- Psychiatry is the specialty concerned with the diagnosis and treatment of mental illness. It requires 4 years (PGY1-4) of training. The PGY1 year is usually included in the training program and offers 3-4 months of medicine and 2 months of neurology, with the remainder of the year spent in psychiatry. The medicine months can vary greatly between programs, with some consisting of mainly outpatient work and others including ICU months. Some programs require 1-2 months in the emergency room as part of the medicine training. Some programs may allow you to do pediatric months in substitute for adult medicine months if you are interested in child and adolescent psychiatry. Some programs rotate with internal medicine services while others rotate with family medicine inpatient services. In addition, some programs incorporate medicine time on med-psych units allowing residents to treat medical issues of psychiatric patients.
- Many programs offer a few spots beginning in the PGY-2 year. This allows for the opportunity to complete a preliminary year in internal medicine, although many residents who enter at this time are switching to psychiatry from a different specialty.
- Programs may also have informal “tracks” built into the residency which allow you greater exposure to certain sub-specialty topics during your residency. These tracks vary by program but may include: child and adolescent psychiatry (CAP) track, psychotherapy track, quality improvement track, ethics track, research track, neuroscience track, etc.
- Fellowships (1-2 years) are popular and include CAP, geriatric psychiatry, consultation/liaison (aka psychosomatic) psychiatry, community psychiatry, forensic psychiatry, substance abuse (aka addiction), eating disorders, and research. The 5 ACGME accredited fellowships are CAP, geriatric, psychosomatic, addiction, and forensics. Some programs offer “fast-track” child psychiatry fellowships which begin in the PGY-4 year and last 2 years. Many programs also offer non-accredited fellowships in areas including public psychiatry, PTSD, psychopharmacology, and a number of other areas.
- There are several programs which offer combined training in psychiatry and internal medicine, family medicine, pediatrics (all 5 years), or neurology (6 years). Information about the medicine and pediatric combined programs can be found at The Association of Medicine and Psychiatry and Triple Board Residency Training.
- Psychiatry programs vary greatly in their structure and philosophy. Some programs may put the primary focus on psychopharmacology while others stress psychotherapy. Programs may also emphasize a particular model of therapy such as cognitive behavioral or psychodynamic, but most attempt to integrate all areas. All programs are required to cover certain specific types of therapy; the degree to which they choose to do so will likely vary depending on the program’s philosophy of practice. When researching programs and interview, it is important to consider: variety of training sites (academic/private/state/VA hospitals), amount of inpatient versus outpatient training, elective and research opportunities, amount of psychotherapy training/supervision, frequency and quality of didactics, protected research and didactic time, where residents end up after residency, available fellowships, moonlighting opportunities, and opportunities for ECT certification.
- Other factors students often consider while choosing programs include geography, program size (smaller programs often mean more personalized attention and a closer-knit program, while larger programs can provide a better distribution of work, especially regarding call time), and collegiality among the residents. Most program directors are looking for residents who are not only qualified but also work well with others.
The Fourth Year Schedule
There is a psychiatry sub-internship available at Maryland. However, your sub-internships may be completed in any specialty (and most programs prefer to see at least one month of internal medicine). There are many psychiatry electives at Maryland, including the PACT (psychiatric assertive community treatment) team, eating disorders at Sheppard Pratt, psychiatry sub-specialty at Sheppard Pratt, inpatient child psychiatry, consult-liaison, forensics, and substance abuse. Away electives are not required or even expected of psychiatry applications. However, if you have a strong preference for a program outside of University of Maryland you may consider spending a month there.
Most programs allow four letters of recommendation. Letters of recommendation are valued highly by many psychiatry programs. It is often preferred that you get at least one letter from a non-psychiatrist (internal medicine, pediatrics, surgery, etc.), and at least one letter from a psychiatry attending. Beyond that, letters can generally be from any faculty member who knows you very well and is willing to reflect very positively on your character and work ethic. Rarely, a program may require a letter from the chair of psychiatry, so if you are interested in a program be sure to check their webpage.
Psychiatry is an ERAS specialty. ERAS should be completed as early as possible in the fall of the fourth year. Some programs begin interviewing in late October, so do not delay ERAS submission. If you have an interest in child and adolescent psychiatry or research, make sure to see what programs offer fast-track or research-track programs as it can allow you to get a fellowship faster without having to change programs. OSA will guide you in choosing how many programs to apply to. Plan to apply to approximately 15 programs, from which you should expect around 10 interviews.
Maryland attendings are very eager to help with the application process. People to talk to:
- Dr. Mark Ehrenreich – the residency director of the Maryland/Sheppard-Pratt program. He trained here and has worked with the program since completing his training. He also previously served as the Psychosomatic fellowship director.
- Dr. Ann Hackman - the medical director of the PACT team. She is very helpful in planning for fourth year and explaining different fellowships.
- Dr. Constance Lacap - the psychiatry clerkship director. She’s a good resource for help with personal statement editing, and she knows a lot about the interview process since her former job was the associate training director for the Maryland/Sheppard-Pratt program.
- Dr. Joseph Martinez – the associate dean of medical education. He knows a lot about residency programs around the country, and isn’t at all involved in interviewing/ranking for the department.
Psychiatry interviews are generally friendly and non-threatening. Use them to determine if the program would be the best place for you to train. To prepare for interviews, think about interesting patients, reasons you are interested in psychiatry, what you are looking for in a program, and why you’ve chosen to apply to that specific program – favorite questions in interviews. Programs will read your application very carefully, so do not include activities you cannot speak at some length about (especially the “hobbies” portion of ERAS). And keep in mind, as much as you are trying to sell yourself to programs, programs are trying to sell themselves to you. Allow yourself to be critical as you consider your options.
Positions in psychiatry have become increasingly more competitive, especially in top programs. However, residency positions are numerous and psychiatry tends to be a “buyer’s market”. Most programs receive several hundred applications and interview approximately 100-150 for 15-20 positions.
Last Revision: February 18, 2020