New Zealand's psychiatrist workforce: profile, recruitment and retention

The Role of Continuing Professional Training or Development in Maintaining Current Employment: A Systematic Review

The impact of continuing job education and professional development on early exit from the labor market is unclear. This systematic review examined how continuing job education or professional development influences the retention of current employment. We searched the PubMed and Embase databases from their start dates to January 2023. Two reviewers screened the full texts of relevant reports and assessed the methodological quality of the included studies using the adapted Effective Public Health Practice Project quality assessment. We qualitatively synthesized the results of the included studies. We screened 7338 publications and included 27 studies consisting of four cohort and 23 cross-sectional studies in the review. The participants of the selected studies were mostly from the health sector (24 studies). There were 19 studies on staying or leaving a current job, six on employee turnover intention, two on job change, one on return to work, one on early retirement, and one on employment. Continuing employee development or training opportunities were associated with increased intention to stay in a current job, decreased intention to leave a current job, decreased employee turnover intention, job change, or early retirement and with faster return to work. One of the two studies that examined the role of age showed that continuing employee development is a more important factor for retaining current employment among younger than older employees. A few studies found that job satisfaction and commitment fully mediated the relationship between employee development and employee intention to leave current employment. This study suggests that participating in professional training/development is related to a lower risk of leaving current employment.

The Impact of COVID-19 on Burnout, Psychological Well-being, and Work Satisfaction in Psychiatry Trainees in Ireland

OBJECTIVE

Prior to the pandemic, trainee doctors were at higher risk of psychological ill health. There is limited evidence measuring the impact of COVID-19 on psychiatry trainees. This study evaluates levels of burnout, work satisfaction, and psychological well-being in psychiatry junior doctors in Ireland and identifies potential contributing factors.

METHODS

The authors carried out a cross-sectional online survey measuring demographic and work-related variables. Questions including exposure to COVID-19 and stress-related factors were included. We evaluated burnout, work satisfaction, and psychological well-being using the Abbreviated-Maslach Burnout Inventory, Basic Needs Satisfaction at Work Scale, and WHO-5 Well-being Index.

RESULTS

One hundred and five doctors responded (21%). The biggest stressor reported was reduced face-to-face contact with family and friends (73%). Forty one percent reported weekly supervision changes. Sixty five percent met the criteria for burnout, compared with 36.2% in 2018. Significant factors associated with burnout included staff shortages, longer hours, and less experience. Changes in supervision and working in non-European Working Time Directive compliant rotas were associated with lower scores across all subdomains of the BNSW Scale. The WHO-5 Well-being Index identified 48% scored low in personal well-being, indicating these trainees met the threshold for depression. Changes in regular supervision (p=0.010) were a significant predictor of low personal well-being.

CONCLUSIONS

High prevalence of burnout and low levels of well-being in this vulnerable cohort, particularly those who are inexperienced, have changes in supervision, and working longer hours is concerning. This study highlights the importance of regular supervision and support for this group.

Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis

BACKGROUND

The global rise in mental health issues calls for a strong psychiatry workforce. Yet, psychiatry training worldwide is facing recruitment challenges, causing unfilled consultant posts and possibly threatening the quality of patient care. An in-depth understanding of trainees' progression through training is warranted to explore what happens to recruited trainees during training.

AIMS

To uncover current trends in psychiatry trainees' progression through training in the UK.

METHOD

This national retrospective cohort study with data from the UK Medical Education Database used discrete-time survival analysis to analyse training progression for those trainees who started their core psychiatry post in 2012-2017 (2820 trainees; 59.6% female, 67.6% UK graduates (UKGs)). The impact of sociodemographic characteristics on training progression were also investigated.

RESULTS

The overall probability of completing training in 6 years (minimum years required to complete psychiatry training in the UK) was 17.2% (ranging from 4.8% for non-UKG females to 29% for UKG males). The probability to not progress was highest (57.1%) from core to specialty training. For UKGs, trainees from ethnicities other than White, trainees with a disability, and trainees who had experienced childhood social deprivation (measured as entitlement to free school meals) had a significantly (P ≤ 0.02) lower probability of completing training in 6 years.

CONCLUSIONS

Less than one in five psychiatry trainees are likely to complete training in 6 years and this probability varies across groups of doctors. Completing psychiatry training in 6 years is, therefore, the exception rather than the norm and this has important implications for trainees, those planning psychiatry workforces or responsible for psychiatry training.

Burnout, Work Satisfaction, and Well-being Among Non-consultant Psychiatrists in Ireland

OBJECTIVE

The aim of this study was to explore the areas of psychological well-being, satisfaction at work, and burnout among non-consultant psychiatrists in Ireland, and to assess for potential contributory factors.

METHODS

The College of Psychiatrists of Ireland distributed the survey online to 100 non-consultant psychiatry doctors working in Ireland. The survey contained questions relating to demographic and work-related variables, the Abbreviated-Maslach Burnout Inventory (a-MBI), Basic Needs Satisfaction at Work (BNSW) scale, and WHO-5 Well-being Index. Descriptive statistics were used by the authors to summarize the data and univariate associations were explored between baseline data and subscales.

RESULTS

Sixty-nine percent of our sample completed the survey. Thirty-six percent of the sample met the criteria for burnout, with lack of supervision the only variable significantly associated with this. Lack of regular supervision was associated with lower scores across all work satisfaction domains of the BNSW scale. The WHO-5 Well-being Index identified that 30% of respondents scored low in personal well-being, indicating that this proportion screened positive for depression, based on international diagnostic criteria. Lack of regular supervision was found to be significantly associated with low psychological well-being.

CONCLUSION

This study indicates that lack of supervision is significantly associated with burnout, lower satisfaction at work, and poorer psychological well-being. Close evaluation of these areas is important to identify vulnerable individuals and areas of training which can be improved upon, which may lead to relevant measures being implemented for the benefit of psychiatrists, patients, and the wider society.

Psychiatry recruited you, but will it retain you? Survey of trainees' opinions

Aims and method

To gather opinion from trainees across England about their current experiences and future career plans. This was done via an internet-based survey.

Results

Out of the 359 responses we received, 65.8% of trainees planned to stay in psychiatry until retirement. Trainees felt several issues were problematic, including the attitude of other specialties towards psychiatry, perceived substandard treatment of psychiatric patients by other specialties and implications of New Ways of Working.

Clinical implications

Despite there being many areas of training respondents were happy with, if attrition is to be minimised, issues such as how psychiatric trainees integrate with the other medical specialties and how the role of doctors in the specialty is perceived need to be addressed.

Bringing them home: a Gippsland mental health workforce recruitment strategy

This paper reports on preliminary findings of a novel program piloted in 2010 to address rural mental health workforce shortages. The program involved exposing allied health and nursing students from rural backgrounds studying in Melbourne to mental health service employment opportunities in Gippsland. A longitudinal study is underway to evaluate the effect and outcomes of the program and includes surveying participants’ interest in rural mental health work through an online questionnaire immediately prior to and following the program; and surveying career decisions at 6 months and yearly intervals. Paired sample t-tests were used to analyse participants’ level of interest in rural work (pre-event 4.67 (1.50); post-event 5.93 (0.96); P = 0.001), career in a rural setting (pre-event 4.67 (1.63); post-event 5.67 (1.23); P = 0.006), mental health work (pre-event 4.73 (1.39); post-event 6.07 (0.80); P < 0.000) and rural mental health career (pre-event 4.73 (1.33); post-event 5.80 (1.21); P = 0.002). These findings indicate a significant increase from pre- to post-event and are supported by strong effect sizes suggesting that the program had a significant effect on participant interest in rural mental health work. Longer-term evaluation will determine whether the program influences participant career decisions and thereby addressing mental health workforce shortages in Gippsland. What is known about the topic? Despite the ongoing challenges that regional and rural mental health services face recruiting and retaining mental health professionals, there is a lack of evidence available to inform rural mental health workforce recruitment strategies. What does this paper add? This paper describes a novel recruitment initiative and preliminary data from a longitudinal evaluation program. The initiative targets allied health and nursing students with rural backgrounds who are studying at a large urban centre (Melbourne). What are the implications for practitioners? This study provides a potentially successful recruiting tool for mental health sector policy-makers and managers which will be evaluated over the long-term.

Stresses experienced by psychiatrists and their role in burnout: a national follow-up study

BACKGROUND

Many studies have looked at sources of stress in psychiatrists, yet the role played by different factors in the causation of burnout in psychiatrists remains unclear. We had two aims, first, to develop a predictive model for the onset of burnout. Second, we aimed to study the differences in the perception of what caused stress between psychiatrists who rated themselves high on Emotional Exhaustion compared to those who rated themselves as low on Emotional Exhaustion.

METHODS

A previously described questionnaire that identified stressors relevant to consultant psychiatrists was mailed out to 426 psychiatrists, with 240 replies. Scores on the Emotional Exhaustion dimension of the Maslach Burnout Inventory were available for 131 respondents.

RESULTS

Based on an earlier literature review, the Sources of Stress Questionnaire (SOS-Q) used in the study had 45 factors, categorized into predisposing, precipitating, perpetuating and protective factors for burnout in psychiatrists. Of these, factor analysis identified 11 non-correlated factors which were used in the final analysis of this study. Four factors emerged as associated with burnout in psychiatrists in New Zealand: too much work; working long hours; an aggressive administrative environment; and lacking support from management. Two factors negatively correlated with Emotional Exhaustion were a high level of job satisfaction and/or enjoyment, and low pay compared to other countries.

CONCLUSIONS

Most factors associated with burnout are preventable and can be managed jointly between psychiatrists and administrators. Service providers need to address burnout seriously.

Coming on board: the assessment of overseas trained psychiatrists by the Royal Australian and New Zealand College of Psychiatrists

OBJECTIVE

The aim of this paper was to investigate key concerns of overseas trained psychiatrists (OTPs) in Australia and New Zealand surrounding the assessment of their qualifications and their experience of the Fellowship examination process.

METHOD

A survey of OTPs progressing towards Fellowship of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) was conducted using an online survey instrument. The survey aimed to explore OTPs' views regarding the key issues encountered in their progression to Fellowship and to gauge their level of satisfaction with a range of RANZCP support initiatives.

RESULTS

Important areas of concern were elicited across a variety of domains, including the examination process itself, issues around immigration, and differences in professional culture and language. The message to the RANZCP was that there were still important areas of dissatisfaction relating to measures taken to address these concerns.

CONCLUSIONS

The authors recommend specific courses of action to address areas where more support is required, and suggest additional areas where more research is needed.

Continuing professional development for Australian rural psychiatrists by videoconference

OBJECTIVE

The Rural Special Interest Group (RSIG) of the Royal Australian and New Zealand College of Psychiatrists provided a program of educational meetings for psychiatrists and trainees in rural locations to decrease professional isolation and facilitate opportunities to obtain credit for continuing professional development (CPD) purposes in ongoing professional registration. A pilot peer review group by videoconference was also implemented in Western Australia, to provide peer review for psychiatrists working in isolation.

METHOD

Six national interactive videoconferenced education seminars were provided. The membership was polled prior to the program for topic preferences and requested speakers, who were subsequently approached to present the seminars. A West Australian peer review group was formed, involving psychiatrists from five different rural locations and one psychiatrist from the metropolitan area.

RESULTS

National seminars were attended by 106 individuals (67% consultant psychiatrists, 17% trainees and 16% allied health professionals). Evaluation demonstrates favourable views of the content and quality of the presentations and impact on practice patterns.

CONCLUSIONS

Attendance at seminars via videoconferencing provided rural psychiatrists with opportunities to obtain CPD credit without the need to travel, providing a cost-effective alternative for accessing education. Involvement enabled interaction among peers throughout Australia, alleviating professional isolation and generating networking opportunities. The West Australian peer review group demonstrated sustainability with a commitment to continuation and positive impact on practice.

Burnout and job satisfaction in New Zealand psychiatrists: a national study

OBJECTIVES

To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population.

METHOD

In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures.

RESULTS

The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores.

CONCLUSIONS

This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.

Psychiatrists in New Zealand: are they burning out, satisfied at work and, in any case, who cares?

OBJECTIVE

To explore possible contributing or mitigating factors for burnout in New Zealand psychiatrists as well as future research directions in this area.

METHOD

A selective review of the literature pertaining to burnout and reports regarding New Zealand's medical workforce.

RESULTS

Possible factors contributing to burnout in New Zealand psychiatrists include rapid changes in the country's health system, the challenge of recruiting and retaining psychiatrists, poor distribution of staff and funds and difficulties in psychiatric training. Potential protective factors against burnout include lifestyle factors, long experience in psychiatry, proposed long lengths of career in New Zealand and potentially positive changes in the health system. Research challenges include subject recruitment, the lack of exploration of personal protective factors and completing longitudinal studies.

CONCLUSIONS

Given the current state of knowledge, it would be difficult to accurately know whether New Zealand psychiatrists were burnt out or satisfied with their work. Carefully designed studies would help to clarify this issue.