1. Private practice of psychiatry on this continent is, in fact, a combination of two quite different types of practice. On the one hand, about one-fourth of such practitioners are substantially pure psychotherapists. They do not willingly make calls, testify in court, sign commitment papers, perform electronic therapies, do significant physical examinations, write many prescriptions, or show professional courtesy to other physicians. This group does not meet the traditional criteria of the practice of medicine, their activities being more akin to the work of clinical psychologists doing psychotherapy. The larger group, representing about 75% of the psychiatrists, has a more medical orientation. Generalizations about the practice of psychiatry are misleading unless the type of practice is specified.2. The present high level of prosperity conceals a curious economic paradox. The private practitioner of psychiatry cannot afford to work for what the average patient can afford to pay. This is because psychiatric therapy requires so much of the practitioner's time. In the long run, the future of private practice psychiatry will probably depend on how this economic challenge is met.