SPEAKER_03 0:03

Hello and welcome back to the Thought Broadcast, the trainee focused podcast from Australasian Psychiatry. Today's episode will focus on an important topic for those entering the final stages of psychiatry training: what to do after fellowship and how to successfully navigate the challenges and opportunities available. This episode will take the format of a panel discussion. My name is Michael Waiteman, and I'm an editorial committee member with Australasian Psychiatry and an early career psychiatrist myself. Joining me today on the panel from the Thought Broadcast team are firstly Andrew Amos, Deputy Editor of the Journal. Welcome, Andrew. G'day, Michael, great to be here. And we also have Associate Trainee Editor Michael Tarran. Hello, Michael.

SPEAKER_04 0:43

Hi, Michael. It's very confusing that there's two Michaels here, but I'll try to keep myself on track.

SPEAKER_03 0:48

Yeah, it is a bit of a new challenge for us. So welcome to the podcasts. Today we are also joined by two special guests, both early career psychiatrists who we look forward to chatting to about their experience with navigating this challenging career stage. I'd firstly like to welcome Dr. Ashley White. Hello, Ash. Could you please tell us a little bit about yourself?

SPEAKER_01 1:08

Okay, so I have really embraced a career in psychiatry and I've pretty much done many jobs since following two and a half years ago, as well as having two babies. So currently I'm sitting on a mountain at a holistic rehab where I'm the psychiatrist. The view is stunning. On other days of the week, I work in a public AIODS clinic where I'm working in drug and alcohol in a lower socioeconomic area. I'm a telehealth psychiatrist for a rural community in Victoria. And I've just dabbled in doing some report writing. And part of that, I've also done inpatient work, I've locumed, and I've done some private practice. So I've worn many hats and I'm happy to share what little knowledge I have.

SPEAKER_03 1:58

Oh wow, and you've certainly done a bit of everything. So look forward to hearing a bit more about that as we as we go along. Thanks, Ash. And our other guest today is Dr. Nathan Jacobs. Hello, Nathan. Could you also tell us a little bit about yourself?

SPEAKER_05 2:10

I I can, Michael. Thanks for having me on the podcast today. Unlike Ashley, I've only had one job since fellowship. Although it's not a job in the sense that I'm self-employed. I fellowed at the end of 2022, and for the last year and a half, I've been a psychiatrist in private practice in Sydney in an affluent area. I see mainly psychotherapy patients, and when I do do general psychiatry, I take it slowly and do at least three sessions for the initial assessment and then often monthly follow-up. But although I've only had one job, I've been doing a lot of extracurricular things. So I've started a couple of WhatsApp groups for early career psychiatrists. I've done some practice improvement presentations online for early career psychiatrists. I've presented at the College Congress, and I'm presenting at the Adult Psychiatry Conference in a week. And I run a couple of peer review groups as well.

SPEAKER_03 3:16

Wow, and you also sound very busy. So yeah, so certainly a lot for us to talk about today. And I think it'd be fantastic for our audience to hear a bit about how it came to be that you know got to this point and some of the things that you've learned along the way and some of the challenges that you've maybe faced. So maybe as a starting point, if I could get you both to sort of go back to your time as a senior registrar when you were close to finishing your uh your training, and if you could tell us a little bit about how it was that you chose or found your very first consultant job and what the pathway was to that for you. Maybe Ash, if you could start us off.

SPEAKER_01 3:49

I have a bit of an interesting journey in that I was heavily pregnant interviewing for my first consultant jobs. That's a very difficult place to be as a woman. You're not the most um attractive proposition. And you know, interviewing for jobs, I found that when I hid my pregnancy, I got the job. And when I showed up, I did not. So I ended up getting my first job at a lower socioeconomic outskirts hospital in Kabbucha, where I was started off doing inpatient and community psychiatry.

SPEAKER_03 4:22

Well, it's unfortunate to hear that there's still that discrimination there in that process for you. That's disappointing, and I'm sure not a unique um experience, unfortunately.

SPEAKER_01 4:30

No, definitely not.

SPEAKER_03 4:32

How about yourself, Nathan? How did things start off with you when you first left training?

SPEAKER_05 4:36

I think Ashley's experience is interesting because I found it hard to get part-time work at the end of my training as a male. It was considered inappropriate for a man to request part-time training. So I echo Ashley's concerns that that a lot of services don't uh prioritize parenthood or carer roles. When I completed my training, I was pretty keen on doing at least some private practice. And I I looked around at local private hospitals and I looked at joining a number of different practices. I guess what was top of my mind was really being able to practice psychiatry in a way uh that allowed me a fair bit of autonomy. So I did interview at a local private hospital and it was incredibly glamorous. But then uh I spoke to some of the people working there and they told me how they were uh directed by management to uh treat patients in a particular way and manage patients in a particular way, and I thought I don't really want to go work there. I I went to another practice that uh also seemed quite attractive, but the rent that they were charging was astronomical, and uh again it looked like they were gonna direct me a bit about how to practice. So the the place I ended up with fantastic. It's basically I run my own practice out of this clinic, even though there's nine of us at the clinic, it's like each of us is in a separate room and we essentially run an independent practice in our own room. And I got to furnish my own room, decorate it how I wanted, and I've got complete freedom about what I charge, who I see, and how I practice psychiatry. And it was very difficult in the beginning to figure all these things out. Like, what the hell do I do? I've been training in public for so many years, I've never run a business. So I I did speak to a lot of senior colleagues, and it took me a while to find my feet. But now that I've figured things out, I'm very happy practicing the way I want to and um running my own business.

SPEAKER_03 6:52

Thanks, Nathan. And I think you've touched on there on a sort of important point that we wanted to talk about, which was that decision about private versus public, and you've spoken about a few of the things that were attractive for you from the private sector around flexibility and those kind of things. Can you maybe elaborate a bit more on that kind of decision about leaving the public sector?

SPEAKER_05 7:10

Certainly. I found public work very bureaucratic, and I found I felt that I wasn't free to practice the way I wanted to. Um, I felt that the resource constraints really caused a lot of moral injury, that I really felt I couldn't give patients the level of treatment that they required, and it was a bit of a rotating door. And and and I understand that the public system plays a very important role, but I decided that I didn't want to spend any more time there. What I've really enjoyed about working in private is that I am able to, I guess, choose patients that really are committed to their own recovery. Uh, I practice psychotherapy, so there's a very strong relationship with each of the patients. They come mainly once a week, but some of them twice a week, some of them only once a month, but they're very committed to their own recovery. Uh, they really want to be there, they value the relationship, the clinical relationship very deeply. And uh you produce some amazing results. The kind of clinical results that I've seen have been uh amazing and incredibly rewarding, and uh I feel very privileged to be able to work uh the way that I do. And in terms of flexibility, I have a young family too, so I don't want psychiatry to be the only thing I do in my life. I want to have plenty of time to pursue my hobbies, to be a good father and husband. And because I run my own practice, I decide when I start, when I finish, how much time I have for lunch, when I go and leave. Um I I have complete flexibility around all those things, uh, which is wonderful.

SPEAKER_03 9:00

Absolutely. And someone who's still in the public system, that all sounds wonderful. So I can certainly see the attraction there. Go going back to you, Ash. It sounds like your first job was still in the public system. What was sort of the things that you're weighing up at the time? And it sounds like obviously family, starting a family was a big thing for you at that point. What was your determination?

SPEAKER_01 9:17

Yeah, no, I always thought I'd be a public doctor. I thought it aligned with my values. I went back to my hometown, um, which, you know, is a very disadvantaged community. It it is a really tough role. Resources are very stretched, and you know, the socioeconomic issues of like, you know, increasing homelessness very difficult. I then, you know, probably did get a bit burned out and jumped into having a private practice in a hospital system. But then I found there was parts I missed from public. So not having to worry about billing people or something, you know, is something which I found quite stressful working privately and probably end up billing a lot and then making less money than what I would as a public doctor. So what I have found works best for me is a mix of public and private. And I feel that I get the best of both worlds. Like in my work here at the Banyans, which is like a retreat uh rehab, I get to practice really holistic psychiatry with a biased psychosocial model. Um, and then, you know, I then work in drug and alcohol with a catchment area of five prisons. So I feel like I've got a broad variety of skills which suits me doing different things, which would be a nightmare for a lot of other people.

SPEAKER_03 10:29

You're right. It is nice having that balance with what you're doing and be able to sort of put all those things together and have a much more rich experience than just doing one of those roles. I might hand over to Michael and and Andrew to ask the next question.

SPEAKER_02 10:41

Both of you seem to have been very flexible when you left training period going into being a fellow. Did you find that there were any really big experiences that you had, particularly in the last couple of years of your training, that then impacted even what sorts of opportunities you're willing to explore in your first couple of years as full psychiatrists?

SPEAKER_01 11:00

I would have to say I, you know, went through exams during the last of the OSCE, the COVID debacle. So I think there was a high level of burnout at the end of training, which I think a lot of people can reflect on. I mean, I found, you know, during the OSCE, I've picked up lots of skills and, you know, I'm sad it's gone. But I do think, you know, you kind of set off on practice probably, you know, on a period of more burnout just because of the extreme stress, you know, like I tried to sit the OSCI exam. It took my fourth attempt to be able to get into it. And then going into a system which is definitely under a lot more pressure, and I think a lot from the social determinants of health. But at the same time, I feel that it's actually forced me to look at my options and maybe, you know, pivot where I would have just gone into, you know, my home hospital, a public job, and stayed there for 30 years because I was a bit more stressed and burned out. I was like, oh, actually, I'm gonna look at my options and I've really explored and I feel like I've really built a career that um brings me a lot of joy and variety.

SPEAKER_02 12:00

Part of the flexibility, I think, when you come out of training is your perception of what psychiatry is, even who is in the profession. The private public divide is probably a good example of that. It's very different what you do in private. So I'd like you both to reflect on your changing view of psychiatry. When we're trainees, it I think it's primarily the people doing the training in our local area and maybe the college sitting out on the periphery. But what has been your changing experience of the profession of psychiatry as you've emerged into full autonomy?

SPEAKER_05 12:32

I think you see a very different patient load in private than in public. What I really like about my patients is that they're coming to see me. They've developed a special relationship with me. Some of them, you know, don't come back, but most of them do. And you're in a real privileged position that they've chosen you, they like you, and they want to develop a clinical relationship with you. It it's very different to being in a public hospital where they're coming to a service, they're coming to see a psychiatrist or whoever's available rather than interacting with a single person, they're they're interacting with the service. So I really like that very personalized aspect of private practice. And there's there's a real misperception that you're only seeing the worried well in private practice. I think all of my patients have been attempted suicide or been close to attempting suicide or had public and private admissions. And as a psychotherapist and someone who also prescribes to his therapy patients, I'm keeping them out of hospital. What you don't really realize in uh public work is that your private psychiatrists, your GPs, the people in the community are actually keeping a lot of your patients out of hospital by the work that they do.

SPEAKER_03 14:02

You're clearly a strong advocate for private psychiatry, Nathan, which is fantastic. And a little bit tangential to the topic today, but I guess that's one of the issues with training as it stands at the moment, is most trainees won't get experience of working in private during their training. So they don't have, I suppose, a concept of some of those things that you're talking about there, which might make it harder then to make the decision to leave the public service and go into private.

SPEAKER_05 14:25

I I think it's a great pity, and I know the college is working on it. I I think there's two big skill sets that are missing in our training. The first is the clinical aspects of private work. And it needn't be either or, you can do both like Ash is doing. But there's a lot of clinical skills that you don't get by not having exposure to private in your training. And the other thing that you miss out on is understanding all the administrative and regulatory aspects that it's been a really steep learning curve for me. Learning how Medicare works, learning how PBS works, that's the pharmaceutical benefits scheme, learning how to run your own business, prepare a budget, uh, prepare your tax and your business activity statement. There are many, many skills that, for example, GPs get during their training that I didn't get during my training program. And I hope that they are included in the training program in the future.

SPEAKER_03 15:28

You're right, it's it's a whole different world and it's so complex navigating all those kinds of things. And I think Ashley spoke about that as well. That was one of the challenges that you found going into private as well. I suppose if I could ask you both, how did you learn about these things? How did you try and upskill and get that training that wasn't part of the formal program?

SPEAKER_01 15:44

I think professional supervision is so important. I um pay for it. I've done supervision with a few different practitioners and it's been really useful. I did the college mentoring scheme and got a mentor in private practice, which I found invaluable. Talking about just the private ADHD, I didn't do any of that in my public training and then, you know, doing upskilling because that's like a huge demand area in private practice. I was able to do that through supervision. I I think one of the big things is you realise how much you don't know in many ways when you actually step out into this different world. And a lot of people think, you know, you got fellowship, you're there. But I think it's more like you realise that you don't know. And as you go on, that becomes greater and greater. So actually, particularly in private, because you're not working in a team environment. I think making sure you have good peer groups and professional supervision and investing in that is just essential.

SPEAKER_03 16:43

Well, that's a really good point. I think, yeah, supervision and and and mentorship is so crucial. And I'm wondering as well. I mean, obviously, working in the public system, it's probably easier to access those kind of things. But for yourself, Nathan, or for Ash with sourcing your own person externally, how how have you gone about finding these people to help support you?

SPEAKER_05 17:01

I've done the like Ash, I've also uh found a clinical supervisor, and I agree it's really invaluable. I was surprised to find out that a lot of people don't do that when they get out into private practice. But I think it's so important to get a mentor, get a professional supervisor that you do have to pay for out of your own pocket, do some short courses in areas that are of interest. And yeah.

SPEAKER_03 17:30

So just to jump in there about the process of accessing that person, was it someone you already had a connection with through training, or was it someone that you contacted or referred to? Like how did you go about actually finding the person that you that you work with?

SPEAKER_05 17:43

The first person I found through a private psychiatrist's WhatsApp group. So I just put something out there. I said, I want a clinical supervisor who who's going to put their hand up, and someone uh put their hand up, and I they were my supervisor for about a year. And then last year I started advanced training in psychotherapy uh through the college, and I really liked one of the lecturers. So after the lecture, I went up to him and said, Can you be my clinical supervisor? And now I've switched to him and he's he's my new clinical supervisor.

SPEAKER_03 18:19

Okay, that's great. I guess as you say, finding someone who you like and respect and can have a really good professional relationship with is important there. How did you find your supervisor, Ash?

SPEAKER_01 18:29

So when I stepped into private practice, I went to a private hospital and they volunteered to pay for supervision and there was a senior doctor of high repute, and I asked them and they were paid for by the private hospital. That was only for a short term, and then really just word of mouth, you know, someone who supervises half a psychiatrist in Brisbane. I approached, emailed if they would take me on. And it's just been so invaluable to have. And it's not just running a practice, it's just, you know, the psychodynamic issues that come into play and the transference and particularly, you know, all these things when you're a bit more isolated in private. I think it's so important to have someone. And my person has a background in psychotherapy, so is it's actually a very nice fit for someone who is going to do your supervision.

SPEAKER_04 19:17

Can I jump in there just out of curiosity, as someone who's perhaps not so near to the end of training, who does supervision as a registrar, are there any differences in the supervision that you're getting from your clinical supervisor compared to the supervision that we may be getting as registrars?

SPEAKER_05 19:37

Absolutely. If this is your supervisor that you are choosing to see that you are paying for out of your own pocket, it's a very different relationship. They're not judging you, they're not passing or failing you, you don't share the same patients. It's a much more equal relationship, and I've found it to be a much more pleasant experience than having a a supervisor as a registrar who is there to pass or fail you and to manage the same patients.

SPEAKER_01 20:12

Yeah, I don't have to agree with that strongly. I mean, doing my training during COVID times, I wasn't even in the same building for you know, five months with my supervisor and you know, barely saw them. And it was just so varied, and just you're not having the obligation of college-based activities, which I think really muddles what true supervision should be. And, you know, for someone completely separate who's not biased by like work-based. And, you know, I when I thought I went into my public job, I thought I would still get some supervision from the service. And, you know, I literally got thrown deep end consultant, massive patient load. I was 0.5, sometimes you know, 20, 40 patients under my care. And there was just nothing in place. And that's why I started looking at my other options, you know, just for my own sanity.

SPEAKER_02 20:58

You both talked about the advantages of full autonomy as a psychiatrist. And sometimes there's the opposite side of that, which is the responsibilities of being fully autonomous. And I think Ash, what you've just talked about, that high patient load with not much support, maybe is um that aspect of it. Did either of you approaching the end of your training have a fear of crossing that divide? I was a director of training, and this was actually a fairly common thing that as people got to that five years or five and a half years, whatever it was, there was a bit of reluctance maybe to jump and and uh accept that full responsibility?

SPEAKER_01 21:32

Not for me. I was desperate to follow. I got through training in five years. I worked until a day before I gave birth purely because of the strictness of college requirements and my desperation to fellow. I definitely know people delay training and take longer and stuff like that. But I felt really that I wanted to take that step. And the happiness I have in my heart is infinitely more than what I had in my final year of training.

SPEAKER_05 21:56

Andy, I was the opposite. I have an anxious team. Temperament and I was quite anxious about having that level of responsibility, especially since I left the multidisciplinary team context of a public hospital where I'd done all my training and threw myself immediately and solely into private practice, where I was essentially running my own business without anyone else looking after the patients. So I did find that quite anxiety-provoking. And I ended up hiring two supervisors in the beginning to alleviate my anxiety. And I also took on a very small patient load in the beginning to again feel like I could do the absolute best by every patient and have a lot of time to reflect with my supervisors, read up a lot, and uh so on to make sure that I was absolutely covering all my bases. I also found it very challenging in the beginning to get my head around this whole new private practice. How much do I charge? I was shaking the first time I asked my first patient for a very large sum of money. I nearly fainted when I heard how much I was charging. But these days it's just routine, and I understand that my fee doesn't just include the time I spend with my patient, but it has to pay the rent, the notes I do when the patient's not there, the time that I spend on CPD, annual leave. There's all this behind the scenes stuff that my fee covers that I understand is actually quite fair now, given all the things that it has to cover that you don't get in private. But it did take me quite a while to get my head around charging fees, running a business, having policies around cancellation and privacy, understanding the rules of Medicare and the PBS, and then setting everything up, like setting up my own medical record system, my e-prescribing, business bank account, and all that. So there's a lot to get your head around. Um and it does take time. And I guess these are the kinds of things that we talk about in our early career private psychiatrists, WhatsApp group. I set it up because I wanted people around me, and now we've got 250 in the group, and we all help each other with these kinds of things.

SPEAKER_01 24:40

I think I'd have to. Oh, sorry, I'd echo that. The WhatsApp groups are very useful, and also just your peer groups as part of the college. Like I have an early career psych group, I have an I'm an addiction psychiatrist, I have an addiction group, I have, you know, a mum psychiatry group, all these different parts of my personality and my work. Having, you know, people that I can connect with and ask for advice. And I use all my WhatsApp and Facebook Messenger groups all the time, you know, even prescribing and stuff like that. It's just a wonderful resource to have.

SPEAKER_03 25:14

So the thing I note with those WhatsApp groups is people ask a question and it's remarkable how many other people are going through needing to find the same information. So it just sort of emphasizes how there's so many people out there who are going through similar things, have similar questions.

SPEAKER_05 25:28

It is, and it's really grassroots stuff. Like I think the college is wonderful for big picture stuff, but for grassroots things, it it often depends on people just having an idea and getting it off the ground. So I've started a couple of WhatsApp groups, and there's probably 10 that I'm a member of now. And I feel like this is what the fellowship is about. I feel like I'm part of a group of colleagues who all support each other, who are all in similar circumstances and who want the best for patients and for psychiatry. I'm really grateful for being part of these groups and every all the support that people give each other.

SPEAKER_03 26:15

I like that point because fellowship's not just a set of letters after your name. It is, as the word implies, membership of a wider body of experts. And being able to sort of access that, I think, yeah, that that's a really nice way to think about it. That's and that's really important professionally as well.

SPEAKER_05 26:30

And I've really felt that way when I've gone to Congress as well. And I guess it can be tricky sometimes to break into different groups. But I I think if you're willing to put in a bit of time and effort and willing to contribute to others, then it doesn't pay you anything financially, that's for sure. I didn't get paid a cent to present three different things at the College Congress, but I got paid enormously in a sense of satisfaction, in lots of people complimenting my work and a sense of connection to other people, uh other psychiatrists.

SPEAKER_01 27:10

Yeah, and I'd echo that. I I mean, I was at Congress, I presented a few things, and I I think you know, some people get a bit turned off when they go through, I'm done, I don't need to do the college. But I mean, actually, you know, I feel that it's better to fix the system from within and try and build it into a better place. And as it's easy to throw stones from the outside, particularly for me, I'm really committed to gender equity and you know, issues facing people in uh for trainees and stuff like that. So like I'm now sitting on the gender uh committee, I'm now sitting on the adult committee. Will I affect change? I don't know, but at least I'm gonna try and you know give it a go. Um, so I think you know, I would, you know, suggest to people that if you can try and get involved. I recently started a job and I met someone who I'd met at Congress. Um, the job I'm doing today is because I went and talked to a stand. Like, you know, putting yourself out there, networking and connecting with people is just really important. It can really open up doors for you as well.

SPEAKER_03 28:09

That's good advice. There often is a sense that maybe early career psychiatrists don't yet have a lot to add at the college level, and maybe people are reluctant about joining. But I think the opposite is true, like you said, Ash. Early career psychiatrists have a lot of valuable perspective and opportunities to contribute. So I think it's great to get involved with those things early in career, and it sounds like it's certainly very rewarding from your point of view so far.

SPEAKER_05 28:30

I think that although early career psychiatrists don't have that level of experience of more senior ones, we often have this energy and enthusiasm, this thirst for change, the energy to do it. We're not jaded or worn down yet. And I'm really happy with what I've been able to achieve in just a couple of years since fellowship. So I've really enjoyed presenting at Congress through the different WhatsApp groups. I've agitated for a few changes. Uh, one of the things that I have lobbied the college for is a private practice prize, and I know that the college is considering that and that it it it it will probably uh happen in the next few months. Um the other thing is I've I've certainly learned a lot by talking with a lot of other people. So when I was thinking about how the hell do I set up my business, um I a lot of uh fellows were very generous in offering to meet with me for an hour here or an hour there just to talk about what they were doing. I've reciprocated that by again. I've said to anyone in my WhatsApp, if you want to uh have a Zoom meeting with me for an hour, I'll do that. No charge, of course. And I learn a lot from speaking to them. I feel a real sense of connection, and yeah, I think this is what the fellowship is about.

SPEAKER_01 30:06

And I think like I really want trainees to know is that it's an excellent job market, regardless of what you want to do in psychiatry. I am literally approached about work nearly every single day. When I open my practice, my books were full within a month. And I think, you know, like it's a really good time and place. So if you're not happy in what you end up doing, don't be afraid to pivot. It's actually a good time to be maybe flexible and looking at your different opportunities. I have found that I've been able to, you know, I've always been respectful and stuff like that and serve my time, but I have been able to step into the other things as they come up purely by knowing there is flexibility there. You don't have to worry. If you want to do public, there's jobs. If you want to do private, there's jobs.

SPEAKER_05 30:55

That's so true. And I think that's a great message to give to trainees that the job market is so good that you can practice in the way that is the right way for you, and that there are so many opportunities. So I've decided to focus on therapy with and without prescribing, depending on what the patient needs. And that's quite a niche area, but there's plenty of work there. I do general psychiatry, but in a kind of slow and considered way, and I see patients that find faster psychiatry kind of not caring enough and too abrupt, and that's again a niche market, but there's plenty of work in that. And if you have a particular interest, whether it's in gender transition or perinatal or whatever it is, there's so much work out there that you can pursue that interest and have plenty of work. And the other thing to add is that telepsychiatry has really opened a lot of opportunities because uh before telepsychiatry was popular, you were confined to seeing people who could physically make it to your office. Now the world's your oyster, you can see patients from anywhere all over Australia using telepsychiatry. So you've got a much bigger pool of prospective patients.

SPEAKER_03 32:24

No, that's a good point. I mean, yeah, as as you both say, we're certainly fortunate to be in a profession where there are so many options and we are in such demand. To change tack a little bit now, I just want to ask about your thoughts on protecting against burnout, which is a really important topic. And I was certainly struck by both of your bios at the start about how many different things you're doing and how busy you are. And I'm wondering how you both manage that, sort of your professional and personal commitments and how you sort of stay on top of um remaining sort of fresh and and healthy yourselves.

SPEAKER_01 32:53

I think it takes a village. Uh I'm not doing four jobs um and two kids with and also a husband that works massive hours. I have a village, I have help, and that's how I'm make it work. And I think for me, protecting that burnout is actually building jobs that I enjoy going to. I think that's the most, you know, you can meditate and exercise, but if you have trauma in the work that you're doing, it's really hard not to burn out. So for me, I like all the jobs I do, I find them all rewarding in different ways. And having a varied practice, I find keeps things fresh for me.

SPEAKER_05 33:33

I'd like to echo what Ash has said. It does take a village. I've got a wonderful wife and a lot of support from my extended family. I take regular breaks, so I tend to take a week off at least four times a year. So I tend to work uh school terms. Yeah, obviously pacing yourself with your patient load. I think that at the beginning it was particularly hard to do private practice because you only get paid when the patient's in the room. When I was in public, I might see patients for an hour or two a day and spend the rest of the day in my office. These days I'll see patients four, five, six, seven hours a day, and the patients in in the room with me all those, all that time. So it's it's a very different way of working. So it's important to make sure that you build up to it as you're making the transition. And like Ash said, I do regular exercise, I do yoga, do things that I love outside of work, and also I really love the work I do. I look forward to going to work each day, and when I come home, I feel really content with the work that I've done.

SPEAKER_03 34:44

That's great. Thank you both for talking about that.

SPEAKER_04 34:46

Sean, I did have a question around what you mentioned with that variety that there is available in practice in psychiatry as a trainee, kind of coming to the middle of training and looking at what variety there is and starting to think about whether I even want to do advanced training. I found the the options overwhelming at times. And even kind of looking at public versus private, I found that quite overwhelming. How did you navigate those choices? Because it there's this endless decision tree there. I'm curious as to how both you, Ash and Nathan, navigated that.

SPEAKER_01 35:25

I mean, I've tried everything. I think I've really I've tried the majority of jobs. Conveniently I gave birth and so I could easily segue into something else. So I I think people think that you make this decision when you finish, and that's it. You know, you can change, you can move. I fell pregnant, I had to wind up my private practice. You know, I still have patients contacting me a year later wanting to come back. I think that, you know, a lot of people put a lot of pressure on themselves when they finish that they have to make a final decision. But I think there's been a real shift that people stay in hospitals or roles for 20, 30 years. I think you can try different things, and I would actually strongly encourage people because you don't know whether you like or dislike something until you give it a go.

SPEAKER_05 36:06

I agree. I think that it can be difficult in your training to figure out what to do. I tried everything in my training, as in I did rotations in so many different areas, and some I really loved, and some I I didn't like so much. So by the time I got to the end of my training, which was a general training, I had an idea of some things I did and didn't want to do. But I only started my advanced training in psychotherapy after I fellowed. So you don't necessarily have to begin your advanced training until once you've fellowed. And like Ash said, you can try things out and see what you like. I I think it's also useful just to chat to people and think am I like that person? Am I like those people in that subspecialty? Do I think I would fit in there or do I think I would enjoy the things that they enjoy? So it's as much about the people, about the work setting as it is about the subject matter that you're working with.

SPEAKER_04 37:15

Thank you. That's very useful and I think very um anxiety relieving to hear.

SPEAKER_01 37:19

I put a lot of pressure on myself. I did two certificates and training. Did I need to do that? No. Uh would it probably have been easier, like you know, trying to navigate that without taking breaks with having children, very difficult. I think now viewing things a marathon, not a sprint, is a much healthier way. You train for five years, but you might practice for 40. You can change and upskill during that time.

SPEAKER_05 37:42

Yeah, and a lot of people do change around. I know that a number of my senior colleagues have started in one subspecialty and moved into others, and and that's quite normal these days. I guess the other thing is maybe try reaching out to people if you get a lecture from someone who you really admire, or you've got someone in your hospital that you you really gel with, then maybe ask them. And these days a lot of hospital psychiatrists have a number of jobs. So they might be at the public hospital a day or two a week, but then they might spend other days in other jobs and maybe ask them about what their other jobs are like, because that's a good way to learn.

SPEAKER_01 38:31

I just would also say for people who are considering public, join your union. You are a public servant and being part of your industrial body is very important. I had a service try and block my maternity leave. I was assisted by my union. You know, I've seen people miss out on things. Um, and we do have EBAs. So I would just really suggest people that it is a good investment. I've seen it benefit a lot of people.

SPEAKER_05 38:59

Absolutely. I do think the unions are very important in supporting registrars when there's challenging situations, and I've also benefited from union membership. I highly recommend it.

SPEAKER_02 39:12

Are there any equivalents in the private sector, Nathan? There is.

SPEAKER_01 39:15

So I mean the AMA, it's not union as such, but you know, it's a most union-like body. And I find being a member of the AMA and having the AMA fee list is something that's useful. That only comes about by people being members of that body.

SPEAKER_05 39:29

Look, to be fair, I do think that the college's section of private practice is doing some exceptional work in the space. Because of the work that I've done in advocating for private practice, I was recently invited to join a meeting of the section of private practice, and I can see they're doing wonderful advocacy work, and I'm doing some private practice advocacy myself, and that's what I'm presenting at the adult psychiatry conference next week. So the section of private practice is very strong and very large in the college, and I'd encourage anyone who is thinking about private practice to join it and to even come along to events. I'm not an official member, I attended as a guest. But if you have an idea, bring it to the section and who knows, they might like your suggestion and might support you to make it happen.

SPEAKER_03 40:36

Any final questions from yourself, Michael, or or Andrew, at this point for our guests?

SPEAKER_04 40:41

I've got one final question, which is again, maybe through the lens of being still a trainee, is looking back on your training, is there anything that you would have done differently in training now that you've got the experiences that you have?

SPEAKER_01 40:57

I would try and do more self-care. I probably really killed myself for always working overtime, always being available, thinking that my whole world was going to be this big public hospital. And then realizing that, you know, it doesn't really count for much. Um and then there's actually a much better world out there. So obviously work hard, do your job, I think is very important. But putting yourself under a lot of pressure and stuff like that, you know, for service demands, I really think you know you should put your training at the forefront. And that's what I would do differently.

SPEAKER_05 41:26

I don't know that there's much I would have done differently at the hospital. I'm actually very happy with the fact that I tried so many different rotations in so many different fields. So I think my advice to trainees would be try a few different rotations. It'll help you rule things in and out. Try to get a private practice rotation if you're lucky enough, there's not many. Try to get along to some college events like the Congress. I think what I really like about going to college Congress and college conferences is you realize that psychiatry is so much more than what you do in training. In training, you have this very narrow exposure to a very small subset of psychiatry. And if you go to college events, you get to see the breadth and depth of psychiatry. And I think that the opportunities beyond public hospitals are very exciting. And seeing the breadth of opportunities available is really fantastic and well worth going to a conference or a congress to see the breadth of opportunities out there.

SPEAKER_01 42:48

Yeah, I really echo that. I've literally got my dream jobs from going to Congress and talking to stands and networking and meeting people. It's not just always going to come on your lap. So putting yourself out there. Um, and plus it's fun, you know. I think connecting with your peers and stuff like that. Like I really enjoy it. I think it's nice to have a community around you. So I would really, you know, strongly encourage people to look at going to things like that.

SPEAKER_03 43:11

Very nice. Well, thank you both so much, Ash and Nathan, for joining us today and giving us your time and wisdom on approaching work as an early career psychiatrist. We really appreciate your input.

SPEAKER_01 43:21

Thank you for the opportunity.

SPEAKER_05 43:23

Thanks a lot, Michael, Michael and Andy, for inviting me to participate.

SPEAKER_03 43:29

Our pleasure. And of course, I'd also like to give a big thanks to my fellow host today, Andrew and Michael. Thank you both.

SPEAKER_04 43:34

Thank you. And thank you for your time, Ash and Nathan. Thanks, Michael. It's been fun.

SPEAKER_03 43:39

Also just like to acknowledge Mr. Kumar from the College who give us such excellent support in producing the show. We are thankful to Australasian Psychiatry for the opportunity to create these podcasts, as well as Sidoni Prentice for our artwork and Shady Dave for our music. We encourage listeners to rate the podcast on whichever app you've accessed it, as well as promoting it to other registrars or supervisors. We always love getting feedback or suggestions for future episodes. Please get in touch through our email account, thethoughtbroadcast.podcast at ranzcp.org, or through the Australasian Psychiatry X account. That's all for now. My name is Michael Waiteman. Catch you next time.