Psychiatry's UK recruitment crisis
Updated on 04 June 2009
Britain's mental health services are facing a "catastrophic" shortage of psychiatrists as the NHS increasingly has to rely on overseas doctors to fill posts. Lewis Hannam and Jenny Wivell report.
Mental health bosses say in some cases doctors are being appointed to posts despite reservations about their suitability, as fewer and fewer UK-trained medics apply for psychiatric posts and overall competition for places falls.
The Royal College of Psychiatrists (RCP) says cultural awareness is essential to being a good psychiatrist, and warns of an over-reliance on overseas doctors to fill mental health jobs.
Just one in eight doctors sitting professional psychiatric exams this year were UK graduates, a record low.
Prof Robert Howard, Dean of the RCP, told Channel 4 News online: "Catastrophic is the word I would use for the shortage we are now facing. We have always struggled to recruit significant numbers but this year is particularly acute.
"It has got to the point where you can count the number of UK doctors coming into it in tens, when we have hundreds of training posts to fill.
"The doctors who are coming in from overseas to work in the UK: some are brilliant, and our president [Dr Dinesh Bhugra] is a shining example. This is not being racist or unpleasant.
"But many of them [overseas doctors] have difficulties with communication and the nuances of the UK's culture. And if there is a speciality where it is essential to know the culture, it is psychiatry. There needs to be a balance.
"Overall, because of the lack of competition, we are giving jobs to some people who are 'appointable' but certainly not people who it fills our spirits to have given jobs to. The fact that we have to make a decision about the minimum standard cut-off point for potential 'appointability', and that we feel relieved when we find sufficient people who just scrape over this is damning enough."
Doctors currently complete two years of foundation training after graduation. If they choose psychiatry as their long-term career they have to complete a further six years on-the-job training. Three years into their psychiatric training they have to pass postgraduate RCP exams. The exams are sat twice a year. This year, of the 519 candidates who sat the first exam, only 64 were UK graduates – a record low. The next exam is in October.
Last year, incorporating both exams, the totals were 230 UK graduates from 1,043 examinees; in 2007 it was 257 from 1,491, in 2006 it was 315 from 1,515; and in 2005 it was 388 from 1,372. The figures highlight the falling competition for places.
Around 400-500 psychiatry posts have to be filled in the NHS each year, with the number set to increase. Most of the psychiatrists employed from overseas come from India and West Africa.
Dr Sharlina Sharma, a 34-year-old Indian trainee psychiatrist at Maudsley Hospital in south London, said working with British mental patients did present some initial problems in terms of cultural differences.
She told Channel 4 News: "At times it is difficult, because the English here is quite different from that spoken in Indian in a way. It is the upbringing too. What you try to say might be interpreted in a different way, when you don't actually mean it in that sense – it was one of the difficulties I have faced but over time you can learn there's always a way around it.
"I remember seeing a patient in A&E and he used the expression 'I feel gutted'. I did not know what he meant – I had to go and ask one of the nurses, things like that you come across.
"With time I am learning and I don't think it's a problem anymore. I can say things slower, or repeat them, and they can understand. It could be frustrating for a mentally ill person but you can help them overcome that issue."
Prof Dinesh Bhugra, president of the RCP, who moved to the UK from India more than 25 years ago and is now the UK's top psychiatrist, told Channel 4 News: "Certainly, less UK graduates are taking up psychiatry after graduation; as a result we are having to rely a lot on international medical graduates.
"The message to UK graduates is that this is most exciting and fun speciality in medicine. Where else would you use cinema, theatre, literature, neurosciences, psychology, sociology and anthropology to pull it all together? But a lot students and junior doctors are being put off for various reasons."
Prof Bhugra, who is based at the Institute of Psychiatry at King's College London, said that cultural awareness was a key part of being a successful psychiatrist.
He added: "If we say 'I feel gutted' we know what that feeling is, it is a metaphor. It is useful to understand what is being said, rather than relying on literal translations.
"Those idioms of distress are incredibly important. They are culturally modulated and it's very important to understand what's going on."
Students say a perception that psychiatric patients cannot be cured, and the stigma attached to mental health – both within and outside the medical profession - are some of the reasons why British graduates are put off from choosing it as a career.
Prof Howard added: "I think psychiatry has struggled to attract UK graduates in the past because it has an image of otherness and weirdness; and a misconception that we don't ever cure people.
"There has also been a lack of engaging teaching on the subject in universities too, with psychiatrists encouraged to focus on research instead.
"The fact is that psychiatrists play a vital role in getting people back to work, keeping them out of the justice system, and assessing who is at risk. On the job there it a real relationship with patients too."
A Department of Health spokeswoman said: "We are working with the Royal College and others to improve recruitment into psychiatry from the UK."
She added that increases in investment meant there were 64 per cent more consultant psychiatrists compared to 1997.
