Psychiatry residency path explorer
Walk through what psychiatry training actually looks like, year by year, and then compare the subspecialty fellowships and practice paths that open up after it. This explains the path; it isn't a database of named programs.
How psychiatry training is built. US psychiatry residency is a four-year program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Training runs 48 months, starting with an intern year that blends medicine, neurology, and psychiatry, then moving through inpatient and emergency work into growing outpatient continuity and subspecialty exposure. After completing training, graduates are board eligible and can pursue certification from the American Board of Psychiatry and Neurology (ABPN).
PGY-1: Intern year
The first year mixes medicine and neurology with early psychiatry. ACGME requires at least four months of primary care (internal medicine, family medicine, or pediatrics) and at least two months of neurology, with the balance in psychiatry. You learn to manage medically complex patients and build the foundation the rest of training rests on.
PGY-2: Core inpatient and emergency psychiatry
The second year is usually the heaviest psychiatry immersion. You spend time on inpatient units and in emergency and consultation settings, managing acute presentations, running admissions, and starting psychopharmacology in earnest. Many programs begin longitudinal outpatient continuity clinics here, which run for the rest of residency.
PGY-3: Outpatient continuity and psychotherapy
The third year shifts toward outpatient care and psychotherapy. You carry a continuity caseload, learn structured therapies such as CBT and psychodynamic work, and deepen your diagnostic and medication management skills across mood, anxiety, psychotic, and personality presentations. Subspecialty rotations often start to appear.
PGY-4: Electives, subspecialty exposure, and autonomy
The final year emphasizes electives, growing autonomy, and preparation for independent practice. You customize toward your interests (child, addiction, forensics, research, administration), often take on supervisory and teaching roles, and finish the 48 months ACGME requires. After completing training you become board eligible.
After residency: fellowships and paths
Once you finish the four years, several routes open up. Some are accredited subspecialty fellowships with their own ABPN certification; others are practice settings you can enter as a board-eligible general psychiatrist. Pick one to see what it involves and how long it takes.
All paths at a glance
This list renders without JavaScript. Lengths are the typical accredited fellowship durations; practice paths need no separate fellowship.
Child and adolescent psychiatry
2-year ACGME fellowship
The most common psychiatry subspecialty. Two years of accredited fellowship in diagnosing and treating mental health conditions in children, adolescents, and families, with its own ABPN subspecialty certification. Programs let you enter after the third year of general residency in a combined track.
Geriatric psychiatry
1-year ACGME fellowship
One year focused on mental health in older adults, including dementia-related behavioral symptoms, late-life depression, and the interplay of medical illness and psychiatric care. Carries a distinct ABPN subspecialty certification.
Addiction psychiatry
1-year ACGME fellowship
One year specializing in substance use disorders and co-occurring psychiatric illness, spanning medication-assisted treatment, detox, and long-term recovery care. Leads to ABPN subspecialty certification.
Forensic psychiatry
1-year ACGME fellowship
One year at the intersection of psychiatry and the law: competency and criminal responsibility evaluations, civil matters, correctional care, and expert testimony. Carries its own ABPN subspecialty certification.
Consultation-liaison psychiatry
1-year ACGME fellowship
One year in the psychiatric care of medically ill patients in hospital and medical settings, working alongside other specialties. Formerly called psychosomatic medicine, with a dedicated ABPN subspecialty certification.
General outpatient practice
No fellowship required
Board-eligible general psychiatrists practicing in clinics and private practice after residency. This is the most common path. Work centers on medication management and, for many, psychotherapy across the adult diagnostic range.
Inpatient and hospital practice
No fellowship required
General psychiatrists working on inpatient units, in emergency psychiatry, or in consultation roles within hospitals. A residency-only path that manages acute and higher-acuity presentations.
Telepsychiatry
No separate fellowship
A practice setting rather than a distinct fellowship. General or subspecialty psychiatrists deliver care remotely, which has become central to reaching the shortage areas mapped in our workforce tool. Requires licensure in the patient's state.
Primary sources: ACGME psychiatry for training and fellowship structure, and ABPN for certification and subspecialty certificates.