Factors Affecting Psychiatry Resident Decision to Pursue Consultation-Liaison Psychiatry or Other Subspecialty Fellowship Training

Psychosomatics. 2020 May 22;S0033-3182(20)30147-X. doi: 10.1016/j.psym.2020.05.009. Online ahead of print.


Background: There is a national shortage of psychiatrists with subspecialty fellowship training, and many fellowship positions are unfilled.

Objective: We conducted a survey of US psychiatry residents to better understand the motivation to pursue fellowship training and to determine any specific factors that were particularly influential in choosing a fellowship in consultation-liaison (C-L) psychiatry.

Methods: Online surveys were distributed electronically to US general psychiatry residents through the American Association of Directors of Psychiatric Residency Training list server.

Results: A total of 219 questionnaires were completed. Interest in fellowship declined during residency training. Most important factors in consideration of fellowship training were lifestyle (89%), finances (69%), and academic opportunities (63%). Specific influential factors were residency experiences, attending staff as a role model, and medical school experiences. Most important discouraging factors were extra training time, financial concerns, and belief that fellowship training was not necessary. Only 30% of residents had outpatient C-L psychiatry experiences. Few residents belonged to any subspecialty organization or attended any subspecialty meeting. Residents interested in C-L psychiatry fellowships had lower expectation of increased salary than other residents. Outpatient practice settings were seen as preferable over inpatient settings by most residents.

Conclusions: Results of this survey suggest that enhancing consultation psychiatry exposure in medical school and residency with strong role models, outpatient C-L psychiatry experiences, facilitating subspecialty organization membership and meeting attendance, emphasizing academic opportunities of fellowship training, and improving remuneration for fellowship-trained psychiatrists might be important factors that could improve recruitment into C-L psychiatry and other psychiatric fellowships.

Keywords: consultation-liaison psychiatry; fellowship; graduate medical education; recruitment; specialization.