How the AMA is Working to Secure Your Future

The AMA and its Resident and Fellow Section (RFS) met in San Diego for five days in early November and demonstrated that the field of psychiatry continues to have a strong presence in the RFS. Among the psychiatry residents attending the meeting were our current APA resident delegate, Paul O'Leary, M.D., and Steve Koh, M.D., the APA alternate resident delegate and chair of the APA Assembly Committee of Area Members-in-Training Representatives.

The recent RFS meeting focused on the AMA's advocacy agenda, and there was considerable discussion about how the recent national election results might change health care reform efforts on Capitol Hill, particularly the outlook for implementation of the new health reform law. At least partly at the urging of its student, resident, and young physician members, the AMA has shifted over the past five years into being a strong advocate of coverage for the uninsured, through a system much like the one President Obama signed into law. Unfortunately, the AMA's resulting support of federal health reform also provoked anger from some of its members, particularly in high-resource specialties that could face tighter utilization review and lower incomes.

Despite the criticisms, at this meeting AMA leadership reaffirmed what psychiatrists have known for years: our country cannot survive when our patients cannot access even basic health services.

The AMA continues working to keep our future practices viable, with renewed congressional lobbying to end Medicare's use of the sustainable growth rate (SGR) to determine physician reimbursement (see Congress Votes Another Delay in Large Medicare Cuts). The SGR is a complex economic formula that has led to threatened Medicare pay cuts to all specialties of about 23 percent by the end of this year. Even if you don't treat Medicare patients, your hospital and your program depend on Medicare revenues, and these cuts would mean a massive decrease in the financial support available for medical education and training. Your AMA delegation and the RFS are also working hard to restore Medicare payment for consultations (eliminated earlier this year), an issue of serious concern to psychiatrists.

On residency issues in particular, the AMA Council on Medical Education provided a report on its efforts to expand access to economic-hardship and public-service-based loan repayment programs, on which many of us will depend if we choose to work in academia or in the community mental health system. Sadly, with massive federal budget cuts looming, especially in light of the Republican takeover of the House of Representatives, we are unlikely to see major loan relief in the near future.

Every AMA meeting also includes a wide variety of focused requests from passionate physician-advocates nationwide. We debated and adopted a report of the Council on Ethical and Judicial Affairs addressing physicians' use of social-networking sites, the rescheduling of cannabis to permit more research into its beneficial and harmful effects, and routine HIV screening that does not require special consent. An issue that received considerable attention was a resolution advocating for federal recognition of same-sex civil marriages, which was referred to the AMA Board of Trustees for study (see AMA Holds Firm on Support of Health Insurance Mandate). APA has already adopted a policy supporting the right of same-sex couples to marry.

All of us who work with gay and lesbian patients have seen how strongly they are affected because our nation considers them second-class citizens. A number of psychiatrists, including Drs. O'Leary and David Fassler, made impassioned statements in support of the resolution on same-sex marriage rights, and it was a shining moment for APA and for psychiatry.

The AMA meeting is also a venue for residents to caucus with leaders of APA and other psychiatric societies. Our biggest question was: where are the jobs? Residents in many parts of the country are having difficulty finding that first job, especially those who do not want to start a solo practice.

In response, APA said it is working to improve its job bank, but we were reminded that we have a much more important resource: our district branch (DB). If your department chair or professors aren't able to help with your job search, your DB's leadership is made up of psychiatrists who know their local community and can give you a helping hand. Most DBs meet every month and welcome residents to their meetings—drop them an e-mail and start networking!

Finally, all of us from the APA member-in-training leadership want to thank those of you who have gone the extra mile and become members of both APA and the AMA. As the only organization in which all of medicine speaks with one voice, the AMA is the strongest advocate for improving the quality of our training, our lives, and our careers. When you join AMA, we as psychiatrists get more representation and a stronger ability to carry your issues forward, and the organization gets the funding it needs to solve those issues. Many of you face financial difficulties, and it is not easy to pay your dues each year. Still, every time you do so, you are making a solid investment in your own future and ensuring that you will be respected, heard, and fairly compensated.

When the AMA asks for your support, please join or renew—we need your help to secure psychiatry's future!