The future of medical education worries new graduates. Locally, there are just enough places for house surgeons, and there are still gaps in registrar (advanced training). But the funding for this is central: the state (who fund the health system) know they need doctors. A similar system works in the USA and Canada.

But not in the USA. Not now. The system is too complex, and too converged. The political system — the American Medical Association, the American Psychiatric Association and similar — spend more time arguing for funding that the Aussies do with their Medicare. And it may affect training.

Third, the current generation of psychiatry residents is very committed to public psychiatry, and we are in a political environment where the emphasis is on cutting social service expenditures to fund infrastructure and defense.

The next major issue is graduate medical education funding. By the end of the Obama presidency, we were anticipating cuts and the replacement of a portion of current entitlements with incentive payments. It’s unclear whether the new administration will move in this direction. I expect that GME funding will be an issue in the coming years, and how a physician and orthopedist as secretary of Health and Human Services will relate to this concern is unclear.

Next, this administration’s commitment to free market health care will likely result in continued fracturing of the care system in psychiatry with ever larger percentages of psychiatrists opting out of insurance and Medicare. This is confusing to trainees, while an understandable decision for individual practitioners, it undermines the commitment to a system into which we are trying to integrate our trainees.

The travel ban may be having a great impact on trainees and psychiatrists already. Depending on the next steps, this policy, and the associated elimination of “premium processing” for H1-B visas, could adversely affect many residency programs with international medical graduates and create greater stress and uncertainty in many training settings.

Finally, the heating up of the culture wars, and the more divisive social discourse, evokes new anxieties and uncertainties in many of our patients as well as our trainees and faculty. Although not exclusively, psychiatrists tend to be socially liberal, and many surely struggle with the greater tone of exclusion and intolerance. We will need to continue to learn from one another how to address this problem

I’m a public psychiatrist. But, in Australia and in the USA, most psychiatrists are in private practice. To train for the minority is foolish. To make this political is doubly foolish. For where the converged turn all into virtue signalling, and there is no training, there will be no residents getting their boards or fellowship, no next generation, and medical education will converge into dust and ashes.