 |
 |
|
|
In preparation for last month's conference on carveouts in psychiatry, APA President-elect Herbert Sacks, M.D., asked participants to ponder the seven questions below for later discussion:
1. Should the APA central office, state psychiatric organizations, or individual district branches (DB's) develop independent practice associations (IPA's) that it sponsors, endorses, or, to a lesser degree, controls? If IPA's are developed under state or DB sponsorship, can they function decisively in the swift currents of the marketplace?
2. Should a state association or DB connect the IPA to a patient population, yet take no legal, moral, or ethical responsibility for the IPA? Can that association or DB maintain dejure and de facto separateness from the IPA, with no leadership, administrative, and infrastructural separation from it? If so, can the DB or state association monitor, criticize, or act against such an IPA if it believes that professional standards are being diminished (fee schedules, treatment interruptions, confidentiality leaks, etc.)?
3. Will shareholders of the IPA be in competition with the rest of the DB or state association membership, fracturing collegiality and endangering membership retention? (Recall, in Connecticut APA's Consultation Service was blamed for consulting to PsychCare and providing expertise that would be deployed ultimately against the interests of non-PsychCare participants.)
4. Should a DB or state association develop a plan and offer it to members without sponsorship or endorsement?
5. In the context of the carveout development, what should the role of APA's Consultation Service be?
6. What guidance, advice, or cautions should we offer members who establish their own freestanding carveouts separate from state associations, DB's, and APA sponsorship? And what is our responsibility to members who have been excluded by these carveouts or who decide not to join by personal choice? If the latter group of members opt for legal action, under some circumstances, what will the organization's obligation be when this latter group seeks APA's help?
7. Departments of psychiatry are setting up their own networks. They have, to date, not sought APA consultation. The items under question 6, above, are relevant to the academic setting. How should these issues be handled in that setting?
(Psychiatric News, May 16, 1997)