Intended for healthcare professionals


Building the future medical workforce: helping students choose psychiatry

BMJ 2021; 375 doi: (Published 02 November 2021) Cite this as: BMJ 2021;375:n2665
  1. Subodh Dave, professor and dean1
  1. 1Royal College of Psychiatrists

My career in psychiatry has been incredibly interesting and fulfilling. Despite the inevitable challenges, I look forward to going to work every day knowing how much of a difference my colleagues and I can make in the lives of people with mental illnesses. At the same time, I am daunted by the unprecedented demand we are seeing on our services and the challenge of the mental health backlog. The long term impact of covid-19 on the nation’s mental health has been greater than anyone could have anticipated. Even before the pandemic, the need to bolster mental health services was recognised as an urgent priority. It has become extremely clear that to effectively respond to patients’ needs will rely on our ability to recruit and retain qualified, inspired, and passionate psychiatrists.

The Royal College of Psychiatrists has been playing its part in tackling the long-recognised workforce crisis in mental health. Our annual Choose Psychiatry campaign has contributed to securing a 100% fill rate for core psychiatry training posts in 2020/21. But convincing medical students to choose psychiatry and progress up the ladder to become consultants can be difficult. They can see the challenges of working in a shortage specialty faced with unprecedented demand, often while working in a dilapidated estate. While my colleagues and I will never stop making the case for choosing psychiatry despite these challenges, we also need the government to step up to the plate.

Firstly, we’ve got to open the tap. A student starting medical school this year won’t become a specialist consultant psychiatrist until at least 2029. With the projected increase in demand on mental health services, we can’t afford to wait. If we are to build the workforce of the future, we must increase medical school places to 15 000 by 2028/29, encouraging students to pick shortage specialties, including psychiatry. Expanding core and higher psychiatry training places at the same pace will be essential, starting with a further 120 core psychiatry training posts in 2022. This will all come at a cost, but one that is dwarfed by the cost of inaction. As the saying goes, the best time to plant a tree was 20 years ago, the second-best time is now.

Secondly, we need to increase retention of those already working in the system. Data from 2019/20 shows that while 1,536 psychiatrists joined the NHS, a staggering 1,455 left the workforce in the same period. Psychiatry can and should be a fulfilling career, yet growing demand coupled with workforce shortages are resulting in high levels of workplace stress and burnout. Psychiatrists work most effectively when their own mental health and wellbeing is protected. The College’s ongoing work to improve morale and training within psychiatry has highlighted how modest local reforms can ensure trainees feel supported and valued, and transform staff and patient experience. There is a clear demand for more flexibility in training and working as a psychiatrist, as well as a desire to see substantive progress on tackling racism and discrimination in the workplace. This demands funding. With the spending review around the corner, investing in an expanded workforce, critical refurbishment of the mental health estate and mental health hubs for staff will make an enormous difference to the day-to-day lives of myself and my colleagues.

The government’s consistent commitments to recovering from the pandemic make for inspiring reading. Yet, in the face of growing demand on mental health services, it’s more important than ever to maintain focus on tackling the pre-existing mental health backlog and getting delivery of the Long Term Plan back on track. Building the workforce of the future must be at the heart of this. As colleagues and I ready ourselves for this year’s Royal College of Psychiatrists campaign, we hope we can count on the government to give us the backing we need to convince medical students and colleagues alike that working in and building the mental health services of the future is the most fulfilling career there is.


  • Competing interests: none declared

  • Provenance and peer review: not commissioned, not peer reviewed