We have obviously entered a new world of psychiatry in which fiscal considerations come first. Some of the uncertainties of five years ago are matters of fact today. Length of stay is shifting, and beds are closing all over the country. Psychiatrists' capacity to work in concert to improve the prospects for a profession whose scientific base of operation is being eroded and abrogated is rapidly deteriorating. A description of the ways in which psychiatrists work with, for, around, and against managed care companies reveals that psychiatry is not a urntary profession, nor are psychiatrists dealt with in a way that indicates there is a stable foundation upon which to build psychiatry's future participation in managed care. Unlike medicine and surgery, where many of the diagnostic categories clearly define how a disorder is treated, what resources it takes, and how those resources have to be used, psychiatry is often inexact. Furthermore, there is a pervasive sense that others can do the job as well as, if n...