December 4, 1998

APA Assembly representatives recently let their leaders know that they are far from finding common ground on proposals to reorganize the policymaking body in which they sit.

At a special forum November 6, which Assembly Speaker-elect Al Herzog, M.D., called "a think tank for the future," representatives had an opportunity to air their views on proposals by the APA Task Force on Strategic Planning and on recommendations by a work group of the task force. Many of the proposals have generated considerable controversy.

The Board of Trustees endorsed the task force's proposals, though not the work group's recommendations, at its July meeting. The Board decided, however, that developing plans for reorganizing the Assembly was best delegated to members of that policymaking body.

The task force looked at reorganization of the Assembly-and the Board of Trustees-as opportunities to increase work efficiency and decrease APA's governance costs. Recognizing that the task force's proposals were going to meet serious challenges from Assembly representatives, task force chair Dale Walker, M.D., said that his years as a member of that body, and eventually as its leader, taught him that "the Assembly is usually willing to experiment." He urged the delegates to view the process as "dynamic," not as a one-time exercise.

Lawrence Kline, M.D., deputy representative to the Assembly from Area 3, articulated a theme that resonated throughout the forum; namely, that the task force's strategy of reducing the size of the Assembly "works in opposition to the goal of increasing member input" into APA's governing bodies. He and others objected in particular to the suggestion from the task force's work group that one way to shrink the size of the Assembly is to eliminate the 50 district branch deputy representatives. (District branches large enough to qualify for more than one representative do not have a deputy representative.)

Supporting this viewpoint, Marc Graff, M.D., one of the representatives from the Southern California Psychiatric Society, emphasized that "size is not as important as effective functioning," and the strategic planning report does not fault the Assembly for functioning poorly.

Graff was particularly opposed to the task force's proposal to save money by doing away with the spring and fall meetings of the seven Area councils, which are usually held at a location within the Area, and having them meet only in conjunction with the two annual Assembly meetings. "Our most effective deliberative bodies are the Area Councils," said Joseph Rubin, M.D., of Maine, the Area 1 representative. Eliminating half of their meetings would be counterproductive, he stated.

Much of the forum was spent in debate of a proposal to move APA from a district branch to a state society orientation. This would have the most impact on the four states with multiple district branches-New York (which has 13), California (five), Missouri (three), and Florida (two).

Reducing the number of district branches represented in the Assembly, the task force suggested, would allow it to increase its diversity by adding representatives of allied and subspecialty psychiatric organizations without compromising the Assembly's ability to function efficiently.

Herbert Peyser, M.D., the Area 2 representative to the Board of Trustees, led the protest against the state organization proposal at the forum. Referring to a position statement developed by the New York State Psychiatric Association and the California Psychiatric Association and described in detail by his Area 2 colleague James Nininger, M.D., Peyser insisted that "no mandatory consolidation [of district branches] should be imposed by APA."

Area 2 deputy representative Barry Perlman, M.D., echoed that sentiment, stressing that APA members "feel allegiance first and foremost to their district branch." The national APA comes in a distant second, he said. Replacing district branches with state organizations would just serve to alienate the psychiatrists in the four states with multiple DBs, he suggested.

Peyser urged instead that a better way to reduce the size of the Assembly and enhance its efficiency is to back the proposal to eliminate the deputy representative positions, which should be accomplished by attrition, Peyser said.

California Psychiatric Association President Yvonne Ferguson, M.D., urged the Assembly to adopt a representation formula based on the number of psychiatrists in each district branch.

She provided data on how much of a reduction the Assembly would realize by using ratios of representatives to APA members of 1 to 600, 1 to 400, and 1 to 300. She urged her colleagues to adopt the 1-to-300 ratio, which she called the "least radical" solution. It would result in 32 fewer representatives; 18 district branches would gain representatives, while the 50 deputies would be removed. All of these formulas would eliminate the deputy representative position, but call for no change in the number of member-in-training, early career psychiatrist, and minority/underrepresented group delegates. The current Assembly ratio is 1 to 279.

She estimated that this shift would result in annual savings to APA of about $32,000.

But John Urbaitis, M.D., of Maryland, the Area 3 representative, stated that the whole debate about reorganizing the Assembly was heading in the wrong direction. "We need to address function before form," he said. The essential issue with which the Assembly should be grappling is how to improve channels of communication within that body and between it and all other APA members. He added that he failed to see how any of the proposals under discussion work toward the goal of enhancing communication, which he considers a "fundamental value" to which APA must always pay heed.

"It's not how we're structured, but how well we carry out our business," maintained Seymour Gers, M.D., of the Brooklyn Psychiatric Society.

Fred Gottlieb, M.D., chair of the Council on Internal Organization and a past Assembly speaker, reiterated that reorganizing APA's governing bodies "should not be thought of as downsizing, but as a path to improved efficiency and functioning."

The members, he said, keep sending the message that APA needs to be more effective, "both internally and externally."

But Strategic Planning Task Force Chair Walker responded to the criticism of his committee's proposals by maintaining that "the Assembly doesn't do as good a job as it could in representing the district branches . . . .The organization needs to look seriously at its linkages with its membership."

"There is inevitably tension about change, but let's not let that derail our efforts" to make the Assembly a more effective body, said Herzog.