WAGONS HO - FORWARD ON THE MANAGED CARE TRAIL

This paper describes the impact of managed care on an academic medical center department of psychiatry. Like the pioneers before us, academi c medical centers have often traveled wilderness paths, training new g enerations of psychiatrists and providing research about and new under standings of psychiatric illness; under assault from powerful competit ive forces, we have all too often circled the wagons in an attempt to survive what we perceive as an onslaught. We describe the ways in whic h our academic medical center department of psychiatry has responded t o managed care forces, in particular, the impact of managed care on re sidency training, inpatient services, outpatient psychotherapeutic and psychopharmacological care, and faculty morale. We describe how we ha ve worked closely with our medical colleagues, formed new committees, and initiated forays into capitated arrangements. Despite difficult ex ternal circumstances, we have been able to survive, regroup, provide l eadership, and continue with renewed purpose.