BY Richard Ratner, M.D., FASAP
Greetings, ASAPers from the aftermath of the annual APA Scientific and Business Meeting in New Orleans! I’m happy to report that the city, at least the part that has always attracted the tourism dollar, is back and up and running. For signs of Katrina you must go outside the central business district, which a few people did on a bus tour showing the devastation still in place. However, the convention center, hotels and happily, the restaurants are either still there or back with vigor. It was also too early in the life of the oil spill for that to have had any effect the city’s mood or food supplies.
Registration was definitely down this year, which it always is relative to the blockbuster cities of New York and San Francisco that historically draw the largest crowds. How much of this is due to the virtual extinction of the pharmaceutical industry-sponsored symposia that traditionally dominated Saturdays and Sundays is hard to say, but to the credit of the scientific program committee, there was a great deal of high quality stuff to attend. With the exception of Sunday, when a good number of people found they could not get into sessions they wanted to see because the rooms could not accommodate them, things evened out subsequently, and I heard no further complaints.
- But what of the Assembly?
As those hardy followers of this occasional column know, the Assembly is the “legislative” arm of the APA, representing the rank and file membership primarily through the District Branches and State Associations, but also though membership by various affiliated organizations like ours, each of which have a vote. Most of the leadership of the APA rises through offices in the Assembly, including most of the current Board, though with the exception of APA president Dr. Schatzberg.
The Assembly’s role is to serve as a voice for the membership, which it does at least in part by having members submit action papers. They are considered, sometimes altered, and often passed for reference to the Board of Trustees, where hopefully, they will be considered and followed. Perhaps the most talked about issues this year involved not action papers but one position statement regarding the relationship of psychiatrists to the pharmaceutical industry and a talk given by Larry Faulkner, head of the ABPN.
- Pharmaceutical Industry Relationship
A statement put together under Paul Appelbaum’s chairmanship lays out guidelines for what we should and should not do with regard to the industry. Much of it is unobjectionable and even overdue, but the devil is in the details, and some of them stuck in the craws of Assembly members. At the heart of the objections is the implicit notion that psychiatrists are rather passively influenced by drug company initiatives, including the visits of detail persons and various little gifts like pens, mugs, and sandwiches for lunch. Proponents argue that Pharma itself has adapted some of these changes, that the document represents guidelines rather than ethical rulings, and that the APA is going along with the rest of medicine in producing guidelines of this sort. Some people saw the conflict as one of older vs. younger colleagues, but this by no means fit every case. In the end, the Assembly again did not approve of these guidelines but sent them back to the Trustees for further consideration.
- Maintenance of Certification
The other issue causing a stir was the description of the structure of the soon-to-arrive “maintenance of certification” guidelines, as described by Dr. Faulkner. Among a variety of other things, they include a section in which physicians will apparently have to seek satisfaction ratings from their patients! It does not appear that anyone has thought through whether this segment of the process is appropriate for psychiatrists, and most of the concerns expressed had to do with this provision.
Just when those older physicians like me who have been long grandfathered into lifelong certification thought we could relax, comes the news that the Federation of State Medical Boards has embraced in principle the notion of making the maintenance of one’s actual medical license contingent on patient satisfaction ratings. This means that some means of gauging “patient satisfaction” may find its way into all of our practices sooner or later. And, of course, all of this comes down when physicians’ incomes are under great pressure with added concerns about the effects of the new Health bill as it unfolds.
- DSM5
On another matter, DSM5 is now entering field trials, as the period for commentary on the information posted on the website has now closed. However, the website is still running for anyone wishing to see what the thinking of various committees are.
Some good news was that the APA is again in the black after some ferocious cost-cutting (including layoffs of notable numbers of APA staff) and after a significant recovery of the stock market since last year.
- APA Professional Liability Insurance
Those of you who have had malpractice insurance through the APA should by now know that the APA is changing its endorsement. PRMS, which had been the chosen agency, had decided it did not want to continue to insure only APA members. For the APA, this was a deal breaker, since this insurance is a membership benefit. Accordingly, APA went back to the market and, after further research and evaluation, has announced that the new official APA agency will be American Professional Insurance Co. Those of you insured through AACAP will know them as the agency that insures AACAP members. It will probably take time for the new company to be able to insure in all states, but when money is at stake, companies can be timely in arranging to do business.
Some other action papers of note addressed the situation that physicians cannot readily rescind prescriptions at the pharmacy when a patient’s circumstances change, which the Assembly felt should be allowed. We were surprised to learn that our President does not now send condolences to the family members of service members who die by suicide, as he does with those who die in the line of duty, so an action paper urged APA to lobby to get this changed. The Assembly also voted to ask mail order drug houses to provide less than 90 days of prescription medication without a financial penalty to the patient, if a psychiatrist does not feel it is safe to provide the patient such a large amount. It also voted to have APA ask to have the entire area of Evaluation and Management Codes revised so that psychiatrists can use them for both inpatient and outpatient visits.
The next annual meeting of the APA is in May 2011 in Honolulu. There may be some concerns about how many will register there, since they were already accepting hotel reservations for next year at this meeting, which I don’t recall ever seeing before. Oh well, to quote the Hawaiians’ all-purpose (hello, good-bye, go in peace, etc., etc.) greeting, Aloha from your ASAP APA Assembly rep—me.
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