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The APA Assembly has strongly endorsed a statement calling for an end to the policy of many state medical boards to impose stricter licensing standards on international medical graduates (IMG’s) than on graduates of U.S. and Canadian medical schools.
The statement adopted overwhelmingly by the Assembly at its November meeting in Washington, D.C., states that "APA fully endorses the need for the equitable, fair, and consistent treatment of all applicants including IMG’s by state boards of medical licensure."
The Assembly’s paper, which needs approval by the Board of Trustees before it can become a formal APA policy, also calls on APA’s delegates to the American Medical Association "to work with the AMA and to support a similar resolution" at that organization.
Introduced by Hani Zaki, M.D., the Assembly’s member-in-training representative for Area 3, the paper points out that several states have adopted "two different standards in granting permanent and/or moonlighting licenses to physicians—one for national and another for international graduates." IMG applicants in such states have to complete three years of residency before they qualify for these licenses, while their colleagues with diplomas from U.S. and Canadian medical schools are eligible after one year of residency.
The unfair nature of this disparity becomes glaring, Zaki suggested, when IMG’s "pass the same licensing exams, work in the same establishments, treat the same patients, and, furthermore, supervise less-senior residents who might have that license while the senior resident does not."
The Assembly also took action on another issue concerning state medical licensing boards, namely, the small number of psychiatrists who gain appointment to these influential organizations.
With only 13 state boards having a psychiatrist member, critical concerns such as doctor-patient relationships, boundary issues, and the consequences of psychiatric impairment or substance abuse problems often fail to benefit from the input of the specialists with the most extensive knowledge of these matters, according to the Assembly action paper.
When state medical licensing boards do contain a psychiatrist, they consistently report that the psychiatrist is "a valuable contributor to their mission of protecting the public and the rights of mentally ill and chemically dependent physicians," point out the paper’s authors, Joseph Rubin, M.D., Area 1 representative; Selby Jacobs, M.D., Area 1 deputy representative; and Paul Sapir, M.D., of the Rhode Island Psychiatric Society.
The Assembly agreed that this lack of psychiatrist representation is a serious deficiency that should be remedied and voted unanimously to encourage district branches and state psychiatric societies to advocate for the appointment of psychiatrists as members and consultants to medical licensure boards in their states and "identify appropriate prospective appointees."
The Assembly wrestled with two controversial legislative issues, one being debated by state lawmakers, the other by Congress.
Many psychiatrists have expressed outrage over a rapidly spreading trend among state lawmakers to implement a form of involuntary commitment in which sex offenders who complete their prison terms can then be confined for indefinite periods in state psychiatric hospitals.
The U.S. Supreme Court found no legal impediment to this strategy when, in its Kansas v. Hendricks decision earlier this year, it permitted the state of Kansas to go forward with this type of commitment law. APA had submitted an amicus curiae brief to the Supreme Court in the case urging the justices to disallow this use of facilities designed to treat the mentally ill.
The Assembly passed a resolution asking the Board of Trustees to make opposition to these laws a high priority on the Association’s government relations agenda. It also wants APA to talk with American Medical Association policymakers about targeting this issue in the AMA’s legislative efforts. The Assembly also referred this matter to the APA Council on Psychiatry and Law. The resolution was brought to the Assembly by Ann Sullivan, M.D., a representative of the New York County District Branch and Barry Perlman, M.D., of the Westchester County Psychiatric Society.
On the national legislative front, Rapheal Good, M.D., of the South Florida Psychiatric Society introduced an action paper asking the Assembly to join other medical specialty organizations in endorsing two Congressional bills that would prohibit health insurance plans that offer prescription benefits from excluding or restricting coverage for prescription contraceptive drugs or devices. Both bills have Congressional sponsors from the two sides of the abortion issue and have been endorsed by the American College of Obstetrics and Gynecology, American Academy of Pediatrics, and American Academy of Family Physicians. The Assembly supported the proposal, which will now go the Board of Trustees for action.