This limited podcast series is brought to you by APA's Women Psychiatrists Caucus and hosted by Anjali Gupta, MD, President of APA's Women Psychiatrists Caucus. Dr.Gupta is an Assistant Professor in the Department of Psychiatry at the Georgetown University School of Medicine. She has led a number of wellness and equity initiatives at Georgetown and was selected to be a Gender+Justice Initiative Faculty Fellow for her research on The Experiences of Women in Medicine. She is active with APA's Committee on Women's Mental Health and is Chair of the AMWA Literary Committee. In this series, Dr. Gupta will interview women psychiatrists across the country who lead in a variety of ways. These conversations will uncover insights from guests' journeys in psychiatry on a range of topics, including work-life integration, mentorship, gender equity, and more.

In this episode, Dr. Gupta is joined by Dr. Ludmila De Faria. Dr. De Faria is an adult psychiatrist who brings an intersectional perspective to her work in psychiatry. Her clinical focus is on college mental health and transitional age youth, and she has a special interest in and works closely with minority populations, increasing access and decreasing mental health disparities among minorities and providing a culturally sensitive environment for patients and trainees. She is an Associate Professor of Psychiatry and Interim Program Director for Residency Training at the University of Florida in Gainesville.

Transcript for Audio

Dr. Ludmila De Faria (00:00): When I started in United States, I didn't know that my particular brand of intersectionality actually could be a barrier. I came in from being just like everybody else in Brazil except that I was a woman and I knew being a woman. Sometimes it's its own thing, but I'm like, well, I've been doing that. I can navigate that. But I didn't realize that being an international medical graduate, a Latin woman, that all of that was going to be a wee bit of a barrier.

Dr. Anjali Gupta (00:37): Welcome to the Women in Psychiatry podcast by the APA's Women's Psychiatrists Caucus. I am Dr. Anjali Gupta, president of the Women's Psychiatrists Caucus, and I will be interviewing women's psychiatrists across the country who lead in a variety of ways so that we can hear their stories and learn from their insights. Thank you for joining us today. I am thrilled to be here with Dr. Ludmila De Faria.

Dr. Ludmila De Faria (01:05): Hello. Happy to be here.

Dr. Anjali Gupta (01:08): Dr. Faria, I would love to just get started and have you talk to us a little bit about your medical school experience. What comes to mind when you think of yourself in medical school?

Dr. Ludmila De Faria (01:23): I went into medical school as the daughter of two doctors and it was basically going to the medical school where I grew up and I knew a lot of the people who taught there. So it was almost like an extension of home. I don't think I got that feeling that I was going out into the world until I came to United States. Medical school in Brazil is six years, I'm from Brazil. And you do two years of basic science and then you go into four years of more clinical work. I had good mentors basically because they knew me from when I was a child and both men and women, my biggest mentors were at home. My mother was a great mentor and I still carry a lot of her teachings in terms of being a woman physician to this date. So medical school was pleasant for most of it. I feel like the challenging part was deciding to move to a different country.

Dr. Anjali Gupta (02:34): And was your mother a psychiatrist as well?

Dr. Ludmila De Faria (02:38): No, my mother was an endocrinologist and my dad was a nephrologist, so they were both internists and they were a little appalled that I decided to go the psychiatry way. That's not what they had in mind for me, but they were supportive.

Dr. Anjali Gupta (02:55): And you mentioned that you came to United States during medical school. What inspired you to do that?

Dr. Ludmila De Faria (03:02): So the University of Miami still has a program that's called the Harrington Program for Latin American Medical students and Physicians. And they basically invite medical students who apply and are chosen to do one year of clinical rotations at a U.S. hospital, in this case, Jackson Memorial in Miami. And so they came to our medical school and they talked about that, kind of alumni that lived in Brazil. And I got interested. My dad had done his fellowship in nephrology in Dallas. And so he's always said it's important for you to have this experience of seeing how people practice medicine in a different country. And my father really liked the technology available and all of the scientific advances and they're like, you really need to expose yourself to that. So he really kind of inspired me to apply. I applied, I was accepted. And I did my entire last year of medical school at Jackson Memorial Hospital.

(04:12): And so I have that certificate plus my university diploma, my medical diploma from my school. And it was an interesting experience. At that time, I don't want to date myself, but that was like 33 going on 34 years ago when I came in. 34 years. And at that time, Brazil was still practicing, it was very much old school. So we order only the labs that we needed to order to prove our point because budget was limited and resources were limited. And there was a significant emphasis on being a good diagnostician and doing good history, really talking to the patient, getting collateral. And what I learned in medical school in my early years was like, you are a good doctor if after you finish talking to the patient, you know exactly what lab work or imaging you need to prove your point, because you have a pretty good idea of what the differential is.

(05:18): And so coming to United States where there was already electronic medical records, or the primordials of that, and medicine and the system, the healthcare system, was way more complex than what I was used to, that was kind of a little bit of a shock, so to speak. I do remember calling home on my first month, which was an internal medicine rotation, and telling my parents, "I feel like I'm in a business rather than in a hospital." I spend half my day looking at a computer screen digging labs and I hardly ever can spend time with the patients. And that for me felt like a dissonance that I didn't spend enough time face-to-face with the patients. Now I know it was because I was a medical student and I was doing the scut work, while other people spent time with the patients. But it felt really weird to me. It was my first experience with this complex medical system that we have and it took me a minute to be able to wrap my head around that.

Dr. Anjali Gupta (06:29): And how did you decide to stay here for residency?

Dr. Ludmila De Faria (06:34): So at the end of my one year, I already knew a lot of people. Believe it or not, at the time I actually wanted to do pediatric oncology. I knew I didn't want to do internal medicine, OB/GYN and surgery and pediatrics was kind of the default. Psychiatry in Brazil, I didn't know a lot of psychiatrists in Brazil, so I didn't have a lot of mentoring or the opportunity to shadow. So it was never an area that I thought I had interested in. And so by the time that I finished my Harrington program here, I knew a lot of people in pediatrics at Jackson Memorial and I stayed to do research in genetics with one of the faculty members that was in the Department of Pediatrics. And at the same time, I did sort of not an observership, it was like an internshipish at the Children's Cancer Center while I passed my tasks to apply for a residency position, which I thought was going to be in pediatrics.

(07:45): And so I was doing all the right things that I had to do to make connections, have my recommendation letters. But then I found out that every single time, instead of doing the procedures, because they knew me and they asked me to do some of the bone marrow aspirations and some of the things that you have to do in pediatric oncology, but I would give that gladly to somebody else because I was following the psychologist that worked with the team.

(08:11): I was much more interested in resilience in the stress of being diagnosed with cancer, the family dynamics, how do people navigate that? And I found myself having more and more conversations about grief, loss, resilience, depression, anxiety. And then one day the psychologist says, well, they're going to have grand rounds in the Department of Psychiatry on this very topic. And so I went into grand rounds to watch grand rounds in psychiatry and I totally fell in love. And so at that point, I had all of the recommendation letters in pediatrics that I needed and I had to tell them, sorry, it's kind of not my thing anymore. And I decided do psychiatry, and I pursued that.

Dr. Anjali Gupta (08:59): Yeah, that story is so interesting and it actually really resonates with me. When I was doing my sub internship on an oncology floor is when I too had a similar feeling that I really wanted to find out all about the coping and the resilience and the dynamics behind the people. So I can really relate to that. So based on your experience as an international medical school graduate and your current role as an interim program director, what are some ways residency training programs can support IMGs?

Dr. Ludmila De Faria (09:45): First of all, identify the IMGs that are already there in your system so that they know who you are. I'm very open about being an international medical graduate and where I went to school and some of my experiences. Because I feel once you share that they are more open to come to you if they're having difficulties and let you know what's going on. And as I just related to you, I know sometimes it's a shock because coming from a different system where medicine sometimes is seen in a very different way, especially psychiatry, it might be a little bit of a shock. So I feel that if we can support them. And I have a international medical graduate that is a resident right now. He comes from Europe and he had a lot of, it was not issues, but with our involuntary commitment system. And we really needed to process a lot about all of the ethical and moral issues that came to his mind about forcing people to have treatment and basically removing civil rights when we lost them, and the judge says that they have to stay for involuntary treatment.

(11:16): And so even that in psychiatry can be quite dissonant for some people. Do we have the right to do that? And even getting used to that system might be an issue. And also, if you encourage diversity in your program or you try to have a equitable recruitment so that people from all over can sort of see themselves or find somebody that resonates with them and their background can make it more welcoming. Sometimes it's like I have had, I'm just thinking about some of the issues that have popped up. I have had people who the language is an issue. They still have... I have an accent. People have very thick accents. And in psychiatry, that can be a little bit of a hurdle depending on the patient that you're seeing. And so to navigate that as well. So oftentimes, you have to reassure them that it will get better and then provide them with the resources that you can, to help them navigate some of those things.

Dr. Anjali Gupta (12:34): So as you think about your professional journey, what are some of the that come to mind?

Dr. Ludmila De Faria (12:43): Well, I like to think of my professional career, like my day job as a potpourri. I am a curious person by nature and I love trying different things. And so when I graduated my residency training, I stayed in academia, I stayed as faculty. But then I was curious about other non-academic career paths. So after a while, after almost a decade in academia, I decided to explore being in private practice. So I had my solo private practice, which I had for one year. And then I found out I'm too talkative and not to have anybody around that I could just go and talk to that wasn't a patient was very hard. I'm not a lone wolf. So I decided I had to be at least in a multi-provider practice.

(13:35): But then at that point I also said, "Hey, if I can manage this, maybe I can manage a little bit of bigger things." And the administrative portion of it was kind of a challenge that I wanted to go for. And so I've done that. I've been chief medical officer for community mental health center, and I stayed there for three years and really found that for me, a lot of the joy is talking to the patients and the clinical work. I like having a little bit of administrative duties, but it cannot be the majority because that really does not satisfy me internally. And so I kind of circle back and I landed in academia again. And so I have this experience of being in different settings and different career paths, which came in handy because as an interim training director, I can address some of the questions that my trainees have from experience, from being able to say, if you're thinking about that, this is what would really set you up in a good path.

Dr. Anjali Gupta (14:53): That's super helpful for students and residents. One of the things that I hear is that people want diverse models and diverse paths and possibilities. And so the fact that you have done a number of those things I imagine was helpful for them to hear about.

Dr. Ludmila De Faria (15:13): And I also like to impart this perspective that there is no one way of doing things. I often tell that when I'm recruiting residents for the next year. I tell them I do see myself as a gardener, and I think my main duty is to make sure that I allow whatever your talent is to flourish. So you might end up being in academics and I can facilitate that. You might end up being a solid community practitioner and I can help you build the skills that you need for that, or you can decide to be a researcher and we can help you with that too. Because I do feel experiencing the variety, even while you are training, it's quite helpful, I think.

Dr. Anjali Gupta (16:04): So as I hear, as I listen to what you're saying, it makes me think about mentorship and that importance of really meeting mentees where they're at, figuring out what they want to do and what's important to them, and helping them cultivate that. As you think about mentorship in your own life, how have you accessed mentorship and how important has this been for you?

Dr. Ludmila De Faria (16:37): I think mentorship is everything, right? I have always looked for that person that is a few steps ahead in whatever shape or form so that I can discuss what's the best way to move to that particular step in my career. And I think about all of the good people in my head. I'm looking back as far as medical school and I can see all of the women, and they were typically women for several reasons when I was in Brazil because Brazil is still a country with a lot of machismo and a lot of misogyny. And that of course plays out in career. So when I had the opportunity to talk to a successful medical in the medical career woman, I really wanted to sit down and talk about what's the path so I don't get stuck. And so I tended to gravitate to women. When I was in academia, there were a lot of international medical graduates.

(17:45): There was a particular one that was, she was almost retiring from the university. She was Cuban and had gone to medical school in Mexico and Spain, and she was wonderful. She answered all my questions. She basically pointed out all of the holes that were on the way and to watch out, not to be pigeonholed. And some of those conversations were really important.

(18:14): And then when I moved to my administrative position that was in a different city, not an academic center, I felt like, my goodness, where am I going to turn, because now I'm at the C-suite. There were no other women physicians in the C-suite. So it felt very isolating. That's when I decided to join the Women Caucus and I submitted an application and the Women Caucus became my lifeline. All of the women in the Women Caucus that were always there, one email away and every year getting together and coming to the meeting and the newsletter that used to come in where people share difficulties, career difficulties, promotion, childcare, raising a family and being a physician in United States, the frustrations about underserved populations and how do we do more work? And the Women Caucus was my place to seek mentorship.

(19:24): And through the mentors that I had at the Women Caucus, a lot of things happened in my career, a lot of good things. I can trace it back to those people because they were there to give a letter of support if I needed one for my application because they told me, have you considered this or that? And I know that they need somebody, how about you kind of apply to that position? And so I feel like a lot of my leadership skills were really sharpened and polished at the level of the Women Caucus and the Association of Women's Psychiatrists, because those overlapped a lot during that particular period of my career.

Dr. Anjali Gupta (20:09): Well, it sounds like mentorship was very important. And I know that you now provide mentorship to so many women and are so helpful to so many people, including myself. As you think about your journey, what have been some of the challenges you have faced along the way?

Dr. Ludmila De Faria (20:34): Well, I have to tell you was out of ignorance on my part. I feel like when I started in United States, I didn't know that my particular brand of intersectionality actually could be a barrier. I came in from being just like everybody else in Brazil, except that I was a woman. And I knew being a woman, sometimes it's its own thing. But I'm like, well, I've been doing that. I can navigate that. But I didn't realize that being an international medical graduate, a Latin woman, speaking a different primary language, that all of that was going to be a wee bit of a barrier. And so the very first time that came to play was when I applied for residency at University of Miami, and I was having an interview with the chief resident. And the chief resident said, "I can't understand anything that you're saying. I think you really shouldn't go into psychiatry because your accent is too thick."

(21:35): And I remember looking at him and going, "I don't know what you're talking about. I have been seeing patients here. And yes, they know that I have an accent, but nobody ever told me they couldn't understand me." So that was the first time that I felt like, oh, this is definitely new territory. And then later on when I got involved with the Women Caucus, I understood ethnic and racial background and how that plays along. And after I had that kind of awakening, much later, I had been an attending for 10 years at that point, I looked back and I saw all of the challenges along the way. For example, whenever you're an immigrant, you tend to typically work hard. The studies and the research that was done on that, say you probably immigrated because you were already working hard and you didn't get faced with a challenge.

(22:38): And so you're like, I'm going to go to this new place and do a career over there. So there were some traits that facilitated the immigration. And then you come to the new place and you continue to work hard. And I remember that mentor at University of Miami who told me, be careful because they often want the immigrants and the people who are not from here for the hard work and to carry the workload. And you don't want to be stamped like just the person who sees all the patients very quietly and don't complain. And that was for me, a cue to kind of get involved in whatever representation locally at the time, at the school that I was, because I'm like, well, I'm going to show them that I have range. Yes, I can see patients and I'm not going to complain about that, but I can also teach and I have a brain with ideas and I want to share my ideas.

(23:36): So my mentors were very important in saying, be very careful because the world sees you a certain way and you're going to have to intentionally show them that that's not all that you are all about. And I have to tell you, I know it's sad but true that even at this stage in my career, I have no complaints. I'm happy with what I do, with what I accomplish. But sometimes when I accomplish something, I can still see surprise in some people's eyes. It's like that, "Oh, I did not realize that. Never thought you were actually going to do this." And it still happens. So as a woman and as a Latin woman and not to conform to people's stereotypes of you, sometimes it's challenging. And the more you forget about it yourself, you're just happy doing your thing, the more when it happens, it's like, oh, yes, that's that. So I still get that, less often, but it hasn't gone away completely.

Dr. Anjali Gupta (24:53): And I imagine as you move forward, it probably even feels more surprising.

Dr. Ludmila De Faria (25:00): It does. It's kind of like even in this new position that I am, I worked as an associate program director before, and some of the people that worked with me, so they kind of know me, they have sat in meetings with me. They know the things that I say. Those people still told me after six months, "I'm so impressed by the good work that you're putting forth." What? It's kind of like, I thought I was putting good work even before I became interim. And so people, it still happens more. Now, I understand where they're coming from. I understand that the first thing that they see is the hands moving. We're in the podcast. Nobody can see that. But I talk with my hands. I'm very Latin. And so when I present myself, that's what people see, that kind of whatever they think being Latin means. And so if I kind of challenge their concept of what a Latin people should do and which ways they should go, it feels a little bit... and another challenge by being Latin is I suppose culturally we're more effusive. We're talkative.

(26:30): I was just sharing that with a Latin friend of mine who's a psychiatrist, who's also often labeled as hard and angry because we're tough. And so I have been in a very formal way called the angry brown woman in one of my past jobs. That was actually a mention on my HR file about that because I guess the expectation was that I wouldn't talk back. And the fact that I did didn't sit well with a lot of people. And so that was another challenge. I don't want to code switch and not be myself. I feel that that would not be right. My mom who has passed almost 20 years ago, my mother wouldn't be happy. She says, above all, be true to who you are. And so I try to soften without losing everything that makes me. And I frequently remember that sometimes that comes across a certain way to people. So that has been a challenge too.

Dr. Anjali Gupta (27:45): Thank you for sharing with such authenticity. Some of those experiences sound like they were very hard.

Dr. Ludmila De Faria (27:53): Oh, yes. Yeah. To be called the angry woman, because that's definitely not how I see myself primarily. And it's interesting that happened to me. And now I have this colleague who is much younger, 20 years younger, and she is kind of beginning the middle part of her career. And that's a feedback that's often given about her is like, oh my God, she's angry all the time. And I'm like, she's not angry. That's not angry. That's just the way she talks.

Dr. Anjali Gupta (28:29): You mentioned being the interim program director. I know that you have led in numerous ways. What has been one of the most enjoyable leadership positions that you've held and why?

Dr. Ludmila De Faria (28:46): I think the most enjoyable one is being chair of the committee on Women's Mental Health. That for me is a joy. It has been from day one, and that has been over the four years of existence of the committee, and now we're going to be a council because of the collaboration. I think working primarily with women. We do have one member that is male in our committee, and I really appreciate him being there and giving that perspective. But working with women is, even if you in the leadership position is so collaborative that I enjoy that. I really enjoy putting heads together and the way women will step up and do the work that needs to be done. People will naturally play to their talents. Or maybe it's just I am blessed that the people assigned to the committee are such wonderful people. So that has been a wonderful experience for me.

(30:04): And even in my position as interim director, training director, I actually bring that in. Now I work with, it's basically half and half. So I do have a more equitable mix of men and women in the position that I am, but I bring all of the collaborative style to this position and it works well. It's kind of like I'm still where the buck stops and I have to ultimately be the person who directs where the work has to go. But that idea of involving everybody and getting everybody from the very beginning to put their ideas on probably the pros and cons, that has all been formed in my leadership position at the committee.

Dr. Anjali Gupta (31:00): And what a strength as part of your leadership style to be so collaborative. I know the committee soon-to-be council, has put forth a number of amazing projects, most recently, the toolkit?

Dr. Ludmila De Faria (31:15): Yes, that's right. We do have the mentorship toolkit and then another collaborative project with the CDC Foundation and the APA, in which several members of the committee took part on that. And that's to determine, assess the gaps in maternal mental care, training, like education and training to form psychiatrists that can do that. And so all of these projects are endurance projects, I call them. Not a sprint, more like a marathon. You're in it for the long run. The maternal mental health, for example, that was a year and a half of a project where we were meeting every other week basically. And so if you don't develop this collaboration, it's the burnout. So that was a wonderful experience, and that's what I like about the committee. Often, we meet every month and I say, so there's this new project. Does anybody want to step up and help out?

(32:27): And I have responses. And people, there was a month a couple of months ago that the APA asked, can somebody write a blog? And we had two blogs, two groups immediately coalesced and put forth two blogs. I love that, that people are happy to do the work. They bring a joyful heart. And I feel that's, it kind of fuels my batteries, charge my batteries to be with people despite the issues that we have, there's many, many challenges. You know because you have come to some of the meetings. You come on a regular basis and some days, there's a lot of bad news. Legal challenges, advocacy issues that need to be done, clinical, all kinds of challenges. And I am happy that people still have that joyful heart and they see it not with desperation, but how can we forge a path? So for me, that's the epitome of working with women. That's what women are all about. But I don't know, there's something that happens when you put a lot of women that is always collaborative. It's always like, I see you're struggling with that. I'm going to help you with that.

Dr. Anjali Gupta (33:56): You mentioned recharged a couple minutes ago. I know that you move in a number of directions as many physicians do. Medicine can be demanding in so many ways. What types of things do you carve out time for to take care of yourself?

Dr. Ludmila De Faria (34:17): So I'm a runner, I know you are too. And I know we're both training as we speak. So running is very important. So I always make time for running. But one thing that I read a long time ago on Academic Psychiatry, the magazine, Academic Psychiatry, it was this woman psychiatrist, I am sorry, I cannot remember who wrote that article. But in the article, they basically said the most important thing you can do as a woman who is raising a family and has an academic career and is a doctor, is deciding that there is a hard time to turn off the computer. And I took that to heart. So for my staff that I work with, the team that helps me out in residency training, I always, whenever there's somebody new that joins, I tell them, you will never get an email from me after 5:30 in the afternoon.

(35:15): I would always time it to be delivered to you at eight A.M. because I will pause and I will not look at it again. I feel that you have to have very clear boundaries. And I think even more than the running, that's important, that you have that notion. Work fills me with joy. Make no mistake. I wake up happy to go to work every day, but that's not all in my life. And so for that, I have very clear boundaries. When it has to stop and I have to do other things, go walk the dog. That's my new thing. I walk my old dog for at least an hour, an hour and a half every end of the afternoon. I don't have a commute. I live in a small town. It's a mid-sized town. And literally, I drive four minutes door to door, so I have no commute.

(36:16): And so I feel like I need a little bit of time to decompress. And I do that by walking my dog. So the minute I come home, they come to me, the two dogs, they know it's time to walk. I strap them up, put my comfortable shoes, and I go walk around our neighborhoods and I can be listening to music, to a podcast, to an audiobook, or just listening to the sounds of nature around. And that helps me phase out of work, speed and into kind of private speed. And by the time I come home, I'm ready to just enjoy being at home with the family and talk to them.

Dr. Anjali Gupta (37:00): During Covid, when everybody was home and not commuting to work, that is often what the recommendation was, was to create some sort of commute, whether that be walking or biking. And so it sounds like you do that on a regular basis.

Dr. Ludmila De Faria (37:18): Yeah. For me, being physical after sitting all day, because in our jobs as psychiatrists, we tend to sit a lot and it's very passive because I'm talkative. So for me, it is a little bit of an effort to sit through my entire days of seeing patients, for example, and just being on the receiving end. So I have a lot of pent up energy, physical and mental. And then also being an educator, it's a lot of listening and being the person that gets to hear a lot of things. And so I feel that walking and being physical, movement helps me get some of that energy out. I know from having not run for little pockets of time, I can tell you I am a much nicer person when I'm running. I tell that to my coworkers, if I start to get grumpy, tell me to get my shoes and go for a run the next morning, because I am so much nicer when I run in the morning and I get to work.

Dr. Anjali Gupta (38:31): So I'd love to end on a little note of inspiration. How many marathons have you run at this point?

Dr. Ludmila De Faria (38:39): At this point in time, I have run 10 full marathons, one ultra marathon, and a lot of half marathons.

Dr. Anjali Gupta (38:51): Wow. And you're training for one currently?

Dr. Ludmila De Faria (38:54): That is correct. I'm training for a marathon in my hometown. I'm going to go to Brazil and run a marathon there. Never run in Brazil. So there you go.

Dr. Anjali Gupta (39:03): Well, good luck, and thank you so much for taking the time to be with us today. It's been very enjoyable listening, and-

Dr. Ludmila De Faria (39:13): Thank you. I appreciate you inviting me, and I think that your project with the podcast is superb. Some of the people that you already recorded are some of the people I admire in our profession, and I am so happy that you are putting them on record.

Disclaimer (39:31): The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.