Changes in health care economics will shape the future of psychiatric practice. Psychiatrists will work as part of a team of mental health professionals, and many will emerge as team leaders. They will recognize that they must more clearly identify the patients they are especially skilled to treat. They will focus their attention on medically oriented psychiatric practice, which treats primarily the psychological aspects of physical disorders, and on mental disorders with a strong biological component.Most inpatient and outpatient services will be short term, but more intensive and longer term treatment will be available, monitored by prospective peer review. Psychiatrists will be found with increasing frequency in nontraditional settings such as employee assistance programs, health maintenance organizations, and general medical units of general hospitals. Those who continue to maintain private offices will be likely to locate them near the offices of other mental health professionals with whom they work in a multidisciplinary system.If future psychiatric practice is to be vibrant and successful, then individual psychiatrists and their psychiatric organizations must take certain steps. They must initiate efforts to increase the acceptance of psychiatrists by both current and potential consumers of services. They must try to reduce the conflict with other mental health professionals, based on the recognition that joining forces to reduce the cost of care is in the best interests of all disciplines.Psychiatrists must be willing to accept peer review as an appropriate method for controlling utilization of services. They must become active participants in the triage process. And finally, they must be willing to focus their attention on populations whose illnesses require treatment based in medical training.