APA Assembly Report - November, 2001
by John P. D. Shemo, MD, FAPA & Anita Everett, MD, FAPA

Anita and I attended the Assembly meeting held from November 8 - 11, 2001, in Washington, D.C. The Area IV Council meeting was held on the day prior to the first day of the Assembly meeting in an attempt to save money for the organization. Area VII followed a similar pattern. Unfortunately, during the Assembly meeting there was a motion passed prohibiting action papers from being submitted just prior to the Assembly meeting. Since successful action papers typically have been reviewed and endorsed by an area council prior to their submission, this rule change makes abutting the area council meeting and the assembly meeting quite problematic. Area V vigorously but unsuccessfully opposed this rule change.

At the time of the Assembly meeting the move of APA headquarters from K Street to Rosslyn, Virginia, was presented as an accomplished fact with all relevant contracts signed. The move was presented as largely economically driven, with the Assembly being told that there would be significant economic savings from such a move. It was stated that the Department of Government Relations would stay at their present location given the critical need for them to be close to Capitol Hill for rapid access. As you may be aware, since November, this move has been canceled. The cancelation of the move was couched in economic justifications. I have not yet been able to clarify with the APA leadership why or how the “economic realities” so quickly and dramatically changed, how seemingly overnight a move touted to save money suddenly became “too expensive.”

On a larger scale, it is noted that the APA this year has a projected budget deficit of $3 million over projected revenues. Much of the Assembly meeting was directed at attempts by the District Branch representatives to understand the lines of responsibility for such an occurrence. It was at least clear that fiscal responsibility for the organization needs to be very clearly delineated and ultimately cannot rest with the APA president or treasurer given their one-year terms of office. The responsibility of the APA medical director in this regard was frequently addressed and it is relevant that Stephen Mirin has since that meeting announced his resignation from that position. At bottom line, the APA clearly needs to set its fiscal priorities and to accept the fact that it cannot financially support every worthy cause presented to the organization.

The APA response to the September 11th terrorist attack was also addressed. Several members of the Armed Services representation to the Assembly, who sit with the Area V Council, were involved in the relief effort. They discussed their impression that most of the people involved in these incidents demonstrated significant resilience and that it was important to not overly pathologize while at the same time not ignoring the fact that people with a past history of violence in their lives are at increased risk for symptom responses. They did point out that the events of 9/11 do seem to have raised the consciousness in parts of the business community that mental health benefits are not optional.

There will be an upcoming vote by the APA membership addressing the issue of by-law changes needing to pass the Assembly and not just the Board of Directors. Anita and I strongly urge PSV members to support this requirement.

As always, there was a plethora of action papers considered. A paper clarifying the roles and responsibilities of district branch Assembly representatives, including the responsibility for making necessary arrangements and sacrifices to attend all relevant representative meetings was passed. A paper addressing the APA’s firm opposition to a developing pattern of aggressive solicitation of psychiatric residents by recruiters was presented by the member-in-training representatives and passed by the Assembly. Apparently in some areas recruiters are obtaining access to residents’ emergency pagers and disturbing them at all hours of the day and night.

An action paper was passed which changed the definition of an “early career psychiatrist.” The new definition is based entirely on time since completion of residency training and not on chronological age. An action paper addressing physician privacy in application processes was also passed. This had to do with the inappropriateness of addressing in applications, such as MCO panel applications, whether the applicant is or has been in psychiatric treatment. An action paper addressing the need for meaningful managed care panels was passed. This addressed the frequent existence of “phantom panels” where many of the individuals listed as being on the panel are non-existent. It is noted that only if MCO’s are required to have meaningful panels with adequate numbers of physicians to meet legitimate patient needs will they have any need to negotiate reasonable rates to attract an adequate number of actually living panel members. An action paper was passed requiring the disclosure of funding sources for authors in all articles published in APA journals.

There was an action paper passed addressing the encouragement of litigation and legislation related to monopsony. Monopsony is in essence a monopoly controlled by buyers of goods or services rather than sellers. Monopsony exists where only a couple of managed care companies control the funding of services in a geographic area and therefore, having “cornered the market,” do not need to ensure access or quality of care to hold market share. An action paper was passed supporting the concept of substance abuse as an intrinsic part of the concept of psychiatric illness. There was an action paper passed decreasing the per diem expense reimbursement for individuals, including Assembly representatives, engaged in APA business. An action paper was withdrawn which addressed the significant problem of the limited and often non-existent availability of psychiatric beds in geographic locations. Through their policies of reimbursement rates for psychiatric hospital beds that do not meet the cost of providing such services, managed care has in many areas led to so much bed contraction that they no longer need to deny needed admissions because the resources are not even available.

It was announced during the Assembly meeting that Virginia was one of five states which were given grants for activities related to addressing the psychologist prescribing issue. As you may be aware, the unfathomable developments in New Mexico of the past couple of weeks makes this issue of critical relevance.

As a final note, Anita and I have noted that many Assembly votes seem remarkably close with the Chair “making the call” on the basis of voice vote. The Assembly, however, is by definition a representational body and each representative does not represent an equal number of APA members. We are looking therefore to present an action paper requiring more frequent “vote by strength” unless the voice vote is unequivocally lopsided. We would want this to occur especially when votes involve the finances of the organization. As always, Anita and I are willingly available to discuss and address concerns of the PSV membership relevant to the Assembly.

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