Psychiatry is a medical specialty focused on the diagnosis and treatment of mental, emotional, and behavioral disorders. Practicing psychiatrists in the United States must first complete a full medical education and obtain medical licensure before specializing. This multi-stage process ensures they possess a comprehensive understanding of both the mental and physical aspects of health.
Educational Foundations: Pre-Med and Medical School (MD or DO)
The foundation of a career in psychiatry begins with a four-year undergraduate degree, where aspiring physicians complete the necessary pre-medical coursework. While no specific major is required, the curriculum must include substantial science coursework, such as biology, general chemistry, organic chemistry, and physics, often with laboratory components. Coursework in biochemistry, psychology, and sociology is also recommended to prepare for the Medical College Admission Test (MCAT).
Success on the MCAT is a significant factor for gaining admission to medical school. Following acceptance, the student embarks on four years of medical school, resulting in either a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) degree. Both degrees are equally valid for pursuing psychiatric practice and grant the same rights and privileges as a fully licensed physician.
MD programs follow an allopathic model, while DO programs incorporate a holistic approach and training in osteopathic manipulative treatment. Regardless of the degree, the four years of medical school cover the full spectrum of medical science and clinical rotations. Upon graduation, the physician must enter the competitive residency matching process to begin specialized training.
Post-Graduate Training: Psychiatric Residency
Following medical school, the physician enters a four-year residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). This is the first step toward specialization in psychiatry. The first year, known as the Postgraduate Year 1 (PGY-1), includes mandatory “off-service” rotations to solidify general medical knowledge. These rotations typically involve at least six months in non-psychiatric settings, such as internal medicine or emergency medicine, along with a dedicated rotation in neurology.
The remaining three years (PGY-2 through PGY-4) focus intensively on specialized psychiatric training across diverse clinical settings. Residents rotate through adult inpatient units, consultation-liaison services, and specialized outpatient clinics. This comprehensive experience covers psychopharmacology, psychotherapy, and the treatment of mental health and substance use disorders. Successful completion of this four-year residency is mandatory and serves as the primary gateway to independent practice.
State Licensing Requirements for Practice
A psychiatric physician must obtain a state-issued license to legally practice medicine, governed by the medical board of the state in which they intend to practice. The primary requirement for nearly all states is the successful completion of the national licensing examinations.
MD physicians must pass all three steps of the United States Medical Licensing Examination (USMLE). DO physicians must pass the three levels of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). These exams test medical knowledge and clinical skills at various stages of training. While physicians often hold a temporary license during residency, they must obtain a full, unrestricted license upon completion of training to practice independently and be eligible for board certification.
Achieving Board Certification in Psychiatry
Board certification is overseen by the American Board of Psychiatry and Neurology (ABPN). Although voluntary, this credential signifies advanced competency and expertise in the field. Eligibility requires the physician to have successfully completed an ACGME-accredited four-year residency program and hold a valid, unrestricted medical license.
The certification process culminates in a computerized examination that assesses the physician’s knowledge, judgment, and clinical skills. The ABPN also requires program directors to submit documentation verifying the resident’s successful completion of clinical skills evaluations. Passing this comprehensive exam grants the status of a Board-Certified Psychiatrist, which is often necessary for obtaining hospital privileges and recognition by insurance providers.
Subspecialization and Fellowship Training
After completing the four-year general psychiatry residency, many physicians pursue further subspecialty training through a one-to-two-year fellowship. This optional period focuses on a specific patient population or specialized area of practice. Completion of an ACGME-accredited fellowship makes the psychiatrist eligible for an additional subspecialty certification from the ABPN.
Common subspecialties include:
- Child and Adolescent Psychiatry (typically two years)
- Addiction Psychiatry
- Geriatric Psychiatry
- Forensic Psychiatry
- Consultation-Liaison Psychiatry (focusing on the intersection of psychiatry and general medicine in hospital settings)
Obtaining subspecialty certification demonstrates a commitment to a focused area of expertise and enhances career options.
Maintaining Certification and Continuing Education
Board certification is not permanent and must be maintained throughout a psychiatrist’s career through ongoing professional development and assessment. The ABPN requires participation in its Continuing Certification (CC) program, which typically operates on a 10-year cycle. Maintaining certification requires holding an active, full, and unrestricted medical license in at least one state.
The CC program mandates several ongoing activities:
- Completion of a set number of Continuing Medical Education (CME) hours, including Self-Assessment CME.
- Engagement in Improvement in Medical Practice (PIP) activities, which are quality improvement projects.
- Passing a secure, comprehensive examination every 10 years.
- Participation in the Article-Based Continuing Certification (ABCC) pathway, involving continuous, article-based assessments.