Psychiatric training and practice under managed care

Today's psychiatry residents are facing many challenges that were unknown to their predecessors who received training before the managed care era. The author explores such challenges including the shift in treatment approach from psychoanalysis toward neurobiology, psychopharmacology, and cognitive and behavioral models of psychopathology and psychotherapy. Other demands that practitioners in training must deal with under managed care are accountability, loss of autonomy, and administrative burdens. Despite these challenges, managed care appears to have brought about positive changes in ways that psychiatry is practiced, such as standardization of credentialing and of authorization forms, and greater use of technology to improve administrative efficiency. Most importantly, systems of care necessarily involve people working together, not in isolation, which should be the central lesson of residency training and private practice under managed care.