[Where is psychiatry going?].

The author, who has been active for 33 years as a psychiatrist in geographically and ethnically diverse areas (Czechoslovakia, Austria, and the U.S.A.) discusses the difficult position today of psychiatry as a medical specialty. Although the number of medical school graduates who select psychiatry in the U.S.A. alternates and is sometimes declining, the future of psychiatry in medical schools and in research facilities does not appear to be in imminent danger. Moreover, the prospect for psychiatrists in other organizations is less favorable. Public state hospitals are gradually being dismantled. The role of psychiatrists in outpatient services and in solo practice is particularly threatened. Psychiatry is subject to unmerciful competition from nonmedical branches of mental health such as psychology and social work. Various therapists, without medical degrees, compete with psychiatrists and in this way restrict the pool of potential private patients. Such therapists capitalize on the fact that a large number of patients in need of professional psychiatric help are not aware of the basic difference between psychiatrists, who are medical doctors, and psychologists and social workers, who are not. The author also discusses how legal liability for malpractice by nonmedical therapists and paraprofessionals is not expected or anticipated, while lawsuits against psychiatrists are taken for granted. In addition, there exists the possibility that such nonmedical therapists will gain the legal right to prescribe psychotropic medication. These individuals would then prescribe medicine without the benefit of the necessary educational and medical background. Poorly defined "courses" would then be expected to replace long years on medical studies, and in this way to devalue the intrinsic quality of medical studies themselves. The opinions expressed are entirely Dr. Krizek is own, and do not represent the views of any other person or organization.