Why Psychiatrists Are Voting with Their Feet—And Where They’re Going

Post-pandemic burnout meets systemic undervaluation, driving psychiatrists toward locum and medicolegal work that finally recognises their expertise

When psychiatrists come together and are unified in their concerns about their working conditions and distress trying to work in a system not fit for purpose, solutions are rarely posed.

The RANZCP congress has ended with panels and discussions about the future of psychiatry, and months after successful pay rise wins in the Industrial Relations Commission, it is timely to reflect on the role of the psychiatrist. Never before have we needed roles that are sustainable and rewarding as we do now, roles that truly encompass our skills and expertise based on years of dedication to study and clinical practice.

At my recent IME Discovery Workshop, there was a discussion about how we fared coming out of the pandemic and the answer was overwhelmingly not good. There has been real, lasting and widespread effects on our energy and ability to continue working in the same way after months of uncertainty with constant demands to change the way we practiced to avoid the spread of the coronavirus. 

Systems that were already stretched suffered more injury when psychiatrists left public posts to try and find a different way to practice.

Personally, I found clinical practice during the pandemic to be unsustainable and extremely stressful. Moving my practice to my home and onto a screen overnight was both practically and financially very burdensome. Working within a craft that relies so much on non verbal communication, viewing people using AV links and their mobile phones left me feeling inadequate on a constant basis. Pivoting to public hospital work and examining people in full PPE, or trying to do emergency psychiatric assessments over the phone was equally burdensome. 

It is naive to think that we all somehow bounced back once restrictions were lifted, yet there has been no discussion or attempt to try and offer some solution for this. What I have observed is that psychiatrists have simply left their posts, placing more stress on the public system that continues to be underfunded and understaffed.

Psychiatrists are seeking different ways to use their skills and qualifications. I am observing trends that fewer psychiatrists are opting for long term public hospital or community roles. Psychiatrists who become consultants are often looking for alternatives within the first few years post training. Telehealth options have opened up and the interest in medicolegal work has grown exponentially and this is a true reflection of the systemic lack of interest in enduring a long term career within the “system”.

When I ran my IME Discovery Workshop in Sydney last week, I was deliberate in my decision to collaborate with Blue Print Medical, a locum agency I have worked with throughout the pandemic for my consultant psychiatrist posts. For me, it was not a consideration to accept a VMO role as I was aware that non medical executives that drive decision making rarely have the interests of its medical staff at heart. The only way to secure a role and ensure I was paid appropriately as well as had my agreed terms adhered to was to work for an agency.

The specialty of psychiatry simply isn’t the same as it was even five years ago. And for years our profession hasn’t been protected by our esteemed colleges and societies as it should. We have witnessed task substitution and a devaluing of what we can do, limited to roles involving the mental health act, and calls to scrap gap payments when working in the private system. This erosion has been met with consequences at the same time that we still struggle with the aftermath of the COVID-19 pandemic. 

At the end of the workshop it was clear via the discussion and on the feedback forms that attendees did not want to work in traditional roles, and were looking for ways to escape. There was a resounding flavour of “If we don’t feel valued we will move to roles where we do”. It is absolutely the case that when psychiatrists complete training where they have no choice over their roles, they will vote with their feet after their training is completed. 

And that’s where locum work and medicolegal practice come in as solutions. There is a huge demand for us as medicolegal experts. It is refreshing to be regarded as experts by the legal profession and system that relies on our opinions to achieve resolution of complicated legal matters. Likewise, gaps within the public health system where psychiatrists are largely unrecognised as experts require a locum agency “middle man” to help us secure a role that offers flexibility and appropriate remuneration for what we actually do, and the risk we hold. 

Based on that, I plan to continue my collaboration with BluePrint Medical, and provide attendees actual solutions for roles that reward them for the experts they are and offer them career opportunities they truly deserve. 

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The next IME DISCOVERY WORKSHOP is open now for bookings. Happening in Melbourne on 12th June in collaboration with Blue Print Medical. Click to the link above to learn more or book your place.