Why psychiatrists choose to leave public mental health services

Our aim was to explore why psychiatrists are choosing to leave publicly funded mental health services in New Zealand.

A qualitative descriptive design was employed. Twelve psychiatrists who had left permanent positions in public mental health services in the last 5 years were recruited. Semi-structured interviews were recorded, transcribed and analysed using thematic analysis.

Four themes were identified: "a burnout job", "responsibility and accountability but without authority", "a lot of near misses" and "inertia". Participants reported an excessive workload in an under-resourced and inefficient system. They reported that their role within the multidisciplinary team had changed, and that their professional skills were undervalued. They felt accountable for poor patient outcomes but unable to improve the quality of care provided. Participants were concerned about their safety at work and reported a desire to improve efficacy, safety and quality of care but believed that the system was non-responsive and resistant to change. Consequently, they reported feeling no option but to leave.

Retention of psychiatrists in public mental health services may be improved by increasing resourcing, embracing innovative change, recognising the unique role of a psychiatrist within the multidisciplinary team and promoting positive organisational culture and medical leadership.