Would-be psychiatrists are being forced to wait months to sit final exams, despite a mental health crisis gripping Australia.
The country's only accreditation body for psychiatrists - the Royal Australian and New Zealand College of Psychiatrists - is under fire over revelations the college has been passing trainees at a "snail's pace", creating a backlog of hundreds unable to treat patients.
The Objective Structured Clinical Examination is one of the six major assessments trainees undertake to become fellows of the College and be able to practise independently as consultant psychiatrists.
However, it has been cancelled five times time in the last two years.
"Things were already bad pre-pandemic, but the pandemic has really brought the College to its knees and to a standstill. That's why we've got a two-year backlog of psychiatrists who are trying to enter the workforce," Dr Bronwyn Moss, a final-year trainee with nine years' experience, said.
One exam sitting was scheduled for October 30 last year, was pushed to November, and many were left without results after the server crashed. Another test was scheduled for March but was cancelled in January.
Of nearly 200 candidates affected, 68 still have no results and 33 are awaiting further assessment.
Disruptions were causing some trainees to consider moving overseas, where the accreditation process is simpler.
Alternate assessment pathways introduced
Following the November failure, the Australian Medical Council (AMC) approved alternative assessment pathways, which include a portfolio review and case-based discussion. But trainees say the system is still slow.
Dr Moss, who is delaying her accreditation due to the uncertainty, said the College was processing alternative pathway candidates "at a snail's pace".
"The mental health of the general public is suffering and waitlists are growing even longer," she said.
The Australian mental health sector has been under an "unstainable strain" for the past two years due to COVID-19, leading to increased demand for psychiatrists.
Impact on trainees' mental health
Other trainees said the lack of clarity was also having an impact on their mental health and little support had been offered by the College. The member welfare line had been down and callers had been met with automated voicemails and month-long waits for a response.
One trainee, who first applied to sit the test in April 2020, told The Canberra Times they studied for two years and attempted to sit the test five times.
"Having to do that so many times and having your anxiety build up over the process, only to have it cancelled and cancelled again, was really awful and so detrimental to my wellbeing and I felt strongly that the College just did not care," the trainee, who asked not to be identified, said.
Major life plans were also being put on hold. Another trainee said they were told they failed two days before Christmas and it delayed their completion by six months.
"It ruined my and my family's Christmas. They then gave me three weeks' notice of my next exam, when usually you study six months for an exam."
College and AMC response
Trainees are calling for better contingency plans in the event of exam cancellations and for a trainee representative to sit on the College's board.
RANZCP president Associate Professor Vinay Lakra apologised for the delays and said an external review was underway in which trainee feedback would be sought. Dr Lakra said eligible trainees could expect results in the next few weeks.
"I'm sorry, I do apologise to them," he said. "I think we've all tried to look at different options, moved and improved things quite rapidly. I think we are at that stage where there is acknowledgement that this is a broader problem."
The AMC said it was "concerned" about assessment delivery by the RANZCP.
"Some refinement of the alternate assessment pathway is still needed and better communication with trainees is required," Kristy White, AMC's accreditation standards director, said.
"The AMC continues to monitor the development of the College's assessments closely. It has a scheduled reaccreditation assessment of the College and its specialist medical training program later this year."
Dr Philip Morris, a fellow at the RANZCP and president of the National Association of Practising Psychiatrists, said the situation was very disappointing.
"My view is that the College really needs to look at training and the whole training program," he said.
"The college needs to take into account the trainees' point of view a lot more seriously."
