A trainee psychiatrist working in the NSW public system says the crisis poses a serious threat to patient safety and the future of psychiatry training in the state.
A NSW public psychiatry trainee fears for up to 90 new trainees due to begin their training less than two weeks after more than 200 staff specialists resign next week.
Dr Lauren Amor, who is just a couple of months away from finishing her training at a Sydney hospital, said the loss of half of the workforce raised serious questions and concerns about who would supervise the incoming trainees.
“It’s estimated we’ve got about 80 to 90 doctors about to start training on the third of February,” she told The Medical Republic.
“I don’t even think they know what’s about to hit them, because this has been really kept quiet by hospitals.”
The psychiatrists have resigned over a pay dispute and what they say is a public system that has been crumbling and understaffed for years. One in three psychiatrists have already left the public service, and on 21 January, another 200-plus are quitting, which accounts for about half of the existing workforce.
Dr Amor, who is also president of the NSW Association of Psychiatry Trainees, said the capacity for remaining psychiatrists to safely and effectively supervise the new cohort of trainees would be extremely limited.
“When you start as a doctor in any training program, you have your own supervisor and mentor there to shadow to begin with,” she said.
“You wouldn’t be expected to do any of your job role that you haven’t got any experience in until you’ve spent some time with that supervisor, watching them, being taught by them. You’d then do some assessments on the job until you had the skills to do that safely, and then you would be provided with that bit more responsibility.
“What we are left with, the situation now is that over 200 psychiatrists are leaving, and most of those psychiatrists would supervise about two trainees. So essentially, you’ve got that massive load of trainees that won’t have their own supervisor to mentor them.
“We’re left with a situation where they just won’t be able to be trained. It’s just not a safe environment.”
It’s a somewhat bitter twist for Dr Amor, who moved to Australia from the UK where she had worked in the NHS six years ago, to complete her psychiatry training.
“The ironic thing is that I came out to Australia because I wanted better working conditions,” she said.
Dr Amor said she could not see the public psychiatry training system in NSW being sustainable.
“They would have to surely look for other places to train,” she said.
“How would you expect a doctor to start working in a training program that takes five years to complete when you can’t actually train [them], and these terms are only accredited to training when they have the minimal mandatory amount of supervision.
“It’s an absolute disaster. If you can’t train the trainees, you also don’t have the new psychiatrists to fill the empty positions.”
The association has already stated its position on the mass resignation of NSW public psychiatrists, saying it “stands firmly” with them in their decision.
Dr Amor said the association was concerned that trainees may be called on to work outside their scope to help fill the massive hole created by the mass resignation.
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She said psychiatry trainees were not equipped or authorised to take on the roles and responsibilities of consultant psychiatrists.
“What the hospitals are saying is that trainees won’t be made to work outside of their scope and that is reassuring,” she told TMR.
“But the reality is, the document that came out by the Ministry of Health [released publicly by the Australian Salaried Medical Officers’ Federation earlier this week] , says that psychiatry registrars and other health professionals will be required to work at the top end of their scope and take on extra responsibilities and have more independence.”
According to the document, “ensuring registrars continue to receive adequate supervision should be a priority, given the anticipated increase in autonomous clinical practice”.
“Districts and networks may need to consider adaptions to how supervision is provided. This may include: virtual supervision by psychiatrists from outside the district/network; group supervision for junior trainees who already have a higher level of day-to-day consultant oversight; support for junior trainees through buddying with a senior registrar for mentorship and supervision.”
Dr Amor said she feared doctors like herself, who were at the end of their training, would find themselves under increasing pressure.
“It’s going to be put people like me in positions where we’re going to have to assert our boundaries,” she said.
“We’re already having to get extra legal advice from our medical defence organisations and from the union about what we can and cannot do, because there are serious ethical dynamics we have to think about.
“We obviously care about our patients so much, and we don’t want our patients to suffer. But we also don’t want to cause them any harm, and we also don’t want to put our registrations at risk, because then we can’t work as doctors anywhere.”
Dr Amor’s own supervisor is among those who will resign next week, and she has witnessed firsthand the distress it is causing the specialists, who don’t want to go but can see no other alternative.
“I was speaking to my supervisor yesterday and he said that he just absolutely loved his job,” she said.
“And I also saw another psychiatrist in tears the other day because she loves her job, and she’s been working for decades with children, and it’s such an important part of her life to help set these children on the right path early in their life and make a difference.
“They are distraught about having to leave these jobs that they really like, but they just don’t feel like they can do that now, with how unsafe the working conditions have got.
“Psychiatrists have been asking for help for 16 months about this and saying that it’s just not sustainable, that the system is going to collapse, that we need an urgent action.”
Meanwhile, Dr Amor is now considering her options for when she finishes her training. A move interstate, back to the UK or even private practice are on the cards. She can’t see herself in the NSW system as it currently is.
And it’s not just about the money. It never has been despite the government’s assertions it is, she says.
“The psychiatrists have seen the response, and I think it’s just made people so demoralised and lose faith in their employer,” she said.
“If this was about money, they would have already gone. There’d be no psychiatrists, because they can easily get jobs. They’re really experienced.
“They could have gone and got jobs in the private sector and be making at least twice what they were earning, so these are people who deeply care.”
