Psychiatrists in private practice have contributed more to treating the mentally ill in America than is generally known. The private practice sector may be viewed as a massive national outpatient and inpatient service for the mentally ill. The impact of national health insurance on the future character of the private practice of psychiatry and the thorny problems to be resolved are discussed and compared with the experiences of England, the Soviet Union, and China. Future trends will most likely include increased emphasis on adjuvant techniques, greater emphasis on resident training in general psychiatry, briefer forms of therapy, and psychiatry's return to the medical model.