Comment

Having worked in Port Macquarie on the mid-North Coast of New South Wales (NSW) for 13 years, I have had the experience as a consultant psychiatrist of working, at different times, in a mental health service with no dedicated doctors, with occasional resident medical officer (RMO) support, sometimes having career medical officers of varying quality and, over the last 4 years, having psychiatry registrars working with our service.

There is no doubt that having a resident psychiatry registrar providing consistent input into the mental health service has changed the culture of our service and has improved the quality of care delivered by that service. The registrar, by having a continuing presence with the mental health team, becomes trusted and the registrar's opinion becomes increasingly valued as both the registrar gains experience and the mental health team values the involvement with the registrar.

The psychiatry registrar is particularly appreciated in a rural setting and, in my experience, more so than a registrar in an urban setting. First, this is because of the relative shortage of doctors in rural areas and so inevitably the registrar sees a considerable number of patients who would otherwise have very little medical/ psychiatric input at all. Their work is therefore satisfying and the patients and their families generally grateful. Second, the registrar is valued by members of the mental health team who otherwise work with little medical input and, despite their often independent natures, crave the professional development and support that comes from the interactions with registrars.

Rural psychiatry registrars are highly valued by rural psychiatrists who have had trainees working with them. The presence of trainees enables the psychiatrist to work more effectively as a consultant, whereas the absence of a registrar forces the psychiatrist to work as a consultant/registrar/RMO or to ‘promote’ non-medical mental health staff to try to fill in junior medical positions.

Registrars living in a rural area can develop a closer, more personal relationship with country psychiatrists who come to know a particular registrar over a longer period of time, rather than the registrar simply being another in a long line of trainees going through a large and at times impersonal system. Registrars are certainly not taken for granted in rural areas and this makes their positions special. As long as that ‘special-ness’ is recognized and dealt with carefully to avoid overwork and to maintain appropriate consultant/ registrar boundaries, the experience of being a rural psychiatry registrar can be uniquely positive.

Despite these advantages, the value of the rural psychiatry registrar is not always acknowledged by management structures, especially where the management structure does not have significant medical input or where the cost of establishing a new registrar position is seen as ‘outside the budget’.

The value of the psychiatry registrar in maintaining a quality/sustainable service is so important that the establishment of rural psychiatry registrars should be a priority for rural mental health services. The associated ‘on-costs’ of training psychiatry registrars in rural areas should be accepted as good value for the area health service, its consumers and the registrars themselves.