A New Presidential Season By Rodrigo Muņoz, M.D. APA President

As many of my predecessors have said in this column, we have a lot of hard work to do in the coming year. I will be the last APA president whose term ends before the new millennium begins, and I want to lead APA, along with the profession of psychiatry, into an era when we provide the direct care that best serves patients who value the special skills we possess.

I am not the first to come before you with this aspiration. I would like to thank the APA presidents who have done important ground work in this area in the past few years, including Harold Eist, M.D., and Herb Sacks, M.D. I know they will work with me, and with other current APA leaders, to continue the push for needed reforms to ensure that all individuals living in the United States have access to the mental health care they need.

By the end of my term, I hope to have accomplished these specific goals:

• APA will have a plan in place to return to psychiatrists their professional freedom, their clinical freedom, and their financial freedom: professional freedom from encroachment by outside entrepreneurs; clinical freedom that returns us to a healing role alongside patients; and financial freedom that permits us to negotiate directly with our patients.



• APA members will know, understand, and use the services and programs offered by our Association and ask for those they need but do not yet exist. They should feel free to communicate with APA leaders and staff through telephone, fax, APA's Web site, and e-mail and be assured of getting a response quickly.



• Patients who are interested in advocating for the mentally ill will be told how they can become involved and given helpful materials. So will patients' family members and the public.

We are fortunate that some of our best thinkers are putting in place the basis for a new APA. Some of the work is already under way. APA Medical Director Steve Mirin, M.D., is reorganizing certain APA functions that will streamline operations, be more responsive to member needs, and ensure cost-effective use of members' dues and other Association revenues. Also leading work on this project is APA's Task Force on Strategic Planning, led by former Assembly speaker R. Dale Walker, M.D.

We are in the age of systems. Computers have transformed the use of information, medical information systems are increasingly sophisticated, and those with access to medical information systems control large sectors of health care.

As we respond to the concern that our patients' medical records are being misused and the right to confidentiality is being eroded, we must be mindful that we are the captains of the ship: the best diagnosticians, the experts in differential treatment, the experts in allocation of treatments and resources, and the only experts in somatic therapies. We can use our expertise to create physician-sponsored networks. We cannot succeed in isolation when information is all around us but going in the wrong direction. If we are going to associate, let's do so with our colleagues. Only by organizing ourselves will we be able to regain control of the systems of care in many places, and, it is hoped, in the whole nation.

The potential gains of psychiatric-sponsored networks are the acquisition of security; leadership in psychiatric systems; networking at local, state, and national levels; and protection from outside attacks.

What we do not need, and APA will oppose, is to lose our clinical independence, to lose control of the doctor-patient relationship, to lose control of confidentiality, and to become other people's employees.

A clear strategy for success is to focus on what we do best. The National Survey of Psychiatric Practice in 1996 revealed that 50 percent of our time is devoted to the treatment of patients with mood and anxiety disorders and 23 percent to the treatment of patients with psychoses and addictions. I want to support and enhance excellence in these fields. I want to bring to every APA member and every patient the best and latest on the diagnosis and treatment of mood and anxiety disorders, schizophrenia, chemical dependence, Alzheimer's disease, learning disabilities, and childhood violence.

Early in my term as president-elect I asked colleagues who are experts in these areas to head up initiatives that will improve our clinical effectiveness and the access of underserved patient populations to psychiatric health services.

Moreover, I have asked several colleagues to help me develop additional initiatives related to strengthening the APA membership, for you are the backbone of this country's patient care system and the reason that APA exists. The involvement of all of our members in APA is necessary to the future of psychiatry. Among the groups initially targeted for outreach are minority and underrepresented psychiatrists, members-in-training, and early career psychiatrists.

Finally, as long as public funds support 58 percent of mental health services, APA will continue to explore alternatives to Medicaid, implementation of defined contributions for Medicare coverage, and medical savings accounts. I envision a time when we will once again have a direct relationship with our patients, independently from those who want to limit care for financial gain.

By the time many of you read this, we will have returned from APA's successful annual meeting in Toronto and resumed our hard work. My colleagues who are leading these initiatives will be reporting their progress to you directly in Psychiatric News. In the meantime, I encourage you to send me your comments, concerns, and ideas by fax at (619) 298-4782 or e-mail at rmunozmd@aol.com. I hope a dialogue may be encouraged by the message center on my Web site at www.rmunozmd.com.