The NSW Psychiatry Crisis: What is the Dispute About?

February 2025

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Key Messages

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1. There are severe difficulties in recruitment and retention of psychiatrists in the NSW public sector, with a shortfall in the psychiatrist workforce of around 30%.

2. Pay disparity, especially with other states, is impacting recruitment and retention.

3. Inability to provide appropriate care in the face of these shortages is leading to ‘moral injury’.

4. The NSW government has not proposed any solution to resolve these issues.

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The problems:

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1. ​​Severe difficulties in recruitment and retention of psychiatrists in the NSW public sector.

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• The NSW Branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Australian Salaried Medical Officers' Federation (ASMOF), and Australian Medical Association (AMA) alerted the NSW Government to severe and persistent problems in recruiting and retaining Staff Specialist Psychiatrists in NSW in 2023.

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• Ministry of Health did not have reliable data on vacancies or locum utilisation, and since that time, measured shortfalls in the psychiatrist workforce were 30% and increasing each year.

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• Surveys of Doctors in Training revealed that only 20% are considering working in the public sector after complete training. This is a marked reduction compared to around 75% who intended to remain in public sector practice in 2002.

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2. Pay disparity

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• NSW Staff Specialist Psychiatrist pay is 30% lower than QLD and VIC, and 52% lower than WA.

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• Psychiatry staff specialists in NSW earn much less than other medical specialties in public practice in NSW, due to an inability to generate sufficient ‘Rights of Private Practice’ revenue compared to medical procedural and surgical staff specialists.

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3. ​Provision of inadequate patient care and ‘moral injury’.

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• The majority of psychiatrists who submitted letters of resignation did so because the critically understaffed system has resulted in a deteriorating standard of care for their patients.

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• Inadequate numbers of psychiatrists means individuals are overstretched to fill gaps.

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• Psychiatrists cannot provide the minimum level of care necessary to their patients in a stretched system, which has led to ‘moral injury’.

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4. Inadequate government responses to the crises.

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• The NSW government responses to the situation have further heightened the crisis.

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• Suggested role substitution with peer support workers and allied health workers is inadequate as these staff do not have appropriate skills or qualifications to cover these roles.

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• Care of public patients in private hospitals is occurring at considerably greater cost to the taxpayer than funding Staff Specialists.

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• Involuntary treatment in private hospitals is being considered despite existing services not having the environmental, clinical or governance frameworks for safe, humane, and effective care.

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• The provision of “virtual hubs” has been an expensive and ineffective initiative that has not reduced the need for psychiatrists on the front line, nor has it improved care.

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The proposed solutions:

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• The only immediate solution to the recruitment and retention crisis proposed is an allowance of 25%, similar to that given by NSW Government to Emergency Staff Specialists in 2011.

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• The government have been unwilling to consider this measure. They have come up with no other offer than the 10.5% over 3 years which has been offered to and rejected by all staff specialists, with the possibility of a 10% onerous duties allowance at the discretion of the employer.