FIG1 When I finished my
residency training in 1973, one natural part of the "coming of
age" of a psychiatrist was to join APA. Everyone I knew did this, and
the membership card that came in the mail was a badge of professional honor
As dues increased during the 1980s and 1990s and competing organizations
and demands rose for practicing psychiatrists, APA membership evolved from
being an expected obligation to serve one's profession into an option.
Americans in general and physicians in particular became less interested in
joining national organizations for the sake of joining and more focused on
specific services and goods that these organizations could deliver.
Another consideration is the level of dues that must be paid to obtain
these services and goods. Thus, the decision to become or remain an APA member
is partly an economic calculation. For many APA members, the combined national
and district branch dues total nearly $1,000. And competing for those dollars
in the psychiatric marketplace are subspecialty psychiatric societies and
other mental health organizations.
Beginning in the late 1990s and extending into the early years of the new
century, APA lost members at an annual rate of approximately 4 percent. In the
last two years, however, the number of APA members has begun to rise again and
has done so in all categories of membership. This is an encouraging sign for
psychiatry, as it is a unique medical specialty with unique issues and needs,
and we need to have a strong national organization in synergy with strong
What makes psychiatry unique? First, and most importantly, are our
patients, who suffer from some of the most complex and difficult medical
conditions known to humankind. They need our expertise and compassion. No
other medical specialty wants our patients, and other mental health
professionals rely on us to work with them. We also rely on them to provide
for the nonpsychiatric needs of these individuals.
The stigma of psychiatric conditions extends to psychiatrists, and this is
especially true in the house of medicine. Other medical specialties look down
on us and discourage medical students from pursuing psychiatric careers.
Despite this, there has been a definite and gradual increase in the numbers of
American medical graduates choosing psychiatry, an increase of about 4 percent
in the last five years.
Second, we are unique as mental health professionals with our
biopsychosocial expertise, our leadership in the diagnostic enterprise, our
capacity to provide a broad array of medical and nonmedical treatments, and
our willingness to be accountable for outcomes. It is in the zone of clinical
uncertainty that psychiatry enters and is essential for quality care.
Leadership from APA, whether it's regarding DSM development, research
on the profession of psychiatry, or the economics of care, is essential in
attracting and retaining resources for the care of our patients. It is APA's
advocacy function that makes all the difference, whether in our political
activities in Washington, D.C., and individual states or through our national
public affairs activities and initiatives. Our advocacy is in alliance with
organized medicine and other mental health organizations that care about the
same issues. A national APA is an important component of the educational and
scientific foundations of psychiatric practice through the journals we
publish, the CME programs we support, and our extraordinary annual meeting (as
you'll see in this and coming issues of Psychiatric News) and
Institute on Psychiatric Services.
APA has a "dual membership" requirement, that is, members of
the national organization must belong to a district branch where they live or
practice, and vice versa. For most APA members, being involved at the state
and district branch levels is critical for our patients because so many
decisions that impact them are made at the local and state levels. With a
membership of about 36,000, we've got quite an army available to do this vital
So, in answer to the question "Why belong to APA?," we need to
turn the clock back to the time when most psychiatrists believed it was their
professional obligation to join. Indeed, even though—or maybe because
of—we are trying to provide care for patients with too few resources and
too many administrative burdens, we should not be asking what APA can do for
us; instead, we need to focus on how we can contribute to attaining
psychiatry's goals through APA as a way of "giving back" to our
profession and helping our patients.
We are all extraordinarily lucky to have the privilege of being
psychiatrists in the 21st century. Being a member of APA today is more than
just a coming-of-age rite as a psychiatrist; it is a way of actively
participating and controlling our fate. ▪