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Commentary and Debate
How can we look at improving
recruitment into psychiatry?
January 2009
By Josie Jenkinson
If recent figures are to be believed, fewer
UK graduates are entering higher
specialist training in psychiatry than ever
before. Just 6% of candidates sitting
Paper 1 of the MRCPsych in diet one of
2008 were UK graduates (Oxtoby, 2008),
and this is likely to be a national indicator
of recruitment trends (Brown et al, 2009).
This has lead to widespread attention
being focused on potential ways of
improving recruitment into psychiatry,
and the Royal College of Psychiatrists
having taken specific steps to address the
issue (Royal College of Psychiatrists,
2009).
The current recruitment crisis is by no
means a new problem. In fact, concerns
regarding poor recruitment into
psychiatry have been discussed since the
1970’s and there have been similar issues
in other countries, most notably in the
USA (Brockington, 2002). As a result,
there has been a substantial amount
written on the subject of recruitment into
psychiatry. Much of the literature has
been concerned with identifying the
factors influencing the choice of
psychiatry as a career as well as
suggesting strategies that might be
adopted to improve recruitment based on
these factors. However, in the light of
ongoing change within the NHS and
medical education, as well as a current
climate of doubt and uncertainty as to
the future role of the psychiatrist this is a
very real and current issue facing the
profession. Increasing reliance on
international medical graduates to
support and maintain delivery of
psychiatric care increases the pressure to
improve the current situation even
further, given the possible impact of
Home Office immigration policy changes
(Brown et al, 2009).
Any strategy aimed at improving
recruitment into psychiatry would need
to take into account the possible reasons
why people choose psychiatry as a career,
as well as what might deter them. This
may be difficult as processes which
influence doctors in their choice of career
have been described as “subtle and
complex” (Eagles 2007), however I shall
outline some of the possibilities below.
Prior to entering medical school, many
specialties including psychiatry are rated
as a very attractive option (Maidment et
al, 2003). However, this attitude is not
maintained throughout the years of
undergraduate training, with medical
students tending to develop more
negative attitudes about the specialty
(Brockington, 2002). This may in part be
due to the negative attitudes towards the
profession from non-psychiatrists and
even psychiatrists themselves, for
example describing psychiatrists as ‘not
proper doctors’ (Craddock, 2008 p70).
This is confounded by the sadly ever
present stigma surrounding those with
mental health problems and those who
treat them, which medical students are
exposed to both inside and outside of
their training (Brockington, 2002). Four
broad categories of negative opinions
surrounding psychiatry as a specialty have
been identified amongst medical
students. These are related to the
assumption that psychiatry lacks
objectivity and is unscientific, that
treatments are ineffective, that
psychiatrists are ‘emotionally unstable’
and ‘second rate’ doctors, and a dislike of
the patient population treated by
psychiatrists (Scott, 1986 p99).
However, undergraduate exposure to
psychiatry seems to be particularly
important as a potentially positive
influence, with consultants in psychiatry
citing a lasting influence of medical
24 Surrey and Borders Online Journal www.sabp.nhs.uk/journal