I was born in Santa Monica, Calif. I was educated in the Los Angeles public schools, went to Columbia University on a scholarship, and returned home to attend the UCLA School of Medicine. I decided on psychiatry during my straight medical internship at Colorado University. Remaining in Denver for my residency, I worked for one year as an associate division director at the Colorado State Hospital. I completed my residency with electives in community psychiatry and substance abuse. I came to Washington in 1970 to do my military service at the Bethesda Naval Hospital. In order to pay for my psychoanalysis, I started a solo private practice.
I became active in my district branch shortly thereafter, first at our Suburban Maryland Chapter. I worked to improve payment in our state Medicaid program and to enact one of the nation’s first parity laws. Graduating to the district branch level, I worked to preserve the original, nondiscriminatory, federal employee health benefits plan and to enact a parity law in D.C. I was elected president of the Washington Psychiatric Society in 1985. That year saw the formation of the first for-profit mental health carveout. Foreseeing the havoc that could be caused, I had our attorney warn it not to mess up parity. I was threatened with a lawsuit. I then wrote the very first action paper on managed care in the Assembly while still a DB president. I have now been a member of the Assembly for 15 years.
After military service, I had also started my career at Suburban Hospital in Bethesda. I served in a number of positions there, eventually becoming its part-time psychiatric medical director. Having become boarded in geriatric psychiatry, I helped found and have served as medical director of our county’s only geropsychiatric program and also the hospital’s home health program.
I am first and foremost a private practitioner. But APA leaders also have to listen to medical students; residents; ECPs; community mental health center, public hospital, and VA psychiatrists; academic faculty; women, gay, lesbian, and other minority psychiatrists; international medical graduates; and other psychiatrists with their own perspectives and concerns. The Assembly has established structures that permit it to hear the concerns of our profession, study issues in depth, and develop such compromises as truly reflect a consensus. Yet, unless both the results of this process and the process itself are effectively communicated, first to the Joint Reference Committee and then to the Board, all the Assembly’s work is for naught.
I believe I am particularly suited to do this. I have the background in quality assurance and economic affairs; private practice; psychotherapy and psychopharmacology; district branch issues; membership and ethics; state, military, and general hospitals; community work; geriatrics; and substance abuse to allow me to speak knowledgeably. And I have the experience in the Assembly advocating for positions, negotiating compromises, and building the coalitions necessary to get things done. As cochair of the Joint Reference Committee, I will effectively advocate for you as one of its two representatives from the Assembly. Working with the speaker and the Area trustees, I can effectively represent you on the Board and with the staff.
We have three crises requiring special attention. The first: we are neither effectively recruiting nor retaining our members. To reverse this, we must not be too afraid to make necessary changes. I have fought for and will continue to work to implement the recommendations that you have supported: a more "user-friendly" and less-expensive APA bureaucracy; a new system for achieving fellowship; an APA that goes to bat for our members who must struggle with budgets, HCFA, and managed care; and an APA that does a better job communicating our accomplishments to our members.
The second crisis is the assault on our scope of practice. We must be more effective communicating to the public that our unique training is essential to be able to do what we do. The speaker-elect is a spokesperson. I have successfully advocated against nurse initiatives in Maryland and psychologists’ ones in the District of Columbia. I know the economic dimensions of this issue. Nonmedical practitioners think the grass is greener where we stand. We have to convince our nonmedical colleagues that their proper battle should be a joint one with us to improve access to all necessary services, not to fight among ourselves.
Finally, the third crisis is the systematic defunding of mental health and substance abuse services. The Center for Mental Health Services of HHS concluded that all services, private and public, have lost 25 percent of their funding over the last 10 years. NAMI and NAPHS found that private-sector insurance funding had fallen 50 percent during the same period. We are being paid 50 percent of the Medicare fee by our mental health carveouts. Our public services are increasingly privatized, and our already inadequate funding is going for investor profit or tax relief. Our more expensive treatments required for our most challenging patients are unobtainable. If elected, I will bring up these issues at every meeting of the JRC and Board. We are doctors, and we must never give up our identities and values as healers and humanitarians. But if we do not understand and deal effectively with business people, we and the patients who look to us for protection will continue to be eaten alive.