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:

• addiction
• anxiety
• 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. The three recognised sub-specialties are liaison psychiatry, substance misuse psychiatry and eating disorder psychiatry.
• child and adolescent - working with children and young people up to 18 years of age who have a range of mental health conditions, including autism spectrum disorder (ASD) and eating disorders.
• old age - specialising in psychiatric illnesses such as dementia and personality disorders.
• forensic - psychiatric care in prisons and secure hospitals or in the wider community. Forensic psychiatrists also act as expert witnesses in court trials.
• psychiatry of intellectual disability - treating patients who have an intellectual or 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 conditions and provide an excellent 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 collaboration 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 salary during foundation training in England is £36,616 to £42,008. Salaries for doctors starting their specialist training range from £49,909 to £70,425.
• As a speciality doctor, you'll earn between £59,175 and £95,400. Salaries for specialist grade doctors range from £96,990 to £107,155.
• Salaries for newly qualified consultants start at £105,504, rising to £139,882 depending on the length of your service.

Resident doctors (formerly known as junior doctors) will earn a basic salary, plus pay for any hours over 40 per week, a pay enhancement for working nights, a weekend allowance and an allowance if you're 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 in England and Wales may apply for local Clinical Excellence Awards and national Clinical Impact Awards. In Scotland, you can apply for discretionary points. Consultants 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.

Salary bands differ across the four countries of the UK. Pay negotiation happens annually at different times, so salaries will change when each country agrees their new pay award. Check your country's pay scales for doctors for the most up-to-date NHS salary information.

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 patients and will see many of them right through from 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, the 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

To become a psychiatrist, you must complete:

• a degree in medicine recognised by the General Medical Council (GMC)
• a two-year foundation training programme of general training
• specialist training in psychiatry, which lasts a minimum of six years - typically three years of core training and a minimum of three years of higher training.

Medical degrees usually take 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 paid foundation training common to all medical graduates that allows you to develop your clinical and professional skills in the workplace. You'll undertake a series of work placements in different settings, such as psychiatry and surgery.

Following successful completion of the Foundation Training Programme, you'll need to apply for core psychiatry training. During core training, you'll complete placements in a number of sub-specialties so that you gain a broad range of experience and knowledge of psychiatry. Find out more about core training in psychiatry.

You'll need to pass the Royal College of Psychiatrists MRCPsych examinations and achieve all core competencies before you can apply for higher training in psychiatry.

There may an opportunity to apply for run-through training in some psychiatry specialisms, meaning you only need to apply once at the beginning of the specialty programme.

During higher training you'll complete a minimum of three years' training in your chosen sub-specialty:

• child and adolescent
• forensic
• general adult
• intellectual disability
• old age
• psychotherapy.

It's becoming increasingly common, however, to do 'dual training', where you pick two areas of practice, typically lasting five years rather than three.

You'll also have the opportunity during higher training to develop a special interest in other areas such as academic psychiatry, addictions, eating disorders, liaison psychiatry, neuropsychiatry, perinatal psychiatry, and rehabilitation and social psychiatry.

On successful completion of higher training, you'll be awarded the Certificate of Completion of Training (CCT), which allows you to join the GMC Specialist Register and to apply for psychiatric consultant positions.

There's an increasingly large number of psychiatrists who are neither trainees nor consultants. They take up posts as specialty and specialist grade doctors (SAS). All SAS doctors are responsible to a named consultant psychiatrist.

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

Skills

You'll need to have:

• clinical expertise in your chosen speciality
• excellent interpersonal and oral and written communication skills
• the ability to treat others with empathy, understanding and respect
• emotional resilience to work in challenging situations
• analytical and problem-solving skills
• an innovative and imaginative approach
• the ability to work under pressure and make informed decisions
• leadership skills with the ability to organise, train and motivate others
• the ability to work flexibly as part of a multidisciplinary team
• initiative and motivation
• the ability to affect change and manage clinical complexity and uncertainty
• an understanding of current developments in psychiatry
• knowledge of relevant legislation.

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, hospice or mental health trust, for example, 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.

Once you're at medical school, try to choose modules in psychiatry. You could also consider an elective placement.

It's a good idea to join your university's psychiatry student society to keep informed about developments in psychiatry. These societies also have social media threads advertising training, opportunities, news or events. See PsychSoc to see if your university has a psychiatry society.

Also, consider becoming a student associate member of the Royal College of Psychiatrists.

During your two-year Foundation Training as a resident doctor, you'll need to choose a psychiatry placement that will give you a good insight into the work. Make the most of networking opportunities by attending conferences and events.

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.

Look for job vacancies at:

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

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 has an eLearning Hub for both trainees and qualified psychiatrists. There is a CPD eLearning section within this hub with online modules and podcasts for consultant psychiatrists. These cover a range of topics such as:

• discharging risky patients
• bedside assessment of cognition
• adult ADHD
• an introduction to mindfulness
• traumatic brain injury.

Additional postgraduate qualifications can be useful but aren't essential. For example, a forensic psychiatrist may take an LLM degree in medical ethics or healthcare, ethics and law, or an MSc in criminology. If you wish to integrate more formal teaching into your work, you can take the Master of Medical Education (MMedEd).

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. There are opportunities 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 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.