The NSW mass resignation and the trainees left behind

CONTENT WARNING - Doctor Suicide

It’s looking very much like the mass resignation of over 200 NSW psychiatrists will happen in three days, save an 11th hour resolution to this workforce crisis. So much has been said about the plight of the psychiatrists who are leaving and for the patients and the system they left behind, but a disturbing dialogue has begun to emerge around what psychiatry trainees those training to be psychiatrists will be expected to do in the wake of the losses.

It is extremely poignant to reflect and remember that exactly 10 years ago next month, we lost three psychiatry registrars to suicide in Victoria, in the spate of three weeks. While we will never know what led to this, I remember that the only positive outcome was that trainee wellbeing became something that was spoken about. Changes were made at some level and people such as myself began campaigning for change around real stressors in the workplace such as AHPRA investigations and systems pressures on doctor’s mental health. The conversations that were being had back then are alarmingly similar to now, being forced to work in a chronically underfunded and under-resourced mental health system was acknowledged, with little done about it. It spurred me on to open a clinic exclusively for doctors. I did a lot of media interviews along with other very dedicated consultants and we hoped for a time that things would be better.

And, in part, some conditions have improved, as I noticed more and more psychiatry trainees and doctors in other specialties coming forward to receive help. The sad thing is they needed to, but people such as myself are aware of the higher rates of mental distress in the medical population for many reasons. Assessment and examination requirements were scrutinised and the trainee experience was examined to see if things could be done in a better way.

Then we had a COVID-19 pandemic to deal with alongside all of those working in healthcare settings around the globe. Life as we knew it ground to a halt, and the mental health needs of our society increased, right at the time that services were disrupted and bed pressures were like never before.

Indirect effects of this disruption included exam delays and bottlenecks in trainee pathways which, in 2025, are still being addressed. Many psychiatrists such as myself decided to abandon the public system for our own reasons. So many healthcare professionals experienced burnout and changed roles.

But psychiatry trainees have been forced to stay behind as they are beholden to their training placements, overwhelmingly in the public system to continue with their training and become consultant psychiatrists. A doctor in training cannot access the Medicare system, cannot work independently and must be supervised to the level that is required to keep their post accredited with the RANZCP.

All of this is about to be challenged next week.

I’m concerned that the roles and limitations of psychiatry trainees have been misunderstood or overlooked when knee-jerk decisions about how to keep the mental health system running next week have been announced. Being extremely capable, diligent and caring has been misunderstood as an ability to work without supervision and also illegally when it comes to administering a mental health act that psychiatrists in training are simply not gazetted to do.

Psychiatry trainees along with all specialties sacrifice a lot to get where they want to be. They earn about half to a third of their consultant colleagues, are beholden to rosters and arduous on-call commitments and are the worker bees of the public health system. They pay thousands of dollars to specialty colleges to train when these colleges rarely provide any education or training, and they pay thousands of dollars more to sit exams with low pass rates. They must complete compulsory requirements such as rotations to acute mental health units for up to a third of their training. That’s the same setting psychiatrists are abandoning next week. Nothing separates the risk or their moral distress from that of the consultants who are supervising them until Tuesday.

I’d imagine that there would have to be drastic and urgent strategies in place next week in most NSW hospital and healthcare settings to mitigate and hopefully prevent a critical incident or perhaps even a death. Last week the RANZCP offered a guide for psychiatry trainees about how to escalate to seniors when they needed support. My concern is that there are no seniors left, many directors of training may have resigned as well, and at the end of the day, they can only recommend a course of action. The RANZCP is not an employer and has no real ability to support a trainee, except as a last resort to remove accreditation of the training post they are working in, sometimes for up to a year.

On top of everything else happening for psychiatry trainees next week is their legitimate concern that the jobs they are working in will become unaccredited, and that means way more than just safety. It poses a significant disruption to their training time and a real chance that some of their training time won’t count. They will face the opposite predicament of the consultants in that they will be forced to compete for those placements that are accredited, and while hoping they remain accredited.

I am also concerned that these psychiatry trainees will be expected to act up in their teams and have nobody looking out for them in the day-to-day running of the ward. If they ask for help or try and escalate something it will be regarded as a competency issue, and they will be belittled for trying to act within their scope. After all the NSW Government has already demanded they work at the top end of their scope, and take over some duties of consultant psychiatrists.

We have a brand new cohort of psychiatry registrars commencing next month, exactly ten years since we lost three to suicide. What better reason to call for action to prevent them walking into this mess in the first place. Our brand new trainees who have paid thousands of dollars and invested hours of time to be there deserve to be protected. Many will face their first day in an acute inpatient unit, one of the most intense and dangerous places to work in the healthcare setting.

And, if somehow there is some 11th hour resolution, lets never forget that our trainee workforce cannot exist and flourish and provide the sustainability and resilience we need without our supervision, guidance and nurturing. And the current mental health system we will have next week regardless of any resolution will be far from that.

Please read with caution and if you find you are distressed by this content, and please reach out to crisis services and to your own GP for further support. There is always help and always somebody to listen.