Psychiatry confronts dramatic changes in its autonomy and scope as practitioners enter into increasingly complex relationships with third parties: industry, insurers, allied health organizations, educational institutions, and government agencies. Earlier role-based efforts to manage competing allegiances contributed to a narrowing of professional scope into situation-specific requirements and loyalties. Frequently the interplay of these new roles and the traditional primary obligation to patients resulted in hardened conflicts or compromises that psychiatrists could sustain only with difficulty. We suggest a concept of professionalism for psychiatrists that maintains a steady focus on the primacy of the patient. It asserts that health care is a relationship, not a consumer good. Looking beyond management of competing roles and compromise solutions, we appeal to a definition of professionalism that moves away from the splintering of roles and acceptance of conflicts of commitment and toward a unitary, stable, and morally protective foundation for contemporary psychiatric practice.