‘The NSW Government needs to realise people will die’: Psychiatry registrar quits for Victoria
NSW is home for psychiatry registrar Dr Nithya Reddy.
It is where she grew up, undertook all of her medical training so far and became passionate about working in the public mental health system.
But six months before her training finishes, she is leaving.
“I can no longer be part of the system here despite being so close to the end,” she says.
It comes as hundreds of senior NSW psychiatrists have tendered their resignations.
Dr Reddy had been thinking about moving to Victoria post-fellowship but after months of being “continuously morally injured”, she has decided she cannot wait.
“My colleagues and I are here to provide the best evidence-based care to our most vulnerable in society, and we have not been able to do that for a while.
“The government does not seem to care, so I felt I could not continue.”
Even before the mass resignations, a third of public psychiatry positions were vacant.
“Psychiatrists have been covering the job of two or three, and that obviously means covering more patients.
“That has been my reality as a registrar many times.
“Even with the best intentions, you cannot do more than what eight hours of time allows.”
To keep the system working, a senior psychiatrist on sick leave with a broken foot was discussing patients with colleagues between X-rays, says Dr Reddy.
Another psychiatrist being treated in ED called Dr Reddy from their bed to advise which child and adolescent patients needed acute input.
“I am giving you this example to illustrate how much these public psychiatrists care about their patients and the extent to which they have extended themselves to provide care,” she says.
“They know there is nothing else, but they cannot do it anymore.”
Dr Reddy has also been pushed to her own limits.
“In the 18 months prior to August last year, I was not able to take more than four days of annual leave.
“This is not to blame any specific hospital or local health district.
“I did not want to let down my colleagues, who would have had to cover.
“It is unhealthy, and it s not something we should accept in any occupation.”
She comes close to tears when asked about the effect a buckling system has on vulnerable patients.
“That is a necessary question, but it is also really difficult to speak about.
“It is hard not to feel personally guilty because, at the end of the day, those patients are in your care and you are doing the best you can.”
“I think it is important that the public realises how difficult it is when you are being forced to make impossible choices, like discharging someone to a community team that does not have the resources you know the patient needs.”
Patients and their family members have told Dr Reddy that they are anxious about what will happen to them and how they will access care in hospital and the community.
“I have seen that anxiety, and it breaks my heart,” she says.
“As a psychiatrist, our duty of care to patients extends beyond immediate evidence-based medical and biological treatment; we must also support patients through linking to and advocating for the resourcing of robust services outside of inpatient care.
“But we cannot provide the reassurance that things will be okay.”
An underappreciated issue is the patients’ physical health, Dr Reddy says.
Psychiatrists are meant to advocate for patients and escalate these issues, but a health system with widespread workforce shortages is struggling to treat them.
“I have been in situations where patients on a psychiatric ward have test results that need to be escalated immediately to the relevant medical team, but that team is not available,” Dr Reddy says.
“Sending these patients to a medical ward for acute care is less than ideal as these wards are not equipped to provide simultaneous complex psychiatric care.”
Patients are often remaining in psychiatric wards for treatment of complicated physical illnesses, Dr Reddy says.
“Those situations are happening, and I think the government needs to realise people will die.”
Dr Reddy is now taking a few months’ break before seeking an interstate offer to finish her training.
She says she is burnt out and frightened by the government’s inaction.
“As a society, we have a duty of care to make sure we have systems that are funded and listened to — for both the safety and rehabilitation of patients and the safety of the population.
“I am worried that the government is not going to do anything until there is a tragedy.”
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