Psychiatrist
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“The role of a psychiatrist is really to explain what the problem is and how we might go about solving it from all of those perspectives.”
Deborah Spitz, MD, Professor of Adult Psychiatry, University of Chicago
More than 122 million Americans live in federally designated Mental Health Professional Shortage Areas, with roughly one psychiatrist available for every 5,000 residents nationwide (HRSA 2024). The gap between the number of people who need psychiatric care and the number of physicians trained to provide it has grown steadily for decades, and there is no quick fix in sight.
Psychiatrists are uniquely positioned to address this need. As physicians who have completed medical school and a four-year residency in psychiatry, they are mental health professionals with full prescribing authority and the medical training to evaluate how physical health conditions, medications, and neurological factors intersect with mental illness. They diagnose and treat conditions ranging from depression and anxiety to schizophrenia, bipolar disorder, and substance use disorders, using a combination of medication management, psychotherapy, and medical care.
The path to becoming a psychiatrist is one of the longest in medicine. After earning a bachelor’s degree and completing four years of medical school, aspiring psychiatrists enter a four-year residency program, then sit for board certification through the American Board of Psychiatry and Neurology (ABPN). Many go on to complete fellowships in subspecialties such as child and adolescent psychiatry, forensic psychiatry, geriatric psychiatry, or addiction psychiatry.
Despite the length of training, the career offers a considerable range. Psychiatrists work in private practice, hospitals, community mental health centers, academic medical centers, correctional facilities, and research institutions. Some focus on medication management; others maintain active psychotherapy practices or divide their time between patient care, teaching, and research.
Read on to learn what it takes to become a psychiatrist, including the education and training required, what the day-to-day role looks like, and what professionals in this field can expect to earn.
Meet the Expert: Deborah Spitz, MD
Dr. Deborah Spitz is a professor of adult psychiatry, vice chair for education and academic affairs, and director of residency training in the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago, where she has been a psychiatric educator for nearly four decades.
Trained at the University of Chicago, Dr. Spitz has led residency programs at Tufts-New England Medical Center in Boston and served as Lead Clinician for the City of Norwich in the United Kingdom’s National Health Service, where she redesigned the delivery of mental health services for 175,000 adults.
Her clinical interests include psychodynamic psychotherapy, mood disorders, and women’s mental health. She has served as president of the Association for Academic Psychiatry, on question-writing committees, and as an examiner for the American Board of Psychiatry and Neurology (ABPN), and as faculty in the MacLean Center for Clinical Medical Ethics at the University of Chicago.
CounselingSchools.com: What do you wish the public understood about psychiatry?
Dr. Spitz: Psychiatry is a field that addresses problems of living, including common ones we all recognize, like depression, anxiety, and trauma, but also less common conditions like schizophrenia, bipolar disorder, substance abuse, and obsessive-compulsive disorder. All of these interfere with people living the kinds of lives they wish they could lead.
A good psychiatrist diagnoses and treats on many levels: biologically, psychologically, behaviorally, and within the context of a person’s family and relationships. The role of a psychiatrist is really to explain what the problem is and how we might go about solving it from all of those perspectives.
CounselingSchools.com: What advice would you give to students considering psychiatry?
Dr. Spitz: If you love it, do it. That’s how you should choose a field. What’s exciting about psychiatry is that it combines a humanistic understanding of people with a growing, sophisticated biological understanding through neuroscience. If you love understanding how the mind works and talking with people, this field is a good fit for you.
I would also caution students not to be lured by the idea that psychiatrists have an easy life. Psychotherapy and psychiatry are emotionally demanding. You have to manage many emotional consequences of dealing with difficult issues and situations. It requires that you be a psychologically mature and adept person.
CounselingSchools.com: What is your favorite thing about working in psychiatry?
Dr. Spitz: Meeting people and coming to understand how and why they see the world as they do, and then inviting them to think about other ways to think about things. I don’t know very many psychiatrists who have retired. People don’t leave psychiatry.
CounselingSchools.com: What do you see as one of the most pressing challenges facing the field?
Dr. Spitz: We have to think about the allocation of resources. There are very few of us, and we are not everywhere people need us. As a result, many non-psychiatrists, including nurse practitioners and physician assistants, are taking responsibility for caring for patients with far less training than we have.
Rather than seeing those providers as competitors, psychiatry needs to do a better job of engaging in their training. We need them. But they need better preparation, and that is our responsibility as a field.
What Does a Psychiatrist Do?
Psychiatrists are physicians who specialize in the diagnosis and treatment of mental illness. Because they hold a medical degree, they are uniquely positioned among mental health providers to evaluate the full picture of a patient’s health, including how physical conditions, medications, and neurological factors may contribute to or complicate a psychiatric presentation.
In clinical practice, psychiatrists meet with patients to assess symptoms, make diagnoses, develop treatment plans, and monitor progress over time. Depending on their setting and specialization, they may prescribe and manage psychiatric medications, provide psychotherapy, or coordinate care with other members of a treatment team, including psychologists, social workers, and primary care physicians. Some psychiatrists maintain a broad general practice; others focus on a specific population or condition, such as children and adolescents, older adults, patients in the criminal justice system, or individuals with treatment-resistant mood disorders.
The day-to-day work of a psychiatrist varies considerably by setting. A psychiatrist in private practice may spend most of their time in one-on-one appointments, while one working in an inpatient unit or emergency department manages acute crises and coordinates rapid transitions in care. Those in academic medical centers often divide their time among patient care, teaching, and research.
Common job duties for psychiatrists include the following:
- Conducting psychiatric evaluations and diagnostic assessments
- Developing and managing individualized treatment plans
- Prescribing, adjusting, and monitoring psychiatric medications
- Providing individual, group, or family psychotherapy
- Consulting with other physicians and healthcare providers on complex cases
- Admitting and discharging patients from inpatient psychiatric units
- Documenting clinical encounters and maintaining patient records
- Supervising psychiatric residents, medical students, and other trainees
- Conducting or contributing to research on mental illness and its treatment
- Participating in continuing education to maintain board certification
How to Become a Psychiatrist
Becoming a psychiatrist is one of the longest training paths in medicine, typically requiring more than a decade of post-secondary education and supervised clinical experience before independent practice begins. The steps below outline the standard route.
Step 1: Earn a Bachelor’s Degree (Four Years)
Psychiatry does not require a specific undergraduate major, but aspiring physicians should plan their coursework carefully. Most medical schools require applicants to have completed prerequisites in biology, chemistry, organic chemistry, physics, and mathematics.
Common majors include biology, psychology, chemistry, and pre-medicine, though students from any academic background can apply to medical school as long as they fulfill the required coursework. Strong academic performance and a competitive score on the Medical College Admission Test (MCAT) are essential for admission.
Step 2: Earn a Medical Degree (Four Years)
Psychiatrists must complete either a doctor of medicine (MD) or doctor of osteopathic medicine (DO) degree at an accredited medical school. The first two years of medical school are typically devoted to foundational coursework in anatomy, physiology, pharmacology, pathology, and neuroscience.
The final two years involve clinical rotations across a range of specialties, including psychiatry, internal medicine, surgery, and pediatrics. It is during these rotations that many students develop a serious interest in psychiatry as a career.
Step 3: Complete a Psychiatry Residency (Four Years)
After earning a medical degree, graduates apply to residency programs through the National Resident Matching Program, commonly known as the Match. Psychiatry residency programs are four years in length. The first year, known as the intern year, typically includes rotations in internal medicine, neurology, and other medical specialties, giving residents a strong foundation in general medicine before they focus entirely on psychiatry.
The remaining three years concentrate on clinical psychiatric training across inpatient, outpatient, emergency, and consultation settings. Residents develop skills in diagnosis, medication management, and psychotherapy under the supervision of experienced attending psychiatrists.
Step 4: Obtain Medical Licensure (Timeline Varies)
All physicians must hold a valid medical license in the state where they practice. Licensure is granted by state medical boards and requires passing the United States Medical Licensing Examination (USMLE) for MD graduates or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) for DO graduates. Most physicians complete the required exam steps during medical school and residency.
Step 5: Achieve Board Certification Through the ABPN (Timeline Varies)
After completing residency, psychiatrists are eligible to sit for board certification through the American Board of Psychiatry and Neurology (ABPN). Certification signals that a physician has met the highest standards of clinical knowledge and competency in the field.
In 2025, 2,184 candidates passed the psychiatry specialty certification exam, with an overall pass rate of 86 percent (ABPN 2025). Board-certified psychiatrists must maintain their certification through the ABPN’s continuing certification program, which involves ongoing assessment of clinical knowledge.
Step 6: Complete a Fellowship in a Subspecialty (One to Two Years, Optional)
Many psychiatrists pursue additional training in a subspecialty after completing residency. Fellowship programs typically last one to two years and are available in areas such as child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, addiction psychiatry, and consultation-liaison psychiatry, among others. Fellowship training is required for subspecialty board certification through the ABPN.
Education & Residencies for Psychiatrists
All psychiatrists must have a medical degree. The residency program a physician chooses shapes the direction of their clinical and academic development for years beyond graduation. Here are five residency programs for psychiatrists.
University of Chicago Department of Psychiatry and Behavioral Neuroscience
The University of Chicago’s ACGME-accredited psychiatry residency is designed to train physicians across several integrated domains of learning, including psychopathology and phenomenology, neuroscience, psychotherapy, and clinical treatment.
Training progresses across all four years, with residents moving from foundational inpatient and consultation-liaison rotations in the PGY-1 year to increasing independence in outpatient and specialty settings. The department houses fellowship programs in child and adolescent psychiatry and consultation-liaison psychiatry, and residents have access to research opportunities across a broad range of psychiatric and behavioral neuroscience disciplines.
- Location: Chicago, IL
- Accreditation: Accreditation Council for Graduate Medical Education (ACGME)
- Expected Time to Completion: Four years
Massachusetts General Hospital/McLean Hospital Adult Psychiatry Residency Training Program
For physicians seeking training at the intersection of world-class clinical psychiatry and research, the MGH/McLean program, affiliated with Harvard Medical School, offers one of the most extensively resourced residency experiences in the country. Residents rotate across Massachusetts General Hospital and McLean Hospital, gaining exposure to a broad range of patient populations and treatment settings, including inpatient, outpatient, emergency, and specialty psychiatry.
The program boasts the largest research enterprise of any Harvard-affiliated psychiatric hospital, and a dedicated Physician Scientist Training Program provides protected research time for residents committed to academic careers. A combined adult and child and adolescent psychiatry track is also available for applicants with interests in both areas.
- Location: Boston, MA
- Accreditation: Accreditation Council for Graduate Medical Education (ACGME)
- Expected Time to Completion: Four years (five to six years for the combined track)
Johns Hopkins Psychiatry and Behavioral Sciences Residency Program
Johns Hopkins is one of a small number of programs with more than 200 full-time faculty and 175 part-time faculty available to train and mentor residents, giving it an unusual depth of clinical and scholarly resources within a single department.
The four-year residency provides comprehensive training in clinical diagnosis and treatment across inpatient, outpatient, emergency, and community settings, with extensive community psychiatry experience grounded in work at the Johns Hopkins Bayview Medical Center. The program was recognized with the ACGME Diversity, Equity, and Inclusion Award in 2023, and graduates have gone on to careers in academic psychiatry, private practice, and public sector psychiatry.
- Location: Baltimore, MD
- Accreditation: Accreditation Council for Graduate Medical Education (ACGME)
- Expected Time to Completion: Four years
UCSF Adult Psychiatry Residency Training Program
Residents seeking training in one of the most clinically and culturally diverse cities in the country will find a strong fit at UCSF, where the four-year program spans multiple training sites, including Zuckerberg San Francisco General Hospital, the San Francisco VA Medical Center, and the UCSF Langley Porter Psychiatric Hospital.
A distinctive feature of the program is its Longitudinal Clinical Experience, in which residents are assigned to a specialty clinic from the first year and follow the same patient cohort across all four years of training. UCSF ranks among the top psychiatry residency programs nationally and consistently matches one of the largest incoming classes in California.
- Location: San Francisco, CA
- Accreditation: Accreditation Council for Graduate Medical Education (ACGME)
- Expected Time to Completion: Four years
Yale Psychiatry Residency Program
Graduates of Yale’s psychiatry residency program have gone on to lead departments of psychiatry, serve as deans of medical schools, and shape the field through research, clinical practice, and the pharmaceutical and biotechnology industries. The program draws on Yale’s broad academic strengths and its deep ties to the Connecticut Mental Health Center, providing residents with exposure to a range of psychiatric conditions across biological, psychological, and social frameworks.
Residents work closely with faculty to develop an individualized education plan, and the department ranks second nationally in psychiatry research funding from the National Institutes of Health. Fellowship opportunities are available in addiction psychiatry, geriatric psychiatry, forensic psychiatry, and public psychiatry, among others.
- Location: New Haven, CT
- Accreditation: Accreditation Council for Graduate Medical Education (ACGME)
- Expected Time to Completion: Four years
Certification & Licensure for Psychiatrists
Becoming a practicing psychiatrist requires meeting two sets of requirements. One is state medical licensure, which authorizes a physician to practice medicine in a given state, and the other is board certification, which demonstrates specialty-level competency in psychiatry. Both are essential, and neither substitutes for the other.
State Medical Licensure
All physicians, including psychiatrists, must hold a valid medical license in every state where they practice. Licensure is granted by state medical boards and requires graduating from an accredited medical school, completing residency training, passing the required licensing examinations, and submitting to a background check.
MD graduates must pass the United States Medical Licensing Examination (USMLE), a three-step exam series completed in stages during medical school and residency. DO graduates must pass the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA).
Because licensure requirements vary by state, physicians who wish to practice in multiple states must apply for licensure in each one, though the Interstate Medical Licensure Compact (IMLC) has streamlined this process for eligible physicians in participating states.
Board Certification Through the ABPN
Board certification in psychiatry is granted by the American Board of Psychiatry and Neurology (ABPN), which has set certification standards for psychiatrists and neurologists since 1934. To be eligible for initial certification, a physician must have completed an ACGME-accredited psychiatry residency and hold a valid, unrestricted medical license. Candidates then sit for the psychiatry specialty certification examination. In 2025, 2,537 physicians took the exam and 2,184 passed, for a pass rate of 86 percent.
Board certification is not a one-time credential. The ABPN requires psychiatrists to participate in ongoing continuing certification to maintain their status. In 2025, more than 38,500 psychiatrists participated in the ABPN’s continuing certification program for the psychiatry specialty, the majority through the Article-Based Continuing Certification (ABCC) pathway, an ongoing professional journal article-based assessment activity offered as an alternative to the traditional ten-year recertification examination.
Subspecialty Certification
Psychiatrists who complete a fellowship in a subspecialty area may pursue additional board certification through the ABPN. Subspecialty certifications are available in child and adolescent psychiatry, addiction psychiatry, forensic psychiatry, geriatric psychiatry, consultation-liaison psychiatry, and neurodevelopmental disabilities, among others.
Work Settings for Psychiatrists
Psychiatrists practice in a wider range of settings than most medical specialties, in part because the nature of psychiatric care spans everything from brief medication management appointments to long-term inpatient treatment and forensic evaluation. The setting in which a psychiatrist works is often shaped by their subspecialty training, clinical interests, and the population they serve.
According to the American Psychiatric Association (2026), approximately half of the roughly 45,000 psychiatrists in the United States maintain a private practice, though most combine private work with hospital affiliations or other institutional roles. Some of the most common settings include the following:
- Outpatient private practice
- Community mental health centers
- Inpatient psychiatric units and hospitals
- Academic medical centers and teaching hospitals
- Emergency departments and psychiatric crisis services
- Veterans Affairs medical centers
- Correctional facilities and forensic psychiatric settings
- Substance abuse treatment programs
- Child and adolescent specialty clinics
- Geriatric care facilities and memory centers
- Research institutions and pharmaceutical companies
- Integrated primary care settings
The distribution of psychiatrists across these settings is uneven. Rural areas and lower-income communities face the most severe shortages, with many counties having no practicing psychiatrist at all. Academic medical centers and urban hospital systems, by contrast, tend to concentrate psychiatric resources, which is one reason why training programs are located almost exclusively in major metropolitan areas. Psychiatrists who choose to practice in underserved areas may be eligible for loan repayment assistance through the National Health Service Corps.
How Much Do Psychiatrists Make?
Earnings for psychiatrists vary by practice setting, geographic location, subspecialty, and the proportion of time devoted to clinical work, research, or administration.
The latest salary data available as of June 2026 is as follows:
- Number employed in the U.S.: 28,040
- Average annual salary (mean): $269,120
- 10th percentile: $77,360
- 25th percentile: >$239,200 per year
- 50th percentile (median): >$239,200 per year
- 75th percentile: >$239,200 per year
- 90th percentile: >$239,200 per year
Please note that the BLS does not provide specific figures for ranges exceeding $239,200.
Employment of psychiatrists is projected to grow 6 percent from 2024 to 2034, faster than the average for all occupations, driven by growing demand for psychiatric care and expanding access to mental health services (BLS 2025).
Professional Associations and Resources for Psychiatrists
- American Psychiatric Association (APA)
- American Board of Psychiatry and Neurology (ABPN)
- American Academy of Child and Adolescent Psychiatry (AACAP)
- American Association for Geriatric Psychiatry (AAGP)
- American Academy of Addiction Psychiatry (AAAP)
- American Academy of Forensic Sciences (AAFS)
- Association for Academic Psychiatry (AAP)
- Accreditation Council for Graduate Medical Education (ACGME)
- National Institute of Mental Health (NIMH)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- APA Division of Diversity and Health Equity (DDHE)
- APA Minority and Underrepresented Caucuses (Asian American, Black, Hispanic, LGBTQ+, Women, and International Medical Graduates)
- APA Foundation Diversity Leadership Fellowship
- AGLP: The Association of LGBTQ+ Psychiatrists
- National Medical Association (NMA)
Kimmy Gustafson
WriterAt CounselingSchools.com, Kimmy Gustafson’s expertly crafted articles delve into the world of counseling and mental health, providing valuable insights and guidance to readers since 2020. In addition to feature pieces and interviews, she keeps the state licensing tables current. Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.