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Two years ago APA began a concerted effort to respond more effectively to the needs of psychiatrists recently out of residency and to include them in all phases of Association governance. Now the results of a survey sent to those early career psychiatrists (ECP’s) are providing APA with data sketching a portrait of those psychiatrists and showing what they want from their professional association.
Some of the responses from these psychiatrists who represent the future of the specialty - and of APA - are predictable, while others are surprising.
It would be expected, for example, that ECP’s, who are defined by APA as being under age 40 or in their first five years of practice, are troubled by the impact of managed care on their profession - and they are. But women ECP’s believe that access to and the quality of continuing medical education will exert more influence on their professional development than will the influence of managed care. They also rated opportunities for "professional contact" higher among their priorities.
Men rank managed care as the most important professional issue, with CME and professional advocacy/governmental affairs close behind on their priority list. For both men and women ECP’s who work in state or other governmental clinical settings, managed care is less critical an issue than it is to those in private practice or academic settings.
Both groups place mentoring further down in their rankings, though women ECP’s attach significantly more importance to that issue than do their male colleagues. The more recently the ECP had completed residency, the more significance he or she assigned to mentoring relationships. Neither group assigned a great deal of importance to the availability of a job bank linking them with professional career opportunities.
The survey sample was also asked to indicate the relative importance of several issues related to their views of membership in a "professional medical organization." The survey question did not specifically cite APA.
Both men and women ECP’s assigned the same relative ranking to the six issues about which they were questioned. The cost of membership dues headed the list of concerns, followed in descending order of importance by the financial value of membership; receipt of journals, newspapers, and other publications; comraderie/fellowship; other services the organization offers its members; and the availability of malpractice and disability insurance.
Several narrative questions did solicit views specifically about the perceptions ECP’s have of APA. The Association’s strengths, according to the survey respondents, are its journals and other publications, including those of the American Psychiatric Press Inc., meetings that offer CME opportunities, and the influence APA has in the political arena.
The amount of APA dues was by far the aspect of the Association that ECP’s most disliked, with its stands on political or social issues and difficulties in dealing with the APA bureaucracy also cited by some respondents.
The amount of APA dues presents a particularly difficult burden for ECP’s because the obligation comes at a time when most are facing the start of careers that involve considerable managed care work and thus lower earnings than many of their older colleagues faced at a similar point in their careers, said Theresa Miskimen, M.D., in an interview with Psychiatric News. She is chair of the APA Assembly’s Committee of Early Career Psychiatrist Representatives and is the ECP representative for Area 3.
Also confronting the early career psychiatrist, Miskimen added, is the prospect of paying for the board-certification process, many more years of education loan repayments, and a dues level that has just increased over what they paid as residents.
ECP’s are constantly "weighing the amount of dues required to belong to APA against the value they receive for them," observed Laura Roberts, M.D., an assistant professor at the University of New Mexico and the ECP deputy representative for Area 7. Her colleagues particularly value APA’s educational opportunities and the publications they receive, but often calculate the cost of these benefits and decide that it is far cheaper to purchase them independently than to join APA to get them, said Roberts, who is a coauthor of the survey.
Another money-related factor, Miskimen pointed out, is that many ECP’s have also joined subspecialty organizations in psychiatry and must pay those dues as well. She offered two suggestions that might make APA dues more palatable to ECP’s - APA could agree to reduce its dues as an offset for members who also have paid dues to a subspecialty organization or APA could prorate its dues for psychiatrists who are in the first five years of postresidency practice. It is in those five years that most of the ECP’s who decide to drop APA membership take that step.
The survey was mailed to about 1,000 ECP’s in 1996, of whom 310 responded. The respondent sample was nearly equally divided between men and women. About three-fourths of respondents are board certified by the American Board of Psychiatry and Neurology - the same proportion as the overall APA membership, and 20 percent of ECP’s are certified in child and adolescent psychiatry or have a certificate of added qualifications in geriatrics, addiction treatment, or forensic psychiatry.
The ECP’s were also asked about the settings in which they practiced. With respondents able to indicate more than one practice setting, the results show that 62 percent spend at least some time in private practice, while 32 percent work in state or other government-run clinical settings. In addition, 31 percent are clinical attendings in academic settings; 24 percent do some teaching; 18 percent work in professional organizations; and 17 percent are affiliated with HMO’s. About 15 percent of the respondents are engaged in psychiatric research. One-fourth work in still "other" settings.
This survey was sent only to ECP’s who belonged to APA, and Roberts and several of her colleagues are developing a new survey that will be sent to ECP’s who have dropped their APA membership or never joined the Association. Roberts said that "APA’s decision to recognize ECP’s was a beautiful move," but it now needs to articulate more precisely the needs of this group of psychiatrists. The new survey is designed to develop a more comprehensive picture of why these psychiatrists rejected the opportunity to be members of APA and what the Association can do to make membership more valuable in the eyes of these psychiatrists.