Are you aware of the many subspecialty paths you can take in psychiatry?
There are five main ACGME-recognized psychiatry subspecialties and even more specialized fellowships. Let’s go over the major subspecialties in psychiatry, including when the additional 1 to 2 years of training is necessary.
Is a Psychiatry Subspecialty Worth It?
The first question to ask is whether or not it’s worth pursuing additional fellowship training. The short answer is, well, it depends.
The demand for psychiatry subspecialty training varies depending on practice location and your career goals. For example, a general psychiatrist in a rural setting may function as a child and adolescent psychiatrist out of necessity without needing additional training. However, specific jobs may require subspecialization in more urban settings where access to board-certified child and adolescent psychiatrists is more concentrated.
You might choose to pursue a fellowship if it aligns with your clinical and academic interests, if it will prepare you for your chosen line of work, or if you’re considering supplementing your income with additional opportunities. For example, working on a forensic unit while providing expert testimony on the side.
1 | Addiction Psychiatry
First up is addiction psychiatry. This subspecialty focuses on the evaluation, diagnosis, and treatment of patients who suffer from disorders related to addiction.
With society’s increasing awareness of the many types of addiction, including substance use, as well as behavioral addictions, including gambling, sex, internet, food, and other impulse control issues, the demand for this subspecialty area has grown exponentially.
These fellowship programs last one year. Fellows rotate in various settings and typically engage in scholarly projects. Although residents could previously complete fellowship requirements during residency and have their addiction time grandfathered in, this is no longer possible.
Given increased federal and state advocacy efforts for addiction medicine, demand for this position is high, and income potential is expected to grow.
This career path is well-suited for psychiatrists who hope to work in dual diagnosis units, although many non-fellow psychiatrists continue to work in these settings due to the demand for these services.
2 | Forensic Psychiatry
Next is forensic psychiatry, which is related to criminology and explores the interaction between the medical and legal systems.
Officially recognized in 1992, this one-year fellowship offers unique opportunities to serve in many different roles, including expert witness, correction psychiatrist, and inpatient work in forensic settings.
This presents a unique opportunity to receive funding from a source other than patients or insurance companies, as law firms hire several forensic psychiatrists to perform evaluations for clients. It’s not uncommon for forensic psychiatrists to work primarily in a public setting while maintaining a small forensic private practice on the side.
If you are struggling to pick between a career in medicine or law, forensic psychiatry may be an ideal fit, as you have the opportunity to work within both systems.
It’s not uncommon to struggle with choosing the ideal career path for you. If you’re interested in a career as a doctor, the physicians at Med School Insiders can help. We offer one-on-one career guidance and medical school application support, as well as a number of courses designed to help you navigate the complex medical school admissions process. Learn more in the description below.
3 | Child and Adolescent Psychiatry
Next is child and adolescent psychiatry.
Child and adolescent psychiatrists focus on youth mental health, helping young patients and their families navigate the complex landscape of childhood disorders. This can include, but is not at all limited to, major depressive disorders, behavioral disorders, eating disorders, speech therapy, obsessive-compulsive disorder, and post-traumatic stress.
This fellowship is unique because it is two years long and can be started early after the third year of residency, which is also known as “fast-tracking”. Additionally, several programs offer a child and adolescent track for residency applicants interested in child and adolescent psychiatry.
These unique tracks often include six months of pediatrics instead of internal medicine training during the intern year and a guaranteed acceptance into their child and adolescent program.
Psychiatrists with this additional training can see patients of all ages, which is a bonus to various clinical settings, including emergency departments and outpatient settings. There are also pediatric-specific settings, including crisis stabilization units, pediatric behavioral inpatient units, and partial hospitalization programs.
Many child and adolescent psychiatrists tend to lean more on psychotherapy skills since there are relatively fewer FDA-approved medications for this age range.
From a lifestyle perspective, many consider this psychiatry fellowship to be the most lucrative, especially if it starts immediately after PGY-3.
4 | Geriatric Psychiatry
Next, we have geriatric psychiatry, which is focused on the study, prevention, diagnosis, and treatment of mental disorders and cognitive impairments that occur in elderly people.
As populations age, the demand for geriatric psychiatrists continues to grow. Many psychiatrists who pursue this additional year of fellowship have an interest in research on aging, including the cognitive and emotional aspects, as well as pharmaceuticals.
Like other psychiatrists, geriatric psychiatrists work in various settings, including outpatient, memory care, nursing homes, and behavioral units.
Similar to child and adolescent psychiatrists, the practice location is essential to consider when pursuing this subspecialty, as general psychiatrists are often trained to practice this role due to the relative scarcity of geriatric psychiatrists in some areas.
5 | Consultation-Liaison Psychiatry
Next is consult-liaison psychiatry, also known as CL, which focuses on the treatment of patients with comorbid psychiatric and general chronic medical conditions. Comorbid means the existence of additional conditions for a given patient.
Prior to 2004, consult-liaison psychiatry was known as psychosomatic medicine. These psychiatrists bridge the gap between mental and physical health within medical settings.
The term liaison **refers to the comprehensive approach these subspecialists offer to help patients, their families, and interdisciplinary medical teams. This subspecialty is well-suited for psychiatrists who enjoy working collaboratively on complex medical cases alongside other physicians in internal medicine, surgery, and other specialties.
CL psychiatry has several focus areas, including psycho-oncology, perinatal psychiatry, addiction medicine, and pain management.
On the lifestyle side, many enjoy the flexibility of seeing these patients on a specialized outpatient panel while following their patients’ care throughout a hospital admission. While many hospitals hire psychiatrists without formal CL training, due to the intensive inpatient experiences of most residency training programs, this one-year subspecialty training is helpful for those who hope to practice in academic settings.
6 | Psychiatry-Adjacent Subspecialties
Next, there are some psychiatry-adjacent subspecialties we should cover, including brain injury, hospice and palliative medicine, and sleep medicine.
While these are not traditional psychiatry subspecialties, they are worth pointing out as relevant options after completing psychiatry residency. These are ACGME board-certified subspecialties that psychiatrists can pursue even though they are not considered the traditional subspecialties of psychiatry.
It’s also important to point out that they tend to overlap with neurology and adult medicine, so they can be pursued by other specialists.
All three options offer a reasonable lifestyle with minimal call burden, if any. Sleep medicine offers a unique opportunity to invest in or own a sleep study center, which is an excellent opportunity for entrepreneurship as well as a passive income.
While these subspecialties are not typically required in the core curriculum for psychiatry residency, they are worth exploring during elective time as medical students or residents to determine if they are a good fit for you.
7 | Research and Specialized Fellowships
The last group includes all of the research and specialized fellowships that the ACGME does not formally recognize. This list is theoretically endless since the academic study of the mind, emotions, and behavior is so broad.
Still, this group typically includes psychodynamic and psychoanalytic medicine, hospital administration, perinatal mental health, emergency medicine, and postdoctoral work in seemingly endless areas. Due to their less standardized nature, these programs tend to come in many varieties and can be flexibly designed for physicians who are working full-time.
Some can even be completed during the elective-friendly fourth year of psychiatry residency. Like the psychiatry-adjacent fellowships, they are worth exploring during elective time to determine if they’re right for you. Whether driven by passion or pragmatism, each pathway offers its unique blend of challenges and rewards.
From the intimacy of a psychodynamic therapy session in private practice to the rigorous attention to detail of expert witness testimony, the possibilities for a career in psychiatry are endless.
Our Insiders are equipped to help you navigate the nuances within a career in psychiatry to help you clarify your career goals, navigate your options, and ultimately succeed in both gaining admission to medical school and matching into the residency and fellowship program that’s right for you.
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