Objective: The authors develop a classification of psychiatric practic
e based on primary and secondary work settings. Method: Data from the
1988-1989 APA Professional Activities Survey were used to characterize
seven practice groups: public psychiatrists, public psychiatrists wit
h private secondary work settings, private psychiatric/general hospita
l psychiatrists, private office practice psychiatrists, private office
practice psychiatrists with secondary private psychiatric/general hos
pital work settings, private office practice psychiatrists with second
ary settings other than private hospitals, and psychiatrists in privat
e organized outpatient settings. Psychiatrists Primarily in government
administrative agencies, medical schools, or nursing homes were among
those excluded. Usable data were available from 16,135 psychiatrists
(82.8% of the target respondents). Results: The largest groups were pr
ivate psychiatric/general hospital psychiatrists (19.6%), private offi
ce practice psychiatrists with secondary settings other than private h
ospitals (18.9%), and private office practice psychiatrists with secon
dary private psychiatric/general hospital work settings (17.4%), follo
wed by public psychiatrists with private secondary work settings (14.5
%), private office practice psychiatrists (11.7%), public Psychiatrist
s (11.4%), and psychiatrists in private organized outpatient settings
(6.6%). During a typical week, the practice groups varied in the avera
ge proportion of their outpatients who received assessments, therapy a
nd medication, therapy and no medication, and medication management. T
he groups also varied in the mean number of patients they treated each
month with affective disorders, schizophrenia, anxiety disorders, and
other disorders. Conclusions: Only about one in 10 clinical psychiatr
ists is engaged exclusively in office-based private practice, and appr
oximately half of the outpatients treated by the average psychiatrist
receive medication. Work setting appears to exert a powerful influence
over whom psychiatrists treat and what services they provide. Because
a majority of psychiatrists work in more than one setting, most psych
iatrists serve a broad range of patients and provide a variety of trea
tments.