Training directors are a special breed of psychiatrists who, at best, are scholarly educators, astute clinicians, warm mentors, meticulous businessmen, and smooth politicians. The past decade only raised the bar of expectation as increased pressures came to bear on training programs, including the explosion of biologic psychiatry, managed care defining ourselves and our trainees as providers, and our supporting institutions refocusing sharply on the fiscal bottom line. The identity of psychiatry has been sorely challenged and undeniably redefined by reimbursers who see us as diagnosticians, dispensers of medication, team leaders—and too costly. Managed care, in its effort to save money (for itself), began to refuse any inpatient care except for crises, began to approve psychotherapy provided primarily by other mental health professions, and took final aim by refusing to reimburse services provided by psychiatry trainees. Chain hospital psychiatry began to flourish, and the private sector became extremely competitive with rampant illegal action, including bribery for referrals. Timberlawn, a private, closely owned Dallas hospital for over 75 years, with many nationally recognized leaders in psychiatry and an abiding commitment to education, could not withstand the challenge. Many units, senior psychiatrists, and staff were downsized. Enormous efforts to restructure debt and/or merge were futile. The psychiatry residency budget became a major controversy. After exhaustive study, debate, and disagreement, Timberlawn's residency was precipitously closed.

As training director at Timberlawn, I made every effort to maintain the program and, when that failed, to help each resident continue training as fruitfully and with as little disruption as possible. There was no good way to do this, especially with hospital morale so desperately low and in the midst of serious threats to and internal conflicts about institutional viability. Further, I too—a trainee of Timberlawn and Southwestern—was disillusioned and disheartened and moved to a new position while attempting to care for "our children." I was on watch as the ship launched by my mentor Jerry Lewis, M.D., suddenly was swallowed up by the icy waters of the changing health care reimbursement system.

Planning for the residents was a task with many shared responsibilities for serious decisions, including the timing of transition to new programs, how long their training and funding could continue at Timberlawn, travel expenses, and locating positions in other quality programs. While the residents would have to live with the results of these decisions, they were not the agency responsible for many of the contingencies. The goal of our working together—hospital administration, training director, and residents—seemed mostly achieved both at that time and in retrospect, at least by this author. Trainees looked for placements. I contacted Paul Mohl, M.D., training director at Southwestern. It became quickly apparent that postgraduate year (PGY)-1s needed to transition as soon as possible. PGY-4s and second-year child fellows could complete their training experience at Timberlawn or move on as opportunities arose. Shortly, a consensus developed that the PGY-2s would transition to either Southwestern or other programs. However, the PGY-3s, as they describe in the accompanying article, were very attached to the Timberlawn training program, as were the first-year child fellows. As a result of their efforts and funding from other agencies (especially Dallas County Mental Health and Mental Retardation, arranged with the aid of Glen Pearson, M.D.), which supplemented Timberlawn's support, the training program was redesigned using volunteer staff supervision and teaching time. As outlined in the accompanying commentary, this step would not have occurred without the leadership of the residents themselves. For all of us, it was a logistic and emotional nightmare.

Timberlawn's training program was in no sense decorative or pretentious. Quite the opposite. It was that very educational program that recruited and banded together what at one time was a very devoted, impressive group of 32 psychiatrists. Many of these clinician—educator—researchers were nationally recognized and held offices in our professional organizations. Timberlawn for many of us was a wonderful amalgam of private inpatient and outpatient clinical work with many of the benefits of an academic appointment. It was stimulating and exciting, and I was fortunate to have been a part of it. The freestanding general psychiatry program flourished for over 20 years, the child residency program for a decade. Both programs were beloved by the medical staff, who devoted countless hours and an arguable number of dollars to it. It was not dismissed as easily as may have been implied by the authors. After all, if these children were given up in the effort to save the institution, so too were about 15 senior psychiatrists.

I left Timberlawn as its mission changed drastically. I remain idealistic about training, and I respect and appreciate all those who tried to hold ground and preserve these residents' learning experience. I especially appreciated the work of the PGY-3s and Paul Mohl, M.D. I regret and continue to mourn the loss of Tara and the training programs that so many people devoted so much to in order to create and maintain. The end result for Timberlawn was a lose-lose for everyone. Maybe the program's demise was a loud wake-up call that private freestanding programs and later academic programs would be greatly troubled, and they too would need strenuous efforts to continue offering quality psychiatric training.

I would close by recognizing the PGY-3s, fondly known at Timberlawn as the "Five Amigos," for their admirable loyalty, camaraderie, devotion to clinical care and education, and class under such unnerving stress. Their work here helps make some sense of and bring closure to the experience for us all. And perhaps the three commentaries in this issue of Academic Psychiatry, together, can help other training directors prepare for a possibility we sincerely hope will come to pass nowhere else.