An open letter to early-career psychiatrists.

The author addresses early-career psychiatrists (ECPs) and graduating trainees about the challenges they will face in preserving the psychotherapeutic aspect of their professional identity during the coming years. Rapidly changing health care systems, high demand for services, conflicting paradigms for treatment, inadequate compensation for psychotherapy, disruptive third-party payers, bureaucratic demands, ECPs' own educational debts, and personal and family needs-all present the potential for stressful internal conflicts and difficult choices. However, ECPs are a scarce commodity. They hold the power of decision about what they will and will not do, and they can be guided by the satisfaction of living out a truly integrated biopsychosocial identity.