APA recently instituted the Office of District Branch and State Society Relations. I would like to offer a suggestion, born of a recent experience we have had in Massachusetts, that I hope will lead to a more effective way for the district branches and state associations to communicate with APA, while ensuring that APA is able to make better use of the skills and experience available, but now not utilized enough, in our membership. The example I cite is of a small matter; the organizational implications of it, however, are much larger.

About four years ago, in response to member requests, APA set out to design a model short form for use by managed care organizations (MCOs) for the prescribing psychiatrist to fill out in requesting additional follow-up medication visits. Most MCOs were then using a very detailed four-page form. APA constituted a committee that, after a three-year process, came up with an improved form shortened to three pages, requiring somewhat less detail. This form was then published in the APA newsletter Psychiatric Practice and Managed Care (March/April 1999).

At the time the APA form was published, our own district branch managed care committee was in the last phase of a series of negotiations with a leading national MCO around its adopting the one-page form our committee had drafted. This form had no details of the patient’s history that were not directly and necessarily relevant to the prescription of medication. It turns out that the MCO managers were as fed up with their overdetailed form as our members were, since it created a lot of unnecessary paperwork for them too. It was not helpful to us at that point for APA to publish a more-detailed, less member-supportive, more onerous form as an APA-sponsored model national standard.

Had the APA committee sent a request to all the district branches at the outset asking for their input on this issue, a lot of time, money, and effort could have been saved. Not only would we not have had, at a minimum, two groups trying to invent a wheel, but also we would have ended up several years earlier with the roundest one. Even after the APA form had been designed, had it been circulated to the district branch presidents in addition to members of the Assembly at that point, the outcome for all the members would likely have been better.

On any given issue that affects practice, one or more of the district branches are likely to be out in front of the rest, as in the case cited above. Massachusetts has the single most heavily "managed" health economy in the nation, especially in psychiatry, and has been so for a long time, thus making it likely that its district branch would have more practical experience in dealing with managed care than many others. The same is likely true of one or more district branches on just about any issue affecting practice.

Thus my suggestion is that APA’s district branches be consulted directly on every issue that affects members’ practices in which an APA committee is set up to look at the issue. Contacting the district branches and studying whatever information comes in should be the first work of any such committee. Then, whenever a conclusion is reached by the committee, it should be run through the district branches and the responses evaluated before publishing it. That, of course, assumes that the district branches will themselves take this seriously and respond rapidly and thoroughly, which we know has not always been the case, but is more likely when a district branch is hot on the trail of an issue.

It seems to me that this would be the kind of helpful role that the new APA office was set up to perform. All committees would be required to submit a list of what they are working on to that office. The office then could send out a monthly summary of all APA projects to the district branches. That doesn’t seem to be an impossible task.

I am aware that many of these issues are discussed in the Assembly, but reliance on that mechanism alone simply will not work. Nowhere that I know of is there sufficient time at district branch council meetings for every action paper and discussion at the Assembly to be presented and discussed. In several district branches, Assembly representatives do not even attend council meetings. Moreover, many committee and component initiatives are not discussed in the Assembly at their outset, and sometimes not at their completion.

The knowledge and experience of our members are by far our biggest and best resources. We simply have to find ways to use far more of these resources, and far more rapidly than we now do.