Academic Psychiatry

, Volume 40, Issue 1, pp 145–148 | Cite as

A Call to Restructure Psychiatry General and Subspecialty Training

  • Paul KirwinEmail author
  • Michelle Conroy
  • Constantine Lyketsos
  • Blaine Greenwald
  • Brent Forester
  • Christine deVries
  • Iqbal Ike Ahmed
  • Ilse Wiechers
  • Kristina Zdanys
  • David Steffens
  • Charles F. ReynoldsIII
In Depth Article: Commentary


Dire shortages of psychiatrists with special expertise in geriatrics, substance abuse, forensics, and psychosomatics create barriers to care for populations with complex mental disorders and pose a significant public health concern. To address these disparities in access to care, we propose streamlining graduate medical education to increase efficiency and enhance cost-effectiveness while simultaneously increasing the number of psychiatric subspecialists in these key areas. We propose that trainees interested in subspecialties complete their general training in 3 years, while meeting ACGME required milestones, and then utilize their 4th year to complete subspecialty fellowship training. Eligible trainees would then qualify for psychiatry subspecialty certification and general psychiatry ABPN certification at the end of 4 years.


Residency education Fellowship training Subspecialty training ACGME ABPN 



All authors are involved with the academic missions of their home institutions. Several are either active Geriatric Psychiatry Fellowship Directors (Kirwin, Greenwald) or Associate Fellowship Directors (Conroy, Zdanys). Several are past Geriatric Psychiatry Fellowship and/or Section Directors (Lyketsos, Steffens, Ahmed), and several are past General Psychiatry Program Directors (Kirwin, Ahmed) and former Deputy Chair (Ahmed). Several are Department Chairs (Steffens) or Chair/Vice-Chairs (Lyketsos, Greenwald). One is an RWJ Fellow (Wiechers). One is a medical school Psychiatry Clerkship Director (Forester). One is a recent CEO of the AAGP (deVries). One is a recent Senior Associate Dean (Reynolds) and two are Endowed Professors (Reynolds, Lyketsos). One author (Ahmed) currently serves on the Psychiatry Review Committee for the ACGME. He worked on this proposal before his appointment to the Psychiatry Review Committee.


  1. 1.
    Eden J, Katie Maslow K, Le M, and Blazer D, Editors, and the Committee on the Mental Health Workforce for Geriatric Populations Board on Health Care Services. The Mental Health and Substance Use Workforce for Older Adults: In Who’s Hands? Institute of Medicine of the National Academies, The National Academies Press, Washington. D.C., July 2012.Google Scholar
  2. 2.
    American Psychiatric Association. “APA Supports Institute of Medicine Report Calling for Increased Mental Health Workforce Capacity to Care for Growing Geriatric Population” July 16, 2012, No. 12–34, .Google Scholar
  3. 3.
    ACGME. 2014. Number of accredited programs for the current academic year (2013–2014) (accessed January 3rd, 2014).
  4. 4.
    Geriatric Workforce Policy Studies Center (GWPSC). 2010b. Table 3.5 Geriatric psychiatry fellowship programs 1995/96-2010/11: American Geriatrics Society. (accessed February 5, 2013).
  5. 5.
    ABPN (American Board of Psychiatry and Neurology). 2012. Initial certification statistics. (accessed January 3rd, 2014).
  6. 6.
    ABPN. 2012. Maintenance of certification statistics. (accessed January 3rd, 2014).
  7. 7.
    Abrams M, Patchan K, Boat T, editors. Research training in psychiatry residency:strategies for reform, Institute of Medicine of the National Academies. Washington: The National Academies Press; October 2003.Google Scholar
  8. 8.
    Emmanuel EJ, Fuchs VR. Shortening Medical Training by 30%. Journal of the American Medical Association, Vol. 307, No. 11, March 21, 2012Google Scholar
  9. 9.
    Zweifler J. Why We Should Reduce Family Practice Training to Two Years. Academic Medicine, Vol. 78, No. 9/September 2003.Google Scholar
  10. 10.
  11. 11.
    Dorsey ER, Nincic D, Schwartz JS. An Evaluation of Four Proposals to Reduce the Financial Burden of Medical Education. Academic Medicine, Vol. 81, No. 3/March 2006.Google Scholar
  12. 12.
    Benbassat J, Baumal R. Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties. Adv Health Sci Educ. 2012;17:145–55.CrossRefGoogle Scholar

Copyright information

© Academic Psychiatry (outside the USA) 2014

Authors and Affiliations

  • Paul Kirwin
    • 1
    Email author
  • Michelle Conroy
    • 1
  • Constantine Lyketsos
    • 2
  • Blaine Greenwald
    • 3
  • Brent Forester
    • 4
  • Christine deVries
    • 5
  • Iqbal Ike Ahmed
    • 6
  • Ilse Wiechers
    • 1
  • Kristina Zdanys
    • 7
  • David Steffens
    • 8
  • Charles F. ReynoldsIII
    • 9
  1. 1.Yale University School of Medicine, VA Connecticut Healthcare SystemWest HavenUSA
  2. 2.The Johns Hopkins HospitalBaltimoreUSA
  3. 3.Long Island Jewish Medical Center/North Shore University HospitalGlen OaksUSA
  4. 4.McLean Hospital, Harvard Medical SchoolBelmontUSA
  5. 5.American Association for Geriatric PsychiatryBethesdaUSA
  6. 6.Tripler Army Medical CenterHonoluluUSA
  7. 7.University of Connecticut Health CenterFarmingtonUSA
  8. 8.University of Connecticut School of MedicineFarmingtonUSA
  9. 9.University of Pittsburgh Medical CenterPittsburghUSA

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