The national shortage of child and adolescent psychiatrists has prompted efforts to improve recruitment. It is uncertain whether these efforts will be sufficient to address this shortage and its impact on youth mental health services. Data were compared from 1990 to 2001 by state, county characteristics, number of youths, and percentage of youths living in poverty to determine any changes in the number and distribution of child and adolescent psychiatrists. Trends in the number of residents and age distribution of child and adolescent psychiatrists were also analyzed. The number of child and adolescent psychiatrists has increased, but it still falls below estimates projected to adequately serve youth mental health needs. Disparities in child and adolescent psychiatrist distribution persist, with significantly fewer in rural counties or counties with a high percentage of children living in poverty. The age of child and adolescent psychiatrists has shifted, with fewer below age 35. The number of residents in training has not changed significantly since 1995. The shortage of child and adolescent psychiatrists remains and is still accentuated for those living in rural areas or in poverty. Despite the increased number of child and adolescent psychiatrists, the number of residents and changes in workforce age indicate that the shortage will continue.