“What Do Psychiatrists Want?”

“You doctors don’t know what you want. Figure it out and come back next year.” So was the experience paraphrased to the APA Board of Trustees last month by Donald Palmisano, M.D., a trustee of the American Medical Association. He was referring to the ways in which political bodies in the U.S. respond when groups of organized physicians come asking with subtly different requests.

Differences in opinion among doctors are to be expected. The needs of the vascular surgeon, such as Dr. Palmisano, differ from those of an endocrinologist. And there is no reason to think that there will not be disagreement within one profession. In psychiatry, the opinion regarding the destructive value of mental health “carveouts” has led to a division between private practitioners and those who work in public-sector clinics. Surely the diminishing health-care dollar is exacerbating such divergent viewpoints.

Organized medical groups and societies, unfortunately, have an ever smaller pie to divide. APA, the AMA, and every specialty society must devote time and resources to so many goals. Thus, infighting among organized medical societies wastes time and energy. But it is naïve to think these differences should be repressed. They do matter.

Knowing what “we” want is important. It is important now, and it will be important 10 and 20 years from now. The need to see down the road is why the involvement of residents in organized medicine is vitally important: We must advocate for our patients and our profession so that in the coming years there are better treatments and more social support for patients, and so that we can practice properly without third-party involvement. It is our work we will be doing, and we must be aware of the issues in order to achieve better mental health care in the future.

I am a card-carrying member of APA. I have and will advocate for patients and for our profession. I plead with other trainees to become involved. You don’t have to be a chief resident or in one of the APA fellowships or an appointed or elected position to be involved. You have to want this profession to remain the unique institution that it is, now and in 10 and 20 years. We have a number of issues before the nation today, and I have listed some of them below. I would not tell you what “we want,” but I want to present some of the issues so you can learn about them. I hope that what we want will be clear: the provision of the highest quality, ethical, science-based mental health care there can be.

You can e-mail me at [email protected] or write to me care of Psychiatric News at APA, 1400 K Street, N.W., Washington, D.C. 20005. ▪