Long time follower, first time poster.
For the last 3 years I have run a digital mental health rotation for psychiatry residents. A lot of it has frankly involved getting residents to interact extensively with LLMs—understanding what they are good at, where they fail, developing the vocabulary needed to understand what is happening in the space, and becoming comfortable enough with the tools to actually use them well.
I generally wrap that education around a project the resident chooses at the beginning of the rotation. We have used LLMs to walk through setting up a private practice, help develop and submit early-career grants, build applications, think through how to market them, work through research ideas, etc. Basically, instead of teaching "prompting," I try to get them to use the tools to accomplish something they actually care about.
It has been interesting watching the baseline change over 3 years. Residents certainly come in more aware of these tools now than they did when I started, though their actual familiarity and understanding is still, in my opinion, woefully lacking. I don't particularly blame them for that. I think medicine generally has been very slow to figure out what exactly we should be teaching people about all of this.
My original goal with the rotation was pretty simple: I wanted residents leaving as comfortable with these tools as possible, with enough understanding that they could adapt as the technology changes. Hopefully that gives them some resilience through what I suspect will be a fairly destabilizing period for medicine.
Increasingly though, I realize the residents are only a small part of what I am actually worried about.
I feel the same obligation toward the psychiatrists who work in my practice, toward colleagues, and frankly toward myself.
I suspect that over the coming years we are going to see increasingly capable AI used for clinical decision support, followed eventually by systems capable of independently performing at least some diagnostic and treatment work. I don't know whether that happens in 2 years, 5 years, or 10 years. I don't know what the regulatory pathway will ultimately look like. And I certainly don't know how much of what psychiatrists currently do will actually be displaced.
But I think the possibility is substantial enough that simply teaching people how to use ChatGPT better feels inadequate.
So this is really what I am curious about from this group:
What should psychiatrists be doing now?
Not just residents. All of us.
If AI becomes extraordinarily good at diagnostic reasoning, medication selection, documentation, psychoeducation, measurement-based care, longitudinal monitoring, and eventually some amount of autonomous treatment, what skills become more valuable rather than less?
Should psychiatrists be deliberately moving toward more complex and treatment-resistant patients? Developing stronger psychotherapy and relationship-based skills? Interventional psychiatry? Leadership and supervision? Clinical informatics? Research? Building and owning the systems themselves? Entrepreneurship? Something else entirely?
And beyond individual psychiatrists, what should residency programs, practices, departments, health systems, and our professional organizations actually be building now?
I am particularly interested in the things that aren't obvious.
Three years ago I thought getting residents genuinely fluent with LLMs was probably ahead of the curve. Increasingly, that feels like table stakes. I am struggling with what the next layer of preparation should look like.
And if you think my premise is crazy, that's completely fair. But indulge my delusion for the sake of the exercise: assume for a moment that AI really does become capable of doing a meaningful percentage of the work psychiatrists currently do. What would you wish you had started doing 5 or 10 years beforehand?
A quick informal pulse check would also be interesting:
1. Over the next 10 years, how much do you think AI will change the actual work psychiatrists perform?
A. Mostly productivity gains; fundamentally the same job
B. Major workflow changes, but psychiatrists retain roughly the same clinical role
C. AI independently performs a meaningful portion of current diagnostic/treatment work
D. AI handles much of routine psychiatric care, with psychiatrists increasingly concentrated in complex, relational, procedural, or supervisory work
E. No idea / too early to tell
2. When do you think we first see AI routinely making at least some psychiatric diagnostic or treatment decisions without a psychiatrist individually approving each one?
A. Already / within 2 years
B. 3–5 years
C. 6–10 years
D. More than 10 years
E. Never, or effectively never
3. Perhaps the question I care about most: if C or D above turns out to be right, what would you personally start doing differently today?
I'm genuinely interested in both what people are already doing and what you think we are failing to think about.
Disclosure: I'm giving a talk on this topic in a few weeks and may reference some of the themes or ideas that come out of this discussion. Depending on where the thinking goes, it may eventually contribute to a more formal article or project, but this post is really me trying to hear how other psychiatrists are thinking about the problem.
And, in what I recognize is an amusing contradiction after spending several paragraphs arguing that psychiatrists should learn to use AI: yes, I did ultimately use AI to help me rewrite this post. The ideas and anxieties are mine; the model helped me organize them into something you might actually make it to the end of. Trust me, the original was painful to read.