The APA is concerned about its declining membership. Only 16 700 psychiatrists were able to attend this year's meeting in New York and many of them came mainly to consult the job bureau in search of employment. For the first time unemployment is a real issue for psychiatrists as health care providers restrict services and seek alternative and cheaper patterns of care. Most health care organisations have lists of approved psychiatrists and anyone not on that list is not able to claim reimbursement for their services. Exclusion may be because of unreported and unchallenged complaints about care or conduct or a penchant for expensive drugs or high risk therapies. In this context a high risk therapy is one which exposes the insurers to a high risk of litigation, such as ‘recovered memory therapy’. The buzz in the corridors, which used to be of art collections, the new home by the lake or the costs of putting the kids through college, is now of managed care. These dread words reduce the most ebullient colleagues to anger or tears. Some time ago I reported in amazement the discussions at an earlier meeting on alien abduction, ritual abuse, multiple personality disorder (110 different individuals in one body was then the record) and the false memory syndrome.