Determining whether senior and specialist registrarschoose or reject a career in general adult psychiatry A survey of factors

Aims and method Following concerns over recruitment into general adult psychiatry, this study was undertaken to determine which factors influence senior trainees in psychiatry with regard to whether or not they choose a career in general adult psychiatry. The method used was by postal surveyof all senior and specialist registrarsin the UK. Results Of those responding, 32.6% had chosen a career in general adult psychiatry, while 38.9% had actively rejected such a career. Twenty-sixper cent of

Recent reports have highlighted problems with recruitment into general adult psychiatry con sultant posts.From 1994 to 1997 the number of vacant posts in general adult psychiatry has risen from 157 (11.1% of total posts) to 212 (13.2% of total posts) (Royal College of Psychia trists, 1997).In addition, many consultants have been retiring early from general adult psychiatry, many for work-related rather than personal reasons (Kendell & Pearce, 1997).The main source of recruitment into these consultant posts is from senior and specialist registrars in higher psychiatric training.The aim of this study was to determine the factors significant in whether or not senior and specialist registrars choose a career in general adult psychiatry.

The study
A survey of specialist and senior registrars training in rotations covering all psychiatric specialities in the UK was carried out between November 1997 and May 1998.A list of all scheme organisers for higher psychiatric training was obtained from the Royal College of Psychia trists.Senior and specialist registrars were contacted through these scheme organisers and asked to complete a questionnaire.
The questionnaire was designed to determine which factors were of relevance in making final career choices.The questionnaire was in two parts: the first part asked trainees their intended career and speciality, for example, consultant in general adult psychiatry.In the second part respondents were asked to indicate which one of three possibilities applied: (a) that they had decided upon a career in general adult psychia try: (b) that they had actively rejected a career in general adult psychiatry and had chosen another speciality; and (c) that they had always intended to pursue a career in a speciality other than Psychiatric Bulletin (1999), 23, 607-609 Choosing general adult psychiatry Rejecting general Choosing another adult psychiatry speciality Speciality choice Fig. 7. Percentage of all respondents choosing or rejecting a career in general psychiatry or actively choosing another speciality, m, male; â€¢¿ female; D-total.

Findings
A total of 1093 questionnaires were sent of which 660 (60.4%)were returned.Of these respondents 301 (45.6%) were male, 336 (50.9%)were female; 23 (3.5%) did not indicate their gender.Of the total, 595 (90.2%) intended to become consul tants, 39 (5.9%) intended to take up academic teaching posts, two (0.3%)wanted to be associate specialists and one (0.15%) intended to become a general practitioner; 23 (3.5%) said they were unsure of their intended status.The total number choosing a career in general adult psychiatry was 215 (32.6%), while the number actively rejecting a career in general adult psychiatry who consequently chose an alternative speciality was 257 (38.9%).The number who had always intended a different speciality and had not actively rejected a career in general adult psychiatry was 172 (26%).A further 16 (2.4%)were unsure of their final career speciality (see Fig. 1).
The 10 most commonly chosen reasons (out of a total of 19 possible factors) for choosing or rejecting a career in general adult psychiatry are detailed in Table 1 and Table 2, respec tively.As respondents were able to choose up to four of 19 given factors, numbers and percentages in the tables reflect the total scores from the survey.

Comment
It is encouraging that despite "plummeting morale in adult general psychiatry" (Deahl &  Turner, 1997) the speciality is still a career choice at consultant level for a significant number of specialist and senior registrars; this seems to be related to factors inherent in the speciality with the large spectrum of disease encountered being cited as the most common favourable reason.Of concern, however, is that the number actively avoiding general psychiatry and seeking an alternative career outnumber those wishing to do general adult psychiatry.
Here the three most commonly cited reasons were poor resources and factors consequent to this, namely high workload and poor working conditions.Thus, the speciality may be appeal ing but the poor resources are not.
If medical students choosing a career in psychiatry do not increase and if specialist and senior registrars avoid a consultant career in general adult psychiatry and choose alternatives, then the problem of filling vacancies is likely to persist.Early retirement of consultants is ex acerbating the problem (Kendell& Pearce, 1997).The vacancies may well represent the Up of an iceberg as trusts are unlikely to be willing to create new posts if they do not believe that these posts can be filled.As a consequence the work load for existing consultants will remain high and these consultants may make their dissatis faction obvious to their trainees and to medical students.The UKalready has a low proportion of psychiatrists per head of population compared with other countries (Muijen, 1993).
General adult psychiatry remains the comerstone of community care for the mentally ill.The Department of Health has now announced its intention to increase funding for mental health and to review mental health legislation in England (BMJ News, 12 December 1998 p. 611).It is vital that this new funding provides real changes to the resources on the ground so that sufficient senior and specialist registrars again become attracted to general adult psychia try in order to help lift it out of its current doldrums.

Table 1
. Top 10 reasons for choosing a career in general adult psychiatry % (

Table 2 .
Top 10 reasons for actively rejecting a career in general adult psychiatry % (