A Career in Psychiatry​

This figure gives you a general guide for the common training pathway in the UK. There are several points where IMGs can enter this pathway.

Psychiatry training starts with three-year core training for which doctors require full GMC registration, foundation competencies and two years of post-grad experience.

Prior experience in psychiatry or any part of the MRCPsych exam is not required to enter core psychiatry training. However, it is strongly advisable to show your commitment to the speciality at the interview stage.

A new run-through programme is being trialled in which a Child & Adolescent mental health (CAMHS) trainees are offered ST1 to ST6 post, in a single region.

During three years of core training. trainees will rotate between various sub-specialities of psychiatry and gain a wide range of valuable skills. CT trainees are usually on first on-call rotas and gain experience of managing psychiatric emergencies on the front line.

• England, Scotland and Wales
  The recruitment for all CT Psychiatry training posts in England, Scotland and Wales is the responsibility of the National Psychiatry Recruitment Office, based within Health Education England’s North West Local Office.RCPysch Recruitment Overview.
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• Northern Ireland
  Northern Ireland continues to operate its own recruitment process for psychiatry.Northern Ireland Medical and Dental Training Agency.

MTI is designed to attract limited numbers of International Psychiatry Graduates to experience training in the NHS for up to two years at CT3 level post, before returning to their home country.

Successful MTI applicants are offered GMC registration following their English language requirement test along with a two year tier-5 visa.

MTI scheme suits psychiatrists who are experienced practitioners in their home country and does not cater the newly qualified graduates.

Although MTI scheme initially grants a two-year visa, MTI doctors have moved onto different visas afterwards to work as staff grades and there are examples of MTI doctors passing membership exams and moving into ST training.

There is an official MTI scheme managed by RCPsych but there are also other organisations involved in recruiting for MTI such BAPIO (British Association of Physicians of Indian Origin).

For more information please check the RCPsych MTI website.

In my view the three years of Specialist Training (ST) in Psychiatry are the most enjoyable part of training as along with clinical exposure it offers protected time for research, management and leadership activities. Trainees take the opportunity to grow their confidence and pave the way as potential future leaders for our NHS.

ST trainees are usually second on-call which is non-residential in most places that I know of.

Psychiatry in the UK has several subspecialties and you can obtain a CCT in 6 different subspecialties. These include:

1. General Adult Psychiatry (GA)
2. Old Age Psychiatry (OA)
3. Child & Adolescent Psychiatry (CAMHS)
4. Forensic Psychiatry
5. Psychiatry of Intellectual Disability (LD)
6. Medical Psychotherapy

Sub-specialty endorsements can be achieved during the ST training in the following subspecialties:

• Rehabilitation psychiatry (as part of General Adult Psychiatry)
• Substance misuse psychiatry (as part of General Adult)
• Liaison Psychiatry (as part of both Old Age and General Adult)

There are dual training programmes combining Adult and Old Age Psychiatry lasting four years.

There are clinical fellowship programmers also on offer which are usually a combination of academic and clinical training posts both at CT & ST training level.

There is a shortage of doctors working in psychiatry; there are plenty of junior level and middle-grade non-training jobs in psychiatry available all across the country. NHS trusts advertise these jobs on NHS jobs website on regular basis. The CT equivalent posts are a good start for IMGs as their first job as it gives them the clinical experience of Psychiatry and the opportunity to improve their portfolios in order to apply for core training jobs.

Psychiatry consultant jobs are also undefiled in various geographical areas and therefore doctors achieving to go on specialist register usually do not have a problem finding consultant positions or suitable locum consultant posts.

Treating patients suffering from mental health issues is extremely satisfying. Unfortunately, there are several myths regarding psychiatry include that people with mental illness never recover and there is a chronic course with no hope. Dispelling these myths can pose a challenge at times but equally overcoming them is truly rewarding.

Psychiatry as a career offers an excellent work life balance and time to involve yourself in teaching, research and management activities alongside your clinical role.

There are several myths about psychiatry and they need to be addressed openly to reduce stigma against mental health.

1. Doctors working with mentally unwell patients experience mental health symptoms themselves.
   False. Mental illness isn’t contagious.In my experience doctors working in psychiatry are more mindful of their own emotions and develop better emotional intelligence during training.
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2. Listening to someone else’s problems all day can cause you stress.
   False. Helping others actually gives you satisfaction.
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3. The mentally unwell patient never recovers.
   False. Many mental illnesses are treated successfully and many patients are discharged from psychiatry services after successful treatment. Some mental illnesses run chronic course but with the advancement of treatment and rehabilitation psychiatry, patients are able to receive appropriate support aiming to live their life to full.
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4. Psychiatrists are paid less than physicians or surgeons.
   False. Psychiatrists are on the same pay scales during training and non-training jobs as physicians and surgeons.

UK- trained psychiatrists are sought after around the world and Membership of Royal College of Psychiatrist is recognised worldwide.

Likewise, a CCT in Psychiatry is also very well recognised.

As the key skill of psychiatrist is communication, understanding the native language while abroad can be a key factor for a doctor deciding to move abroad. However, this has rarely prevented successful moves to Canada, Middle East, Australia to name a few.

As a psychiatrist, there are many opportunities in the private sector. Some consultants conduct private clinics. There are private sector organisations managing low and high secure forensic units and rehabilitation units and may on average offer a more attractive remuneration for doctors in comparison to NHS.

There are additional areas of work in out of hours such as Section 12 and DOLS assessments which are paid on average around £175 per assessment (pre-tax).

Some psychiatrist also chose to do medico-legal work and court reports.

There are plenty of teaching opportunities in Psychiatry and these go much beyond medical student teaching. I have seen colleagues teaching in secondary schools about mental health, working with charity organisations, teaching in primary care, general hospitals and multi-disciplinary professionals. There is a need for more mental health training for everyone and you could be instrumental in its delivery.

Psychiatry is at the cutting edge of research in the UK and there are opportunities for undertaking both qualitative and quantitative research. There is ongoing excellent research work in the universities and you can generate numerous opportunities by networking with the academics working within the field of mental health, neurosciences and Psychology to kick-start your own research portfolio.

Trainees at CT and ST training level can successfully complete their independent literate review projects and experiment with qualitative research methods.

There are a lot of opportunities to show real leadership which goes beyond your regular clinical role. These include taking initiative and motivating teams, designing service improvement projects, reshaping services, working with charity organisations and make a tangible impact.

For more information on Psychiatry training pathways and recruitment please check the following links.

• RCPsych training information
  RCPsych training website.
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• Central Psychiatry recruitment site
  For upcoming psychiatry training rounds and updates please check the website.
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• RCPsych Training curriculums
  RCPsych training curriculums.
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• Facebook Group
  I created a Facebook group to provide support for Psychiatrists and I post regular training and non-training opportunities.

I am starting to write a blog based on commonly asked questions about psychiatry training in order to help juniors.