Our dues should be spent on projects that affect the world outside: to
recruit medical students into psychiatry; inspire our residents; help our
members attain and maintain knowledge and skills and board certification;
increase the diversity of our workforce; educate the public and decision
makers about our unique expertise; advocate for psychiatric research,
training, care, and reimbursement—all this is in the service of our
patients and the mental health of our society. We want to spend only enough
inside, on our own governance, to achieve these
ends.
Last year I discovered that, in addition to our Board and Assembly, APA had
more than 90 components: committees and councils. We have tended to form a
permanent committee or council every time we identify an issue as important.
Some very useful products, like our new guide on patient safety, "SAFE
MD: Practical Applications and Approaches to Safe Psychiatric Practice,"
have come from our components. Many dedicated APA members have served on
components over the years, and hundreds are serving as I write. However,
setting up a permanent component is not the only or even the best way to
address the importance of an issue, and travel and staff time make components
expensive. Consequently, I appointed a Board work group to look at all our
governance and make recommendations for a reorganization. The working group
was chaired by Dr. Alan Schatzberg, currently APA president-elect, and Dr.
Ronald Burd, speaker of the Assembly. At its March 2009 meeting, the Board
considered and adopted many of the recommendations of the work group (see
Board Enacts Big Reduction in Governance Structure).
As a result, we will consolidate the work of most of our components into
nine councils, which will be charged with most of the functions of the
committees they used to oversee.
The councils are Adult Psychiatry; Children, Adolescents, and Their
Families; Communications; Advocacy and Government Relations; Healthcare
Systems and Financing; Minority Mental Health and Health Disparities;
Psychiatry and Law; Medical Education and Lifelong Learning; Research and
Quality Care.
Task forces of experts and stakeholders will be appointed to perform
specific tasks as they are needed. The bulk of the work will be carried out
via electronic communication. Most of the other current committees will sunset
at the end of next month's annual meeting, though some will continue working
to complete projects.
I have been working with our information technology department to develop a
more inclusive and accessible way for members to address the issues we care
about. We will establish Web-based groups that can accommodate all interested
members; the groups can generate draft policies and projects for consideration
by the Board and Assembly, as the committees have in the past.
The Board will also reorganize to improve efficiency and lower costs. We
will eliminate the position of vice president and two trustees-at-large, add a
second voting member-in-training, and maintain the trustee position for an
early career psychiatrist. The elected chair of the Assembly Committee of
Representatives of Minority and Underrepresented Groups will sit on the Board
and have a vote. The Assembly will undergo a budget cut and is in the process
of deciding how to reorganize. We recognize that we may have to make changes
as we see how the new structure works out.
This is a good time to economize. The relationship between APA and the
pharmaceutical industry has been a concern to many members. I appointed
another work group in March 2008 to inform the Board about the amounts and
kinds of revenue we receive from pharmaceutical companies and the activities
the revenue supports and to offer options for decreasing that revenue. The
group began its work before the issue attracted major negative attention by
the government and media. Last month, the Board voted to phase out
industry-supported symposia and meals at our scientific meetings. During the
past year, the world economy suffered great losses, and pharmaceutical
companies significantly reduced their advertising expenditures. The Board has
voted to set up a work group to rethink and recast APA's relationships with
industry, and the Assembly will consider guidelines for the relationships of
individual psychiatrists with industry at its May meeting. The process of
reorganization was not undertaken to save money, but now we need to. We are
determined to maintain our mission, our financial reserves, and a balanced
budget.
The Board has devoted a year of consideration and planning to these
important decisions. I wrote about these issues, and solicited your feedback,
in earlier columns of mine. We know that the changes will not be universally
popular. The component meetings provided collegiality and stimulation. But we
can address important issues without maintaining a permanent component for
each one. Our younger colleagues prefer focused tasks carried out by
electronic communication. Our internal governance exists only to affect the
external world: to help us prevent, diagnose, and treat the psychiatric
conditions that inflict pain and disability on millions of suffering people.▪