Paul S. Appelbaum, M.D.

At this time of crisis—when psychiatric care is being systematically defunded—we must act decisively to protect the interests of our patients and our profession. How do we do it? We must target our priorities, develop effective strategies, and bring the diverse psychiatric community together by emphasizing those ideals that we all share. Here is the agenda for which I believe we can all fight:

• Reining in managed care companies, including removing their immunity from liability for their decisions.

• Increasing funding for public sector and VA programs.

• Combating nonphysician prescribing, with zero tolerance for psychologist-prescribing laws.

• Encouraging innovation in psychiatric education.

• Promoting psychiatric research and protecting it from unwarranted attacks.

• Fighting to preserve doctor-patient confidentiality.

• Educating the public and building alliances with citizen groups.

• Supporting our district branches with adequate resources to get their job done.

To accomplish these ends while holding dues down, we need a lean and supple APA. We’ve made a good start this year, having reallocated $2.5 million from administration and governance to advocacy, dues reduction for young psychiatrists, and revenue sharing with the district branches. Next, we need to implement an ongoing evaluation of the effectiveness of our components and staff offices, eliminating those that have outlived their usefulness. A two-way conversation with our members is critical in this process. We must listen to their needs, but also let them know the many ways that APA is working for them.

I respect my opponent as a psychiatrist, but I believe his proposals for abolishing the Assembly—our most broadly representative body—and radically downsizing the components where so much of our work gets done (for example, DSM, practice guidelines, task force reports on topics from ECT to sexual offenders) are fundamentally wrongheaded. This is not the time to cripple our organization.

How will we know whether we’ve been successful? We’ll have reached our goal when it would be unthinkable for a psychiatrist not to be a member of APA. I look forward to the opportunity of working with you for the benefit of our patients and our profession.

We have a wonderful profession because we can integrate biological, psychological, psychosocial, rehabilitative, and existential understanding in the care of people with mental illness. Our work is to help patients acknowledge, bear, and put in perspective that which is most painful and provide skilled medical intervention.

APA is at a crossroads! Our dues are one of the highest; our income is one of the lowest in medicine. Members definitely drop out because of high dues. They must receive value for their dues dollar.

• We must begin by rightsizing and downsizing our Assembly, committees and other components, and bureaucracy. Rightsizing can save $3 million to $4 million at a minimum.

• Develop a Senate governance with one Senator per state serving staggered terms with representation from underrepresented and subspecialty organizations.

• Replace many committees with task forces and caucuses.

• Rightsizing will support a truly meaningful connection and enhance communication between members, the state associations, district branches, and central administration. Commitment to members will be enhanced.

• Rightsizing will permit necessary dues relief.

• Our highest priority is to reject prescribing authority by nonphysicians. We must work with the AMA and medicine to ensure nonphysician-prescribing authority is not extended.

• Limit unfair managed care practices by legislation permitting patients to recover damages.

• Lobby for national and state parity bills, support a patients’ bill of rights, and maintain confidentiality.

• Partner with mental health organizations to promote education.

• Show industry, business, employers, unions, and health plans that psychiatric disorders have major adverse effects on the work force.

• Demonstrate that psychiatric treatment can reduce the cost or burden of mental illness.

• Show that the right mix of integrated psychotherapy and psychopharmacology benefits our patients and is worth the investment.

• Recruit the best and the brightest into psychiatry.

• Promote diversity with special attention to women, minorities, gay and lesbian psychiatrists, international medical graduates, and subspecialty organizations.

We have a fine profession that needs experienced leadership. I have the background—clinician, administrator, teacher, clinical investigator—and the desire to serve with passion and dignity. I ask for your vote.

Web site: <www.jongudeman.org>