Differences in opinion among doctors are to be expected. The needs of the vascular surgeon, such as Dr. Palmisano, differ from those of an endocrinologist. And there is no reason to think that there will not be disagreement within one profession. In psychiatry, the opinion regarding the destructive value of mental health "carveouts" has led to a division between private practitioners and those who work in public-sector clinics. Surely the diminishing health-care dollar is exacerbating such divergent viewpoints.
Organized medical groups and societies, unfortunately, have an ever smaller pie to divide. APA, the AMA, and every specialty society must devote time and resources to so many goals. Thus, infighting among organized medical societies wastes time and energy. But it is naïve to think these differences should be repressed. They do matter.
Knowing what "we" want is important. It is important now, and it will be important 10 and 20 years from now. The need to see down the road is why the involvement of residents in organized medicine is vitally important: We must advocate for our patients and our profession so that in the coming years there are better treatments and more social support for patients, and so that we can practice properly without third-party involvement. It is our work we will be doing, and we must be aware of the issues in order to achieve better mental health care in the future.
I am a card-carrying member of APA. I have and will advocate for patients and for our profession. I plead with other trainees to become involved. You don’t have to be a chief resident or in one of the APA fellowships or an appointed or elected position to be involved. You have to want this profession to remain the unique institution that it is, now and in 10 and 20 years. We have a number of issues before the nation today, and I have listed some of them below. I would not tell you what "we want," but I want to present some of the issues so you can learn about them. I hope that what we want will be clear: the provision of the highest quality, ethical, science-based mental health care there can be.
• President Bush’s initiative to have faith-based organizations provide care and services: Who will work in these sites? Who will monitor them and their quality?
• The new privacy rules created during the Clinton administration: Privacy is a top priority for APA, but are the rules a burden for the solo practitioner?
• Carveouts of managed care mental health services: APA and AMA recognize the discriminatory nature of these. For many psychiatrists (and residents) ceasing this practice is paramount.
• Revision of Medicare copayments and prescription drug coverage: Ending the discriminatory 50 percent copay for psychiatric services covered by Medicare is the goal of Rep. Marge Roukema’s House bill introduced in January.
• Parity: This is a federal and a state issue.
• Psychologist prescribing legislation: At the moment bills are pending in Connecticut, Illinois, Louisiana, Tennessee, and Texas. Anyone who knows voters in those states could have an impact! And be on the lookout for the sources of funding for the psychologist lobby.
• Laws and regulations about seclusion and restraint.
• Pharmacy industry influences on education and prescribing patterns.
• Funding for graduate medical education, including the financing of the PGY-6 year.
• Funding for research: The budgets for the National Institute on Alcohol Abuse and Alcoholism, Substance Abuse and Mental Health Services Administration, and National Institutes of Health have grown in recent years, and President Bush has indicated the intent to continue this trend.
The APA Web site is a tremendous source for information about these issues, particularly the Division of Government Relations area under "Public Policy Advocacy." That section has a program that creates letters for you to send to legislators. Also, sign up for both the APA residents and fellows’ chat room and the weekly APA Online News—both great ways to communicate about our profession and the advocacy we all can do for it today and for our future.
This column is a regular feature of Psychiatric News that is written or edited by the member-in-training trustee to address issues pertinent to training in psychiatry. I am about to leave my adult residency at the Harvard Longwood Program in Boston to become a fellow in child psychiatry at Columbia University/New York State Psychiatric Institute in New York City. I eagerly seek ideas, comments, and feedback about these columns and about any issue that trainees feel deserves attention.
You can e-mail me at firstname.lastname@example.org or write to me care of Psychiatric News at APA, 1400 K Street, N.W., Washington, D.C. 20005. ▪
Dr. Mack is APA’s member-in-training trustee.