Objective: Several conspiring factors have resulted in an increase in the level of medical burden in psychiatric patients. Psychiatry residents require increasing levels of medical sophistication. To assess the medical decision-making of psychiatry residents, the authors examined the outcome in subjects initially seen in the emergency psychiatric service and referred to the medical emergency department for medical evaluation and treatment. Method: Psychiatry residents completed a survey sheet for every patient referred for medical evaluation from the emergency psychiatric service. The survey collected information on demographics, the level of subjective concern, and the anticipated level of medical intervention. Results: Twenty-seven medical referrals were made in the 6-week study period. Complete data were available for 23 (85.2%) subjects. Psychiatry residents accurately predicted the medical intervention 43.5% of the time. They overestimated the intervention 26.1% of the time and underestimated the intervention 30.4% of the time. Conclusions: Psychiatry residents’ medical decision-making can be improved. Additional research is required to determine whether additional medical training is needed or whether our findings are a consequence of the variability in how different physicians address medical problems.