Member Referendum

The American Psychiatric Association was petitioned by APA members to hold a referendum on the issue of informing the American Board of Psychiatry and Neurology (ABPN) as follows regarding its proposed maintenance of certification requirements.

1) The patient feedback requirements for the purpose of reporting to the Board is unacceptable, as it creates ethical conflicts, and has the potential to damage treatment.

2) The requirements other than a cognitive knowledge examination once in 10 years, regular participation in continuing medical education, and maintenance of licensure pose undue and unnecessary burden on psychiatrists.

You will be asked to vote in favor of or against this statement on the ballot for APA's 2011 election. The following are statements provided by APA's Board of Trustees and the petitioners to explain their respective positions. Passage of a measure in a member referendum requires (a) valid ballots from at least 40 percent of the voting members, (b) the affirmative vote of at least one-third of all the voting members of the Association, and (c) the affirmative vote of a majority of those members who return a valid ballot.

Board of Trustees Statement

The proposed requirement of the ABPN for patient feedback is part of the American Board of Medical Specialties (ABMS) Maintenance of Certification Program affecting all medical specialties, not just psychiatry. The ABPN will ask physicians to complete a small number of feedback evaluations over a 10-year period. Only the physician will see the evaluations and attest that evaluations have been completed. The ABPN will not receive or review any patient information.

The Ethics Committee of APA reviewed the ABPN/ABMS requirement and determined it did not violate APA's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. Requirements for patient satisfaction surveys, independent of certification, are part of the health care reform bill.

APA will continue to work closely with ABPN, ABMS, and other organizations to reduce unnecessary burdens that may be associated with MOC programs and to assure that such programs are consistent with high-quality patient care.

Petitioner Statement

Our petition is not against soliciting patient feedback, but against the pernicious effect of an external mandate for it as a condition for maintaining certification. This will damage the time-honored doctor-patient relationship. Patients may now think that their doctors are treating them nicely not because of their intrinsic worth or the doctor's helpful nature, but because the doctor has to comply with an external agency requiring it. Distrustful patients might become even more distrustful. There is potential for ethical conflicts and damage to treatment by preferential treatment of a select few patients whose feedback the psychiatrist has decided to seek for his/her own benefit (maintenance of certification), distortion of transference, and adversely influencing prescriptions, limit settings, and discharge plans. Requiring 10 chart reviews, 10 peer reviews, and 10 patient reviews every three years is onerous. Any supposed benefits are questionable. Making too many demands on physicians' time can impair performance.