Psychiatry has nine subspecialties recognized by the American Board of Psychiatry and Neurology (ABPN), each entered through an ACGME-accredited fellowship.
Child and adolescent psychiatry takes 24 months — and is the one fellowship a resident can start before the residency ends.
Addiction, forensic, geriatric, and consultation-liaison psychiatry each take 12 months after general psychiatry is complete.
No subspecialty examination can be attempted until the psychiatrist is certified in general psychiatry first.
The nine psychiatry subspecialties — and who can hold one
The ABPN's list is fixed: the subspecialties it recognizes for board-certified psychiatrists are addiction psychiatry, brain injury medicine, child and adolescent psychiatry, consultation-liaison psychiatry, forensic psychiatry, geriatric psychiatry, hospice and palliative medicine, pain medicine, and sleep medicine.
Each is a credential layered on top of the general psychiatry certificate — not a replacement for it.
The sequencing rule is explicit in the ABPN's own requirements: "candidates are not eligible to apply for a subspecialty examination until after they have been certified in the applicable primary specialty."
General psychiatry boards come first, the subspecialty exam second, every time.
A second boundary matters when reading job postings: addiction medicine is not on this list, and calling it a psychiatry subspecialty is wrong — the two addiction credentials come from two different boards, and the distinction is taken up in its own section below.
This page follows the five fellowships most psychiatrists enter from the psychiatry residency — child and adolescent (24 months) plus the four 12-month fellowships in addiction, forensic, geriatric, and consultation-liaison psychiatry — with the fellowship lengths and prerequisites fixed by the ACGME's 2026 program requirements.
How the fellowship math works: 48 months, then 12 — or 24
The base the fellowships build on is the psychiatry residency, which the ACGME requires to be "48 months in length."
What the residency contains — and the licence and board exams around it — are the subject of how to become a psychiatrist; this page starts where that one ends.
The residency already samples every subspecialty on this list before a fellowship is ever chosen: the ACGME's program requirements mandate two months FTE of child and adolescent psychiatry, two months of consultation-liaison, one month of geriatric psychiatry, one month of addiction psychiatry, and a required forensic psychiatry experience.
The fellowship is what turns a rotation into a credential.
The five fellowships and their entry points, per the ACGME's 2026 program requirements:
| Fellowship | Length | Entry point |
|---|---|---|
| Child and adolescent psychiatry | 24 months | After the first year of a psychiatry residency (fast-track) or after the residency |
| Addiction psychiatry | 12 months | Fellows "must have satisfactorily completed a general psychiatry program" |
| Forensic psychiatry | 12 months | General psychiatry completed first |
| Geriatric psychiatry | 12 months | General psychiatry completed first |
| Consultation-liaison psychiatry | 12 months | General psychiatry completed first |
Those ACGME rules govern entry to training.
The ABPN adds its own gate at the examination stage — primary certification first — and its own clocks, covered under the clocks-and-costs section below.
Child and adolescent psychiatry: the 24-month fast-track
Child and adolescent psychiatry (CAP) is the longest of the fellowships — the ACGME requires it to be "24 months in length" — and the only one a resident can enter early.
Its program requirements make an applicant eligible after completing "the first year of a psychiatry residency program or a program in another primary care specialty," and the psychiatry program requirements cap how much overlap this allows: up to 12 months of the fellowship may be double-counted toward both the fellowship and the residency.
The fast-track has one hard edge, and the ABPN states it without asterisks.
A resident fast-tracking into CAP at a different institution "must complete the entire 12-month continuous outpatient requirement during their psychiatry residency prior to moving," and "the ABPN will not approve exceptions to this requirement for any reason."
Plan the institution before planning the early start.
CAP is also the largest cohort in the subspecialty data: 9,597 CAP certificates were active as of December 31, 2025, out of 10,827 in the ABPN's post-1991 cohort — and the credential goes back furthest of the five, to a first examination in 1959, with 14,094 certificates awarded in all.
Addiction psychiatry vs addiction medicine: two boards, two credentials
The addiction credential is the one employers and payers most often describe loosely, so the exact lines matter.
Addiction psychiatry is the ABPN subspecialty.
It requires ABPN certification in general psychiatry — by December 31 of the year before the subspecialty exam — plus "one year of … (ACGME) accredited fellowship training in addiction psychiatry."
The 12-month fellowship's ACGME requirements state that fellows "must have satisfactorily completed a general psychiatry program," and the ABPN adds a detail that catches residents out: addiction rotations completed during residency "do not count" toward the fellowship requirement.
Addiction medicine is certified by the American Board of Preventive Medicine (ABPM) — a different board entirely — and it is not a psychiatry subspecialty.
Its eligibility is open to physicians of any primary specialty holding "current primary specialty certification through an ABMS member board, the American Osteopathic Association (AOA), the Royal College of Physicians and Surgeons of Canada (RCPSC), or the College of Family Physicians of Canada (CFPC)," plus "successful completion of a minimum of 12 months in an ACGME-accredited Addiction Medicine fellowship program."
That fellowship's ACGME requirements run 12 months, must be completed within 24 months of matriculation, and require completion of "a residency program" — any specialty.
The practical upshot: a psychiatrist can hold either credential, while a family physician or internist can hold only the ABPM one.
When a posting asks for one board's certificate and not the other, the two are not interchangeable.
Name the board when you name the credential
Forensic, geriatric, and consultation-liaison psychiatry
The remaining three of the five core fellowships share the same ACGME shape — 12 months each, entered after general psychiatry is complete — and differ in the cohorts the certificate data shows.
Forensic psychiatry
The forensic psychiatry fellowship is 12 months, taken after general psychiatry.
Its certificates: 1,614 active as of December 31, 2025, in the ABPN's post-1991 cohort of 2,279 — and 2,989 awarded in all since the first examination in 1994.
In 2025, 175 of 190 examinees passed (92 percent); among first-time takers from 2021 to 2025 the pass rate ran 94 percent.
Geriatric psychiatry
The geriatric psychiatry fellowship is likewise 12 months after general psychiatry — for a subspecialty whose residency exposure is a single mandated month, against the fellowship's 12.
It is the smallest active cohort of the five: 1,371 active certificates as of December 31, 2025, in the post-1991 cohort of 2,310 (59 percent), with 3,851 awarded since the first examination in 1991.
Recent cohorts have been thin: 81 new certificates in 2020, 116 in 2022, 97 in 2024.
First-time takers passed at 97 percent across 2021–2025.
Consultation-liaison psychiatry
Consultation-liaison (C-L) psychiatry is the youngest credential of the five — the first examination ran in 2005 — and its fellowship is 12 months, after general psychiatry.
The cohort: 1,597 active certificates as of December 31, 2025, in the post-1991 cohort of 2,017.
In 2025, 176 of 189 examinees passed (93 percent), with first-time takers at 97 percent across 2021–2025.
What the certificate counts show — and what they do not
The subspecialty cohorts are an order of magnitude smaller than general psychiatry's.
The ABPN counted 42,509 active psychiatry certificates as of December 31, 2025; the five core subspecialties together accounted for 15,582 active ones — 9,597 of them CAP.
For the individual counts: child and adolescent 9,597 active of 10,827 (89 percent), consultation-liaison 1,597 of 2,017 (79 percent), forensic 1,614 of 2,279 (71 percent), addiction 1,403 of 2,112 (66 percent), geriatric 1,371 of 2,310 (59 percent).
What the columns count needs care before reading those numbers as a labor market.
The active/total figures cover certificates held by diplomates who were certified in their primary specialty in 1991 or later — assuming a 35-year career after that primary certification — and known not to be deceased, per the ABPN's own notes; the all-time totals count every certificate ever issued, including those whose holders have died or whose certificates are no longer active.
That population filter, not the calendar, is why forensic psychiatry shows 2,989 certificates awarded since its first examination in 1994 but only 2,279 in the post-1991 column.
And an active certificate is still held by a person — it is not a job, a headcount of practising psychiatrists, or a match for the wage-and-salary employment the federal wage series counts.
The clocks and costs that govern sequencing
Three rules shape when a psychiatrist can sit a subspecialty exam, and none of them are annual.
Exams are not offered every year.
The ABPN states it plainly — "subspecialty examinations are not offered every year" — and its published calendar shows the cadence: addiction psychiatry ran in 2020, 2022, and 2024; forensic in 2021, 2023, and 2025; geriatric in 2020, 2022, and 2024; consultation-liaison in 2021, 2023, and 2025.
A fellowship completion date that misses its exam year means waiting for the next sitting.
The seven-year clock applies to subspecialties too.
Since January 1, 2012, the ABPN has required a physician to become certified "within seven years following successful completion of ACGME-accredited or ABPN-approved residency training in their primary specialty or ACGME-accredited subspecialty" — the rule covers both certificates, each on its own clock.
The fees are separate.
The ABPN's 2026 schedule puts the initial subspecialty certification examination at $1,900, with the CAP subspecialty exam priced like an initial certification exam at $1,945 — fees the board published as unchanged for 2026.
For reference on the odds once an exam is sat: first-time pass rates across 2021–2025 ran 98 percent (addiction), 97 percent (geriatric), 97 percent (consultation-liaison), 94 percent (forensic), and 88 percent (child and adolescent).
The 2025 results for all examinees — a different population, and the two numbers get conflated constantly — were 83 percent for CAP (502 of 608), 92 percent for forensic (175 of 190), and 93 percent for C-L (176 of 189).
Subspecialty certification and the job market
A subspecialty certificate does not change the licence underneath it — the state medical licence is the same document whether a psychiatrist holds zero fellowships or two, and how the licence works across states is covered on what a psychiatrist does.
What the certificate changes is the work a psychiatrist is credentialed to lead: the 24-month CAP credential is what a child and adolescent program hires against, and the ABPN-versus-ABPM addiction distinction in a job ad maps to different boards, not different intensity.
One honest gap: no sourced per-subspecialty pay series exists.
The federal wage series for psychiatrists (SOC 29-1223) reports one distribution for the whole occupation — the national figures and their caveats are in the salary section of the psychiatrist hub — and neither major national compensation survey splits psychiatrists by subspecialty.
Any page quoting a "child psychiatrist salary" or a "forensic psychiatrist premium" as a distinct number is presenting data that does not exist.
For the roles themselves, browse psychiatrist jobs and read how postings name credentials — the difference between "board eligible" and "ABPN certified," or between the two addiction boards, is the difference between a stack of applications and a short list.
And for the non-physician route into the same prescribing work, the nursing comparison is walked through in PMHNP vs psychiatrist.
This article is career information, not legal, clinical, or medical advice, and it is not guidance for anyone seeking treatment. Fellowship lengths and prerequisites are set by the ACGME; certification rules, exams, and fees by the ABPN and ABPM; and licensure by state medical boards — each changes its rules on its own schedule, so confirm current requirements with the relevant board before relying on any figure here.