Profound and meaningful healthcare system change is in progress and will accelerate over the next decade, whether we like it or not (1–3). We suggest in this article that psychiatry residency education has to change so that graduates have the requisite skills needed to function in a changed and changing healthcare environment. To cite only a few examples, the Affordable Care Act (ACA) and the Federal Government’s fiscal situation are already resulting in decreases in graduate medical education (GME) reimbursement (4). The ACA, in concert with a host of other recommendations, is mandating an increased emphasis on multidisciplinary team practice, a major restructuring of the way care is delivered, and “value-based purchasing.” Buying the best value care as measured by quality standards will result in increased reporting requirements. Residency programs will have to meet or exceed a variety of quality measures that may become standards by which funding will be determined (5, 6).