Reject Call for New Private Practice Committees

By Michael Hughes, M.D.

A maelstrom of change in health care financing is impacting the private practice of psychiatry. This is old news. What is new is the growing proactive response of individual psychiatrists and of APA to these changes.

Two recent initiatives, both from private practitioners striving to work within APA, are of special interest. In one such initiative, Dr. Thomas Allen of Maryland has proposed to the Assembly the establishment of a committee on private practice for members who choose to work on a fee--for-service basis without accepting any contracts or payments from managed care organizations (MCO's). In the second, Dr. Marcio Pinheiro, also of Maryland, has proposed a solo practitioner committee for psychiatrists who are increasingly becoming "managed care organization providers." Dr. Pinheiro has publicized his proposal on the list serve for APA members and in the Letters to the Editor column in the March 20 issue of Psychiatric News.

These two undertakings highlight major concerns as well as adaptations of psychiatrists to changing circumstances, but they also point to a potential schism.

APA established the Committee on Private Practice in 1981 and charged it with the following tasks:

1. To raise, discuss, monitor, and present options for action on issues relevant to private office practice



2. To identify resources among and for the membership and serve as an information center regarding the Association's activities and capabilities on issues of concern to the private practice constituency.



3. To increase coverage of private practice activities and issues in existing publications.

This committee is composed of and represents private practitioners-those who work with managed care, those who work outside of managed care, and the growing number of members who do both.

There are many committees on private practice at the district branch level as well. The APA Committee on Private Practice hosts a luncheon program at the annual meetings for district branch private practice committee representatives-the focus is on mutual collaboration, consultation, and commiseration. This year we have invited Drs. Pinheiro and Allen to join us and discuss their initiatives and other issues with our committee and with APA leadership, including Drs. Rodrigo Muņoz, president-elect; Joanne Ritvo, chair of the Committee on Managed Care; Donna Norris, speaker-elect of the Assembly; and Theodore Hovagiumian, chair of the World Psychiatric Association Section on Private Practice. Attorney Joseph Sahid will also review the status of the lawsuit against several managed care organizations for restraint of trade, to which APA is a party. Committee members will also present topics of interest for a colloquy with our district branch compatriots.

In addition, the Committee on Private Practice offers a workshop each year at the annual meeting. Last year we discussed the establishment and maintenance of a private practice, emphasizing development and diversification of referrals and sources of income.

This year the vital topic is "The Future of Private Practice." Our prescient panel of private practitioners consists of Herbert Sacks, M.D., APA president and a child and adolescent psychiatrist; Norman Clemens, M.D., chair of the Commission on Psychotherapy by Psychiatrists and a psychoanalyst; Tracy Gordy, M.D., member of the AMA CPT Editorial Board and a neuro-psychiatrist; and Ronald Shellow, M.D., chair of the APA Joint Commission on Government Relations, with a forensic and adolescent subspecialty.

The committee members recently wrote an action paper, now APA policy, that highlights the destructively restrictive, procrustean practice of MCO's that limits psychiatric hospital treatment only to patients who are in imminent danger of taking their own life or the life of another.

This action paper's adoption committed APA to advocating for the use of our treatment guidelines and level-of-care criteria for hospital treatment and to hold MCO's responsible for untoward consequences resulting from inadequate treatment funding. Other committee initiatives include projects involving confidentiality; site visits; complete patient record reviews by MCO's; mandated treatment outcome studies for MCO's; and efforts to clarify the nature, scope, and perhaps a definition of what constitutes present day private practice.

The issue of separate components for managed care and non-managed care private practitioners has been discussed by our committee and by the Committee on Managed Care, the Council on Economic Affairs, and other components.

At this point the committee believes that it can best represent private practitioners who work with or without managed care. The range of issues described here is what private practice is about these days. Both managed care and non-managed care perspectives are relevant and essential to contemporary private psychiatric practice.

On hearing of these proposals for new and separate committees, I was initially saddened that the work of our committee was not better known by some members. However, it is incumbent upon APA leadership-officers, councils and committees, Board of Trustees, and Assembly-to communicate what the Committee on Private Practice is doing and to open access for new participation, ideas, and initiatives.