Sugarman & Nimmagadda (Psychiatric Bulletin, November 2007, 31, 404–406) have highlighted a very topical issue. It is interesting that psychiatrists in general feel stigmatised and discriminated against by their colleagues from other medical specialties. Yet, NHS psychiatrists themselves seem keen to encourage stereotypes about psychiatrists working in the independent sector. The prejudice increases logarithmically when the independent-sector psychiatrist happens to belong to an ethnic minority or works in an ‘unfashionable’ specialty (for some that would be, for instance, learning disabilities).

Although psychiatrists working in the independent sector are perceived to be earning huge salaries and working in cushy jobs, they do not have the job security that NHS psychiatrists enjoy. The authors have rightly pointed out that independent psychiatrists do not benefit from the generous NHS final-salary pension scheme.

The performance of independent-sector psychiatrists is constantly monitored. They do not tend to have armies of trainees to assist them and they provide a consultant-delivered service, not unlike in the US system. As they are under increased scrutiny working in the independent sector, the feeling of isolation and lack of peer support is a huge problem. Hence the benefits are balanced by the personal costs and a decision to work in the independent sector is often a difficult choice.

As Professor Hollins rightly alludes to in her commentary (Reference HollinsHollins, 2007), with the expansion of the private sector and possible difficulties in obtaining NHS employment, this is a choice that senior trainees will increasingly have to make.