Coping with the crisis in psychiatric training

No article on the future of psychiatry seems complete without mention of a sea change or a paradigm shift. The demands for cost containment and accountability have fueled a shift away from retrospective fee-for-service, solo practice to prospectively reimbursed care through giant health systems (Schreter 1993). These systems substitute less expensive, less well-trained and often less-experienced clinicians for psychiatrists whenever possible. Managed care gatekeeping utilizes psychiatrists mainly for medication management. Psychotherapy, a signature product of our profession, is being demedicalized. What will be the roles for psychiatrists in the emerging health care delivery system?