Health Equity

This resident psychiatrist stakes her claim as physician leader

Sara Berg, MS , News Editor

AMA News Wire

This resident psychiatrist stakes her claim as physician leader

May 11, 2023

As a small town girl living in a rural area of South Mississippi born to parents who worked blue-collar jobs, AMA member Avani K. Patel, MD, MHA, always dreamed of becoming a doctor. Like her sister, also a physician, Dr. Patel looked at physicians as heroes. Dr. Patel has found ways to break barriers and biases to help patients and pave the way for other physicians like her.

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“I’ve always been the youngest in the group in everything that I’ve ever done—serving on boards, committees and in a variety of different opportunities,” said Dr. Patel, a psychiatry resident in Jackson, and a delegate in the House of Delegates for the AMA Resident and Fellows Section. “Although I spend a lot of time observing the environment and strategy in the room, I’m not just there to smile and shake my head. I fully acknowledge and always address that I lack experience in time given my age, but I do not lack intellect, ambition, ideas and putting in the effort required to understand.”

“Being a South Asian female—in my 20s and now newly 30, having accomplished all of this—none of that really adds up for people oftentimes as there is an element of surprise,” she said. “And to add, growing up in Mississippi, I faced a lot of racial bias, and I still continue to experience some of that albeit much less so than where I grew up. However, when you’ve experienced adversity, in a way, you learn how to respond and manage those feelings and experiences.

“It can still be quite emotional, but I will share that when my patients have shared with me the racial bias that they’ve experienced, it puts me in a unique position because I’m one of the few people who can empathize,” Dr. Patel added.

During a Q&A with the AMA, Dr. Patel discussed overcoming biases, her passion for advocacy and mental health, and how leadership roles help her pave the way for other physicians who look like her.

AMA: What inspired you to get involved as a Medical Justice in Advocacy Fellow through the AMA and Satcher Health Leadership Institute at Morehouse School of Medicine?

Dr. Patel: When I first saw that the AMA made the big announcement that they were partnering with Satcher Health Leadership Institute, I thought: Wow, what an opportunity. What an incredible space, especially because that's the direction we're moving toward. And it's something that's been a long time coming. I wasn’t sure if I’d even be on their radar, but I’ve never been one not to try.

I live in one of the most resource-poor states in the country where most of the population—unlike the rest of the country—is Black. And I found, especially in the realm of mental health, I wanted to make sure that I was educated to better serve my community. I also had a lot of my own personal experiences of adversity, so this was the one application that was the most cathartic and therapeutic for me, because it was the most honest I had ever been with myself. I had revealed experiences about my humble background that I had never shared before—some of the discrimination that I've had to face. It was very raw and very real, but it was very me and my lived experience.

In fact, I’ll share a story about a patient encounter that made quite the impression on me—so much so that I shared it in my application. There was an 18-year-old patient who identified as a Black woman, and she shared with me the stigma around mental health in her community and culture. She refused to speak to anyone on the unit except for the occasional small talk with the floor nurse, and I just happened to be the physician on call that weekend. I spent time building rapport, and over the course of a few minutes, she opened up to me. We spent much time finding the appropriate resources and getting her plugged in with some extended family support which led her to say: Thank you for not judging me and for understanding. You didn’t tell me how I was supposed to think or how I was supposed to feel, and you tried to understand. Thank you for that.

She went on to share that although I was not visually of the same background, she felt understood. That made me realize how important it is to be mindful of cultural differences—of being able to acknowledge the elephant in the room that, no I won’t have the exact same lived experiences, but I work really hard to empathize and understand.

I was only one of two resident physicians selected at the time for the fellowship from over 300 applications across the country. We were a small cohort of 12 and the other resident physician had graduated to become an attending during the time of the fellowship. However, I was the only resident who still had much training left but was fortunate to participate in that fellowship cohort. I was truly inspired by the individuals around me who were much more experienced in time. My project was centered around equity in the mental health framework—not only for physicians but also for patients in the community and what should that look like in medical school, residency and in colleges. If colleges are starting to do this work, why aren’t we?  

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AMA: How did you get involved in advocacy related to stopping inappropriate expansions of scope of practice, which is part of the AMA Recovery Plan for America’s Physicians?

Dr. Patel: So that's something I'm really, really passionate about and a leading topic in the state of Mississippi. We're one of the few states left where we still practice a physician-led team care model. There are a lot of states that have really struggled with that over the years, so that's something we very much have pride in.

Oftentimes, we get bullied with the statement that “Mississippi doesn’t get a lot right.” But that’s one of quite a few things that we do get right, as well as our strong vaccination laws. I’ve been fortunate to have many mentors here in Mississippi and the AMA who have shown me how rewarding it is to be a strong advocate.

Going back to some of the gender bias and experiences that I’ve faced as a woman in medicine, I want for people to understand that I have given up my entire 20s to serve in this career. I don’t think many people recognize or even realize what you’re giving up when you choose a career in medicine and oftentimes, that means making social sacrifices. I know many of my female mentors can relate to this.

As women, particularly in the South, we’re oftentimes told: Well you know, there’s that ticking clock. And that’s when you truly grasp that sometimes you have to put some of your personal life and your social life on hold to pursue your passion and dream, and oftentimes, people don’t think about those types of sacrifices that you end up making.

So, all of that to say that scope of practice is something that I care very deeply about because it’s personal for me. I’ve made those sacrifices so that patients can receive the safest and highest quality of care. Every member of the team is vital, but it’s very important to understand what your limitations are. Even as a psychiatrist, there are certain medications that I’m not comfortable prescribing or general medical conditions where I’m not going to provide much commentary because I’m not the expert in that field—that’s not what I’m doing residency for. It’s very niche and highly specialized, so it’s important to respect that dedication to training. You can’t replicate that level of knowledge by taking shortcuts in training.

If I can understand my own limitations as a medical doctor trained in psychiatry, then I feel like nonphysician providers and other trainees should understand what their limitations are. When you don’t respect that boundary, that’s when medicine gets dangerous. I've also had very personal stories with patients who I've seen while being inpatient that have, quite frankly, traumatized me. And when I tell the legislators these stories, I say: Now you understand it's not just about access to care.

AMA: What are some of those personal stories with patients related to scope of practice?

Dr. Patel: The amount of patients I've had this past year who were seeing a nonphysician provider previously and then began seeing me who said: “You've changed my life. I had no idea that I'm supposed to be explained these things. Thank you for educating me and helping me understand what is safe for me. I had no idea.”

The education piece while avoiding medical jargon is so important. When patients come to me, they are trusting me with some of the most sensitive issues they are facing. These are problems they oftentimes won’t even share with their loved ones. If I had a dollar for every time a patient was misdiagnosed or on an unsafe medication regimen, particularly in the realm of psychiatry, I may not even need to practice. And that’s the part that worries me about breaching scope.

For example, there are many times that even general medical specialties, such as family medicine and internal medicine, don’t realize that many drug-drug interactions or certain medical diagnoses or combinations thereof that can create a false perception of psychosis. But they recognize that and call in the experts. And that's where I come in. That is why I believe strongly that medical school does matter, particularly in the realm of psychiatry. People, oftentimes, forget that I am a medical doctor—that’s what allows for the safest and highest quality of care. The intricacies of medical school training are what allows me to be good at my job.

I’ll share this one experience of mine in training that moves me more than any other. There was a child patient I was seeing on inpatient consults, and he was prescribed horse tranquilizer doses of psychiatric medications by a nonphysician provider. Unfortunately, the child patient suffered from permanent brain damage, which we were able to see on imaging. The child’s guardian was his grandmother who found herself crying at my feet and said: I did this to my child. I had no idea. I thought they were a doctor.

That was one of the most heartbreaking moments I’ve experienced in my training. And there I was trying to pick up the pieces and let her know that it wasn’t her fault as she didn’t know. Asking someone for their credentials wasn’t something that came to mind for not just her but for many, especially when you’re in an area with high levels of illiteracy rates. There have been many times my patients have shared: Dr. Patel, I can’t read. Thank you for explaining. Thank you for not making me feel small. I was too embarrassed to tell you.

That’s an experience I share with many of our legislators. This child will never have the same future he could have had previously because it’s not reversible. And we must do better. That is why medical school matters.

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AMA: What can you tell our readers about the work you are doing on the board of directors of the AMA Foundation?

Dr. Patel: It all started with my participation in the AMA Foundation funded Leadership Development Institute [LDI] for fourth year medical students. It was one of the best non-clinical training experiences, and little did I know that it would lead me to an opportunity to serve on the AMA Foundation Board of Directors as the first resident physician on the board.

I will share that during the LDI program, I was paired with Jeremy Lazarus, MD, and he is a psychiatrist, a past AMA president, and very involved in both the AMA and the American Psychiatric Association. And that was really special because here we are a few years later serving on the board of directors together as he continues to mentor me along, serving as a special role model in my life.

It feels very full circle. It’s been an honor to see how a high-level non-profit organization functions, particularly one I really believe in and want to fully support. It’s been a learning experience, and I hope to continue to engage our members and the resident-fellow section.