Private Practice and Managed Care

Abstract

Private practice has been the traditional modus operandi and identity for American psychiatrists. Sigmund Freud and his colleagues were private practitioners. It is seen by many as the bulwark of psychiatry with the fullest expression of the talents and capacities of our profession; to some critics as a system of care that inadequately served significant socioeconomic and ethnic groups; for others as a part-time opportunity for professional and economic fulfillment while working at a salaried job in the public sector; and currently by many beginning psychiatrists as beyond their reach because of perceived financial risks, time demands, and future uncertainty. About 50% of American psychiatrists consider ourselves in private practice, a number in steady decline. The current maelstrom of change in the economics of medical care—the advent of managed care—has impacted all of medicine, but has most adversely affected psychiatry.¹