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The APA Board of Trustees will move to implement the goals elaborated by its Task Force on Strategic Planning in coming years following the task force's submission of a final report.
The goals approved by the Board will become guiding principles throughout the activities of the Association, said APA Medical Director Steven Mirin, M.D. (Psychiatric News, July 3 and August 21).
The task force was established in March 1997 to identify APA's top priorities for the next five years and devise a budget framework to ensure more funding on these priorities and less funding for lower priorities. The top strategic goals defined by the task force include advocating for patients; advocating for the profession; supporting education, training and career development; defining and supporting educational values; and enhancing the scientific basis of psychiatric care. The goals were scheduled to be presented to the Assembly at its November meeting
"This is not the end, but the beginning," APA Medical Director Steven Mirin, M.D., told Psychiatric News.
One set of task force recommendations was aimed at increasing the efficiency of Board meetings. These recommendations asked that the Board "consider reducing the number of individuals seated at the Board table" during its meetings. The task force suggested that the Board consider adopting a policy of reimbursing expenses only for voting representatives, plus a limited number of past presidents, the speaker-elect of the Assembly, the member-in-training trustee-elect, and "the small number of presenters required at each Board meeting to inform discussion." The task force noted that the removal of nonvoting representatives would eliminate the nonvoting representative of certain constituencies.
This sparked a protest from the chair of the Committee of Black Psychiatrists, Gloria Pitts, D.O., who who serves as the committee's nonvoting representative to the Board. She pointed to the dearth of African Americans in leadership positions within APA, and said that eliminating the committee's representative would further disenfranchise black psychiatrists.
Later, in discharging the Task Force on Strategic Planning and vowing to embrace its principles, the Board noted that the recommendations on reducing the number of people attending Board meetings, including the possibility of eliminating nonvoting representatives, were options, not directives.
In a discussion about the RBRVS Work Group, Chair Donald Scherl, M.D., praised the efforts of the APA Division of Government Relations for its role in working with the Health Care Financing Administration to alter the RBRVS (resource-based relative value scale) formula in a way favorable to psychiatrists. The RBRVS system is a set of calculations used to determine the amount that the government will reimburse physicians for treating Medicare patients each year. The change is expected to result in an average 9.2 percent increase in psychiatrists' net income, from $148,800 to $162,490 (in 1995 dollars).
The Board voted to direct the medical director or his designee to bring APA's concerns about the equity and access to the Clinical Skills Assessment (CSA) examination to the attention of the Educational Commission for Foreign Medical Graduates (ECFMG) and its sponsoring organizations. The Board also voted to ask the AMA Section Council on Psychiatry to explore strategies with AMA to influence the ECFMG to make the examination more accessible and equitable.
International medical graduates must pass the CSA examination to be certified by the ECFMG. The new examination is designed to evaluate a physician's ability to obtain a relevant patient medical history; do a competent physical examination; produce a complete, accurate written patient record; and show appropriate interpersonal skills and proficiency in spoken English.
The Board adopted a recommendation from the Council on Psychiatric Services to increase the management fees that pharmaceutical companies are charged for industry-supported symposia at APA's Institute on Psychiatric Services.
The increase involves a $1,500 hike in the charge for a 90-minute symposium-from $5,000 to $6,500-and a $4,000 hike in the fee for a three-hour symposium-from $9,000 to $13,000. The increase will become effective in January 1999.
The Board extended the tenure of the APA Commission on Psychotherapy by Psychiatrists by two years. Under the extended tenure, the commission will expire in July 2001.
The Board also approved the com-mission's mission statement. "Psychiatry is a profession of physicians whose training and therapeutic efforts involve both the mind and the brain; therefore, psychotherapy must remain a critical core skill for psychiatrists," the statement asserts. One of the statement's key planks observes: "Viewing mind, brain, and body from a unitary perspective, the commission affirms that patients must have access to integrated psychotherapy and pharmacotherapy by one psychiatrist when combined treatment is indicated. . . ."
In addition, the Board approved receipt of a $23,000 grant from Pfizer to support a psychotherapy education conference scheduled for March 1999 in conjunction with the annual meeting of the American Association of Directors of Psychiatric Residency Training. Philip Perera, M.D., medical director of Pfizer's depression and anxiety disorders disease management team, presented the check to Norman Clemens, M.D., APA's Area 4 Trustee and chair of the Commission on Psychotherapy by Psychiatrists.
The conference, titled "Integration and Specificity in Psychotherapy Education," will involve five presenters and will be aimed at psychotherapy educators and senior residents.
"Pfizer is involved in a number of initiatives to help the training and education of residents and medical students," Perera told Psychiatric News. "This includes not only psychopharmacology education, but all aspects of medical training. It is our hope that this particular grant furthers the education of residents and psychiatric educators to make them all-around better physicians."
Clemens praised Pfizer for providing a grant focused primarily on psychotherapy rather than psychopharmacology.
Among the topics to be covered at the conference are teaching residents integrative models of combining psychotherapies; specific tracks in focused short-term therapies including cognitive-behavioral therapy, interpersonal therapy, and psychodynamic therapy; the role of long-term psychodynamic therapy; and combining medication and psychotherapy.
Five district branch presidents-elect attended the Board meeting and spoke briefly. Their attendance is part of an ongoing effort by the Board to improve communications with the district branches.
Attending were Jerome Rogoff, M.D., president-elect of the Massachusetts Psychiatric Society; Marvin Nierenberg, M.D., president-elect of the New York County District Branch; Anwar Ghali, M.D., president-elect of the New Jersey Psychiatric Association; Allan Axelrad, M.D., president-elect of the Texas Society of Psychiatric Physicians; and Rhonda Lehr, M.D., president-elect of the Utah Psychiatric Association.
The consensus of the presidents-elect was that managed care has hurt the practice of psychiatry, particularly psychotherapy. The trend is "away from teaching psychotherapy in residency training programs," said Nierenberg. Despite APA's efforts on parity and in other areas, many members "are not feeling supported by APA," he added.
Although APA "does a helluva lot" for the dues members pay, many members are confused about what APA does for them, said Rogoff. "People are getting their money's worth, but they just don't know it."
Utah's Lehr said that she went into medicine because "it was scientific and altruistic" and into psychiatry because "it was creative," but that under managed care she feels that she is "on a conveyor belt."
Each trustee must complete and return a "Disclosure of Interests" form each year prior to the first meeting of the Board in which the trustee will participate. If an issue arises in the course of the Board's work that may create a conflict of interest, the trustee must disclose his or her other interest at the outset of the Board's discussion of the issue.
The introduction to the disclosure form notes that "in almost all circumstances, complete disclosure of potentially competing interests and/or apparent conflicts will suffice."