Recruitment and retention of psychiatrists is a major concern in commissioning and providing mental health services. With consultant vacancies overall in the UK running at over 12% for many years, current services are stretched and in some areas only locum provision enables them to be maintained. This means that plans to reshape services with new teams, strengthening community-based work, could founder. Most professions within mental health share similar difficulties. The different stages of the career pathway of aspiring psychiatrists, from interested teenagers through to post-retirement consultants, are described. Difficulties at each stage in attracting and retaining the most appropriate people are discussed, and solutions at each point of the career cycle that could add up to a permanently better staffed service and a happier workforce are offered.

Manpower planning is not normally a topic of considerable interest for most psychiatrists. That is, until their trust is faced with recruiting a new or replacement consultant from what may seem to be an ever diminishing pool of qualified applicants. “Where have all the specialist registrars gone?” is often the woeful cry which goes up after increasingly large and ever more expensive advertisements fail to draw in desperately needed recruits. Having an accurate picture of the current state of the psychiatric workforce and seeing the trends in recruitment and retention at all grades is vitally important for the profession. It was the realisation of the gross inadequacy of officially collected statistics some years back which led to the first College census on psychiatric staffing.

The exercise of hospital accreditation by the Royal College of Psychiatrists has resulted in a significant improvement in the standards of psychiatric training in this country.1 The North West, more than any other region, adopted the policy of District General Hospital psychiatry2 in the sixties which had the effect of creating small psychiatric units, unable to muster enough resources, to provide comprehensive training programmes by themselves. These developments have highlighted the problems of organising viable rotational schemes for training in psychiatry.3,4,5