Reports to the Membership
Publication: American Journal of Psychiatry
Abstract
The following are edited/abbreviated versions of the annual reports of the APA Secretary, Treasurer, CEO and Medical Director, Speaker, and Speaker-Elect and the chairpersons of the APA Committee on Bylaws, Membership Committee, Committee of Tellers, and Elections Committee. The full reports were presented at the APA Annual Business Meeting in Atlanta, May 15th, 2016.
Report of the Secretary
Altha J. Stewart, M.D.
It is my constitutional duty and personal privilege as Secretary of the American Psychiatric Association to report to the membership on the actions taken by your Board of Trustees over the past year. The official actions of the Board are summarized in the appended documents. The following are some of the highlights.
International Resident-Fellow Member
The APA Board of Trustees at its July 2015 meeting approved under the recommendation of the Membership Committee a new category of membership called International Resident-Fellow Member. Physicians are enrolled in a psychiatry residency training program or fellowship in a psychiatry subspecialty outside of the United States and Canada, verified with a letter from the training program.
Joint American Psychiatric Association (APA)-Canadian Psychiatric Association (CPA) Statement on Canadian Border Entry
The Executive Committee of the APA Board of Trustees approved during its August 2015 conference call the following joint APA-CPA statement on Canadian Border Entry:
“The American Psychiatric Association and Canadian Psychiatric Association agree that the indiscriminate sharing of information regarding police assistance for suspected mental health issues with the Canadian Police Information Centre (CPIC) threatens the right to privacy of patients. Further, the subsequent distribution of these records to American border authorities without scrutiny or guidelines can lead to discrimination on the basis of mental illness. It is imperative that criteria be developed to guide the Canadian agencies in the use of CPIC data, and to advise Canadian police services in the management of sensitive medical information so that health record confidentiality remains protected.”
New APA Commentary on Ethics in Practice
The APA Board of Trustees approved at its December 2015 meeting the document titled “APA Commentary on Ethics in Practice,” which is designed to provide a framework for psychiatrists in which to think about ethical issues in current practice. The document can be found on the American Psychiatric Association’s website at http://www.psychiatry.org/psychiatrists/practice/ethics.
Position Statements
Position statements can be found on the American Psychiatric Association’s website: www.psychiatry.org (under “Policy Finder”). The APA Board of Trustees addressed several position statements throughout the year. Eight new position statements were approved, eight position statements were revised, 10 position statements were reaffirmed, and four position statements were retired.
New Position Statements.
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The APA Board of Trustees approved the proposed Position Statement: Role of Psychiatrists in Reducing Physical Health Disparities in Patients with Mental Illness at its July 2015 meeting.
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The APA Board of Trustees approved the proposed Position Statement: Inquiries about Diagnosis and Treatment of Mental Disorders in Connection with Professional Credentialing and Licensing at its July 2015 meeting.
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The APA Board of Trustees approved the proposed Position Statement: Neuroscience Training in Psychiatric Residency Training at its July 2015 meeting.
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The APA Board of Trustees approved the proposed Position Statement: Need to Train Psychiatrists in Provision of Care and Support to Individuals with Disorders of Sex Development and their Families at its July 2015 meeting.
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The APA Board of Trustees approved the proposed Joint Position Statement: Opioid Overdose Education and Naloxone Distribution at its December 2015 meeting. APA and American Academy of Addiction Psychiatry proposed this joint position statement.
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The APA Board of Trustees approved the proposed Position Statement: Substance Abuse Disorders in Older Adults at its December 2015 meeting.
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The APA Board of Trustees approved the proposed Position Statement on Tobacco Use Disorder at its December 2015 meeting.
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The APA Board of Trustees approved the proposed Position Statement on Involuntary Outpatient Commitment and Related Programs of Assisted Outpatient Treatment at its December 2015 meeting.
Revised Position Statements.
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The APA Board of Trustees approved the Revised Position Statement: Medical Necessity Definition (Endorsed AMA Policy) at its July 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement: Confidentiality of Electronic Health Information at its July 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement: Psychiatric Implications of HIV/HCV Co-Infection at its July 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement: Publication of Findings from Clinical Trials at its July 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement: Use of Animals in Research at its July 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement: Bias-Related Incidents at its December 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement: Hypnosis at its December 2015 meeting.
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The APA Board of Trustees approved the Revised Position Statement on Telemedicine in Psychiatry at its December 2015 meeting.
Reaffirmed Position Statements.
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The APA Board of Trustees reaffirmed and retained the 2008 Position Statement: Consistent Treatment of All Applicants for State Medical Licensure at its July 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2005 Position Statement: Use of the Concept of Recovery at its July 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2009 Position Statement: Medication Substitutions at its July 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2007 Position Statement: Electroconvulsive Therapy (ECT) at its July 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 1979 position statement Active Treatment at its October 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2012 Position Statement: Recognition and Management of Substance Use Disorders and other Mental Illnesses Comorbid with HIV at its October 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2008 Position Statement: Ensuring Access to, and Appropriate Utilization of, Psychiatric Services for the Elderly at its October 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2010 Position Statement on Posttraumatic Stress Disorder and Traumatic Brain Injury at its December 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2010 Position Statement on High Volume Psychiatric Practice and Quality of Patient Care at its December 2015 meeting.
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The APA Board of Trustees reaffirmed and retained the 2014 Position Statement: Psychotherapy as an Essential Skill of Psychiatrists at its December 2015 meeting.
Retired Position Statements.
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The APA Board of Trustees approved the retirement of the 2007 Position Statement: Psychiatric Disability Evaluations by Psychiatrists at its July 2015 meeting.
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The APA Board of Trustees approved the retirement of the 2009 Position Statement: Employment-Related Psychiatric Examinations at its July 2015 meeting.
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The APA Board of Trustees approved the retirement of the 2007 Position Statement: The Right to Privacy at its December 2015 meeting.
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The APA Board of Trustees approved the retirement of the 2009 Position Statement: Interference with Scientific Research and Medical Care at its December 2015 meeting.
Report of the Treasurer
Frank Brown, M.D.
The consolidated statements include the financial activities of APA, APAF, APA PAC, and the dormant APA Insurance Trust. The annual financial statement audit is nearly complete; however, until the final report is issued and approved by the audit committee in June, the numbers presented herein should be considered preliminary and subject to change.
Preliminary, Unaudited Financial Information
Consolidated Net Income: Year-end statements show consolidated net income of $719K, which is lower than the $6.6M in net income during 2014, but is significantly better than the $7.2M net loss budgeted. The variance from 2014 to 2015 is attributable to a reduction in investment income from $7.9M to $901K due to changes in the stock markets.
American Psychiatric Association: Preliminary year-end statements show an unrestricted operating net surplus of $1.9M, compared with the budgeted net loss the Board approved reserve utilization plan of $3.2M. The positive variance was largely due to better-than-expected results from the DSM and budget savings from vacant positions.
Revenue Generating Activities produced $2.6M more in net revenue than was anticipated in the budget.
Membership dues and programs: End-of-year net revenue was $9.6M, which is $394K greater than the $9.2M budgeted. The better-than-budgeted results are due to higher than expected dues revenue, higher job classified ads, and slightly lower than anticipated membership expenses.
DSM net revenue: Net revenue was $9.3M, which was $2.2M greater than budgeted. DSM sales were $570K lower than budgeted; however, expenses were $2.7M lower than budgeted, mainly due to longer amortization of development costs than was anticipated in the budget. The $21M in development costs are now being amortized over 12 years instead of the 8 years included in the budget.
Miscellaneous net revenue was $340K and was not budgeted. The majority of this line item was made up of tax refunds from 2010, 2011, and 2012. APA pays unrelated business taxes on net advertising revenue.
Programs and Services Expenses were $9.5M, which was below budget by $1.9M, but $1.3M higher than 2014. The lower expenses were the result of vacant positions included in the budget.
Governance and Operations Expenses were $885K lower than budgeted based on vacant positions included in the budget in addition to lower than expected travel and meeting expenses.
American Psychiatric Association Foundation
Revenue Generating Activities: Unrestricted contributions totaled $400K, which was $118K lower than budgeted and $223K lower than 2014. Fundraising from the Corporate Advisory Council members and the Fundraiser at the APA Annual Meeting was lower than anticipated.
Programs and Services Expenses were $1.4M, which was $513K below budget, primarily in the Policy, Programs and Partnerships line item. The lower expenses were the result of vacant positions in the areas of Research and Diversity and Health Equity.
Statement of Financial Position
APA: APA is in a strong financial position, with cash of $14.1M, investments of $73.2M, and net assets of $81.1M. Cash and investments are both higher than the 2014 balances, as APA had positive net income, received an advance from the insurance company for the liability insurance program, and reduced the outstanding advance to APAF.
APAF: APAF is in a healthy financial position, with cash of $8.9 million, investments of $51 million, and net assets of $59 million. Cash and investments are both down from 2014, as the assets were used to fund the foundation’s net loss noted above.
Included in the $5.5M of temporarily restricted net assets is $1.2M in funds for the Stepping Up summit, which took place last month. Summit expenses are expected to be around $950K.
Report of the CEO and Medical Director
Saul Levin, M.D., M.P.A.
I am pleased to present the CEO and Medical Director’s report for the APA President’s year May 2015–May 2016, which outlines the Administration’s actions, activities, and accomplishments in the past year.
The APA Administration continues its progress toward full implementation of the Board’s strategic initiative objectives within the organization’s core areas:
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Advancing the integration of psychiatry in the evolving health care delivery system through advocacy and education.
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Supporting research to advance treatment and the best possible clinical care, as well as to inform credible quality standards; advocating for increased research funding.
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Educating members, patients, families, the public, and other practitioners about mental disorders and evidence-based treatment options.
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Supporting and increasing diversity within the APA; serving the needs of evolving, diverse, underrepresented and underserved patient populations; and working to end disparities in mental health care.
Reorganization of Healthcare Systems and Financing (HSF) and Quality Improvement and Psychiatric Services (QIPS) Divisions
Psychiatry is evolving in the new healthcare delivery systems, and our strategic initiatives, along with the recommendations from the Board’s Healthcare Reform Workgroup report, highlighted the need for APA to advance our initiatives in new delivery models, reimbursement, as well as ensuring parity and equity in the delivery of mental health services. As a result, in order to meet these objectives, in December of last year, we internally reorganized both Healthcare Systems and Financing (HSF) and Quality Improvement and Psychiatric Services (QIPS), by creating three coordinated areas: 1) Reimbursement Policy, 2) Practice Management and Systems Delivery Policy, and 3) Mental Health Parity Enforcement and Implementation Policy.
Ad Hoc Work Group on Healthcare Reform
Anita Everett, M.D., Chair of the third Healthcare Reform Board of Trustees Work Group, reported on the progress of the recommendations passed by the Board in March 2015. The report focuses on APA activities in the following areas: quality, integrated care, financing/reimbursement, research, workforce/education, and health information technology. Dr. Everett reported that all of the activities in the report are either ongoing or completed and now rest with a Council or Committee. The Board of Trustees agreed to sunset the work group and receive additional reports from the pertinent components at future JRC meetings.
Ad Hoc Work Group on Telepsychiatry
Jay Shore, M.D., Chair of the Board of Trustees Ad Hoc Work Group on Telepsychiatry, reported on their activities over the year and future recommendations for APA. The work group developed a toolkit for members with a series of videos on various aspects of telepsychiatry, including clinical, training, and policy considerations. They also planned and presented at both the Annual Meeting and IPS meetings. Other recommendations to the Board included: 1) the APA should take a leadership role in advocating for and educating about telepsychiatry at the national and state level to improve access to care (e.g., develop model state legislation, endorse the Interstate Medical Licensure Compact, support an extension of the federal telemedicine license process); 2) the APA should collaborate with the American Telemedicine Association (ATA) on a joint telepsychiatry guideline; and 3) the APA should collaborate with the American Academy of Pediatrics (AAP) and the American Association of Directors of Psychiatric Residency Training Programs (AADPRT) on providing telepsychiatry education materials for residency training programs. The Board approved establishing a telepsychiatry committee under the Council on Healthcare Systems and Financing to continue the work group’s effort.
American Psychiatric Association Headquarters
The APA’s lease for its office space at 1000 Wilson Boulevard, Arlington, Va., expires December 31, 2017. This past July, the Board of Trustees voted to authorize the CEO/Medical Director to execute the lease for 800 Maine Avenue, SW, Washington, D.C. The agreement also includes an option, exercisable by the Board of Trustees, to purchase the leased space in 2020 and in so doing approve the terms of the purchase option, including the purchase and sale agreement that will govern the purchase of the property in 2020 if APA elects to exercise the purchase option in 2019/2020. The APA will move from Arlington to D.C. at the end of 2017.
Cultural Competence
APA’s Cultural Competence webpage, “Best Practice Highlights for Treating 6 Diverse Patient Populations,” is now available. The site features short video clips of prominent APA and M/UR caucus members, including Rahn Bailey, M.D., Maureen Van Niel, M.D., Robert Cabaj, M.D., Mary Roessel, M.D., Albert Gaw, M.D., and Lisa Fortuna, M.D. The site also provides information on the demographics of various populations, historical information, and background on disparities and stigma to help viewers contextualize assessment and treatment.
DSM-5 Steering Committee
In March 2014, the Board of Trustees approved a report from a Board Work Group on updating of individual diagnostic categories as new data become available to support such changes. The report led to the establishment of a DSM Steering Committee that made recommendations to the Board in July 2015 on: 1) establishing criteria and format for submission of proposals to make changes, additions, or deletions to diagnostic criteria or categories for future revisions of DSM; 2) the creation of six DSM review committees that will review scientific proposals from the field; and 3) the creation of an “editorial committee” that can make changes to the DSM-5 criteria with the understanding that such changes will be reflected in an ”updates” section of the DSM website and incorporated into print versions of the DSM-5 when feasible. The Board of Trustees approved all of the committee’s recommendations.
International Update
The release of the APA Learning Center presented an opportunity for APA to better understand the psychiatric training and maintenance of certification processes outside of the United States. This understanding has proven to be useful when determining the supplementary and complementary benefits of the Learning Center to psychiatrists outside the United States and to APA international members.
A May 2015 meeting between APA leadership and the psychiatric organizations of Canada, the United Kingdom, Australia, New Zealand, and South Africa established the foundation for this exchange of knowledge and presented information about the psychiatric core competencies utilized in the respective countries. Including the CanMEDS framework utilized by Canada, the United Kingdom, Australia, and New Zealand and the European Framework for Competencies in Psychiatry (EFCP) in development by the European Board of Psychiatry, part of the European Union of Medical Specialists (UEMS). Further, the leadership of the World Psychiatric Organization provided insight on the psychiatric training and education needs facing other national psychiatric organizations.
Member Webinar on Quality Reporting
APA hosted a webinar for members providing a comprehensive overview of the Physician Quality Reporting System (PQRS) to avoid the 2018 penalty in the 2016 reporting year. The webinar was led by Dan Green, M.D., Medical Officer, CMS Division of Ambulatory Care, Center for Clinical Standards and Quality, who discussed how to report, choose measures, and avoid the 2% financial penalty on allowable Medicare Part B charges. Dr. Green reviewed the reporting criteria for 2016, as well as how to report without an electronic health record (EHR) or qualified registry and identify appropriate measures. The webinar is the first of a series we have planned to educate our members on how to report to avoid future penalties, as well as the move from PQRS to the Merit-Based Incentive Payment System (MIPS).
Partnership With Chiefs of Police
Over the last several months, APA has met with the International Association of Chiefs of Police (IACP) to explore possible opportunities for collaboration. Our new partnership led to a plan to update IACP’s 2010 white paper on police responses to persons with mental illness. IACP held a blue ribbon committee meeting in March to review, critique, and update the content of this 2010 report to reflect current policies and best practices. We will also be working with IACP to develop a companion document that will provide law enforcement agencies with specific step-by-step guidance to officers on how to interact with individuals with mental illness.
Registry
Changes to healthcare delivery as a result of the Affordable Care Act will require improvement in quality of care, while at the same time reducing costs. With an increasing national focus on quality and cost, the opportunity to leverage clinical registries to improve outcomes and appropriate utilization has never been greater. APA believes that the establishment of a registry will assist members in meeting these new requirements and is an investment for the future of the profession of psychiatry.
In March 2016, the Board of Trustees voted to proceed with development of a mental health registry and authorized funding for 2 years with reports back to the Board at each meeting. The registry will have a Registry Oversight Committee with representatives from various components, including the Assembly and others approved by the Board of Trustees. Registry development will begin immediately with implementation early in 2017.
Support Alignment Networks (SAN) Grant
In late September, APA received one of the SAN grants from the Centers for Medicare and Medicaid Services’ (CMS) Transforming Clinical Practice Initiative. APA’s overall goal for the grant is to train 3,500 consulting psychiatrists in collaborative care. We have partnered with the AIMS Center at the University of Washington to conduct the trainings, which will take place in person and online. The South Dakota District Branch recently conducted training with 38 psychiatrists, residents, and medical students in attendance. We are offering three training sessions at the Annual Meeting with a total of 360 attendees. We launched our online modules in mid-January, and over 100 psychiatrists have signed up to participate in this opportunity. We have reached out to the majority of the DB/SA executive directors regarding the recruitment of participants, and many are becoming engaged with their local practice transformation networks in addition to seeking opportunities to incorporate these trainings into their respective meetings. We anticipate exceeding our 1-year goal of training 500 psychiatrists by reaching approximately 600 in the first year.
Veterans’ Commission on Care and Military Efforts
In January, APA was invited to speak on mental healthcare and treatment before the Veterans’ Commission on Care. The commission held informational hearings to examine veterans’ access to health services and how to meet their needs more effectively. Jenny Boyer, M.D., J.D., Ph.D., spoke to the commission about the need for collaborative and team-based care, telepsychiatry, and ensuring that clinicians are providing the highest level of care. The commission also heard similar testimony from the American Psychological Association and the National Association of Social Workers (NASW).
In addition, APA met with the Commandant of the Marine Corps four-star General Robert Neller to discuss collaborative efforts on mental health, including suicide prevention.
Working to Support the Food and Drug Administration (FDA) Reclassification of ECT
The FDA has proposed to reclassify ECT from a class III (high risk) medical device to class II (low risk) for use in treating severe major depressive episode (MDE) associated with major depressive disorder or bipolar disorder in patients who are treatment-resistant or who require a rapid response due to the severity of their psychiatric or medical condition. This is a change that is largely supported by APA, though there are some concerns for the FDA to address to ensure there are not unintended consequences of adopting this proposal. Specifically, we recommended a class II designation also be given for catatonia, manic episodes (in bipolar disorder), schizophrenia, and schizoaffective disorder and that the patient population in each of these illnesses be limited to individuals with treatment-resistant psychiatric disorders and/or patients with life-threatening conditions related to their underlying psychiatric condition. We also recommended that the class II designation include ECT treatment for children and adolescents meeting the criteria for treatment resistance and in need of a potentially life-saving intervention for the conditions previously indicated and for MDE associated with major depressive disorder or bipolar disorder.
American Psychiatric Excellence (APEX) Awards
On April 18, 2016, the APA and APAF hosted an orange-tie event featuring the television series Orange Is the New Black (OITNB). The APEX Awards program celebrated those who have demonstrated the highest levels of mental health advocacy and who are working to reduce the number of Americans with mental illness in our prisons and jails. Natasha Lyonne, Matt McGorry, and Dascha Polanco from OITNB joined us for a conversation about how the show has opened a window into the experiences and treatment of people with mental illness in America’s prisons and jails. Award-winning journalist Cokie Roberts hosted the 2016 APEX Awards. APEX awardees included U.S. Senator Al Franken, Minority Leader Nancy Pelosi, and Florida State Sen. Miguel Diaz de la Portilla.
Comprehensive Mental Health Reform
The Helping Families in Mental Health Crisis Act (H.R. 2646), introduced by Representatives Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Tex.), has bipartisan support with 186 cosponsors. Presently, Representative Murphy is working to find agreement within his caucus on several of the bill’s more contested provisions, including the expansion of privacy exemptions under HIPAA for certain individuals with serious mental illness, a partial raise of the current Institutions for Mental Diseases (IMD) exclusion under Medicaid, and a way to offset the bill’s overall expected cost of at least $5 billion. Energy and Commerce Committee Chairman Fred Upton (R-Mich.) has indicated some compromises will have to be reached between Representative Murphy and his colleagues before the bill is marked up by the full Energy and Commerce Committee. APA has joined other mental health stakeholders to press Representative Murphy and his colleagues on the committee to reach resolution on these issues so the process of enacting meaningful mental health reform can advance.
With the conclusion of this report, I want to especially thank the Board, which has made many important decisions over the past year and has worked to elevate the APA and secure its future into the next few decades. I also want to thank the Assembly Executive Committee, Assembly, and all of the DBs/SAs and their leadership (elected leadership and executive directors) for their concerted effort to engage membership and make a noticeably positive impact on patients and our members.
I look forward to another year of the APA growing, strengthening, and enhancing its position in the healthcare discussion. I also look forward to our continued journey together.
Report of the Speaker
Glenn A. Martin, M.D.
I have really enjoyed this past year as your Assembly Speaker. The Assembly serves a pivotal role in the functioning of the APA. We frequently serve as the canary in the coal mine, often recognizing emerging trends in psychiatry, regulations, and technology before other structures in the APA, and have been a strong stimulus for action. We host the M/UR caucuses and other sections and caucuses, as well as our affiliated ACROSS member organizations. By our very size and diversity, consisting of a mélange of members from a multitude of backgrounds—ethnic, political, religious, and others, coming from all over the United States and Canada, and even further, working in the full range of private, public, and academic settings (and frequently all three), with accents, speaking styles, and temperaments from across the spectrum—we provide a needed eclectic and sometimes idiosyncratic voice to help guide the APA leadership and administration. We can be unruly at times, even a tad unfocused, but we are the incubator of ideas and leaders for our organization at the national and local level.
During the past year, we have addressed many important issues facing psychiatry. The Assembly voted unanimously to support a new Practice Guideline, Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia, which is in an area of care affecting our most vulnerable patients that has been a focus of regulation and legislation that has not always been guided by a dispassionate evaluation of the science. Having played a key role in the completion of the DSM-5, the Assembly remains focused on the future of that living document and launched a new Assembly Committee on DSM. Recognizing the ongoing national tragedy that is the criminalization of the mentally ill, we heard a compelling presentation and call to action at the Fall meeting from Dr. Paul Burton, Chief Psychiatrist at San Quentin State Prison.
We have established or continued key work groups on member issues, including maintenance of certification, access to care, and public and community psychiatry. We have worked to improve the functioning of the Assembly by establishing a workgroup to develop meaningful metrics. And, despite the obvious political risk, we have tackled some thorny issues of the organization of the MUR caucuses as compelled by changes to District of Columbia incorporation laws. The members involved in these groups and those who volunteer (or are elected) to serve on key committees, like AEC, Procedures, Rules, Nominating, Awards, etc., expand their Assembly member duties to include innumerable night and weekend meetings and calls. I thank each of them for their wisdom, their generosity, and their ongoing dedication. They educate us all, improve our structure, and inform our decision making,
Just in November, we supported new or revised position statements on Hypnosis; Tobacco Use Disorder; Involuntary Outpatient Commitment and Related Programs of Assisted Outpatient Treatment; Telemedicine in Psychiatry; Substance Use Disorders in Older Adults; and Bias Related Incidents, and we voted to retain the 2007 Position Statement Sexual Harassment. After a period of budget-compelled shrinkage, we returned to an even more robust Assembly representation with the move to reinstate full attendance at the meeting, moving district branch deputy representatives into full-voting district branch representatives. This was a result of a hard-fought but well-accepted reorganization that would not have been possible without the goodwill and organizational skills of our previous Speaker Dr. Jenny Boyer, our Speaker-Elect Dr. Dan Anzia, the AEC, and current and past Presidents of the APA, Drs. Binder and Summergrad.
For May 2016, our Assembly agenda includes 32 action papers, 19 position statements, and one request for ratification of a bylaws change. The action papers address PIP certification, eliminating the federal parity opt-out, standards for inpatient psychiatric care, DSM, ethics, and other core issues of the association.
The Assembly continues to work to improve its functioning. Our meetings this year made concrete changes to the placement and labeling of microphones, seating arrangements within the room, timing changes to the agenda, and more robust staffing and reporting from the reference committees. Our November meeting, held in a new venue over Halloween during the World Series, overcame all those distractions to be by all accounts a fun, productive, and memorable affair. I have no doubt that Dr. Anzia will continue our ongoing efforts at self-improvement while maintaining a needed and appropriate focus on finances.
We of the Assembly truly represent our members as they strive to practice the best medicine possible in settings and systems that do not always support that goal, while working with patients that society does not always treat with the dignity, respect, and compassion they deserve. The Assembly serves the professional needs of our member psychiatrists and to a significant extent the needs of our patients and our society. When we do our job, hear and address our member concerns, propose solutions, or at times simply sound the alarm and call for action within the APA governance system, we can feel proud. That is how I feel as I prepare to end my tenure as Speaker.
And so I will take this final opportunity to formally thank Drs. Anzia and Miskimen, the entire Assembly Executive Committee, our past, current, and future APA Presidents, Drs. Summergrad, Binder, and Oquendo, the APA Administration, and our CEO Dr. Saul Levin, and of course Margaret Dewar, Allison Moraske, and the entire Governance team, for the encouragement, support, hard work, and devotion.
Report of the Speaker-Elect
Daniel J. Anzia, M.D.
It has been my privilege to serve the Assembly and the American Psychiatric Association for this past year as Speaker-Elect and to work with the Speaker, Dr. Glenn Martin, the Recorder, Dr. Theresa Miskimen, and Past Speakers Dr. Jenny Boyer and Dr. Mindy Young.
Beginning with the Assembly meeting at the end of October 2015, the Assembly reorganization approved in May 2015 took full effect. The reconstituted Assembly now includes at least two representatives from every district branch, with more from the larger district branches and state associations. All representatives and deputy representatives of the minority/underrepresented groups, the early-career psychiatrists, and the resident and fellow members, as well as the representatives of the subspecialties and sections, are now full participants in both the November and May Assembly meetings. In this way, and by encouraging district branches and state associations allotted new representatives to seek diverse representation, the Assembly has sought to further the APA’s strategic goal of “supporting and increasing diversity within APA.”
The Assembly Executive Committee carefully and thoughtfully attended to the financial aspects of this Assembly reorganization, aiming to balance the competing pressures of the effective functioning of the Assembly as the most diverse and representative voice of the APA membership within governance with the broader interests of members, such as the cost of APA operations and the value of work products. The Assembly has yet to complete our work to provide predictable and consistent support to the area councils for their functions, including full incorporation of minority and underrepresented groups and subspecialties and sections, as well as the resident and fellow members and early-career psychiatrists, in the meetings and functions of the area councils between Assembly meetings.
How the Assembly participates in the budget process of the APA, and especially in its own part of the budget process, has varied from year to year. Of course, the Assembly has members on the APA Budget and Finance Committee, as well as on the APA Board of Trustees, which has full fiduciary responsibility for the Association’s finances. But budget processes for the Assembly could be clearer and more standardized. Several years ago, the Assembly instituted an Assembly Committee on APA Budget Planning, which was intended to participate at an early stage of planning of each annual APA budget. Mostly for practical timing reasons, this function was soon left to the Assembly Executive Committee. At a minimum, the Assembly leadership and Executive Committee should have annual institutionalized processes for Assembly budget development, including review of prior-year expenses, which will enable the Assembly to take appropriate accountability for its costs and value. I have been working with the APA Administration, especially the Chief Financial Officer and Association Governance, to lay the foundation for a more predictable and transparent process for the future, and hope to complete this work within my year as Speaker.
As Speaker-Elect, I have been the Vice Chair of the Joint Reference Committee (JRC), chaired by our President-Elect Dr. Maria Oquendo. I believe that the JRC has continued to improve its oversight and coordination of the work of the APA Councils and Committees on behalf of the Board of Trustees and the Assembly. The Position Statements of the APA, most often drafted by the Councils, are shared accountabilities of the Assembly and the Board of Trustees. All finalized Position Statements are available on the APA website.
In November 2015, the Assembly approved the following Position Statements (among others), all of which were subsequently approved by the Board of Trustees:
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Opioid Overdose Education and Naloxone Distribution
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Substance Abuse Disorders in Older Adults
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Tobacco Use Disorder
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Involuntary Outpatient Commitment and Related Programs of Assisted Outpatient Treatment
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Hypnosis (Revision)
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Telemedicine in Psychiatry (Revision)
During the May 2016 Assembly meeting the Assembly will have considered the following Position Statements (again among others):
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Emergency Department Boarding of Patients with Acute Mental Illness
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Patient Access to Electronic Mental Health Records
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Trial and Sentencing of Juveniles in the Criminal Justice System
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Equitable Access to Quality Medical Care for Substance Related Disorders
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Integrated Care
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Off-Label Treatments
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Call to Action: Accountability for Persons with Serious Mental Illness (Revision)
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College and University Mental Health (Revision)
The Assembly will also again be considering revision of the APA Position on Direct to Consumer Advertising.
As the Assembly develops metrics to track its outcomes and value, it is likely that one of them will involve the Assembly’s many contributions to the APA’s Position Statements. We also aim in other ways to further the APA’s strategic goals. As a trial initiative during my upcoming year as Speaker, for each of the Assembly’s two meetings I will issue a call for action papers aimed at one of the APA strategic goals.
I thank the Assembly for the opportunity to have served as Speaker-Elect, and I thank the APA Officers, the Board of Trustees, and the Administration for all their support. I look forward with enthusiasm to this coming year as Speaker.
Report of the Committee on Bylaws
Rebecca W. Brendel, M.D., J.D.
Members: Edyth P. Harvey, M.D., Roger Peele, M.D., Christopher Pelic, M.D., Rudra Prakash, M.D., J.D., and Sidney H. Weissman, M.D.; Administration: Margaret C. Dewar, Chiharu Tobita.
At the July 2015 meeting, the Board of Trustees voted to approve the recommendation of the Membership Committee to establish a new category of membership for international psychiatry residents as follows:
“International Resident-Fellow Member: Physicians enrolled in a psychiatry residency training program or fellowship in a psychiatry subspecialty outside of the U.S. and Canada, verified with a letter from the training program.”
The Committee on Bylaws drafted the following proposed APA Bylaws language in August 2015, and the Board of Trustees voted to approve the language at its meeting in October 2015:
“International Resident-Fellow Members. International Resident-Fellow Members shall be physicians enrolled in a psychiatry residency training program or fellowship in a psychiatry subspecialty outside of the U.S. and Canada who obtain written verification from the training program director. International Resident-Fellow Member status shall not exceed ten years or the duration of residency and fellowship training in psychiatry, whichever is shorter.”
The updated APA Bylaws can be accessed on the APA website in the Association Governance section.
The Committee on Bylaws discussed and addressed the concerns noted by the Board of Trustees and the Membership Committee that some countries do not have an accrediting organization for residency training programs similar to the ACGME. As a result, the length of residency and fellowship training in psychiatry varies by country. At least two medical societies allow international residents to be in the category for up to 10 years. In accordance with the Board of Trustees and the Membership Committee, the Bylaws language states that an international resident is permitted to remain in the category for up to 10 years or the duration of residency and fellowship training in psychiatry, whichever is shorter.
During the May 2016 meeting, the Assembly voted to ratify the language of the International Resident-Fellow Member Category to be incorporated into the APA Bylaws.
Report of the Membership Committee
Rahn Kennedy Bailey, M.D., DFAPA
Membership Summary
In 2015, APA dropped 3,099 members who had not paid dues by the drop date of June 30, 2015. In the 6 months from July 2015 through December 2015, the APA initiated multiple mail and e-mail campaigns, in tandem with the DBs/SAs, to promote new member value related to the new website, LMS, content, brand, and advocacy/communication initiatives. Table 1 highlights performance since the drops occurred.
| Member Type | July 2015 | December 2015 | % Change |
|---|---|---|---|
| Total members | 35,363 | 36,490 | 3.2% |
| Dues-paying categories | 26,310 | 27,821 | 5.7% |
| Resident-fellow members (RFMs) | 3,456 | 4,525 | 30.9% |
| Early-career psychiatrists (ECPs) | 4,589 | 4,719 | 2.8% |
| Internationals | 1,799 | 1,856 | 3.2% |
| Medical students | 2,625 | 2,302 | –14.0% |
The decline in medical students and increase in residents is primarily due to the transition points. A better measure to smooth out the transitions points is the total medical student, RFM, and ECP categories, which increased by 3.6% during the 6-month period.
Overall membership is at one of the highest points in 13 years, as illustrated in Figure 1. Performance from 2001–2010 may be affected by general members and medical students being carried 12 to 18 months before being dropped for nonpayment.
There has been a 7.8% increase in total membership from 2013–2015 (2,628 new members) and a 4.7% (1,244) increase in dues-paying members.
The administrative reinstatement period is the time in which the dropped member pays dues owed in full and is automatically returned to the membership rolls. Nearly 20% (N=606) of members who were dropped in 2015 subsequently paid dues and were reinstated by the end of the year. The net final drop count (after administrative reinstatements) was 2,493, which is 25% more than the previous year.
Retention efforts for 2016 started in the fall of 2015 encouraging members to renew by December 31, 2015, which is technically the deadline for renewal. This is the first dues renewal cycle where the grace period for dues payment has been shortened from June 30 to March 31. Members must either pay dues in full or enroll in the Scheduled Payment Plan by March 31, 2016, to avoid being dropped. Members who pay dues with employer funds from a budget year that begins July 1st or later must notify the Membership office to avoid a lapse in membership.
In early February 2016, APA’s calling program vendor began calling members on the pending drop list. At the same time, the annual DB/SA member retention campaign kits were sent to all district branches with a request to engage local leadership in an effort to reach out to members-at-risk of being dropped. Multiple print invoice mailings, e-mail blasts, and post card reminders have been sent since September 2015 to encourage members to renew for the 2016 dues year. On April 11, 2016, 3,210 members were dropped for nonpayment of 2016 dues. This included 2,726 U.S./Canadian members owing both APA and DB/SA dues, 98 members owing dues only to the four DBs that collect locally, and 386 internationals.
Membership ended 2015 with some successful recruitment and retention programs. Highlights from some of the programs include:
100% Club.
•
Eighty-seven residency training programs, including five new programs, qualified for 100% Club stats (a 23% increase from 2014). These programs represent 1,920 residents (a 9% increase from 2014).
ECP Focus Offer.
•
Quarterly e-mail promotions to ECP members yielded a year-end total of 757 ECP members that took advantage of the complimentary online Focus subscription.
Find a Psychiatrist.
•
Quarterly e-mail promotions to general members in the United States and Canada yielded a year-end total of 985 members that have opted in to the Find a Psychiatrist database.
FAPA and IFAPA.
•
Quarterly e-mail promotions to eligible general and international members yield a year-end total of 761 FAPA applications received/approved and 211 IFAPA applications received/approved.
AMSA Medical Students.
•
Quarterly direct mail and e-mail promotions to AMSA medical student members graduating in 2016–2017 yielded a total of 1,527 new medical student members in 2015.
Rebate Program.
•
Total membership applications collected at the meeting=172.
-
General member applications received=77 (10 more than 2014); 59 processed.
-
RFM applications received/accepted=19 (first year of program); 15 processed.
-
International applications received=76 (60 APP gift certificates were redeemed=$7,554.95); (first year of program); 64 were processed, and 13 were not because they did not supply the required documentation. One international member was considered a reinstatement around Annual Meeting time, and his application was included (count=77).
International Members Ambassador Program (IMAP).
•
A 118% increase in IMAP successful referrals, year over year 2015 to date: 24 new members from 12 countries were brought in by 11 ambassadors.
In 2016, our membership recruitment and retention goals are to refine not only our promotions campaigns but also target the messages to specific audiences’ needs. This requires more in-depth analysis of membership data and campaigns results, as well as collaborating with the Marketing Department to create responsive and attractive HTML e-mail campaigns to produce increased results.
In the first quarter, we have planned new and exciting recruitment and retention campaigns.
•
In response to the organization’s new communication strategies and challenges, Membership created new Member Advantage quarterly e-mail promotions to segmented membership categories to promote timely member benefits that are specifically targeted to their eligibility for certain programs.
•
The 100% Club will be revamped this year with a new name, benefits, and deadline to provide a fresh approach, more member value, and educational driven benefits. While exhibiting at the AADPRT meeting in March, Membership will be surveying residents, training directors, and program coordinators on their needs. We hope to launch the details of the new program in the spring.
•
New membership collateral has been created and available for use in print and electronic formats. Materials include:
-
Membership Guide and Application: general member, resident-fellow, international, and medical students. International resident-fellow member is currently in development and will be made available during the Annual Meeting.
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Membership Benefits Flyers: general member, early-career psychiatrists, resident-fellow, international, and medical students.
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Member outreach tools, including PowerPoint presentations and Talking Points.
-
FAPA and IFAPA Flyers.
-
Engagement calendar for resident-fellow members.
-
Dues-saving ads, flyers, and buck slip.
-
2016 lump sum dues flyers: U.S., Canada, and international.
•
Recruitment and recovery e-mail campaigns are in development with Marketing. HTML designed e-mails are targeted to nonmember and lapsed members in various membership categories in our database.
•
An e-mail recruitment campaign to AMSA members graduating in 2017–2019 is scheduled for the first week of March. We are also exhibiting at the AMSA Annual Meeting in Crystal City, Va., at the end of March. We are collaborating with the Division of Diversity and Health Equity to promote Medical Student Awards, as well as membership promotions at various shows they will be attending this year.
In 2015, the Committee agreed to use $150K of the $180K approved for the grant process to award 56 expedited grants to DBs/SAs in the amount of $2,678.57 each for a total award distribution of $149,999.92. There were 16 submissions for innovative grants, and ultimately six were awarded in amounts ranging from $2,500 to $7,460.
The Membership Committee recommended a new student loan marketplace program (Credible) as a new benefit that could be useful to members with heavy student loan debt because of the ability to save money by refinancing.
A new membership category for international residents was approved in 2015 and will be launched in 2016.
The Committee recommended changes to the Guidelines for Distinguished Fellowship to clarify the intent of what the Membership Committee expects the nominees to document in their application. The Board of Trustees approved the revised guidelines in December 2015.
In 2015, 759 applications for fellowship and 211 applications for international fellowship were approved. Additionally, 127 distinguished fellowship and three international distinguished fellowship nominations were approved.
Report of the Committee of Tellers
Catherine Stuart May, M.D.
Members: Alexis A. Seegan, M.D., Jose P. Vito, M.D.; Administration: Margaret C. Dewar, Chiharu Tobita.
At the March Board meeting, the Board of Trustees approved the final results of the 2016 APA National Election as reported by the Committee of Tellers below (also see Table 1).
| President-Elect | Anita S. Everett, M.D. | 3,366 (63.7%) | ||
|---|---|---|---|---|
| Frank W. Brown, M.D. | 1,916 (36.3%) | |||
| Treasurer | Bruce J. Schwartz, M.D. | 2,748 (53.2%) | ||
| Linda L.M. Worley, M.D. | 2,419 (46.8%) | |||
| Trustee-At-Large** | Richard F. Summers, M.D. | 1,842 (35.0%) | 2,201 (42.4%) | 2,758 (54.0%) |
| Rebecca W. Brendel, M.D., J.D. | 1,205 (22.9%) | 1,559 (30.0%) | 2,350 (46.0%) | |
| Jenny L. Boyer, M.D., Ph.D., J.D. | 1,127 (21.4%) | 1,436 (27.6%) | ||
| Geetha Jayaram, M.D., M.B.A. | 1,084 (20.6%) | |||
| Resident-Fellow Member Trustee-Elect (RFMTE)* | Uchenna B. Okoye, M.D., M.P.H. | 265 (54.6%) | ||
| Jacques H. Ambrose, M.D. | 111 (22.9%) | |||
| Matt R. Salmon, D.O. | 109 (22.5%) | |||
| Area 3 Trustee | Roger Peele, M.D. | 499 (56.3%) | ||
| Steve Daviss, M.D. | 388 (43.7%) | |||
| Area 6 Trustee | Melinda L. Young, M.D. | 407 (69.5%) | ||
| Robert P. Cabaj, M.D. | 179 (30.5%) |
*
A majority vote (>50%) is necessary in a three-way contest. If a majority does not exist after tallying all first-choice votes, voters’ second-choice votes for the candidate with the least amount of first-choice votes are tallied and added to the remaining candidates’ tallies.
**
A majority vote (>50%) is necessary in a four-way contest. If a majority does not exist after tallying all first-choice votes, voters’ second-choice votes for the candidate with the least amount of first-choice votes are tallied and added to the remaining candidates’ tallies. If there is still no majority winner, an additional round is necessary. Voters’ third-choice votes for the candidate with the least amount of first- and second-choice votes are tallied and added to the remaining candidate’s tallies.
Eligible voting members in the 2016 election received either an electronic or paper ballot. Voting members with an e-mail address listed in the membership database received an electronic ballot on January 4th, while voting members without an e-mail address listed in the membership database received a paper ballot. As in the past three elections, voting members were able to utilize an alternative voting method by accessing their ballot through the APA homepage or the APA election website after entering their membership username and password.
The election management firm, the Survey & Ballot Systems (SBS), managed the distribution and tallying of ballots while providing technical support to voting members. According to a survey provided at the end of the electronic ballot asking voters to rate their “level of satisfaction with the web voting process,” over 95% rated their experience as “satisfied” or “very satisfied.”
Voter turnout decreased slightly, from 21% in 2015 to 18% in the 2016 election. A total of 5,483 of 30,546 of eligible voters participated.
Report of the Elections Committee
Barry K. Herman, M.D., M.M.M.
Members: Tanya Nayyirah Alim, M.D., Josepha A. Cheong, M.D., Justin W. Schoen, M.D., Robert E. Kelly Jr., M.D. (Consultant); Administration: Margaret C. Dewar, Chiharu Tobita
Campaigning in the 2016 APA election began with the announcement of candidates on October 28, 2015, and ended with the voting deadline on February 1, 2016. The voting period started on January 4th at 5:00 a.m. Eastern Standard Time and ended on February 1st at 11:59 p.m. Eastern Standard Time.
The Committee met with the candidates via conference calls to review the Election Guidelines in the beginning of the campaign period starting with the announcement of the final slate by November 1st. The Elections Committee was available for questions or concerns from candidates, their supporters, and the APA membership and provided clarification to the APA Election Guidelines when it was needed.
This year, the Elections Committee agreed to pilot a new campaign opportunity for the 2016 APA election cycle. A total of eight candidates running for the three nationally elected positions (President-Elect, Treasurer, and Trustee-at-Large positions) were invited to Arlington, Va., to videotape their candidate interviews on December 12, 2015. The videos were made available on the electronic ballots or voting page and the election page of the APA website (http://www.psych.org/elections).
The Elections Committee oversaw the project to make sure the process was fair and in keeping with APA Election principles and guidelines.
At the March 2016 Board of Trustees meeting, the Elections Committee endorsed having this project continue and implemented in the next APA election. The candidate video scan increased member familiarity and understanding of both the candidates and their association.
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