By John P.D. Shemo, MD, DLFAPA
Medical Director, Psychiatric Alliance of the Blue Ridge
Associate Clinical Professor, University of Virginia
The Area 5 spring 2025 meeting was held virtually on Saturday, February 22, and Thursday, February 27.
For new Psychiatric Society of Virginia members, when the American Psychiatric Association Assembly was founded, there were relatively few psychiatrists in the Southern United States. Area 5 extends from Florida in the south to Virginia and West Virginia to the north, Oklahoma and Texas to the west, and also includes Puerto Rico and the military district branch. It is, thereby, the largest of the seven APA areas and, in terms of vote by strength, it alone with any other of the areas could represent a majority if voting in full unison.
One of the benefits of both Area Meetings and the full Assembly Meeting is the opportunity to learn what is happening in other states, both positively and problematically.
At this meeting, we had a discussion about the variability in the states regarding insurance reimbursement rates and policies. In some states, the insurance entities are reimbursing all practitioners, regardless of their degree or length of training, the same for each reimbursement code. Thus, nurse practitioners and physician assistants are reimbursed at the same rate as psychiatrists in those states for both medical management and psychotherapy codes.
Not surprisingly, this is leading some healthcare systems to preferentially hire practitioners with lesser training, as the system collects the same reimbursement for their services from insurance, but pays the lesser trained practitioners less, leaving more “profit” for the healthcare system. This increased use of lesser trained/experienced practitioners in turn leads to an increased use of “protocols” rather than individualization of care.
At the national level of the APA, the integration process of recent staff turnover continues. The Assembly has given assurance that the APA is financially secure. Budgetary adjustments, however, are being proposed and implemented that will impact the nature of the organization. One such “adjustment” is that there will be more virtual rather than “live” meetings of the Assembly and the Areas. This, of course, did occur during the COVID pandemic. In this context, it was clear that virtual meetings, especially large ones, are less productive in both quantity and quality of work than what occurs in person. It is estimated that virtual meetings have about one-third the output of live meetings. At the last “live” Assembly Meeting held in Chantilly, Virginia, in November 2024, 42 Action Papers and Position Statements were processed – far more than at preceding virtual meetings.
While, if need be, we can learn to be more productive in virtual meetings, it remains my observation that a lot is lost in terms of the breadth of input, the energy of debate, and the ultimate sense of consensus.
The APA is also looking at options for potentially altering district branch numbers, and/or setting imposed term limits for members, rather than leaving this to the discretion of the district branches and other entities that have representatives in the Assembly, such as allied organizations.
It has been my, and others, observation that good deliberative bodies have a mix of “new blood” in members with experience with the organization and knowledge of what has been tried in the past – how and why past attempts at problem solutions did or did not work.
The Assembly does have steady turnover and is reasonably reflecting the demographics of our membership. It is of value to the APA membership to have representatives in the Assembly with historical perspective that matches or exceeds that of the APA staff and board. It increases the weight of the Assembly’s influence and it is not to the memberships’ benefit to have this lost.
Despite these observations and concerns, having a strong professional organization is critical to our and our patients’ wellbeing in an ever changing world. Please encourage your colleagues who may not be APA members to join. Larger numbers clearly provide more influence in the legislative arena.
As always, Adam, Sherin, and I are always available, as your Assembly representatives, to discuss your concerns in the Assembly form and to potentially craft Action Papers addressing those concerns.
