Trainees’ views on the future of psychiatry: a plethora of challenges ahead of us

In 2010 Katschnig published a paper in this journal on internal and external challenges to psychiatry as a profession 1. The article identified six challenges for the profession: three from inside (decreasing confidence about the knowledge base concerning diagnosis and classification; decreasing confidence about the knowledge base regarding therapeutic interventions; and lack of a coherent theoretical basis) and three from outside (client discontent; competition from other professions; and negative public image). The Board of the European Federation of Psychiatric Trainees (EFPT) decided to carry out an online survey among trainees on their opinions regarding these and similar challenges. The questionnaire asked the respondents: a) to indicate the three most important future challenges to psychiatry as a profession and challenges to postgraduate psychiatric training, and b) to rate the importance of eight statements reflecting the major challenges (all of them derived from the six identified by Katschnig) in terms of their importance on a 4 point Likert scale (very important, important, not important, not at all important). Sixty-six trainees from 32 countries, representing national trainee associations within EFPT, participated in this survey. Thirty-nine percent were male; the mean age was 30.9±3.7 years, and the mean number of years of completed training was 3.3±1.6. In the open-ended question on the three most important future threats to psychiatry as a profession, the negative public image of psychiatry was mentioned most frequently (45.4%), followed by the questionable results of studies on psychiatric treatment (42.4%) and by the lack of a coherent theoretical foundation of the discipline (34.8%). Other issues of concern were the funding of the mental health system, the role of pharmaceutical companies, client discontent and problems of recruitment to psychiatry. All of the eight closed questions had a very high endorsement rate (“important” or “very important”). Nearly nine of ten respondents (87.9%) regarded the negative public image of psychiatry as threatening, and related to this, nearly three quarters (74.2%) were concerned with the low status of psychatry within medicine. A majority felt that the questionable validity of psychiatric diagnosis (83.3%), the questionable results of scientific research (78.1%), and the waning confidence in the results of therapeutic intervention studies (72.3%) are a challenge. Lower endorsement, but still above 70%, was obtained for the opposing ideologies and concepts within psychiatry (71.2%). The least important threats were seen in the mounting patient and carer criticism (66.7%) and the intrusion of other professions into psychiatry’s traditional field of competence (63.1%). In relation to the future of psychiatric training, two crucial challenges were identified: to improve the quality of educational opportunities (62.1%), and to achieve international standardization of training programs (31.8%). Clearly, the issue of the negative public image of psychiatry and the problems of the validity of psychiatric diagnosis and treatment studies are a major concern of psychiatric trainees in Europe, which is in accordance with previous findings 2. What is reassuring, however, is that 94% of the respondents are not thinking of leaving the field of psychiatry and as many would advise medical students to choose psychiatry as a specialty. Over 80% said that psychiatry was their first specialty choice. So, this is a determined group, that sees the problems but will certainly cooperate in tackling them.