APA and AMA: A Partnership for the Ages

Dilip Jeste, M.D.

2012 will go down as a momentous year in the history of the APA AMA relationship. For only the third time in its history, and for the first time in the last 73 years, the AMA has elected a psychiatrist as its president—Jeremy Lazarus, M.D., a distinguished psychiatrist in private practice in Denver, Colo. He is a former speaker of the APA Assembly and former chair of APA’s Ethics Committee. A past president of the Colorado Medical Society and Colorado Psychiatric Society, Jeremy has been one of the AMA’s chief spokespersons on the uninsured. We are proud to have a decorated colleague to head the world’s largest medical organization.

Historically, the relationship between APA and the AMA has undergone many changes over the decades. The AMA was founded in 1848, four years after APA (then called the Association of Medical Superintendents of American Institutions for the Insane) was born. The initial meeting of the AMA was attended by delegates from 22 states. The main theme of discussion was improving the quality of medical education across the country. It is fascinating to note that a psychiatrist who was one of the founders of APA was also one of the founders of the AMA. His name was Pliny Earle II, and he went on to become president of APA. He also became professor of materia medica and psychology at the Berkshire Medical Institute in Massachusetts, the first professorship of mental diseases established by a medical college in the United States.

On several occasions between 1850 and 1925, a merger of APA and the AMA was discussed—and ruled out. Toward the end of this period, the AMA elected its first psychiatrist president—Hubert Work, M.D., whose term of office was 1921–1922.

While the AMA considered issues relevant to mental illness from time to time, it was not until 1930 that it created a Committee on Mental Health. In 1933, the AMA, APA, and American Neurological Association collaborated in establishing the American Board of Psychiatry and Neurology. Six years later, a second psychiatrist assumed the presidency of the AMA—Rock Sleyster, who was medical director of the Milwaukee Sanitarium in Wisconsin. And now comes Jeremy Lazarus in 2012.

The AMA and APA need each other to ensure a national focus on health promotion—both physical and mental. The AMA, by virtue of its size, visibility, and resources, has a degree of power and presence that individual specialty organizations cannot have. In recent years, there has been a growing and positive focus on psychiatric concerns in AMA policies and priorities. Much of the credit for this harmonious relationship between the AMA and APA goes to several APA leaders, especially Joe English, Jay Scully, Jack McIntyre, and Carolyn Robinowitz. Below, Carolyn will describe succinctly the recent history of this exciting collaboration.

(Acknowledgement: I want to thank Gary McMillan from the APA staff for digging up historical information from the APA archives for me to review for possible use in this and other president’s columns in Psychiatric News.)

Carol Robinowitz, M.D.

APA is celebrating the inauguration of Jeremy Lazarus as president of the AMA—the third psychiatrist to hold that office. Why is this so important to our profession and our patients?

The AMA is the largest medical organization in the world; it has a major role in shaping public policy and medical education. Through its policymaking body, the House of Delegates (House), the AMA represents physicians from state and local medical societies and from medical specialty and subspecialty organizations. Psychiatry’s official participation is through the Section Council on Psychiatry. Other psychiatrists such as Jeremy, who was a delegate from Colorado, participate in the house as representatives of their state medical societies.

In 2000, the AMA modified its structure from that of a federation of state medical societies to near-equal representation of specialty and subspecialty organizations, expanding diversity of membership in the House, with greater numbers of women and minorities participating. That year, under the leadership of APA’s former President Joseph English, the Section Council on Psychiatry developed a long-term strategic plan to enhance our effectiveness. It requested appointments of psychiatric representatives who worked well with colleagues in other medical specialties and who could serve long enough to become well known and influential in the AMA decision-making process. We identified potential candidates for appointment and election to councils, where initial proposals for AMA policies are developed, and developed plans to increase their visibility and recognition. We worked with colleagues in state delegations and other specialty societies to prepare resolutions on topics important to psychiatry, and then promoted their adoption. We participated in caucuses and work groups, testified at reference committees, and served on numerous committees, bringing the voice of psychiatry to the AMA’s deliberations. APA also committed significant resources—especially first-rate staff—to support this plan.

Our efforts have produced outstanding results. In addition to Jeremy’s uncontested unanimous election, numerous psychiatry delegates have been elected or appointed to councils and various important committees, as have several psychiatrists from the state delegations. Psychiatrists also chair several organizational components such as those on women physicians, international medical graduates, and minorities, and serve on the Joint Commission. Patrice Harris, former president of the Black Psychiatrists of America, was elected to the AMA Board of Trustees.

Well-received reports have addressed topics such as college-student mental health, health care disparities, depression and suicide, SSRIs in children and adolescents, and discrimination in medical licensure. Additionally, through our participation and leadership, psychiatry has positively influenced other physicians’ perception of and respect for our profession.

The AMA has been supportive and effective in highlighting our particular interests as part of advocacy for all of medicine in areas such as health care reform, universal access to care, privacy and confidentiality, malpractice liability, and reform of the Medicare payment system. The AMA-led Scope of Practice Partnership emphasizes broad patient-safety concerns and protections in multiple specialties.

To continue our achievements, we need APA members’ assistance, best offered through continued membership. Please join the AMA this year to support its president—our president—Jeremy Lazarus, as he works to further the AMA’s leadership in promoting the health of our nation.