title: The tipping point from private practice to publicly funded settings for early- and mid-career psychiatrists.
abstract: OBJECTIVE
  Practice settings for American psychiatrists were examined for recent trends.
  
  
  METHODS
  Surveys were conducted in 1996 (N=970) and 2002 (N=917) among members of the American Psychiatric Association.
  
  
  RESULTS
  Between 1996 and 2002 the percentage of direct patient care hours in publicly funded settings increased from 40 to 50 percent for early-career psychiatrists and from 29 to 44 percent for mid-career psychiatrists. By 2002 the percentage of direct patient care hours was higher in publicly funded settings than in solo office practices for early-career psychiatrists (50 percent versus 17 percent) and mid-career psychiatrists (44 percent versus 29 percent).
  
  
  CONCLUSIONS
  The popular image of the psychiatrist sitting in a private office does not conform with current survey data, which show that psychiatric practice is increasingly taking place in publicly funded settings. Because it extends to mid-career psychiatrists, the shift from private office practice to publicly funded settings is not just a manifestation of early-career psychiatrists' earning a salary while building up their private practices but is a more enduring change in the landscape of psychiatric practice. The authors discuss the implications of these findings with regard to professional identity and training of psychiatrists.
authors.affiliation: Public Psychiatry Fellowship, Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, Box 111, New York, NY 19932, USA. jmr1@columbia.edu
authors.forename: Jules M
authors.initials: JM
authors.lastname: Ranz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Vergare
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Wilk
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Ackerman
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lippincott
authors.forename: W Walter
authors.initials: WW
authors.lastname: Menninger
authors.forename: Steven S
authors.initials: SS
authors.lastname: Sharfstein
authors.forename: Ann
authors.initials: A
authors.lastname: Sullivan
mesh_terms: D002202:Capital Financing / Q000191:economics*; D019538:Health Care Surveys; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000191:economics*; D017150:Public Sector / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology