By a close vote, APA Trustees approved making the Statement on Psychotherapy with Medical Evaluation and Management a "resource document" rather than an official APA "position statement."

A position statement is the most formal declaration of an official stance of the Association. Other categories of statements, including resource document, do not carry the strength of a position statement.

Norman Clemens, M.D., chair of the Commission on Psychotherapy by Psychiatrists, presented the statement for approval as a resource document to the Board at its meeting last month in Washington, D.C.

Although Clemens referred to the statement as the position of the commission, he explained that the data were lacking to support APA's taking an official position that psychotherapy performed by psychiatrists is better than psychotherapy performed by other clinicians.

The statement argues that psychiatrists are physicians medically trained to integrate the biological with the psychological; "therefore, all psychotherapy conducted by a psychiatrist is psychotherapy with medical evaluation and management."

Clemens cited concerns by the Joint Commission on Government Relations (JCGR) and the Council on Economic Affairs about having a position statement that argues that psychotherapy by psychiatrists always involves medical evaluation and management. "This could be misused by other health care professionals and would limit our flexibility in dealing with major changes."

Alan Tasman, M.D., reviewer and Board liaison to the commission, told the Trustees that "the intent of the statement is to assert that whatever we are doing, we are functioning as physicians and our medical knowledge informs all of our activities."

APA President-elect Herbert Sacks, M.D., supported making the document a position statement of APA, which was the original intent of presenting it to the Joint Reference Committee, which approved it in January.

"Notwithstanding the concerns expressed by [Ronald Shellow, M.D., chair of the JCGR], making this a resource document weakens the usefulness of the document. I think the organization needs to take a stand in these difficult days and call it a position statement."

Shellow explained to Psychiatric News following the Board meeting that the impetus for developing a position statement by the commission last fall was the news that the Health Care Financing Administration (HCFA) planned to develop new reimbursement codes for psychotherapy.

"The intent was to show the advantages of psychotherapy by psychiatrists, including cost-effectiveness."

In the meantime, APA's advocacy efforts to increase the work values for psychotherapy by psychiatrists were rewarded, noted Shellow. HCFA announced last November the creation of separate billing codes for psychotherapy and psychotherapy with evaluation and management (E&M). The E&M "G" codes reflect the higher work values and apply only to physicians (Psychiatric News, December 20, 1996).

(Psychiatric News, April 4, 1997)