# shrinkiatry

> shrinkiatry (shrinkiatry.com) is an independent, ad-free publication about the profession of psychiatry: how psychiatrists train, how practices are built and paid, how telepsychiatry and AI are changing the work, and the ethics and economics of access. Written and reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist. Professional commentary and education, not medical advice, and it does not provide clinical care. It's the profession layer of The Shrink Network. Flagship feature: The Psychiatry Operating Room, an interactive map of twelve behind-the-scenes areas of practice.

## Machine-readable

- [Concept graph](https://shrinkiatry.com/concepts.json): this site's pages mapped to shared Shrink Network concept IDs
- [Page index](https://shrinkiatry.com/index.json): machine-readable index of every page, with canonical Shrinktionary concept ids, for cross-network deep-linking
- [Full index](https://shrinkiatry.com/llms-full.txt): the expanded companion to this file
- [Sitemap](https://shrinkiatry.com/sitemap.xml)
- [RSS feed](https://shrinkiatry.com/feed.xml): newest articles, with dates
- [Resource library](https://shrinkiatry.com/resources/): free downloadable educational practice forms, documentation aids, coding references, and checklists (PDF), plus six standalone practice guides, each with its own page and PDF and DOCX downloads: ending care without abandonment (https://shrinkiatry.com/resources/ending-care-checklist/), emergency-protocol checklist, prior-authorization checklist, a continuity-of-care letter, a practice-website legal-page checklist, and what every psychiatric practice website should contain

The flagship named system, The Psychiatry Operating Room (https://shrinkiatry.com/psychiatry-operating-room/), is referenced from every article on the site. Shared identity nodes: Person @id https://shariqrefai.com/#person; network Organization @id https://shrinknetwork.com/#organization.

## What shrinkiatry is

- A publication about the *profession* of psychiatry, not a patient-education site about conditions or medications, and not a clinic.
- Topics: careers and training (medical school, residency, board certification, fellowships), the business of practice (cash-pay vs insurance, practice models, documentation, controlled-substance rules), technology (telepsychiatry, electronic records, ambient AI documentation, artificial intelligence), economics (the psychiatrist workforce shortage, reimbursement, access, the Collaborative Care Model), culture, ethics, leadership, and innovation.
- Every page is written or reviewed by Shariq Refai, MD, MBA, FAPA, sources its factual claims to primary materials (ACGME, ABPN, AAMC, the American Psychiatric Association, HRSA, the DEA, the FDA, the AMA, and peer-reviewed literature), and states the limits of the evidence.
- Independent and ad-free: no advertising, nothing for sale, no affiliate or referral commissions. The editor's financial interest in shrinkMD is disclosed plainly.
- Editorial strategy is published openly at https://shrinkiatry.com/editorial-strategy/: what the site owns versus hands off to each sister site, how a page earns its place, the evidence standard, how care is routed (as one of several options, with shrinkMD named and disclosed), independence, and the machine-readable spine.

## Author and reviewer

- Shariq Refai, MD, MBA, FAPA: board-certified psychiatrist, founder of shrinkMD, editor of shrinkiatry, based in Jacksonville, Florida. Shared cross-network identity node: Person @id https://shariqrefai.com/#person.
- Identifiers: ORCID 0009-0009-1090-4373 (https://orcid.org/0009-0009-1090-4373); NPI 1467680660 (https://npiregistry.cms.hhs.gov/provider-view/1467680660); Wikidata Q139822307 (https://www.wikidata.org/wiki/Q139822307).
- Profile: https://shariqrefai.com
- In the media: interviewed by Top Doctor Magazine ("Mental Health Does Not Discriminate: An Interview with Dr. Shariq Refai," 2024); quoted as a board-certified psychiatrist in The Epoch Times ("10 Research-Backed, Natural Ways to Counter Depression," 2025), DomesticShelters.org ("Survivors in Isolation," 2025), and EatingWell (2025).

## The Shrink Network

shrinkiatry is part of The Shrink Network (https://shrinknetwork.com), a family of independent mental-health sites, each with a distinct job, published by shrinkMD Publishing, LLC:

- Understand: Shrinkopedia (https://shrinkopedia.com, encyclopedia of mental health), Shrinktionary (https://shrinktionary.com, dictionary of terms), ShrinkDaily (https://shrinkdaily.com, the daily learning layer: one evidence-based concept about human functioning at a time), AnxietyResource (https://anxietyresource.org), DepressionResource (https://depressionresource.org), AnxietyResearch (https://anxietyresearch.org, research summaries), PsychiatryRx (https://psychiatryrx.org, medication guides).
- Apply: shrinQ (https://shrinq.com), Unstuck (https://beunstuck.app), QuitScrolling (https://quitscrolling.app).
- Care: shrinkMD (https://shrinkmd.com, independent multistate telepsychiatry practice).
- Profession: shrinkiatry (https://shrinkiatry.com), Shariq Refai (https://shariqrefai.com).

shrinkiatry deliberately does not duplicate the other sites. When a topic is clinical it links to Shrinkopedia; medication detail to PsychiatryRx; specific conditions to AnxietyResource and DepressionResource; and clinical care to shrinkMD.

## Flagship and key pages

- The Psychiatry Operating Room (https://shrinkiatry.com/psychiatry-operating-room/): an interactive map of twelve areas of practice usually kept behind the scenes (training, clinical judgment, documentation, telepsychiatry, ethics, medication systems, business model, economics, AI and technology, burnout, patient access, and the future of psychiatry).
- Psychiatry Residency Guide (https://shrinkiatry.com/residency/): a structured guide to psychiatry residency. Publishes its inclusion criteria, a three-layer profile model (verified structured facts, program-reported details, and editorial context), verification and correction discipline, and a badge policy that is explicitly not an endorsement, built to the network governance standard. Includes a sourced application guide (https://shrinkiatry.com/residency/how-to-apply-to-psychiatry-residency/) with current NRMP Match data and how the ERAS and NRMP timeline works, and a submission and correction form (https://shrinkiatry.com/residency/submit-a-program/). Verified program profiles publish in reviewed batches by state, each checked against the program's official website and dated; thirteen state pages are live. Michigan (https://shrinkiatry.com/residency/michigan/) is complete with all eleven ACGME-accredited psychiatry residencies in the state (University of Michigan, Wayne State/DMC, Henry Ford Detroit, Henry Ford Jackson, Michigan State, Western Michigan/WMed, Corewell Health East/Beaumont, Central Michigan, Authority Health, Pine Rest/MSU, Trinity Health Livonia). Ohio (https://shrinkiatry.com/residency/ohio/) is also complete with all eleven ACGME-accredited psychiatry residencies (Ohio State, University of Cincinnati, Case Western/University Hospitals, University of Toledo, MetroHealth, OhioHealth Riverside, Wright State, Summa Health/NEOMED, Cleveland Clinic, Cleveland Clinic Akron General, and Adena Health). Maine (https://shrinkiatry.com/residency/maine/) is complete with both of its ACGME psychiatry residencies (Maine Medical Center in Portland and Northern Light Acadia Hospital in Bangor), and Nebraska (https://shrinkiatry.com/residency/nebraska/) is complete with both of its (University of Nebraska Medical Center and Creighton University, both in Omaha). Florida (https://shrinkiatry.com/residency/florida/) is complete with all thirty ACGME-accredited psychiatry residencies in the state: the four university programs (University of Florida in Gainesville and in Jacksonville, University of Miami/Jackson, and University of South Florida), Florida State University, Florida Atlantic University, the six University of Central Florida/HCA consortium programs (North Florida, Osceola, Capital/Tallahassee, West/Pensacola, plus Largo and Aventura HCA programs), USF's second program at Tampa General Behavioral Health Hospital, both BayCare programs (St. Joseph's and Morton Plant North Bay), both Nova Southeastern osteopathic programs (Orlando VA and Bay Pines VA), Larkin, Mount Sinai, Memorial Healthcare, HCA Orange Park, HCA JFK North, Citrus Health Network, Community Health of South Florida, Banyan Community Health Center, Southern Winds Hospital, Broward Health, Lakeland Regional Health, Centerstone, and SMA Healthcare. Each verified from the program's own official page and dated. No thin or fabricated entries. Hawaii (https://shrinkiatry.com/residency/hawaii/) is complete with both of its ACGME psychiatry residencies: the University of Hawaii John A. Burns School of Medicine program and the Tripler Army Medical Center military program, both in Honolulu. New York (https://shrinkiatry.com/residency/new-york/) is now complete for every ACGME psychiatry residency in the state that maintains a verifiable official presence, with 44 programs published and each checked against the program's own official website (or, where a program publishes no standalone site, the official NRMP Main Residency Match directory and the AMA's FREIDA database). These span the academic centers (Columbia at NewYork-Presbyterian and the New York State Psychiatric Institute, Weill Cornell, NYU Grossman, the Icahn School of Medicine at Mount Sinai and its Morningside-West, Elmhurst, and Queens programs, Montefiore Einstein, SUNY Downstate, SUNY Upstate, the University at Buffalo, the University of Rochester, Albany Medical College, Westchester Medical Center, and both Stony Brook programs), the New York City public and safety-net hospitals (Harlem, Lincoln, Jamaica, Woodhull, Metropolitan, Creedmoor, BronxCare, St. Barnabas, Brookdale, Interfaith, Richmond University, and the Family Health Centers at NYU Langone), Long Island and Hudson Valley community programs (Nassau University Medical Center, Staten Island University Hospital, Mather, Putnam, Good Samaritan and St. Catherine, Stony Brook Eastern Long Island, and the brand-new Lenox Hill program), and upstate community programs (Rochester Regional, United Health Services, Arnot Ogden, Mohawk Valley, Garnet Health, and the New York Medical College program at Saint Joseph's in Yonkers). Two remaining directory listings are documented but not published: the South Oaks (Amityville) program is still in formation and recruiting its first program director with no official program page yet, and the "St. Joseph's Health Syracuse" psychiatry listing is a directory artifact, as that hospital's own residency site lists only family medicine, dentistry, pharmacy, and a transitional year. Texas (https://shrinkiatry.com/residency/texas/) is complete for the state's verifiable ACGME psychiatry residencies, with 21 programs published, each checked against the program's own official website or, where a program publishes no usable page, the official NRMP Match directory and the AMA's FREIDA database. These span the university programs (UT Southwestern, Baylor College of Medicine, UTHealth Houston, UT Health San Antonio, UT Medical Branch at Galveston, UT Austin Dell, UT Rio Grande Valley, UT Tyler, and Texas A&M), the Texas Tech programs (Lubbock, Permian Basin, the Paul L. Foster program in El Paso, and the Transmountain program in El Paso), Baylor Scott & White in Temple, John Peter Smith in Fort Worth, a rural track at UT Tyler and UT Health Pittsburg, the military program at Carl R. Darnall Army Medical Center, and the community and safety-net programs at Baptist Hospitals of Southeast Texas, Project Vida, DHR Health, and the new Sam Houston consortium in Conroe. One remaining directory listing is documented but not published: the TIGMER program in San Antonio, whose primary teaching site (Texas Vista Medical Center) closed in 2024 and whose official page no longer publishes program details. Indiana (https://shrinkiatry.com/residency/indiana/) is complete with all six of its ACGME psychiatry residencies, each verified against its official page: the Indiana University School of Medicine flagship program in Indianapolis and its three regional-campus programs in Merrillville, Vincennes, and the brand-new Evansville program (with Deaconess Hospital), plus Community Health Network in Indianapolis and the new Parkview Health program in Fort Wayne. Georgia (https://shrinkiatry.com/residency/georgia/) is complete with all eight of its ACGME psychiatry residencies, each verified against its official page: the Atlanta academic programs (Emory University and Morehouse School of Medicine), the Medical College of Georgia at Augusta University, and the community and regional programs at Piedmont Macon (with Mercer University School of Medicine), St. Francis-Emory Healthcare in Columbus, Northeast Georgia Medical Center in Gainesville, Gateway Behavioral Health's community-service-board program in Savannah, and the rural Georgia South program at Colquitt Regional Medical Center in Moultrie. California (https://shrinkiatry.com/residency/california/) is complete with all thirty-nine of its ACGME psychiatry residencies, each verified against its own official page or, where a program publishes no usable page, the AMA's FREIDA database and the official NRMP Match directory. These span the University of California programs (UCLA David Geffen, UCLA-Kern, UCLA/VA Greater Los Angeles, Olive View-UCLA, UC Irvine, UC Davis, UC San Diego, UC Riverside, UCSF, and UCSF Fresno), the USC programs (USC at Los Angeles General and Keck), Stanford, Loma Linda (its main university program and a separate forensic program based at Patton State Hospital), Harbor-UCLA, Riverside University Health System, the four Kaiser Permanente programs (Fontana, Oakland, San Jose, and Sacramento), Sutter's California Pacific Medical Center in San Francisco and its Sacramento-region program at Sutter Roseville, San Mateo County, the Naval Medical Center San Diego military program, Charles R. Drew University, and a large group of community and safety-net programs (Kaweah Health in Visalia, Arrowhead Regional in Colton, Community Memorial in Ventura, Eisenhower Health in Rancho Mirage, St. Joseph's in Stockton, Mission Community in Panorama City, College Medical Center in Long Beach, Healthy Rural California in Chico, Family Health Centers of San Diego, Oroville Hospital, the Prime West Consortium at St. Francis in Lynwood, Imperial County Behavioral Health Services in El Centro, and Brain Health USA in Van Nuys). Where a program's official page did not name a current program director in a citable form, that name is omitted rather than taken from a directory. Virginia (https://shrinkiatry.com/residency/virginia/) is complete with all nine of its ACGME psychiatry residencies, each verified against its own official page or, where the official page did not name the director in a citable form, the AMA's FREIDA database: the University of Virginia in Charlottesville, Old Dominion University (formerly Eastern Virginia Medical School) in Norfolk, Virginia Commonwealth University in Richmond, the Carilion Clinic and Virginia Tech Carilion program in Roanoke, the Naval Medical Center Portsmouth military program, HCA LewisGale in Salem, Inova Fairfax in the Northern Virginia suburbs of Washington, Mary Washington Healthcare in Fredericksburg, and Augusta Health in Fishersville. Alaska (https://shrinkiatry.com/residency/alaska/) has no ACGME-accredited psychiatry residency at all, verified against the residency directories and Providence Alaska's own graduate medical education listings (which show only pharmacy, palliative medicine, pastoral education, and family medicine), so its page is an honest explainer rather than a program list; Alaskans generally train through the WWAMI pathway, in which the University of Washington School of Medicine serves Alaska, and through out-of-state programs. Wisconsin (https://shrinkiatry.com/residency/wisconsin/) is complete with its four verified ACGME psychiatry residencies, each checked against its official page: the University of Wisconsin in Madison, and the Medical College of Wisconsin's three regional programs in Milwaukee, Green Bay (Northeastern Wisconsin), and Wausau (Central Wisconsin). Two directory listings are documented but not published: a "Neenah" listing is a duplicate of the Green Bay program, which already rotates through Neenah and the Fox Valley, and a Gundersen La Crosse psychiatry listing has no active program on Gundersen's own residencies page. State pages are being built out in the order of the states shrinkMD serves, starting with Maine.
- Psychiatry Innovation Atlas (https://shrinkiatry.com/atlas/): a verified, sourced directory of real psychiatric care programs and models, organized by state and by category (collaborative and integrated care, primary-care access programs, first-episode psychosis and coordinated specialty care, physician and clinician mental health, rural and telepsychiatry access, and reproductive and maternal mental health). It's distinct from the /innovation/ topic articles: the Atlas documents specific named programs, each checked against an official source and dated, with a three-layer profile (verified facts, program-reported details, and shrinkiatry context) and a correction form at https://shrinkiatry.com/atlas/submit/. Being documented is not an endorsement, award, or ranking, and no one pays for inclusion. It's built out state by state in verified batches. As of July 2026 it documents 39 programs across 11 states (Maine, Nebraska, Florida, Hawaii, New York, Texas, Indiana, Georgia, California, Virginia, and Wisconsin), the states the shrinkMD network serves, with each program checked against an official source and dated.
- Contribute (https://shrinkiatry.com/contribute/): the contributor program for qualified clinicians and researchers, who can peer-review content or add short attributed expert perspectives. Each contributor gets a permanent, verified profile at https://shrinkiatry.com/contributors/, a shareable badge, a record of their contributions, and a credit line on the content they review. There's no payment and no guaranteed selection, and a listing is editorial recognition, not a medical-quality endorsement. Only real, credentialed people are listed; the founding reviewer is Shariq Refai, MD, MBA, FAPA, and the first outside contributor is Lisa Abrotsky, LMFT (https://shrinkiatry.com/contributors/lisa-abrotsky-lmft/), founder of New Reflections Counseling.
- Interviews (https://shrinkiatry.com/interviews/): edited conversations with real, named clinicians, researchers, and founders about how the profession works, kept separate from reported articles and opinion, with each interviewee's byline linked to their verified contributor profile. The first interview is with Lisa Abrotsky, LMFT (https://shrinkiatry.com/interviews/lisa-abrotsky-lmft/), founder of New Reflections Counseling, on building a couples therapy practice across eleven states, choosing between EMDR and the Gottman Method, supervising across four boards, community-based care, and fixing the psychiatry to therapy handoff.
- The Psychiatry Decoder (https://shrinkiatry.com/decoder/): plain-English answers to the confusing realities of psychiatric care (why appointments feel short, why getting seen is hard, why cash-pay, why controlled substances have extra rules).
- The State of Psychiatry (https://shrinkiatry.com/state-of-psychiatry/): sourced data briefs on the workforce shortage, telepsychiatry, burnout, and AI.
- The State of Psychiatry Access 2026 (https://shrinkiatry.com/reports/state-of-psychiatry-access/): the flagship data report, built from public HRSA data. About 137 million Americans live in a designated mental-health shortage area, about 27 percent of the need in those areas is met, and about 6,800 more practitioners are needed to remove all designations (HRSA, as of December 31, 2025). Includes a state-by-state directional read and a downloadable CSV dataset and PDF summary. Public data only, dated and sourced, not a survey or a ranking.
- Careers (https://shrinkiatry.com/careers/): residency, board certification, fellowships, and career paths.
- Business (https://shrinkiatry.com/business/): cash-pay vs insurance, practice models, documentation, controlled substances.
- Technology (https://shrinkiatry.com/technology/): telepsychiatry, ambient AI scribes, and an honest read on AI.
- Economics (https://shrinkiatry.com/economics/): the psychiatrist shortage and the Collaborative Care Model.
- Ethics (https://shrinkiatry.com/ethics/): the coercive and consent-related machinery behind psychiatric care. How involuntary commitment actually works (the danger-to-self, danger-to-others, and grave-disability standards, emergency holds, and why the statute changes at the state line); the limits of confidentiality (the duty to protect after Tarasoff, which is a state-by-state patchwork rather than one national rule, plus mandatory reporting); capacity, competence, and who gets to decide (Appelbaum's four abilities, and why a patient with capacity can refuse care); and the 2-year rule for therapists.
- Culture (https://shrinkiatry.com/culture/): identity, the stigma psychiatry carries inside medicine, burnout, the volume model, and the hidden curriculum (Hafferty) that training transmits without writing it down.
- Leadership (https://shrinkiatry.com/leadership/): clinical leadership, supervision, and what a psychiatry medical director actually does.
- Opinion (https://shrinkiatry.com/opinion/): clearly labeled editorial, each piece ending with the strongest case against it. Includes the argument that the 15-minute med check is a policy choice produced by payment design, not a clinical standard.
- Tools (https://shrinkiatry.com/tools/): a Psychiatry Practice Policy Builder that drafts eight editable documents (refill, cancellation, financial and payment, communication, telehealth expectations, telehealth informed consent, controlled-medication policies, and a patient FAQ) from a few inputs, with practice contact details and hours woven into each; a private-practice revenue estimator; a psychiatry panel size (caseload) calculator; a psychiatry workforce shortage explorer; and a residency path explorer. All free, browser-only, and educational (not legal, medical, or financial advice), sourced to DEA, CMS, HHS, HRSA, and ACGME.
- Resources (https://shrinkiatry.com/resources/): a free, ad-free library of downloadable educational assets for psychiatrists and psychiatric nurse practitioners, 33 branded PDFs and 2 spreadsheets. Groups: forms and policies (intake, telepsychiatry consent, release of information, records request, referral, primary-care letter, controlled-substance agreement, cancellation and financial policies, Good Faith Estimate); documentation aids (progress note structure, mental status exam, risk-assessment documentation structure, safety-planning overview); billing and coding (E/M and coding references, superbill and CMS-1500, Collaborative Care codes); privacy and compliance (HIPAA safeguards, Notice of Privacy Practice