How to Become a Psychiatrist
Psychiatrist Education Requirements
Psychiatrists are medical doctors who practice in mental health. They prevent (or attempt to do prevent), diagnose and treat mental illnesses and emotional and addiction-based disorders. Their methods of treatment typically include personal counseling (psychotherapy), psychoanalysis, admitting patients to hospitals or mental treatment facilities and medication – especially for chemical imbalances that may contribute to the illnesses. In examining or treating patients, the psychiatrist gathers information on the patient’s behavior and life, physical and mental histories.
The psychiatrist education requirements — from medical school through certification as a psychiatrist – are rigorous and take many years. Since psychiatrists practice medicine, the education and training they require tracks in many respects that of doctors in general. They must prepare for and get admitted to medical school, become licensed to practice medicine and complete training that allows them to independently practice psychiatry.
The Road to Medical School
Becoming a psychiatrist begins with admission to medical school. The preparation for that post-undergraduate life begins with classes that build the knowledge base for familiarity with medical school work – and admissions tests. Applicants do not have to earn a specific degree, but should include subjects such as biology, chemistry, physics, English, humanities, social science and math. Psychology courses can afford the aspiring psychiatrist a basic knowledge of mental, emotional and behavioral issues.
Medical school applicants must take the MCAT (Medical College Admissions Test). This standardized examination judges applicants’ knowledge of natural, behavior and social science and their talents in critical thinking and solving problems. The MCAT specifically tests on four sections:
*Biological and Biochemical Foundations of Living Systems
*Chemical and Physical Foundations of Biological Systems
*Psychological, Social and Biological Foundations of Behavior
*Critical Analysis and Reasoning Skills
The scores in each section range from 118 to 132, with 125 serving as the midpoint. This translates to a total score in the range of 472 to 528, with 500 in the center.
Medical schools take into account, in addition to MCAT scores, the applicant’s extra-curricular activities, demonstrated leadership qualities, personality, and letters of recommendation. Depending on the school, the admissions committee interviews applicants.
The Journey in Medical School
The four years of medical school exposes the future psychiatrist to the broader practice of medicine. In the first two years, students focus on subjects such as anatomy, biochemistry, pharmacology, clinical practice and the ethics and laws covering the practice of medicine. In this period, the curriculum covers skills such as interviewing patients, taking and obtaining medical histories and diagnosing conditions. These introductory courses lay the foundation for further psychiatry training, especially in residency programs. For example, psychiatrists dispense or prescribe medications that the federal and state governments treat as controlled substances and the psychiatrists must know the rules for when and how they can be prescribed. Medical doctors must register with the United States Drug Enforcement Agency (DEA) to prescribe controlled substances.
In years one and two, the student learns primarily in lecture halls and laboratories. Depending on the medical school, faculty from the psychiatry department offer shadowing opportunities and lectures.
In years three and four, the students turn to hands-on learning as they follow and work under the supervision of physicians at the hospitals. In these rounds, or rotations, the students visit, examine and offer diagnoses of patients’ conditions or illnesses. Students can take electives in psychiatry, such as in inpatient, outpatient and emergency psychiatry.
Licensed to Practice Medicine
Upon completion of medical school, the graduates then apply for and become licensed to practice medicine. State-created and controlled medical and licensing boards handle this aspect of the physician’s professional development. While specific requirements vary by state, candidates for licensure generally must demonstrate good character and fitness to practice and pass an examination. Convictions for felonies and for offenses involving drugs may also disqualify applicants, unless the conviction in question is overturned, withdrawn or has undergone a lapse in time. Prospective medical doctors, including psychiatrists, take a standardized exam called the U.S. Medical Licensing Examination.
Taking Up Residence
Once the aspiring psychiatrist has obtained a license to practice medicine, he or she can assume the title physician – but is not completed with training. In the medical field, the next step on how to become a psychiatrist is residency. This program bridges the physician’s medical school education with the ultimate finish line of independent practice. Upon being licensed to practice medicine, the physician enters a residency program of at least four years, mostly specializing in psychiatry. Generally, medical schools run these residency programs, offering their teaching hospitals or partnering with nearby local facilities or hospitals.
Residency provides a training and proving ground for the would-be psychiatrist. In this four-year period, the resident examines, evaluates and treats patients under the supervision of a certified or credentialed psychiatrist. The experience builds for the resident skills in obtaining medical, family and other relevant histories of a patient, conducting the mental status examination and participating in treatments and therapies.
The standards for psychiatry and other residency programs are set by the Accreditation Council of Graduate Medical Education (ACGME). In their first year, residents must work at least four months in a clinical setting affording comprehensive clinical care. The time spent in psychiatry may not exceed eight months so that the resident is exposed to other facets of the medical practice in a primary care facility.
The ACGME also sets standards for specific specialties and areas of psychiatric residency:
Inpatient psychiatry (Between six and 16 months): The resident must spend at least six months assessing, diagnosing, and treating patients admitted to a traditional psychiatric hospital or wing.
Outpatient psychiatry (Twelve months) At least one year is devoted to evaluation and treatment of patients receiving psychotherapy and being seen by appointments on almost a weekly basis. The resident may employ psychosocial rehabilitation to chronically-ill patients and emphasize various approaches to outpatient treatment. No more than 20 percent of the resident’s workload should involve child or adolescent patients.
Child and adolescent psychiatry (Two months): This clinical experience involves evaluating and treating children, youth and families of the patients. Interventions often come into play with this segment.
Geriatric psychiatry (One month): Here, the resident focuses on mental disorders in elderly patients. Within this specialty, the resident may encounter medical issues in addition to the mental ones. Cases may require the management of the cognitive aspects of degenerative disorders and the interaction of various drugs taken by geriatric patients. The rounds may include basic neuropsychological testing of the cognitive abilities of elderly patients.
Addiction psychiatry (One month): This realm concentrates on patients with drug, alcohol or other substance abuse problems. The treatment for these patients typically involves detoxification, managing and ameliorating overdoses of drugs (including prescriptions) and self-help groups.
Consultation-liaison psychiatry (Two months): The resident practices sharing and collaborating with other medical and surgical providers.
Forensic psychiatry: The resident gains experience in determining whether a patient poses a risk of harming himself or herself or others. The evaluations often determine whether to involuntarily commit a patient. In the field of forensic psychiatry, the resident learns the practical and legal aspects of evaluating the competency of patients or others.
Emergency psychiatry: Crisis management and triage of psychiatric patients, including those who present with suicide attempts or other episodes of self-harm, afford residents the experience in emergency psychiatry. Residents may not use emergency psychiatry experience to meet the inpatient residency requirement set by the ACGME nor may they allocate on-call experience by itself to meet the emergency experience requirement.
Community psychiatry: This experience in dealing with patients in the public sector, such as state-run mental hospitals or community mental health centers.
The American Board of Psychiatry and Neurology certifies psychiatrists who have completed their residency. This phase involves a written and oral examination. The clinical skills evaluation rates the psychiatrist in the areas of the physician-patient relationship, conducting psychiatric interviews and mental status examinations and presentation of cases. The candidate must demonstrate their competence before a psychiatrist currently certified as such by the American Board of Psychiatry and Neurology, although the evaluation takes place where the psychiatrist is in residence. The residency program director selects the patient, who must be unknown to the psychiatrist and someone whom the psychiatrist has not treated. The American Board of Psychiatry and Neurology does not permit simulated or standardized patients or live streaming to be the basis of the evaluation.