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A distinguished group of members of the Group for the Advancement of Psychiatry (GAP) has formulated a statement, issued in GAP's name, assailing the constraints of managed care.
The GAP statement, which was crafted with input from three former APA presidents who are also GAP members, urges the psychiatric profession to insist on a fully integrated biopsychosocial approach that incorporates psychotherapy and focuses on the best interests of patients rather than economic factors.
Robert Gibson, M.D., one of the former APA presidents, spoke with Psychiatric News about the statement.
"We started out feeling there needed to be more of a focus on the rather broad ways in which the whole practice of psychiatry was being influenced," said Gibson. "We felt that there is sort of a reaction on the part of many psychiatrists that there's really nothing we can do about this, it's all happening, and all we can do is adapt and get along the best that we can."
As the GAP members met, however, they concluded that residency training is being "subtly influenced" as the time residents can spend with patients decreases, said Gibson. This, in turn, influences residents' perception of what constitutes appropriate practice and they "begin to think more and more like managed care executives," Gibson observed.
GAP consists of members whose training and commitment are to "a kind of psychiatry that places the emphasis on the individual as a person and not as a specimen to receive a drug designed for a target symptom," said Gibson.
GAP was founded in 1946 by William Menninger, M.D. At the time, GAP saw itself as an alternative to APA, Gibson recalled. "In the early days [GAP members] challenged APA and were dubbed 'the young turks,'" he noted. Menninger went on to become APA president, and the relationship between GAP and APA ceased being adversarial.
Despite the cordial relationship, "we did, as a group, have a feeling that APA has some difficulty in speaking out as forcefully as we can, since many members of APA work for managed care companies," said Gibson. This creates a constituency within APA that is less critical of managed care than those not so beholden, he observed. "We felt that APA was not being forceful enough in making a statement."
Between the time GAP members started working on the managed care statement and its completion late last year, Harold Eist, M.D., had become APA president and made a forceful criticism of managed care the theme of his presidency, Gibson pointed out. Eist addressed some of GAP's concerns, while GAP still wanted to issue its statement.
The hope is that "there will be some further mobilization by psychiatrists and psychiatric organizations to keep resisting the inroads of managed care and trying to maintain what we view to be our professional responsibility."
One top priority is that psychotherapy continue as "an essential treatment for patients," said Gibson. Under managed care it has become "so limited that we fear we are moving toward a situation where psychiatrists merely diagnose and write prescriptions, and the whole process of psychotherapy will be done by others. What we are getting at is that if psychotherapy is no longer a part of psychiatry, then you really have stopped looking at the patient as a person."
A complete copy of the GAP statement on managed care is available at no charge by writing to Donald Ross, M.D., Director, Division of Education and Residency Training, Sheppard-Pratt Health System, 6501 North Charles Street, Baltimore, Md. 21204; telephone: (410)-938-3000.