling in that direction was an interesting remark made by a friend who was a social worker for the Brandon School Division, Laura Crookshanks. She later became the head of their Student Support Services. I forget the circumstances under which we were meeting but in parting she remarked, and I could see the desire for this in her eyes and her smile, "Think about going into child psychiatry. We need help in that area," or words to that effect. She may have also mentioned, which was something I also probably already knew, that the only long-serving child psychiatrist in the community, Dr. Richard "Dick" Parker, was nearing retirement. Somehow, her request stuck in my mind and began to figure in my considerations as I moved forward.

The way the University of Manitoba Psychiatry Residency was structured at that time was that Child Psychiatry was something that one entered into in the second year. Thus it was, that the first six months of my second year found me in the Child Psychiatry Program at St. Boniface Hospital. If my memory serves me correctly, it was mostly an inpatient residency, which is what introductory residencies often were in those days (1991). When it came time for my mid-rotation evaluation, my preceptor really gave me quite a negative report, which was somewhat surprising. In retrospect, I have often wondered if this was somewhat intentional, because at the end of the six months, his report was entirely the opposite. Certainly, I may have worked harder at what I was doing, but I can hardly think that three months would have meant that much improvement over what he negatively reported on midway.

In any case, the final report was the important one. That, and my experience, was encouraging enough that I then began to look at choosing my electives to complete my residency with a major in Child Psychiatry. At that time, this subspecialty was not yet a recognized area with its own certification examinations and title. However, there was an understanding that one needed at least 18 months of residency in this area to be accepted as a practitioner in the field, so that was what I aimed for. I mentioned previously that I could have taken a year's credit for my Family Practice Residency and experience. Not having looked at that at all, I am not sure how that would have figured into the structure of my residency. It could have given me the extra year of child psychiatry training that could then have allowed me to pursue a full Fellowship in Child Psychiatry. However, as I had said then, I had elected not to do so, which decision was made before I began to move in the direction of child psychiatry, so that door was closed at the time.

I then took another six months of Outpatient Child Psychiatry, also at St. Boniface Hospital. Then I took an elective combination of Eating Disorders Consultation Service and Emergency Child Psychiatry Consultation concurrently, both at Winnipeg Health Sciences Center Children Center. Here I had the interesting experience of working with a classmate who had already become a child psychiatrist, Dr. Robert Steinberg. Finally, to get more experience with a wider range of child and adolescent programming, I set up an elective at the Manitoba Adolescent Treatment Center, which gave me exposure to inpatient psychiatry, outpatient psychiatry, groups and an on-site school. This was a new rotation which I had to set up with the help of mentors such as Dr. Eric Sigurdson, whom I had previously superficially known as a fellow family practitioner in Dauphin, a larger town to the northwest of where I had been practicing in Gladstone, but now in child psychiatry. Most interestingly, the preceptor I was assigned to was Dr. John Varsamis, the same sauve chain-smoking Egyptian Alexandrian Greek psychiatrist whom I had worked under as a medical student and who had encouraged me to go into child psychiatry. It was a privilege to share an office with him and be the recipient of much of the writing this advancing-in-years psychiatrist was doing, which was ahead of the times for his age, on his Apple computer. It was also interesting to see how, in spite of the fact that he always wore a suit and tie, he was so well-liked by his adolescent clients. It all pointed to the fact of how one related to them. We also worked on a project for identifying schizophrenia early, but never did complete that. Much of this involved looking at potential pre-morbid factors, as the earlier one can pick up warning signals, hopefully the more effective intervention at that stage would be.

So it was then, out of my four years of psychiatry residency, a full two years were in child psychiatry training as I recall. Perhaps the St. Boniface outpatients and Health Science Center rotations mentioned were only three months each, as my memory seems to tell me that I only had 18 months of child psychiatry, which was six months short of the requirement for being able to work towards a fellowship. In terms of learning therapy, instead of closing off training therapy sessions with children after completing the child rotations, as was the practice, I kept working with children with appropriate mentors, to support my overall direction. One of these mentors was Dr. Philip Katz, a prominent member of the department, whose son Lawrence Katz also became a child psychiatrist.

I had mentioned earlier the special circumstances under which I entered the residency which required me to return to rural Manitoba. As I said, I was intending to return to Brandon, which was considered rural still, at least as far as psychiatry was concerned, anyway. And there, a spot in the regional mental health program was just waiting for me. Some 50 or four weeks after completing my residency, I started working at the Brandon Mental Health Center as a Child Psychiatrist.