The article ‘The trouble with NHS Psychiatry in England’ ^{Reference St John-Smith, McQueen, Michael, Ikkos, Denman and Maier1} coincided with the Dean of the Royal College of Psychiatrists Professor Howard's interview on Channel 4 news on 4 June 2009. ^{Reference Hannam and Wivell2} The very fact that psychiatry is one of the least favoured specialties for UK medical graduates suggests that there is trouble with NHS psychiatry in the UK. Perhaps the College and its members need to look at the possible reasons. ^{Reference Kerby, Calton, Dimambro, Flood and Glazebrook3}

The College has already been dealing with stigma that psychiatry and psychiatry patients face. It appears that many recent medical graduates secured a psychiatry post as part of their foundation training on the basis of favourable placements as a medical student ^{Reference Eagles, Wilson, Murdoch and Brown4} at the time of ‘old’ ways of working. Unfortunately, their subsequent experience with the ‘new’ ways of working for psychiatrists has been less reassuring. They have often noticed psychiatrists being marginalised and their role being reduced to firefighting with a lack of proactive interventions. This has led to many medical graduates deciding not to take up a career in psychiatry or even to seek higher training in psychiatry abroad.

Medical graduates are often attracted to various specialties by role models. ^{Reference Wright, Wong and Newill5} We wonder whether a relative lack of role models is the reason for UK graduates not opting for psychiatry. In his interview on Channel 4 news, Professor Howard suggested that psychiatry is being forced to recruit trainees who just meet the minimum criteria. This might lead to fewer role models in psychiatry, further recruitment problems and more trouble.

Perhaps the College might consider introducing ‘newer’ ways of working, recruiting and training.