A passion for psychiatry: How this DO is creating meaningful change in the medical world

Journey with us this month as we talk to forensic psychiatrist and residency program director Almari Ginory, DO, about her path as a lost medical student who developed a love for psychiatry in Key West, Florida. Follow us as she shares her love of teaching that ultimately blossomed into an inaugural program directorship.

Explore the importance of physician mental health and the obstacles DOs are still facing in residency. She promises she is not analyzing me as we speak, and she cannot read minds. Dr. Ginory is a proud DO who cares deeply about your mental well-being and the osteopathic profession.

Dr. Ginory is of Cuban descent and a native of Miami. She is a graduate of Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM). She completed her psychiatry residency at Jackson Memorial Hospital in Miami and a forensic fellowship at the University of Florida in Gainesville.

How did you end up at NSU-KPCOM and what brought you to osteopathic medicine?

I’m originally from Miami, and I wanted to try and stay in South Florida for medical school to be near family. As I was looking at options, my father, who is a physician in Miami, said, “Well, I’ve got these students that rotate with us from Nova, and they seem well-trained.”

I inquired about Nova and what a DO is and learned about A.T. Still, DO, MD, and the tenets of osteopathic medicine. I thought, “It’s kind of a cool philosophy.” At that point, I was considering sports medicine, and I’m like, “Well, the osteopathic techniques would be great for sports medicine.” On a whim, and looking back probably not the wisest choice, I applied to only one osteopathic medical school and thankfully, I was accepted and thus able to stay in South Florida.

How did you develop a passion for psychiatry?

My transitional year was in family medicine because I still was not too sure what I wanted to do. I knew family medicine would get me into sports medicine; that was the extent of my plan. Digging deeper into my thought process, I really wanted to get to know patients and see them longitudinally, and I thought family medicine is going to let me do that.

I matched at Palmetto Hospital in Miami in family medicine. But there’s a twist to this story. Before I graduated and started residency, I needed to do a three-month rural rotation. I did two months in Indiantown, Florida. NSU-KPCOM lets the student choose where they want to go for the third month. Like any young person, Key West sounded pretty cool, but the only rotation available was psychiatry.

In Key West, I remember having this epiphany when I was in the middle of a group therapy session with multiple veterans with PTSD. I’m like, “This is amazing. I really get to know patients, really get to dive into their stories and see them longitudinally. And you can make a huge difference in their lives.”

The trust relationship between the patient and psychiatrist really sparked my passion. That was the latter half of my fourth year. I had already matched into family medicine at Palmetto Hospital. I went to my program’s director and said, “Is it okay if we turn this into more of a traditional rotating internship with an elective in psychiatry? This will let me know if I really want to do psychiatry.”

The director allowed me to do an elective at the University of South Florida, and that year solidified my love for psychiatry. Then I re-matched into a psychiatry program and later did my forensics fellowship.

What would you like other doctors know about forensic psychiatry?

When people think forensics, they think of dead people. That’s not what we do. That would be more forensic pathology. There are some people who unfortunately have passed, and we do some postmortem stuff, but the cool thing about forensics is the interaction between psychiatry and the legal system.

Whenever there’s a mental health-related question in the legal system, that’s where forensic psychiatry gets involved. We can serve as expert witnesses in both civil and criminal cases. We do evaluations for questions like competency to stand trial, insanity at the time of the crime and guardianship. Unfortunately, with all my program director duties, I don’t have enough time to do forensic cases anymore.

How did you become a program director and what advice would you give to doctors who would like to be program directors?

My wife and I went up to Gainesville, Florida, for psychiatry fellowships, and she had an extra year more of fellowship then me. With that extra year we were at Gainesville, and with my positive experience at the University of Florida (UF), I decided, “I could do teaching.” I was chief resident at the University of Miami, and I really enjoyed administrative tasks, teaching and peer mentoring.

To my luck, there was a job opening to do consults, forensics and teach. It was a good fit for me, because with my transitional year, it gave me an extra year of medicine. I signed on to do consults and I continued to really love teaching. My first year, I won Teacher of the Year for the department of psychiatry. My second year, I won Mentor of the Year. Then I became an associate program director at UF. I was also a director of the forensic psychiatry fellowship. As I started taking on more leadership roles, I realized how much I really liked the residency education part of it.

Another opportunity came with my current program through the University of Central Florida and HCA North Florida, where they were going to start a new residency. I was excited to establish a new program because I had all these ideas that I wanted to incorporate into a residency. In some established places, it’s a little bit harder to make changes. This was my big chance to make the changes I wanted for a program. Long story short, I was able to get the program director position and have been doing it for seven years now.

If you are interested in becoming a program director, I would make sure that you are interested in the education of residents. That’s a huge part of the job. For those four years, I feel like my residents’ surrogate family. I’m their listening ear. You are part parent, part confidant and part mentor.

It’s a full-time job with long hours and work on the weekends. When I’m on vacation, I’m still answering questions and solving problems. If you have this type of dedication and love for the job, then go for it.

In 2021, there was a Pew research study stating that 7% of physicians and surgeons are Hispanic in America. Meanwhile, The U.S. Census reports 18.9% of the population is Hispanic. How do we start to address this underrepresentation of Hispanic medical students and physicians?

We see the underrepresentation not only in Hispanics, but also in African Americans in medicine, which then leads to worsening health care disparities. A lot of patients want to go to a doctor who has a similar cultural background to them. A good amount of the effort must start young. We need to go into the high schools and really encourage underrepresented minorities to consider a career in health care.

I see that medical schools are trying to increase underrepresented minorities in medicine. In residency, there is a big push also to have a holistic review of the applications and not just rely on one score or one metric. There are significant efforts underway to improve diversity in medicine. We do a pretty good job of recruiting underrepresented minorities into our program. This helps our patients, and it will hopefully aid long-term with addressing some of these health care disparities. More diversity in medical school and residency leads to more diversity in the health care profession.

As a psychiatrist, what are your thoughts on physician mental health and burnout?

The key is that as physicians, we must set aside time for our own mental wellness. That’s where one of the problems lay. For example, it was very difficult in the ICU during the peaks of COVID, especially Delta, because there were a lot of deaths of young people. I know internal medicine, family medicine, all of them were very affected by it.

What we tried to do was schedule groups throughout the day, or we would have one of our senior-level residents sitting in the ICU in a little area in case someone needed to process or talk about what was happening. Unfortunately, it was rarely used. The biggest reason for the lack of use was physicians saying, “I don’t have time for that. I need to be seeing patients.” It seemed that the last thing on our list of priorities was our own mental wellbeing. We need to do a better job at prioritizing our own mental health.

How has psychiatry evolved during your career?

There’s still stigma around mental health, but it has gotten a lot better. Initially when I started in psychiatry, when I would say I was a psychiatrist, the first thing people would say was, “Are you reading my mind?” and I would reply, “I’m not a psychic, I’m a psychiatrist.” Another favorite of mine was when people would say, “Are you analyzing me right now?”

Now, when I say I’m a psychiatrist, people are telling me, “I started seeing someone and it’s changed my life,” or “My family member suffers from schizophrenia or bipolar and the medications have helped them so much.” People are much more open to talking about it. With COVID, rates of depression increased, but in many ways telepsychiatry helped people get improved access to mental health.

At the same time, many doctors are still worried about the stigma of mental illness. When it comes to receiving mental health care, physicians wonder, “Is it going to affect my license?” or “Is it going to affect my ability to get credentials?”

It doesn’t necessarily! In Florida, the licensure application used to ask something like, “Do you have a mental illness, yes or no?” The question has been changed, now it is: During the last two years, have you been treated for or had a recurrence of a diagnosed physical or mental disorder that impaired or impairs your ability to practice?

This change in the licensing wording now allows physicians to confidently see a psychiatrist and/or therapist as long as it doesn’t affect your ability to practice. Some physicians remember the old questioning and don’t realize that it’s OK to see somebody. I hope that with continued conversations about the importance of mental well-being and decreasing stigma, more physicians will feel comfortable seeking mental health treatment.

Editor’s note: The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare, any of its affiliated entities, the AOA or The DO.