‘It’s a war zone’: why Dr Nithya Reddy is quitting the health system just months from end of training
Dr Nithya Reddy wanted to change the mental health system after enduring unimaginable trauma. Now senior doctors are warning the accreditation of future psychiatrists, like Dr Reddy, is at critical risk in NSW.
Caring for mentally distressed patients at the worst time of their lives is the life’s ambition of psychiatry registrar Nithya Reddy. But just six months shy of finishing her specialist training in her home city of Sydney, she can no longer hold on.
“To say the system is broken in NSW doesn’t even come close to explaining what it is like,” says the young doctor. “It’s a war zone. We cannot provide the care that every patient needs. To constantly go through that day after day, it just does not seem tenable for me to continue.”
Dr Reddy has decided to quit and plans to move to Victoria. She’s not the only one. An exodus of staff specialists amid mass resignations from the public mental health system in NSW has left scores of trainee psychiatrists without supervisors.
Now the site co-ordinators of training for nine major hospitals across NSW are warning of a “dire situation” as numerous psychiatry training terms are at risk of being refused accreditation to train junior doctors working as psychiatry registrars.
“At almost every training site in NSW, we anticipate losing a significant number of training positions due to the resignations,” training site co-ordinators say. “Already, some trainees have been left without adequate supervision. This situation will escalate further as resignations take full effect, leading to a critical gap in supervision and training opportunities across the state.”
Up to 100 training supervisors have been lost to the system as of this month due to the NSW mental health system crisis, and 80 more resignations are due to take effect in the coming weeks and months.
“This is a tragedy for psychiatry training in NSW – the loss of supervisors will have catastrophic effects on training, accreditation, workload, patient care, and workforce sustainability in psychiatry,” say the training site co-ordinators who have penned a letter calling for the Royal Australia and New Zealand College of Psychiatry to take a stronger stance on the issue.
Senior doctors lead psychiatry training in major teaching hospitals, including the Prince of Wales, Royal Prince Alfred, St George, Northern Beaches, Macquarie and Campbelltown hospitals in Sydney, and Lismore Base and Wyong hospitals in regional NSW.
Dr Reddy’s determination to devote her life to psychiatry was reinforced when she endured the unimaginable trauma of losing her sister, Preethi, who was murdered at the hands of her ex-boyfriend five years ago. She is passionate about advocating for more trauma-informed services in the mental health system and has a unique understanding of the intersection between family and domestic violence, psychiatry, mental illness and child protection.
“Since then, it’s been even more imperative for me, in my kind of consciousness, that we fix the system. But it’s a losing battle,” Dr Reddy says. “We are there with people who are going through the worst mental trauma, suffering from severe mental illnesses that require holistic care, which we’re not able to provide.
“And with the revolving door of staff, it seems like at times we’re creating more harm than good because of shortages. It often means that more restrictive care is being practised, and that’s not what we want but that’s the practical reality. It’s been exhausting and I am burnt out. For the past year-plus working in the system, seeing what my mentors, my supervisors, constantly go through, it just does not seem tenable for me to continue.
“It’s just difficult to describe the unrelenting nature of the work, because it’s not like you can really switch off a lot of the time. I think this is a watershed moment for the mental health system.”
The NSW government is currently plugging the gaps after mass resignations that occurred after 15 months of failed negotiation on pay and conditions as psychiatrists tried to take action to stem the mutiny of staff specialists from public hospitals. They’re scrambling to employ locums and some psychiatrists have been rehired as visiting medical officers, but hospitals are currently critically understaffed and crisis arrangements are in place. An arbitrated hearing in the Industrial Relations Commission is scheduled for March 17.
Those in charge of training say that as the crisis rolls on, trainee psychiatrists as well as patients are copping the brunt of the awful impacts. They’ve been asked by RANZCP to escalate concerns, but many are hesitant to do so, fearing the loss of accreditation.
“They also fear consequences from services as a result of speaking out,” the site supervisors say. “This places trainees in an untenable position, forcing them to choose between the risks associated with escalation and de-accreditation, and persisting in an unsafe work environment. The approximately 90 new Stage 1 trainees commencing training in NSW next week are in a particularly vulnerable position.
“If adequate supervision requirements aren’t met as per the college, this will result in numerous psychiatry terms losing accreditation. Psychiatry trainees will then be forced to look interstate to complete training which would result in an irreparable loss to the future psychiatry workforce in NSW for the coming decades. The lack of accredited training positions and adequate supervisors in the public sector would also significantly impact future recruitment into psychiatry.”
