APA 2012 President-Elect Candidate Responses

BINDER:  I believe that it is very important for my colleagues in psychosomatic medicine to have a seat at the APA table. To this effect, if elected APA President-Elect, I will consult with the leadership of the APM to help me make appointments to relevant APA components, especially the Council on Psychosomatic Medicine and Geriatric Psychiatry. The model for this is what has been already been done by the APA and the leadership of another subspecialty organization, the American Academy of Psychiatry and the Law. Forensic psychiatrists who have been active in AAPL have been appointed to many of the forensically oriented components of the APA including the Council on Psychiatry and the Law, and the Committee on Judicial Action. This has enabled the forensic psychiatry group in AAPL to have a strong voice in the issues and the stances of the APA. The APM can have a similarly strong voice in APA as the AAPL group has had. This can be accomplished through the APA component appointment process.
DAVIS:  As a member of both the APM and the APA I am naturally interested in collaborative relationship building. For the past two years I have brought key leadership within the APA to present at the APM annual meeting, most recently inviting current APA President John Oldham to participate in a workshop and facilitating his being a keynote speaker. APM has strength in innovation and APA has strength in numbers, improved integration and communication between association leadership will create a synergy beneficial to both our organizations, our members and our patients.

If elected I plan outreach to subspecialty organization leadership on a regular basis and set up a rotating schedule to have presidents of subspecialty organizations attend and report to the board of trustees and other APA governance structures. I would also look to this leadership group to suggest names for appointments to key components and task forces. Another area of planning would include collaborative efforts around scientific programming and promoting the cutting edge advances at both annual meetings.
LIEBERMAN:  In order for the APA to effectively represent the interests of psychiatrists it must work very closely with relevant agencies such as the ABPN and work virtually hand in glove with allied organizations like the APM. The interest of the APA parent organization and the allied subspecialty groups are largely congruent. I would make it a key priority to work to engage allied organizations like the APM and develop closer and more substantive interaction. Given the movement in the health care reform process to integrate behavioral and general medical health care, no subspecialty is more important than psychosomatic medicine.  To facilitate coordination between the APA and APM, I would ensure adequate representation on councils, by offering allied organizations the opportunity to nominate psychiatrists who are both APA members and members of the allied organizations, and convene a meeting of subspecialty organization leadership at the Annual Meeting. In addition, I would encourage APA leadership attendance of the annual allied organization meetings and meet with their leadership.  This would permit more focused discussion of the unique issues the each group wishes to discuss.  For an organization like the APM, which holds a mid-year Council meeting, I would hope to attend this meeting to collaborate with the APM leadership to focus the efforts of the APA and APM.

In addition, I would plan to set up a regular on line forum for members to communicate with me.  In this way APA leadership can hear the broad variety of members’ concerns and expertise.  The messages and responses will be posted for all members to review.

APA needs to foster more collaboration with all of the allied organizations to coordinate efforts.  We all have the same goal, which is to provide the best care to all those in need and to receive appropriate payment for our services.  I will work toward creating a “virtual council” of allied organizations where the leadership of those organizations can meet together and with APA using available technology.  Collaboration between subspecialty organizations may create opportunities for innovative fellowship experiences that allow combine training.  Public psychiatry and psychosomatic medicine may be areas where the changes in healthcare create such opportunities.

BINDER:  I agree that financial issues can make it difficult for our residents to pursue subspecialty training. One of the solutions is to find work opportunities for our subspecialists that will enable forgiveness of student loans. These include work with underserved populations and in underserved areas. Another solution is to promote part time fellowship opportunities that will allow psychiatrists to work as general psychiatrists while pursuing subspecialty training.
DAVIS:  Subspecialty training needs to be valued in the healthcare market in addition to the academic arena. This requires a strategy of educating healthcare decision makers, hospital administration and health care systems on the types of training programs and skills set that come with fellowship training. Members in training need to have confidence that added training will translate to a competitive position and rewarding career.  Fellowships need to incorporate leadership training, management of multidisciplinary teams and integration into models of healthcare delivery to ensure that their fellows are highly sought after in the current market.  APA has lobbied for preservation of GME funding, we will also have to explore alternative systems of funding to preserve and protect all our training programs.  Loan forgiveness programs need to be explored especially for those fellows working in underserved or shortage areas.
LIEBERMAN:  Subspecialty training remains a vital part of our preparatory process as our field diversifies and becomes more subspecialized. This is a consequence of the maturation and expanding knowledgebase of our field.  In this context, we must also consider that the number of fellowship positions offered may exceed the number of applicants in a particular subspecialty. The APA can help programs more accurately plan for the future by helping the subspecialty organizations assess the level of psychiatric residents’ interest in the various subspecialties.  APA can use the MIT listserve and other resources to facilitate cross-residency surveys.  The data from such surveys will assist individual programs to more accurately assess interest.  In areas of particular need, APA can work with the leadership of subspecialty organizations to work with Congress in obtaining loan forgiveness programs.

BINDER:  As President-Elect, I would increase the role of caucuses within the APA for practice and specialty groups in order to provide a stronger voice to these groups within the APA and thus increase the value of APA membership for these groups.  I would also use my influence as President-Elect to increase membership benefits for our members in subspecialties, such as "Maintenance of Certification" tools and assistance with electronic medical records.
DAVIS:  The APM is a select specialty organization that has seen growth in membership numbers and does an outstanding job with new member recruitment. The rising cost of professionalism from certification to organization and membership dues is a significant issue. We have to find mechanisms to provide relief for multiple membership dues to avoid member attrition. I would ask the membership committees of both organizations to meet and designate a taskforce to consider the impact of combined dues reduction as well as ways to promote ongoing value to members.
LIEBERMAN:  APA has worked diligently over the past several years to streamline costs.  I plan to continue these efforts in order to keep dues at the minimum particularly for younger members while continuing to provide the many services APA offers to its members.

BINDER:  As APA President-Elect, I will continue and expand upon the initiative of the current APA President, Dr. Oldham, who has addressed the role of psychiatry in health care reform by appointing a work group of the BOT for this purpose. Part of psychiatry’s role in accountable care organizations should be in patient-centered medical homes.  Since persons with serious mental disorders often have excess rates of medical morbidity and mortality, they might be better treated in integrated care systems such as medical homes located in community mental health settings or in psychiatric practices. Please see my web site at: www.ReneeBinder.com for more information about my stance on health care reform.
DAVIS:  Concepts of health care reform include integration, patient satisfaction, value-based versus volume-based care, quality measures and cost reduction. When fully implemented there will be an expansion of enrolled patients at a time when the nation will be facing substantial workforce shortages. The five most costly disorders include alcohol and substance use disorders, depression and mental disorders, cardiovascular disorders and nicotine use. If at least four of the top five disorders reside in our domain then it would follow that cost containment could not occur without addressing these disorders. Population health and integration of mental health care into the house of medicine will be one of my top priorities. We must not only integrate psychiatry into primary care but we must bring primary care into the community mental health centers if we are to impact the medical morbidity and mortality that impacts our patients. The APM has shown significant leadership and innovation with member involvement in collaborative care models. This expertise must be brought to a broader section of psychiatric providers in order to meet the demands of healthcare reform. I would extend the current workgroups on collaborative care, initiate a taskforce on healthcare systems to address the trends toward hospital mergers and employed physician models and be proactive in ensuring that psychiatrists are at the helm of the behavioral health care team.
LIEBERMAN:  The medical home offers a unique opportunity for psychiatry.  APA must advocate for mental health access for all patients as an essential element of health care.  This advocacy must also include sufficient support for research on what services and models of car do and do not provide the best and most cost efficient mental health care.  APA needs to play a leadership role in the configuration of healthcare mandated by the new Congressional legislation and work in support of district branch efforts at the State level.