NSW Psychiatry Wins for Specialists — But What about Trainees?

On 3 October 2025, the NSW Industrial Relations Commission (IRC) handed down a significant decision: public sector psychiatrists are to receive a temporary 20% uplift in remuneration (10% “attraction and retention” supplement + the existing 10% “abnormal duties allowance”) for 12 months, to help staunch the exodus of psychiatrists from the public mental health system.

[Reported here: https://www.news.com.au/finance/work/at-work/nsw-industrial-relations-commission-awards-public-sector-psychiatrists-20-per-cent-pay-bump/news-story/5930bd0f307acbf8aa20027307526347 ]

This is an undeniable win for the staff specialist psychiatrists — long undervalued, overworked, and stretched by systemic staffing shortages. But there is a shadow side to the celebration: the trainees, the next generation, are being left behind.

The Trainee Predicament

While the IRC decision addresses one layer of the crisis, it does nothing for psychiatry trainees, who are integral to public mental health services and to the sustainability of the workforce. 

I’ve worked alongside these doctors on busy inpatient units and in overstretched community teams when working as a locum psychiatrist for the Illawarra/Shoalhaven LHD, as well as in Albury and Newcastle. Psychiatry trainees alone are the ones who shoulder the after-hours work, the assessments in ED, and the daily clinical reviews that keep services afloat. 

I know through my work coaching and training psychiatry registrars that are struggling financially on registrar salaries with the burden of training fees. More and more are turning to breaks in training in order to chase better pay rates as locums, leaving their regular posts and formal training behind for extended periods. Locum positions without support to complete assessments, little examination preparation, or formal education opportunities. 

Psychiatry trainees deserve to be mentored, educated and supported — yet this year many have had very little of that. With locums filling vacant posts and permanent specialists stretched thin, trainees often find themselves carrying service loads without the supervision and learning opportunities that should be expected of a specialist training program.  

To now see them excluded entirely from this pay decision is another blow. It sends the message that their contribution doesn’t count, even though they are the future of psychiatry in NSW and the current workforce keeping the doors open and the lights on for patient care. 

Without them, there is no workforce to inherit the system we are trying to stabilise.

I worry about what this means for morale, recruitment and retention. If our trainees see that only senior doctors are valued, while their own role is overlooked, why would they stay? Why would the next generation choose psychiatry at all?

Here’s how the trainees’ interests are being sidelined:

1. No catch-up or recognition in pay or conditions
   The pay increase applies only to staff specialist psychiatrists. Trainees — whether registrars or advanced trainees — are excluded. There is no parallel uplift or adjustment to their compensation or allowances, despite their often intense responsibilities in understaffed teams, and burden of specialist training fees.
   
2. Training environments under threat
   Staff shortages force hospitals to rely heavily on locums and visiting medical officers (VMOs), who typically do not engage in supervision, teaching, or continuity of care. This undermines training quality. In hearings, it was revealed that at least ten hospitals risk losing accreditation as training sites due to insufficient supervision and staffing. The Guardian https://www.theguardian.com/australia-news/2025/mar/17/nsw-psychiatrists-arbitration-hearing-pay-conditions?utm_source=chatgpt.com 
   Without stable specialist staff anchoring clinical services, trainees may find themselves adrift — doing service work without mentorship or academic support.
   
3. De facto devaluation of their role
   As permanent roles become vacancies filled by high-cost locums, trainees may see their work reframed as “gap cover” rather than meaningful career development. The message becomes: you’re replaceable and not deemed worthy of investment.
   
4. Attrition risk accelerates
   The missed signal is stark: if trainees see that intensive negotiations and industrial leverage deliver for senior specialists — but not for them — morale will suffer. Many may choose alternative specialties or move interstate. private practice settings. Indeed, in NSW, evidence was presented that interest among junior doctors in psychiatry is about half what it is in Victoria, partly due to pay and working conditions.
    

The Irony & Inconsistency

• The state government’s fallback strategy has been to fill vacancies with locums at crisis (high) rates — reportedly up to $3,000+ per day — yet it refuses to invest in the core of the system: its trainees and public service clinicians.
• Psychiatrists leaving staff roles are sometimes re-hired as contractors (VMOs) at higher hourly rates, but without the non-monetary benefits, job security, or role in training that permanent public positions provide.
  
  

Why Trainees Matter — And Must Be Valued

• They are the pipeline. Without motivated, well-supported trainees, the specialist workforce declines further.
  
• They perform critical service roles. In many understaffed units, trainees often shoulder patient care, risk assessments, emergency cover, and follow-ups.
  
• They deserve parity of respect. If senior psychiatrists are deemed worthy of a special retention supplement, then trainees deserve to at least be part of the conversation about fair remuneration, allowances, and career pathways.
  
• Equitable reform demands inclusive solutions. A system that rewards only senior staff will inevitably fracture morale, incentivise departures, and worsen inequities.
  

What Should Be Done

To ensure the IRC decision is more than a temporary patch for entrenched inequities, stakeholders must act swiftly:

1. Extend a “trainee retention & recognition allowance”
   A bridging payment or supplementary allowance for psychiatry trainees, acknowledging their crucial role in the system, should be negotiated immediately.
   
2. Mandate protected supervision and education time
   Even in the face of staffing gaps, trainee rotations must preserve time for teaching, supervision, and reflective practice—not just service delivery.
   
3. Secure training site accreditations
   Hospitals threatened with loss of accreditation must be prioritised for staffing support, so trainees are not left stranded.
   
4. Include trainees in the industrial negotiations
   The next round of bargaining (or any arbitration) must encompass all levels of the psychiatry workforce, not just staff specialists.
   
5. Create incentives to retain trainees long term
   Bonded service agreements, scholarships, or career development plans can help anchor trainees in public psychiatry beyond training.
   
   

Call to Arms

The IRC decision is a victory for staff specialist psychiatrists — but only if it catalyses lasting structural reform. Trainees cannot continue to be invisible in the debate. They are critical to the sustainability of public mental health in NSW, and they deserve fair treatment, not deferred hope.

We cannot build a sustainable mental health system by ignoring those who will one day lead it. NSW Health and the IRC must look again — and bring psychiatry trainees into the fold.