Almost half of all pediatric outpatient visits involve a behavioral health concern, according to recent data. Yet pediatric residents have historically received limited formal preparation in mental health care—and only in July 2025 did the Accreditation Council for Graduate Medical Education (ACGME) begin requiring additional mental health experience as part of pediatric residency training.
“When you talk to residents coming out of their program, they’ll tell you they are woefully unprepared to take care of kids with mental health problems,” explains developmental-behavioral pediatrician and longtime REACH faculty member Gene Hershorin, MD.
Dr. Hershorin spent 45 years in academic pediatrics and has concerns about how today’s residency programs prepare pediatricians for real-world outpatient practice. We asked him to explain how residency training has shifted since he went to school, why doctors struggle to evaluate and initiate mental health treatment, and what resources are helping to bridge that gap.
The Slow Evolution of Mental Health Training in Pediatrics
In the 1970s, when Dr. Hershorin was completing his pediatric residency, mental health was completely absent from the standard curriculum. “I never even heard the words depression, anxiety, or ADHD,” he recalls. “There were electives in psychiatry where you basically sat behind a mirror and watched, but almost nobody took them.”
During that era, pediatric residency focused almost exclusively on inpatient hospital wards and intensive care units (ICUs). Even today, residents spend months staffing neonatal and pediatric ICUs treating acute physical illness, even though most will transition into outpatient primary care after graduation. While acute medical care remains a vital part of pediatric training, outpatient practice demands a much stronger emphasis on mental health.
Progress has been slow, though recent changes represent an important step forward. In 1997, the ACGME established a required four-week rotation in Developmental and Behavioral Pediatrics (DBP). And while research shows that the rotation block improved pediatricians’ initial confidence, it produced only modest changes in actual clinical practice.
In July 2025, ACGME introduced an additional requirement: four weeks of dedicated mental health training for pediatric residents. But the new requirements allow programs flexibility in how they structure the experience, so the additional four weeks do not necessarily translate into a standardized set of practical competencies or hands-on experience.
“One month of training is simply not enough,” he emphasizes. “To be proficient in diagnosing and treating mental health problems, we need much, much more than a month.”
The Mental Health Surge vs. The Specialist Shortage
Primary care visits involving a mental health diagnosis have risen dramatically over the past decade, making primary care physicians (PCPs) the frontline contact for behavioral health issues.
According to a 10-year study of more than 1.8 million Massachusetts children published in JAMA Network Open, pediatric primary care visits for mental health sharply increased between 2014 and 2023, with anxiety-related appointments more than tripling, jumping from 1.7% of visits to 6.1%. Furthermore, a recent nationwide study published in JAACAP Open tracked 13.3 million children and adolescents (ages 3-18) and found that, compared to pre-pandemic baselines, national psychiatric diagnoses rose 24% from October 2018 to December 2022.
These data reveal a clear need to support these children. However, Dr. Hershorin shares that there are roughly only 700 practicing board-certified developmental-behavioral pediatricians (DBP) and 5,000 child and adolescent psychiatrists nationwide. A 2024 workforce study published in Pediatrics underscores this severe deficit, reporting that in 2023 there was only 1 DBP subspecialist per 100,000 US children.
As a result of these numbers, Dr. Hershorin says the average waiting time for a new patient to access a DBP in the US is six months—making the role of PCPs (and their training) absolutely essential in mental health care.
The Need for Actionable, Practical Training
According to Dr. Hershorin, “Pediatricians are pretty good at recognizing when there’s a mental health issue. But how to be confident in your diagnosis… and to be confident enough to start a treatment…that’s where they can struggle.”
Effective training requires a shift towards interactive, case-based learning (like The REACH Institute model) where providers don’t just learn theory, but actually review real-world cases and build longitudinal clinical confidence.
“There are good books on various aspects of mental health topics, but I don’t know that that’s where you want to go to make yourself comfortable in diagnosing and treating these kinds of things. You’d have to read 100 books to get the variety of things that you’ll get just by attending a REACH training.”
Upcoming Pediatric Mental Health Training for Residency Program Facilitators
In order to fill in the mental health gaps in residency programs, The REACH Institute launched a training for the educators who shape residency experiences: Resident Education in Anxiety, Depression and Suicidality (READS).
Rather than teaching residents directly, READS equips residency faculty, core clinical educators, child and adolescent psychiatrists, and psychologists with the skills, confidence, and ready-to-use tools to effectively teach evidence-based mental health care to the next generation of pediatricians.
RESOURCES:
Learn more about the new requirement from The Accreditation Council for Graduate Medical Education (ACGME) here.
Learn more about REACH’s mental health care training for residency faculty and register for the October 22–23 program here.
Read this article in The Journal of Pediatrics on “Mental Health Training in Pediatric Residency”
Check out these mental health education resources for residency programs from the American Academy of Pediatrics.
