Trustees Act on AAMC Brief in Harvard Case, Multiple Other Issues
Abstract
APA President Rebecca Brendel, M.D., J.D., said the Board’s support of an amicus brief supporting affirmative action “demonstrates APA’s commitment to fostering and sustaining a diverse workforce in psychiatry and medicine.”
APA’s Board of Trustees voted to sign on to an amicus brief by the Association of American Medical Colleges (AAMC) in support of Harvard College and the University of North Carolina in an affirmative action case before the United States Supreme Court. The case is Students for Fair Admissions v. President and Fellows of Harvard/UNC.
The decision by Trustees, after reviewing the AAMC brief, was one of a range of issues they considered at its July meeting in Washington, D.C.
The AAMC brief does not address the particular policies of any university, but instead provides information to the Court regarding the importance of affirmative action in ensuring that medical schools have diverse undergraduate candidates to choose from to fill their classes. The brief furthers the argument by pointing out that diversity in medical schools promotes a wide range of cultural benefits that help physicians better understand the populations they serve.
The Supreme Court will consider the case in its term beginning in October.
“The Board’s carefully considered support of the AAMC’s amicus brief demonstrates APA’s commitment to fostering and sustaining a diverse workforce in psychiatry and medicine to advance the health and well-being of psychiatrists and all whom we serve,” said APA President Rebecca Brendel, M.D., J.D.
The plaintiff in the case, Students for Fair Admissions, alleges that Harvard University/UNC discriminated against Asian Americans and is seeking to prevent colleges and universities from using race as part of their holistic review of applicants. In November 2020, the U.S. Court of Appeals for the First Circuit upheld a lower court’s ruling in 2019 that Harvard does not discriminate against Asian Americans when its undergraduate college uses race and ethnicity as factors in reviewing applicants, according to an article in the February 25, 2021, Washington Post.
APA CEO and Medical Director Saul Levin, M.D., M.P.A., said support of the AAMC in the case is in keeping with APA’s policy of seeking to increase the diversity of undergraduate students entering the medical school “pipeline.”
“Research supports that social and cultural factors play a major role in health outcomes,” Levin said. “When there is racial concordance between patient and physician, patients report higher levels of trust and satisfaction. Therefore, ensuring a pipeline of diverse candidates from college to medical school and from medical school through residency is an important part of training psychiatrists who are respectful and knowledgeable and demonstrate cultural sensitivity with the patients they serve.”
Building a Roadmap for the Future
Brendel began the first meeting of the 2022-2023 APA Board of Trustees with a team-building exercise to set the stage for the Board’s work over the next year, with an emphasis on openness to new ideas, turning challenges into opportunities, and creating opportunities for the next generation of psychiatrists. Her presidential theme is “A Roadmap for the Future.”
‘If We Do Not Reimagine the Future, Others Will Do It for Us’
Psychiatrists “need to look internally at who we are, what our identity as psychiatrists is, and what our aspirational goals are,” said Robert Trestman, M.D., Ph.D., chair of APA’s Council on Healthcare Systems and Financing, in a report to the APA Board of Trustees in July.
Trestman recounted the well-known problems of lack of access and the familiar culprits: poor reimbursement; administrative hurdles and barriers; inadequate infrastructure investment; and longstanding stigma against mental illness, substance use, and psychiatry as a field.
But Trestman suggested that psychiatry, as a profession, needs to hold itself to account as well. “What makes us different from others providing care to people dealing with mental illness and substance use disorders? We typically assert that our training is the difference. Four years in medical school, training in neuroscience, four years in residency, and—for many—additional years in fellowships. We assert that gives us unique skills in differential diagnostics, differential therapeutics, management of medical comorbidity, and severe illness management.
“Compared with the other [mental health] disciplines, this is extraordinary,” he said. “And then we undercut ourselves by often choosing to treat people who quite reasonably might be cared for by those with far less training: patients with uncomplicated mood or anxiety disorders, moderate severity personality disorders, or subsyndromal disorders.”
Trestman said psychiatrists abdicate their medical training by not coordinating medical care of straightforward and common conditions such as noninsulin-dependent diabetes, hypertension, and hyperlipidemia. “And many of us choose to opt out of insurance reimbursement and accept only cash payments from the financially secure patients,” he said.
“There are many justifications for focusing on higher functioning patients: our own autonomy and income; the satisfaction of working with high functioning, cognitively sophisticated patients; conducting psychotherapy at our own pace and using our own protocols; avoiding the complexity and challenge of hospitalizing acutely ill patients; and the real-world difficulty of finding community resources for those with social inequities. Indeed, this approach appeals to many of us: A best-guess estimate is that over 30% of all psychiatrists choose to opt out of insurance, Medicaid, and/or Medicare.”
But Trestman said there’s a problem with that: Those with less training can do much of that work.
He concluded: “As leaders of APA, here is our challenge: How are we going to address the future of psychiatry and psychiatrists? How do we justify those years of training—and federal investment in our residency training? If we do not reimagine it, others will do it for us.”
She invited Robert Trestman, M.D., Ph.D., chair of the APA Council on Healthcare Systems and Financing, to discuss with the Board issues of access, equity, and professional identity and how to ensure psychiatry takes a leadership role in expanding access to quality care (see box). Charles Dike, M.D., M.P.H., chair of APA’s Ethics Committee, shared his thoughts on the ethical and professional responsibilities of psychiatrists in the future.
“The current mental health pandemic is a time of both challenge and opportunity,” Brendel said. “The goal of the Board’s work on our Roadmap for the Future is to envision where psychiatry and APA need to be in the coming decades to advance our profession, be prepared, and lead the way for high-quality, evidence-based mental health care for all Americans.”
Other Business
The Board approved the creation of three new caucuses: the Caucus on Social Determinants of Mental Health under the Council on Minority Mental Health and Health Disparities; the Caucus on Pain Management under the Council on Consultation-Liaison Psychiatry; and the Caucus on Neuromodulation under the Council on Research.
Trustees approved six new or revised position statements. These include:
Position Statement on Level of Care Determinations for Acute Psychiatric Treatment (revised)
Position Statement on the Impact of Structural Racism on Substance Use and Substance Use Disorders
Position Statement on Police Interactions with Children and Adolescents in Mental Health Crisis
Position Statement on the Use of Psychedelic and Empathogenic Agents for Mental Health Conditions
Position Statement on the Role of Psychiatry in HIV (revised). ■
