A psychiatry residency is one of the in the US and Canada, especially as demand for mental health care grows. The pandemic; inflation; climate change; all these issues and more are causing people in the US and Canada to seek the services of a mental health professional. But there are a lot of reasons to pursue a career in psychiatry. Psychiatry, in general, lets you ; involves lifetime learning; the near-limitless career options in terms of where and who you can work with. Before all that, though, you have to complete at least five years of residency training before getting your licence. This article will go in detail into what a psychiatry residency is like in the US and Canada, and what you can do to get in.
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A psychiatry residency builds upon the psychiatry training you received in medical school and prepares you to enter the profession through a combination of clinical rotations, research experiences, and in-class instruction. A psychiatry residency is not that different from any other residency, such as a or an , in terms of structure and teaching methods. You have to complete a certain number of required rotations during your first years, and then choose among electives in subsequent years to better hone your particular skills or pursue your research interests; a typical psychiatry residency can last for a minimum of five years.
There are also a number of subspecialities within psychiatry, as with any other field of medicine. But there are five subspecialities recognized in both the US and Canada and offered at school and hospital-based programs in both countries. These subspecialties have their own accrediting and licensing bodies, while others are unregulated and do not have any accreditation or licensing scheme, although that does not mean these other subspecialties are illegitimate.
The five subspecialities include:
- Addiction psychiatry
- Child and adolescent psychiatry
- Consultation-Liaison psychiatry
- Forensic psychiatry
- Geriatric psychiatry
The three other subspecialties include:
- Hospice and palliative medicine
- Pain medicine
- Sleep medicine
and all make a psychiatry (psych) rotation mandatory during your clerkship years. The fact that as a psychiatrist you can practice in several different locations means that you need to gain special training to serve the needs of patients in any of these formats. You could be based in any of the following locations after a psychiatry residency:
- Hospital-based practice
- Inpatient or outpatient clinic
- Community-based clinic
- A psychiatric hospital
- Private practice
But, for whatever reason, the field has not always been popular, even though psychiatry and psychiatry residencies have a lot of positive qualities, which we’ll explore later. Psychiatry is for people who want to find out more about diseases of the mind and how to treat them. But, it’s not only about that.
Because so many factors can influence a person’s mental health, the practice requires a lot of cross-collaboration and an interdisciplinary mindset. Even though there are several approaches to treating mental health, a psychiatrist has medical training and a more complete understanding of all the physiological issues behind someone’s mental illness, and can even discover whether a patient’s illness arises from a mental or physical ailment.
You probably know someone who sees a mental health professional; maybe you see someone yourself. But even though mental illness carries less of a stigma now, psychiatry residencies do not attract a lot of US medical graduates. The number of psychiatry residents in the US has increased only by 27%; far too low to meet the spike in demand.
Over 33% of all adults in the US describe having symptoms of either anxiety or depression, so there is a demand, but it is also at this time that both countries are experiencing shortages of qualified psychiatrists. The number of psychiatry residency programs has not increased and it may take years before programs start attracting more candidates, which makes securing a spot in a psychiatry residency program even more competitive.
So, if you are thinking about a career in psychiatry, you need to start planning in your third or fourth-year of medical school, and pick programs that have a range of different specialities, renowned faculty members, and research opportunities.
A psychiatry residency in the US involves a lot of the same training and qualifications as it does in Canada. In your first year, you start with a series of specialty-based training that does not see you interact with patients or go out into the field yet. Some programs even require that you take a but that is mostly if you want to transfer to another program after your first post-graduate year.
For example, the program at Columbia has you more focused on didactic training, which comes in the form of specialized seminars tackling specific issues and areas such as psychotherapy, pharmacotherapy, forensic psychiatry, cultural psychiatry, and interviewing. But Yale is more hands-on and puts you into at least five blocks each, in your first year, of general medicine (inpatient and outpatient) and psychiatry done throughout the school’s various clinical partners and affiliates.
Every psychiatry residency program is different, obviously, but some of the things that you should look for or consider when choosing one include:
- Whether they offer a specialty you are interested in (geriatric psychiatry, adolescent psychiatry)
- Whether they have electives that interest you
- Whether they have specialized tracks aimed at specific patient groups (BIPOC, LGBTQ+, rural patients)
- Whether they offer research opportunities or
- Whether they are located in a specific area or region that interests you
There are a lot less hard requirements in both countries to get into a psychiatry residency. For example, you will have to have a lot of research experience and published papers to enter more medicine-based programs, such as a , but psychiatry does not typically require you having a lot of published scholarly work. It is definitely a “good-to-have" but a lot of programs look for other qualities and credentials.
You must have a medical degree from an accredited school in the US or Canada to apply to a psychiatry residency (although some programs require US or Canadian citizenship, and do not accept as out-of-state applicants), and the other application requirements are standard for all residency programs that use the :
- Between 3 and 4 recommendation letters
- Official transcripts
- Complete ERAS application form
- Supplemental application (if applicable)
The other standard requirements include having taken your and , even though the latter is not a requirement at all programs. You usually don’t need to have a certain score for your board exams, or even to have passed, but each program is different, so make sure you know whether your program has a USMLE cut-off or not.
Primarily, they want to see your dedication to the field of psychiatry. And since you will have a lot of direct contact with patients, your communication and interpersonal skills are also important. One way to tick off both those boxes is by taking a lot of psych electives during your in medical school. Even better, would be to take away or off-site electives or rotations that take you out into medically underserved areas.
A lot of communities in the US struggle with access to quality health care and the same applies to mental health. Close to 150 million people in the US live in an area considered by the federal government to lack sufficient mental health practitioners, so following your interest and passion for mental health into one of these areas show true commitment to psychiatry and the medical profession in general. The length of a psychiatry residency in the US is typically four years, but some programs may have longer lengths.
If you are applying to a psychiatry residency in the US, or any residency, for that matter, you have to submit your application via ERAS. It is a required step to apply to any program in the US but you also need to make sure that you know and understand the program’s particular application requirements and meet them.
Every psychiatry residency program in the US uses its own teaching methods, curriculum, special tracks, and rotation schedule so there is no general scheme that applies to all programs. The one thing that most psychiatry residency programs in the US share is their length, which usually tops out at four years, even though, depending on your specialty, you may have to add another year for specialized training.
Aside from general or adult psychiatry, child and adolescent psychiatry, is the second most popular subspecialty for psychiatry residents. Going into a C&A psychiatry specialty requires are least another year of training and research. But research is another standard component of a psychiatry residency. You can choose to use your electives to pursue a research interest, unless a research/capstone project is part of the curriculum.
But as you progress through the program, your responsibilities and opportunities for direct patient experience increase. By your third year, you may already be involved with long-term treatment of outpatients and have more autonomy to choose your electives or do off-practice rotations in other medical specialties such as internal medicine, or even another psychiatry specialty.
By your final year, your entire curriculum may involve only electives, and a few core rotations, which may or may not involve a research project. In your final year, you may also take a position to bolster your non-medical skills in managing a clinical environment, administration, and teaching.
In Canada, psychiatry residencies usually last for five years. Programs from the University of British Columbia to in Newfoundland all offer specializations in the five main subspecialties in psychiatry, but programs across Canada also offer training in unaccredited specialties that are particular to Canadian populations, such as aboriginal, women’s and cross-cultural mental health.
What’s different about a psychiatry residency, and, from now on, all residency training programs in Canada is that some programs are switching to a Competence by Design (CBD) model. The CBD model is slowly being adopted by nearly all major residency programs in Canada, regardless of the specialty. The model uses four different stages to measure your progress:
- Transition to Discipline
- Foundations of Discipline
- Core of Discipline
- Transition to Practice
The CBD model tests whether you are ready to progress to the next stage based on whether you are able to complete a series of Entrustable Professional Activities (EPAs) and milestones, which each residency program, including psychiatry, will define on its own.
Basically, rather than testing your knowledge through an exam, CBD makes you do a task, which can incorporate various sub-tasks and competencies, to ensure you have understood the core competencies required to perform the task.
In the previous model, you had to complete a set of core rotations, electives and other requirements to get to the next year. Of course, residents in the old model also take in-training and board-licensing exams to test their competency, but the CBD model uses a series of milestones and tasks to test your knowledge in a more hands-on way.
The requirements for a majority of psychiatry residency programs in Canada are not that different from the US. You have to have either Canadian citizenship or permanent resident status, and international graduates also have to prove their English proficiency, but other than those, you also have to submit the usual, including:
A few programs in Canada have also begun incorporating the CASPer exam into their application process, such as the so make sure you know the full requirements before applying and give yourself time to do some .
You send all your residency applications for Canadian programs through , including psychiatry. The CaRMS website is only one of the best references for every psychiatry residency program’s admission requirement, its format, what qualities it looks for and any prompts or questions that you need to address in your .
Preparing for your psychiatry residency interview? Here're some more quick tips:
The new CBD assessment model that Canadian residency programs are now introducing means that the structure, curriculum and teaching models used by these programs will also change. AT the beginning of your first you, you will now have a clearer idea of what will be required of you by the end of the year, so your training, both didactic and clinical, will prepare you for that. The University of Toronto is home to the largest psychiatric residency department in North America, so we’ll use that as a model.
U of T is incorporating new models for electives called Personalized Learning Experiences (PLEX) that gives you the chance to explore different specialties or prepare you for the EPA that you have to complete. But it also has more traditional blocks of rotations that have varying durations in specialties such as addiction, and emergency psychiatry. You also have 2 blocks dedicated to PLEX during your first year so you can gain more experiences and learn .
Your second and third years at U of T is where you focus on the Foundations of Discipline and Core of Discipline, which basically boils down to more rotations in other psychiatric specialties such as geriatric, emergency, serious mental illness, and psychiatry for underserved populations. Your fourth year is also dedicated to broadening your knowledge of different specialties but also where you would start deciding what specialty is right for you. The Transition to Discipline is where you take up the responsibilities of a chief resident and learn how to make the jump to the professional field and apply for licensure.
Commit to the Field
What does this mean?
It means that if you had an early interest in psychiatry, follow through with that interest in any number of ways. Of course, this applies to all residency applicants, but if you have wanted to be a psychiatrist from an early age, even before medical school, you should have experiences and extracurriculars that show your passion. Volunteer in a community-based setting, such as an assisted living center, or participate in an outreach program to bring mental health services to an underserved area. If psychiatry is only a back-up for you to more prestigious specialities like neurology, then you won’t seem as dedicated as someone who is genuinely committed to psychiatry.
Take Off-Practice Electives and Other Medical Specialities
You take basic introductions to all fields of medicine during your required rotations. But when it comes time to choose your electives, choose ones closely related to yours, even if they are not necessarily in the same field, such as, in the case of psychiatry, neurology, internal medicine and neuroimaging. Psychiatry is interdisciplinary by nature and it necessitates training on all the biological, social, and psychological causes of mental illness to better understand and, hopefully, treat them. The more training you have in other aspects of the field means you know how complex and multi-faceted mental illnesses are, while also being better-equipped to find new treatments and treatment modalities.
Get Great Letters of Recommendation
The and the all want you to submit letters of recommendation from your most recent teachers, usually the faculty who taught you during your clinical rotations. For psychiatry, you should have letters of recommendation from instructors who saw you perform well during patient interactions, who supervised your research or are well-respected members of other medical disciplines such as family or internal medicine who had experience teaching you.
Prioritize Your Wellness
All residencies can be tough. But psychiatry is especially distressing, since everyone, regardless of age, education, career and socio-economic status can fall prey to mental illness. As a psychiatrist-in-training you are exposed to illnesses and maladies that you can also succumb to, which is why a good psychiatrist should have coping mechanisms and other ways to deal with the distressing nature of the work to excel.
1. How long are psychiatry residency programs?
In the US, psychiatry residency programs last for up to four years. In Canada they last longer, five years, with additional preliminary training before entering the psychiatry-specific part of the residency.
2. Are psychiatry residency programs competitive?
In the US, psychiatry residencies are not that competitive since there is a glut of positions with a small number of applicants, so anyone interested can match easily if they have at least good USMLE scores and do well during their psychiatry rotations. But in the following years, it may become more competitive as it is an attractive and in-demand specialty. In Canada, the same applies, as there are more applicants to psychiatry residencies each year.
3. How much do psychiatry residencies pay?
One psychiatry residency program in the US offers $77,969 as a starting salary that goes up to $85,442 in your final year. The average salary for a Canadian psychiatry resident depends on the province where you are training so a starting first-year salary in Newfoundland ($69,175) is different from a first-year starting salary in Alberta ($58,934).
4. How much do psychiatrists make?
In the US, the median salary for a psychiatrist is $247,350. In Canada, the median salary is $273,510.
5. Do psychiatrists have long hours or poor work-life balance?
One of the reasons that psychiatry’s profile has risen recently is because of the lifestyle, meaning you have more autonomy and independence to decide your work hours and do not have to put in the punishing hours of a surgeon or radiologist. But psychiatrists experience burnout too, and many experience stress and anxiety regardless whether they are hospital, community-based or in private practice. In Canada, 54% of psychiatrists surveyed said they had an adequate work-life balance, but 36% reported being over-worked.
6. Do psychiatry residency programs include research components?
Whether a research component is a part of the curriculum at the program you want to apply to depends on the program. Residents are usually encouraged to pursue research during their training, but in what capacity and which project is up to you.
7. Do psychiatry residency programs value certain parts of the application more than others?
Yes, psychiatry is where you should have excellent letters of recommendation from people who’ve seen you work in various settings – inpatient, outpatient – and know whether you have the communication and interpersonal skills to be a good psychiatrist.
8. Do MDs fare better than DOs in getting into psychiatry residency residencies?
In psychiatry, the MD vs DO divide doesn’t really matter, even though many of the most coveted programs will prefer MDs over DOs. But if you apply to a program outside of the Ivy League, for example, you will have as good a chance as an MD, as long as your application is strong.