Personal Reflections on a Career of Transitions
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* Larry R. Faulkner

When I first received Ezra Griffith's letter asking me to write a “very personalized” account of my decision to change my career, I was somewhat taken aback and reluctant to do it. After all, I reasoned, what did I have to say that others would find useful? Other than perhaps to my own family, my personal reflections about career decision-making would make for rather boring reading. Not wanting to reject the editor's invitation out of hand, however, I set his letter aside and ruminated about it for several more days. I finally agreed to give the article a try, provided I could find a way to do so that was consistent with an academic and educational perspective on the issue of career transition. In other words, I wanted to use my own career and its transitions as the basis for a discussion of the factors that others might consider when pondering similar changes in their lives. To that end, I will begin this article with a brief overview of my career. Then I shall make some observations on my career transitions, the career themes that I have tried to emphasize over the years, and the colleagues and mentors who have helped to reinforce those themes. I shall also review some of the factors that contributed to my recent decision to change careers before presenting several specific suggestions based on my experiences that others might find useful as they reflect on their current and future career paths.

This is indeed an article of “personalized” reflections, not an academic study. It will suffer from several limitations, not the least of which is its inherent subjectivity. There may well be major factors that have influenced my career that are not entirely apparent to me at this time, and some of the matters that seem important to me now may actually have had relatively little influence on what I have done during my career. In addition, I want to underline the fact that others have had a major impact on all that I have accomplished throughout my professional life. I thank them for their help and support, and I apologize for any insights I now claim as my own that they may well have expressed to me years ago.

## Brief Review of My Career

After graduating from the University of Washington School of Medicine in 1974, I completed a family medicine internship and a psychiatric residency at the University of Arkansas for Medical Sciences (UAMS), spent the last four months of my Chief Resident year as an Administrative Fellow in the Psychiatry Education Branch of the National Institute of Mental Health (NIMH), and returned to Arkansas for two years as Deputy Commissioner for Community Mental Health Service and Affiliated Programs in the Arkansas State Mental Health Division (ASMHD).

In 1980, I had the good fortune to go “home” to the Northwest to join the faculty of the Department of Psychiatry at Oregon Health Sciences University (OHSU). During my 10 years at OHSU, I spent most of my time as first the Director of Residency Training and later the Director of Education. It was also at OHSU that I began my association with two organizations that would ultimately have a major impact on my entire career: The American Academy of Psychiatry and the Law (AAPL) and the American Board of Psychiatry and Neurology (ABPN).

In 1990, I was recruited to the University of South Carolina School of Medicine (USCSOM) and the South Carolina Department of Mental Health (SCDMH) to be the Chair of the Department of Neuropsychiatry and Behavioral Science (DNPBS) and the Director of the William S. Hall Psychiatric Institute (WSHPI). In 1994, I was asked by the President of the University of South Carolina (USC) to serve as Interim Dean of the USCSOM, which I then did for 18 months. In 1995, at the conclusion of a national recruitment process, I was appointed USC Vice President for Medical Affairs and Dean of the USCSOM. During my time in South Carolina, I had the honor and privilege to serve as the AAPL President (1998–1999), a Director of the ABPN (1999–2005), and the President of the AAPL Institute for Education and Research (2002-Present). In July of 2006, after 16 years in South Carolina, 12 of which were spent as a Vice President and Dean, I was selected to become the Executive Vice President of the ABPN.

## Career Transitions and Themes: The Influence of Colleagues and Mentors

As outlined in Table 1, several specific themes have permeated my entire career, and they have been both stimulated and reinforced by the many exceptional colleagues and mentors with whom I have worked over the years. These mentoring relationships also helped to pave the way for me at each step along my career path. For example, I first met James Eaton and Pedro Ruiz in 1977 at the Chief Residents' Conference in Tarrytown, New York. At that time, Eaton was Chief of the Psychiatry Education Branch at NIMH and one of the most influential people in academic psychiatry in the country. He had established an Administrative Fellowship in the Psychiatry Education Branch to mentor young psychiatrists he believed had the potential to become future leaders in academic psychiatry. After our time together at the Chief Residents' Conference, he selected me to become one of his fellows. He had a major impact not only on my career but on the careers of many others as well, including those of Jay Scully, Burton Reifler, and Victor Reus. When Eaton was a psychiatric resident at Tulane University, Scully was one of his medical students, and Burton Reifler and Victor Reus both preceded me as administrative fellows with Eaton.

View this table:
[ Table 1 ](http://jaapl.org/content/35/2/253/T1)

 **Table 1**  
Career Positions and Major Themes

I began to develop my interest in administration while working with James Eaton and his colleagues in the complex organization that was the NIMH. It was there that I learned how to design effective programs to facilitate psychiatric education and to appreciate the complex relationships between academic psychiatry and public psychiatry programs for the mentally ill. I came to understand the importance of taking a scholarly approach to my career interests. Above all, however, I watched Eaton and saw the powerful positive influence that a supportive network of colleagues can have on one's career. It was he who introduced me to Michael Rankin and also made it possible for me to meet Joseph Bloom, James Shore, and many other influential psychiatrists around the country.

As I was completing my Administrative Fellowship at NIMH, Michael Rankin just happened to be moving from California to his home state of Arkansas to become the Commissioner of Mental Health. Rankin was a very close friend of Eaton, and Eaton recommended me to Rankin as an eager young psychiatrist with an interest in administration, public psychiatry, and medical education. After interviewing me during an Annual Meeting of the American Psychiatric Association, Rankin recruited me to become Deputy Commissioner for Community Mental Health Services and Affiliated Programs for the ASMHD. My major responsibilities were to coordinate Arkansas' system of community mental health programs and to facilitate the relationship between the ASMHD and the UAMS. While the main focus of my experience as Deputy Commissioner was on administration and public psychiatry, I also had the opportunity to draft Arkansas' new civil commitment law, promote psychiatric education programs within the pubic mental health system, and begin to submit articles for publication. In Arkansas, I also continued my relationship with the Psychiatry Education Branch at NIMH by participating in several site visits of academic departments of psychiatry around the country that were applying for federal grants to support their medical student and residency education programs. On one of these site visits, my co-site visitor was Joseph Bloom, who was at that time the Director of the Community Psychiatry Training Program (CPTP) in the Department of Psychiatry at OHSU, where James Shore was then the Chair.

When Rankin left Arkansas to return to California in 1980, I decided that it was time to redirect my career toward more academic endeavors. At this same time, the Department of Psychiatry at OHSU was searching for a junior faculty member to join Bloom and his colleagues in their CPTP. After the requisite interviewing process, I was recruited to join the faculty at OHSU, where my primary responsibility was to oversee the education and supervision of psychiatry residents during their state hospital rotations. Shortly after I arrived at OHSU, however, Shore reorganized his department and made me the Director of Residency Training. I later became the Director of Education with responsibilities for both medical student and resident education.

I view the decade I spent at OHSU as the “golden years” of my academic career. While I continued my interests and publications in administration, public psychiatry, and medical education, it was at OHSU that my scholarly work in forensic psychiatry began in earnest and where I was introduced to the AAPL by Bloom. He went out of his way to help me get to know Jonas Rappaport, Howard Zonana, Ezra Griffith, Renée Binder, John Bradford, Thomas Gutheil, Jeffrey Metzner, Roy O'Shaughnessy, Robert Phillips, and many other AAPL members who were to become my colleagues and friends. It was also during my time at OHSU that I began my involvement with the ABPN. I was first invited to be an oral examiner by William Webb, who was a friend of Michael Rankin, and later by Layton McCurdy from South Carolina. Subsequently, James Shore, who had by this time moved from OHSU to become the Chair of the Department of Psychiatry at the University of Colorado, invited me to serve as a Senior Examiner on his ABPN team. Shore also introduced me to Jay Scully and Daniel Winstead. Scully was Shore's Residency Training Director at the University of Colorado and another one of his Senior Examiners, and Winstead was the Chair of the Department of Psychiatry and Neurology at the Tulane University School of Medicine.

Shortly after I arrived at OHSU, I was introduced by Bloom and Shore to Donald Bray and John Talbott. Bray had been Director of the Oregon State Mental Health Division, and Talbott was the Chair of the Department of Psychiatry at the University of Maryland and a like-minded proponent of psychiatric education in the public sector. Shore, Bloom, Bray, Talbott, and I collaborated with other colleagues at OHSU and elsewhere on many academic projects pertinent to public psychiatry, forensic psychiatry, and medical education.

It was not known to me at the time, in the late 1980s, that the USCSOM and the SCDMH were in the process of recruiting someone to become the new Chair of DNPBS and the Director of the WSHPI. This joint USCSOM-SCDMH position would report to both the Dean of the USCSOM and the Commissioner of the SCDMH. During this period, Bray happened to be at the SCDMH as a special consultant to the Commissioner. The Dean of the USCSOM and the Commissioner of the SCDMH had also sought outside consultation concerning the future direction of the relationship between the USCSOM and the SCDMH. Two of their consultants were John Talbott and James Shore. My understanding is that Bray, Talbott, and Shore all recommended that the Dean of the USCSOM and the Commissioner of the SCDMH consider me for this combined position, and I was indeed contacted by the Dean and invited to apply. This invitation surprised me, and it was only after considerable reflection that I agreed to seek a position on the other side of the country. During the preliminary visits, I came to understand that a move to South Carolina would afford me ample opportunity to further all of my career interests. When offered the position, I readily agreed to accept it.

While I thought that my time in South Carolina would eventually benefit my career, it turned out to be far better than I could ever have imagined. Not only did it allow me to further my interests in administration, public psychiatry, forensic psychiatry, and medical education, but it also enabled me to continue my scholarly activities, to expand my involvement in the AAPL and the ABPN, and to develop very positive working relationships with many of the other faculty leaders and administrators within the USCSOM and its affiliated institutions. This type of involvement likely had some influence on the USC President's selecting me to serve first as the Interim Dean of the USCSOM and later as USC Vice President for Medical Affairs and the Dean of the USCSOM. In the recruitment process for the position of VP and Dean, Eaton, Rankin, Shore, Bloom, and Talbott all stepped forward to support my candidacy. Subsequent to becoming the VP and Dean, I was fortunate enough to recruit Jay Scully to succeed me as Chair of the DNPBS and Director of the WSHPI. It was also fortuitous for me that in my early years as VP and Dean, Layton McCurdy held similar positions at the Medical University of South Carolina in Charleston. In time, we were able to expand significantly the relationship between South Carolina's two medical schools and minimize much of the rancor that had existed for many years between those institutions.

Surprisingly enough, even during my 12 years as a VP and Dean, I was able to continue most of my career interests, albeit in slightly modified forms. Those positions were obviously predominantly administrative in nature with more broad-based medical education responsibilities. While I was no longer specifically involved in public psychiatry, much of what I had learned over the years about administrative relationships between academic psychiatry and the public sector was directly relevant to the relationships that I had to nurture between the community-based USCSOM and its affiliated institutions. My scholarly activity during this period also continued, but I now focused most of my writing on medical education, workforce questions, and the collaborative relationships of the USCSOM. As noted earlier, my involvement in the AAPL culminated in my election to its presidency in 1998, and I became an ABPN Director in 1999. Jay Scully was selected to be an ABPN Director at the same time, and we joined a group of Directors that included Pedro Ruiz, whom I had first met years earlier while at the Chief Residents' Conference. Subsequently, Daniel Winstead, Burton Reifler, and Victor Reus all joined Scully and me on the ABPN Board of Directors.

## From the Dean's Office to the ABPN

Near the end of my second official five-year term as the USC VP and Dean of the USCSOM, I realized that I was at an important juncture in my career. Given my age, if I stayed for another term at the USCSOM, it seemed likely that I would retire there as well. It is my firm belief that for an individual to remain in a leadership role at an institution for longer than 10 to 15 years is good for neither the institution nor the individual. It made sense for me to consider voluntarily stepping aside while things were still going very well at the USCSOM. If I did leave, however, what should I try to do? Returning to a department of psychiatry somewhere as a faculty member or even as a Chair did not appeal to me, nor did the thought of becoming the dean of another medical school. I have never been inclined to replay an experience that I have already had. I needed an opportunity that was unique yet would allow me to pursue at least some of my career interests.

As chance would have it, the position of Executive Vice President (EVP) and Chief Executive Officer of the ABPN was to become available in July of 2006. Since I was in my seventh year as an ABPN Director, I knew a great deal about the ABPN and I was also well aware of the plans for a change in its leadership. Even with this level of familiarity, however, the thought of leaving the USCSOM for the position of the ABPN EVP gave me pause. I had spent almost all of my career immersed in an academic medical school, and I was very comfortable with that culture. I was a tenured full professor with significant job security. When I eventually did step down as the VP and Dean and returned as a faculty member to the DNPBS at the USCSOM, I knew that I would likely be allowed to do whatever I wanted until retirement. After all, what Chair of the DNPBS would be foolish enough to try to force a very popular ex-dean with significant influence to do anything he did not volunteer to do? All of these factors weighed heavily on my wife and me as we pondered what to do with the next phase of our lives. Ultimately, however, the sense that it was my time to leave the USCSOM, my familiarity with the ABPN and its Directors, the belief that the EVP position would indeed allow me to continue most of my career interests, and the quest for a new “adventure” convinced me to enter the recruitment process. The Search Committee for the ABPN EVP included Shore, Ruiz, and other Directors and ex-Directors who were very familiar with me and my work. Letters of recommendation were written on my behalf by Joseph Bloom, Renée Binder, and Layton McCurdy. After the requisite interviewing process, I was selected to become the EVP by an ABPN Board of Directors that included Jay Scully, Daniel Winstead, Burton Reifler, and Victor Reus.

## Lessons Learned and Career Suggestions

My decision to become the ABPN EVP is only the latest in what I would argue have been a series of logical career decisions over the past three decades that have moved my family and me back and forth across the country. In the process of these career moves, I believe I have learned several lessons that I will now use as the basis for some specific suggestions I hope others will find helpful as they consider their own career development. I will not necessarily present these suggestions in any order of priority, as they all seem relevant to me at this time.

### Nurture a Network of Supportive Colleagues and Mentors

The detail with which I have reviewed my career, influential colleagues, and mentors was purposeful, not to document how many psychiatric leaders I have been fortunate enough to know, but rather to illustrate what a powerful effect such individuals can have during the entire span of one's career. Time and again throughout my professional life, they have provided me with advice, guidance, and support, especially during the unsettling periods of transition. They have stimulated my academic development, encouraged me to assume positions of responsibility, and done all that they could to help me fulfill my career goals. Having a rich network of colleagues and mentors across the country with whom I come into contact at regular intervals, either socially or at professional events, has also made it easier for me to consider career transitions that have led me to challenging new positions in unfamiliar parts of the country. I knew that I did not have to be concerned about professional isolation or a lack of support. Rarely did I need to call upon it, but just knowing that this supportive network was there behind me was very helpful.

How does a young person go about developing the type of network of colleagues and mentors that I have just described? Mentoring relationships are indeed complicated, and I do not claim to understand them fully. The best advice I might give, however, would be for that person to identify individuals he likes and respects who are known for their work in areas of mutual interest, to indicate a desire to collaborate on specific professional activities and then to work extremely hard to make sure that those collaborations are successful. That process, repeated time and again, is essentially what I did throughout the early years of my career, and I followed a similar process whether my area of activity at the time was administration, service, education, or research. All of the mentoring relationships that I have had in my career have begun with my working extremely hard for modest pay under individuals who later took a special interest in me and my professional development. I believe it was the initial effort and sacrifice on my part that brought me to the attention of these individuals and led them to believe that I was worthy of their subsequent efforts on my behalf. It is clear to me now that the support of my mentors has been a major factor in my ability to transition into positions that have more than compensated me for whatever early effort and fiscal sacrifices I had to make.

Another observation that I hope is apparent from this review of my career is the complicated and interconnected network that exists among these individuals. The importance of a mentoring relationship is not just what transpires between the mentor and the mentee, but also the positive entrée the mentee is provided into the mentor's network of colleagues and professional organizations. Making these contacts would require years of strenuous effort for a young person flying solo, and some would not be possible at all. I credit my well-connected mentors with facilitating my introduction to the influential individuals and professional organizations that subsequently made the major transitions during my career possible many years earlier than I might otherwise have been able to accomplish on my own.

### Identify Career Themes and Priorities

One of the advantages of the specialty of psychiatry is that it offers a wide range of career possibilities and many different organizations in which psychiatrists can become involved. The challenge for a young person entering the field may not actually be what to do, but rather what not to do with his limited amount of professional time. There is only so much emotional energy available to devote to both personal and professional endeavors, and the difficult process of setting priorities is a key component of any successful career. Early in my professional life, I decided to emphasize the themes shown in Table 1, and I made a conscious decision to focus my energy on these specific areas. While I was somewhat active in other career areas and organizations (e.g., the American Psychiatric Association), I never made an attempt to become heavily involved in them. I also tried to reinforce my career themes with overlapping activities. For example, I not only practiced administration, but I studied it, taught it, and wrote and made presentations about it. When presented with opportunities to make career transitions, I pursued only those that would enable me to advance my career themes. Not only did this strategy help to ensure that I would be satisfied with the new position, but it also made it likely that I would actually have the knowledge and skills necessary to do the job well. In many ways, it has meant that what may appear on the surface to be major career transitions for me have actually not been very significant changes at all. I believe that this approach has been a crucial factor that has contributed to whatever success I have experienced in my career.

### Objectively Assess Abilities and Interests

As a result of my experiences and my observation of the experiences of many of my colleagues, it is my opinion that anyone who considers a transition to a significant new position must, above all else, be coldly objective in his assessment of his own abilities and interests. To consider seriously any new position, but especially one of some importance and stature, an individual must possess at least four key characteristics: the knowledge and skills to do it, the professional standing to assume it, the “fire in the belly” to want it, and the fortitude to lose it. Difficulties in any of these areas do not bode well for success.

Shortcomings in knowledge and skills are obviously a problem in any position. This is one of the main reasons that I have emphasized the importance of career themes and priorities. Focusing on related administrative, service, educational, and scholarly activities will help ensure adequate preparation to assume new responsibilities.

Inadequate professional standing, while perhaps more subtle, will also make it very difficult for some individuals ever to be considered for certain positions or to obtain the support of those they need to be successful. Stated somewhat differently, many people might well be able to fulfill the requirements of a position if they could only obtain it, and it is their lack of professional standing that prevents them from having the opportunity to demonstrate their knowledge and skills. Involvement in a broad network of colleagues, mentors, and professional organizations will make this unfortunate situation less likely. It is also important to understand that professional stature is based in large measure on one's academic accomplishments. This underscores the fundamental necessity of continued scholarly activity in areas of career interest, if for no other reason than to bolster one's stature for the next possible career transition. For many positions, it is not enough to be just an effective administrator, clinician, or teacher. To be recognized as a credible candidate with the requisite professional standing, one must also write and lecture about what one has done.

The lack of what I call the “fire in the belly,” or the intense desire to expend the time and energy required to obtain and fulfill all aspects of a position, will also cause serious problems. One lesson I have learned well is that a person would be very wise not to enter into the recruitment process for a new position if he has no intention of ever actually assuming it. These intense experiences are exhausting, and they often entail complicated interpersonal aspects as well. For example, one should not underestimate how difficult it can be ultimately to reject a position after several visits that have resulted in beginning friendships with new potential colleagues and the lessening of attachments to one's current position.

Another aspect of possessing the “fire in the belly” is the willingness to fulfill certain roles required in the new position. For example, while public speaking, official ceremonies, social functions, and extensive travel might seem glamorous at first, they are soon seen in a different light, when it becomes apparent that these activities usually occur at night or on weekends and often away from family and close friends. The point here is not to be critical of these or other types of activities that are often crucial components of important positions, but rather to emphasize that individuals must be willing to make sacrifices by dedicating themselves to fulfilling all aspects of a desired position and not just those they happen to enjoy.

Anytime a person gives serious consideration to a transition into a new career position, there are two possibilities: he can get it or he can lose it, and he should be prepared to deal with both outcomes. Stated bluntly, if a person cannot handle being rejected for a new position, then he should not seek it in the first place. It is important to realize that the decisions made by search committees and senior administrators often appear to defy logic. This frequently is so because outside observers are not privy to all of the complex factors that go into a final decision to hire a specific individual. It is for this reason that candidates should try not to take the process too personally. Being passed over for a position does not necessarily mean that one is less qualified than the person appointed. When faced with similar difficult situations in my own career, it has been my observation that better opportunities are just over the horizon, and that things ultimately work out for the best in the end.

### Make Opportunities Where They Are Found

One of the most important things I have learned over the years is that there is not just one best place to develop a career. Good colleagues and career opportunities are available all across the country, and the task is to match individual career interests with what is available at the time. It is also true that the best opportunities for career advancement may not be found in the most prestigious locations or in the most sought after positions. More humble surroundings may yield fertile ground in which to develop one's career and reputation. I have come to appreciate that every environment has its own inherent personal and professional advantages and disadvantages. To be successful, one must adapt and find ways to make the best of the situation at hand. It is unrealistic to expect the system or culture to change significantly to accommodate the preferences of someone new who enters it. Transitions in my own career have always been periods when I have been reenergized by a new adventure and the opportunity to be stimulated by new colleagues and friends.

### Prepare for Good Timing and Luck

Often it appears to an outside observer that good timing and just plain luck play a large part in successful career transitions. It may be that being in the right place at the right time is helpful in some situations. However, it is frequently an individual's hard work, done in advance, that prepares him to take advantage of a fortuitous opportunity that presents itself. In my case, it is true that Michael Rankin just happened to be returning to Arkansas when I needed a job after my fellowship; that a faculty position just happened to be available at OHSU when I wanted to leave Arkansas; that I just happened to be at the USCSOM when the Dean decided to step down; and that I just happened to be a Director of the ABPN when it was recruiting for a new EVP. In reality, however, I would never have met James Eaton if I had not taken the initiative to attend the Chief Residents' Conference; he would never have recommended me to Rankin, Shore, and Bloom if I had not done a good job as an Administrative Fellow; I would not have accepted a position at the USCSOM if I had not believed it would be compatible with my career interests; the President of USC would not have appointed me as Interim Dean if he had not been impressed by my work as a Department Chair and Hospital Director and confident in my abilities; and my fellow ABPN Directors would not have selected me to be the new EVP if I had not demonstrated my capabilities to them during the years that we worked together. Good timing and luck may well open a few career doors, but it is initiative and hard work that prepare one to step through and seize those opportunities.

## Conclusion

This has indeed been a very personalized account of my career. Anyone who has tried something similar understands well how difficult it is to draw objective conclusions from one's personal experiences. I hope that my attempt here has been at least partly successful, and that some of the things I think I have learned over the years will be helpful to younger colleagues just entering our profession. I especially hope they appreciate that their professional destiny is mainly in their hands, and that the extent to which they nurture a supportive network of colleagues and mentors, identify career themes and priorities, objectively assess abilities and interests, make opportunities where they are found, and prepare for good timing and luck will have a major impact on their readiness for whatever career transitions come their way.

*   American Academy of Psychiatry and the Law