Diversity and retention in academic psychiatry

To the Editor

We agree with the sentiments expressed by Suetani et al. (2022) in that there is an urgent need to inspire the next generation of academic-psychiatrists. Mental health and addiction have been highlighted as areas of national priority in a number of state and national commissions, with the need for innovation never more imperative following the impact of the COVID-19 pandemic. Yet progress in psychiatry research has been stymied by systemic and long-term underinvestment relative to burden of disease. From the view of early to mid-career academic-psychiatrists, we put forward two key counter-arguments to complement the perspectives of Suetani and colleagues.

First, Suetani’s primary focus is on the attraction and recruitment of an academic psychiatry workforce. While this is an important step in creating a pipeline for the field, we propose that retention rather than recruitment is a more urgent priority in Australia. The rationale for this is the significant changes in the resource context and funding volatility in which clinician-scientists practice, both within psychiatry and, more broadly, in other medical disciplines (Australian Society for Medical Research, 2022). Operating within this context of extreme scarcity, academic-psychiatrists are under constant pressure to re-evaluate their commitment to a research career, particularly when clinical academic positions and ringfenced funding are few and far between. The downstream consequences of attrition include a loss of role models and mentors from the academic psychiatry workforce, the erosion of research culture and perpetuation of the perspective that academic psychiatry is an unattractive career choice.

Relevant to retention, Suetani et al. suggest that we need to quantify, qualify and characterise academic-psychiatrists in New Zealand and Australia (‘how many academic psychiatrists … their habitats and who they interact with’). We appreciate the analogy to animals and extinction; however, despite this jest, the term extinction refers to the termination of a species. This implies that quantification has already been completed – so far, the authors also state that this is yet to be done. We agree that investigating the reasons for the decrease is required, for the ‘capacity for the species to breed and recover’. Thus, apart from subjective experience, it is difficult to know whether the decrease is due to academic-psychiatrists retiring (i.e. ‘natural’); hence, the danger of retrospective study means that there is risk of a ‘Lazarus taxon’. To contribute to benchmarking, we have already conducted a survey targeted at Early Career Psychiatrists (Frederick et al., 2022). Of the 73 respondents, 33 (43%) reported participating in research. Of these, 19 (56%) held a university appointment (paid or Honorary). There were only 9 who had an actual paid position, with the remainder doing research in unpaid time and no allocated research position.

Second, Suetani and colleagues suggest that progress has been made towards gender equity; we offer a different perspective of early to mid-career clinician-researchers. The stark reality is that retention of mid-career women in health and medical research remains poor, with consistent university statistics that women drop out of academia at higher levels. For the National Health and Medical Research Council’s largest scheme, Investigator Grants, funding rates for women significantly drop with seniority, and at the highest level, only 21% are women, resulting in an additional AU$66M going to male researchers. Over the past 3 years of the Investigator scheme, even though equivalent applications have been submitted by men and women, men have been awarded 20% more grants equating to a total AU$300M more than women (Purton and Boerger, 2022). In terms of academic psychiatry, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) has invested in a range of strategies to support research, including initiation of the Research Foundation and support of early career seed fund grants. Seven (17.5%) out of 40 past recipients of RANZCP research awards at early career level have been women, and this significantly decreases to 3/40 (7.5%) at senior research level. An important consideration in gaining a deeper understanding of the systemic barriers underpinning this disparity is how career disruption and relative-to-opportunity frameworks are applied in these award and grant schemes. We are not aware of a framework or guidelines supporting such considerations within the RANZCP and argue that this is urgently needed. On a positive note, Suetani et al. report that in 2021, the RANZCP established the Clinical Academic Psychiatry Steering Committee to ‘consult and advise the next generation of academic-psychiatrists’. We are hopeful that this Steering Committee is representative and consultative in its activities; inclusive in diversity across gender, academic level, colour and indigenous representation; and seeking cross-specialty and state, territory and binational perspectives.

In summary, we reiterate Suetani et al.’s (2022) call for more data regarding the psychiatry research workforce, the need for greater clarity in the outcomes of research training efforts and finally, a national effort required to promote, implement and sustain the training of psychiatrist researchers.