A career in psychiatry

What do psychiatrists do?

Psychiatrists are doctors who look after patients with mental health problems, such as depression and schizophrenia. Unlike other acute specialties in which drugs and operations play prominent roles in the management of patients, management of mental health patients involves a combination of measures, such as drugs, psychological counselling, improving home environments and social networks, and occasionally physical treatment such as electroconvulsive therapy (ECT). Therefore, their management depends on a wide range of professionals, including clinical psychologists, social workers, (community) psychiatric nurses, and occupational therapists. The psychiatrist needs to work together with these professionals as a team.

Although psychiatrists play a leading role in treatments involving drug and physical treatment, their skills and roles overlap to some extent with other professionals. Therefore, trainee psychiatrists receive some training on basic knowledge in psychology and basic skills in various forms of psychotherapy. However, the psychiatrist often relies on the skills of these other professionals in deciding the best form of drug or physical treatment to give to each patient.

There are few mental health disorders for which there is a definitive diagnostic laboratory test. Most psychiatric diagnoses are made on the basis of a full history and mental state examination. This is why good communication skills are essential to be a good psychiatrist and why psychiatrists sometimes disagree on the exact diagnosis of patients.

Another distinctive aspect of psychiatry is that patients sometimes have no insight into their own illness. These patients sometimes need to be treated against their will without their consent. To safeguard the rights of the patients, mental health professionals need to follow precise procedures in the Mental Health Act before they are allowed to admit and treat patients against their will.

What is the day to day work like?

The workload and duties vary widely between jobs. The senior house officers (SHOs) are usually responsible for the day to day management of inpatients, review them regularly, and present updates at the ward round. They also see both new and follow up patients in outpatient clinics. Quite a lot of time can be spent in meetings, such as community team meetings, where team members representing different professions can discuss the problems and needs of patients living in the community. SHOs are also involved in administering ECT and assessing patients presenting with deliberate self harm. There is protected time for consultant supervision, psychotherapy training, and attending teaching sessions including at the local MRCPsych course. On call duties are usually less hectic than acute specialties and many rotas allow you to be on call from home. Some hospitals have teams of nurses trained to deal with deliberate self harm assessments and patients who present in crisis. They help to reduce the workload for the trainees and make the job more pleasant.

The career structure

The recent option of a four month general practice attachment as a house officer might be more relevant to psychiatry than the traditional six months in medicine and surgery. A career in psychiatry begins with a place on a junior SHO rotation that usually involves posts in general adult and old age psychiatry. Part I of the MRCPsych examination can be attempted after one year of training, and progression to a senior SHO scheme occurs usually after passing the Part I or gaining sufficient experience in the specialty. The senior scheme allows the SHO to rotate through a number of subspecialty posts before taking the Part II exam. To become a member of the Royal College of Psychiatrists the SHO must pass both parts of the examination and complete six months training in child and adolescent or learning disability psychiatry.

Specialist registrar training is shorter than in any other specialties and currently lasts for only three years for training in a single subspecialty, and four or five years for those training in two subspecialties.

Future job prospects

Career progression in psychiatry is more rapid than in other specialties. Due to the large number of vacant posts, a fully trained psychiatrist can be in quite a powerful bargaining position when choosing a job. Service provision is poor in some areas, which allows interested consultants to develop their own services. There are opportunities for part time work and there are many staff grade equivalent posts for those who cannot or do not wish to progress to consultant grade. You can also develop other interests such as research, teaching, audit, or management.

Conclusion

So if you like talking to people and working as a member of a team, have an inquiring mind, and the ability to tolerate uncertainty then a career in psychiatry may be for you. Psychiatry offers a wide range of job opportunities within its subspecialties. Unfortunately, you may not experience them all as a student.

With the recent trend of managing patients with mental health problems in the community and the well publicised cases of homicides by mentally disordered patients in recent years, the management issues of patients with mental health problems become high on the agenda for both politicians and hospital managers. This may bring both opportunities and threats to the work of psychiatrists. Overall a career in psychiatry can offer you fast career progression and excellent job opportunities.