The Ultimate Career Manual for Aspiring Psychiatrists

A Psychiatrist's Role

A psychiatrist's job is to diagnose and treat mental illnesses in people of all ages. Psychiatry is a medical specialty that includes six subspecialties: child and adolescent psychiatry, forensic psychiatry, general adult psychiatry, medical psychotherapy, old age psychiatry, and learning disability psychiatry. Psychiatry is the fifth most popular medical specialty in the United Kingdom. 1

It combines scientific knowledge, medical expertise, and personal skills such as communication, problem-solving, and situational awareness to form therapeutic partnerships that facilitate psychiatric care through pharmacological, psychological, and social interventions. A career can be combined with other interests such as medicolegal work, teaching, and research. 2

Much is still unknown about the brain and, consequently, this is a rapidly developing field with significant potential to conduct innovative research and develop novel treatments In 2017, women made up 51% of psychiatrists. 1 

Child and adolescent psychiatrists treat mental health disorders in children and adolescents up to the age of 18. They collaborate with multidisciplinary and multiagency teams that include, for example, mental health nurses, educational psychologists, and teachers. Care is primarily provided in outpatient clinics and the community through the use of psychotherapeutic and pharmacological modalities. Running cognitive behavioral therapy, meeting with school staff about children in difficulty, and conducting medication reviews are examples of daily activities. Every day, they handle four to ten cases. 3 

Forensic psychiatrists work with people who have a history of violent behavior, such as prisoners or people who have committed crimes due to mental illness. The goal is to reduce the risk of harm to patients and the general public, which is accomplished in collaboration with multidisciplinary teams that include mental health nurses, psychologists, and lawyers.

Work is done in prisons, secure hospitals, and in the community. Forensic psychiatrists counsel colleagues on the care of patients who are at risk of engaging in violent behavior, including risk management, pharmacological and psychological treatment modes, and psychotherapeutic strategy.

Furthermore, they serve as expert witnesses in courts, assessing defendants' fitness to stand trial and capacity to form intent, as well as advising on relevant psychiatric defenses. 4 

Adult psychiatrists in general diagnose and treat mental health problems in adults. The specialty benefits from longer appointment times. Adult general psychiatrists plan and carry out management strategies that include both pharmacological and psychological treatments. Furthermore, they make interventions that take into account individuals in social contexts. 1

Typically, care is provided in the community by a team that includes general practitioners, psychologists, and mental health nurses.  

Medical psychotherapists use psychotherapies such as psychoanalytic psychotherapy, cognitive behavioral therapy, and trauma focused therapy to treat patients of all ages. They evaluate complex cases and develop treatment plans.

Longer appointment times and longer treatment durations allow medical psychotherapists to be more involved in patient care. In outpatient clinics or the community, they work in multidisciplinary teams. A typical week might include providing individual and group psychotherapies, consulting with colleagues, and teaching. 5 

Traditionally, old age psychiatrists cared for people over the age of 65. Individuals with cognitive disorders who have physical and mental comorbidities are increasingly being included in the specialty. As people live longer lives, the field of old age psychiatry is expanding. Dementia accounts for a significant number of cases, but it is balanced in equal parts with other mental illnesses such as schizophrenia and personality disorders. 6

To promote independence in the elderly, old age psychiatrists use a holistic and socially contextualized approach. In general, they work in multidisciplinary teams in the community and at patients' homes.  

Learning disability psychiatry is concerned with the treatment of mental health problems in people with intellectual disabilities. Pharmacological, psychological, social, and educational interventions are used in a multidisciplinary and holistic approach. Care is typically provided in the community. 2 

A Normal Week

According to the 'Working Time Regulations 1998,' psychiatrists work an average of eight hours per day and no more than 48 hours per week. A typical week includes approximately ten hours devoted to non-clinical activities such as clinical governance, teaching, and training.

In comparison to other medical specialties, psychiatry typically provides regular and flexible working hours with a significantly lower frequency of on-call work. For example, an on-call rota of one in ten may be followed, and on-call work is frequently performed remotely. Many psychiatrists work on a part-time basis.  

The Route To Psychiatry

The path to psychiatry begins with a medical degree (MBChB) and two years of foundation training, which usually consists of six rotations across various specialties and healthcare settings. Following that, Core Psychiatry Training is obtained. 2 The program lasts three years.

This is applied for via a form that examines entry requirements such as core competence, clinical reference, and details of achievement in various areas - and an interview. The competition ratio for Core Psychiatry Training in 2016 was one. 50 1 During Core Psychiatry Training, trainees work in a variety of psychiatric specialties. Prior to advancing to advanced training, candidates must pass the Membership of the Royal College of Psychiatrists (MRCPsych) examination, which consists of two MCQ papers and a Clinical Assessment of Skills and Competencies.  

Typically, advanced training in one of the six psychiatric specialties takes three years. The competition ratios in 2019 were 0 96, 1 13, 0 99, 2 67, 1 09 and 0 45 for child and adolescent psychiatry, forensic psychiatry, general psychiatry, medical psychotherapy, old age psychiatry, and learning disability psychiatry, in that order. 7 For child and adolescent psychiatry, it is possible to apply for run through training, which begins immediately after foundation training. 2 For this, the competition ratio was 8. 57 in 2019 7 Dual training in specific psychiatric specialties combinations may be completed. This is accomplished in four or five years.  

Finally, trainees receive a certificate of completion of training (CCT) from the General Medical Council and are eligible to apply for consultant positions. Dual training results in the completion of two CCTs.  

The South London and Maudsley NHS Foundation Trust is a renowned institution in psychiatric care and research, offering the most comprehensive range of mental health services in the United Kingdom.  

Medical students interested in a career in psychiatry can become Student Associates at the Royal College of Psychiatrists (RCPsych). Associates are invited to medical student events, receive discounted tickets to the college's annual international conference, and have access to online learning and journal subscriptions. RCPsych also provides a variety of awards, prizes, and bursaries with comparable benefits.

Additionally, careful observation and enquiries on clinical placements, attendance at conferences and selection of relevant topics for student selected components is favourable  

Foundation trainees should try to secure full-time positions in psychiatry. The RCPsych, in collaboration with the UK Foundation Programme Office, appoints Psychiatry Foundation Fellowships (PFF) to supplement foundation training and increase exposure to psychiatry. Fellows have regular access to psychiatric supervision and Balint groups. Furthermore, the RCPsych facilitates educational opportunities such as attending the college's annual international congress and having access to online learning and journal subscriptions. 8

These opportunities can also be obtained by enrolling as Foundation Doctor Associates at the college. It is beneficial to gain research and management experience.  

Core and specialty trainees should also gain research and management experience. As Pre-Membership Psychiatry Trainees, core and specialty trainees can join the RCPsych.  

Subspecialties 

General psychiatry has three established subspecialties. Liaison psychiatry, addictions psychiatry, and rehabilitation psychiatry are three of them. Liaison psychiatrists serve as the link between physical and psychological health, as well as care for medical patients with psychiatric disorders who have presented to general hospitals. They are employed in emergency rooms, hospital wards, and outpatient clinics.  

Addiction psychiatrists use physical and psychological interventions to treat people suffering from substance abuse disorders.  

Finally, rehabilitation psychiatry focuses on improving the quality of life and social integration of people suffering from long-term and complex mental illnesses. 2 

Other emerging subspecialties include eating disorders psychiatry and perinatal psychiatry. Furthermore, psychiatrists of all specialties have the opportunity to enter academic psychiatry and take on expanded teaching and research responsibilities. In accordance with personal interests, research can be conducted on biological, social, or psychological disciplines relevant to psychiatry.  

Earnings

NHS consultant salaries are the same across all specialties but vary by region (highest in Scotland), England, Northern Ireland, and Wales (lowest), and increase with service (up to 19 years). Salary bands in 2020 range from £77,779 to £109,849 NHS excellence awards can boost 9 salaries even more.  

Many psychiatrists work privately in addition to their NHS jobs. Private practice has significant earning potential; earnings may match or exceed NHS salaries.  

The starting salary for accredited consultants in the British Army is comparable to that of the NHS. This was £80,527 in 2017. 9 

Please see The Complete Guide to NHS Pay for more information on salaries in the NHS.

Resources 

The primary body operating to support psychiatrists in the UK is the RCPsych It has faculties for each of the psychiatric specialties and subspecialties. In addition to the RCPsych's international congress, each of the faculties organizes annual conferences.

The World Psychiatric Association (WPA) is a global alliance of psychiatric societies from 120 countries that promotes collaborative work through numerous scientific sections, education programs, publications, and events. The World Psychiatric Association also hosts the World Congress of Psychiatry.  

The British Journal of Psychiatry, an international peer-reviewed journal, is published by the RCPsych. World Psychiatry, Lancet Psychiatry, and JAMA Psychiatry are also notable journals in the field.  

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References 

1. [Internet] General Psychiatry Health Professions [retrieved on May 12, 2020] Available 

originating at: https://www healthcareers nhs uk/explore-roles/doctors/roles- doctors/psychiatry/general-psychiatry

2. How to Become a Psychiatrist [Internet] [cited 12 May 2020] Royal College of Psychiatrists Available at: https://www rcpsych ac uk/become-a- psychiatrist/pick-psychiatry/how-to-become-a-psychiatrist

3. [Internet] Child and adolescent psychiatry Health Professions [retrieved on May 12, 2020]  

Accessible at: https://www healthcareers nhs uk/explore-roles/doctors/roles- doctors/psychiatry/child-and-adolescent-psychiatry

[Internet] Forensic psychiatry Health Professions [retrieved on May 12, 2020] Available 

originating at: https://www healthcareers nhs uk/explore-roles/doctors/roles- doctors/psychiatry/forensic-psychiatry

5. Medical Psychotherapy [Internet] Health Professions [cited 12 May 2020] Available 

originating at: https://www healthcareers nhs uk/discover-roles/doctors/roles- doctors/psychiatry/medical-psychotherapy

[Internet] Old-age psychiatry Health Professions [retrieved on May 12, 2020] Available 

originating at: https://www healthcareers nhs uk/explore-roles/doctors/doctors' roles/psychiatry/old-age-psychiatry

[Internet] Specialty Recruitment Competition Ratios 2019. Health Instruction

2019 [cited 12 May 2020] England Available at: https://specialtytraining.com/ hee nhs uk/Competition-Ratios 

Fellowships for Psychiatry Foundation [Internet] The Royal College of Physicians  

2020 [cited on May 12, 2020] Accessible at: https://www rcpsych ac uk/become-a-psychiatrist/medical-students/awards-prizes-and-bursaries/foundation- fellowships

9. [Internet] Pay The British Medical Association (BMA) [retrieved on May 12, 2020] Available at:

https://www bma org uk/advice/employment/pay