Why don’t more doctors choose a career in psychiatry?BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7714 (Published 09 January 2014) Cite this as: BMJ 2014;348:f7714
There are still too few UK trainees choosing to go into psychiatry. Tanya Deb and Alice Lomax discuss why this might be, and what can be done to solve the problem
Many medical students show an interest in psychology and neuroscience, but when they come to apply for specialty training posts, too few foundation trainees choose to go into psychiatry. In 2011, about one in five UK core training psychiatry posts was unfilled owing to a lack of suitable candidates, and only half of those who did take up posts were UK graduates.
One reason trainees may be reluctant to apply for specialty training in psychiatry is because there are still so many misconceptions about the specialty that create a stigma for those working in it. For instance, a study presented at the Royal College of Psychiatrists’ 2013 congress found that 26% of medical students and 47% of the public said they would be uncomfortable sitting next to a psychiatrist at a party.1 In addition, 54% of members of the public did not realise that psychiatrists have a medical degree, and about half of medical students and the public thought that psychiatrists “know what you are thinking.”
Part of the reason for this stigma may be because medical students and other doctors often think that treatments in psychiatry are “unscientific,” and that they lack the same evidence base as treatments in other specialties (see box). Other myths include a sense that psychiatric treatment is inhumane and that psychiatrists resemble those portrayed in films such as One Flew Over the Cuckoo’s Nest and Silence of the Lambs. There is also a perception that psychiatric patients are violent, epitomised by the outcry around Asda selling a Halloween costume depicting a “mental patient” covered in blood.
Whoever cured anyone of diabetes?
Many medical students and doctors consider that treatments in psychiatry are “unscientific.” In reality, there is an excellent evidence base for psychotropic drugs, and psychotherapies have good meta-analysis level evidence to support their use.
A study published in the British Journal of Psychiatry in 2012 showed that psychotropic drugs have similar effect sizes to those used in many medical illnesses.2 The number needed to treat for pharmacological and psychotherapy treatments in psychiatric illness ranges from three to nine, whereas the number needed to treat for statins ranges from 30 to 100.
Psychiatry has created many structured, evidence based guidelines for best practice. The first National Institute for Health and Care Excellence guideline was on the treatment of schizophrenia. The specialty also set up the first national audit programme for the UK, the Prescribing Observatory for Mental Health.
Tom Brown, the Royal College of Psychiatrists’ associate registrar for recruitment, says the effectiveness of psychiatric treatments compares favourably with that of therapies in other specialties. “The perception that our treatments are ineffective is just that— a perception,” he says. “They are broadly as effective as treatments in other specialties. Whoever cured anyone of diabetes, for example?”
New recruitment drive
Tom Brown, associate registrar for recruitment at the Royal College of Psychiatrists, is leading a five year drive to recruit more psychiatry trainees, and to dispel myths about the specialty. This project, running from 2011 to 2016, is targeting sixth formers interested in psychology or neuroscience; medical students; and doctors in foundation training. It focuses on increasing psychiatry work experience placements for sixth form students and taster weeks for foundation doctors.
The Royal College of Psychiatrists now offers free student associateship for medical students and foundation doctors. The college has also developed pathfinder fellowships to support medical students who are interested in psychiatry as a career. By the end of the five years the aim is to achieve a 50% increase in applications and a 95% fill rate of core trainee posts.
Brown has a number of suggestions to reduce stigma. “Psychiatrists need to remain in the mainstream of medicine and mix with other doctors,” he says.
One way of allowing trainees to work more closely with doctors in other specialties is through integrated training programmes, such as broad based training, which includes psychiatry, paediatrics, and general practice, and allows mixing between these specialties.
Another way is to locate psychiatry services nearer other specialty teams. In the past, psychiatric hospitals were often geographically isolated, but many psychiatry units are now in the centre of major UK cities and are on the same site as the acute medical and surgical hospital trust. Onsite liaison, perinatal, and neuropsychiatry teams are becoming more common in acute trusts, increasing psychiatry’s integration with mainstream medicine.
Opportunities within psychiatry
As well as improving interactions among specialties, medical students also need to be educated earlier about the opportunities available in the specialty. At present, medical students’ understanding of psychiatry is poor. Only around 6% of second year medical students realise that psychiatrists can treat dementia, only 3% realise they can treat learning disabilities, and only 2% realise they can treat attention deficit hyperactivity disorder.1 Brown says psychiatry “appeals to those with an interest both in neuroscience and in what makes people tick.” The specialty offers huge opportunities for doctors, including liaison, forensics, perinatal, older adults, and child and adolescent psychiatry, and even academic psychiatry and the emerging field of sports psychiatry.
Psychiatrists can make a real difference to patients. They use the science they learn at medical school and are also allowed into people’s lives in a unique way. They hear people’s most important stories, and find out what makes them who they are.
Expressing all these benefits to students early in their training may make them consider psychiatry more favourably and help to reduce the current shortage of trainees in the UK.
We have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.