As psychiatry prepares to enter the new century, it does so on a foundation far removed from its knowledge and standing of 100 years ago. Although many of the forces impacting psychiatry have nothing to do with the academic enterprise, we must understand the role of academic psychiatry, intellectually.
Academic departments shape our field.
Our knowledge base is determined by research in these departments. The clinical skills of the new generation of psychiatric practitioners are determined by their experiences in residency programs housed in these departments. These same departments are also responsible for determining medical student experiences in psychiatry and determining how the next generation of nonpsychiatrist physicians sees psychiatry. The academic psychiatry department is frequently one of psychiatry's best representations of what our field is really about. The forces that will shape and determine the future structure and content of psychiatry consist of scientific advances that inform each practitioner and the complex variables that govern the economics of health care in the United States.