“Why would you waste your medical training to go into psychiatry? Do you not want to be a real doctor?” I have heard about a hundred variations of this in my career. If you decide to become a psychiatrist, people will question your wisdom, and then if you decide to become a child psychiatrist, they will almost want to stage an intervention.
I want to be upfront here. I never did a formal child psychiatry fellowship, but I have worked as a child psychiatrist most of my career. I came into psychiatry by choice in order to pursue a neuroscience research career, but my foray into child psychiatry was purely serendipitous.
Pediatric mental health care is in short supply and rarely prioritized. According to American Academy of Child and Adolescent Psychiatry (AACAP) data, 72 percent of U.S. counties lack a practicing child and adolescent psychiatrist. Instead of attracting more people, the shortage appears to have the opposite effect on career choices. Shortage is taken as an indictment of the specialty.
In a classic survey of graduating U.S. medical students, 3 in 4 had heard their chosen specialty run down, and 1 in 6 changed course as a result. In a U.K. study, psychiatry was one of the two most disparaged specialties, and 27 percent of students had changed their choice as a direct result.
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Psychiatry itself is increasingly popular now, and more students are choosing it than before: The latest Match filled 97 percent of psychiatry residency positions. But the pipeline still narrows where children come in. In 2025, about 1 in 6 child and adolescent psychiatry fellowship positions went unfilled.
We are recruiting with the wrong storyline.
I have spent most of my career working with some of the sickest children there are, children who are psychotic almost the entire time they are awake, at the childhood-onset schizophrenia study at the National Institute of Mental Health (NIMH). One day Emily walked onto our ward, and eleven-year-old Molly, who had not said a word that made sense in over six weeks, but was now on clozapine for almost two weeks, looked up, smiled, and said, “Good morning, Mommy.” I don’t think I can ever forget the sight of Emily simply bursting into tears, unable to let go of the hug.
That first glimpse of that dense fog of psychosis lifting with clozapine is nothing short of magical. The parents, like Emily, who never give up on these children probably made me a better parent, and the success of wraparound care I saw at the NIH has given me a lasting optimism about what can bring even the sickest children back from their illness.
It is hard. The suffering is real, and yes, not every child got better, and those who got better often did not return to where they were before. The system delivering mental health care sometimes appears worse than the illness itself, and the relentless efforts of patients, parents, and caregivers are exhausting even to watch. But that is also why we need more help, and why the work is worth choosing: to make a small difference, but a meaningful difference.
To the attendings and residents who interview applicants this season: Tell them what the work gives back and counter the disparaging narrative. And to program directors: Invite each student to come and spend a day to witness what the work is about.
I met Judy Rapoport by chance, with an hour to kill after a day-long interview in the adult schizophrenia program at the NIMH, which I had all but decided to join. She asked whether I could come and spend a day with her group. I came for a day and stayed nearly two decades.
Nobody asked me that afternoon whether I wanted to be a real doctor. Judy asked whether I would spend a day with her team. It is a better question, and we should be asking it of every student.
Emily and Molly are composites drawn from many families; dialogue is reconstructed.
Nitin Gogtay is a psychiatrist.
