The author describes his two years of experience as a physician reviewer for two managed care companies. With case examples, he illustrates how the training process and his early activities as a reviewer increased his awareness of the need for accountability in psychiatric practice. He describes several issues that he had to clarify before he felt comfortable in the reviewer's role. Among them were the need for psychiatrists to practice more crisis intervention; the difference between intensive treatment and 24-hour inpatient care; the need to find alternative solutions to situations in which patients are hospitalized for social or logistical reasons; the need for careful discharge planning; and the need to recognize and deal with the adversarial relationships that develop with colleagues whose cases are reviewed. The author offers a typology of the interactions that occur between physician reviewers and attending psychiatrists. He concludes that reviewing may have both salutary and detrimental effects on psychiatric practice.