The APA Assembly debated a number of proposals intended to improve the care that psychiatric patients receive or to enhance the ability of psychiatrists to practice their craft effectively.

One such proposal calls on APA to identify a mechanism to ensure that psychiatrists are paid by managed care organizations and other third-party payers for the time psychiatrists are forced to spend performing administrative tasks required by those payers. Assembly members want APA’s Practice Research Network to begin gathering data showing how much time psychiatrists must devote to these tasks. The Assembly asked for a report on these issues for its November 2000 meeting.

The representatives supported a proposal from the Texas delegation urging APA to help other district branches replicate the Utilization Review Complaint Service that the Texas Society of Psychiatric Physicians has developed. Through this initiative the district branch reviews and then alerts state regulatory bodies to psychiatrists’ complaints about managed care and utilization review practices they believe violate state or other regulations.

• urge APA to adopt as official policy "that the choice of medications shall be made by the treating physician." The proposal was a reaction to public and private health care plans that deny beneficiaries access to certain medications by using restrictive formularies or delay prescribing what the physician believes is the optimal drug for a particular patient.

• reject a proposal to have APA reconsider the inclusion of a multiaxial system in DSM-IV. Several members maintained that the five axes are problem plagued and do not help psychiatrists make diagnoses. The majority of members indicated, however, that they believe that to abolish the multiaxial system via an Assembly action paper that contained no evidence or data would render a decision based on political considerations rather than hard research findings from an assessment of the multiaxial system. APA Medical Director Steven Mirin, M.D., pointed out that this is one of the issues that will be addressed in a text revision of the diagnostic manual that is about to begin.

• dismiss the idea of having APA officially endorse a moratorium on capital punishment. Most members agreed with those who pointed out that while APA does occasionally speak out on social issues on which psychiatrists have expertise, this is not one of those issues and should not be on APA’s agenda. It is an extremely sensitive issue on which APA does not know its members’ opinions, other speakers noted. One of the paper’s authors, Michael Blumenfield, M.D., maintained that while psychiatrists "may be powerless to make changes" on how the country views capital punishment, it is important for them "to stand up for what [they] believe."