News and Updates

May 2009 Assembly Report

by Robert Feder, M.D.
New Hampshire APA Assembly Rep

The following are the major updates on what’s happening with the APA at a National level:

1. Major revenue sources continue to decline. Publishing revenues are down 60% from the previous year, and pharmaceutical industry symposia at the Annual Meeting were down 50% from the previous year. This is necessitating major revisions in the APA structure to reduce expenses. The home office, Board, and Assembly are all being down-sized to accommodate this. Overall the APA remains fiscally sound, and there is no immediate plan to reduce financial support to district branches or government relations.
2. Psychology prescribing bills were defeated in 9 States this legislative session. Bills in Oregon and Wisconsin are still pending.
3. Rules are currently being written for the National parity legislation which will take effect on January 1, 2010. The APA has been actively involved in this project, and the outlook is optimistic for rules which will benefit our patients and our members.
4. The APA is actively involved in discussions with the Obama administration and Congress regarding proposed health care legislation. The APA is working along with the AMA in this effort. At this point it appears that mental health parity will be a part of any public health plan that is created. The word from those who have spoken with Zeke Emanuel, M.D. (Obama’s chief advisor on health care issues) is that he is a thoughtful, intelligent, and honest person who clearly favors some type of universal health care system.
5. “Healthy Minds” is a PBS television show out of WLIW in New York City which has been getting rave reviews from APA members and patients. It is hosted by Jeffrey Borenstein, M.D., an APA member. The APA is supporting the airing of the show on local PBS stations throughout the country starting in the fall. Episodes are available on the web at www.wliw.org

6. The Workgroup on Relationships Between Psychiatrists and the Pharmaceutical and Medical Device Industries, chaired by Paul Appelbaum, presented its report to the Assembly. Key recommendations in this report included:

   1. That psychiatrists not accept gifts of any value from pharmaceutical or device entities
   2. That psychiatrists should not permit pharmaceutical or device entities to supply free food and refreshments for educational or social functions, or to wards, clinics, and offices, and should not accept food that they are aware is being paid for by pharmaceutical or device companies
   3. That psychiatrists limit the use of free samples to situations in which their use is clearly in the interests of patient care. Such samples should not be used by psychiatrists themselves or their families
   4. Psychiatrists should participate in educational sessions sponsored by pharmaceutical or device entities only if they are ACCME-accredited or have procedures to ensure that speakers are fully responsible for their content. Payment for travel and lodging to attend CME programs should be declined.
   5. Psychiatrists other than salaried employees of pharmaceutical and device companies should not participate as presenters in industry-sponsored speaker’s bureaus

   This report generated a great deal of heated debate in the Assembly, with ardent supporters and detractors. The report was never actually brought to a vote by the Assembly; had it been, my guess is that it would have been defeated. The fate of this report, and an official APA policy on these issues, remain to be determined and will ultimately be up to the Board to decide.

7. Many APA members are not aware that the APA includes thousands of Canadian members, who are active in their respective Areas and the Assembly.

   Joseph Berger, M.D., is the retiring Assembly Rep from Ontario. He has written the following essay on the APA Assembly that I would like to share with you:

   The APA Assembly
   And Why It Is Important That You Know About It

   Joseph Berger

   The seven geographical areas have their own councils which may meet one or more times per year, either at - or separate from - the main Assembly meetings.

   Many psychiatrists in Canada are often unaware of what the APA does other than sponsor a very large annual meeting each year and an academic journal and newsletter.

   But for many American psychiatrists, the APA is their main lobbying organization, as well as an organization that offers them certain benefits and discounts.

   Political lobbying in the United States is a very serious business, and because of the different nature of health care organization in the United States lobbying by the medical profession is very necessary, and has a far greater impact that its equivalent in Canada.

   In psychiatry, the main lobbying organization is the APA, and therefore a considerable amount of the APA’s work and budget is devoted to lobbying and advocacy.

   In the United States, most insurance companies will cover the costs of psychotherapy that is provided by psychologists and by social workers to a very similar level to that provided by psychiatrists. Psychologists in the United States, who are about four times greater in number than psychiatrists, are demanding the right to prescribe medication – without having gone to medical school and become licensed physicians. The APA leads the fight against that by offering expert support and help to the appropriate lobbyists in each state where the battle has to be fought.

   But that is just one very significant issue that the APA has to deal with and that costs a lot of money - and in case you wonder what that has to do with us in Canada, well, there has been some agitation recently in Canada by psychologists and by pharmacists to obtain the right to prescribe.

   We in Canada learn from what happens in the United States, and they also pay attention to developments in Canada. In fact right now one of the most contentious issues is a fight between those in the United States who are so appalled by the deficiencies of the health care system in the United States that they would like to adopt the Canadian socialist single-payer model, and those who are well aware of the very significant deficiencies of the socialist system and our long waiting lists for consultation and treatment, and our long delays for surgery, and our inadequate supplies of the latest technological equipment and our delays in obtaining some of the latest medications, and who are vehemently opposed to adopting a government-controlled socialist single-payer model.

   The Assembly is where a lot of these matters are debated, and where resolutions that are meant to give direction to the Board or Executive emerge.

   The Assembly is that vital part of the APA that too few members know about or understand.

   The Assembly is the most visible forum for the expression of the views and wishes and desires of the membership as a whole.

   In many organizations, there is some tension between the larger parliament and the smaller board of directors (or trustees in the case of the APA) or executive. The smaller board often sees itself as being far more knowledgeable of the day-to-day necessities and practicalities of what can be done and what can’t, and what must be done and what must not be done, and often over-rides the wishes of the larger Assembly. Some members of the Assembly, especially those who have had their resolutions approved of by the Assembly but then rejected by the Board, often feel very aggrieved and angry.

   But that tension is probably common to most similar organizations. Even the ‘mother’ of democracies, the British parliament, long ago enacted the practice that the Monarch could refuse to sign a new law twice, but if presented a third time had to accept it.

   I have been your representative to the Assembly for the past six years. I would say it has been one of the most rewarding volunteer activities of my life. I trained in Psychiatry in the United States, and was a Board Examiner for the American Board of Psychiatry and Neurology for more than twenty five years, and being your Assembly representative has enabled me to keep in contact with some of the hardest-working, brightest, most articulate and accomplished psychiatric colleagues in the world.

   It has enabled me to keep up with the concerns shared by the world’s leading psychiatric organization, and I have had the opportunity on many occasions to share our Canadian experiences with Americans who have been extremely interested in what we do, in what works for us and what doesn’t.

   So I hope that when you see reports of Assembly meetings in Psychiatric News or elsewhere, you take a closer look. Because what is discussed at the Assembly usually reflects the very core of what is happening in American psychiatry today, and has implications for us in Canada and for other countries as well.