Understanding Trainees' Career Choices in Psychiatry

The Royal College of Psychiatrists (RCPsych), Health Education England (HEE) and the NHS have all raised concerns about the flow and retention of staff within the mental health workforce (for example, the Centre for Workforce Intelligence’s review on the psychiatric workforce and HEE’s ‘Stepping Forward’ report).

Driven by a desire to understand this further, in 2018-2019 HEE London and the RCPsych commissioned UCL to undertake research to aid our “Understanding [of] Career Choices in Psychiatry”.

The full report can be accessed online at the following link: UCL Trainees’ Career Choices Report.

The key findings from this study were in relation to two areas, namely progression through training and experiences during it.

Progression through training:
  • The minimum time to complete training (to CCT) is 6 years. Psychiatry trainees overwhelmingly took longer than 6 years to reach this point.
  • Training programmes have been historically designed to accommodate full time trainees taking the minimum time to complete training. LTFT trainees are often placed into whole time posts and even planned absences can be viewed as unexpected and destabilising for a rotation.
  • Progression differed between groups of trainees (direct progression for UK graduates (UKGs): 18.4% vs non-UKGs: 6.5%; males: 17.8% vs females: 12.8%).
Experiences during training:
  • Satisfaction with the training programme and supervision was generally high.
  • Support from peers and seniors, and a sense of belonging in psychiatry, was of key importance to help trainees through challenges in training.
  • Positive expectations for the future were important to be able to endure high service pressure and under-resourcing; role models were very influential in shaping these expectations.
  • 23.9% of trainees were experiencing high or very high levels of burnout.
  • 22% of trainees had thought about leaving the profession. Strong self-identity as a psychiatrist was key in keeping trainees committed to the specialty and becoming a consultant.
  • Being valued on a personal and professional level made a substantial positive difference to trainees. Otherwise, training was perceived as treadmill-like and impersonal.

  • Trainees desired training arrangements that would support both their progression and work-life balance, including allowing Out of Programme time and Less Than Full-Time hours.

Those on longer breaks or working as Specialist and Associate Specialist Doctors are often keen to become consultants but require an adjustment to the standard programme, or more advice and support to return to training. There is a clear tension between the immediate pressures of workforce supply (i.e. to fill consultant vacancies) and supporting flexibility and choice at the expense of a slower route. Workforce modelling may need to adjust expectations to consider slower training with better long term retention.

All groups highlighted the need for a broad change in approach to careers with a need for long term investment in individuals who may have very different development needs. The RCPsych’s approaches to reducing differential attainment and developing a culture of equality, diversity and inclusion should underpin all recommendations from this report.

To have an impact on the workforce, stakeholders need to be engaged from all levels:

  • national (HEE, RCPsych);
  • regional (Post Graduate Deans, Heads of School, Faculties and Divisions);
  • local (Medical Directors (MDs), Directors of Medical Education (DMEs), Training Programme Directors (TPDs), Educational Supervisors (ES), Clinical Supervisors (CS), HR and post-graduate departments).

The RCPsych have convened this task and finish group to develop a response to this report. While trainees should continue to be supported to take the most direct route though training, members of the task and finish group identified and focused on three target response areas:

  1. Cultural Change (Prof. Nandini Chakraborty, Dr Ross Runciman, Dr Helen Bruce)
  2. Transitions (Dr Ellen Wilkinson, Dr Isabel McMullen, Dr Harriet Greenstone)
  3. Trainee Wellbeing and Welfare (Prof. Vivienne Curtis, Dr Mihaela Bucur, Dr Clare Inkster)