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PROFESSIONAL STATUS OF PSYCHIATRISTS:
GOOD BUT NOT GREAT

Luty, Fekadu, O'Gara, Gallagher, Umoh & Mahadevappa

ABSTRACT

There are concerns about recruitment and retention of medical doctors, especially psychiatrists in Britain. There is an assumption among health professionals and the public that psychiatry is a stigmatised profession. This project aims to examine the status of psychiatrists compared with other occupations. A postal survey of a panel of 306 UK adults was conducted. Subjects were asked to rate psychiatrists amongst a list of 26 other professions according to which they most respected and admired. The results indicate that psychiatry is one of the less stigmatised professions ranking as the top 8th in a group of 26. However psychiatrists had the lowest ranking compared to other medical professions such as GP, pathologists and nurses. Recruitment is likely to remain difficult compared to other medical specialities.

Declaration of interest: None. Funding detailed in Acknowledgement.

Key points: There are concerns about recruitment and retention of medical doctors, especially psychiatrists in Britain.

There is an assumption among health professionals and the public that psychiatry is a stigmatised profession

The results of this study indicate that psychiatry is one of the less stigmatised professions ranking as the top 8th in a group of 26.

However, recruitment is likely to remain difficult compared to other medical specialities.

INTRODUCTION

In 2001the UK National Health Service employed approximately 2,960 consultant psychiatrists with 500 consultant posts vacant (1). Another 1000 consultants are needed by 2009 (2). Recommendations to improve recruitment and retention of psychiatrists have been suggested (3). However there remains concern about the recruitment and retention of mental health professionals (4). One potential explanation is that the profession of psychiatry is stigmatised and neglected - mental health is still the “poor relation” (1). This may be partly due to historical reports of the notorious and controversial procedures in psychosurgery and other practices (5,6,7). A recent survey of UK adults showed the general public still have a negative opinion of people with mental illness (8). This was particularly prominent in younger people - the age group that forms the majority of medical students. A recent survey of medical students showed that the two most common reasons for not choosing psychiatry as a profession were that it was 'boring' and 'unscientific' (5). This study attempts to rank the status of psychiatrists against other professionals in the opinion of members of the general public, a subject which to our knowledge has not been addressed in the literature.

METHOD and RESULTS

Questionnaires were sent to a representative sample of 550 UK adults. They were drawn from a panel of over 1000 subjects who were recruited for a previous study using direct mail shots and adverts in local newspapers (9). Subjects were instructed: “There is a list of professions on the next page. We want to find out if you admire and respect the people who do these jobs. Give each profession a mark out of 10 from those you most admire (10) to those you least admire (0).” The list of 26 professions is indicated in Table 1 - these were chosen to produce a balance of low and highly paid jobs from various sectors including law, finance and service industries. Paramedical professions were: Pathologist, General Practitioner, Nurse and Psychiatrist. Three of the professions (traffic warden, fireman and estate agent) were chosen deliberately to produce a strongly negative or positive response to test the face validity of the questionnaire (see Discussion). Four versions of the questionnaire were produced and the list of the professions was presented in random order on each version. The mean and standard deviation on all responses are given in Table 1.

405 completed questionnaires were received (74% response rate). A further 8 questionnaires were received with more than half the responses uncompleted and were therefore disregarded. The mean age of respondents was 48.2(SD=16.6) years, 58% were female with 39% of the total subjects in paid employment, the rest were retired, unemployed, students or housewives. The mean age leaving full-time education was 17.4 (SD=3.5) years with a median of 16 years. The top four most respected and admired professions were fireman, nurse, GP and schoolteacher. Psychiatrists ranked 8th overall. A further analysis of correlation between overall rank and salary revealed no correlation. Salaries were accessed on the government resource for young people, Connexions (http://www.connexions-direct.com/). Average salaries were used where available. Otherwise the midpoint of the given range was used.

DISCUSSION

Professions expected to have a poor image (e.g. traffic wardens, estate agents) ranked low while those describing highly respected professions, especially the emergency services, ranked highly. This indicates good face validity. Psychiatrists ranked 8th overall behind schoolteachers, soldiers and the police. Psychiatrists rated lowest amongst the medical and paramedical professionals (for example nurses rated second - above each of the medical professions cited in the list). Nevertheless, psychiatrists rated above unskilled and highly stigmatised professions - dustbin men rated 15th, shop assistants 22nd while MPs rated 23rd (third from bottom). Although psychiatrists are recognizably less conspicuous compared with highly acclaimed professions, they remain among the most admired and respected professionals. However the relative low status of psychiatrists amongst other medical professionals is therefore likely to prolong the problems of recruiting psychiatrists from medical graduates in the future.

Unfortunately it is notoriously difficult to change stigmatised public attitudes. For example the UK Royal College of Psychiatrists’ Changing Minds Campaign involved a survey of the general public’s attitude to people with mental illness. This was repeated at the conclusion of the 5-year anti-stigma campaign. Interviews were performed with 1,725 people from the original cohort (8). Despite the enthusiasm of those involved in the national campaign, the changes in public attitudes were small. There were no measurable effects on public attitudes towards people with substance use disorders while most people still regarded those with schizophrenia as dangerous and unpredictable. These results are comparable to the previous “Defeat depression” campaign that had a “marginal effect on public opinion” (10).

Crisp and colleagues (8) have noted that knowing someone with a psychiatric disorder will reduce the negative opinion towards people with a specific diagnosis - although this does not generalise to other mental health problems. A similar process may be operating in our survey, as the majority of respondents are likely to have some contact with GPs and nurses whereas only a small proportion of the population have ever seen a psychiatrist. Furthermore, the more recent highly publicised scandals involving doctors, such as the Shipman case, have not involved psychiatrists. The public image of psychiatrists is likely to be based on respected although controversial models such as Sigmund Freud or the celebrity, Raj Persaud.

Some limitations should be acknowledged. The response rate for the survey was good. However the panel from which the respondents were taken is necessarily self-selecting and may not be truly representative of the British public. The majority of respondents gave their age and employment status, which was reasonably matched to that from census surveys. (The mean age of the UK population which is eligible to vote is 48.5 years, SD=18.0 years; Government Actuary Department, 2000).

There was an excess of female respondents although subgroup analysis showed no significant difference between sexes in responses. These results suggest that the sample provides a reasonable reflection of the attitudes of British adults as far as can be reasonably expected in surveys of this nature.

In the ideal situation, interviews could be conducted using a quota-survey of households with repeat visits for non-responders (8). Unfortunately this procedure is prohibitively expensive. An alternative is to use organisations of professional interviewers, such as MORI or Gallup, who canvass members of the general public. Unfortunately these samples are also self-selecting as interviewers tend to approach passers-by at preferred public places (11). As a further example, a recent MORI poll of “a representative quota sample” of 2017 UK adults a MORI poll of 2 017 UK adults found that 91% of the respondents generally trust doctors to tell them the truth (www.bma.org.uk/ap.nsf/content/MORI105). Although canvassers were given lists of addresses to approach at sites likely to be representative of the community as a whole, canvassers were only be expected to obtain interviews from a minority of households within these samples. The majority of people approached at the selected households would decline or be unavailable.

The study presented a list of professionals – it was not possible to measure stigmatised behaviour towards actual people. Social desirability bias is likely to affect the results. Hence the written views and expressed attitudes may not translate into any enduring behavioural change such as recruitment of young people into various professions. Other facts such as income, duration of training, workload and shift patterns are likely to affect recruitment within medical professions as well as perceived status.

ACKNOWLEDGEMENTS

There are no conflicts of interest. The study was funded entirely by the authors.

REFERENCES

1) Hoadley, A., Philip, M. & Dillon K. (2005). Scoping the current problems and solutions relating to consultant psychiatrist vacancies, consultant recruitment and the use of locums in England. London: Sainsbury Centre for Mental Health.

2) Newman M. (2005). Bull market in psychiatry pay. Hospital Doctor, 10 March, Pp 4.

3) Royal College of Psychiatrists (2004). National Working Group Report: New Roles for Psychiatrists. London: Department of Health.

4) MEARS A., Pajak S., Kendall, T., Katona, C., Medina, J., Huxley, P, Evans S. (2004) Consultant psychiatrists’ working patterns: is a progressive approach the key to staff retention? Psychiatric Bulletin 28: 251-253.

5) WILKINSON G. (1986) Political dissent and “sluggish” schizophrenia in the Soviet Union. British Medical Journal, 293: 641-2.

6) DOUBLE D. (2002) The limits of Psychiatry. British Medical Journal 324: 900-904

7) PERSAUD R (2005). Back to the future: a history of lobotomy. Progress in Neurology

8) CRISP A, Gelder M, Goddard E, Meltzer H. (2005) Stigmatisation of people with mental illnesses: a follow up study within the Changing Minds campaign of the royal College of Psychiatrists. World Psychiatry 4(2), 106-113.

9) LUTY, J. FEKUDU, D., OMOH, O. & GALLAGHER, J. (2005).Validation Of A Short Instrument To Measure Stigmatised Attitudes Towards Mental Illness. Psychiatric Bulletin, (in press).

10) Paykel, E.S. Hart, D. & Priest, R.G. (1998). Changes in public attitudes to depression during the Defeat Depression Campaign. British Journal of Psychiatry, 173, 519-522.

11) Oppenheim, A.N. (1992) Questionnaire, design, interviewing and attitude measurement and Psychiatry, 9(5), 7-9. London: Continuum.

Table 1. Ranked order of relative preference of professions most admired and respected by a study of 306 UK adults

Profession	Mean score	Standard deviation	Salary range (R), average (A) (All presented in £stg.)
1. FIREMAN	8.99	1.42	R, 16,886-40,000
2. NURSE	8.87	1.61	R, 18,114-50,000
3. GP	8.53	1.45	A 66,280
4. SCHOOLTEACHER	8.00	1.97	R, 18,552-96450
5. SOLDIER	7.67	2.28	R, 11,774-36,416
6. POLICE	7.68	2.25	R, 19,803-55,000
7. PATHOLOGIST	7.58	1.96	R, 20,000-160,000
8. PSYCHIATRIST	7.30	2.29	R, 20,000-160,000
9. SOCIAL WORKER	7.22	2.32	R, 15,000-28,000
10. FARMER	7.02	2.18	R, 16,000-50,000
11. JUDGE	6.83	2.16	R, 90,000-155,404
12. POSTMAN	6.52	2.05	R, 13,000-18,000
13. SOLICITOR	6.33	2.25	R, 18,000-100,000
14. COMPUTER PROGRAMMER	5.86	2.49	R, 18,000-70,000
15. DUSTBIN MAN	5.79	2.27	R, 11,000-17,000
16. BUSDRIVER	5.62	2.38	R, 10,200-20,000
17. CAR MECHANIC	5.55	2.05	R, 10,400-15,600
18. ACCOUNTANT	5.50	2.43	R, 16,000-150,000
19. SECRETARY	5.34	2.26	R, 8,300-20,000
20. BANKMANGER	5.09	2.92	R, 25,000-50,000
21. BUTCHER	4.92	2.47	R, 10,000-25,000
22. SHOP ASSISTANT	4.88	2.38	R, 8,000-15,000
23. MP	4.23	2.27	57,485
24. ESTATE AGENT	3.79	2.45	R, 20,000
25. TRAFFIC WARDEN	3.41	2.83	R, 11,000-13,000
26. CAR SALESMAN	3.36	2.26	R, 6-50,000

Authors

Dr Jason Luty* PhD MRCPsych

Consultant in Addictions Psychiatry, South Essex Partnership NHS Trust,

Honorary Consultant in Psychiatry, Cambridge and Peterborough Mental Health NHS Trust, The Taylor Centre,

Queensway House

Essex Street

Southend on Sea

Essex SS4 1RB

Dr Daniel Fekadu MD MRCPsych

Clinical Lecturer

King's College London

Institute of Psychiatry

London SE5 8AF

Dr. Colin O’Gara MB BCh BAO BMedSc MRCPsych,

Medical Officer,

Smoking Cessation Clinic,

Maudsley Hospital,

Denmark Hill,

London SE5 8AZ.

Mr John Gallagher

Senior Lecturer in Nursing Studies

Centre for Health and Social Care Research

Anglia Polytechnic University

Bishop Hall Lane

Chelmsford

Essex CM1 1SQ

Dr Okon Umoh MB ChB MRCPsych

Specialist Registrar in Psychiatry,

c/o The Taylor Centre

Queensway House

Essex Street

Southend on Sea

Essex SS4 1RB

Dr Harish Mahadevappa

Staff Grade in Old age Psychiatry

North Essex Mental Health NHS Trust

The Lakes Mental Health Unit

Colchester

First published: February 9, 2007

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