The Un-State of NSW Psychiatry and Leading the Next Generation

It’s six weeks into the new training year for medical trainees, including our future psychiatry consultants.

It’s also time for the invested parties in the NSW psychiatry pay dispute to head back to the Industrial Relations Commission, with hearing set to occur from today onwards.

It’s been pleasing to see the RANZCP communicate to its members that it has the needs of psychiatry trainees first and foremost in their minds during this unprecedented and disruptive time for those that work within the public mental health system and those that have no choice but to rely on it.

Last week, the RANZCP announced a series of commitments to support trainees who may be working in posts that do not have the required amount of supervision, leading to fears that accredited training posts may become un-accredited down the track.

In particular, trainees who have found themselves caught up in the recent strikes at the same time as sitting their examinations have been notified that:

“Where disruptions cause a trainee to withdraw from the 4 March 2025 enrolment of the Modified Essay Question (MEQ) and/or Critical Essay Question (CEQ) examinations or withdraw from the enrolment for the 21 March MCQ examination, a full refund of the examination fee will be made.

Disrupted trainees who sit for the MEQ or CEQ on 4 March 2025 or the MCQ on the 21 March will not be disadvantaged if their attempt is not successful, i.e. these attempts will not contribute to targeted learning or training review triggers. Evidence of such circumstances and disruptions will be needed”. (RANZCP email to members, 14 March 2025).

It’s reassuring to see that advocacy around the plight of trainees has been successful, and there is some consideration towards the impending workforce and safety concerns many RANZCP trainees are now finding themselves in on a daily basis.

It’s also a measure to stop the exodus of NSW trainees to other states as they contemplate discovering that not only are their training positions unsafe, but their efforts in manning them may be fruitless when it comes to completing their training time.

Working with inadequate or lack of supervision is not a phenomenon unique to NSW trainees and it’s not unique to this current crisis. Most trainees know that at times their ability to work with the guidance and support of a consultant will be hampered. Many regional centres that rely on locum workforces also use these locums as supervisors to trainees posted there, and it’s not uncommon for a psychiatry trainee to have numerous supervisors during the one rotation.

I know because I was a supervisor for quite a few trainees in NSW as well as other states when I worked as a locum consultant psychiatrist. It was a role that I really found rewarding, often the highlight of the locum post as I took breaks from my private practice to work in the public mental health system.

Many of us are aware that the NSW psychiatrists are acting as the canaries in the coalmine, signaling the state of our public mental health system that is underfunded, understaffed and overstretched at times beyond capacity. For that reason, I don’t believe that an investment in parity with awarding NSW psychiatrists a 25% pay rise will fix the issue, at least not in the short term.

Many NSW psychiatrists have already abandoned their posts, leaving behind their trainees and are now settled into working in the private system. Some are now locuming, often in roles abandoned by their NSW psychiatrist colleagues and earning a lot more than the proposed VMO rates demanded by ASMOF to fix the problem.

No matter what happens this week, the damage has been done.

We have also discovered what the NSW State Government thinks about he value and role of psychiatrists and that is not much at all. In their eyes we are expendable and replaceable, and their argument will be that this has occurred with nothing to see. From the outside and months into this dispute, the impression is that there still is a public mental health system despite the resignations and that will do just nicely.

We will all be watching this week, especially our trainees who are looking to us for leadership and a demonstration about conviction that our specialty is one worth striving to be a part of, one that deserves the best and brightest medical talent to staff it for generations to come.

Because right now, with the messages that have been sent out to the media and the public about our profession and the current arduous training pathway that one must endure to become a psychiatrist, trainees are going to need some pretty big incentives to keep going. Despite the outcome of the IR Commission’s arbitrations this week, it will take more that one training rotation to see some reprieve and any fix, and it is quite possible that what we have right now in NSW will become the new norm for all that rely on it.

Dr Helen Schultz is a consultant psychiatrist and coach and mentor to doctors in training. She is also a professional writer and media authority. More details at www.drhelenschultz.com.au