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From the President
How Are We Doing?
Psychiatric News
Volume 38 Number 9 page 3-59
Anchor for JumpAnchor for JumpErstwhile New York City mayor Ed Koch, a compulsive extrovert, used to pump the hands of prospective voters wherever he could find them and ask, "How’m I doin’?" Whatever led Hizzoner to reverse the usual social convention (most of us, after all, ask the people we meet, "How are you doing?"), the impulse to take stock of one’s performance can be a positive one for both people and organizations. With my year as APA president soon coming to an end, it seems like an appropriate time to ask "How is APA doing?"

In many ways, APA is doing very well indeed. From a financial perspective, after two deficit years in 1999 and 2000, APA finished in the black in 2001 and will show an excess of revenues over expenses of more than $1.2 million for 2002. In part, the turnaround is due to striking increases in revenue from our income-producing activities, including the publishing business of American Psychiatric Publishing Inc., our subsidiary and the largest psychiatric publisher in the world. Moreover, dues income markedly exceeded expectations, as the decrease in membership leveled off and more members paid up back dues.

Of course, even a strong performance on the revenue side can be dissipated by profligate spending. That is precisely what did not happen in 2002. The Board and the medical director worked together to hold the line on expenditures and to identify economies at every level of the organization. Nonessential staff positions were held vacant, and administrative reorganization allowed reductions in the ranks of management. A complete reorganization of our council and committee structure, implemented this past fall, trimmed the number of components and maximized the use of new communication technologies in lieu of expensive face-to-face meetings. And our newly created Financial Oversight Committee meets monthly by conference call to make sure things stay on track.

Despite the strong performance this year, we are not entirely out of the woods yet. Structural factors in the APA budget mean that 2004 will be another tight year—although hopefully the last in which we begin budget planning with a multimillion dollar gap to close. The Board has rejected reliance on investment income and one-time gains to balance our budget, and the benefits of this more prudent approach to fiscal management will be evident in subsequent years. We have used the surpluses of the last two years to begin rebuilding our reserves, which have been hammered by both deficits and a poor investment climate.

Other changes we made in 2002 should set the stage for future improvements in APA functioning as well. Our new medical director, Jay Scully, M.D., has taken charge of our staff with a "can-do" attitude that has brought a new level of energy and enthusiasm to the APA offices. And the offices themselves have moved to bright, efficient, lower-cost space just across the Potomac River from Washington, D.C., in Arlington, Va. Planning is under way for a revamping of APA’s antiquated computer systems—a major capital investment that should bring a long-needed improvement in our ability to serve members’ needs. In this year’s election, our members approved a streamlining of APA’s Board that will downsize two positions over the next few years and should improve the Board’s deliberative and decision-making functions.

Every balance sheet, of course, has two sides. Despite APA’s progress in so many areas, there is no question that much remains to be done. Our procedures for enrolling and transferring members are archaic, serving only as a deterrent to people joining and remaining in APA. Member service is not always what it should be—hence the importance of Dr. Scully’s reminders to our staff that the members are the people for whom every staff person works—and, I would add, every APA officer, Board member, and Assembly member too.

No organization, of course, exists merely to perpetuate itself. The ultimate assessment of how we are doing will be based on how well we promote the interests of our patients and our members. With regard to member services, this past year we initiated Focus, a new quarterly journal of lifelong psychiatric education, the value of which was evident when the projected subscriber base topped projections by 50 percent even before its second issue appeared; members receive a very substantial discount on Focus subscriptions. A free Grand Rounds CME program now appears regularly on the members-only section of our Web site. Also on the Web site is a package of materials designed specifically to help our members deal with the complex requirements of the new HIPAA medical privacy regulations. Preliminary steps are under way for the production of DSM-V later in this decade, and we have a task force busily at work on a 21st-century update of our ethics annotations for psychiatry.

On the advocacy front, APA continues to fight psychologist prescribing, with successes in two states—Wyoming and Hawaii—so far this year. A package of materials has been prepared to help members and district branches combat cuts in Medicaid and the introduction of restrictive formularies. My particular focus, as many of you know, has been calling attention to the systematic defunding of psychiatric services in both the public and private sectors, a problem that is only getting worse in the current budget climate. In anticipation of the coming President’s Commission report on mental health, a task force I appointed has developed a vision for a revitalized mental health system, which has already received enthusiastic responses in Washington and from our members. Coverage of this plan will appear in a future issue of Psychiatric News. (Like so much of the advocacy material APA produces, it too can be accessed on the Web site.)

I just returned from the annual APA-sponsored Academic Consortium, an opportunity for psychiatric researchers and department chairs to advocate with Congress for greater funding for psychiatric research (see article on page 1). And we continue our advocacy work on mental health parity, VA funding, state mental health system funding, and many other areas as well.

That’s my take on how we are doing. Many things are going right, but there’s no question that there remain challenges to overcome. Ed Koch, of course, had the essential insight that what really matters is how the voter—or in this case, the member—would answer the question.

So tell me what you think. How are we doing? I will pass along your responses to our incoming president, Marcia Goin, M.D., and our medical director, Jay Scully, M.D. After all, they work for you. ▪

Anchor for JumpAnchor for JumpErstwhile New York City mayor Ed Koch, a compulsive extrovert, used to pump the hands of prospective voters wherever he could find them and ask, "How’m I doin’?" Whatever led Hizzoner to reverse the usual social convention (most of us, after all, ask the people we meet, "How are you doing?"), the impulse to take stock of one’s performance can be a positive one for both people and organizations. With my year as APA president soon coming to an end, it seems like an appropriate time to ask "How is APA doing?"

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