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Assembly members want to see a controversial report on the reorganization of APA that one of the report's authors says is being deliberately ignored by the Board of Trustees.
The Assembly unanimously voted last month to ask the Board of Trustees to make available to Assembly representatives a special task force report submitted to the Board in June that calls for sweeping constitutional changes in the Association--including the formation of a "unicameral" governing body to replace the Board and Assembly.
The Board did not act on the report at its June meeting, when it was preoccupied with negotiations with new Medical Director-designate Steven Mirin, M.D.
The report is the product of a subcommittee of the Assembly/Board Task Force on Strategic Planning.
Richard Bridburg, M.D., a cochair of the subcommittee, told Psychiatric News that he has since received no feedback from the Board about the substance of the report.
Radical in its vision of a "streamlined" APA, the recommendations in the report would entail elimination of some groups and components, and a wholesale shifting of power within the governance structure.
It "gores everybody's ox equally," commented Bridburg.
The vote by the Assembly to release the report to its representatives came at the end of a meeting highlighted by intense debate on reorganization of the Association's governance structure, member dues, and use of the Association's resources.
Throughout the weekend-long meeting last month, Bridburg told Psychiatric News, "Many people in the Assembly were coming up to me and saying, 'What happened to the report?' "
He added, "It became very clear to me that the Assembly is strongly concerned about the way [APA is] using our money."
It was during prolonged debate on a motion to "streamline APA" (see story on page 1) that Bridburg was asked to comment on the fate of the subcommittee's report.
The recommendations in the report were based on criteria developed by the subcommittee to evaluate alternative governance structures for APA. Those criteria include the following: support for APA's mission, streamlining of the governance process, ensurance of high-quality products and a focus on priority issues, representation of diverse constituencies, a high level of involvement by members, reduction of costs and improved cost-effectiveness, elimination of duplication, and ability of staff to implement and manage the changes.
After meeting with representatives from several other medical associations--including the American Medical Association and the American Ophthamological Association--to determine the strengths and weaknesses of various forms of governance, the subcommittee opted to recommend a unicameral system.
Such a system would merge the present Assembly and Board and do away with the Joint Reference Committee and many other components.
"Executive functions would be delegated to a Board of Directors, which sits and votes in the [new unicameral governing body]," according to the subcommittee report. "It would assume many of the functions of the current Board of Trustees and Assembly Executive Committee, which it would replace. By eliminating the overlapping of functions between the current Assembly and Board of Trustees, there would be no need for the Joint Reference Committee. The principal advantages of the new approach would be improved communication, less duplication, faster action, and lower costs. The speaker of the House and the president of the Board would in essence be partners, with each having a somewhat different focus."
The subcommittee recommendations come at a time of change for the Association, and not a little strife: many members are reeling financially from a rapidly changing health care environment, and some have questioned APA's ability to respond in a timely and cost-effective fashion to the distress many members feel.
Adding to the upheaval is the departure next year of Melvin Sabshin, M.D., after more than two decades as APA's leader, and the arrival of Mirin, who was a corresponding member of the subcommittee that produced the report on internal reorganization.
APA President Harold Eist, M.D., has stated that there will be no reorganization under his tenure while he is leading a headlong charge against managed care.
In his speech to the Assembly last month, Eist said that a unicameral governance structure has consistently been shown to be inferior to a bicameral structure.
Yet Bridburg says he believes the recommendations contained in the report represent a wellspring of agitation within the membership for greater accountability, efficiency, and cost-effectiveness.
"I believe there are several reasons why APA needs to be restructured," he said. "The first is that its governance structure is unwieldy. . . . Basically, items of importance get lost."
Moreover, the present structure allows controversial items to be ignored--as in the case of the subcommittee report on reorganization, Bridburg said.
"[E]ither the Board or the Assembly, when it doesn't want to deal with an issue, can push it around forever [from component to component] until hopefully it disappears," he said.
Bridburg told Psychiatric News he believes the subcommittee report was "finessed" by the Board of Trustees.
"I believe it means something when nobody gives me any feedback on it," he said.
Bridburg acknowledged that the recommendations in the report would be upsetting to many, and that with a new medical director there were already "too many things going on."
But he added, "There are always too many things going on."
Bridburg said, "The report should be seen by the present governance structure including the Assembly. . . . Even if the constitutional changes do not take place, the report provides a blueprint by which changes can be made without constitutional change."
It is clear, he added, that the Assembly is saying, 'Things have to change'."
(Psychiatric News, December 6, 1996)