Changing role of the junior psychiatrist – implications for training

Imagine the daily life of the junior psychiatrist in the not too distant past: clerking of new admissions to the ward day or night; physical examinations and routine phlebotomy; providing a service to the general hospital for psychiatric emergencies, including overdose assessments; reviewing the patients’ mental state in the clinic and prescribing medication; responding to requests from nursing staff manning the wards when all others are sleeping.

How the life of the junior doctor has changed! The first to go was routine phlebotomy, closely followed by a variety of other tasks which are now performed by non-medical professionals whose roles are ever increasing. As highlighted by Woodall et al (Psychiatric Bulletin, June 2006, 30, 220–222), liaison assessments are increasingly being carried out by specialist nursing staff, with an inevitable effect upon the experience gained by senior house officers. The driving force behind this remains unclear. The European Working Time Directive has been implicated in these changes, but the other more cynical view is that doctors’ time is more costly than that of nursing and auxiliary staff.

With nursing staff taking on prescribing, triaging of emergency calls and assessment in all settings and at all hours, what are the doctors left with? How ironic that junior doctors who no longer perform these roles as part of training will very soon, with the introduction of the run-through grades, be supervising the practice of these highly experienced non-medical professionals.