What does Gabbard's warning that "things will probably get worse before they get better" really mean (1)? Some of the demoralization he describes results from what managed care insiders call "slash-and-burn" programs. Responsible psychiatrists, whether academics or front-line managed care clinicians, need to speak out against programs of this kind. There is reason to believe that these destructive programs will not survive in a marketplace that increasingly attends to outcomes, not costs alone. Academic psychiatrists will be most effective at improving inferior or unacceptable managed care if they demonstrate that they know how to conduct managed care practice well. The academic critique will be ignored, however, if the managed care partners perceive it as a rationalization for avoiding change.If Gabbard means that the kinds of population-based practice and efforts to achieve a more just allocation of limited resources seen in ethical managed care programs will continue to change the role of the phychiatrist, he is right. Compared with the unhappy clinicians in the vignettes he presented, the psychiatrist of the future must be prepared to be more medical, more eclectic in methodology, to work with more patients, and to provide services by supervising and guiding the work of others as much as by providing direct care.None of this means being less compassionate, humane, psychodynamically minded, or professionally satisfied. But our future graduates will not see the exciting promise of these roles unless we—their senior academic role-models—re able to fefect deep changes in training programs and in ourselves. if we do not, we will have to agree with cartoonist Walt Kelly and Pogo— "We have met the enemy...and they are us."Abstract Teaser