Psychiatrists in the new medical marketplace

The changes managed care has brought to the medical marketplace have been driven by a variety of cost-containment strategies. The current era of healthcare reform is marked by a push to merge, acquire, consolidate, and integrate to achieve economies of scale. The authors describe new opportunities and risks for psychiatrists in this rapidly changing healthcare marketplace. They see an increasing role for psychiatrists as members of multi-specialty treatment teams who provide a combination of psychotherapeutic and psychopharmacological treatment. There are also likely to be increasing opportunities in a number of subspecialty areas, including child, adolescent, and geriatric psychiatry, where the demand for skilled clinicians exceeds supply. Increased opportunities are also to be expected in dual diagnosis treatment programs, in the treatment of Alzheimer's disease, and in consultation liaison psychiatry. Psychiatrists are also likely to assume more innovative roles in special treatment areas and in providing "niche" services. Telemedicine will create new opportunities for psychiatrists who are skilled in the application of the new computer and communication technologies now available. Some psychiatrists will also be able to fill new roles as team leaders, system designers, and healthcare administrators and executives. Finally, the authors stress the importance of constantly advocating for quality care in order to regain control of and succeed in the new medical marketplace.