“Who wants to be a psychiatrist?” a London Division academic day, was an interesting day of talks, workshops and discussion examining reasons and solutions for the current problems of UK psychiatric recruitment.
Prof Robert Howard, Dean of the Royal College of Psychiatrists, perhaps summed the current situation the most baldly. "The recruitment crisis is the biggest challenge psychiatry faces". Concerning, he also said that this is leading to an "unacceptable variation in quality amongst trainees and consultants".
The situation does indeed appear to be dire. This year the London Deanery received 250 applications for core training posts, down from 400 in previous years. In the country as a whole the competition ratio of applicants to psychiatric training to jobs available is 1:1. The result, as Michael Maier, head of the London Specialty School of Psychiatry put it, is that “psychiatry is a recruiting, not a selecting specialty”.
Yet despite this, a recent Royal Society of Medicine study found that, alongside general practice, it was doctors who worked in psychiatry who found their lives the most satisfying. The popularity of the study of psychology suggests that, amongst school leavers, a general lack of interest in the mind and its problems is not a problem; however again and again, upon leaving foundation jobs, doctors in training choose other specialities for a career.
How could this have come about? Prof Ania Korszun from Barts and the London suggested three culprits: psychiatry is seen as not ‘medical’ or ‘scientific’ enough; psychiatry recruitment suffers by association with the widespread popular stigma surrounding mental disorder; and medical students are discouraged from psychiatric careers by the negative views held by doctors working in other specialities with whom they spend much of their training.
This relentless disparagement directed towards the ears of impressionable medical students appears to be particularly potent. Dr Gianetta Rands, who talked about psychiatry as a part of foundation training, told us that the longer medical students spend in non-psychiatric specialities the less likely they are to choose a career in psychiatry. The split between acute trusts and mental health trusts also means that psychiatrists are rarely present – be it at grand rounds or in the canteen – to put forward an alternative viewpoint. It has been recognised that more psychiatry foundation year placements are required, especially in year one. There are currently 500 placements over both years, but 2000 are needed.
Psychiatry undoubtedly has an image problem and Dr Peter Byrne, chairman of the Royal College of Psychiatry’s public education committee, presented a fascinating talk about the profile that psychiatrists have in the media and also our role as ‘evidence based public educators’. An interesting insight was that whilst newspaper stories about physical health most often concerned the stereotype of ‘bad patient’, those concerning mental health focus on that of the ‘bad doctor’. The recent BBC programme Mental: A history of the madhouse is an example of this. Dr Byrne encouraged media engagement by psychiatrists and this theme was further examined in a workshop run by Dr Mark Salter, the event’s organiser. Other workshops tackled writing skills, running student psychiatric societies and making a psychiatric documentary.
Given the current situation, it might have been possible to find some of the messages of the day dispiriting. Fortunately there were many moments of levity and an overall note of optimism. Dr Chris Manning, a GP with experience of mental health services from both sides, praised psychiatrists and delivered an enthusiastic panegyric: “Minding the brain – the best job in the world”. Dr Kate Stein, a foundation doctor, was equally enthusiastic when she told us about her plans for a psychiatric career. The active role of medical students present as delegates was also welcome and encouraging.
Of course it is not simply enough to identify a problem and there is a plan of action, in which – amongst others – Prof Howard, Dean of the College, is taking a special interest. He wishes to raise the profile of psychiatry, especially with medical students, and to make medicine in general ‘more psychiatric’.
The day closed with a rabble rousing talk from Prof Simon Wessely “Why psychiatrists still need to be doctors”. Prof Wessely convincingly argued that patients both want and need their mental health disorders to be treated by psychiatrists who are also doctors. He spoke of the value of our ability to make a diagnosis and in our use of the biomedical model. Psychiatrists’ ability to distinguish physical from psychiatric disease makes us indispensible to our physical medicine colleagues.
Psychiatry has in fact never recruited as many UK trained doctors as it needs to fill its posts and in seeking to reverse this phenomenon we seek to overturn a historical precedent. Improving the situation requires action on many fronts. It particularly concerns me that we may be recruiting the wrong mix of students to medical school, as current science focused selection criteria favours technical knowledge over a candidate’s potential to flourish into the practitioner of holistic medicine that psychiatric practice requires and may preclude those who will eventually wish to take the path required by psychiatric practice. A central message of “Who wants to be a psychiatrist?” is that we can all become involved in this debate and every day should regard ourselves as “walking, talking adverts for psychiatry”.
Also published in the June newsletter of the RCPsych London Division
Image credit Wikipedia