The heralded national shortage of psychiatrists

[WolfBoy3000]

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Agreed. I can't speak for everyone's experience but psychiatry has been a wonderful career choice for me. I have never struggled to find good work, though I consider in the 300-350k range for 40 hours of reasonable intensity work to be pretty good.

I also remember being a medical student deciding on a specialty almost 15 years ago and I heard lots of pessimism back then too. Admittedly things change and fields tend to do some regression to the mean, but I haven't personally experienced psychiatry becoming difficult to thrive in with reasonable expectations.

Psychiatry is GREAT! There's nothing better. There might be issues, sure, but they are easily managed and similar things likely happen in any other field. This thread should in no way dissuade someone from psych.

Thank you for the sentiment docs, I really want to go with my innate drive towards the field, but that’s how I ended up in med school in spite of growing saturation concerns. If so many attendings have already been noticing negative impacts in live time, how can I confidently decide psychiatry is a wise specialty choice compared to many other options?

Plus you are both established now and likely insulated from what new grads are experiencing, no? I won’t be in practice until the 2030’s..

I know autonomy & entrepreneurial potential is being extinguished across the board in medicine but IMO that was one of the golden advantages of psych. Feels more and more I’ll be destined to be a plug & play big box shop pawn. Plus a deflating salary? I want to believe it’ll all work out, but it increasingly feels like a recipe for regret :\

 

[NeedAdvicelol]

Okay sure in comparison to most other jobs, I agree. But is it too much to expect a great job after the exceptional rigor that is med school & residency? PMHNPs are truly a slap in the face..

Psych is likely transitioning from red hot (pre-pandemic and during start of pandemic) to warm in terms of the jobs. Don’t get me wrong, we’re still pretty decent in the big picture of things. You will be able to find a job. Def don’t worry about that.

What I’m noticing is that the quality of jobs out there has changed and it is no longer as easy to find something that checks most of your boxes on the first try. You used to have your pick of those. However that said, they do exist out there and people I know have found them.

True, there are more players now trying to tap into the psych field, whether they be NPs, Wall Street, etc. But I think if you’re strategic, you can still craft a career that you enjoy.

 

[lobstar]

This thread is a dagger through this M3s heart.. truly no other specialty seems as stimulating, meaningful, and enjoyable longterm. But if becoming a psychiatrist means having a good job will be like finding a needle in a haystack, what difference does it make! The one thing that gives me some optimism is that surely when psychedelics are legalized, treatment oversight will have to be in person right? Right?..

For what it's worth, as a non-trad that worked for a TMS device manufacturer, it was pretty clear to me even in 2023 that there really was not a scarcity of psychiatric providers. Our sales reps literally never ran out of people to pester lol (sorry if you were a victim).

But the 'shortage' Koolaid is strong. I drank it. Now to make the decision of a lifetime... F***

I don’t know, go talk to people of other specialties and everyone seems pretty burnt out, everyone says things got worse across the board since COVID. I would still do what you like. I remember when doing inpatient consults and it sure wasn't green grass everywhere else.

At the end of the day medicine applies personal liability to you, which just doesn't happen in other jobs, and holds you personally accountable for other people's shortcomings, so I think it's universal stress and some degree of saying f this.

But yes you can still find a good psych job it's just harder.

 

[calvnandhobbs68]

The extra kicker is that most of those SPMI/SMI patients aren't even going to hit criteria for 99215 at most appointments, so you're still billing mostly 99214 codes anyway.

I think he was envisioning longer appts with the 30-60 min appt slot thing. Even 30min appts with a few minutes of chart review and 5+ minutes of documentation on the same day will hit 99215s based on time (40+ min) if that's how you wanted to bill. It's not the most financially efficient way though.

 

[sloh]

So very true. I don't really know what the answer would be. If you reimbursed differently for various diagnoses and/or did a capitation model for covering a certain number of SMI pts, then you just incentivize misdiagnosis (likely fraud) and poor care. If you just do 1.5x private insurance, then places can just see non-SMI medicaid patients. I think it would need to be some sort of state-supported system that lived outside of FFS Medicaid, included validation of diagnoses (no idea what that looks like) and likely overpaying the psychiatrists involved. That said, because this group of people is so easily marginalized, I think it's unlikely to happen... realistically society just wants to minimize the impact folks with SMI have on other people in society... antipsychotics, state hospitals and jail do that fairly well.

The lesser of the evils would probably be a value based care model, which is extraordinarily difficult if not impossible to actually implement for patients with SMI. The math behind value-based care and risk-adjusted capitation sounds great in a boardroom, but the operational realities for clinics taking on complex populations are brutal.

Tracking "functional independence" or stability in severe patients is highly subjective. Tying revenue directly to these functional scores inevitably leads to documentation creep. Furthermore, no matter how pristine your clinical workflow or how audit-proof your charting is, you simply cannot out-prescribe social determinants of health. Penalizing a clinic's revenue because a patient lost their housing and couldn't refrigerate their meds is a fundamental mismatch of clinical accountability.

Then you run into the attribution nightmare and the financial float. Complex patients often navigate a highly fragmented web of specialists and out-of-network ER visits, making it impossible to accurately assign systemic failures to one clinic's PMPM clawback. On top of that, relying on a 12- to 18-month claims lag for withheld bonuses requires working capital that independent medical ventures just don't have. This structure naturally favors massive hospital systems and incentivizes private groups to engage in "lemon dropping"—selectively avoiding the absolute most severe, chaotic patients to protect their margins. Then we are back at square 1 again haha.

 

[Cath Up]

Okay sure in comparison to most other jobs, I agree. But is it too much to expect a great job after the exceptional rigor that is med school & residency? PMHNPs are truly a slap in the face..

It is helpful to keep in mind that the group here talking about great jobs are considering the cream of the crop of psychiatry jobs… stuff that is above average. One can find a job that ticks 2/3 of whatever boxes you decide are important to you fairly easily, and the realistic floor for salary is around 97th percentile in the US.

It has also always been the case that to get a “great” job you have to work a little harder - Building a private practice is a ton of work, networking or job cobbling takes a fair bit of effort. But yeah the average employed job has probably suffered a bit in the last several years due to midlevels. I don’t find myself feeling very pessimistic about jobs though (I had 4 job offers with straightforward paths to >400k, 2/4 involving an additional afternoon part time gig), as many people do eventually feel the difference of bad psychiatric management and seek better care.

 

[DareGreatly]

Thank you for the sentiment docs, I really want to go with my innate drive towards the field, but that’s how I ended up in med school in spite of growing saturation concerns. If so many attendings have already been noticing negative impacts in live time, how can I confidently decide psychiatry is a wise specialty choice compared to many other options?

Plus you are both established now and likely insulated from what new grads are experiencing, no? I won’t be in practice until the 2030’s..

I know autonomy & entrepreneurial potential is being extinguished across the board in medicine but IMO that was one of the golden advantages of psych. Feels more and more I’ll be destined to be a plug & play big box shop pawn. Plus a deflating salary? I want to believe it’ll all work out, but it increasingly feels like a recipe for regr

I mean, what sort of practice setting do you think you want to work in? I've seen your comments on this forum before and you see very anxious about committing to psychiatry even though it's your interest. You're trying to predict the future, which is impossible. I think A LOT would have to change for the average psychiatrist job to become poor/pawn-like. This is especially the case if you want to do outpatient psychiatry. Sure, you can't hang up your shingle, do no marketing/networking, only take cash and have a 6 month waiting list which was maybe the case for a short period of time in the past. But realistically, you can have a full case load with 200 patients if you do a modicum of therapy - do you really think the field is so saturated that you can't get 200 patients? You can do this easily if you take insurance (see the numerous case studies on this forum) or more slowly if you don't. Patients realize the expertise of psychiatrists and will seek them out over NPs (this happens to me all the time) - the real saturation is happening on the NP level - I think becoming an NP will look less and less appealing as time goes on and this will affect the numbers entering that field. Overall, I find this forum skews negative (which is common online) and seems divorced from the reality on the ground.

 

[Stagg737]

Okay sure in comparison to most other jobs, I agree. But is it too much to expect a great job after the exceptional rigor that is med school & residency? PMHNPs are truly a slap in the face..

As others have said, depends what you consider “great”. If your expectations are like some redditors and you only want inpatient jobs seeing 10 people per day and making $400k+ in San Diego or Seattle, then you’re in for a bad time. If you just want to practice outpatient in a city or decent suburb and are somewhat flexible about geography, there are plenty of options.

I know autonomy & entrepreneurial potential is being extinguished across the board in medicine but IMO that was one of the golden advantages of psych. Feels more and more I’ll be destined to be a plug & play big box shop pawn. Plus a deflating salary? I want to believe it’ll all work out, but it increasingly feels like a recipe for regret :\

Psych is by far the most insulated from this as the the barriers to create your own practice are still far lower than any other field of medicine. I’m 1000% confident that if I wanted to start my own private practice I could be full in 6 months, as our outpatient waitlist is over 1000 patients deep and 2 former co-residents have done exactly that in the last 3 years. If you’re willing to put the work in to build a PP, it is still very doable. Most younger graduates just don’t want to do that. I can’t tell you how many times I’ve heard: “I don’t want to deal with admin stuff. I just want to see patients and collect my paycheck.” As I’ve said before, that’s definitely an option, but you’ll almost never make as much and won’t ever have the same security as building a practice yourself.

 

[FatherPsychiatry]

 

[comp1]

I get feeling that a current med student might feel that practicing attendings don't fully grasp their anxiety, but the reality of the situation is...what are you thinking is better than psychiatry? What are you thinking is better than medicine, particularly if you're already in med school? AI is theoretically coming for every job, from plumbing to stock trading. There are NP surgical fellowships. You can spend your life trying to guess things or focusing on a past that was supposedly better, but that's not much of a life.

 

[FlowRate]

Okay sure in comparison to most other jobs, I agree. But is it too much to expect a great job after the exceptional rigor that is med school & residency? PMHNPs are truly a slap in the face..

Depends quite heavily on what you mean by "great." All jobs in medicine are stressful and expect you to actually be working the vast majority of your day. Most jobs in medicine require more hours (either officially or unofficially) or call or both. Almost every other specialty has a higher chance of seriously harming or killing a patient as a direct result of a medical decision that you make.

The relatively low stress, high pay (hourly and annually), and reasonable work hours in psych are pretty optimal whether you compare to other specialties or to all other possible jobs.

 

[mistafab]

Yeah the market is still great for psych currently. This may not be the case forever. Right now, and likely for at least the next 5 years, anyone with a few ounces of business savvy can get great jobs still. Fair jobs are plentiful. Good jobs are around but need some networking, luck, or savv.

You absolutely can make 400k working 40-50 hours a week. I'm doing that now. You can do that pretty much straight out of residency.

You absolutely can work less than average in medicine without call requirements and still make 250-300 to start (or more) after residency. 40 hours or less.

Psych also has benefitted the most from tele-work compared to other specialties. I hate tele work but the work is out there if you want it. As PE keeps injecting itself into the tele market, the jobs will get worse and worse - but some opportunities that aren't bad are still out there. Especially hybrid jobs with local psych practices/orgs/big boxes.

 

[Merovinge]

Depends quite heavily on what you mean by "great." All jobs in medicine are stressful and expect you to actually be working the vast majority of your day. Most jobs in medicine require more hours (either officially or unofficially) or call or both. Almost every other specialty has a higher chance of seriously harming or killing a patient as a direct result of a medical decision that you make.

The relatively low stress, high pay (hourly and annually), and reasonable work hours in psych are pretty optimal whether you compare to other specialties or to all other possible jobs.

Yes anyone on this board should have made friends in residency with folks in hospital based IM, ED, surgery, gas. While psychiatry work is hard in a different way, listening to the death, lawsuits, issues around dying, etc should help put into perspective how good most of us have it.

 

[G Sheb]

Pushing back a little bit to the idea that our job is less stressful or demanding than others.
We spend 15-30 minutes talking to patients at least to be able to come at a proper diagnosis and treatment. The active listening needed is far more demanding than reviewing labs and writing notes or doing a quick physical exam.

 

[DareGreatly]

Pushing back a little bit to the idea that our job is less stressful or demanding than others.
We spend 15-30 minutes talking to patients at least to be able to come at a proper diagnosis and treatment. The active listening needed is far more demanding than reviewing labs and writing notes or doing a quick physical exam.

Agreed. Some days I fantasize about a less interpersonally demanding job. I think there's no escaping stress in medicine - it's just about what type you can tolerate or even enjoy at times.

 

[comp1]

Eh, FM has to do the same 15-30 minutes of active listening to the patient about their psych issues and ALSO manage their diabetes and HTN in the same timeframe. Psych is still much better. Someone's borderline PD doesn't resolve when they step into the orthopedic surgeon's office.

 

[Merovinge]

Pushing back a little bit to the idea that our job is less stressful or demanding than others.
We spend 15-30 minutes talking to patients at least to be able to come at a proper diagnosis and treatment. The active listening needed is far more demanding than reviewing labs and writing notes or doing a quick physical exam.

To be clear, I did say the work was difficult in a different way, psychiatry is by no means on the list of "easy" high paying jobs and most people do not have the fortitude to listen to the type of trauma I have treated in my career. In the UK, historically (not sure if this is still the case), psychiatrists are able to retire with full pension benefits several years before IM/FM/surgery. But compared to my friends in the ED, in the ICU, or my partner as a surgeon, I still think we come out with an overall less stressful setup.

 

[Candidate2017]

Thank you for the sentiment docs, I really want to go with my innate drive towards the field, but that’s how I ended up in med school in spite of growing saturation concerns. If so many attendings have already been noticing negative impacts in live time, how can I confidently decide psychiatry is a wise specialty choice compared to many other options?

Plus you are both established now and likely insulated from what new grads are experiencing, no? I won’t be in practice until the 2030’s..

Innate drive or interest towards a specialty doens't mean you will enjoy or stand the actual day to day work of a specialty. You don't know what you don't know. Med students tend to approach specialties as if they are PhDs choosing an area of science. For example, many people interested in neuroscience would likely hate the day to day work of neurology. A cognitive interest in the topics addressed by a specialty does not imply an interest in the actual work of a specialty, and vice versa. Am I cognitively interested in bones and joints? No. Can I tolerate swinging a hammer to pound home a bunch of knees and hips for $800k a year? Yes.

Realize that everyone in every specialty will burn out.

Figure out the specialties for which you are competitive, then narrow it down to the ones you can sort of see yourself not totally hate doing. Then pick the one that pays the most (the one that will financially allow you to move on after 10-15 years). As a bonus, at the end of those 10-15 years, you might prefer to continue to work in that specialty for another 20-30 years rather than retire early from medicine. Win-win.

 

[Candidate2017]

Yeah, I don't know what to believe. I think there's a shortage of high-quality insurance-based care (commercial, Medicare and Medicaid) in the outpatient setting. In my area, there are tons of virtual NPs, and they seem to have a lot of availability (i.e., it's oversaturated for them) but it's very difficult to get in with a psychiatrist. It's relatively hard to see anyone in-person, including NPs. If you pay cash/OON, you can see someone relatively quickly. So, I think it is generally a two-tiered system currently.

It's a two tiered system because psychiatry broke away from its origins as an inpatient specialty designed to treat SMI in the asylum. Listening to someone talk about their mild depression, anxiety, and ADHD wasn't the purpose of our specialty.

With the expansion of psychiatry residency slots, and the scare of NPs/AI/whatever, my guess is that psychiatry loses some of the sheen of the past 10 years and the quality of the average resident decreases. We will see, though.

Yes, there are some terrible residents.

 

[NeedAdvicelol]

Yes, there are some terrible residents.

Yea about the residents, funny you mention. Concurrent to all these changes that people are talking about, I’m also noticing a change in the type of resident applicants that psych attracts.

10+ years ago we were a magnet for foreign trained docs who wanted to get their foot in the door to do residency in the US. A lot of them were actually practicing in a different field back home, applied to the US and psych was the only thing they got into.

More recently I’m seeing lots more interest among US grads however theres two tiers. One is genuinely interested in mental health and cannot do without it. The other I feel like is burned out by medicine in general and is looking for a way out, picking psych for its perceived low stress and acuity. But once they start they realize that isn’t really the case and you have a sizable group who are unmotivated and allergic to work.

 

[clausewitz2]

Innate drive or interest towards a specialty doens't mean you will enjoy or stand the actual day to day work of a specialty. You don't know what you don't know. Med students tend to approach specialties as if they are PhDs choosing an area of science. For example, many people interested in neuroscience would likely hate the day to day work of neurology.

I resemble that remark.

 

[psydocc]

It's a two tiered system because psychiatry broke away from its origins as an inpatient specialty designed to treat SMI in the asylum. Listening to someone talk about their mild depression, anxiety, and ADHD wasn't the purpose of our specialty.

That's still not the purpose of our medical speciality, that is what therapists are for. Even in a simple case of mild depression, anxiety, and ADHD, a psychiatrist can be useful so that a patient does not end up on a PCP/NP cocktail of Lamictal 400mg, Xanax 2mg QID, and Adderall 30mg QID.

 

[clausewitz2]

It's a two tiered system because psychiatry broke away from its origins as an inpatient specialty designed to treat SMI in the asylum. Listening to someone talk about their mild depression, anxiety, and ADHD wasn't the purpose of our specialty.



Yes, there are some terrible residents.

Psychiatry as a specialty wasn't 'designed' to treat anything. It does have its origins in the alienists and medical superintendents of asylums but psychiatrists followed close behind the neurologists (who were the true pioneers of listening to someone talk about their mild depression and anxiety) once it became apparent that it was actually possible to find patients outside of said asylums.

Teleology is a mistake when it comes to historically contingent phenomena. We have the niche we do because of historical accidents, just like how critical care is not an intrinsic part of pulmonology and in many parts of the world most ICU docs are not coming out of pulm. Or how dentists are not medical doctors but opthalmologists are.

 

[Stagg737]

More recently I’m seeing lots more interest among US grads however theres two tiers. One is genuinely interested in mental health and cannot do without it. The other I feel like is burned out by medicine in general and is looking for a way out, picking psych for its perceived low stress and acuity. But once they start they realize that isn’t really the case and you have a sizable group who are unmotivated and allergic to work.

Idk that they’re even burned out. I think they just see psych as a “lifestyle specialty” or want all the perks of being a doctor without the hours and work of many other fields. There are more than a few psychiatrists who have a pretty significant social media presence, more so than other fields from what I see. Maybe it’s just a bias on my part, but I also agree that the types of applicants in general entering the field are different (ie, more US grads and less IMGs/FMGs).

 

[sloh]

Psychiatry as a specialty wasn't 'designed' to treat anything. It does have its origins in the alienists and medical superintendents of asylums but psychiatrists followed close behind the neurologists (who were the true pioneers of listening to someone talk about their mild depression and anxiety) once it became apparent that it was actually possible to find patients outside of said asylums.

Teleology is a mistake when it comes to historically contingent phenomena. We have the niche we do because of historical accidents, just like how critical care is not an intrinsic part of pulmonology and in many parts of the world most ICU docs are not coming out of pulm. Or how dentists are not medical doctors but opthalmologists are.

Indeed. The need to manage massive wards of patients in iron lungs (polio epidemics of the 1950’s), and the subsequent development of positive pressure ventilation, created the need for intensive, continuous care. While anesthesiologists largely control the ICU in Europe, in the United States, pulmonologists eventually claimed the medical ICU space because mechanical ventilation aligned heavily with pulmonary physiology.

 

[Merovinge]

Indeed. The need to manage massive wards of patients in iron lungs (polio epidemics of the 1950’s), and the subsequent development of positive pressure ventilation, created the need for intensive, continuous care. While anesthesiologists largely control the ICU in Europe, in the United States, pulmonologists eventually claimed the medical ICU space because mechanical ventilation aligned heavily with pulmonary physiology.

Thank you for that, I've always wondered how to explain the pulm/crit space to my European friends.

 

[comp1]

I'm still confused by dentists and podiatrists not being MDs on a regular basis.

 

[sloh]

I'm still confused by dentists and podiatrists not being MDs on a regular basis.

The dentists were rejected by us.
In the 1830s, pioneers of dentistry attempted to integrate dental education into medical schools in Maryland, but physicians rejected them, viewing tooth extraction as the crude work of barber-surgeons. Consequently, the Baltimore College of Dental Surgery was founded in 1840, forever splitting dentistry into its own siloed educational and regulatory path.

 

[Taddy Mason]

The dentists were rejected by us.
In the 1830s, pioneers of dentistry attempted to integrate dental education into medical schools in Maryland, but physicians rejected them, viewing tooth extraction as the crude work of barber-surgeons. Consequently, the Baltimore College of Dental Surgery was founded in 1840, forever splitting dentistry into its own siloed educational and regulatory path.

Interestingly the first postgraduate program in dental medicine (Stomatology) in the US was actually part of a medical school (BU).

 

[FlowRate]

The dentists were rejected by us.
In the 1830s, pioneers of dentistry attempted to integrate dental education into medical schools in Maryland, but physicians rejected them, viewing tooth extraction as the crude work of barber-surgeons. Consequently, the Baltimore College of Dental Surgery was founded in 1840, forever splitting dentistry into its own siloed educational and regulatory path.

Also kinda interesting how that integration eventually happened on the academic side, e.g. some DMD programs actually take (to varying degrees) the first two years of classes with the medical students at some schools (HMS/HSDM being one example, although I don't know if that changed after HMS redesigned the timing of the core clinical year 8ish years ago.)

 

[Stumpyman]

It’s been briefly mentioned here but I want to emphasize, the rise in shoddy, trash quality psych residency programs has been terrible for both quality of care and the job market for psychiatrists. The town I did residency in had 3 residencies open up during the four years I was there, one of them being HCA which was taking 12 residents a class. These places had NO business teaching residents, I would see what their notes and decision making looked like and it tended to lack any formulation, very questionable drug regimens, and a general lack of understanding of the nuances of psychiatry which we’ve always said separate us from NPs.

So all these residents are graduating and getting jobs, metro areas are becoming oversaturated. And psychiatry in general doesn’t care about med school or residency prestige, so despite residents not being “up to par”, the industrious ones are pushing into the previously higher paying jobs (I can say that has been true with locums). I’ve talked at length about NP oversaturation but physician oversaturation is just as concerning. When you churn out residents you are putting people in your job market workforce for 30+ years. I don’t know why there hasn’t been a pushback at all outside of random underseen comments on forums like this

 

[G Sheb]

It’s been briefly mentioned here but I want to emphasize, the rise in shoddy, trash quality psych residency programs has been terrible for both quality of care and the job market for psychiatrists. The town I did residency in had 3 residencies open up during the four years I was there, one of them being HCA which was taking 12 residents a class. These places had NO business teaching residents, I would see what their notes and decision making looked like and it tended to lack any formulation, very questionable drug regimens, and a general lack of understanding of the nuances of psychiatry which we’ve always said separate us from NPs.

So all these residents are graduating and getting jobs, metro areas are becoming oversaturated. And psychiatry in general doesn’t care about med school or residency prestige, so despite residents not being “up to par”, the industrious ones are pushing into the previously higher paying jobs (I can say that has been true with locums). I’ve talked at length about NP oversaturation but physician oversaturation is just as concerning. When you churn out residents you are putting people in your job market workforce for 30+ years. I don’t know why there hasn’t been a pushback at all outside of random underseen comments on forums like this

This is much bigger issue than NPs imo, which has always been overstated. There is an evident qualitative difference between the training NPs and MDs get, and the more NPs there are the more obvious the difference is. But when you lower the bar this much for medical school and residency, the two letters after your name matter even less and ironically you become even more susceptible to NP encroachment. This was obviously a political decision that was taken, which is I'm a bit skeptical about this never ending 'enormous' and 'critical' demand we keep hearing about. We have been very slow, late and ineffective in having any kind of voice in these decisions. It sure works great for hospital administrators to have their pick of doctors and pit them against each other.

It's going to be even more important for medical students to match into top residency programs. Don't think we want to see the medical field landscape turn into something more similar to law.

 

[FatherPsychiatry]

From my regional APA chapter:

Two New Psychiatry Residency Programs In The Inland Empire​

by Gillian Friedman, MD​

As of July 1, 2026, two new psychiatry residency programs in the Inland Empire have welcomed their inaugural PGY-1 residency classes, expanding psychiatrist training opportunities in this region of SCPS’s district that still experiences a great shortage of psychiatrists.

The Eisenhower Health Psychiatry Residency Program, based in Rancho Mirage, CA (Coachella Valley area) utilizes rotation sites at Eisenhower Medical Center in Rancho Mirage, Riverside University Health System in Riverside, Innercare (a regional healthcare facility for ambulatory/outpatient care), Barbara Sinatra Children’s Center in Rancho Mirage, and Desert Marriage and Family Counseling. As highlights of its training program, this residency program offers exposure to interventional psychiatry (including TMS and ketamine, with ECT services launching soon); a social medicine rotation serving vulnerable populations through street medicine, mobile health units, and community clinics; and opportunities for scholarly activity.

The Loma Linda University Health Education Consortium Psychiatry – Patton Program is a partnership between Loma Linda Health Education Consortium and Patton State Hospital to offer psychiatric training in both a public forensic setting and a community-based nonprofit psychiatric setting. Highlights of the training program include best practices in treating patients with the most intractable serious mental illness, including extensive experience with clozapine, ECT, and behavioral interventions like dialectical behavior therapy and CBT for psychosis. Says Roger Cabansag, M.D., Residency Program Director, “We are excited to partner with Loma Linda for a residency training program that offers extensive exposure to public and forensic psychiatry. There is a need for psychiatry residency programs to ensure that residents have experience treating patients with severe and persistent mental illness, including knowledge and comfort with using clozapine and ECT.”

These two psychiatry residency programs are the latest additions to growing training opportunities in the Inland Empire. The Loma Linda University Health Education Consortium Psychiatry – Redlands Program has trained psychiatry residents since 1965, and for a long time was the flagship training program for the Inland Empire. The psychiatry residency program at Arrowhead Regional Medical Center (San Bernardino County’s public hospital) originally started in 2008, and was granted formal accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in 2017. The psychiatry residency program at the Kaiser Permanente Fontana Medical Center was established in 2013, and the UC Riverside School of Medicine psychiatry residency program began in July 2014. Riverside University Health System (RUHS) officially started its own psychiatry residency program in 2020.

The Inland Empire is one of the fastest growing regions in California, and this growth – historically with few psychiatrists moving in – has led the region to face one of the most severe psychiatrist shortages in California, with only half as many psychiatrists per capita as the state average, according to 2024 data from the UCSF Healthforce Center. Expanding psychiatry residency training is an important mechanism to build the psychiatric workforce, for a number of reasons. First, graduating residents often choose to settle in the geographical area where they have trained. Indeed, Dr. Peter Ureste, Psychiatry Residency Training Director at UC Riverside, reports that greater than 30% of the residents who have graduated from UCR psychiatry residency have taken jobs in the Inland Empire. Second, academic programs become centers for excellence that offer important support for private practice psychiatrists and county behavioral health services, making those psychiatric jobs in the area more appealing.

Says Dr. Ureste, “Psychiatry residency training programs play a vital role in addressing the growing mental health needs of the Inland Empire by preparing psychiatrists who are committed to serving our region’s diverse communities. At UCR, residents train in a wide range of settings, including county behavioral health, Veterans Affairs, Patton State Hospital, community clinics, private health systems, and integrated primary care. These various community sites provide a well-rounded educational experience while fostering the adaptability, cultural humility, and commitment to public service needed to care for patients across the continuum of mental health and substance abuse disorders.”

SCPS Treasurer Daniel Fast, MD, who operates a solo private practice in Palm Springs, welcomes the start of Eisenhower’s psychiatry residency, as he has been juggling a very full panel and has many patients who drive hours to see him. “There is an extreme lack of psychiatrists in the Inland Empire; most of the practices are full and not everyone takes every insurance. Many patients end up for several months on a waiting list, particularly when one of the senior psychiatrists begins to cut back their practice.” He is hoping that the launch of Eisenhower’s psychiatry residency will also bring some opportunities for continuing education to psychiatrists in the area, as currently in-person opportunities require driving to Loma Linda or Riverside.

Programs are opening up left and right!!!

 

[comp1]

It is an underserved area for a reason. Price of LA, weather of Fresno.

 

[NeedAdvicelol]

From my regional APA chapter:


Programs are opening up left and right!!!

Yea they open these programs to “solve the shortage” in the inland empire, then scratch their heads when all their future grads take jobs in SF or LA.

Then they go back to the drawing board, next opening a program along the Salton sea. “Major Shortage Area Detected”

 

[comp1]

I mean statistically MOST people will stay where they do their residency. It's why I always tell med students that geography is the most thing since you have to think about where you want to spend the rest of your life, not just residency. However, not ALL residents stay there, particularly in places like Riverside. So if you try to fix this problem with just more and more residencies, you are definitely going to depress the market in actually preferable places well before you alleviate a shortage in the given area. I think pay differentials are likely to be more successful, but these places tend to go in the opposite direction instead. You need to be paid to live in Riverside specifically. You're already paying to live in LA.

 

[NeedAdvicelol]

I mean statistically MOST people will stay where they do their residency. It's why I always tell med students that geography is the most thing since you have to think about where you want to spend the rest of your life, not just residency. However, not ALL residents stay there, particularly in places like Riverside. So if you try to fix this problem with just more and more residencies, you are definitely going to depress the market in actually preferable places well before you alleviate a shortage in the given area. I think pay differentials are likely to be more successful, but these places tend to go in the opposite direction instead. You need to be paid to live in Riverside specifically. You're already paying to live in LA.

Agreed. I hope they implement a model similar to some rural NY programs where they offer loan assistance in exchange for staying in the area after graduation for a couple years.

 

[Stagg737]

I mean statistically MOST people will stay where they do their residency. It's why I always tell med students that geography is the most thing since you have to think about where you want to spend the rest of your life, not just residency. However, not ALL residents stay there, particularly in places like Riverside. So if you try to fix this problem with just more and more residencies, you are definitely going to depress the market in actually preferable places well before you alleviate a shortage in the given area. I think pay differentials are likely to be more successful, but these places tend to go in the opposite direction instead. You need to be paid to live in Riverside specifically. You're already paying to live in LA.

I wonder if there’s a significant difference (ie less people staying) when there is a highly desirable area in the same state <2 hours away. I know people tend to stay near where they did residency (though def not the case where I’m at the last 2-3 years), but what does “stay near” mean? Same town city? Same metro? Same state? I imagine when there’s a highly desirable place 1-3 hours away the motivation to stay local is a lot lower unless the person has major connections there pre-residency.

 

[comp1]

Yes, I think Riverside is in a particularly bad situation because it is a relatively very undesirable area (bad CA still beats most of the rest of the country) right next to a very desirable area. This is not quite like getting people to stay in Boise by building a program there. Rural isn't entirely right either, more like suburban blight. Residencies will not fix any of that.

 

[eyeeye_captain]

While I imagine the ~55% practice within 100 miles of their residency program stat is real, there are definitely some caveats. Literally half of the US population lives in the top 50 metros by population. None of those have less than 1M people. Obviously, that is where you’re going to have larger hospital systems and more residencies as well, so it’s not overly hard to match back home. From my experience, most people wind up somewhere relatively close to their and/or their spouse’s family. There’s a pretty strong drive to try to get a residency where you’re from. Natives of NYC, Texas, and California are notorious for staying.

My psych example of sticking around is someone who trained in what I imagine is an underserved area (still a 500k+ metro, and having visited, calling it a dump is an insult to dumps), and then stayed. The reason? Spouse had set up a retina practice in the metro during the totality of their training and it didn’t make financial sense to leave. So basically family again.

Cities are going to city. There are 111 metros over 500k in the US. If it’s a desirable place, maybe you can convince someone to hang around, but if not, good luck. Also 2 hours/100 miles to a nice place is a dang lot. Fun and flights are a slog to plan and do, even without kids. Some people, especially with niche stuff like beach, ski, lake etc. interests are fine with it, but most people have tasted city life during residency and it’s hard to go back - even the hicks from the sticks like me.

 

[Wilf]

Yes, there are some terrible residents.

We have a fairly new DO residency we work with (they of course also occasionally have MD) and I cannot believe the poor quality of some of the residents. I have noticed that it is pretty rare to find truly bad MDs and I think it is because of the USMLE (I have known a number of MDs who had to leave the field bc they could never pass Step 3 and in all these cases they did need to be weeded out.) Unfortunately, COMLEX is quite a bit easier and is not weeding out people who should be. I have also wondered if this is to decrease the difference in quality between doctors and midlevels by politicians.

 

[Stagg737]

We have a fairly new DO residency we work with (they of course also occasionally have MD) and I cannot believe the poor quality of some of the residents. I have noticed that it is pretty rare to find truly bad MDs and I think it is because of the USMLE (I have known a number of MDs who had to leave the field bc they could never pass Step 3 and in all these cases they did need to be weeded out.) Unfortunately, COMLEX is quite a bit easier and is not weeding out people who should be. I have also wondered if this is to decrease the difference in quality between doctors and midlevels by politicians.

I think that’s mainly the program you’re working with. There are definitely some DO programs that are worse than others and should be weeded out. That’s said, Level 3 is not really easier than Step 3. Some people say it is, but it’s a different kind of difficult and questions often don’t give enough info to get the correct answer without making inferences.

I agree though that the variability in quality of DOs is generally a lot wider than US MDs. It also makes bad US MDs stand out a lot more.

 

[Sushirolls]

Just got spam sent to my office.
FNP who is advertising as PCP AND as mental health expert for TRD....
Doing IV ketamine, Esketamine, hallucinogen assisted therapy, TMS, psych med management, and Trans hormones

FNP! Not even Psych MHNP.
This is the goat rodeo.

 

[finalpsychyear]

Just got spam sent to my office.
FNP who is advertising as PCP AND as mental health expert for TRD....
Doing IV ketamine, Esketamine, hallucinogen assisted therapy, TMS, psych med management, and Trans hormones

FNP! Not even Psych MHNP.
This is the goat rodeo.

Yup any and everyone is doing psych. Glad ive worked hard and saved and invested even harder. Entering phase 2 at the end of the decade.

 

[calvnandhobbs68]

Yup any and everyone is doing psych. Glad ive worked hard and saved and invested even harder. Entering phase 2 at the end of the decade.

I will say psych has always been perceived as the easy speciality people go to when they don't want to do medicine or surgery or whatever. What did all the interns in House of God end up doing? Psychiatry.

So this kind of ridiculous stuff has always been there, anesthesia setting up ketamine clinics, EM docs opening up "wellness clinics", FM advertising themselves as "mental health experts" or something. It's just the sheer volume of poorly trained NPs and the stuff they feel they should be able to do.

We're getting back to pre-Flexner report times lol history doesn't repeat itself but it sure does rhyme.

 

[psydocc]

I will say psych has always been perceived as the easy speciality people go to when they don't want to do medicine or surgery or whatever. What did all the interns in House of God end up doing? Psychiatry.

So this kind of ridiculous stuff has always been there, anesthesia setting up ketamine clinics, EM docs opening up "wellness clinics", FM advertising themselves as "mental health experts" or something. It's just the sheer volume of poorly trained NPs and the stuff they feel they should be able to do.

We're getting back to pre-Flexner report times lol history doesn't repeat itself but it sure does rhyme.

Psychiatry is by far the easiest speciality to do poorly without anyone (outside of psychiatrists) noticing.

 

[VA Hopeful Dr]

Psychiatry is by far the easiest speciality to do poorly without anyone (outside of psychiatrists) noticing.

FPs notice, we just don't have time to do anything about it

 

[Stagg737]

FPs notice, we just don't have time to do anything about it

Or just make it worse by throwing benzos and stims at everyone…

 

[VA Hopeful Dr]

Or just make it worse by throwing benzos and stims at everyone…

Gotta get those Press Ganey scores up!

 

[WartsnAll]

Hawaii and Vermont just passed RxP psychologist laws

Should upcoming residents and med students be worried? Idk how much the "shortage" ps psychiatrist will matter in the future when not only we have to deal with a bunch of NPs and degree mills popping up everywhere and now this

Seems they are pretty confident this will be more popular in the future in the psychologist forum. Although it's odd I barely hear a peep about it. I wonder how popular it is considering a small minority of psychologist presue RxP, even in states that had it for decades