Reports to the Membership

Report of the Secretary

Philip R. Muskin, M.D., M.A.

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 following are some of the highlights.

American Foundation for Firearm Injury Reduction in Medicine (AFFIRM)

At the December 2018 Board of Trustees meeting, the Board approved APA joining the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) consortium. AFFIRM is a physician-led foundation that aggregates private-sector financial resources to fund high-quality, high-impact research to prevent firearm injury. The AFFIRM health consortium currently includes the American Medical Association, the American College of Emergency Physicians, the American College of Surgeons, the American College of Physicians, and the Annals of Internal Medicine, to name a few.

New Committee on Well-being and Burnout

At the July 2018 Board of Trustees meeting, the Board approved the formation of a Committee on Well-being and Burnout, under the Council on Medical Education and Lifelong Learning, as a permanent home for the efforts that were undertaken by the Board of Trustees’ Ad Hoc Work Group on Well-being and Burnout. The workgroup completed its primary deliverables, which included the following: an online resource center, an online self-assessment tool, a series of articles in Psychiatric News, a Well-being Ambassador slide deck and manual, and a series of sessions at the 2018 APA Annual Meeting and IPS: Mental Health Services Conference. Nearly 2,000 individuals have completed the online burnout assessments.

Position Statements

Position statements can be found on APA’s website (www.psychiatry.org) under “Policy Finder.” The APA Board of Trustees addressed several position statements throughout the year. Seventeen new position statements were approved, 10 position statements were revised, four position statements were reaffirmed, and three position statements were retired.

New position statements.

• The Board of Trustees voted to approve the proposed position statement Peer Support Services at its July 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Discrimination of Religious Minorities at its July 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Weapons Use in Hospitals and Patient Safety at its July 2018 meeting.

• The Board of Trustees voted to approve the position statement Risks of Adolescents’ Online Activity at its July 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement on Solitary Confinement (Restricted Housing) of Juveniles at its July 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement on Psychiatric Services in Adult Correctional Facilities at its July 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Research with Involuntary Psychiatric Patients at its July 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Utilization of Measurement Based Care at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Physicians Health Programs in the Treatment of Addiction and Substance Use Disorders in Physicians at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Police Brutality and Black Males with minor editorial changes at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Mental Health Equity and the Social Structural Determinants of Mental Health at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Human Trafficking at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Conversion Therapy and LGBTQ Patients at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Role of Psychiatrists in Palliative Care at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Core Principles for Alternative Payment Models for Behavioral Health at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Use of the Principles of Recovery at its December 2018 meeting.

• The Board of Trustees voted to approve the proposed position statement Separation of Immigrant Children and Families at its December 2018 meeting.

Revised position statements.

• The Board of Trustees voted to approve the revised position statement Telemedicine in Psychiatry at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Abortion at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Resolution Against Racism and Racial Discrimination and Their Adverse Impacts on Mental Health at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Religious Persecution and Genocide at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Access to Care for Transgender and Gender Diverse Individuals at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Discrimination Against Transgender and Gender Diverse Individuals at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Inquiries about Diagnosis and Treatment of Mental Disorders in Connection with Professional Credentialing and Licensing (2015) at its July 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum at its December 2018 meeting.

• The Board of Trustees voted to approve the revised position statement All Applicants for State Medical Licensure at its December 2018 meeting.

• The Board of Trustees voted to approve the revised position statement Elder Abuse, Neglect and Exploitation at its December 2018 meeting.

Reaffirmed position statements.

• The Board of Trustees voted to approve the retention of the 2013 position statement Legislative Intrusion and Reproductive Choice at its December 2018 meeting.

• The Board of Trustees voted to approve the retention of the 2014 position statement Residency Training Needs in Addiction Psychiatry for the General Psychiatrist at its December 2018 meeting.

• The Board of Trustees voted to approve the retention of the 2015 position statement Neuroscience Training in Psychiatry Residency Training at its December 2018 meeting.

• The Board of Trustees voted to approve the retention of the 1973 position statement Family Planning at its December 2018 meeting.

Retired position statements.

• The Board of Trustees voted to approve the retirement of the 1981 position statement Confidentiality of Medical Records: Does the Physician have a Right to Privacy Concerning His or Her Own Health Records at its December 2018 meeting.

• The Board of Trustees voted to approve the retirement of the 2000 position statement Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) at its December 2018 meeting.

• The Board of Trustees voted to approve the retirement of the 2007 position statement Reactive Attachment Disorder at its December 2018 meeting.

Report of the Treasurer

Gregory W. Dalack, M.D.

For the year ended December 31, 2018, APA had a net loss of $5.5 million, based on $47.3 million in revenue and $52.8 million in expenses (see Figures 1 and 2). The $5.5 million net loss compares to $11.2 million net income during 2017, a change of $16.7 million, and the 2018 budget, which projected revenue to equal expenses. In 2017, the $11.2 million in net income was based on revenue of $60.5 million and expenses of $49.3 million.

The variances in net income noted above are attributable to the change in investment returns. During 2017, APA’s investments generated $13.3 million in revenue, a 15.3% return. In 2018, the investment values declined by $3.3 million, a 3.6% loss. The 2018 budget anticipated using $2.2. million in investment returns to fund operations in accordance with the reserve spending policy.

Revenue-producing activities, which are those business lines that generate a positive return and fund the Association’s programs and operations, include membership programs, publishing activities, and medical education and meetings. These activities provided $24.9 million in revenue after expenses. This amount was $.7 million higher than in 2017. The higher revenue is attributable to higher revenue from the annual meeting, higher dues revenue, and higher DSM print sales offset by lower print advertising revenue. The 2018 annual meeting was held in New York and saw increases in attendance and the number of exhibitors and sponsors. The year 2018 included a one-time 2% dues rate increase, which resulted in a dues revenue increase of $.4 million. Print advertising for Psychiatric News and the American Journal of Psychiatry continued to decline in 2018, as pharmaceutical companies have fewer psychiatric drugs in development.

Expenses for Programs and Services, which includes federal advocacy, policy development, research, education, diversity, and communications, was $.4 million higher than in 2017. The increase is due to the filling of vacant federal advocacy positions.

The Board has set aside reserves to fund state advocacy initiatives, expansion of the PsychPRO mental health registry, expanded development of practice guidelines, and the expansion of legislative grant program to district branches. During 2018, $1.5 million was expended on these efforts, a reduction of $.5 million from 2017.

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 2018–May 2019, which outlines the Administration’s actions, activities, and accomplishments in the past year according to the APA’s strategic initiatives.

Advancing the Integration of Psychiatry

The Opioid Epidemic

In October 2018, Congress passed comprehensive opioid-related legislation. The bill, H.R. 6, contained a broad range of initiatives to curb the epidemic, including several APA-supported provisions:

• Telehealth: Eliminates facility fees for the provision of telehealth services via Medicare and waives geographic requirements for “originating sites” for treatment of substance use disorders via telehealth under Medicare. In addition, the bill directs the Attorney General to promulgate final regulations within 1 year specifying the “limited” circumstances under which a special telemedicine registration can be issued and the process for issuing such a registration.

• Parity: Requires coverage of mental health and substance use disorder services as mandatory for Children’s Health Insurance Plan (CHIP) programs and imposes parity obligations on mental health/substance use disorder services covered by CHIP.

• Loan repayment: Creates a new student loan repayment program (maximum of $250,000 per individual) for substance use disorder treatment providers who agree to provide services in mental health professional shortage areas or areas with higher-than-average overdose rates for a period of 6 years.

APA is continuing to play a leadership role with the Coalition to amend 42 CFR Part 2.

During the last Congress, the APA Administration strongly supported legislation introduced by Representatives Markwayne Mullin (R-OK) and Earl Blumenauer (D-OR) that would modernize patient privacy protections by aligning 42 CFR Part 2 with HIPAA standards for treatment, payment, and health care operations. After a strong push with APA’s Capitol Hill and coalition allies, including outreach to multiple House offices and engagement from many members of APA’s Congressional Advocacy Network, the bill passed overwhelmingly by a vote of 357 to 57 in June of 2018. In April of this year, Reps. Earl Blumenauer (D-OR) and Markwayne Mullin (R-OK), as well as Senators Joe Manchin (D-WV) and Shelley Moore Capito (R-WV), reintroduced legislation in the House and Senate, respectively. The legislation provides a vehicle through which to continue to educate Congress and build support for modernizing Part 2, as the Coalition encourages HHS to propose strong new rules that would improve implementation of the law.

Mental Health Parity

Ten years after passage of the Mental Health Parity and Addiction Equity Act (MHPAEA), the APA continues to pursue an aggressive federal legislative agenda to ensure robust enforcement of the original law. The cornerstone of this effort is the advancement of federal legislation designed to improve compliance with MHPAEA based on model state legislation advanced by the APA. If enacted, insurers would be required to submit information to the Department of Labor regarding how they design and apply managed care practices, such as prior authorization, step therapy, network admission standards, and reimbursement rates, among others.

Federal Advocacy Conference

In April, 100 psychiatrists from across the country converged on Washington, DC, wearing their white coats, to lobby Congress during APA’s 2019 Federal Advocacy Conference. Attendees received hands-on advocacy training before they engaged in face-to-face meetings with their elected lawmakers. Through their efforts, APA was able to educate 135 congressional offices on issues vital to the practice of psychiatry, including achieving true mental health parity, ways to address the physician workforce shortage, and increasing federal investments in public mental health programs. The Jacob K. Javits Award was presented to Rep. Doris Matsui (D-CA) for her work on the Excellence in Mental Health Act and the 21st Century Cures Act.

State Advocacy Conference

The APA hosted the State Advocacy Conference in Park City, Utah, in response to requests from multiple district branches. The main theme of the conference was “relationships matter.” Speakers explained how their relationships with legislators, medical societies, their communities, and coalitions can help shape policy and positively affect patients’ lives. Thirty-eight states were represented, and 91 members attended sessions on parity enforcement, positive approaches to scope of practice legislation, and community and coalition building. As a result of the Conference, DGR conducted multiple follow-up activities, including region-specific outreach by State Government Relations staff and individualized follow-up with each attendee to encourage ongoing involvement with APA and advocacy.

Increasing Access to Care Through State Legislation

state associations are also/state associations are proactively promoting alternatives to increase access to care, including mental health parity, network adequacy, telemedicine, and the Collaborative Care Model. Last year, APA developed a 50-state model parity enforcement legislation that is adapted to each state law, complete with talking points, one-pagers, and an infographic on parity, for use by APA members.

• Progress of parity legislation: Last year, mental health parity legislation was signed into law in Delaware, the District of Columbia, Illinois, New York, Tennessee, and Texas. This year, legislators in California, Connecticut, Florida, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, and Pennsylvania have introduced parity legislation so far this session. Governors in New Jersey, Colorado, and Wyoming signed parity language into law this spring.

• Collaborative care and other legislation: state associations are beginning to pursue legislation to implement the Collaborative Care Model (CoCM). APA has developed model legislation that requires private insurance to cover CoCM codes. Illinois became the first state to enact APA’s legislation. Delaware and New Jersey are likely to see introduction of the legislation soon, with several other states interested in 2020 introduction. In states like Ohio, the APA is working closely with district branches/state associations to expand telemedicine.

APA Urges Senators and HHS to Limit Family Detention

APA was one of the first organizations to join efforts opposing potential legislation that would authorize extended immigrant family detention. This was in response to an announcement that the Trump Administration intended to modify the 1997 Flores Settlement Agreement, which limits the government’s ability to keep children in immigration detention. APA signed onto a coalition letter to the Senate Homeland Security and Governmental Affairs Committee, detailing how extended immigrant family detention exacerbates child traumatization and is harmful, costly, and unnecessary. The letter urges Congress to reject any efforts to expand family detention and overturn current child protection principles and instead encourages Congress to invest in more sensible and humane alternatives. Other signatories included the American Civil Liberties Union, the American Psychological Association, the American Academy of Pediatrics, and a host of other organizations.

Trauma-Informed Care

The ongoing conflict and discussion about immigration at the southern border and the Administration’s policy regarding the separation of children and families has resulted in a heightened Congressional interest on the topic of trauma and its lasting impact. To date, several Congressional Committees (Judiciary, Oversight, Energy, and Commerce) have convened hearings to discuss the impact of the separation policies, and we anticipate additional activity moving forward. APA’s work with congressional appropriators led to an invitation for Altha Stewart, M.D., APA’s President, to testify before the Labor-HHS-Education subcommittee on February 27, 2019. Dr. Stewart was asked to help the subcommittee understand the long-term impact and costs of the resulting trauma on the affected children, families, and society.

In addition, the concept of trauma-informed care overall is gaining momentum. Provisions from a broad trauma-informed care bill, led by Sen. Richard Durbin (D-IL) and Rep. Danny Davis (D-IL), were added to the comprehensive opioid bill (H.R. 6) last year, and the APA is working with bill sponsors to identify potential additions for this Congress’ version. As part of this process, Dr. Stewart met with Rep. Danny Davis in February to discuss the bill, as well as broader opportunities to raise awareness about the importance of trauma-informed care.

Congressional Briefings

In May 2018, Dr. Stewart also participated in a Hill briefing on the “Innovations and Challenges in Providing Mental Health Services to Prisoners and Returning Citizens.” Dr. Stewart was joined by leaders from the American Psychological Association, the Legal Action Center, the Association of State Corrections Administrators, and the National Association of Social Workers.

In July, Eric Yarbrough, M.D., participated in a Hill briefing by providing a clinical perspective on “Demystifying Gender Dysphoria.” The APA was joined by the American Psychological Association and Beverly Fisher, M.D., a plastic surgeon.

In November 2018, APA hosted a Hill briefing entitled, “Mental Health Parity through the lens of the Opioid and Suicide Epidemics,” which was moderated by Bruce Schwartz, M.D., APA President-Elect. The Hill briefing provided an overview of the parity law and a clinical perspective on the importance of parity and how lack of enforcement affects patients. Senator Bill Cassidy (R-LA) joined the briefing, made remarks, and answered questions.

In December 2018, APA participated in a Hill briefing entitled, “Racial Disparity in Mental Health: the Need for Inclusion in Research and Resources.” William B. Lawson, M.D., represented APA on a panel that also included researchers from major universities and the National Institutes of Health.

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 whose symptoms 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, although there are some concerns for the FDA to address to ensure that there are not unintended consequences of adopting this proposal.

Supporting Research

APA Mental Health Registry (PsychPRO)

PsychPRO has successfully completed 2018 MIPS reporting for close to 600 clinicians who participate in the registry as solo practitioners, small and large group practices, and community and hospital systems. The majority achieved MIPS scores of 70% or higher, which puts them in the range for bonuses on their 2020 Medicare reimbursements. All these practices participated through full PsychPRO integration with their EHR, which provided for an efficient and effective system for reporting. PsychPRO staff are currently putting together the Data Validation Plan for 2018, which is required by CMS to ensure the quality of data that was reported to the program. This is one among many requirements to remain a certified QCDR throughout the year. Other requirements include monthly support calls held by CMS that must be attended by PsychPRO staff.

CMS Quality Measures Development Grant

Research and Registry staff and our subrecipient, NCQA, have successfully recruited experts to serve on the Technical Expert Panel (TEP) and the Consumer and Family Panel (CFP) to assist in advising the development, refinement, and testing of the proposed quality measures. Separate informational webinars were held in January and February to orient TEP and CFP members to the goals of the measure development initiative and their roles in the process. These webinars were followed by all-day in-person CFP (March 21, 2019) and TEP (March 28, 2019) meetings, where panel members were able to engage in discussions about the proposed measure concepts and associated standardized assessment tools. Both sessions provided invaluable information that is being used to refine the descriptions and specifications of the measures.

Research Colloquium for Junior Psychiatrist Investigators

The application deadline for this year’s Research Colloquium was December 31, 2018. Of the sixty applications we received, 47 awardees were selected following a thorough review process. Forty-one of the awardees are from the United States and Canada, while six international awardees were selected from Brazil (N=2), Colombia (N=1), France (N=2), and Japan (N=1). Currently, three precolloquium webinars are scheduled throughout the month of April to facilitate early engagement between mentors and mentees prior to the 2-day Colloquium at the APA Annual Meeting. Both the American College of Neuropsychopharmacology and Society of Biological Psychiatry have continued their partnership with APA Foundation (APAF) on this important mentoring initiative.

Proposals for Changes to DSM-5

Currently, there are six proposals for major revisions in various stages of the review process, including text changes and removal of a disorder. Three proposals are under review by their relevant Review Committees, who have recently submitted recommendations to the Steering Committee. Four new proposals have been received and are under consideration by the Steering Committee for referral to the appropriate Review Committees. One proposal for a minor change was approved by the Steering Committee and is currently posted for public comment (April 1st–30th). In addition to these active proposals, a consensus workshop is being planned for after the Annual Meeting (summer 2019) to determine the agreement on the inclusion of a set of diagnostic criteria for grief in Section II (https://www.psychiatry.org/psychiatrists/practice/dsm/submit-proposals).

Education and Annual Meeting

Work Group on Physician Well-being and Burnout

The standing Committee on Psychiatrist Well-being and Burnout is chaired by Richard Summers, M.D., and continues to survey and collect data focusing specifically on the issue of burnout among minority/underrepresented (MUR) psychiatrists. The work group is drafting a manuscript describing findings from their 18-month survey project and examining factors associated with higher burnout scores among psychiatrists. The work group is also conducting a grounded-theory assessment of burnout in MUR groups, specifically conducing qualitative research interviews, which will inform the development of a survey instrument. Currently, 38 sessions have been accepted for inclusion into the 2019 APA Annual Meeting program in San Francisco on physician well-being and burnout.

Substance Abuse Education

In 2018, the APA hosted seven Providers Clinical Support System (PCSS) webinars highlighting motivational interviewing, medication-assisted treatment (MAT) in the emergency room setting, recovery support for young people with opioid use disorder, and methods for addressing substance use disorder in pregnancy. This initiative offers education on opioid use disorder and medication for addiction treatment to provide up-to-date evidence-based information to psychiatrists and other mental health care providers. Through PCSS, APA is also conducting its second Train the Trainer program, which seeks to create MAT trainers at the district branch level. Additionally, APA serves an important role in the national States Targeted Response-Technical Assistance (STR-TA) project, which provides ECHO-style learning collaboratives to help physicians implement evidence-based care for opioid use disorders. Learning collaboratives have focused on adolescents and medication for addiction treatment, telepsychiatry, “implementing the basics,” and a number of additional topics. Both PCSS and STR-TA are supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Clinical Support System for Severe Mental Illness (CSS-SMI)

In July 2018, APA was awarded a 5-year $14.2 million grant from SAMHSA to establish a Clinical Support System for Serious Mental Illness. The SMI Adviser website (www.SMIadviser.org) was launched in November 2018. Weekly live webinars started in January 2019, as well as virtual e-mail-based consultations to clinicians. Between January and April, nearly 1,500 clinicians participated in an SMI Adviser educational activity. Later in 2019, a chatbot-based “answer engine” will be added to the website to guide users to items in the website’s knowledge base of evidence-based resources, guidelines, and toolkits.

APA Annual Meeting

The 2019 Annual Meeting opening and convocation speakers were Valerie Jarrett, Senior Advisor and Assistant to the President for Public Engagement and Intergovernmental Affairs during the Obama Administration, and La June Montgomery Tabron, President and CEO of the W.K. Kellogg Foundation. The scientific program for the 2019 Annual Meeting included more than 650 sessions, with a special track commemorating the history of psychiatry for the 175th anniversary of APA’s founding. There were several interactive learning labs. Notable speakers included Patrice Harris, M.D., President-Elect of the American Medical Association, and Nora Volkow, M.D., Director of the National Institute on Drug Abuse.

To commemorate the 175th anniversary of the APA, the APA hosted an anniversary gala at San Francisco City Hall as well as a history track. Within the history track, there were eight workshops dedicated to the seven MUR/s as well as international relationships with APA partners and four symposia dedicated to the following four eras:

• Era 1: The advent of organized medicine in caring for people with mental illness (Early years of APA)

• Era 2: The dawn of the modern era: reforms in care and treatment (Deinstitutionalization)

• Era 3: Advancing diagnosis, treatment, and education (DSM)

• Era 4: Shaping the future of psychiatry: breakthroughs in research and delivery of clinical care (Looking ahead)

In addition, Annual Meeting booths were available, hosted by APA and APAF, offering an opportunity for members to celebrate the 175th Anniversary by contributing their story to a permanent collection held at the Melvin Sabshin, MD Library and Archives. The stories were brief clips (1–3 minutes) in which participants responded to prompts such as, “Why did you become a psychiatrist” and “What is the most meaningful story of successful treatment you can recount?”

APA’s CME Program

In 2018, the APA accredited 321 activities and delivered 1,752 hours of accredited education to 53,499 learners. The APA’s Joint Sponsorship program allows outside organizations, such as district branches and allied organizations, to apply for CME credit from the APA for their meetings. The joint sponsorship program welcomed six new organizations into the program in 2018: the Group for Advancement of Psychiatry, the Tennessee Psychiatric Association, the Iowa Psychiatric Society, the American Association of Directors of Psychiatric Residency Training, the Regional Council of Child and Adolescent Psychiatry of Eastern Pennsylvania and Southern New Jersey, and the American Society for Adolescent Psychiatry. Our joint providers held 51 meetings in 2018, which provided 320.5 possible CME credits for their attendees.

Medical Student Application Resources

Working together, the American Association of Directors of Psychiatric Residency Training (AADPRT), Academic Psychiatry, the Association of Directors of Medical Students in Psychiatry, and the APA are currently developing resources for medical students applying to psychiatry. Topics to be included in these web-based toolkits include advice on letters of recommendation, personal statements, and “how many programs should I apply to?”

Online CME Learning

The Division of Education has launched a new process for expediting the development of evidence-based online education modules. This process includes a peer review system to ensure that all our products are objective and evidence-based, aligned with APA’s vision, mission, values, and goals, and suitable for publication in the APA Learning Center. A number of activities are currently working through this development process, including new online modules on “Racism and African-American Mental Health,” “Internet Gaming Disorder,” and “An Update on Restraint and Seclusion Practices.” The Supplemental Education and Training program has also been extended into 2019, with access to online resources in our learning center for resident-fellow members.

Course of the Month Promotion

In 2015, APA began a free CME opportunity for all APA members. Each month, a new online course is promoted to members that they would be able to complete for category 1 CME credits. On average, between 600 and 900 members participate in this monthly promotion. This is a member benefit that consistently garners positive e-mails and member feedback.

Diversity and Health Equity

Workforce Inclusion and Pipeline Programs

The Division of Diversity and Health Equity (DDHE) is currently creating workforce inclusion and pipeline programs that are reflective of APA’s seven minority and underrepresented groups of psychiatrists. These programs include:

• Black Men in Psychiatry Early Pipeline Program (BMPEP): In 2018, the BMPEP was extended beyond the pilot phase into a full national program. BMPEP currently has eight participants from multiple universities and HBCUs, including Howard University (Washington, DC), Wayne State University (Detroit), Washington University (Saint Louis), Duquesne University (Pittsburg), and Xavier University (New Orleans). This specific program has representation from three of the seven APA-designated membership areas.

• Pilot Native Americans in Psychiatry Early Pipeline Program: DDHE deployed a pilot for the Native Americans in Psychiatry Early Pipeline Program in early 2018. The program’s two-fold objective is to 1) increase workforce diversity by building an early pipeline for Native Americans to enter the field of psychiatry and 2) reduce mental health disparities through education about stigma, early intervention, and prevention of mental health within underserved Native communities.

• Pilot Hispanic Americans in Psychiatry Early Pipeline Program: In early 2019, DDHE developed a proposal to increase the number of Hispanic American undergraduates entering psychiatry. The program will be deployed with at least one student by the end of 2019.

• Pilot Asian American in Psychiatry Career Advancement Program: Separate from the early pipeline programs that address recruitment of minorities into psychiatry, DDHE has developed a proposal to address the low number of Asian Americans in leadership positions within the field of psychiatry. The objective of the program is to guide early- and mid-career Asian American psychiatrists with achieving senior leadership roles through mentorship and sponsorship from expert psychiatrists. The program will be deployed by the end of 2019.

Fellowships

SAMHSA Minority Fellowship Program (MFP).

In June 2018, DDHE secured funding for a 5-year $7.1 million grant for the SAMHSA MFP, one of the oldest federally funded grants at APA.

The purpose of MFP is to 1) reduce health disparities and improve behavioral health care outcomes for underserved populations and 2) encourage more racial and ethnic minorities to join the behavioral health workforce. MFP fellows will be provided individualized support for their projects on mental health disparities as well as mentorship from fellow MFP recipients, MFP alumni, and APA leaders.

APA/APAF fellowships.

In addition to the SAMHSA-funded MFP, APAF has six other fellowship programs. For the 2019–2020 application cycle, APA/APF received a total of 199 applications across all fellowships. Sixty-nine applicants were selected for fellowships.

Medical Student Opportunities

A total of 15 medical students received the SAMHSA-funded APA/APAF Travel Scholarship to attend the 2019 APA Annual Meeting. Selections are still being made for the 2019 Medical Student Summer Mentoring Program and the Externship in Addiction Psychiatry. Applications are open for the Medical Student Elective in HIV and the Travel Scholarship to the IPS: The Mental Health Services Conference.

Other Member Updates

Communications Update

The APA held a Wreath Laying Ceremony on November 1, 2018, at the Vietnam Wall Memorial in response to an action paper titled “A Call to Recognize and Honor the Psychiatrists Who Served in Vietnam.” This tribute is to honor the estimated 200 military psychiatrists who served during the Vietnam War (see Figure 3).

For the remainder of 2019, APA will use the phrase “over 38,500 members” in its communications.

Membership Update

Due to the combined efforts of leadership, the APA Administration, and district branches/state associations, APA now has 38,617 members and is at a 17-year high in membership.

The APA Administration is deeply appreciative of your efforts and support.

Thank you for promoting the great work of this remarkable organization in your practices and institutions. Please continue to use the available resources (i.e., PPT and talking points) on our website when presenting and speaking to colleagues about the benefits of membership.

I look forward to our continued discussions and another year of the APA growing and enhancing our position in the mental health/health care field.

Report of the Speaker

James R. (Bob) Batterson, M.D.

It has been a busy 6 months since our last Assembly meeting. I have attended two Board of Trustees meetings, a meeting of the Assembly Executive Committee, of which I am chair, several area meetings, and the Federal Advocacy Conference, at which I spoke. I have also participated in conference calls with APA staff and with the Finance and Budget Committee late last fall. Following the due date for this report, I will be attending the APA/American Board of Psychiatry and Neurology (ABPN) summit in Chicago to discuss maintenance of certification (MOC), among other items.

In May, the Assembly elected Drs. Joseph Napoli and Mary Jo Fitz-Gerald as Speaker-Elect and Recorder.

The result of our work to deal with the underfinancing of areas for their meetings and basic functions resulted in cost savings in several areas of the Assembly budget, with an increase in area block grants such that the areas with higher travel costs (areas 4, 5, and 7) were able to receive a budget allowing for more regular meetings. For 4 years, we had asked the Finance and Budget Committee to be able to carry over unused funds in the area block grants and not to exceed 1.5 times the yearly block grant for that area. As per policy of APA regarding a carry-forward request, the Finance and Budget Committee and Board reviewed and approved the Assembly to carry forward unused funds for 1 year. The Assembly Executive Committee (AEC) Contingency Fund was the recipient of the accumulated surpluses from areas that had them at the end of 2018. While I am pleased that the money remains in the Assembly for 1 year, it does place pressure on us to be innovative in a fiduciary manner. There have been several successful proposals for use of the fund, including meetings for areas 1 and 7 that are in needed parts of their region, which are also more expensive. Area 3 is funding their Resident Merit Award as well.

Future Assembly speakers and the AEC will need to be actively involved with the budgets for the Assembly, with some emphasis on the block grants. When areas need to travel to more expensive locations or have a special program, they will need to work on ways to fund this. Creative solutions to manage future increases in travel costs need consideration, including use of electronic meetings for some area and AEC activities.

The Assembly listserv has remained quite active, and that points to an active and engaged set of representatives in our Assembly. I commend the work the Assembly does between meetings, and I am pleased to see the professional nature of the discussions this year on the listserv. MOC, Scope of Practice, and professional integrity regarding leadership issues in departments of psychiatry have all been discussed.

It has been a pleasure serving as your Speaker this past year.

Report of the Speaker-Elect

Paul J. O’Leary, M.D., FAPA

Greetings fellow Assembly members. Since our Annual Meeting in New York 5 months ago, I have been quite active with our organization, and here is a quick snapshot:

• APA Fall Assembly Meeting: November 2018 in Washington, DC

• AEC: February 2019 in Savannah, Ga

• Joint Reference Committee (JRC): February 2019 in Savannah, Ga

• Area 5 Meeting: March 2019 in Raleigh, NC

• Board of Trustees Meeting: March 2019 in Washington, DC

• Federal Advocacy Conference: March 2019 in Washington, DC

• Area 1 Council Meeting: March 2019 in Providence, Rhode Island

• Area 2 Council Meeting: March 2019 in New York

• Area 6 Council Meeting: March 2019 in Sacramento, Calif

• Area 3 Council Meeting: March 2019 in Philadelphia

Here are some of the issues the Assembly leadership has been dealing with since our November meeting:

• Area block grant allocation. The AEC has been reviewing proposals by areas to allocate the money for projects for this year. Area 7 has already submitted a proposal that was voted on and approved by the AEC. We are looking forward to additional proposals, as the fund must be spent by the end of the year.

• MOC activity has resulted in ABPN changes. The APA was notified in September 2017 that the ABPN plans to pilot an alternative pathway for the MOC-3 10-year exam. The ABPN has put forward a pilot program, which launched in January 2019. Diplomates who are eligible to participate in the pilot have received invitations to opt into the pilot. Based on reports from ABPN, approximately 60% of eligible diplomates have opted in. The pilot program will use journal-based self-assessment as an alternative to the 10-year exam. Over the course of 3 years, diplomates will be required to read 30 articles chosen from a broad library of approved articles. After each article, diplomates would complete a short online quiz. If they answer four of five questions correctly, they will have successfully completed one article. The article selection committee includes 10 individuals, four of which have been nominated by APA. The list of articles is available on the ABPN website. Approximately 70% are free, with another 15% free to APA members. A group of APA representatives are meeting with ABPN in Chicago in April to discuss our concerns with the MOC.

• The American Board of Medical Specialties conducting a strategic review of the MOC process across medicine, including input from multiple stakeholder groups. The APA has provided testimony to the Vision Commission (https://visioninitiative.org) sharing concerns that the APA Board of Trustees has previously expressed to ABPN, specifically:

• Ensure that MOC status is not used for licensure, hospital privileges, or insurance paneling;

• Ensure that psychiatrists receive credit for quality and practice improvement activities they are already completing within the scope of their own practice;

• Address concerns about the fees associated with maintaining certification;

• Reduce the burden of MOC as a contributor to physician burnout; and

• Ensure that APA’s investment in MOC products is not orphaned with changes to MOC requirements by the boards.

• Enacting APA Positions: State medical board licensure queries. Last summer, 2018, APA conducted research into the standards required by the ADA and caselaw interpreting it and reviewed the mental health and substance use disorder questions posed by each state’s medical licensing board applications. We concluded that 23 jurisdictions have potentially noncompliant questions relating to mental health in their medical license applications. These states are Alabama, Alaska, Arkansas, California, Colorado, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Louisiana, Maine, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Texas and Wyoming. District branches were informed of the findings for their states and can determine whether or not to notify the license board and/or post something about the board’s compliance on the district branch webpage.

• Annual Meeting Location 2021. The Board voted to move the May 2021 meeting from Honolulu to Los Angles after reviewing the cost versus revenue of the Hawaii versus other annual meeting sites. The revenue generated from the APA annual meeting is a substantial portion of the organization’s annual budget. Hence as the projected difference would be more than a million dollars between going to Hawaii versus Los Angles, the Board voted to approve the move.

• Action paper: Medication Assisted Treatment of Physicians in Treatment Participating in Physician Health Programs (ASMMAY1812.F). The JRC received a referral update and supported the Council’s recommendation regarding the action paper on Medication Assisted Treatment of Physicians in Treatment Participating in Physician Health Programs and voted to close this action. This was approved by the Assembly and Board of Trustees. In addition, the JRC requested the staff to the Council on Addiction ensure that the Action Item Tracking System include a synopsis of the work of the Council on this issue and the final outcomes of the Council’s efforts.

• Revised position statement: Hospital Privileging of Psychologists and Other Non-Psychiatrist Mental Health Professionals (JRCFEB188.B.1). In October 2018, the JRC referred the position statement on Psychologists and Other Mental Health Professionals and Hospital Privileges to the Council on Healthcare Systems and Financing to create a new position statement based on current standards of hospital care, as it is important that mental health professionals be supervised by a physician.

• The JRC recommended that the Assembly approve the revised position statement on Hospital Privileging of Psychologists and Other Non-Psychiatrist Mental Health Professionals.

• Proposed position statement: Civil Commitment for Adults with Substance Use Disorder. The JRC referred the proposed position statement on Civil Commitment for Adults with Substance Use Disorder back to the Council on Psychiatry and Law and requested that the position include a statement on substance abuse disorders and policy. In addition, the JRC requested the term “qualified” be revisited and suggested using the word “privileged” or “credentialed” instead.

• Revised position statement. Against the Use of Cannabis for PTSD. The JRC recommended that the Assembly approve the revised position statement on Against the Use of Cannabis for PTSD, with minor edits by the JRC, and if approved, forward it to the Board of Trustees for consideration.

• APA involvement with 42 CFR Part 2. Meetings with Representative Gary Palmer, Senator Richard Shelby, and Senator Doug Jones to discuss the support of workforce issues:

• 1) The passing of 42 CFR Part 2 to help physicians access their patient’s information as well as to relax the stipulations that go above and beyond HIPPA and clarify regulations.

• 2) Bringing broadband to rural Alabama to improve internet access and quality, which would assist with telepsychiatry and telehealth needs in the mental health community.

Report of the Committee on Bylaws

Esperanza Diaz, M.D., Chairperson

Members: Brian Crowley, M.D., Rudra Prakash, M.D., J.D., Robert Paul Roca, M.D., M.P.H.; Administration: Jon Fanning, M.S., C.A.E., and Chiharu Tobita.

There have not been any amendments to the APA bylaws this year.

Report of the Membership Committee

William Arroyo, M.D., DFAPA, Chairperson

Total membership at the end of 2018 reached 38,617, the highest level in 16 years. The APA has recognized a 14% growth from 2013 through 2018 (see Figure 4).

Recruitment and Retention Efforts

Retention efforts started in September 2018 by encouraging members to renew by the December 31, 2018, deadline, which is when they become lapsed members. Members must either pay dues in full or enroll in the Scheduled Payment Plan by March 31 (the grace period) to avoid being dropped. The 2019 retention efforts have increased over the prior year and included the following:

1. E-mail: Beginning in September, members received up to nine e-mails encouraging renewal.

2. Mail: Members in the United States and Canada received up to three print invoices beginning in October 2018, as well as reminder postcards from December through March.

3. The American Journal of Psychiatry (AJP): Members at risk of being dropped received a cover tip encouraging renewal on their March issue of AJP.

4. Direct payment links/online renewal: Of the members not on a scheduled payment plan, more than two-thirds are paying dues online, most using the direct payment link.

5. APA calling campaign: In February, APA conducted its annual calling campaign to members in the United States at risk of not renewing.

6. Segmented communication: Members who have not yet renewed received special editions of the popular Course of the Month e-mail beginning in December, encouraging their renewal to maintain access to this benefit.

7. Digital and social media advertising: APA increased renewal awareness on Facebook and Google, both of which performed very well, and we will be expanding our presence for reinstatements.

8. Exhibiting: APA promoted membership when exhibiting at IPS, AACAP, WPA, AADPRT, the Nevada Psychiatric Association, and AMSA during the renewal period (September–March), where more than 130 members joined, renewed, or reinstated.

Promoting Member Value

In 2018, members received regular communication via e-mail regarding member benefits and services, including the following:

1. The Course of the Month program

2. PsychPRO: APA’s Mental Health Registry

3. Early-career psychiatrists (ECPs) free online Focus subscription, including easier ability to access subscriptions

4. Lifelong member e-mail, providing information to those members at or nearing retirement

5. Member Advantage, which promotes a variety of member benefits and discounted learning opportunities

6. Resident-fellow member (RFM) and ECP listservs relaunched in November 2018, which currently have more than 150 and 1,300 participants, respectively

If you’re not receiving your Course of the Month e-mails or other communications, log in to my.psychiatry.org and select Communication Preferences, or contact [email protected] for assistance.

RFMs and 100% Club

APA ended 2018 with a 13% year-over-year increase in both the number of residency programs participating in the 100% Club and number of residents training in 100% Club programs. This is especially significant retention given that the 100% Club has increased nearly 50% since 2015 (see Table 1).

To support the 100% Club, Membership and APA Publishing have collaborated over the past few years to create new products used as free benefits for residents, including the Pocket Guide to Psychiatric Medications for Depression and the Pocket Guide to Antipsychotic & Substance Use Disorder Medications. The latter in the series, released in early 2019, is designed to increase residents’ awareness of APA expertise on clinical and practice topics.

Throughout 2019, we intend to 1) increase awareness of the new benefits of the 100% Club among nonparticipating programs (including access to free online buprenorphine prescriber training), and 2) encourage additional programs to take advantage of institutional billing to streamline the onboarding and renewal of resident members.

How Members Can Participate

Our psychiatric community grows stronger as our members are more active and engaged. Here are five small ways you can participate in the APA membership strategy:

• Complete your APA profile. Let us know about your interests and practice to help us better serve you with resources and benefits that are relevant to your daily life. Log in to my.psychiatry.org to update or complete your profile.

• Participate in grassroots advocacy. Participating in national calls-to-action and working with your district branch to visit and build relationships with your local legislators are essential to ensuring that psychiatry has a seat at the policy-making table. Learn more about APA advocacy efforts and issues at psychiatry.org/advocacy.

• Converse with your colleagues. The Member Outreach Toolkit equips you with talking points to have meaningful conversations with your colleagues about APA membership. Access the toolkit at http://apapsy.ch/outreach.

• Stay in touch. We want and need to hear from members to ensure that we are building value that is relevant and important to your daily practice. Contact us any time with your feedback at [email protected].

• Get involved. There are a variety of ways for members to participate in the Association, from leadership roles and committee participation to contributing articles to Psychiatric News. Need help getting started? Contact us at [email protected].

Assisting District Branches and State Associations

The APA membership department supports the two state associations and 71 of 74 district branches to help grow and support membership by:

• Sending out dues notices

• Collecting dues and special assessments

• Completing transfers between district branches when members move

• Tracking revenue and allocating dues payments and monthly reports to the district branches/state associations

• Paying all credit card fees for district branches/state associations for member renewal and acquisition transactions

• Providing directors and officers insurance coverage for district branch/state association leadership

Additional assistance is provided to all district branches/state associations, including:

• Conducting monthly webinars to train district branches/state associations and their staff how to use the District Branch Window for operations and reports

• Facilitating innovative, expedited, infrastructure, and CALF grants

• Holding President/President-Elect orientation at the Annual Meeting

• Supporting state/district branch government relations

• Coordinating monthly DB/SA executive calls with Dr. Levin

District Branch/State Association Competitive Grant Process

There are two grant processes, expedited grants and innovative grants. Expedited grants are intended to be accessible to all district branches/state associations that apply. These grants, funded at $150,000, are equally divided among all applicants that adhere to the application process and are immediately processed and funded upon receipt of the grant agreement. In 2018, 53 district branches/state associations applied for and received grants in the amount of $2,830.18 each.

The innovative grant process is more rigorous and includes funding criteria calling for new, creative, and innovative ideas that may be replicated by other district branches. The Membership Committee is charged with evaluating grant submissions leading to a formal recommendation for funding to the Board of Trustees. The total available funding for innovative grants is $30,000.

In 2018, 11 district branches/state associations submitted grant applications. At its December 2018 meeting, the APA Board of Trustees approved grants to three district branches/state associations. The amounts and a brief description of each project are summarized in Table 2.

The Membership Committee looks forward to another year working toward continued growth and collaboration across the Association.

Report of the Committee of Tellers

Jose P. Vito, M.D., Chairperson

Members: Edythe Harvey, M.D.; Steven S. Sharfstein, M.D.; Administration: Jon Fanning, M.S., CAE, Chiharu Tobita.

Eligible voting members in the 2019 Election received either an electronic or paper ballot (for election results, see Table 3). Voting members with an e-mail address listed in the membership database received an electronic ballot on January 2, 2019, while voting members without an e-mail address listed in the membership database received a paper ballot postmarked January 2, 2019. As an alternative to using the electronic or paper ballot, eligible voting members could access their ballot through the APA Election website (www.psychiatry.org/election) using their psychiatry.org username and password.

The election management firm, Survey & Ballot, managed the distribution and tallying of ballots while providing technical support to voting members.

Voter turnout for the 2019 Election was 18%, with 5,525 of 30,776 eligible voting members participating.

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,” more than 95% rated that they were “satisfied” or “very satisfied” with their experience.

Report of the Elections Committee

Josepha A. Cheong, M.D., Chairperson

Members: Tanya N. Alim, M.D., Fructuoso R. Irigoyen-Rascon, M.D., Justin W. Schoen, M.D.; Administration: Jon Fanning, M.S., CAE, Chiharu Tobita.

Campaigning in the 2019 APA Election began with the announcement of candidates on October 15, 2018, and ended with the voting deadline on January 31, 2019. The voting period started on January 2nd at 7:00 a.m. (EST) and ended on January 31st at 11:59 p.m. (EST).

The Committee met with the candidates via conference calls to review the APA Election Guidelines in the beginning of the campaign period starting with the announcement of the final slate. The Elections Committee was available for questions or concerns from candidates, their supporters, and the APA membership and provided clarification to the Election Guidelines when it was needed.

The Elections Committee is pleased to report that the 2019 APA Election ran smoothly overall.

There have only been a couple of major violations of the Election Guidelines, which were appropriately addressed and resolved by the Committee during the course of the election campaign:

1. Violation of the APA listserv policy:

• 2. Violation of the District Branch newsletter policy: