Reports to the Membership

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. Full versions of the reports can be obtained from the Central Office or APA website. The full reports were presented at the APA Annual Business Meeting in New York, May 4, 2014.

Report of the Secretary

Maria A. Oquendo, 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. Following are some of the highlights.

Establishment of the APA Council on International Psychiatry

The Board of Trustees approved at its October 2013 meeting the establishment of the APA Council on Global Psychiatry. The APA Membership Committee unanimously endorsed the concept and the charge of the new council in terms of working on international membership, increasing international membership by education, and advocacy in conjunction with the membership staff that process the applications. In March 2014, the Board of Trustees approved the name change of the Council on Global Psychiatry to the Council on International Psychiatry and voted to approve the charge to the new Council on International Psychiatry.

Charge to the Council on International Psychiatry

The purpose of the Council is to facilitate understanding of problems facing international psychiatrists and their patients. It will do so by focusing on international membership in the APA, and through increased membership in the APA, avail all members of the opportunities in education, advocacy, prevention, and clinical care that membership in the APA provides.

• 1) The Council works in collaboration with the Membership Committee to recruit international members.

• 2) The Council assists APA in ensuring that APA policies and positions on international issues are current and appropriate.

• 3) The Council, in collaboration with the Council on Research, provides recommendations and defines strategies to enhance the scientific base of international psychiatric care and global mental health.

• 4) The Council identifies opportunities for partnership with other organizations to foster the creation of financially self-sustaining international programs that will benefit all members of the APA and their patients.

• 5) The Council assists APA in establishing mutually beneficial relationships between the APA and other internationally focused psychiatric organizations. The Council facilitates collaborative development of clinical, research, training, and forensic guidelines by these various organizations, including the APA, for use by psychiatrists globally, with appropriate modifications for specific countries or regions. The Council facilitates publication of news about these organizations and their activities in Psychiatric News.

• 6) The Council promotes engagement to enhance shared learning and leadership to achieve participation of all APA members.

The Council members are experienced in global mental health and broadly representative (geographically and culturally) of the diverse APA membership. The Council has a standard council composition. APA members who have membership in international organizations may be appointed as corresponding members and serve as liaisons to their international organizations. The Council will utilize freely available electronic communication technology to interact and coordinate with organizations and individuals outside of the United States in lieu of international travel. No APA funds will be budgeted nor used for travel outside the United States by members of this council for the work of this council.

Position Statements

Position statements can be found on the American Psychiatric Association’s website: www.psychiatry.org in the “Learn Section,” Library & Archives under APA documents. The APA Board of Trustees addressed several position statements throughout the year. Seven new position statements were approved, one position statement was reaffirmed, five position statements were revised, and five position statements were retired.

New Position Statements

Reaffirmed Position Statements

Revised Position Statements

Retired Position Statements

Report of the Treasurer

David Fassler, M.D.

The 2013 year-end process is under way with several year-end steps to be completed. Because the final year-end results are not yet available, all numbers presented here are preliminary and subject to change (see Figure1).

The annual audit is under way and will take approximately 6 weeks, of which 3 are onsite. The consolidated Audit Committee will review the statements at its meeting in the summer.

Preliminary, Unaudited Financial Information

• American Psychiatric Association: Preliminary year-end statements show an unrestricted operating net surplus of $4.8M, compared with the planned reserve spend-down of $2.7M, after adjusting for new revenues from DSM-5. The positive variance was largely due to revenues from meetings, as well as a one-time decrease in pension expense.

• Unrestricted Revenue was greater than budget by $18.9M. DSM-5 revenues exceeded expectations by $18M. Revenues from the Annual Meeting and other CME activities were $2.1M above budget. Non-DSM publishing revenue was $1.4M below budget.

  	•.	Membership dues: End of year membership dues revenue was $9.7M, which was on budget, slightly higher than last year.
  	•.	Non-DSM publishing: Actual revenues were $14.7M, compared with a budget of $16M. Advertising receipts continue to decline, and book sales were less than anticipated; however, this appears to be a timing issue as titles related to DSM were delayed. Prior year revenues were $13.3M.
  	•.	DSM sales were $41.4M, which was $18.3M above budget.
  	•.	Continuing medical education: Actual revenue for CME activities, including the Annual Meeting and IPS, was $11.9M, compared with the budget of $9.7M. Prior year revenues were $9.1M

• Unrestricted Expenses were $53M, which was below budget by $3.5M. Expenses were $12.1M higher than the prior year.

  	•.	Advocacy: Actual expenses were $4.6M, compared with a budget of $5.5M. Positive variances were due to reduced spending for the Advocacy Leadership Conference, CALF grants, and consultant activities.
  	•.	Publishing: Actual expenses were $12.1M, compared with a budget of $14.1M. The major positive variances resulted from the delay in book sales and reduced spending for promotion.
  	•.	Administration: Actual expenses were $10M, compared with a budget of $12.6M. The major positive variance was a one-time reduction in pension expense. In 2013, the Board of Trustees approved a recommendation to freeze the Defined Benefit Pension plan at current plan levels. This resulted in a one-time reduction of the liability of $1.3M. There was approximately $1.2M in vacancy savings.
  	•.	Governance: Actual spending for Governance Activities (Board, Assembly, support for district branch executive meetings) was $2.3M, compared with a budget of $2.7M. Major positive variances include legal fees, JRC meeting costs, and some travel costs.

• American Psychiatric Foundation (APF)

  	•.	Foundation revenue, including federal awards, was $1.3M, which was $379K below budget, and $444K less than the prior year. Federal award revenue was below budget; however, unrestricted giving was $47K above budget and restricted awards were $1.2M above budget.
  	•.	Foundation expenditures were $5.5M, which was on budget.

• Nonoperating Activity reflects investment increases or decreases in both the short-term and long-term portfolio, net of investment fees. The balance of the reserves increased by approximately $31M, representing an increase of $15M in net from investment activity, and $16M in reserve additions during the year. In December, $5M of Foundation funds were moved from reserves to the operating account as part of the planned effort to improve the charity rankings of the Foundation. APA’s share of the portfolio at the end of December is $53M (50%), and APF’s share is $53M (50%), prior to adjustment for intercompany transactions.

Statement of Financial Position

• APA: Total assets increased $30M from December 2012 balances. The positive growth in current assets was due to influx of cash and receivables related to the sales of DSM-5. There is an increase of long-term assets due to positive market return and transfer of operating funds into the long-term accounts. Liabilities decreased $1.5M, due primarily to the liability associated with the accrued pension expense.

• APF: Total assets increased $5.2M from December 2012 balances. The positive growth was due to positive market return. Liabilities increased $700K, due primarily to the amount owed to the APA for centralized services (facilities, information technology, finance, human resources).

Report of the CEO and Medical Director

Saul Levin, M.D., M.P.A.

In May 2013, Dr. Saul Levin, an APA member since 1987, was chosen to succeed Dr. James Scully as Chief Executive Officer and Medical Director of the American Psychiatric Association. Dr. Levin began his tenure as CEO and Medical Director-Designate in July 2013, and assumed the role of CEO and Medical Director on October 15, 2013. Dr. Levin has served on several APA components, including Board of APA’s Political Action Committee (APAPAC), the Scientific Program Committee, and as a consultant to the Finance and Budget Committee. He has also been a member of the APA’s delegation to the American Medical Association.

Prior to joining the APA, Dr. Levin served as head of the District of Columbia Department of Health and chair of the D.C. Essential Health Benefits Package Subcommittee of the Health Benefit Exchange Authority, where he was a board member. He has also served as Senior Deputy Director of the District of Columbia Addiction, Prevention and Recovery Administration. Before taking on his positions in Washington, D.C., Dr. Levin was Vice President for Science, Medicine, and Public Health at the AMA. Dr. Levin also served as a special expert in the Department of Health and Human Services and was the CEO and President of Medical Education for South African Blacks, in which over 11,000 scholarships were distributed to South African blacks under his tenure to promote equity and diversity in the health care arena. Additionally, Dr. Levin is a former President of the Gay and Lesbian Medical Association.

Throughout 2013, APA led many initiatives that not only enriched the field of psychiatry but benefited the mental health community. Along with new activities, Dr. Levin and the APA have outlined a new vision that emphasizes members, membership benefits, internal and external strategic issues, supporting and recruiting domestic and international members, and increasing partnerships within the mental health field (see Figure 2). This report will highlight a few of the APA’s major activities for 2013 surrounding this vision.

Mental Health Parity

On November 8, 2013, the Obama Administration issued the Final Rule for the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which was a major accomplishment for the APA and the field of psychiatry. The Final Rule, issued jointly by the Departments of Treasury, Labor, and Health and Human Services, clarified key issues and areas of the Interim Final Rule of the Parity Law, such as the significant role played by states in enforcement of parity. The Rule takes effect for insurance plan years beginning on or after July 2014 and applies to the individual market for both grandfathered and nongrandfathered plans.

Within weeks of issuance of the Final Rule, APA convened a summit and invited over 25 mental health leaders to join in a discussion on identifying and exploring the most pressing issues around parity that impacted the individual organizations, its members and patients. The objective of the Summit was to identify a common strategy to deal with similar and significant issues related to parity implementation and enforcement. The Summit provided an opportunity for organizational leaders to collectively address education, policy implementation and enforcement, and possibly additional legislation in the future.

The Final Rule was a critical first step toward eliminating barriers to care that people with mental and substance use disorders have typically faced. The APA continues to be in the forefront in articulating how this rule impacts our profession and our patients by utilizing virtually all the premier media outlets.

Medicare Part D

CMS released a proposed rule in January 2014 that would have removed antidepressants and antipsychotics from the six protected classes within Medicare Part D. At the inception of this program, APA fought to include antipsychotics and antidepressants in these protected classes. CMS inappropriately cited APA practice guidelines as their argument for efficacy of medications across classes, by selectively quoting from them and ignoring strong recommendations that evidence for efficacy is only one factor that must be considered when choosing an antidepressant or an antipsychotic.

In response, APA created a coalition of medical organizations (AMA, AGP, AACAP, AAFP ACP, and AOA) to address the clinical and medical aspects of the proposed rule. APA also submitted comments to CMS stating that the proposed rule was not based upon reliable clinical evidence or data and that this change would impede access to clinically appropriate pharmaceutical treatments for mental illness. As a result of APA’s advocacy efforts, including the district branches and primary care and mental health coalitions, CMS rescinded its proposed rule. In the release of its decision, the CMS Administrator said that it would seek input with more stakeholders in the future before proposing rules of similar magnitude.

DSM-5

After nearly 13 years of planning and development, DSM-5 was launched in May 2013 during the Annual Meeting. The DSM-5 collection includes a pocket guide, self-examination questions guide, clinical cases, a handbook for differential diagnosis, a guidebook, and a study guide. It is available in hardcover, paperback, as an e-book and a desk reference. APA continues to identify new ways to leverage this resource by developing new products in a variety of media.

During the planning stages of DSM-5, APA began working with the National Center for Health Statistics to ensure that the manual would be compatible with ICD-10 codes, and included ICD-10 codes in the manual. The APA continuously works with NCHS to make sure that the transition will be seamless and easy for our members. The APA anticipates that implementation of ICD-10 will occur in October 2015.

The Physician Payment Sunshine Act (PPSA)

The APA took a leadership role in educating our members about the impact of the PPSA. As of August 1, 2013, drug and medical device manufacturers are required to collect and report information about physicians who have received payments or gifts from them. CMS will then publish this information on a public website, including the name of physicians receiving the payment or item of value, and the manufacturer from whom he/she received the payment or item of value. Because the penalties for not complying with the PPSA are costly, APA members are advised that manufacturers are likely to be overly cautious in implementing the law when interpreting the law, which could potentially result in over-reporting to CMS.

The APA continues to work with CMS and applicable medical device and drug manufacturers to better understand how PPSA’s implementation will impact psychiatrists. Our discussions with a few manufacturers indicate that each company may take different approaches as to how they will implement the law. Through our partnership with the AMA and other physician associations, including those that comprise Council of Medical Specialty Societies, we continue to explore how manufacturers and CMS interpret and, consequently, implement PPSA. To learn more about PPSA reporting and to obtain information on the APA’s educational materials on PPSA, visit www.psychiatry.org/sunshineact.

Current Procedural Terminology (CPT) Awards

The AMA CPT Editorial Panel presents three awards annually at the Panel’s Annual Meeting held each October, consisting of the Staff Liaison Excellence Award, the Educational Excellence Award, and the Burgess Gordon Memorial Award.

APA was mentioned in all three awards, winning two and being named honorable mention in the third. APA staff liaison to the CPT Editorial Panel and APA’s CPT Advisor, Rebecca (Becky) Yowell, was selected as the winner for the Staff Liaison Excellence Award. This award recognizes the “outstanding specialty society staff members who provide extraordinary support to Advisors, AMA staff and the CPT Editorial Panel.” APA was also named the winner of the Educational Excellence Award, which recognizes the specialty society’s efforts in educating their physician/members about the CPT code set.

The third award, the Burgess Gordon Memorial Award (“Father” of CPT), is selected by AMA CPT staff and awarded for outstanding service by advisory committee members. APA member Benjamin Shain, M.D., was named honorable mention for his overall work with the CPT Editorial Panel as an Advisor from AACAP.

Psychiatric News

Psychiatric News launched a revamped and more dynamic website in May. Due to this change, Psychiatric News is now in an “online-first” publication environment in which news and other timely material of interest to APA members can be posted as developments occur. Articles from the print publication are also posted on the website, but the site is no longer just a “mirror image” or archive copy of the print version. The site is also optimized for easy mobile and tablet reading and includes video and audio reports. Development of an app for Psychiatric News and other PsychiatryOnline products is planned for 2014, which will further streamline multichannel electronic distribution of content.

Conclusion

We thank the APA Board of Trustees, Assembly, and district branches, our partnering organizations, and all the members for their dedication to serving persons with a mental illness and substance use disorder and their families. The APA administrative staff looks forward to continuing to enhance member services and advocate for our psychiatrists and their practices, along with promoting of quality care for all in 2014.

Report of the Speaker

Melinda L. Young, M.D., D.F.A.P.A.

The Assembly has played an increasingly important role in the affairs of the APA as it addresses the needs of our members:

Maintenance of Certification (MOC)

When the Assembly became aware of MOC, we recognized potential problems in the inflexibility of its rigid application across all subspecialties of psychiatry, and we went into action. Although not all action papers directly led to change, Assembly members’ dissatisfaction and concern was noted at both the American Board of Psychiatry and Neurology (ABPN) and at the APA. Wording on the ABPN website referring to diplomates whose lifetime certificates did not require MOC participation was changed from “not participating in MOC” to “not participating in MOC and not required to do so,” on the basis of an action paper passed in November 2012. Although the hiring of a new CEO at the American Board of Medical Specialties (the parent organization of all specialty boards, including the ABPN), did not make MOC go away, under new leadership the ABMS has developed new standards for MOC, allowing greater flexibility and discretion in how specialty boards, including the ABPN, apply the standards to diplomates. Among other changes this year, the ABPN has heard and responded to the Assembly’s concerns about the patient survey portion of the Performance in Practice (PIP) section of MOC, which has now become optional, as one option among many that members can choose to complete the section. The ABPN also now offers outreach to any district branch that requests it, offering both a meeting and training about MOC. The APA’s Office of Education has heard Assembly concerns and has made the electronic version of Focus available to early-career psychiatrists as a free member benefit and offers four PIP modules to all members as a free benefit of membership. Additionally, the APA has now added an Assembly member to the APA’s delegation to the ABPN.

Government Relations

There is new energy in how the Department of Government Relations relates to members’ concerns, pushed in large part by the Assembly. For example, APA is increasingly addressing Veterans Affairs, including developing legislation for a 3-year pilot project within the VA that will offer loan forgiveness to psychiatrists who choose to work in the VA. Assembly Speaker-Elect Dr. Jenny Boyer has been instrumental in bringing this about.

Train-the-Trainers in Health Care Reform and the Affordable Care Act

A new task for the Assembly this year will be its participation in this new Train-the-Trainers program. Assembly members will be actively partnering with their district branch councils to identify and support one “trainer” per district branch who, once trained, will take the information and educational materials home to provide additional training for APA members within his or her district branch.

Board of Trustees

With the Board of Trustees, many ad hoc work groups that would typically involve only members of the Board of Trustees have become joint Board of Trustees/Assembly Work Groups.

Assembly Meetings

We are continuing to use our Assembly meetings to address topics of importance to psychiatry. Last November, former Congressman Patrick Kennedy spoke movingly about mental health parity just as the Final Rule for the Mental Health Parity and Addictions Equity Act of 2008 was issued, legislation on which he and his father, Senator Ted Kennedy, had worked together. We also heard from Dr. Ron Burd, Assembly member from North Dakota and a former Speaker of the Assembly, about how to use the recent changes in CPT coding to drive parity. Dr. Greg Harris, a former Assembly member from Massachusetts, spoke about how an ethical psychiatrist can advocate for mental health parity and coverage with insurers, state legislatures, and regulatory bodies based on his advocacy efforts in Massachusetts. Dr. Howard Goldman discussed the work of the Board of Trustees’ Ad Hoc Strategic Action Work Group on Healthcare Reform. And Suzanne Shutty, Director of APA’s Marketing Department, wrapped it up with a discussion of branding, messaging, and communications, all in the service of taking the information home to Assembly members’ district branches.

At this Assembly meeting, we will hear from Professor Sue Bailey, O.B.E., F.R.C.Psych., President, Royal College of Psychiatrists in the United Kingdom, about “Using the Lever of Parity of Esteem” (or equality of regard) and “Between Mental and Physical Health to Close the Mental Health Gap,” a focus of hers during her presidency of the Royal College. We will again hear from Dr. Howard Goldman about the continuing work of the Board of Trustees’ Ad Hoc Strategic Action Work Group on Healthcare Reform. And, to close out the Assembly meeting, we will hear from Congressman Tim Murphy (R-PA), Chairman of the House Energy and Commerce Subcommittee on Oversight and Investigation, and Co-chair of the Congressional Mental Health Caucus, about his work on behalf of mental health.

In addition, during this Assembly meeting we will have an opportunity to evaluate 27 action papers, four proposed position statements, proposed changes to our Bylaws, proposed annotations to the Principles of Medical Ethics, and nine practice guidelines.

The Assembly has continued its work during the year through the activity of its task forces, work groups and committees. We will have further opportunities, as we did in November, for Assembly members to participate with the Access to Care Task Force (led by Dr. Joe Mawhinney), communications (led by Dr. Steve Daviss), legislative/public affairs (led by Dr. John Bailey), membership engagement and mentorship (led by Dr. Harry Brandt), the Assembly Work group on Maintenance of Certification (led by Dr. Bob Batterson), and the Assembly Committee on Public and Community Psychiatry (led by Dr. Larry Miller). Our two special caucuses, on Veterans Affairs and psychotherapy, will be meeting during the Annual Meeting.

Area and District Branches

One of my greatest pleasures as Speaker has been to attend area and district branch meetings across the country. I have visited all areas at least twice and have had the opportunity to spend time with 18 district branches, where I have met many bright and dedicated members, learned new information from the didactic portions of many annual meetings, and have come to appreciate the range of struggles we all engage in as we bring mental health care to our communities and our patients. I have been dismayed, however, by the number of times I have been asked, “What is the Assembly?” and “What benefits do I get for my dues?” While both the Assembly and the APA do an enormous amount of good work and provide great value to our members, we continue to be challenged by how to communicate what we do and what we offer. Because the Assembly reaches into every district branch through our district branch representatives, the Assembly has a tremendous opportunity to help fill that gap in knowledge. To that end, Dr. Bob Batterson is developing a toolbox for area representatives to use in organizing and communicating with their district branch representatives, and Dr. Joe Napoli has developed a toolbox for district branch representatives to use to increase their communication and direct work with their district branch members. In addition, Dr. Napoli has developed a terrific Area 3 website that can serve as a model for other areas to increase their visibility and communication with members. While these tools have not yet been released, once available, I urge Assembly members to take advantage of them.

Conclusion

As I come to the end of my year as Speaker, I must recognize the invaluable contributions made to the Assembly by many others. Dr. Scott Benson, the Immediate Past Speaker, has been tireless in providing his advice and in chairing a committee addressing Assembly long-range planning. Dr. Jenny Boyer, Assembly Speaker-Elect, has also been tireless in tracking down past, and passed, Assembly actions and pushing them toward completion. In addition, she has been instrumental in bringing about a new focus on Veterans Affairs and has pursued and developed the VA caucus. Dr. Glenn Martin, Assembly Recorder, has been involved in every discussion of consequence and has added his sage advice. Dr. Bruce Hershfield, Assembly Parliamentarian, has remained my trusted advisor. And my greatest thanks and recognition goes to Allison Moraske and Margaret Dewar, the Assembly’s energetic, determined, and very effective, staff. None of this work would have been possible without them.

It has been my distinct pleasure to serve as Speaker of the Assembly this year. I am proud to be part of an organization that brings such value to the members of the APA, to the practice of psychiatry, and to the patients we serve.

Report of the Speaker-Elect

Jenny Boyer, M.D.

I am grateful for the opportunity to serve as Speaker-Elect and to work with the Assembly Speaker Dr. Melinda Young and Assembly Recorder Dr. Glenn Martin. I have enjoyed attending the meetings of the Joint Reference Committee, the Assembly Executive Committee, and the Area Councils. It has been a pleasure to interact with the APA components and the AMA and especially to meet individually with Assembly members and Dr. Saul Levin and his staff, the new and the old.

Under Dr. Young's leadership, the Assembly has had work groups addressing access to care (Dr. Joseph Mawhinney), communications (Dr. R. Scott Benson), legislative/public affairs (Dr. Young), long-term planning (Dr. Ann Sullivan), maintenance of certification (Dr. Bob Batterson), membership engagement/mentorship (Dr. Harry Brandt), and DSM-5 (Dr. Glenn Martin). Some of these groups are in the process of completing their reports.

The Assembly was supposed to participate with other elements of the APA to offer area-wide training session for members concerning the Affordable Care Act, similar to the training on CPT and DSM-5. The focus was to be on psychiatrists who are in solo practice. This training did not materialize to date, but is scheduled for June 2014.

There has also been improvement in the process for action papers. The JRC not only gave feedback to the original authors of the papers but kept track of all the papers and position statements on a grid until they could be implemented. Specific dates for reports back to the JRC from a specified person to whom the papers were referred were enforced. Of the 90 actions that were referred to the JRC for their three meetings in 2013, there was one that was withdrawn and one failed. Of the remaining 88 actions, 50 were implemented. Implemented means that a position statement was developed or that requested action was completed. The remaining 38 actions are in progress. Councils and their committees have been very helpful in providing valuable input, both through the use of their e-mail lists and through discussions at their meetings. Ideas and feedback concerning action papers have also been solicited to a greater degree from the general membership. One of the action papers resulted in the first piece of federal legislation initiated from APA in years. Executive directors of district branches have been instrumental in improving our ability to communicate with members in that they have been more actively working with representatives of the Assembly to communicate actions of the Assembly and other important actions of the APA.

The past 6 months—the second half of the lifetime of a Speaker-Elect—has been a very exciting period for me. I am excited to be a part of the leadership team that I will work with so closely, Dr. Levin and Dr. Summergrad. I think there will be a focus on current issues of our time—that is integrated care and improved communication within the staff and broader leadership of APA and to its members. I think there will be more diversity in the APA and more inclusiveness of all members, including those from specialty organizations. The significant issues have not changed. The public is still expecting more from health care than is economically or logistically feasible. The media remain full of stories about those experiencing psychiatric disorders committing violent crimes as well as veterans being homeless and suffering from PTSD and traumatic brain injuries. There is increasing pressure to expand “scope of practice” to those we either do not supervise or cannot adequately supervise. Parity is threatened at many levels, though APA is addressing the issue at the grassroots and lawsuit level. Providers are facing being paid less in the new integrated care models, which are less and less fee-for-service but rather population based.

We cannot rest on our laurels. We need to do more in each branch of our organization. District branch presidents and executive directors need to expand their proactive roles in involving local members who often consider themselves disenfranchised. Action papers developed from all parts of the APA need to be nurtured by the Assembly and the Components. With the support of the Joint Reference Committee and the APA staff, under the new leadership of Dr. Saul Levin, the Assembly can help revitalize our organization.

To paraphrase Benjamin Franklin, our members will “We must all hang together, or assuredly we shall all hang separately.” I believe that we as members must hang together, or we will not survive as physician specialists called psychiatrists. If we hang together, we can better serve our patients and our communities. I plan to communicate better to our members what the Assembly is doing so that the members will feel included and will be a part of our whole, and we all will survive the changes of our times.

Report of the Committee on Bylaws

Rebecca W. Brendel, M.D., J.D., Chairperson

Members: Edyth P. Harvey, M.D., Christopher Pelic, M.D., Eric Martin Plakun, M.D., Rudra Prakash, M.D., J.D., Sidney H. Weissman, M.D.; Staff: Margaret Dewar, Chiharu Tobita.

In its attempt to overhaul and modernize its business organizations code, the District of Columbia Council passed the “District of Columbia Code Title 29 (Business Organizations) Enactment Act of 2010.” This law governs all organizations incorporated in the District of Columbia, including the APA. The portion relevant to the APA is the “The Non-profit Corporation Act of 2010,” which became effective as of January 1, 2012. In light of this new law, at the July 2012 Board meeting, the Board of Trustees asked the Bylaws Committee to review the Bylaws with the assistance of APA General Counsel, Colleen Coyle, and to recommend changes to the Bylaws in order to maintain the APA’s organizational and operational status quo. The Committee began its work at the September 2012 Component meetings and continued its work through conference calls and an additional meeting at the 2013 Components. The Committee completed the draft proposed amendments in November of 2013.

In summary, a number of new provisions governing matters included director standards of conduct and liability, indemnification, review of contested corporate actions, Board actions and meetings, and business meeting requirements. The structure of the law provides automatic default positions where the APA Bylaws are silent. The goal of the Committee’s work was to address areas of silence in the Bylaws regarding current operations and to add explicit language in the Bylaws where the practices and operations of the APA have been contrary to the default positions of the DC Act. The proposed changes, therefore, are anticipatory to preserve the status quo. That is, the changes are proposed so that the APA can continue to do business as it has to date and so that, if there were an issue in the future, the Bylaws would be clear and explicit and the APA would not be subject to the law’s default positions.

The Committee welcomed the input of the Assembly Executive Committee (AEC), Assembly, and Board to make the Bylaws changes as clear and effective as possible in maintaining APA structure and operations. Review, comments, and questions were submitted to the Committee on Bylaws from January 21–31, 2014. The Committee then discussed the final and further proposed draft amendments after reviewing the comments and suggestions made by members during the comment period and comments previously made during prior presentations to the Board, AEC, and Assembly. The Board of Trustees approved the final proposed Bylaws amendments at this March meeting. Ratification vote by the Assembly took place at the May Assembly meeting.

Report of the Membership Committee

Jonathan Amiel, M.D., Chairperson

The 2013 fall meeting of the Membership Committee began with a strategic planning discussion. The Committee reviewed its charge as outlined in the Operations Manual and very clearly prioritized three functions:

There was also continued dedication to review of distinguished fellowship applications and district branch/state association grants. These were viewed as programs that support the goals of member recruitment and retention.

The Committee was charged with designating outcome measures to evaluate new initiatives in early-career psychiatry recruitment and retention. Proposed outcome measures agreed upon by the Committee include:

The Committee also discussed the need to gather updated data on practice settings of both members and nonmembers to help inform recruitment and retention methods.

Membership Activity in 2013:

There were significant recruitment and retention activities in 2013, and the total membership is growing. Membership gains were higher than 2012 in all membership categories as noted above. The membership losses offset some of the gains, though there were fewer losses in all membership categories compared to 2012. The net result of all membership activity was an increase of 3.4% (1,141 members) from January 2013 (33,862 total) to January 2014 (35,003 total). It was also the second year of membership growth.

Several FTE positions in the Membership Department were restructured to provide more resources for membership recruitment and retention. There are now two Membership Development Coordinator positions to assist the Associate Director of Membership Development. One position focuses efforts on medical students, residents, and early-career psychiatrists. The other position focuses efforts on international members, as well as all other members in mid- and late-career. The Membership Department has increased efforts to send more targeted messages to the various member and prospective member segments by multiple contacts through direct mail and e-mail. Approximately 10 direct mail campaigns and 10 e-mail campaigns were conducted throughout the year, reaching thousands of lapsed and never-member residents, early- and mid-career psychiatrists, international psychiatrists, as well as medical students.

In June, the APA membership department hired an outside firm to call members-at-risk to encourage them to renew. With those who were not interested in renewing, the company tried to learn the reasons why. Membership staff wrote the script and provided detailed information about the dropped members for callers. The phone calls were made in June leading up to the June 30th drop date, and over 800 members agreed to renew.

The APA 100% Club was established to encourage residents throughout the United States and Canada to join the APA with all of the other trainees in their program. The 100% Club was expanded for the 2013–2014 academic year to recognize additional programs that come close to reaching 100%. The new structure is comprised of Gold (100% of residents enrolled), Silver (90%–99%), and Bronze (80%–89%). Additionally, there is now a Platinum level to recognize programs that have been part of the 100% Club Gold level for the past 5 or more consecutive years. Sixty-eight programs were confirmed for the 2013 2014 year, an increase of 23 programs over the previous year.

The APA had a membership booth at the following meetings in the United States to promote membership:

APA Membership staff has been working with international ambassadors and prospects to help facilitate new international member enrollments. Eighteen potential new members have been identified to date. As part of the International Ambassador Program, which launched in spring 2013, APA members who live or travel abroad are trying to recruit new international members into the APA. The countries participating in the initial pilot include Australia, Brazil, India, Japan, and the Netherlands, with 5–10 members in each country serving as “ambassadors.”

2013 was the first year for the new category of international fellowship, and Membership staff actively promoted the new category to current international members and to nonmembers (internationals). Ongoing promotional announcements appeared in APA Headlines and Psychiatric News Alerts. Several e-mail blasts regarding the new category were e-mailed to international members throughout the year. A promotional flyer was developed and distributed at the various meetings. Nearly 150 new international fellows were approved in December 2013.

The Membership Committee and Board of Trustees Work Group on International Psychiatrists co-hosted a New International Member Welcome Reception on Monday morning during the Annual Meeting. There were approximately 75 people from 26 countries in attendance, including presidents of international psychiatry organizations. Drs. Jeste, Scully, Levin, Rubin, and Riba all gave welcoming remarks. Dr. Riba also presented certificates of appreciation to the international presidents. The reception seemed to be very much appreciated by those in attendance.

PsychPRO provides members with access to a free *Surescripts-certified ePrescribing platform and point-of-care resources for patient care available online (*there is a $20 annual fee for security processing). The resources are U.S. based because they are pulled from the resources based on the U.S. drug filings. The ePrescribing service is certified to operate under U.S. regulations; therefore, Canadian members are unable to utilize the service without U.S.-based credentials of a DEA, NPI, and/or U.S. state license. This benefit is seeing steady growth in member usage.

The Committee discussed partnering with Affinity Marketing Group (AMG), a sales and marketing agency that partners with nonprofits and other organizations to provide members access to a wide variety of member benefit programs. Through AMG, APA members would be eligible to receive discounts on insurance products, financial services, office supplies, cell phones, prescription pharmacy discounts, electricity and natural gas, travel, and more. Partnering with an organization such as AMG would provide the APA the opportunity to offer members access to discounts on a variety of products and services, with AMG responsible for vetting products and services and negotiating group discounts based on the combined size of all of their clients and the members they represent. (90% of AMG’s clients are nonprofits.) The Committee was very interested in this program and recommended it to the Board of Trustees where it was approved in December 2013.

The Committee discussed establishing an affiliate membership category. They identified some of the pros and cons of inviting other mental health professionals to become members of APA. They also raised a lot of questions and issues to address in a larger discussion with the full Committee. The full Committee discussed whether the category should be limited to nurse practitioners and physicians assistants or opened to a broader definition of mental health professionals. They also discussed how a new category would affect APA’s advocacy efforts and whether or not the category would be mandatory for district branches to offer. If the primary goal of expansion is to advocate for patients, some suggested that this could be accomplished through stronger alliances with other professional organizations. Not hearing full support at this time, Dr. Amiel suggested that the work group continue to study the issue.

The Committee sponsored a meeting for District Branch/State Association Membership Chairs Meeting that was held during the Annual Meeting in May 2013. The Committee wants to continue to foster its relationship with local membership chairs and expand communication throughout the year. A listserv has been established, but it is underutilized. They discussed ways to better engage with this group and will include this as a topic on the agenda for next year’s District Branch Meeting.

In 2013, the Committee approved 48 expedited grants ($2,500) for district branches in the amount of $2,500 for educational initiatives. Another $60,000 was awarded to seven of 22 applicants for innovative grants.

In 2013, 668 applications for fellowship and 147 for international fellowship were approved. Additionally, 103 distinguished fellowship and seven international distinguished fellowship nominations were approved.

Report of the Committee of Tellers

Hind Benjelloun, M.D., Chairperson

Members: Bruce A. Hershfield, M.D., William B. Lawson, M.D., Ph.D., D.L.F.A.P.A.; Staff: Margaret Dewar, Chiharu Tobita.

At the March Board meeting, the Board of Trustees approved the final results of the 2014 APA National Election as reported by the Committee of Tellers (see Table 1).

Eligible voting members in the 2014 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 2, while voting members without an e-mail address listed in the membership database received a paper ballot postmarked January 2.

As an alternate voting method to the electronic and paper ballot, eligible voting members had the opportunity to access their ballot through the APA homepage or the APA election website with their username and password. This was considered an excellent addition to the voting process and a means of steering members toward our informative APA website.

The election management firm, the Survey & Ballot (SBS), managed the distribution and tallying of ballots while providing technical support to voting members. As in the previous elections, voters had the option to request a paper ballot from either the SBS or the APA staff. 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,” approximately 95% rated their experience as “satisfied” or “very satisfied.”

Voter turnout continues to be a key focus for the Committee. For the 2014 election, voter turnout was only 19%; 5,694 of 29,842 of eligible voters participating. This number will increase with a drastic, diligent approach to engaging members to vote, as proposed below. Of the voters submitting ballots, 81% voted electronically. This signals the need for using cyber outlets to enhance interest. E-mails with links to the electronic ballot were sent to approximately 80% of eligible voters, while the remaining eligible voters received a paper ballot.

In the 2014 Committee of Teller’s Annual Meeting, the Committee demonstrated strong interest in significantly increasing APA voter interest and turnout. Although the APA is in line with other specialty organizations in our 19% member voter turnout, the Committee believes this can change. One proposed idea is to incorporate a friendly question/answer informative video clip to each and every APA member prior to electronic voting. This could be either simply as an embedded video or as a link to the voting website. In this way, members will have a personalized message from the candidates that is sure to ignite curiosity and enthusiasm. We also encourage the use of social media venues in order to publicize these videocasts, possibly including Facebook, Twitter, LinkedIn, and Doximity.

The Committee strongly believes that the APA must incorporate the use of technology and must become increasingly savvy in our strategies to stir and encourage member interest, involvement, and voter turnout. It has been our pleasure to serve on this Committee and to provide our thoughts.

Report of the Elections Committee

Barry K. Herman, M.D., M.M.M., Chairperson

Members: Steven Alan Epstein, M.D., Robert E. Kelly Jr., M.D., Michelle B. Riba, M.D., M.S.; Staff: Margaret Dewar, Chiharu Tobita.

Campaigning in the 2014 election began with the announcement of candidates on November 1, 2013, and ended with the voting deadline on January 31, 2014. The voting period started on January 2nd at 5:00 a.m. (Eastern Standard Time) and ended on January 31st at 5:00 p.m. (Eastern Standard Time).

The Elections Committee met via conference calls with the candidates to review the Election Guidelines in November. Most campaign issues raised by candidates and supporters simply required the Elections Committee and APA staff to clarify the recommendations already referenced in the Election Guidelines. They included inquiries received about the guidelines for professional presentations, the use of APA (including district branches/state associations and area branches) resources for campaign purposes, the use of social networking sites, blogs, and homepages (Facebook, Twitter, etc.), and the use of member-to-member list server.

Some highlights of the 2014 APA election cycle and Election Committee activities are summarized below: