Jeffrey Geller, MD, MPH
Candidate for APA Area 1 Trustee 2012 Statement
Jeffrey Geller, MD, MPH
Candidate for APA Area 1
Trustee 2012 Statement
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To reduce the gap in medical service, I shall propose vigorous steps to combat the misery and national loss involved in mental illness." President Eisenhower, 1955
APA members face old quagmires that have lingered since well before Eisenhower’s State of the
Union message, and face new ones with potentially harmful outcomes for our members and our patients. A sense of never-ending problems and challenges can be appreciated from how contemporary former APA Presidents’ annual speeches sound:
The greatest therapeutic error is administering too much medication (Everts, 1886).
The populations of our hospitals could be reduced and better served in non-institutional care (Barrett, 1922).
The complexities of modern hospitals contribute to a loss in dealing with patients as individuals (White, 1925).
Psychiatrists face a myriad of problems: loss of psychiatrists as the leaders in mental health services; reimbursement at less than the cost of providing treatment; marginalization in health care reform, i.e., no seat at the table; shifts to less expensive practitioners (APRN, PA, MSW, Psychologist); devalued billing codes; inadequate numbers of minority psychiatrists, e.g., Hispanics, African Americans; and a loss of trust in psychiatrists. Our patients fare far worse: rising numbers of the uninsured, health care disparities, rising medication costs with shrinking formularies, medications causing the metabolic syndrome and early mortality, homelessness, substance abuse, and a greater likelihood of ending up in county jail than in a state hospital.
The current APA Vision Statement should focus our work:
The APA is an organization of psychiatrists working together to ensure humane care and effective treatment for all persons with mental illness, including substance use disorders. It is the voice and conscience of modern psychiatry. Its vision is a society that has available, accessible quality psychiatric diagnosis, treatment and prevention.
Too many in and outside the APA say we’ve lost our focus.
APA leadership must refocus its efforts to turn the APA vision into reality.
The APA Board of Trustees must lead the membership to:
Attack stigma and discrimination directed at psychiatric patients and psychiatrists.
Provide tools and supports for treatment of co-occurring psychiatric and substance abuse disorders.
Attend to specific needs of each minority, underrepresented and IMG group of psychiatrists.
Advocate with zeal and passion for our members and our patients at every health reform decision point.
Participate fully in the integration of psychiatry and medicine.
Advance Child/Adolescent psychiatry up APA’s list of priorities.
Sit at the table when alternatives to current healthcare insurance are considered, including the migration of a variant of Canada's single payer system.
Ensure treatment provided by APA members shall be appropriately valued and reimbursed.
Ensure outpatient/inpatient psychiatrists shall have reasonable caseloads, safe working environments, and realistically be able to provide psychotherapy.
Nurture Residents, Fellows, and Early Career Psychiatrists in their education and transitions.
Like any good treatment plan, each of these goals needs interventions. If elected, I would work to create these with the President, Board of Trustees and membership. I would report to you, the members of Area 1, on a regular and ongoing basis.
There should be no doubt that if we responsibly improve the practice of psychiatry, we will dramatically improve the care and treatment of psychiatric patients.
There should be no doubt that if we do not, psychiatry will be marginalized to the precipice of extinction.
In 1878, Andrew McFarland described the American Psychiatric Association as follows:
It has presented the noblest incentive under which men can act. It has stimulated the loftiest ambitions, it has kept pure and unsullied the most philanthropic purposes. It is the furthest possible remove from a "guild" to promote selfish ends.
Let us strive to achieve this characterization of the APA.
I welcome your feedback and support.
Je me félicite de vos commentaires et de la prise en charge.