Challenges and Perspectives to the Fall in Psychiatry Fellowship Applications

  • James R. Agapoff IVEmail author
  • Daniel J. Olson
In Depth Article: Commentary

According to the U.S. Department of Labor [1], there has never been a better time to be a physician. Employment for physicians is expected to grow 13% between 2016 and 2026, faster than for any other occupation. In psychiatry, demand for expert clinicians continues to grow [2]. Despite this, applications to psychiatry fellowship programs continue to stagnate or decline even as applications to general psychiatry residency programs rise [3, 4, 5, 6].

The Institute of Medicine published a report in 2012 projecting that by 2030, there will be 72 million adults above the age of 65 in the USA. About 14–20% of these individuals (10 to 14 million people) will have a mental health or substance use disorder. The Institute estimates that in 2030, the ratio of geriatric psychiatrists to individuals over the age of 65 will drop from 1:23,000 to 1:27,000. At the same time, shortages in psychiatrists trained in addiction, consult-liaison, and child and adolescent psychiatry continue to grow [2]....



This article was supported by the Department of Psychiatry, University of Hawai‘i at Mānoa. The contents of this article are solely the responsibility of the authors. The authors would like to express their appreciation to the residents, faculty, and staff of the Department of Psychiatry.

Compliance with Ethical Standards


On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    The United States Department of Labor. Bureau of Labor Statistics. Occupational Outlook Handbook. Physicians and Surgeons. Job Outlook. [Accessed 25 November 2018].
  2. 2.
    Eden J, Katie Maslow K, Le M, and Blazer D, Editors, and the Committee on the Mental Health Work force for Geriatric Populations Board on Health Care Services. The mental health and substance use work force for older adults: in who’s hands? Institute of Medicine of the National Academies, The National Academies Press, Washington D.C., 2012.Google Scholar
  3. 3.
    Agapoff JR, Tonai C, Eckert DM, Gavero G, Goebert DA. Challenges and perspectives to the rise in general psychiatry residency applications. Acad Psychiatry. 2018;42(5):674–6. Scholar
  4. 4.
    Bragg EJ, Warshaw GA, Cheong J, Meganathan K, Brewer DE. National survey of geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs’ Geriatrics Workforce Policy Studies Center. Am J Geriatr Psychiatry. 2012;20(2):169–78. Scholar
  5. 5.
    Lieff SJ, Warshaw GA, Bragg EJ, Shaull RW, Lindsell CJ, Goldenhar LM. Geriatric psychiatry fellowship programs in the United States: findings from the Association of Directors of Geriatric Academic Programs’ Longitudinal Study of Training and Practice. Am J Geriatr Psychiatry. 2003;11(3):291–9.CrossRefGoogle Scholar
  6. 6.
    Moran M. Few residents entering addiction fellowships. Psychiatric News. 2007;42(7):16–29. Scholar
  7. 7.
    Kirwin P, Conroy M, Lyketsos C, Greenwald B, Forester B, deVries C, et al. A call to restructure psychiatry general and subspecialty training. Acad Psychiatry. 2016;40(1):145–8. Scholar
  8. 8.
    National Resident Matching Program. Charting outcomes in the Match Specialties Matching Service®, Appointment Year 2018 Characteristics of applicants who matched to their preferred specialty. 2nd Edition. 2018. [Accessed 24 November 2018].
  9. 9.
    National Resident Matching Program. Results and data: Specialties Matching Service® 2008–2017. [Accessed 24 November 2018].
  10. 10.
    Juul D, Colenda CC, Lyness JM, Dunn LB, Hargrave R, Faulkner LR. Subspecialty training and certification in geriatric psychiatry: a 25-year overview. Am J Geriatr Psychiatry. 2017;25(5):445–53.CrossRefGoogle Scholar
  11. 11.
    Accreditation Council for Graduate Medical Education (ACGME). Addiction Psychiatry Programs Academic Year 2018–2019. [Accessed 6 January 2019].
  12. 12.
    Accreditation Council for Graduate Medical Education (ACGME). Forensic Psychiatry Programs Academic Year 2018–2019. [Accessed 6 January 2019].
  13. 13.
    The Association of American Medical Colleges. Medical student education: debt, costs, and loan repayment fact card. October 2017. [Accessed 1 January 2019].
  14. 14.
    Renner JA, Karam-Hage M, Levinson M, Craig T, Eld B. What do psychiatric residents think of addiction psychiatry as a career? Acad Psychiatry. 2009;33(2):139–42.CrossRefGoogle Scholar
  15. 15.
    The Association of American Medical Colleges. Medical student education: debt, costs, and loan repayment fact card. October 2014. [Accessed 25 November 2018].
  16. 16.
    Berman J. This government loan forgiveness program has rejected 99% of borrowers so far. MarketWatch. Published: Sept 23, 2018. [Accessed 26 November 2018].
  17. 17.
    Balon R. Subspecialty training: time for change. Acad Psychiatry. 2017;41(4):558–60.
  18. 18.
    Guerrero PS, Roberts LW. Snapshots from the cutting edge: innovations in child and adolescent psychiatry training to address workforce shortages. Acad Psychiatry. 2017;41:571–3.CrossRefGoogle Scholar
  19. 19.
    Harris JC. Meeting the workforce shortage: toward 4-year board certification in child and adolescent psychiatry. J Am Acad Child Adolesc Psychiatry. 2018;57(10):722–4. Scholar

Copyright information

© Academic Psychiatry 2019

Authors and Affiliations

  1. 1.University of Hawai‘i at Mānoa, John A. Burns School of MedicineHonoluluUSA

Personalised recommendations