Following last winter’s vote by members of the American Medical Association, psychiatry gained significant seats and influence in the AMA’s House of Delegates. As a result, at this year’s annual meeting of the House, held in Chicago in June, the newly expanded delegation was kept busy steering and influencing several issues key to psychiatry.

Last winter’s voting resulted in the AMA’s Section Council on Psychiatry being expanded to include seven delegates and seven alternate delegates from APA. In addition to the 14 APA members, the Section Council includes one delegate and one alternate from the American Academy of Child and Adolescent Psychiatry (AACAP), as well as representatives of the American Association for Geriatric Psychiatry (AAGP), Academy of Psychosomatic Medicine, American Society for Addiction Medicine, and American Academy for Psychiatry and the Law.

APA was also represented by APA President and alternate delegate from the State of California, Daniel Borenstein, M.D., President-Elect Richard Harding, M.D., Assembly Speaker R. Michael Pearce, M.D., and immediate past speaker, Alfred Herzog, M.D.

"APA was extremely pleased with the results of the campaign to have AMA members designate APA as their representative in the House," said Joseph T. English, M.D., APA delegate and chair of the Section Council on Psychiatry. "As a result of the strong response," English told Psychiatric News, "our delegation has more than doubled in size. As a result of the enthusiasm, dedication, and conviction of the members of the expanded delegation, our influence with the AMA has more than doubled."

The newest members to the delegation were appointed by APA President Daniel Borenstein, M.D., and immediate past president Alan Tasman, M.D. According to Borenstein, he and Tasman appointed new members with significant experience in their local medical associations. They also considered geographic distribution, that minorities, women, and child psychiatrists were represented, as well as age and number of years as a psychiatrist.

Members of the delegation worked very hard on issues critical to psychiatry as well as issues germane to the entire house of medicine.

APA delegate Judy Linger, M.D., and AACAP delegate David Fassler, M.D., were successful in leading a debate on the floor of the House to restore original wording to the two organizations’ joint resolution dealing with ways to enhance physicians’ ability to advocate effectively on legislative and regulatory efforts involving nonphysicians’ scope of practice. Their work on the floor of the house was instrumental in orchestrating successful passage of the original resolution.

The Section Council worked continuously on the resolutions before the house concerning discriminatory Medicare limits on outpatient psychiatric services. The passage of two antidiscriminatory resolutions is a significant win for psychiatry.

"We are absolutely delighted," APA Medical Director Steven Mirin, M.D., told Psychiatric News, "that the AMA has affirmed its strong opposition to the 50 percent copayment for outpatient psychiatric services under Medicare Part B. With AMA’s support, APA can work more efficiently and effectively to put pressure on key members of Congress and HCFA to change this regulation, which unfairly discriminates against our patients."

In addition, APA member Ken Certa, M.D., was successful at removing limiting language in a resolution regarding Medicare/Medicaid dual eligibility. The resolution, which calls on the AMA to seek legislative efforts to restore the requirement that states pay the deductible, copayment, and coinsurance amounts for such dually eligible patients, was adopted after Certa’s efforts.

APA delegate Rodrigo Muñoz, M.D., provided impassioned testimony on the floor of the house regarding a resolution on international medical graduate (IMG) representation to the Educational Commission for Foreign Medical Graduates (ECFMG). Muñoz, a former APA president and himself an IMG, testified in favor of adopting the original resolution, requiring the AMA to appoint an IMG as one of its representatives to the ECFMG. The resolution had earlier been significantly weakened by an AMA reference committee.

"It is not only logical," Muñoz told Psychiatric News, "but imperative that an IMG sit on the commission. Only an IMG can understand the unique circumstances of those physicians who come here from other countries. Who better can understand what is best for new IMGs than someone who has been through the process of coming to the United States, fulfilling the requirements, and then practicing, successfully in this country."

APA delegate John McIntyre, M.D., gave compelling testimony on the house floor to remove a requirement of one resolution, which would have required physicians to print all e-mail messages exchanged between their office and their patients, with the exception of highly sensitive information, and place a copy in the patients’ charts. McIntyre pointed out that this would require physicians to print out messages even when patients simply e-mailed to confirm the time of their appointment.

"This would involve," McIntyre told the AMA delegates, "a huge accumulation of nonclinical information that would be unduly burdensome and unnecessary." An amended resolution was passed following McIntyre’s testimony that recommended that e-mail communications between physician and patient be included as part of the medical record, at the discretion of the physician.

"APA delegation members were very visible and active during the entire meeting," English said. "As a result, our coordinated efforts were noticed. AMA staff indicated that they consider us a ‘model delegation’ for the specialty societies." These comments are especially encouraging to APA’s continuing efforts to increase psychiatry’s voice and presence on AMA councils and components, he added.