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How to work in psychiatry

Historically, psychiatric patients and their families, as well as psychiatrists, were stigmatised. Fortunately, this is rapidly changing as psychiatry becomes more embedded in medicine, says Dr Volker Hitzeroth.

Lesson 1: Remember mental health problems can affect anyone.

Numerous national and international studies have shown that the number of people suffering from a mental illness continues to escalate. Mental health complaints also make up a large percentage of all consultations. This suggests that psychiatrists will continue to be in demand in South Africa and across the world. Furthermore, psychiatry is entering its “golden age”. The last decade has seen rapid advances in neuroscientific research. At the time of writing, the USA is funding the “BRAIN Initiative” (Brain Research through Advancing Innovative Neurotechnologies) at a level of $100 million in 2014. Similarly, the EU’s “Human Brain Project” is a decade-long $1.6 billion project. Such efforts have a profound impact on our understanding of mental health, its pathologies, and clinical psychiatry.

Lesson 2: The future of psychiatry looks positive.

How do I qualify?

All medical universities in South Africa offer registrar posts in psychiatry. Formal training as a psychiatric registrar takes four years in a registered training post. It is usually beneficial to do one or two years of medical officer training, either within psychiatry or in medicine, but with a special interest in psychiatry.

Lesson 3: Working as a medical officer with exposure to psychiatry broadens your experience and instils confidence.

Prospective candidates can improve their chances of a successful registrar application by working in psychiatry, completing the Colleges of Medicine South Africa (CMSA) diploma in psychiatry and participating in some form of undergraduate research experience.

Lesson 4: Any research experience is good – mental health experience would be best.

Registrar training is usually divided into two important examinations: Part I and II examinations. Part I comprises anatomy and physiology (both with a neuroscience emphasis), as well as psychology. Part II entails a written examination, OSCE and an oral examination. Throughout the registrarship a candidate is also expected to complete a number of therapy cases with the help of a supervisor. Each university has their own in-house annual academic training programme that a candidate will be expected to attend and participate in (eg, case or journal presentations).

South African psychiatrists are generally sought after and well-accepted in the international community
Upon successful completion of the Part II examination from the CMSA and the confirmed four-year training a candidate will qualify with a degree of FC Psych (CMSA). This will allow the individual to work in the public or private sector, as well as some international territories. In order to receive the MMed (Psych) degree, a candidate will have to complete a research project to the specific departmental or university specifications (eg, publication in a peer-reviewed journal). South African psychiatrists are generally sought after and well-accepted in the international community.

The average day

As a registrar, your working hours are pre-determined. You will be expected to work daily from 08:00 to 17:00 during the week. On-calls usually occur on a rotational basis after-hours, over weekends, and public holidays. On-call work can be very demanding, whilst other times may be quiet with sufficient spare time to study or prepare your research project and read prescribed articles. On-call may also entail travel between a number of mental health facilities.

A consultant is usually available by telephone to assist in problem situations. Once you are a qualified psychiatrist, your working hours are determined by your working environment. Within the public sector there is no real flexibility and you may be expected to complete a log sheet of your working week. In the private sector, you remain your own boss. Those choosing to establish a full-time private practice can expect to work very long hours.

Lesson 5: You will have to be very disciplined to manage your working hours.

In the public sector, your focus is the establishment and delivery of psychiatric services to the local population. Many such posts are popular as they provide a good income with clear working hours in some of the more beautiful locations within our country.

Establishing a private practice

If you have decided to open a private practice you can expect to take a number of years to become established.

Lesson 6: Your success depends on your availability, personal style and location.

Managing a private practice has become a specialist field of its own and will require a clear business plan and support services.

Managing a private practice has become a specialist field of its own and will require a clear business plan and support services

Lesson 7: It is best to get advice and professionals to assist you, but beware of unnecessary high costs.

Some urban regions seem to be saturated, eg, Cape Town, Pretoria East and Northern Johannesburg. In these areas, you can expect to work harder and longer to be successful unless you link up with a kind, willing and established private practitioner who is prepared to show you the ropes and share his overflow with you.

Lesson 8: Be polite to your private practice colleagues, as you may want to join them after your training.

If your heart was more academically inclined you would have to apply for the occasional academic post at the tertiary facility or mental health hospital of your choice.

Lesson 9: Be a hard-working registrar who is diligent and reliable, as well as academically sound, and get along with your colleagues, as you may want to apply for a job after training.

Like most specialties, psychiatry has a professional organisation called the South African Society of Psychiatrists (SASOP), which looks after the interests of our profession.

Lesson 10: The HPCSA generally looks after the standards of medical care received by the public. A professional organisation like SASOP, looking after psychiatrists’ interests, can be useful.

Registrars are welcome to join SASOP at a reduced fee. SASOP takes an interest in various aspects of psychiatry, including the training and support of registrars. SASOP meetings also offer an opportunity to network with senior colleagues from across the country.

SASOP has a specific interest group called the “Young Psychiatrist Special Interest Group” (YPSIG) which is run by young psychiatrists for young psychiatrists in order to support, guide and mentor newly-qualified colleagues.

Lesson 11: It is useful to make helpful contacts during your registrarship.


Within the state and academic sector, psychiatrists earn the standard prescribed government salary depending on their post and experience. Within the private sector remuneration is calculated per time unit, eg, half or full hour. Whilst this is generally a good income, it is limited by the hours you are able to work, ie, after 8-10 hours of daily consultations one is generally exhausted and risks burnout.

Lesson 12: You and your time are the product that you sell – both are limited resources.

Overall, however, the remuneration for a qualified psychiatrist is good and can ensure a high standard of living for you and your family.

The remuneration for a qualified psychiatrist is good and can ensure a high standard of living for you and your family

Core features of working in Psychiatry:

  • If you think you can work with severely ill people, intensely stressful situations, manage conflict successfully, you are honest, and have very high levels of empathy, then psychiatry may be for you.
  • You have to have exceptional interpersonal skills and be able to get along with people from all walks of life.

Lesson 13: The doctor-patient relationship is critical to any successful consultation, even more so within psychiatry.

  • You have to be comfortable with severely disturbed individuals, distressed families and threatening situations.

Lesson 14: Psychiatrists are exposed to daily situations that their medical and surgical colleagues have never even dreamt of.

  • You have to be able to manage ruthless honesty, complete vulnerability, and intense fear.

Lesson 15: Psychiatry is the specialty that sees the most damaged psyches, scarred souls, and traumatised minds.

National and international subspecialties within psychiatry:

  • Child and adolescent psychiatry
  • Old age psychiatry
  • Forensic psychiatry
  • Addiction psychiatry
  • Neuropsychiatry
  • Consultation – liaison psychiatry.