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In the last column, we looked at how two new district branch presidents addressed their membership on the issues on which they plan to focus in the coming year. This column highlights the plans and concerns of two more newly elected DB presidents.
While the presidents of the Ohio and North Carolina DB’s focused on the need for increased member participation, the two presidents featured this time express concerns about being able to represent fully the diversity of their respective organizations.
"We are an odd lot," writes Thomas Carli, M.D., the new president of the Michigan Psychiatric Society in the May-June issue of the Michigan Psychiatric Society Newsletter (Beth Goldman, M.D., editor). "The membership of MPS must truly be as diverse a collection of individuals as can be found in any organization in this country. We range in age from late ‘lifers’ to wet behind the ears. Our profession has one of the largest proportions of women in any medical specialty. We have members who are straight, gay, lesbian, and bisexual. We have almost the complete rainbow of skin colors and representatives from just about every region of the planet. Our members speak more than 47 different languages, ranging from Arabic and Armenian to Urdu and Yiddish.
"Every major religion in the world is represented. We work in state, county, and local governments, managed care organizations, solo and group private practices, academic medical centers, prisons, community mental health centers, and medical-surgical settings. We have practitioners who are salaried employees and others who operate their own small or large businesses. We have psychoanalysts and psychopharmacologists. Our members take opposite positions on numerous current issues such as assisted suicide, nurses’ scope of practice, managed care practices, etc. We are a remarkable collection of absolute diversity."
Viewing the astounding diversity of the more than 1,000 members he has been elected to represent, Dr. Carli is puzzling over several questions that will affect his decision making: "What unites this diversity? As the president, executive committee, and elected representatives to Council consider numerous issues, how are we to determine what our members want? This is especially problematic because so many of our members are silent. The recent MPS survey is one effort to find out who our members are and what they value.
"Harold Eist told me that when he was president of the Maryland Psychiatric Society, he had every member over to his house in small groups to get to know them over coffee and dessert. Harold had a two-year presidential term and a unique populist approach (not to mention a wife with the tolerance of a saint). I don’t think I can approximate his dedication. But I do intend to reach out this coming year through visits to chapter meetings. I also intend to call on you to help serve on time-limited task forces and special-issue groups."
Dr. Carli recognizes that few MPS members can commit to open-ended tenure on the DB’s standing committees, but he hopes that a sizable number will "find time to participate in constructive tasks around meaningful issues."
Dr. Allan Brock Willett, M.D., is the incoming president of the Colorado Psychiatric Society. Writing in the June issue of that organization’s newsletter (Drs. Claire Zibler, Deborah Stetler, and Laura F. Michaels, editors), Dr. Willett observes that CPS’s election process probably has not provided an opportunity for most members to become familiar with his views on critical issues facing psychiatry and the district branch. He, too, is concerned that he may fail to represent the views of the majority of his members.
"To avoid [the election of a new DB president] being a Kafkaesque metamorphosis, I choose to hearken back to the themes and perspectives of previous CPS presidents," Dr. Willett writes. "I am aware that managed care remains the foremost professional concern on the minds of most members. Each of us has achieved a certain meta-stable equilibrium with this ever-evolving model for the delivery of psychiatric care. We are all affected significantly, and we know that we must change in some way to adapt to managed care."
He then goes on to explain some of his views on managed care, particularly on the need to develop standards to measure the quality of care. He cites previous newsletter articles that "separated out the issues of managed care into cost, access, and quality. . . ." He notes that "even though APA and CPS have been effective in various venues in dealing with cost and access issues, the matter of defining quality has a long way to go."
He acknowledges the role of the National Committee on Quality Assurance, which sets minimum standards for managed care organizations, but points out that the NCQA’s efforts are only a start. "There remains a lack of consensus about the appropriate measures of quality of care. Various regulating, accrediting, and funding groups, both public and private, are trying to develop reliable measures of quality by defining critical pathways and expected outcomes." But he emphasizes that it is the responsibility of psychiatrists to "directly, immediately, and significantly lead this discussion wherever it occurs. To do this, we must accept the need to open our treatments to review and measurement for other than scientific purposes and accept the view that our patients, as our customers, provide an essential perspective about what we do."