Starting your career in psychiatry? Here’s what to expect

“My first job out of residency was one of careful consideration. I chose based not only on financial rewards but also on the impact to my long-term professional growth. This has paid off through continued learning, networking, and opportunities.” — Ramana Surya, DO, Mindpath Health 

As you near the end of your residency, you are likely considering your next career steps and landing your dream job. Never has there been a more promising time to begin a career in psychiatry.  

• Demand is high: In the past several years, the need for psychiatric and mental health care has increased dramatically across specialties, ages, and demographics. In the US, approximately 15% of youth (age 12-17) reported suffering from at least one major depressive episode (MDE) in the past year, an increase of 1.24% from the previous year. Almost 20% of adults are experiencing a mental illness, nearly a quarter of whom report an unmet need for treatment.¹ 
• Supply is low: The number of mental health providers has been steadily declining. For example, in 2013, a deficit of more than 6,000 psychiatrists was projected for 2025, representing 12% of the workforce.² In 2022, that estimate is now more than 7,500.³ This means your services will be in high demand.  

Seize the day: Take time to explore your options. You may have already chosen your psychiatry specialty, or you are choosing a broader path. Did you complete your residency in a hospital, outpatient, or office environment? Consider the unique rewards and challenges for each of these areas, so that you set your sights on a role that will support your long-term career objectives. 

• Solo private practice: This provides the most autonomy and flexibility, but you will also need to manage the business side of the practice: billing, insurance, paying the rent, managing patient scheduling, and marketing your practice. Downsides can include professional isolation if you are the only clinician, too many or too few patients, and potential work-life balance concerns. 
• Group private practice: This allows you to experience many of the same benefits of a solo private practice. You have the added benefit of not having to handle all the practice management tasks. In addition, you can avoid professional isolation through access to a strong business and clinical team for mentorship.  
• Hospital in-patient: This option provides unique research and clinical experience to help build your reputation, specialization, and expertise. Make sure the hospital is well equipped to support psychiatry and your specialization by asking about patient types. Will you be expected to be on call, and if so, is there on call pay? This will allow you to increase your earning potential. 

Network, network, network: Reach out to all the support available to you to gather the information you need to make a well-considered decision.  

• Did you work with any mentors during your residency? 
• Are there any individuals leading professional lives that resonate with you?  
• Are there peers who graduated the year before from whom you can glean insights?  

Invite them to have a coffee and conversation with you. Ask them to share what worked, what didn’t, and provide insights on different settings. Learn from the pros and cons of their experience. 

Reflect for clarity: After you have gained all the knowledge you can, take time to reflect on what matters most to you. It is your career. Don’t rush forward until you are clear on what would make the most sense for you, now and in the future – professionally, financially, and emotionally. 

More: 
Stand out: Get the offer you want 
Contract negotiations: 9 steps to get what you want 

Resources: 

1. Reinert, M, Fritze, D. & Nguyen, T. (October 2021). “The State of Mental Health in America 2022” Mental Health America, Alexandria VA.  
2. The National Council for Behavioral Health’s Medical Director Institute. Medical directors’ report recommends training more psychiatrists and expanding telepsychiatry. March 28, 2017. Accessed March 17, 2022. https://www.thenationalcouncil.org/about-us/leadership-experts/medical-director-institute/   
3. Shortage areas. Health Resources and Services Administration. Accessed March 17, 2022. https://data.hrsa.gov/topics/health-workforce/shortage-areas