Factors Affecting Psychiatry Resident Decision toPursue Consultation-Liaison Psychiatry or Other Subspecialty Fellowship Training.

Abstract

There is a national shortage of psychiatrists with subspecialty fellowship training, and many fellowship positions are unfilled. 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. Online surveys were distributed electronically to US general psychiatry residents through the American Association of Directors of Psychiatric Residency Training list server. 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. 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.