The number of U.S. medical school graduates choosing to enter a psychiatry
residency has risen slightly for the fifth year in a row. A total of 653 U.S.
medical graduates "matched" into psychiatry residency programs
around the country in the annual National Resident Matching Program (NRMP).
That figure is up from 641 last year and 597 in 2003 (see chart).
In addition to the 653 U.S. medical graduates, 330 students—including
mostly international medical graduates (IMGs), Canadian students, and U.S.
seniors who had graduated in previous years—also filled slots this year,
for a total of 983 students scheduled to enter PGY-1 general psychiatry
residency positions this summer.
"Since 2000, psychiatry has seen a slow and steady increase in our
match numbers every year," said Deborah Hales, M.D., director of APA's
Division of Education and Career Development. "I believe there are
several trends behind this increase. First, the scientific advances in
neurosciences and progress in understanding and treating mental illness make
psychiatry an exciting career choice.
"Second, psychiatry offers physicians a controlled lifestyle, where
the individual determines his or her own schedule, which is very attractive to
medical students today.
"And last but not least, psychiatry is still the specialty where
doctors have a significant relationship with their patients and are able to
spend time with them, and this too is something valuable when choosing a
Sidney Weissman, M.D., APA's Area 4 trustee and a past president of the
American Association of Directors of Psychiatric Residency Training, told
Psychiatric News that the modest increase in the number of students
entering psychiatry also reflects a continued shift away from primary care
that began at the end of the 1990s. Earlier in that decade there had been a
rapid increase in the number of students entering family practice and related
primary care fields, when health policy experts were predicting that primary
care physicians would be the gatekeepers of a new, highly managed American
health care system.
Public backlash against managed care and a widespread perception that
managed care had fallen far short of its promise, along with physician
dissatisfaction with the role of gatekeeper, caused the trend to reverse. In
the last five years students have been returning to specialty practice,
including some fields—such as anesthesiology and radiology—that
had at one time been considered moribund.
"The match this year appears to have consolidated the career shifts
of students that began at the end of the last decade," said Weissman,
professor and director of psychiatry residency training at the Feinberg School
of Medicine at Northwestern University. "From 1997 until today, 1,200
fewer U.S. seniors are selecting family practice. In the same period, our
recruitment of U.S. seniors into psychiatry has increased by nearly 50
"We can understand the career choice of U.S. seniors in the past
seven years as a movement away from family practice with more than 1,000
students now filling positions in a diverse fields, including diagnostic
radiology, anesthesiology, emergency medicine, and psychiatry."
Weissman has maintained a longtime interest in psychiatric workforce issues
and provided Psychiatric News with data on the match this year
specific to psychiatry, which includes information from the NRMP.
The NRMP is a private, not-for-profit organization established in 1952 to
provide "an orderly and fair mechanism" to match the preferences
of applicants to U.S. residency positions with the preferences of residency
program directors for those applicants. The NRMP is sponsored by the American
Board of Medical Specialties, the AMA, the Association of American Medical
Colleges, the American Hospital Association, and the Council of Medical
Because the match results reflect the fields of medicine preferred by
tomorrow's doctors, they are watched like tea leaves by medical educators and
policymakers. And while psychiatry has benefited from the return of students
to specialty medicine, said Weissman, that shift is likely to level off
pitting psychiatry in a "fierce competition" with other
specialties for students.
As in past years, Weissman stressed that the profession's own
self-definition—what the nature of psychiatric practice will be in the
future—is crucial to attracting students.
"In mapping psychiatry's recruitment strategy for the second half of
this decade, we will be competing not with family practice for residents, but
against varied medical specialties," he said. "We must ensure that
students know what psychiatry is, what the requisite skill sets are to become
a psychiatrist, and what practice opportunities exist in diverse settings
after completing training."
Weissman noted also that psychiatry—like the rest of
medicine—is heavily dependent on international medical graduates and
will remain so for the future.
"American medicine is dependent upon IMGs to fill one-fifth of all
residency training positions," he said. "This reliance will
continue for many years to come. For the foreseeable future, approximately a
third of psychiatry's residents will be IMGs."
Information about the NRMP and 2005 match results is posted online