Is the market for Psychiatry going down?

[Sushirolls]

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Yes, to all your questions. And my retirement time clock will be on the old human time scale.

Seasons.

Planting season, fishing season, calving season, haying season, hunting season, manure spreading season. Winter projects, summer projects. I'll happily stitch some gloves in December with a nice wood fire, and cup of Yaupon Holly while the bear stew is simmering with Korean spices, as I've psychologically abandoned the Mon-Sun calendar for - what's the season, what's the weather.

 

[randomdoc1]

Yes, to all your questions. And my retirement time clock will be on the old human time scale.

Seasons.

Planting season, fishing season, calving season, haying season, hunting season, manure spreading season. Winter projects, summer projects. I'll happily stitch some gloves in December with a nice wood fire, and cup of Yaupon Holly while the bear stew is simmering with Korean spices, as I've psychologically abandoned the Mon-Sun calendar for - what's the season, what's the weather.

you wanna join me in the youtube channel? We can say provocative things to annoy the population and maybe get monetized on ad revenue.

 

[Sushirolls]

LOL. There's enough provocative channels and click bait out there, that market is saturated. The good ones are the slow tempo, minimal talking.
Ever watch the videos of people just haying?
Hydraulic presses smashing things?
Engine rebuilds?
Logging videos?

Almost akin to meditation ocean sound tracks.

 

[randomdoc1]

LOL. There's enough provocative channels and click bait out there, that market is saturated. The good ones are the slow tempo, minimal talking.
Ever watch the videos of people just haying?
Hydraulic presses smashing things?
Engine rebuilds?
Logging videos?

Almost akin to meditation ocean sound tracks.

Well...I was thinking more along the lines of talking about the very real placebo effect. And saying something like..."it's all in your heads, just get over it" 🤣

 

[Stagg737]

Most of us can cut down on cost of living without living like preppers in the woods 🤣

Some of this sounds like prepper fantasy stuff. Have you even looked into the practicality of a wood gasifier? There's a reason the vast majority of rural areas use propane....it's actually not more cost effective.

Other stuff, if you really like doing it as a hobby is fine but the time/effort isn't actually any more cost effective....it's like woodworking, it's a great and beautiful hobby but it's not terribly cost effective unless you're really good and efficient.
16 dollar deerskin leather work gloves I can get from harbor freight aren't gonna be the thing that let me FIRE or not lol.

Dude, you've been around long enough that you should know the the answer to that question if we're talking about Sushi.

What you really meant to ask was if he's taken the time to calculate how many pounds of biomass will need to be converted to syngas to adequately provide the energy for the farm equipment he'll be using and to heat square footage of the house he's going to build with the tools he made from the animals he hunted.

 

[calvnandhobbs68]

Dude, you've been around long enough that you should know the the answer to that question if we're talking about Sushi.

What you really meant to ask was if he's taken the time to calculate how many pounds of biomass will need to be converted to syngas to adequately provide the energy for the farm equipment he'll be using and to heat square footage of the house he's going to build with the tools he made from the animals he hunted.

I think Sushi likes to cosplay a prepper and actually doesn't have that calculated at all nor does he actually have a functional wood gasifier of any sort that he's using...if he does actually have one, it's not actually any more efficient or cost effective than grabbing some propane tanks and so would make no sense in "reducing the cost of living budget" but sounds impressive to people who are praising what he's talking about.

I think we might be kind of saying the same thing there though 🤣

 

[clozareal]

16 dollar deerskin leather work gloves I can get from harbor freight aren't gonna be the thing that let me FIRE or not lol.

Depends on how many leather work gloves you go through.

 

[Stagg737]

I think Sushi likes to cosplay a prepper and actually doesn't have that calculated at all nor does he actually have a functional wood gasifier of any sort that he's using...if he does actually have one, it's not actually any more efficient or cost effective than grabbing some propane tanks and so would make no sense in "reducing the cost of living budget" but sounds impressive to people who are praising what he's talking about.

I think we might be kind of saying the same thing there though 🤣

Kind of. I think if the options are cost-effectiveness vs self-sufficience Sushi is going to take the latter every time and I wouldn't be surprised if Sushi's already been experimenting with it in his backyard.

 

[Merovinge]

you wanna join me in the youtube channel? We can say provocative things to annoy the population and maybe get monetized on ad revenue.

I can't say provocative right wing talking points, but if you are interested in discussing mental health topics with guests I am certainly open to hoping onto a Youtube channel.

 

[randomdoc1]

I can't say provocative right wing talking points, but if you are interested in discussing mental health topics with guests I am certainly open to hoping onto a Youtube channel.

And THIS my friends is what the world has come to. All that med school and prestige. Just to make a better living as an internet troll. 🤣
I ain't kidding you, my former neighbor...cashed over 10 mil on youtube.

 

[Stumpyman]

What are some recommendations folks in psychiatry would have for job security?


I keep reading doom and gloom about our field, and as a graduating fourth year I really haven't seen a great job market, definitely not as booming as when I was in med school. Maybe reddit is overly negative, but the numbers speak for themselves. 10-12K total NPs in 2020 and 60K psychiatrists, and by 2020 NPs almost equal the number of psychiatrists. That kind of growth is alarming, and sure as docs we always say we provide a higher quality of care, but IMO administrators don't really care. I keep seeing inpatient gigs for docs dwindle and more NPs taking over CL/inpatient. I know it's geographically dependent, but when you flood the market with so many providers even the "less desirable" areas will see a squeeze. Also, some folks have told me to just go cash pay private practice but for early career psychiatrists that's not exactly easy to setup right away and also a lot of us prefer inpatient. I'm at a loss, would appreciate advice/thoughts from this forum

 

[Cath Up]

What are some recommendations folks in psychiatry would have for job security?


I keep reading doom and gloom about our field, and as a graduating fourth year I really haven't seen a great job market, definitely not as booming as when I was in med school. Maybe reddit is overly negative, but the numbers speak for themselves. 10-12K total NPs in 2020 and 60K psychiatrists, and by 2020 NPs almost equal the number of psychiatrists. That kind of growth is alarming, and sure as docs we always say we provide a higher quality of care, but IMO administrators don't really care. I keep seeing inpatient gigs for docs dwindle and more NPs taking over CL/inpatient. I know it's geographically dependent, but when you flood the market with so many providers even the "less desirable" areas will see a squeeze. Also, some folks have told me to just go cash pay private practice but for early career psychiatrists that's not exactly easy to setup right away and also a lot of us prefer inpatient. I'm at a loss, would appreciate advice/thoughts from this forum

Job cobbling. Have a W2 if you can then 1-3 1099 gigs. That way you can best play offers off of each other, negotiate better, and if demand for one goes down you can increase the others. I know a new attending doing this and they recently negotiated one gig from 250/hr up to 400/hr because they don’t enjoy it and they bring a ton of value. And security from other gigs.

 

[comp1]

The actual labor stats, as opposed to anecdotal observations, just do not support the doom and gloom. There are more than enough jobs for NPs and MDs. Salaries are up for both, well above inflation. I really think the only thing that can actually help people process this anxiety is to become an administrator and actually try to recruit and hire NPs and MDs

 

[finalpsychyear]

What are some recommendations folks in psychiatry would have for job security?


I keep reading doom and gloom about our field, and as a graduating fourth year I really haven't seen a great job market, definitely not as booming as when I was in med school. Maybe reddit is overly negative, but the numbers speak for themselves. 10-12K total NPs in 2020 and 60K psychiatrists, and by 2020 NPs almost equal the number of psychiatrists. That kind of growth is alarming, and sure as docs we always say we provide a higher quality of care, but IMO administrators don't really care. I keep seeing inpatient gigs for docs dwindle and more NPs taking over CL/inpatient. I know it's geographically dependent, but when you flood the market with so many providers even the "less desirable" areas will see a squeeze. Also, some folks have told me to just go cash pay private practice but for early career psychiatrists that's not exactly easy to setup right away and also a lot of us prefer inpatient. I'm at a loss, would appreciate advice/thoughts from this forum

Job cobble as mentioned. Doing a combo of inpt and outpt to build a PP. If i was starting as an attemding in 2026 id be working surgeon hours for a few years till i got a better idea of the landscape. Just 5 years ago the NP threat was being downplayed but i was seeing it and worked harder and i am glad i did. Now with Ai and np expansion i paused my reduction in hrs till 2030 to reevaluate. Hope im wrong.

 

[phantasmagoric]

I’ve been advised by several attendings—both recent graduates and more senior physicians—to consider pursuing a fellowship (e.g., child and adolescent psychiatry, forensics, interventional pain), as these subspecialty job markets appear to be somewhat less impacted by recent developments.

 

[FlowRate]

I’ve been advised by several attendings—both recent graduates and more senior physicians—to consider pursuing a fellowship (e.g., child and adolescent psychiatry, forensics, interventional pain), as these subspecialty job markets appear to be somewhat less impacted by recent developments.

Seems like it's really hard to make a career on forensic work alone. Advice from people on the forum who do that work is you need a solid clinical practice as well. There was another thread about pain and that most psychiatrists who do pain don't do the interventional part (underprepared before fellowship to do that sort of work.) Lots of NP's see children since they don't have to do a fellowship to do so.

I don't think job market concerns have meaningfully impacted that a fellowship in psychiatry should primarily function as a way of getting to do work that you're more interested in, rather than some sort of economic boon.

 

[finalpsychyear]

Seems like it's really hard to make a career on forensic work alone. Advice from people on the forum who do that work is you need a solid clinical practice as well. There was another thread about pain and that most psychiatrists who do pain don't do the interventional part (underprepared before fellowship to do that sort of work.) Lots of NP's see children since they don't have to do a fellowship to do so.

I don't think job market concerns have meaningfully impacted that a fellowship in psychiatry should primarily function as a way of getting to do work that you're more interested in, rather than some sort of economic boon.

I should probably add a disclaimer that standard big box shop jobs 250-300k are still abundant. Its just getting harder in other ways i.e. only nps being hired at existing shops and the ratio of MD/NPs will get slimmer esp in states that get rid of the collab agreements.

 

[Wilf]

I really think the only thing that can actually help people process this anxiety is to become an administrator and actually try to recruit and hire NPs and MDs

I am an administrator of a fairly large mental health entity. We are not having trouble finding psychiatrists or midlevels, and I would not say we are a particularly desirable location or workplace, around middle for both. The proliferation of DO schools, and even MD schools to a lesser extent, the past 5+ years has been a real hit, in addition to the massive proliferation of NP programs as mentioned many times. Imagine how it will be in 5 years when all those DO schools/residencies and NP mills have been pumping them out full force (if AI has not taken over by then).

For many years when I have heard people shouting, "we need more medical schools!!", "we need more psychiatry residencies!!!", I always said that it needed to be done thoughtfully if we did not want to become saturated. What a shock, it was not done thoughtfully.

 

[comp1]

I am an administrator of a fairly large mental health entity. We are not having trouble finding psychiatrists or midlevels, and I would not say we are a particularly desirable location or workplace, around middle for both. The proliferation of DO schools, and even MD schools to a lesser extent, the past 5+ years has been a real hit, in addition to the massive proliferation of NP programs as mentioned many times. Imagine how it will be in 5 years when all those DO schools/residencies and NP mills have been pumping them out full force (if AI has not taken over by then).

For many years when I have heard people shouting, "we need more medical schools!!", "we need more psychiatry residencies!!!", I always said that it needed to be done thoughtfully if we did not want to become saturated. What a shock, it was not done thoughtfully.

You are very fortunate and definitely in the minority of every survey I have ever seen of hiring managers.

 

[Taddy Mason]

Maybe reddit is overly negative, but the numbers speak for themselves.

I really despise Reddit, but wouldn’t say it’s overly pessimistic in this case given threads like this one, posts I’ve come across on the Psychiatry Network FB group, and my own experience of trying to find a new job for the past 3 months (finally found one a few weeks ago, but have to move halfway across the country to the middle of nowhere). I do think there are differences in demand geographically, but even recruiters I’ve spoken with over the past several months have made comments about not having to look as hard for psychiatrists/positions filling quicker and more easily and Midwest recruiters seeing a larger influx of applicants from the east coast with no ties to the areas.

 

[splik]

Job Security today means the ability to keep working in your field, not keeping the exact same job. And most people don't want to stay in the same job forever nowadays and that kind of longevity isn't rewards (usually means less pay due to salary flattening) or desired by most gen-zers or millennials. From that perspective, psychiatry offers a level of job security that very few non-medical fields have.

If you don't want to compete with NPs, then don't compete with NPs. Don't take crappy jobs that see NPs as interchangeable. Don't work with big telehealth platforms, pillmills, or contract with MSOs like Headway or Alma (which have 10:1 NPs: Psychiatrists). Don't take jobs where your role is relegated to be a "prescriber". Don't limit yourself to a very narrow biomedical view of psychiatry.

Get the best training you can. Strongly consider fellowship training. Continue to build your skills and knowledge. Continue reading and attending conferences. Seek out peer consultation. Build your brand and reputation. Master soft skills. Become proficient in systems based practice. Hone your skills in formulation and psychotherapy (regardless of whether you do psychotherapy proper).

There are definitely a lot of NPs nowadays but in some ways they have been a convenient scapegoat. There are also way more psychiatry residents graduating than ever before and older psychiatrists often don't retire. Add to that, once you were limited to your community, but now people zoom in to different communities and offer telehealth which affects competition. Private Equity and Venture Capital have "disrupted" the mental health arena in the worst way.

The new "golden age" of psychiatry is over. It was never going to last. And yet we still have it very good and more AI proof than most. By the time AI comes for our jobs, it will be the very last of our worries.

 

[comp1]

Older psychiatrists DO retire, on average around age 72. As with everything baby boomer related, even with delays, there are actual biologic limits involved here. Even with the increased numbers of training spots, there will be 20% fewer psychiatrists in 2030 than last year.

 

[Stumpyman]

Older psychiatrists DO retire, on average around age 72. As with everything baby boomer related, even with delays, there are actual biologic limits involved here. Even with the increased numbers of training spots, there will be 20% fewer psychiatrists in 2030 than last year.

And that is true, but near me an HCA facility opened up 2 separate new psych residencies, with class sizes >10. More and more keep popping up each year. That, and the NP proliferation being SO rapid, more than any other branch of medicine, is really scary for an early career psychiatrist. And it seems like people all over are echoing that sentiment, as Taddy Mason mentioned it's not just doomers on reddit.

I've been thinking hard about pivoting to pain. I've always enjoyed procedures (though not major surgeries) and have done a lot of work with chronic pain patients through outpatient therapy. But I'd be lying if I said it isn't a hedge against where our field is going. Pain is in a strong downtrend right now due to compensation changes, but it's so much more midlevel proof and IMO there will always be a rising need for pain docs. Plus they have so many new innovations and procedures on the horizon

 

[Stagg737]

What are some recommendations folks in psychiatry would have for job security?


I keep reading doom and gloom about our field, and as a graduating fourth year I really haven't seen a great job market, definitely not as booming as when I was in med school. Maybe reddit is overly negative, but the numbers speak for themselves. 10-12K total NPs in 2020 and 60K psychiatrists, and by 2020 NPs almost equal the number of psychiatrists. That kind of growth is alarming, and sure as docs we always say we provide a higher quality of care, but IMO administrators don't really care. I keep seeing inpatient gigs for docs dwindle and more NPs taking over CL/inpatient. I know it's geographically dependent, but when you flood the market with so many providers even the "less desirable" areas will see a squeeze. Also, some folks have told me to just go cash pay private practice but for early career psychiatrists that's not exactly easy to setup right away and also a lot of us prefer inpatient. I'm at a loss, would appreciate advice/thoughts from this forum

Reddit is absolutely overly negative. There was literally a thread complaining that the job market is awful because there weren't any inpatient jobs in San Diego paying over $400k. If you're going to limit yourself to dream jobs in a one of the most desirable cities in the country you're going to be in for a rude awakening.

That said, your observations aren't totally off. I have noticed since becoming an attending that more residents seem to want inpatient psychiatry, which I do think is the one area that is starting to get harder to find. The positions for inpatient are obviously limited by availability of beds and you can't just make a new position without significant resources. So I can see how there would be less inpatient positions available especially in highly desirable cities. However, there are still an abundance of outpatient positions including the possibility of creating your own (which does NOT have to be cash only). The problem here is that many young graduates just want to see patients and get paid and don't want to take on any administrative responsibilities themselves.

Like others have referenced, if you just want to be a psychiatrist and are flexible the job market is still great. You may not get the setting your want (IP vs OP vs C/L or other) in the exact city you want making 75th percentile but if you're flexible you'll always be employed (for now). I literally get multiple e-mails per week for jobs all over the country, some of which seem like very solid opportunities and not just desperate or malignant rural positions. Or if you're willing to learn some business basics, you can certainly build a practice, though that likely takes planning and patience.

I say all this as an early career attending doing C/L knowing I could pivot and increase my income by 50%+ tomorrow if I really wanted to.

 

[comp1]

Yes, inpatient is amazing, but you do have to trade off things. I saw the job thread below about perfectly reasonable call schedules for inpatient and, quite frankly, a darn good academic salary and people were still pooh-poohing it here. For salaried jobs, go into the job interview volunteering for some sort of alternative work schedule if needed. Be confident with basic diabetes and high blood pressure management. Expect to stay the day and actually help out. Heck, offer to run groups even if they ultimately aren't interested. These are how you make yourself stand out with inpatient. Planning to round and bounce is not it.

 

[Taddy Mason]

That said, your observations aren't totally off. I have noticed since becoming an attending that more residents seem to want inpatient psychiatry, which I do think is the one area that is starting to get harder to find. The positions for inpatient are obviously limited by availability of beds and you can't just make a new position without significant resources.

It doesn’t help that there’s a continuous decline in general hospital and community psych beds nation wide, and the only thing keeping the number of total psych beds stagnant/only slightly declining is private equity/for-profit beds (read - less desirable job positions). On the other side of inpatient, C/L, the market is also getting tighter as well. I’m currently in one of the densest areas for C/L training programs and have a number of friends who are C/L psychiatrists, and many are ending up with outpatient and non C/L gigs out of necessity not choice (and this isn’t because they’re trying to stay specifically in this area).

 

[Taddy Mason]

I saw the job thread below about perfectly reasonable call schedules for inpatient and, quite frankly, a darn good academic salary and people were still pooh-poohing it here.

People were just poo-pooing the salary; however, the salary from that thread was well within the range for what is being offered in the NE, even in rural areas.

 

[Stagg737]

Yes, inpatient is amazing, but you do have to trade off things. I saw the job thread below about perfectly reasonable call schedules for inpatient and, quite frankly, a darn good academic salary and people were still pooh-poohing it here. For salaried jobs, go into the job interview volunteering for some sort of alternative work schedule if needed. Be confident with basic diabetes and high blood pressure management. Expect to stay the day and actually help out. Heck, offer to run groups even if they ultimately aren't interested. These are how you make yourself stand out with inpatient. Planning to round and bounce is not it.

I said total comp would be "a little low" if it wasn't academic. Average inpatient pay is over $300k for salary alone and rural inpatient should be well over that unless it's a 5 bed unit. Agree with the rest of this though. The attitude of "I showed up, now pay me" is something I have noticed more and more and is not beneficial to anyone.

 

[NeedAdvicelol]

Yes, inpatient is amazing, but you do have to trade off things. I saw the job thread below about perfectly reasonable call schedules for inpatient and, quite frankly, a darn good academic salary and people were still pooh-poohing it here. For salaried jobs, go into the job interview volunteering for some sort of alternative work schedule if needed. Be confident with basic diabetes and high blood pressure management. Expect to stay the day and actually help out. Heck, offer to run groups even if they ultimately aren't interested. These are how you make yourself stand out with inpatient. Planning to round and bounce is not it.

Lol if you're talking about the one job I posted a few days back... yea took me 6-8 months to come across that one. Whereas a couple years back you'd have 5 similar offers within the first month of looking. Ultimately tho I may not take it- spoke with someone who's currently over there and the call does not seem as easy as management says it is.

 

[UHNWI7$]

Job Security today means the ability to keep working in your field, not keeping the exact same job. And most people don't want to stay in the same job forever nowadays and that kind of longevity isn't rewards (usually means less pay due to salary flattening) or desired by most gen-zers or millennials. From that perspective, psychiatry offers a level of job security that very few non-medical fields have.

If you don't want to compete with NPs, then don't compete with NPs. Don't take crappy jobs that see NPs as interchangeable. Don't work with big telehealth platforms, pillmills, or contract with MSOs like Headway or Alma (which have 10:1 NPs: Psychiatrists). Don't take jobs where your role is relegated to be a "prescriber". Don't limit yourself to a very narrow biomedical view of psychiatry.

Get the best training you can. Strongly consider fellowship training. Continue to build your skills and knowledge. Continue reading and attending conferences. Seek out peer consultation. Build your brand and reputation. Master soft skills. Become proficient in systems based practice. Hone your skills in formulation and psychotherapy (regardless of whether you do psychotherapy proper).

There are definitely a lot of NPs nowadays but in some ways they have been a convenient scapegoat. There are also way more psychiatry residents graduating than ever before and older psychiatrists often don't retire. Add to that, once you were limited to your community, but now people zoom in to different communities and offer telehealth which affects competition. Private Equity and Venture Capital have "disrupted" the mental health arena in the worst way.

The new "golden age" of psychiatry is over. It was never going to last. And yet we still have it very good and more AI proof than most. By the time AI comes for our jobs, it will be the very last of our worries.

What are some conferences that you have found to consistently offer a valuable learning experience?

 

[Cath Up]

I am an administrator of a fairly large mental health entity. We are not having trouble finding psychiatrists or midlevels, and I would not say we are a particularly desirable location or workplace, around middle for both. The proliferation of DO schools, and even MD schools to a lesser extent, the past 5+ years has been a real hit, in addition to the massive proliferation of NP programs as mentioned many times. Imagine how it will be in 5 years when all those DO schools/residencies and NP mills have been pumping them out full force (if AI has not taken over by then).

For many years when I have heard people shouting, "we need more medical schools!!", "we need more psychiatry residencies!!!", I always said that it needed to be done thoughtfully if we did not want to become saturated. What a shock, it was not done thoughtfully.

MD matriculants 2010: 18600
MD matriculants 2024: 23000
diff: 4400

DO matriculants 2010: 5200
DO matriculants 2024: 10400
diff: 5200

I totally agree DO school proliferation is an issue, and it is concerning to me. And DO percentage growth is obviously greater. But the change is not that different between MD and DO going back the last 15 or so years. Additionally, MDs enter psychiatry at a
~3:1 ratio to DOs compared to a~2.4:1 ratio of grads.

 

[HemeOncHopeful19]

MD matriculants 2010: 18600
MD matriculants 2024: 23000
diff: 4400

DO matriculants 2010: 5200
DO matriculants 2024: 10400
diff: 5200

I totally agree DO school proliferation is an issue, and it is concerning to me. And DO percentage growth is obviously greater. But the change is not that different between MD and DO going back the last 15 or so years. Additionally, MDs enter psychiatry at a
~3:1 ratio to DOs compared to a~2.4:1 ratio of grads.

It’s less about proliferation of schools IMO although it certainly is an issue.

NRMP releases match data every year and the # of Psych residency spots is probably more important. In theory the rise of DOs would just push out some of the FMGs/IMGs from the match over time.

Coincidentally I don’t know the Psych numbers off the top of my head but I love to cite NRMP data whenever someone talks about the conspiracy of the doctor shortage being driven by greedy docs it is very easy to prove mathematically that residency spots have massively outpaced population growth (thus docs being trained per capita) over the past 20-30 years

 

[FatherPsychiatry]

I am an administrator of a fairly large mental health entity. We are not having trouble finding psychiatrists or midlevels, and I would not say we are a particularly desirable location or workplace, around middle for both. The proliferation of DO schools, and even MD schools to a lesser extent, the past 5+ years has been a real hit, in addition to the massive proliferation of NP programs as mentioned many times. Imagine how it will be in 5 years when all those DO schools/residencies and NP mills have been pumping them out full force (if AI has not taken over by then).

For many years when I have heard people shouting, "we need more medical schools!!", "we need more psychiatry residencies!!!", I always said that it needed to be done thoughtfully if we did not want to become saturated. What a shock, it was not done thoughtfully.

I was curious about this argument so I asked Claude:

Psychiatry Residency Positions Over Time (NRMP Match — Positions Offered)
The most reliable year-by-year data comes from NRMP Match reports. Here's what can be pieced together:

Match Year	Approx. Positions Offered	Notes
2015	~1,490	AAMC data: 5.3% growth from 2010–2015
2016	~1,570	Baseline for 34% growth calculation
2017	~1,640	Steady growth period
2018	~1,710
2019	~1,800
2020	~1,900	34% increase from 2016 to 2020 per published data
2021	~1,910	NRMP baseline for recent comparisons
2022	2,047	Highest on record at the time; 99.2% fill rate
2023	~2,200	Continued growth
2024	~2,300
2025	~2,388	+25.2% from 2021 (481 more positions)
2026	2,516	+128 over 2025; 97.4% fill rate

Quite a jump.

Subjectively, I feel like I run into someone every couple months in my large metro (Los Angeles) from a local residency I've never heard of before and definitely wasn't around when I was applying for residency in mid 2010s. Like this:

Psychiatry Residency Program

Psychiatry Residency Program | Brain Health USA – Van Nuys Home About Mission Training Sites Curriculum Research Benefits Apply Faculty Contact Us × Home About Mission Training Sites Curriculum Research Benefits Apply Faculty Contact Us Home/Psychiatry Residency Program PsychiatryResidency...

brainhealthusa.com

 

[Stagg737]

Yes, it’s the proliferation of residency positions, not just medical schools that drives supply as residency is the real bottleneck. I’ve gotten 4 or 5 emails in the past few months alone asking if I would be interested in being the program Director for a new residency program. All but one of those or maybe two our programs being started at HCA hospitals.

 

[comp1]

Why ask AI about residency positions and not projected numbers of psychiatrists?

 

[FatherPsychiatry]

Why ask AI about residency positions and not projected numbers of psychiatrists?

I like AI but I'd rather stick to objective numbers that I can verify if possible. Right now if I ask about material like projections, it might tell me that goblins might start managing psych meds lol

 

[Merovinge]

I was curious about this argument so I asked Claude:

Quite a jump.

Subjectively, I feel like I run into someone every couple months in my large metro (Los Angeles) from a local residency I've never heard of before and definitely wasn't around when I was applying for residency in mid 2010s. Like this:

Psychiatry Residency Program

Psychiatry Residency Program | Brain Health USA – Van Nuys Home About Mission Training Sites Curriculum Research Benefits Apply Faculty Contact Us × Home About Mission Training Sites Curriculum Research Benefits Apply Faculty Contact Us Home/Psychiatry Residency Program PsychiatryResidency...

brainhealthusa.com

I believe the initial epoch when psychoanalysis was trendy psych was quite competitive and brought quite strong med students. Then when I was in training a lot of the older psychiatrists were IMGs (nothing against them, just less competitive applicants) or clearly not the brightest docs in their classes due to how non-competitive psychiatry was. Then it got trendy and became a mid tier competitiveness specialty and most of the residents I met at reasonable academic programs were quite good. Now we have rampant growth among spots and quality is going to decline again. Let's see what the next chapter unfolds...

 

[FatherPsychiatry]

I believe the initial epoch when psychoanalysis was trendy psych was quite competitive and brought quite strong med students. Then when I was in training a lot of the older psychiatrists were IMGs (nothing against them, just less competitive applicants) or clearly not the brightest docs in their classes due to how non-competitive psychiatry was. Then it got trendy and became a mid tier competitiveness specialty and most of the residents I met at reasonable academic programs were quite good. Now we have rampant growth among spots and quality is going to decline again. Let's see what the next chapter unfolds...

Definitely. The residency program affiliated with my medical school (lower tier mid-west school) used to be almost all IMG/FMG with the occasional DO / American grad back when I was there. Now its entirely US MD grads including several Ivy league MD grads!!

 

[Stagg737]

Definitely. The residency program affiliated with my medical school (lower tier mid-west school) used to be almost all IMG/FMG with the occasional DO / American grad back when I was there. Now its entirely US MD grads including several Ivy league MD grads!!

This is true. My old residency program is somewhat similar in that IMGs used to be common but now they are very rare. DOs are still common there, but that's partially because there's a major DO school in town that rotates at the medical center. My biggest concern is the quality of MDs entering psychiatry. I think a lot of these threads on sites saying "I was told psych was the land of mild and honey, what do you mean jobs aren't lining up in front of me to be filled?" speaks a lot to the mentality of a lot of current residents where there's some entitlement and less of a work ethic in general as they prioritize being in an "easy" field as much as or more than they actually have interest in the field. This could partially be that many residents don't enjoy consults like other areas of psychiatry which is where I interact with them the most. However, even when I staff inpatient or OP clinic being able to leave seems to often be more of a priority than learning.

 

[TexasPhysician]

Definitely. The residency program affiliated with my medical school (lower tier mid-west school) used to be almost all IMG/FMG with the occasional DO / American grad back when I was there. Now its entirely US MD grads including several Ivy league MD grads!!

A residency program in Texas matched 100% IMG/FMG 17 years ago. Last 15 years combined - 0% IMG/FMG

 

[Taddy Mason]

Definitely. The residency program affiliated with my medical school (lower tier mid-west school) used to be almost all IMG/FMG with the occasional DO / American grad back when I was there. Now its entirely US MD grads including several Ivy league MD grads!!

Same with my med school (lower tier midwest). It was all IMGs/FMGs when I graduated in 2018 but for the past several years has been all US MD grads.

 

[Stumpyman]

This is true. My old residency program is somewhat similar in that IMGs used to be common but now they are very rare. DOs are still common there, but that's partially because there's a major DO school in town that rotates at the medical center. My biggest concern is the quality of MDs entering psychiatry. I think a lot of these threads on sites saying "I was told psych was the land of mild and honey, what do you mean jobs aren't lining up in front of me to be filled?" speaks a lot to the mentality of a lot of current residents where there's some entitlement and less of a work ethic in general as they prioritize being in an "easy" field as much as or more than they actually have interest in the field. This could partially be that many residents don't enjoy consults like other areas of psychiatry which is where I interact with them the most. However, even when I staff inpatient or OP clinic being able to leave seems to often be more of a priority than learning.

At the place I trained at, residents would be irate if they had to stay past 1PM when on a psych rotation. 2 new evaluations today? I'm slammed and working too hard.

Maybe there's a bit of a generational divide. But also, the constant hammering of "HUGE shortage of psychiatrists" and "Psych is work-life balance specialty" has corrupted the minds of a lot of residents. I think we can or used to be a work-life balance specialty, but in looking at the job market, if you want to make a market rate salary, you work similar to many other specialties. There are a lot of new residencies every year in psych, and many of them being at for-profit hospitals that don't *need* psych residents, so there's an overemphasis on work-life balance during residency, where I've known many residents who never worked more than 25-30 hrs/week while on psych. This perpetuates the same oversaturation cycle, how can we claim to be providing better care than the NPs when our primary goal is to leave by noon and not provide much more value to the hospital/patients?

 

[comp1]

I do think that psychiatrists should generally expect to be working similarly to internists in terms of hours. I still think it's less draining. I do think residencies could probably do a bit more to prep residents for workload expectations post graduation, but honestly the change is universal. ACGME reduced workload for all specialties. Psych just started out a bit lower.

 

[Stagg737]

At the place I trained at, residents would be irate if they had to stay past 1PM when on a psych rotation. 2 new evaluations today? I'm slammed and working too hard.

Maybe there's a bit of a generational divide. But also, the constant hammering of "HUGE shortage of psychiatrists" and "Psych is work-life balance specialty" has corrupted the minds of a lot of residents. I think we can or used to be a work-life balance specialty, but in looking at the job market, if you want to make a market rate salary, you work similar to many other specialties. There are a lot of new residencies every year in psych, and many of them being at for-profit hospitals that don't *need* psych residents, so there's an overemphasis on work-life balance during residency, where I've known many residents who never worked more than 25-30 hrs/week while on psych. This perpetuates the same oversaturation cycle, how can we claim to be providing better care than the NPs when our primary goal is to leave by noon and not provide much more value to the hospital/patients?

Lol, it's not that bad where I'm at, but I agree that I can see where the entitlement comes from. There are more USMDs matching psych than before, but I'd argue we're seeing "better candidates" enter psych who have attitudes that it should just be easy. Obviously many residents are great and maybe I'm just getting a larger sample size now, but the talking to attendings around my age there is a stark difference in what we thought was a reasonable workload and lifestyle vs what current residents expect.

I do think that psychiatrists should generally expect to be working similarly to internists in terms of hours. I still think it's less draining. I do think residencies could probably do a bit more to prep residents for workload expectations post graduation, but honestly the change is universal. ACGME reduced workload for all specialties. Psych just started out a bit lower.

Idk that we should be working similar hours to internists (depending on what you consider "normal" for internists) and imo psych is significantly MORE draining. That said, I do think expectations need to be managed a lot better. Telling my residents to look at the C/L rotation like a medicine rotation seems to help.

 

[Wilf]

I do think that psychiatrists should generally expect to be working similarly to internists in terms of hours. I still think it's less draining. I do think residencies could probably do a bit more to prep residents for workload expectations post graduation, but honestly the change is universal. ACGME reduced workload for all specialties. Psych just started out a bit lower.

Completely ridiculous to say psychiatrists should work the same amount as internists. The quality of psychiatrists would decrease for sure. I agree with Stagg that psychiatry is more draining, and I believe largely due to documentation. Almost every specialty has much easier (and wiser) documentation than psychiatry. Psychiatrists who think long rambling notes are great (~33-66% of psychiatrists?) do not realize that they do not help with lawsuits (and sometimes make it worse) and that the next provider does not have the time/desire to read a biography on the patient to find out that olanzapine was increased to 20 mg. Imagine how great psychiatry would be if we wrote IM/FM/surgery/peds type notes!

 

[comp1]

It can be ridiculous and also still the expectation... I think it's telling in the first statements that psychiatrists don't "work" as much as internists. Work can mean a lot of things. I personally specified hours, but it may mean things like emotional labor too. That's what I always assumed is what is meant by draining in the field. I think that's going to be even less reimbursed going forward (it's not much now) and thus the field directed towards less of it, either in the type of people recruited or the processes or both. In terms of documentation, I didn't quite follow. Is more documentation something the market should direct towards or away? Personally I adore long documentation and I don't find it draining to write or read, medicolegally helpful or not. Regardless, I think AI will ultimately eliminate the documentation part, so that's not really a long term issue.

 

[mistafab]

Not sure what the hubbub is about psych working hard. We basically don't work hard. We write short fan fics on our patients and get paid lots of money to sit at a desk. We work 40 hours a week or less on average. We dispense little tablets that make people less sad or hear less voices. Really a great specialty. For most settings we are not responding to codes, onerous call, or weekends/nights. What a dream we have, helping people enormously and getting paid well too! Much better than shoveling ditches. Or driving into the hospital at 2am on a Thursday to stick a tube in someone's brain. Or worse, a stat ex lap on a bowel catastrophe (REMEMBER THE SMELL??).

Lots of the note can be sped up with smart phrases. We can document during the visit. We can charge money for the patient to sit there as we author their little story and order their little tablets. Their life gets changed from a few keystrokes and active listening grunts, or body language gesticulations. "Stop doing drugs" - another life changed. I'll bill for motivational interviewing. PHQ9 filled out prior to any visit? I reviewed that page, that's another bill. Gad7 is critical too. Critical to your treatment, actually - that's 40 dollars. Your kids notice you're a better human now after 3 months of sertraline dust and being told to stop being a jerk. You get promoted at work. You stop assaulting strangers. Little victories here and there. What an awesome job. Haldol for everyone.

 

[MedMan80]

Not sure what the hubbub is about psych working hard. We basically don't work hard. We write short fan fics on our patients and get paid lots of money to sit at a desk. We work 40 hours a week or less on average. We dispense little tablets that make people less sad or hear less voices. Really a great specialty. For most settings we are not responding to codes, onerous call, or weekends/nights. What a dream we have, helping people enormously and getting paid well too! Much better than shoveling ditches. Or driving into the hospital at 2am on a Thursday to stick a tube in someone's brain. Or worse, a stat ex lap on a bowel catastrophe (REMEMBER THE SMELL??).

Lots of the note can be sped up with smart phrases. We can document during the visit. We can charge money for the patient to sit there as we author their little story and order their little tablets. Their life gets changed from a few keystrokes and active listening grunts, or body language gesticulations. "Stop doing drugs" - another life changed. I'll bill for motivational interviewing. PHQ9 filled out prior to any visit? I reviewed that page, that's another bill. Gad7 is critical too. Critical to your treatment, actually - that's 40 dollars. Your kids notice you're a better human now after 3 months of sertraline dust and being told to stop being a jerk. You get promoted at work. You stop assaulting strangers. Little victories here and there. What an awesome job. Haldol for everyone.

 

[WolfBoy3000]

Not sure what the hubbub is about psych working hard. We basically don't work hard. We write short fan fics on our patients and get paid lots of money to sit at a desk. We work 40 hours a week or less on average. We dispense little tablets that make people less sad or hear less voices. Really a great specialty. For most settings we are not responding to codes, onerous call, or weekends/nights. What a dream we have, helping people enormously and getting paid well too! Much better than shoveling ditches. Or driving into the hospital at 2am on a Thursday to stick a tube in someone's brain. Or worse, a stat ex lap on a bowel catastrophe (REMEMBER THE SMELL??).

Lots of the note can be sped up with smart phrases. We can document during the visit. We can charge money for the patient to sit there as we author their little story and order their little tablets. Their life gets changed from a few keystrokes and active listening grunts, or body language gesticulations. "Stop doing drugs" - another life changed. I'll bill for motivational interviewing. PHQ9 filled out prior to any visit? I reviewed that page, that's another bill. Gad7 is critical too. Critical to your treatment, actually - that's 40 dollars. Your kids notice you're a better human now after 3 months of sertraline dust and being told to stop being a jerk. You get promoted at work. You stop assaulting strangers. Little victories here and there. What an awesome job. Haldol for everyone.

I can't tell how much of this is pseudo-real and how much is satire but... I'm in! - M3 in need of hope amidst the d&g (doom n gloom)

 

[FatherPsychiatry]

I can't tell how much of this is pseudo-real and how much is satire but... I'm in! - M3 in need of hope amidst the d&g (doom n gloom)

Maybe it seems sort of dark in this thread, but its still a good job / market overall IMO, just not as good as ~5-10 years ago or so. Now you may have to make more compromises than before, such as geography, salary, call requirements etc, but there's still plenty of work out there. Whereas five years ago you had a higher chance of getting a "golden" job that ticks most/all of your boxes.

With all that being said, I would do psych in today's market than any other specialty in any market.