OBJECTIVE This article describes the need for and development of an outpatient primary care psychiatry fellowship program. METHODS The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. RESULTS The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. CONCLUSIONS The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.