Psychiatrist

Psychiatry could be the career path for you if you have a strong scientific mind, excellent communication skills and the desire to improve the lives of people living with mental illness

Psychiatrists are medically qualified doctors specialising in the diagnosis and treatment of patients with mental health disorders, such as:

• dementia
• depression
• bipolar disorder
• eating disorders
• schizophrenia.

Psychiatric disorders can be caused by physical illnesses, and many patients with mental illness are at greater risk of physical illness. Because of this, psychiatrists are skilled in recognising mind and body symptoms to evaluate and assess risk and draw up treatment plans, which may include prescribing medication.

Types of psychiatry

As a psychiatrist you'll usually specialise in one of the following areas:

• general adult - for patients aged 18 to 65 in inpatient and outpatient settings. Sub-specialties include liaison, substance misuse, rehabilitation psychiatry, eating disorder psychiatry and neuropsychiatry.
• child and adolescent - working with children and young people up to 18 years of age who have a mental illness.
• old age - specialising in psychiatric illnesses such as dementia, which are common in the 65+ age group.
• forensic - psychiatric care in prisons and secure hospitals. Forensic psychiatrists can also act as expert witnesses in court trials.
• psychiatry of intellectual disability - managing patients who have a learning disability.
• medical psychotherapy - providing treatment for psychiatric disorders through different forms of psychotherapy.

Responsibilities

Specific tasks depend on your specialty. For example, the work of a forensic psychiatrist is very different from the work of a child psychiatrist. There are, however, some responsibilities common to all specialties.

As a psychiatrist, you'll:

• work directly with patients suffering from a range of mental health problems and provide a good standard of practice and care
• assess patients by reviewing their mental and physical health, their background and current social situation, thoughts and past health issues, as well as any potential risk factors
• take notes and keep detailed records of any interactions and decisions
• decide on suitable psychiatric treatment plans for patients, which often include a mix of psychological, medical and social interventions in conjunction with other health professionals
• prescribe medication when necessary
• monitor and review treatment regularly
• have excellent knowledge of physiology, anatomy, psychology, pharmacology and mental health law, as well as an awareness of the social factors that influence mental health
• work closely within, or lead, a multidisciplinary team of health professionals, including psychiatric nurses, psychologists and occupational therapists
• supervise and teach junior medical staff (depending on your post)
• carry out research and keep up to date with new information relevant to your field.

Salary

• The basic starting salary for junior hospital doctor trainees at foundation level is £29,384 in the first year, rising to £34,012 in the second year. As a trainee at specialty level you can earn between £38,694 to £49,036.
• Salaries for specialty doctors (staff grade) range from £41,158 to £76,751.
• Salaries for newly qualified consultants start at £84,559, rising to £114,003 depending on the length of your service.

Allowances are paid for working nights, weekends and being on call. High-cost supplements are available to psychiatrists working in London. You'll automatically be enrolled in the NHS pension scheme, but you can opt out.

Consultants may apply for local and national Clinical Excellence Awards and are also able to supplement their salary by working in private practice.

Figures relate to the pay and conditions of medical doctors within the NHS, which is the largest employer of psychiatrists in the UK.

Income data from NHS Health Careers. Figures are intended as a guide only.

Working hours

You'll typically work a 40-hour week, with hours between 9am and 5pm, Monday to Friday. However, depending on the trust you work for and your chosen specialty, you may have to work nights, weekends or be on on-call duty. Most trainees at foundation, core and higher level will be expected to work on call.

Part-time work is possible with opportunities for a good work-life balance. As a core and speciality trainee, you'll usually be employed on short-term contracts.

As a consultant you can run your own private practice in combination with part-time employment.

What to expect

• You'll have regular contact with a variety of patients and will see many of them through the initial stage of requiring treatment to the final resolution. Many psychiatrists find this very rewarding.
• You may work with challenging patients who are under severe strain, and at times you may encounter physical risk.
• Jobs are available throughout the UK in a range of settings, including hospitals, community, prisons, schools, special units and residential homes.
• The number of people currently entering psychiatry is generally lower in comparison with other medical specialties.
• During your three-year core training you'll have the opportunity to try out the different psychiatry specialties before making your final choice for the three-year higher training.

Qualifications

The only way to get into psychiatry is with a degree in medicine recognised by the General Medical Council (GMC). This usually takes five years to complete, although if you've already got a degree in a subject other than medicine (usually a 2:1 or above in a science-related subject), you can apply for a four-year accelerated medical graduate entry programme (GEP).

This is followed by two years of Foundation Training common to all medical graduates, where you'll work in a hospital as a junior doctor on a rotational basis in different departments, including psychiatry. On successful completion you'll be awarded a Foundation Achievement of Competency Document (FACD).

At this point, you'll start your six-year training in psychiatry. Training is split into three years of core training and three years of higher training. For the first three years, you'll work in a range of different psychiatry settings, such as a hospital or in the community, to give you as much experience as possible. Each post lasts four to six months. After that, you'll complete three years in your chosen specialty, split into three 12-month posts. However, it's becoming increasingly common to do 'dual training', where you pick two areas of practice, typically lasting five years rather than three.

After passing all workplace-based assessments and the Royal College of Psychiatrists MRCPsych examinations, you'll be awarded with the Certificate of Completion of Training (CCT) and Fellowship of the Royal College of Psychiatrists (FRCP). This allows you to join the GMC Specialist Register and to apply for psychiatric consultant positions, which you can start six months prior to completion.

Increasingly, a large number of psychiatrists are neither consultants nor trainees and take up posts as Specialty Doctors and Associate Specialists (SAS). As a specialty doctor you're expected to be registered with the GMC and to have completed four years of postgraduate training, including two years of specialty training.

See hospital doctor for full details on the qualifications and training required to be a doctor.

Skills

You'll need to have:

• excellent interpersonal and communication skills with the ability to treat others with empathy, understanding and respect
• emotional resilience to work in challenging situations
• an analytical and scientific approach with good problem-solving skills
• the ability to work under pressure and make informed decisions
• good leadership skills with the ability to organise, train and motivate others
• the ability to work flexibly as part of a multidisciplinary team
• clinical expertise in your chosen speciality
• initiative and motivation.

Work experience

Before applying to do a medical degree you're expected to undertake work experience, either paid or voluntary, in areas relevant to medicine. This could be through work experience at your local hospital, nursing home or mental health trust or through work shadowing a doctor. This experience shows your commitment to becoming a psychiatrist and provides insight into the physical and emotional demands of working in medicine.

Consider becoming a member of the Royal Society of Psychiatry Student Associates or join a university PsychSoc, a psychiatry student society, to keep informed about developments in psychiatry. PsychSocs also have social media threads advertising training, opportunities, news or events, such as the Royal College of Psychiatry's taster weeks. These allow you to find out more about the different psychiatric specialties.

During your two-year Foundation Training as a junior doctor, you'll need to choose a psychiatry placement that will give you a good insight into the work.

Find out more about the different kinds of work experience and internships that are available.

Employers

The NHS is the largest employer of psychiatrists. There are also opportunities to work in the private sector, as well as setting up a private practice. There are currently plenty of opportunities available for psychiatrists.

Look for job vacancies at:

• BMJ Careers
• NHS jobs - England and Wales
• NHS Scotland Recruitment
• Northern Ireland Health and Social Care jobs
• Royal College of Psychiatrists Job Board

Look for training posts at:

• National Psychiatry Recruitment (England, Wales and Scotland) - national psychiatry recruitment portal, coordinated by Health Education North West, for core and speciality psychiatry training posts.
• Northern Ireland Medical & Dental Training Agency (NIMDTA)

Professional development

As a psychiatrist you'll be expected to continue learning throughout your career. Continuing professional development (CPD) is essential if you want to remain on the GMC register. CPD activities can include attending courses, conferences, meetings and workshops, as well as undertaking research and peer-reviewing journal papers. The Royal College of Psychiatrists provides guidance on undertaking CPD - see Your CPD for more information.

Additional postgraduate qualifications can be useful but aren't essential. For example, a forensic psychiatrist may take an LLM degree in medical law or mental health law, or an MSc in criminology. If you wish to integrate more formal teaching into your work, you can take the MMedSci Medical Education.

Search postgraduate courses.

For an academic research career, you'll need to study for a PhD in an area of original research.

Career prospects

As a consultant you'll gradually gain more experience in your clinical duties and take on more responsibilities. You'll have the opportunity to move into managerial roles, initially as a medical lead (a lead consultant for a team), then a clinical director (a lead consultant for a department) and later on as a medical director (a lead consultant for a hospital trust).

If you're working as a specialty doctor, you'll spend most of your working day on patient care and are responsible to a named consultant psychiatrist. There is some scope for leadership and management roles and you may also have the opportunity for teaching, research, committee work and more.

If you wish to take up scientific research and an academic career, you'll need to start early during your Foundation Training as this field is highly competitive.

Psychiatrists interested in teaching future doctors may become a director of medical education, training programme director or associate dean in charge of the entire training programme.

There are also opportunities to work in the private sector or set up your own practice.

At the moment, it's comparatively easy to progress in a psychiatric career. Depending on your specialty, however, you may have to be geographically mobile in order to move up to the next level.