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Ordinarily, I would consider it a pleasure to be cited by Detre and McDonald¹ in their commentary describing the effects of managed care on the field of psychiatry. However, among the many points I made in the article that the authors cited² (their reference 9), there is one that surely stands out—that "it is unwise to allow new clinical settings to dictate the contents of the residency curriculum." In 1991, managed care was an unpredictable and moving target in that it was rapidly evolving; 6 years later this is even more the case. It therefore came as a surprise that my voice was enlisted in support of managed care dictating new educational and practice directions.

The conceptualization by Detre and McDonald of the "clinical neuroscientist" is not consistent with the definition of the role of a psychiatrist expressed in my earlier article² or in subsequent ones.³ I still feel strongly . . . [Full Text of this Article]

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