Health care reform offers psychiatrists, who are trained in both general medical and behavioral health care, many opportunities to assume leadership roles on collaborative care teams and improve patient outcomes. This column describes such opportunities in primary care and public mental health settings and outlines new competencies, such as enhanced primary care skills, that will allow psychiatrists to expand their scope of practice in new models of care in the era of reform. These changes will require training, and the author calls on leaders of the American Psychiatric Association to help psychiatrists obtain new skills and undertake new roles.