"[T]he need for more widespread participation for the membership in the affairs of the Association was recognized. . .[and]. . .as a result. . .constitutional amendments were recommended and approved. . .for the establishment of District Branches and an Assembly of District Branches. . .in order that you personally could make your wishes and needs known through your respective District Branch and its Delegate to the Assembly."

So said C.N. Baganz, M.D., speaker of the Assembly, in the first Speaker's Report, which was published in the American Journal of Psychiatry in 1955.

As Baganz noted, the Assembly was conceived from the beginning (in 1952 at the APA annual meeting in Los Angeles) as the voice of the grass-roots APA member. Within two years, there were 23 district branches throughout the country, each with an elected delegate to the Assembly; today there are 76 district branches.

In 1955 the Assembly divided the Association into geographic Areas, of which today there are seven: Area 1--New England/Eastern Canada; Area 2--New York; Area 3--Middle Atlantic; Area 4--North Central; Area 5--South; Area 6--California; and Area 7--West/Western Canada.

Each Area has a representative to the Assembly, a deputy representative, and a member-in-training representative, each of whom is elected by the delegates from the district branches within the Area.

The Assembly also includes representatives from a number of minority and underrepresented groups: American Indian, Alaska Native, and Native Hawaiian psychiatrists; Asian-American psychiatrists; black psychiatrists; Hispanic psychiatrists; international medical graduates; lesbian, gay, and bisexual psychiatrists; and women psychiatrists.

A district branch representing the Society of Uniformed Services Psychiatrists is incorporated into Area 5.

For a time the Assembly was perceived as a lesser body of unsophisticates or--alternately--as a bulwark of wisdom from the trenches to counter the Board of Trustees, composed (so it was perceived) largely of academics.

Irvin Cohen, M.D., recalls: "The Assembly was established by the Board in 1952, somewhat reluctantly, I suspect, largely to pacify protestors demanding increased membership input. Until only relatively recent times, the Board regarded . . .the Assembly as an impudent, rebellious body consisting largely of a collection of strident private practitioners who were totally unsophisticated in matters of the psychiatric body politic."

Since that time, the Assembly has grown in size and prominence, and early tensions between the Board and Assembly have largely dissolved. "I don't think there was one defining moment that changed all that," Cohen said. "It was just a gradual change that is more akin to drops of water eroding stone than it is to some victorious palace coup."

Cohen and others said this evolution is likely to continue (see "Grass-Roots Participation Is Essential to Making APA Assembly Effective, Democratic"). And they note the large number of current and recent Board members who have been graduates of the Assembly.

Moreover, the distinction between the Board and Assembly according to practice type is no longer so easy to make; a substantial number of Board members are in private practice, while the Assembly includes psychiatrists involved in a variety of practice types, including the administration of managed care.

Gerald Flamm, M.D., the 1988-89 speaker of the Assembly, said the Assembly may tend to be more oriented to "guild" issues, "because they are practitioners whose livelihood depends on it," while the Board is the fiduciary agent of the Association, responsible for APA's fiscal solvency. Consequently, the Board sometimes must reject or revise good ideas from the Assembly for budgetary reasons. But Cohen noted that Assembly requests are now matters for serious consideration and debate.

He added, "The Board has the final decision, and the Assembly can't dictate to the Board what to do nor can it veto its decisions, but I suspect this will not always be so. . . ."

(Psychiatric News, September 20, 1996)