Faced with increasing concerns about APA’s ability to recruit new members and retain current ones, the APA Assembly acted on several proposals last month designed to give members more information about how APA operates and respond to what members say they want from their Association.

One concern involved the progress of the upgrading of APA’s information systems and the impact it has had on communication between the national office and district branches. Several representatives expressed dismay with instances in which the district branches were unable to get accurate and timely data from APA on membership, dues, and other financial issues, despite a substantial investment in new technology and systems in the central office.

Wanting to be informed about the progress of the system’s enhancements, the Assembly voted to have the medical director or other appropriate staff report at every meeting on the status of the ongoing information systems development. Representatives also want to be informed at their twice-yearly meetings about the "timeliness of communication and funds transfer to the district branches." In addition, the Assembly wants the central office to report quarterly to the district branches on membership changes, report annually on dues paid by members according to membership class, set a date each month when a check for dues payments will be issued to the district branch, and forward APA directories, such as the annual directory listing members of every committee, council, and commission, to district branches for review prior to publication.

The Assembly also asked the APA treasurer to provide annual breakdowns of money received from the pharmaceutical industry showing budget-related details on advertising in publications, exhibits at annual meetings, research and educational grants, and awards underwriting. Income derived from pharmaceutical companies has long been reported and available to the membership, but this action asks for a more precise accounting of how the funds were earned or what they were for.

The Assembly took several other actions on membership-related issues. It voted to

• ask the Membership Committee to think of methods for making it easier for previous members, such as those dropped for failure to pay dues, to rejoin APA. It also called on the committee to improve the system by which members are informed that their dues are in arrears and what benefits and discounts they sacrifice when they fail to pay.

• reject a proposal changing APA policy to allow psychiatrists to decide whether they want to join APA but not their district branch, only their district branch, or both.

• redefine fellowship categories "to make fellowship more readily obtainable for APA members while still maintaining the prestige and respect" that fellowship status confers. It was thought that the criteria are too difficult to meet in light of practice pressures. Under this proposal, which next goes to the Board of Trustees for approval, to be eligible for fellowship, a member would have to have belonged to APA for five years; be certified by ABPN, Canada’s Royal College of Physicians and Surgeons, or the American Osteopathic Association; and have three letters of recommendation from APA fellows. District branches would have 90 days to comment on a member’s fellowship application.

The current requirement for significant and broad-based achievement in psychiatry, including involvement in community activities, would become a criterion for the category of "distinguished fellow." In the future, members applying for this designation would no longer have to be APA fellows first. All current APA fellows would become distinguished fellows, while existing distinguished fellows—a designation now used for nonpsychiatrists—would be shifted to a new category called "honorary fellow."

A proposal to make these changes was on the 1999 APA election ballot in the form of an amendment to APA’s Bylaws, but while it received an overwhelming majority of votes, vote totals fell just short of the number needed for such a bylaws change to be enacted.

• agree with the Board of Trustees’ decision to eliminate the sanction of "admonishment" from the APA’s ethics code and give district branches the option to conclude an ethics investigation "without a finding," which could result in a "letter of concern" to the member.

• ask the Council on Medical Education and Career Development, in collaboration

with the Committee of Residents and Fellows, Committee on Medical Student Education, Ethics Committee, and the APA Office of Education, to develop guidelines for the appropriate boundaries between teachers and learners in medical education.

• recommend that the Board of Trustees in the name of APA join with more than 500 national and local organizations in endorsing the Precepts of Palliative Care developed by the Last Acts Palliative Care Task Force. Last Acts is a coalition of more than 300 organizations representing health care providers and consumers nationwide. The precepts focus on improving the quality of life for people who are dying and for their loved ones. Michael Blumenfield, M.D., chair of the Joint Commission on Public Affairs, contended in the action paper that endorsement of the precepts will support psychiatrists who work in medical settings and advocate for palliative care, encourage psychiatric educational programs to integrate the principles into education programs, and assist in educating the public about palliative care.

• endorse two APA position statements. One puts the Association on record supporting "the legal recognition of same-sex unions and their associated legal rights, benefits, and responsibilities."

The second position statement concerns access to atypical antipsychotic medications. It says, "the new generation of antipsychotic medications (except clozapine) need to be made available as first-line treatments for appropriate individuals throughout all systems of care. Similarly, clozapine needs to be made available for individuals with treatment-refractory psychotic disorders. Access to these medications needs to be made available in all systems of health care and by all public and private insurers including jails, prisons, and youth services facilities."

• recommend several principles concerning coding and reimbursement for seclusion and restraint that are to be reviewed by appropriate APA committees. The Assembly believes CPT codes should be created for evaluating seclusion and restraint. and that psychiatrists should be eligible to be reimbursed as often per 24-hour period as the evaluation needs to be made.

The Assembly also honored psychiatrist Jerome Lance, M.D., of Ventura County, Calif., with the Assembly’s Profile of Courage Award. Details of how Lance earned this award will appear in the next issue of Psychiatric News.