Trainees cannot be lumped with this workload, neither legally nor in good conscience. We’ve seen what happens.
Much has been said about the plight of the psychiatrists who are leaving and for the patients and the system they left behind, but a disturbing aspect of this event is what psychiatry trainees will be expected to do in the wake of the losses.
Exactly 10 years ago next month, we lost three psychiatry registrars to suicide in Victoria in just three weeks.
While we will never know exactly what led to this, I remember that the only positive outcome was that trainee wellbeing became something that was spoken about. Changes were made and people such as myself began campaigning for action around real stressors in the workplace, such as AHPRA investigations and systems pressures on doctor’s mental health.
The conversations that were being had back then were alarmingly similar to ones now. It was acknowledged that psychiatrists and trainees were being forced to work in a chronically underfunded and under-resourced mental health system, and little was done about it. It spurred me to open a clinic exclusively for doctors. I did a lot of media interviews along with other dedicated consultants and we hoped for a time that things would be better.
And some conditions improved, with more and more psychiatry trainees and doctors in other specialties coming forward to receive help. It’s sad that they needed to, but we were at least aware of the higher rates of mental distress in the medical population. Assessment and examination requirements were scrutinised and the trainee experience was examined to see if things could be done in a better way.
Then we had a pandemic.
Life as we knew it ground to a halt, and the mental health needs of our society increased, right at the time that services were disrupted and bed pressures were like never before.
Indirect effects of this disruption included exam delays and bottlenecks in trainee pathways which, in 2025, are still being addressed. Many psychiatrists such as myself decided to abandon the public system. So many healthcare professionals experienced burnout and changed roles.
But psychiatry trainees have been forced to stay behind as they are beholden to their training placements, which are overwhelmingly in the public system, to continue with their training and become consultant psychiatrists. A doctor in training cannot access the Medicare system, cannot work independently and must be supervised to the level that is required to keep their post accredited with the RANZCP.
All of this is about to be challenged.
I’m concerned that the roles and limitations of psychiatry trainees have been misunderstood or overlooked when making knee-jerk decisions about how to keep the system running as psychiatrists leave.
Being extremely capable, diligent and caring has been misunderstood as an ability to work without supervision – and illegally, when it comes to administering a Mental Health Act that psychiatrists-in-training are simply not gazetted to do.
Psychiatry trainees, like those in all specialties, sacrifice a lot to get where they want to be. They earn about half to a third of their consultant colleagues, are beholden to rosters and arduous on-call commitments and are the worker bees of the public health system. They pay thousands of dollars to specialty colleges to train when these colleges rarely provide any education or training, and they pay thousands of dollars more to sit exams with low pass rates.
They must complete compulsory requirements such as rotations to acute mental health units for up to a third of their training.
That’s the same setting psychiatrists are abandoning next week. Nothing separates the risk or their moral distress from that of the consultants who will cease to supervise them. Drastic and urgent strategies will have to be in place next week in most NSW hospital and healthcare settings to prevent critical incidents or even a death.
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Last week the RANZCP offered a guide for psychiatry trainees about how to escalate to seniors when they needed support. What if there are no seniors left? The RANZCP is not an employer and has no real ability to support a trainee, except as a last resort to remove accreditation of the training post they are working in, sometimes for up to a year.
On top of everything else, psychiatry trainees will have legitimate concerns that their jobs will become unaccredited, and that means a lot more than just safety. It poses a significant disruption to their training with a real chance that some of their training time won’t count. They will face the opposite predicament of the consultants in that they will be forced to compete for those placements that are accredited, and hope they remain so.
I am also concerned that these psychiatry trainees will have nobody looking out for them in the day-to-day running of the ward. The NSW government has already demanded they work at the top end of their scope, taking over some duties of consultant psychiatrists.
We have a brand-new cohort of psychiatry registrars commencing next month, exactly 10 years since we lost three to suicide. What better reason to call for action to prevent them walking into this mess in the first place?
Our trainees, who have paid thousands of dollars and invested hours of time to be there, deserve to be protected. Many will face their first day in an acute inpatient unit, one of the most intense and dangerous places to work in all of healthcare.
And even if there is some 11th-hour resolution, let’s never forget that our trainee workforce cannot flourish and provide the sustainability and resilience we need without supervision, guidance and nurturing. And the current mental health system we will have next week will be far from that.
Dr Helen Schultz is a consultant psychiatrist, a coach and mentor to RANZCP psychiatry trainees.