Board Reviews Controversial Texas Restructuring Plan

Current and former officers of APA's Texas district branch, the Texas Society of Psychiatric Physicians (TSPP), were invited by APA President Michelle Riba, M.D., to last month's Board of Trustees meeting in Phoenix to explain the details of and answer questions about the controversial establishment of two new psychiatric organizations in the state.

TSPP President Clay Sawyer, M.D., past president Priscilla Ray, M.D., and Robert Denney, M.D., a former TSPP representative to the APA Assembly, outlined how the new organizations—the Federation of Texas Psychiatry and Texas Academy of Psychiatry—came to be formed last summer.

They stated that the federation is an umbrella body whose members will be psychiatric and mental health organizations throughout the state. The academy is an organization for individual psychiatrists who don't belong to TSPP, which as a district branch requires dual membership in the branch and in the national APA.

Both TSPP, with its 1,345 members, and the new academy, which had 13 members as of mid-October, have joined the federation. The two members of the TSPP staff have resigned to become the staff of the federation, Sawyer said. The federation will provide administrative services for TSPP (see box on Original article: page 40).

TSPP, along with several other district branches, has been facing shrinking income and membership numbers that they say make it difficult to achieve its goals (though recent figures show the TSPP's membership decline may be reversing). As a way to bring more psychiatrists—and increased dues revenue—to TSPP, and to provide a voice for Texas psychiatrists who are not APA members, TSPP leaders had originally proposed an affiliates program in which psychiatrists could participate without also joining APA. Dues for the new affiliates were to be the same as for district branch members. Affiliate members would, however, avoid the dual-membership requirement.

APA leaders believed that this plan violated the Association's dual-membership policy.

Confronted with strong opposition and rejection of the plan by the Assembly Procedures Committee last November, as well as the possibility that the alleged violation of the dual-membership requirement could lead to TSPP's being “de-linked” from APA, TSPP's Executive Council decided in April to abandon the affiliates program.

The plan that eventually replaced it involved the formation of a separate organization open to non-APA members, which, TSPP leaders have maintained, had the approval of the then Assembly speaker, APA president, and Area 5 trustee. These APA leaders, however, disagree with this contention, saying that no specific endorsement of this or any other specific proposal was given.

Details Recounted

On March 15 then APA president Marcia Goin, M.D., wrote a letter to Ray, who was then TSPP president, informing the DB that at the APA Board's March meeting, Board members agreed with the Assembly's Committee on Procedures and its Executive Committee that the proposed affiliates program for nonmember psychiatrists would constitute a new membership category and would thus violate APA policy.

Goin stated that the Board was, however, “interested in supporting programs, activities, and other pilot projects to increase and strengthen membership in the TSPP and APA.” She urged TSPP leaders to discuss additional ideas with the APA leadership, including ways in which APA“ could provide assistance including support for communicating to members/nonmembers about any new [TSPP membership] project.”

In April Goin attended a TSPP Executive Council meeting in Austin and learned that the TSPP had decided to establish a separate corporation for its affiliates program. She followed up with a letter to Sawyer informing him that the APA Board's Executive Committee was concerned about the implications of the plan and asking him to explain several facets of the new structure, including ones related to tax status, relationship with TSPP, membership parameters, sharing of staff, and financial factors.

In September APA learned from other sources of the two new corporations—the Federation of Texas Psychiatry and Texas Academy of Psychiatry—and TSPP's relationship to the federation's structure and function.

On September 30, Riba and Assembly Speaker James Nininger, M.D., sent a letter to all TSPP members in which they communicated the Association's position on the new organizational structure and related issues. Emphasizing that they are “deeply concerned” about what the actions of the TSPP mean for the future of organized psychiatry in the state, they explained their belief that “in establishing the academy and federation, TSPP leadership has set up organizations that will compete with TSPP and are certain to undermine its future. We are also concerned” that in backing the new structure, TSPP leaders are ignoring the DB's “obligation as an APA district branch and are undercutting APA” at a critical time“ when advocacy is crucial and a central element of [APA's] mission.”

Riba and Nininger, expressing their regret that a situation they tried to avoid came to pass, noted that APA has for years tried to help TSPP address its “problems of membership loss and financial needs.... While TSPP's membership recruitment and retention problems have been more severe than those of most other district branches, we have stopped and reversed the course of membership loss at APA and have helped other district branches do so as well.”

Despite these and other communications between TSPP leaders and APA, Sawyer and other leaders maintained and told their members that APA had not given them sufficient opportunity to explain the function of the two new organizations and was spreading misinformation about the plan.

At the October Board meeting, the Trustees provided an additional forum for TSPP leaders to explain the plan and address APA's concerns. Sawyer stated that TSPP had no involvement in creating either the federation or the academy and has no control over either organization.

“The federation simply offers administrative services” for its member organizations and, TSPP leaders hope, will raise the visibility of organized psychiatry in Texas, Sawyer said.

Denney told the Trustees that TSPP members “don't want to be disengaged from APA” and warned that any such disaffiliation will end up damaging APA, as well as the district branch. APA might want to consider becoming a member of the Texas federation, he suggested.

Of the 13 members the academy had as of the October Board meeting, he added, seven had resigned from APA and TSPP or had their memberships terminated because of failure to pay dues. The latter category included the academy's president, Sanford Kiser, M.D., Sawyer told the Board.

Trustees Explain Concerns

The presentations by the three TSPP leaders left many Board of Trustees members concerned about the implications for APA and the future of the Texas district branch. Area 5 Trustee Jack Bonner, M.D., whose Area includes Texas, said that despite protestations to the contrary from Sawyer, the new structure still seems designed “to circumvent the intent of the dual-membership requirement.”

Immediate past president Marcia Goin, M.D., raised the issue of use of funds that APA provided TSPP for state-level lobbying on scope-of-practice issues, since it was explained that the federation, not the TSPP, would become the chief advocacy group for psychiatrists in Texas. The TSPP leaders did not respond to her concern during the session.

Paul Appelbaum, M.D., who preceded Goin as APA president, suggested that the “surprise” that TSPP leaders had expressed in response to APA's strong objection to this and the affiliate proposal was an indication that they did not understand APA's concerns. He explained the objections by emphasizing that despite TSPP's claims, the academy is in essence competing for psychiatrists with the district branch and thus “negating the dual-membership requirement” that the Board believes is “essential for the future of organized psychiatry.”

If other district branches follow TSPP's lead, he said, it could siphon off APA members, leaving “both the DBs and the national APA with fewer resources and fewer members” and serve as the “opening wedge in what could be the devastation of APA.”

After the presentations and questions, the Board went into executive session to discuss the situation further. Following that closed-door session, the Board issued a statement saying it “anticipates that a further response to the TSPP action will be forthcoming shortly.”

At press time, the Assembly planned to discuss the developments in Texas at its November meeting. A report of that meeting will appear in the next issue.

Other Actions

The Board also had several other issues on its agenda, voting to