If the NSW government doesn’t think it needs psychiatrists to run its public wards, let the registrars go private.
When I coach psychiatry trainees for the RANZCP essay exams, I emphasise the importance of considering what the examiner reads when marking their essays, not what they plan to say.
Gaps in communication happen often here, leading to the wrong message landing or inadvertent or incorrect beliefs being conveyed to those who are listening and responding.
Despite all the advocacy from the NSW psychiatry workforce about the value and expertise only consultant psychiatrists can offer, what the government appears to be hearing is that psychiatrists care only about money and that money could be spent elsewhere, including on a temporary locum workforce.
I worry about the psychiatry trainees walking into our public psychiatry wards next week with little direct supervision. They will also be rostered to placements with bed closures due to the lack of psychiatrists, wasting valuable resources, skills and manpower at a time when that couldn’t be more needed. And there has been no direction from the stakeholders about contingency plans for this.
I also worry about what the trainees are reading and hearing in the updates about the NSW mass resignation of psychiatrists, which has begun in force. They will be hearing and may be believing that the medical specialty of psychiatry is redundant and a sure trajectory to burnout, demoralisation and serious safety breaches.
While psychiatrists have spoken in unison about the decimated public mental health setting – one not fit for purpose, but also the only setting that first-year psychiatry trainees are rostered to – many enthusiastic and passionate trainees may be re-evaluating their decisions to dedicate their medical careers to psychiatry.
Those who rely on the system for treatment, support and care must be experiencing a great deal of fear. Vulnerable patients who already know how difficult it is to access care in crisis will be reeling, especially if they reside in NSW, with alerts issued by NSW Health similar to those published during the covid pandemic.
But the trainees about to start work next week may also be living in some fear.
What must they be feeling right now, as they finish up their resident placements this week and prepare for the life of a registrar, without the access to the consultant psychiatrist teaching and supervision they need to work safely?
When reflecting on my career, I can see that my clinical expertise came from working in a wide range of settings, and in many locations in Australia and the UK. I can look back and be reassured that all of the experiences, good or not so good, helped shape my career as a consultant psychiatrist. I know that my decision to pursue psychiatry in was the right one for me – it was the only field I wanted to work in. I wonder if I would have felt the same if the landscape was what it is now, post-pandemic, and with critical shortages of medical and allied health professionals.
I am also hearing the message that private psychiatry is the best place to work if you are determined to be supported and remunerated well. That’s where the NSW government is seeking beds for inpatient admissions, now that whole wards are closed. It’s also the place that is not staffed by psychiatry trainees, and especially not in the first few years of their training.
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Working exclusively in the public mental health system in the first few years of training ensures that trainees gain a lot of experience in what we call low-prevalence disorders – those that are rarer but more complex, such as schizophrenia. Patients with low-prevalence disorders do deserve best-practice care, but leaving trainees in these workplaces will mean less exposure to disorders such as depression, anxiety and many other psychiatric conditions that are seen more frequently. They will also find their supervisors are moving to the private system, along with the patients who can access private psychiatric beds.
The argument to allow psychiatry trainees to work in more diverse settings is a perennial issue that goes nowhere, probably because they are indeed the workhorses of the public system, and psychiatrists often choose not to work there once they become consultants. Trainees earn much less than consultants, and keeping them chained to these roles ensures the system gets a lot of work for not much money.
Maybe this crisis is a time to change how we do things, for doctors and patients alike.
It’s never been more important to listen to what psychiatrists are saying about giving our trainees the best experiences and learning by allowing more training places in the private system. Perhaps it is time to move trainees out of the public wards if they are not safe there and our governments believe they can amend the skills shortage by using non-medical staff. Keep them with their psychiatrist supervisors, enhance their training experience and leave the NSW government to sort out the workforce until it is safe to return.
Dr Helen Schultz is a consultant psychiatrist, a coach and mentor to RANZCP psychiatry trainees. This piece was originally published at medium.com.
