title: Coping with the crisis in psychiatric training.
abstract: 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?
authors.affiliation: Sheppard Pratt Health Plan, Lutherville, MD 21093, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Schreter
mesh_terms: D003363:Cost Control; D006279:Health Maintenance Organizations; D006801:Humans; D011570:Psychiatry / Q000193:education*; D011613:Psychotherapy; D012017:Referral and Consultation; D000078329:Workforce