Psychiatry Residency Overview

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Psychiatrists work to prevent, diagnose and manage psychiatric disorders – covering the mental, emotional and behavioural wellbeing of often-diverse groups of patients. The specialty therefore also requires an understanding of common and major medical and neurological disorders that relate to the field. Salaries for psychiatrists are relatively lower than many other specialists, although with increasing interest in the area this may change; salaries can also be impacted substantially by the choice of subspecialty made after graduation from Residency.

Residency Core Requirements

Core requirements for training in Psychiatry are a four year residency in an accredited training program. Following the four year program, one may choose to take on a range of different subspecialties. These include the following: addiction psychiatry, child and adolescent psychiatry, forensic psychiatry, geriatric psychiatry, pain management, psychosomatic medicine, hospice and palliative medicine, and sleep medicine.

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Application Statistics & Competition

There were a total of 1640 US Senior MD and DO graduates who matched into Psychiatry residencies in the latest available data. Of these, 1253 were MDs and 387 were DO graduates. This was a significant increase, with only 1537 matching the year before. There were 321 IMGs and 69 applicants from previous years who also matched, for a total of 2030. There were only 17 psychiatry positions that were unfilled. The increase from the previous year is representative of increasing numbers year-on-year, with this being the trend since 2011. The number of US MD Seniors selecting psychiatry has almost doubled since that point, with only 640 in 2011, compared to 1253 in the most recent data. The number of residency programs for Psychiatry has increased in tandem, from 183 to 352.

Sample Interview questions

What effect has COVID-19 had on mental health in developed countries?

I studied the effect of COVID on mental health in the UK as part of a research paper. Key facts that I would highlight include that ⅙ of the UK population needed mental support as a direct consequence of the pandemic, with 1.5m of these being children under the age of 18; that those with pre-existing mental health conditions and those from worse-off socioeconomic backgrounds were far more likely to suffer; that inequality in mental health outcomes became worse than ever before. Looking at the US, a 93% increase in patients taking their anxiety screen was seen, whilst a 62% in patients taking their depression screen was noted. Mental ill health hit a peak at the end of 2020. Rates of anxiety, depression and worry were highest in those aged 18-24, as were the rates of COVID-19 diagnosis.

How would you diagnose major depressive disorder?

To diagnose major depressive disorder, there must be 5 or more symptoms during the same two week period that are a change from previous functioning. These symptoms are:
– Depressed mood (most of the day, nearly every day)
– Anhedonia or loss of interest (most of the day, nearly every day)
– Weight loss or gain (change of >5% body weight in a month) or decrease in appetitive nearly every day
– Insomnia or hypersomnia
– Psychomotor agitation or retardation
– Fatigue
– Feeling of worthlessness or excessive / inappropriate guilt (may be delusional)
– Decreased concentration (nearly every day)
– Suicidal ideation or thoughts of death

Additional criteria (must have all four, plus 5 or more of the above)

– Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
– Episode is not attributable to physiological effects of a substance or another medical condition
– Episode is not better explained by other specified and unspecified schizophrenia spectrum and other psychotic disorders
– No history of manic or hypomanic episode

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Important considerations

Perhaps the most important consideration for most students is the increased level of attention that mental health, and the treatment of mental illness, has in today’s society. It is therefore perhaps a pragmatic choice for many, with a mixture of relatively less-stressful residency rotations and a rising general profile. However, salaries currently are still relatively low, so this will be a choice through passion and interest for many, with others perhaps choosing other, better paid areas.

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