Reflections at Year's End

How time flies! One of the paradoxes about getting older is that time goes by much more quickly than it used to. It is difficult for me to believe that my year as your president is almost over. I thought I would use this column to reflect on the experience, as many of you have asked what it is like to be president of APA.

Stepping into the job last May, I soon learned that any fantasies I may have had about the APA presidency were just that—fantasies. The experience was not what I had expected, but I can certainly say that it has been phenomenally educational and growth enhancing. I feel truly privileged to have been able to serve the psychiatric community in this capacity and hope to continue to make valuable contributions in the coming years.

I first became involved in APA when I was a resident—struggling with the usual issues residents face, such as trying to find a bed for a patient needing admission from our emergency room (how little has changed in this regard through the years!). I enjoyed meeting residents from across New York City through the New York County District Branch Residents' Committee, and even though we didn't have the clout to increase our bed capacity, working together helped ease some of the tension.

Following completion of my training, I continued my involvement with the district branch Executive Committee, the Area 2 Public Relations Committee, and ultimately the APA Assembly and the Board of Trustees. I also had the opportunity to chair APA's medical student and graduate medical education components, and through these experiences, I developed both an interest in and appreciation for the role of organized psychiatry in advancing the agenda on behalf of our patients and our profession.

One of the most interesting aspects of serving as APA president-elect and president has been representing the field in both the national and international arenas. Speaking with legislators, advisors to the executive branch of government, the public, and reporters and other media personnel has been so important for our effectiveness as an organization and profession. In addition, the experience has greatly improved my ability to articulate our concerns more clearly and convey the essence of our work. Reviewing the many letters and statements that APA receives as well as writing my twice-monthly columns in Psychiatric News have honed my focus on issues important to our members and to the community at large. The experience has had the added bonus of improving my writing ability and has enabled me to contemplate future writing about graduate medical education.

I have most enjoyed meeting with our younger colleagues and feeling the energy of their hopes and commitment. To those of you who know me, that's not surprising. In my "day job" as vice chair for education in psychiatry and associate dean for graduate medical education at New York University School of Medicine, I appreciate every opportunity I have to inspire the next generation of psychiatrists about the rewarding career they have chosen, the dramatic advances in our understanding of the brain and behavior that have enabled us to improve treatments, and the importance of being active advocates for those suffering from psychiatric and substance abuse disorders. Our residents and early career psychiatrists are the future leaders of our field. Their use of ever-evolving electronic communication vehicles (we have so much to learn from them!), their insistence on a true work-life balance, and their focus on deliverables and outcomes can only help psychiatry move forward in a positive direction.

On the other end of the age spectrum in psychiatry are those of us who hail from the baby-boom and World War II generations. We are the backbone of APA, and this past year, I was constantly reminded of the great wisdom and experience we generously share. We continue to forge on despite—or perhaps because of—the setbacks and disappointments we have experienced. We have seen many of our values and practices in medicine turned upside down. We worry about the future of the doctor-patient relationship and how our ethical and humanitarian values will be maintained in a professional specialty where regulation seems out of control. While we are proud of our hard-fought victory for parity, we wonder if the economic climate will preclude our patients' benefiting from it.

Along the way, I have also learned that you cannot please all of the people all of the time. I came into the APA presidency with high hopes about our ability to communicate effectively about the issues that matter to us and about our capacity to come together as an organization to advocate for outstanding science, exceptional treatments, access to care, and high-quality educational opportunities for our members. For the most part, my hopes have been realized, but I have come to see how easy it is for information to be misrepresented and how difficult it is to get our messages across accurately and effectively.

I continue to believe that the organization must function at the grass-roots level to move forward. We must use new electronic media to transmit information—but in a personal way. And while posting news and information on our Web site and publishing them in Psychiatric News and DB and Area newsletters are essential, they are no substitute for a personal connection. I believe our national leaders must work locally to mentor and develop our recent graduates.

Finally, I don't see the close of my presidency as an end, but as a beginning. You have my pledge that I will continue to work to advance the mission of APA. I look forward to our continuing collaboration on behalf of all those who suffer from psychiatric disorders.