Our annual meeting is a time of leadership change, not only for APA, but also for district branches across the country. Not surprisingly, many of the summer DB newsletters featured columns written by the incoming presidents, outlining their evaluation of the psychiatric landscape and their theme for their presidential year.

Two of these assessments cite the effects of managed care on the practice of psychiatry, and both see organized psychiatry as a vehicle for dealing with the realities of the changes we all face.

In his inaugural message titled "The Three Bears. . .We Feel Your Pain," Texas Society of Psychiatric Physicians President Conway L. McDanald, M.D., compares the changes in the way we practice medicine today with the changes the three bears must have felt after their tranquil domicile was disturbed by Goldilocks.

Writing in the TSPP Newsletter, Dr. McDanald states, "Sadly the three bears entered a new era. Although the intruder left them, they felt bereft at the passing of the 'good ole days' and were left feeling vulnerable to future invasions.

"Unfortunately for organized medicine, our own tale is perhaps a bit fractured. Medicine may wish to be left alone, but its autonomy and sense of ultimate control are a thing of the past. Influential strangers not only have entered the House of Medicine, but they have taken up residence. These strangers are powerful and organized forces that are attempting to direct how medicine is practiced and how patients access care. Some of the efforts by these strangers are well intentioned and contribute to meaningful and inevitable change. Others are clearly intrusive, destructive, and self-serving, creating havoc and eliciting a multitude of emotions for those involved."

Dr. McDanald notes that it was inevitable that someone would be blamed for letting these "intruders" into our domain.

"As we enter this stage of pointing fingers, organized medicine is frequently identified as the culprit," he writes. "This includes APA, TSPP, the AMA, and the TMA. Had organized medicine taken a walk oblivious to the oncoming onslaught, like the three bears, or was the entry of outsiders so fast and forceful that medicine quickly found itself in occupied territory? Organized medicine must accept this ongoing role of being under the physician microscope. It both identifies our strengths and our weaknesses.

"The irony is that as we examine the past, present, and future actions of organized medicine, we are looking at the microcosm of our individual participation or inaction. Organized medicine is not the anonymous entity that some imagine it to be. Organized medicine is ALL physicians who choose their own level of involvement."

Dr. McDanald concludes, "In dealing with the stresses facing medicine today, I believe that we all have the choice to be part of the problem or part of the solution. There is no single right idea or correct approach . . . . Organized medicine is composed of a diverse group of clinicians who have chosen to positively impact medicine through their participation.

"How strong and effective medicine and the Texas Society of Psychiatric Physicians will be rests on our collective participation. We work to protect the practice of medicine and, most importantly, the rights of our patients."

Jerry Lewis, M.D., is president of the Iowa Psychiatric Society. Writing his first "President's Letter" for the summer issue of the Iowa Psychiatrist, Dr. Lewis observes, "As I assume this office, I find psychiatry in the midst of very troubled waters. I've heard presentations by managed care providers proposing that we only need half the number of psychiatrists we have now, and that they are going to put the rest of us out of business. The business, insurance, and government sectors of our society increasingly encroach on the confidentiality of our patients in the name of controlling costs. Many of our patients are being denied services or having their rights compromised, again in the name of controlling costs. Mental health care is being forced into the role of being business oriented instead of service oriented. Unfortunately, since the mentally ill population is a minority and most are unable to speak for themselves, these cutbacks in services are heralded as great success because it 'appears that these services were never needed in the first place.' When we providers attempt to say otherwise, we are written off as doing nothing else but trying to line our pockets. Thus, this population continues to suffer because they essentially have no spokesperson who understands their true illness."

He goes on to explain that there has been concern raised that the Iowa district branch was on its way to becoming "a one-issue organization" and that he disagreed with that assessment since many issues were on its agenda. He explains that he has come to believe, however, "that our salvation lies with our becoming a one-issue [psychiatric] society" and that issue is the "need to become advocates for the mentally ill. All other issues that concern IPS flow from that one issue. Therein lies our purpose for being. When we do research, it should be done for the purpose of helping the mentally ill. When we educate, it is to pass on knowledge to help relieve the suffering this disenfranchised population has to endure. When we see patients, it is to help them overcome their illnesses. Our own well-being is intertwined with our patient's well-being. If our well-being becomes primary, it will be seen as such, and we might as well pack it in and go home, because no one else will support us."

Dr. Lewis concludes by emphasizing that he and his colleagues "need to place the needs and concerns of our patients as the guiding principles of the IPS and let all other issues stem from that."

(Psychiatric News, September 20, 1996)