PENNSYLVANIA
APRIL 2021
P S YC H I A T R I S T NEWSLETTER OF THE PENNSYLVANIA PSYCHIATRIC SOCIETY
PRESIDENT’S MESSAGE
By Richard R. Silbert, MD, DLFAPA PaPS President
Hello to my fellow psychiatrists. I am writing this summary of my perspective of our Society’s activities on a sad morning. We just heard of Dr. Larry Real’s passing. If you are not either from the Philadelphia region or on statewide committees, you might not know he was a true champion and inspiration in his professional endeavors especially as it relates to public psychiatry. I hope you all can view his accomplishments and if appropriate, offer sympathies to his family and loved ones. Meanwhile the PaPS remains very active advocating on your behalf as to several critical concerns: 1. O ur all-too-common COVID-19 stressors include the well-known need for PPE and access to vaccines, but also support for reimbursement on a continuing basis for telepsychiatry. We also advocate for the use and reimbursement for phone (audio) only services since some of our patients either live in rural areas with poor internet signal or many who cannot afford computers or phones capable of video meetings. 2. W e partner with the PPLC (PA Psychiatric Leadership Council) in efforts to remediate racial disparities and structural racism. These efforts included a roundtable summit for African American psychiatry residents and the first of four learning collaboratives which was very well attended and received by residency directors from across the state. We will change our logo and award nomenclature to be sensitive to concerns of Benjamin Rush and his history as a slave owner. 3. The Society has been partnering with APA and PAMED’s government relations experts to strategize on alternatives/solutions to counter proposed legislation being advocated at the state level to allow prescriptive authority expansion for licensed clinical psychologists. Although all scope of practice issues are extremely complex and politically sensitive, the tireless dedication of our staff and leadership will ensure success. 4. T hanks to our education committee and its leadership, we have had multiple superb virtual webinars that were well-attended and continued to provide for our CME and licensing requirements. A silver lining in the COVID times – the esteemed presenters offered their expertise with little or no cost to us. Before concluding and hoping you go enjoy beautiful spring weather while staying safe, I must alert those of you not on Council, that we have spent a great deal of time discussing our Society budget concerns that have existed several years even before COVID-19 affected sources of revenue, such as sponsors. Without changes, we would very much risk exhausting our assets. To do good, we must be good. As such, proposal requests have been sent out both to other and our current administrative management services, seeking services necessary to fulfill our goals and mission at affordable costs. Thank you all for the work you do to further our profession and your patients.
Rich
TABLE OF CONTENTS 3 | Editor’s Column 4 | Activity Update 6 | Executive Director Update 7 | APA Trustee Board Report 10 | Calendar of Events 11 | Area 3 Update 15 | Resident Update 16 | PaPS New Members
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CLASSIFIED AD The Capital Area Intermediate Unit has an opening for a contracted, part-time, Board-Certified Child and Adolescent Psychiatrist to provide professional consultation to our team of mental health professionals and/or treatment services to students attending our programs. Services would be provided at Hill Top Academy in Mechanicsburg, PA. We can be flexible with time commitment and options for virtual services. For more information or to discuss further, please contact Patrick Rieker, Psy.D., 717-732-8484 x8265, prieker@caiu.org.
E D I T O R ’S C O L U M N Chronic—The Book by Edward C. Leonard, Jr., MD, DLFAPA
The third author, Kristin Loberg, uses her professional writer skills to weave the ideas of Stephen Phillips and Dana Parish into an engrossing story. Phillips, a physician, finds that many multisymptom patients have long-lasting infections. Parish is his former patient and a Lyme Disease activist. Loberg has edited many best-selling books and it looks like Chronic: The Hidden Cause of the Autoimmune Pandemic and How to Get Healthy Again will be another. It is well worth a psychiatrist’s attention. The reader will learn about many vector-transmitted diseases--how to test for them and what may help. Phillips and Parish criticize physicians who rush to use autoimmune treatments without looking for possible causative infections. They suggest that long-lasting medical, neurologic, and psychiatric disorders may be caused by chronic infections. This book can be divided into three parts, but the boundaries are faint. Careful reports of research, painful memories of illness, and enthusiastic treatment testimonials interact to show the role of infection. The primary authors suffered greatly during standard treatment for their initially ignored Lyme Disease. They ultimately improved with prolonged use of rationally selected antibiotics given in pulses and not continuously. They describe many therapies that helped maintain them while the disease raged, probably causing PTSD. Somatic Experiencing and EMDR are praised.
The book generally provides pertinent facts without undue repetition. However, I find it ludicrous that Phillips always admonishes the reader to check with doctors before starting any treatments, although he constantly quotes patients as finding their doctors are ignorant. His advice may be needed to document that there is no doctor-patient relationship on which to base a lawsuit against the authors, but it becomes a distracting drone. Chronic ends with a comparison to Ignaz Semmelweis who discovered 150 years ago that there were fewer patient deaths when obstetricians, after doing autopsies, washed their hands and instruments and rinsed with a chlorine solution. His peers mocked his ideas, and he died with his research unaccepted. Does Dr. Phillips imply a similar sad fate for his book’s teachings? Probably not, for he ends with a militant plea: “We need to wash our hands clean of the dirty politics of medicine and forge ahead with resolve to end the scourge of chronic and autoimmune diseases with science.” I wish each of the quoted testimonials came with a research grant because too much remains too little studied.
The section on COVID-19 continues Chronic’s discussion of the inadequacies of many physicians by detailing the challenges facing adoption of repurposed generic medicines. Physicians are seen as herding together to avoid examining new research findings. Economic realities also may be involved. The companies developing off-patent medicines have no multi-million-dollar budgets to buy advertisements in medical journals, and reprints of the favorable articles their editors accept. Generic manufacturers cannot afford large public-relations staff to foster positive media stories. They have few staff devoted to flattering interactions with regulatory agencies’ officials and have no positions open for former government employees. Perhaps crucial to lack of respect for repurposed medicines is that generic companies make few political contributions. Is it possible that some pharmaceutical businesses encourage attacks on inexpensive repurposed medicines to protect potential profits from their newly patented drugs?
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by Deborah Shoemaker, Lobbyist and Ethics Specialist
ACTIVITY UPDATE Spring Forward…Fall Back In our family, spring was serious stuff. Although not officially “spring”, we celebrated St. Patricks’ Day (yes, I am part-Irish) with getting that annual Shamrock Shake at McDonald’s. Easter was very sacred and serious to the Hildesheim family. It began every Christmas when my Aunt Pearl would buy us our Easter dresses at the Sears down on Cottman Avenue. On Easter Sunday, we would go to church and then go out to eat with all my Hildesheim relatives—various restaurants in Northeast Philadelphia and then did the egg hunt. I will always hold these memories dear to my heart, especially since my parents are gone. The real reason why spring has a special meaning to me is because its commencement brings a new awakening—maybe because of Eastern Standard Time, maybe because of the weather. But to me, it signifies new life, new beginnings, new possibilities. Such as in the world of politics. I would like to highlight issues that we are springing ahead but making sure we do not fall back.
COVID-19 and new possibilities Spring forward: At the beginning of 2020, our district branch began to collaborate with the Pennsylvania Psychiatric Leadership Council (PPLC) to hold weekly Zoom meetings providing a forum to discuss COVID-19, share stories and support each other during this difficult time. It was an hour each week that was an “informal” support group to brainstorm on how to provide care and find alternatives to traditional practice to ensure that needs were being met during this pandemic. It continues on a bi-monthly basis. Accomplishments of this project include at least one letter to the editor published in the commonwealth, with others in the works. We also have been working closely with the Wolf administration to provide guidance and expertise as policies are developed and implemented. COVID-19 has caused a malaise in many of our lives. Pennsylvanians are itching to visit friends and family—without masks or limitations. They want to go see their sports teams, favorite musician, or even just eat out without having to feel limited. I think their time is coming…very soon. Within the state legislature, bills continue to be introduced to provide additional liability coverage for workers, along with other initiatives to ensure a smooth transition now and, God forbid, we have another pandemic in the future. Although many proposals are well-intentioned, they are fraught with partisan politics—blaming one party over another in how vaccines are distributed, who gets top priority, which entities get top billing with always “a better way to do it.” Partisan politics has caused the filing lawsuits/intense scrutiny on how nursing homes
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were regulated during the pandemic. The restaurant industry and other entities, who previously experienced some sort of regulation/limitation on patrons, also have cried foul. Fortunately, spring is here. As many of you are aware, April 4th signified a new beginning in PA—where occupancy limits for dining establishments, indoor and outdoor entertainment, and sporting events were revised to allow more personal interaction. Although still difficult, vaccine distribution has commenced at a more rapid pace over the past few weeks. Again, still not optimal, but we are going in the right direction.
Fall back: Unfortunately, the COVID-19 pandemic has, from the start, been politicized. The wearing of masks became a political statement. Whether or not people got the vaccine was not just determined by availability, but it became a further issue as to what was in the vaccine, who was profiting, if Republicans or Democrats really can take credit for the distribution, and most importantly, if another stimulus check will help the economy and its citizens or just usher in “another round of entitlements and government waste that we saw under President Franklin Delano Roosevelt.” We have come too far to fall back. We need to keep moving ahead.
Protections for Physician Practice While Maximizing Patient Affordability Spring forward: A new legislative session means a fresh start for all proposals. This past legislative session was unlike many others via the world pandemic’s role in the delivery of patient care. In-person outpatient care was replaced with online or audio telemedicine visits. Prescribed medications and other treatment/services (which previously needed prior authorization) were often relaxed during the pandemic. But how long will take last? Prior to the end of the 116th United States Congressional session, the No Surprises Act was signed into law. The primary focus of this Act was to protect patients from Out of Network/Surprise Billing and to determine a more equitable way for providers to bill insurance companies for their services. Our Society has been monitoring this issue for many years at the request of our medical specialty colleagues. Our leadership and I have participated in numerous provider coalition calls and have supported grassroots lobbying efforts to ensure that patient medical costs were not so onerous to inhibit or create barriers to care. After careful review by various physician provider organizations (including the AMA, APA, the PA Medical Society, and our medical specialty colleagues within anesthesia, emergency medicine, pathology, and radiology), it was determined that the federal Act satisfies concerns at the state level. PaPS recently signed onto a joint provider letter to members of our state House to request further deferred action at this time. For more information about the No Surprises Act or our grassroots advocacy efforts, please contact me.
Our work is not done. So far, we have accomplished the following: 1) held a resident roundtable for APA/PaPS member RFMs who self-identify as Black psychiatrists to discuss challenges, concerns, opportunities and to network on future endeavors. This roundtable was facilitated by three of our Black psychiatrist members in the Philadelphia area. We plan on compiling findings from the event and work on next step(s).
Another legislative initiative near and dear to all our hearts is prior authorization. For numerous legislative sessions, attempts have been made to severely limit and/or eliminate onerous prior authorization policies being imposed by commercial (and sometimes publicly covered) insurers. With a powerful insurance lobby and limited consumer input, our efforts have not been successful. However, this spring seems different. Grassroots advocacy efforts have begun in earnest. More consumerfocused healthcare organizations are at the table, engaging their members. The Society has already sent out one member alert on this issue with the promise of more solicitations. Senate Bill 225 has been filed and House Bill 225 should be filed soon. I am very optimistic that this will be our year.
Fall back: As with all reimbursement issues, the insurance lobby is strong. Providers and healthcare facilities are often pitted against each other or mischaracterized as greedy, self-serving and/or not willing to take patients on a sliding scale or those uninsured or underinsured. These misrepresentations of your life-long dedication and often painstaking personal and professional sacrifices are, quite frankly, personally insulting, and devoid of any truth. The only way to change that perception is to continue to educate our state and federal officials and their staff on the crucial role of the physician-patient relationship and how any barriers to treatment can cause adverse outcomes or impede recovery. I think our work is always cut out for us, so we can only fall back if we do not do our part in fighting for our patients.
2) created model curriculum and drafted a resource list on diversity, the Black psychiatric experience, and historical documents. These documents are being finalized and continue to evolve. They will be placed on the PPLC website for use by the public and those interested in learning about this project. 3) PPLC Executive Director David Dinich and myself, reached out to every psychiatric residency director across the commonwealth to invite them to join a residency program collaborative on race, and how to change how residency programs train their residents on structural and institutional racism and health inequities. Although we did not have 100% participation as of this date, we were successful because we recruited Society members to work with us on personal contacts to encourage participation. Our first collaborative was held on March17th at 3 PM. This meeting had representation from most if not all residency directors (or their delegate), discussing their current programs and their work in educating their residents and/or faculty in the areas of implicit bias, structural racism, and in the creation of a welcoming culture for all individuals within and outside their walls. Future monthly meetings will be focused on our statewide Black psychiatric residency collective, curriculum/training, and how to recruit and retain diverse and integrated psychiatrists. 4) applied for APA Assembly’s District Branch Practice Award. Although we did not win, we will continue to share our experiences with those district branches within Area 3 and beyond.
Striving for a More Equitable, Unbiased Approach to Training Our Future Psychiatrists
Next steps for our Task Force on Racism are to continue our work, extending it to discussing the experience of all psychiatrists of color, of women psychiatrists, of the LGBTQIA psychiatrists, and any group seeking the need to address inequities within the behavioral health arena. For that reason, we believe this project will continue to evolve over the next few years. This work has been successful through the collaboration between our Society and the PPLC, and the dedicated members who want change.
Spring forward:
Fall back:
With the tragic deaths of Ahmad Arbery, George Floyd, and Breonna Taylor (among others), our Society and the PPLC replaced our weekly COVID-19 calls with a weekly discussion on racism, especially the experience of Black psychiatrists. It was our goal to focus on Black psychiatric residents/ECPs and to provide a forum for change across the commonwealth.
The APA has opened the door for change and a new path is being forged to break down structural and institutional racism barriers, and to atone for the sins of our psychiatric forefathers. Some APA members have not been satisfied with the work of the task force on racism, including the Board of Trustees’ public apology to all members, patients, families and even members of the public for historical policies and actions negatively affecting Black, Indigenous and People of Color (BIPOC). Although I understand an apology cannot erase history, this is a critical start to moving to affect change. We can only fall back if we let our anger cloud our vision, or willingness to move ahead.
We created a Task Force on Structural Racism, co-chaired by myself and Mary Anne Albaugh, MD (APA Area 3 Assembly member, among her many duties). The task force split into two subcommittees: a subcommittee on education, curriculum and training and another subcommittee on recruitment and retention.
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Our subcommittees are comprised of numerous members, including Dr. Kenneth Certa (our Area 3 Board of Trustees member), Dr. Richard Silbert (our president), a few of our APA Area 3 Assembly representatives, and leadership at the state and chapter level. P E N N S Y L V A N I A P S Y C H I A T R I S T | A P R I L 2 0 21
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ACTIVITY UPDATE Continued from page 5
Enhancing Practice of Medicine While Promoting Appropriate Access to Care Spring forward: Change is inevitable, especially when we are living in a world that changes not just daily, but by the minute. Healthcare delivery is no exception to the rule. Within just one year, telemedicine is the norm. These technological advances, along with the increased healthcare needs of our citizens, force all healthcare facilities and those providing services to be creative with not just how they deliver care, but how to recruit and retain highly qualified and appropriately trained healthcare personnel. As we navigate in this new healthcare arena, where insurers are looking to reduce their costs while providing “quality care” in a post COVID-economy, how do we proceed? What solutions can we suggest ensuring that each healthcare provider practices within their level of education and training and not beyond their scope? Not an easy fix, especially when well-intentioned legislators want to expand non-MD scopes beyond their reach. However, your Society continues to spring ahead with solutions. Yes, we respond to proposed legislation as it is introduced. But we have wanted to do more. Thanks to the productive relationship we have with our medical specialty colleagues within the walls of PAMED, we work in coalitions to be a unified voice of medicine to oppose removal of collaborative agreements for non-physicians, or additional responsibilities being advocated to allow non-medically trained medical providers to prescribe psychotropic medications, to oversee a treatment team without a physician present or an attempt to call themselves a physician when a PhD. The APA’s government relations team has worked hand in hand with us and are invaluable resources for us as we perform grassroots advocacy efforts. Your leadership is also working in earnest with interested stakeholders on ensuring that both public and commercial insurance are mandated to cover collaborative care codes, where individuals in need of substance use and mental health needs can benefit from treatment than begins at the primary care level and extends to consultations by psychiatrists and other mental health providers to integrate care or to expand access to treatment. As updates are available, we will provide them with action plans.
Fall back: In an ideal world, funding for mental health and substance use treatment would be endless. Unfettered access to every prescription medication or cutting-edge treatment would be the norm not the outlier. Physicians would be able to practice without concerns about liability, or without having to work double shifts because there are enough psychiatrists to cover every specialty in every practice setting (and not just in urban areas). Patients would not be encumbered with excessive costs and/or must decide if they will go for preventive care or even follow-up care instead of paying their bills or feel stigmatized. Well, unfortunately, that ideal world does not exist. However, we will keep falling back if your voice is not heard. When it is time for us to react, we need all of you to answer the call to get involved. If you are willing to spring ahead with me and affect change, contact me via email (dshoemaker@pamedsoc.org). Let me know if you have questions about our grassroots advocacy efforts or how to get involved in being part of the solution.
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EXECUTIVE DIRECTOR UPDATE Jennifer Redmond PaPS Executive Director Spring is here and I do not know about you, but I am very excited to get out and enjoy everything in bloom. Spring is usually a very busy time for the Society and here are some Society items you might be interested in. Events: The Pennsylvania Psychiatric Society has been very busy since last October! Chapters have held a variety of events including in-person resident poster nights, virtual awards events, and virtual CME events. I think the Society has adapted to the constraints of the pandemic, but we are all looking forward to some in-person events in the fourth quarter of 2021. Check the website for event information. Committees: The Council approved the formation of a Social Media Task Force to review ways PaPS can increase their social media footprint. PaPS has a variety of committees you can get involved in. For a list of committees, check out the Council page of the website. If you are interested in social media or another committee and would like to learn more, please contact the office at papsych@papsych.org or 800-422-2900. Annual Business Meeting: The Annual Business Meeting of the Pennsylvania Psychiatric Society will be held in conjunction with the May 15th Council Meeting. Both meetings are being held via Zoom. If you are interested in attending the meetings, please let me know at jredmond@pamedsoc.org or 800-422-2900.
“ If everyone is moving forward together, then success takes care of itself.”
A PA B O A R D O F T R U S T E E S R E P O R T Kenneth M. Certa, MD, DLFAPA There are several issues which APA has had to deal with over the past year. Three contentious items dominated discussion at the March board meeting, again: institutional racism, the budget, and our relationship with the American Board of Psychiatry and Neurology. I hope that anyone reading this will keep in mind that our organization is exactly that—OUR organization. As a board member I recognize the responsibility to keep the organization faithful to its mission, and attentive to the wishes of its members. The decisions facing us, and really all organized medicine, are complex, and I hope that the current impulse to demonize others in the discussion is put on hold for a bit. Racism is real, pervasive, and commonly unrecognized. We in psychiatry know well how our early upbringing influences us in so many ways. When I was a child, my family (generally decent, loving, generous people) frequently spoke of Black people in ways which make me cringe to remember. I try hard to see how this still influences me, and read and participate in whatever workshops I can, but there is no doubt some of this persists. This hit home after the events of January 6, when the natural conclusions of white supremacy were on display; fragile white men were literally up in arms as the nation tries to move on to a more inclusive community. Recognizing this reality, the APA board has struggled with how to address the effects of racism within APA and the country. The Task Force on Structural Racism has come up with a series of recommendations which the board voted on, trying to increase involvement of under-represented groups. Term limits in components is one effort, so that there are more open slots for newer members, with explicit efforts to reach out to groups not currently represented. The elections committee has proposed, and the Board approved, piloting changes in election procedures to level the playing field to try to be more inclusive. The biggest change is to limit election activities only to those sanctioned by the election committee itself, making it a violation to use listservs of other organizations. There is some worry that this will drive down election participation to even lower levels (fewer than 20% of members voted this cycle) but we will see. APA’s budget is a continual challenge and impacts our members very directly in both the services provided and the dues charged. So many members and former members post online, and tell me directly, that they are not sure that they get anything for their dues money. So much of what APA does benefits all psychiatrists, really all society, and so there is no convenient divide between members and non-members. We will still fight for better reimbursement for psychiatrists, for clearer confidentiality rules, for careful management of scope of practice, for parity of coverage for mental illness and substance use disorders— whether a particular person joins or leaves. The pandemic has contributed to a reversal of our year-over-year membership gains—
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down 3.6% last year. Practices are hurting, as patients lose their jobs and watch expenses. Not having an in-person annual meeting two years in a row has contributed to losing people who take advantage of the member discount. Losing the meetings also blows a hole in our budget by itself, since they are a reliable source of income. Costs are down in some areas, since virtual component, Assembly, and Board meetings are much less expensive, which is the only way we can keep a reasonably balanced budget. Budget concerns also play a role in one of our more difficult discussions, the relationship between APA and the American Board of Psychiatry and Neurology. If there were easy solutions to this, they would have been followed a long time ago. It is many layers, with a lot of things mixed up which I will try to tease apart. Even before the Maintenance of Certification wars, there was dissatisfaction with ABPN. It is high-handed, costly, and of uncertain meaning. Board certification itself is much debated but is considered a necessary part of a self-regulating specialty. Without some certification process, it is not clear how one could prevent other physicians from styling themselves as practicing a particular specialty competently. Which board can certify in which specialty has been a work in progress, and at this point the winner has been the American Board of Medical Specialties, a group to which ABPN belongs (along with nearly all of the other major specialty boards)? ABMS is where MOC started many years ago, and several of the other specialties are quite happy with it; procedure-oriented specialties appreciate having a method to demonstrate continued competence. One of the many issues is whether the ABMS one-size-fits-all (some wiggle room for individual boards, but not much) serves specialties like ours. ABMS is poised to issue new requirements for its member boards this spring, and it is expected they will be even more problematic for psychiatry. There is no agreement on whether board certification denotes minimal competency, or a higher standard. And there is very little in the way of outcomes research, showing that psychiatrists who are board certified have better outcomes. (That we still have no great outcomes measures to look at is a big part of this problem.) With all this, board certification was sort of grudgingly accepted so long as it was a one-time thing. When the time-limited certificates came into being (nine years after I certified) there was a hue and cry about differences in practice, sub-specialization, and how the exam could be fair to all. Very few failed, unlike in internal medicine, whose diplomates rose up and started the revolution against continuing certification. MOC was mandated by the ABMS, and initially had very objectionable requirements (remember the patient questionnaire mandate)? Continued on page 9
APA BOARD OF TRUSTEES REPORT Continued from page 8 There is no unambiguous right answer; increased dues will cost memberships, cutting services could be harmful to the organization and profession, yet there is worry about the conflict of interest. In preparation for the meeting, I asked as many groups as I could about their opinions and got many different answers (including some who thought ABPN should give us much more). The board voted to keep the money, accept more this year, while at the same time exploring ways for APA to potentially enter to board certification business.
Through APA’s efforts with ABPN, we have been able to make much of MOC far more palatable. The pilot project, reading among a choice of articles and answering questions, rather than the secure exam, is the best example. I do not think that would have happened without APA’s work. The whole process remains cumbersome, complicated, and costly, as a recent survey of our members demonstrated (awaiting publication in peer-reviewed journal, to carry more weight). What APA members, and psychiatrists in general must ask, is whether our specialty is prepared to go it alone and cut ties with the ABMS monopoly? No question, power tends to corrupt, and absolute power corrupts absolutely. Without an alternative, we are beholding to the ABMS/ABPN. An alternative certification system, the National Board of Physicians and Surgeons, is trying to get established to challenge this, but even they require initial certification by an ABMS board. NBPAS certification accepts the initial certification, and then continues certification if the physician maintains license and documents CME (back to the pre-MOC way). It is only accepted at 138 hospitals (more than 6000 in US), unclear how many insurance companies, and so is uncertain. And for those who let their certification through ABPN/ABMS lapse, starting over means really starting over.
Please let me know what concerns you have about this or other issues of which APA should be mindful by contacting the PaPS office. Please stay engaged in the process; without APA, and the other medical specialty societies, our professions and health care system would suffer greatly.
APA, AMA and other specialties are united in opposing board certification requirements as a condition of hospital privileges, insurance empaneling, or licensure. But our opposition only goes so far; most hospitals want to see the board certification. Should APA try to take over the whole board certification process, or at least the MOC part? Exploring the legal, ethical, and financial aspects of this is one of the things that the Board voted to approve at the March meeting. There is more on the APA website about the actions being taken regarding MOC here. One serious issue for which there is no good answer, is whether APA should accept unrestricted educational grants from ABPN. The arguments generally are whether this should be seen as APA recouping money that psychiatrists paid too much of already, to serve the profession; or that it is a bribe to keep APA in line to not oppose ABPN too much. The amount of money is substantial and returning what has been given (as some have suggested) would require either significant program cuts, or significant dues increase. P E N N S Y L V A N I A P S Y C H I A T R I S T | A P R I L 2 0 21
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Calendar of Events Small Chapter Coalition PRMS Webinar Minimizing Risks in Technology April 22, 2021
IN MEMORIAM Lawrence A. Real, MD, DLFAPA
REGISTER HERE
APA Annual Meeting | Virtual May 1-3, 2021
I N F O R M AT I O N H E R E
Philadelphia Psychiatric Society Women’s Symposium May 22, 2021
REGISTER HERE
Save the Date Patient Safety and Risk Management | Virtual November 13, 2021
Larry Real, MD passed away peacefully surrounded by his loved ones on Thursday, March 25, 2021. Larry was a colleague, friend, and mentor to many within the Pennsylvania Psychiatric Society. Larry was a past president of the Pennsylvania Psychiatric Society (2001-2002) and the Philadelphia Psychiatric Society (1992-1993). He remained very active in the Philadelphia chapter serving on committees and mentoring many young psychiatrists in the Philadelphia area. He was medical director at Horizon House, Philadelphia and served as the Co-Director of the Fellowship in Public Psychiatry program at the University of Pennsylvania. Larry’s accomplishments included the 2017 Paul J. Fink Leadership Award from the Philadelphia Psychiatric Society, the 2013 Exemplary Psychiatrist Award from NAMI, PA, the 2012 Bell of Hope Award from the Mental Health Association of SE PA, and the 2011 “Righteous Person” award from the TIKVAH/ Advocates for the Jewish Mentally Ill, an organization that he co-founded. He was a charter member of the Pennsylvania Psychiatric Leadership Council and a Distinguished Life Fellow of the APA. A celebration of Larry’s life will be held in the fall when everyone can gather safely.
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AREA 3 UPDATE Maryanne Albaugh, MD, DLFAPA Daniel Neff, MD, FAPA The Pennsylvania Psychiatric Society is represented in the national APA by our state representatives (Dr. Mary Anne Albaugh, Dr. Daniel Neff, Dr. Hector Colon-Rivera, Dr. Nazanin Silver and Dr. Robert Wilson). Collectively with New Jersey, Delaware, Maryland, and the District of Columbia we form the APA Area 3. There are several issues which APA has had to deal with over the past year. A new administration in Washington, the ongoing challenges of the COVID-19 pandemic, and society’s continuing grappling with structural racism have been at the forefront of matters. The APA has a complex governance structure, atop which major decisions come before the Board of Trustees (BOT). We are lucky to be represented there by one of our own members Kenneth Certa, MD. Three contentious items dominated discussion at the March board meeting, again: institutional racism, the budget, and our relationship with the American Board of Psychiatry and Neurology. Recognizing the reality of institutional racism, the BOT has struggled with how to properly address it. The BOT has recently voted in favor of numerous recommendations from the Task Force on Structural Racism and will continue to move forward with their guidance. The BOT has heard member dissatisfaction with ABPN and MOC and has taken a strong stance that Board Certification and MOC should have no place in employment or state licensure decisions. The BOT also voted recently to acknowledge the existence of competing certification boards and commissioned a study to evaluate next steps. As with all large membership organizations the APA has been impacted by the COVID-19 pandemic and has been working hard to continue to deliver the same high-quality education, advocacy, and membership services in the current environment. The APA continues to promote mental health in the political sphere with the excellent efforts of our APA Political Action Committee (PAC). The PAC actively communicates the priorities of our members, organization, and patients to legislatures and maintains relationships on both sides of the aisle. Individual members are always
encouraged to get involved locally with the APA Congressional Action Network (CAN). The APA Foundation (the APA’s partner charitable organization) continues to provide generous support to Minority Mental Health Fellowships and is working on several important initiatives including the Notice.Talk.Act.TM at School program and the Center for Workplace Mental Health. Like last year, the 2021 APA Annual Meeting will be online on May 1st through May 3rd. The live meeting will include 13.5 hours of AMA PRA Category 1 CME credit, while the popular APA Annual Meeting on Demand product will feature up to 75 additional hours of additional CME. Mental health disparities and the social determinants of health are the main topics for this year. As before, there will be a pre-conference expo day so participants can familiarize themselves with the meeting platform. Keynote speakers include Anthony Fauci MD, director of NIAID. There will be two Town Halls, one on Structural Racism in Psychiatry and the other on defining the number of hospital beds needed in our communities. The Town Hall on structural racism is the fifth Town Hall of the APA Presidential Task Force. The Task Force has submitted its final report to the BOT and the Assembly to develop and promote guidelines and initiatives to address structural racism’s impact on our colleagues and patients. During the meeting, we will welcome the APA’s next president Vivian Pender, MD, the president-elect Rebecca Brendel, MD, JD and our new secretary Sandra DeJong, MD. New members joining the board of Trustees include the Minority and Underrepresented Trustee (MUR), Felix Torres MD, and the Early Career Psychiatrist (ECP) trustee Elie Aoun MD. These new leaders will work together to actively address the important issues that face the APA as an organization. They will also serve to work with the new Biden Administration and Congress to advocate for issues related to mental health, the opioid epidemic, reform of the criminal justice system, structural disparities in society, and insurance parity among others. APA member Octavio Martinez, MD has been appointed by the Biden Administration to the COVID-19 Health Equity Taskforce. In Area 3, we would like to extend special congratulations to Jenna Cheng, DO and Hephsibah Loeb, MD who were recognized by Area 3 with the Resident-Fellow Member (RFM) Achievement Award. This award is a new innovation of Area 3 that we have implemented to promote the voices of our RFMs which are so important for the future of our organization.
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APA Position Statement on MOC The APA Board of Trustees (BOT) discussed APA’s relationship with the American Board of Psychiatry and Neurology (ABPN) and the National Board of Physicians and Surgeons (NBPAS) at its March 2021 board meeting. The BOT recognizes that maintenance of certification (MOC) is a contentious issue for many of APA’s members. A recent study conducted by the APA of APA members participating in MOC showed that nearly equal numbers of individuals felt that MOC helps them keep up to date with current information as those who do not (41.3% agree; 37.8% disagree; 20.9% neutral). The same study showed that most felt that participating in MOC is a time-consuming, expensive, overly complicated, and burdensome process. At the same time, the BOT is also aware that many APA members are required to participate in MOC as part of their employment, ability to engage in teaching activities, or to be credentialed in certain insurance panels. For example, the ACGME requires that all training directors and core faculty in psychiatric residencies are ABPN-certified. Continued board certification may also increase pay for individuals applying for a new salaried position, such as for VA or state facilities, and to be eligible for fast-track licensure under the interstate compact. The BOT reaffirms its previous position that MOC should not be used as a condition of employment, insurance paneling, or state licensure. APA, through its state legislative advocacy and in meetings with the ABPN, has made this very clear. Simultaneously, the APA acknowledges that many members need access to ABPN-approved activities in order to meet MOC requirements and that APA is well positioned to provide relevant, high-quality educational materials at a low cost to support members who are participating in the current MOC process. Consistent with this position, after thorough discussion, the APA BOT approved the following actions: •
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The Board of Trustees voted to continue the creation of MOC products so that members who choose to participate in MOC will have access to highquality, relevant, and low cost MOC products. The Board of Trustees voted to acknowledge NBPAS as an alternative to ABPN’s maintenance of certification program and will provide information about NBPAS on its website. NBPAS is recognized at far fewer hospitals than ABPN certification but is an alternative for some psychiatrists. APA will make
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APA Position Statement on MOC
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members aware of this and other potential limitations of holding only NBPAS certification. The Board of Trustees voted that APA publicize to APA membership, and bring to the attention of the ABPN leadership, results of the APA survey of member reactions to ABPN MOC, areas of APA member dissatisfaction with MOC, and, on behalf of our members, ask ABPN to respond to these concerns. The Board of Trustees voted to approve that APA work with ABPN to develop a society-based alternative to ABPN’s MOC program. If accepted by ABPN, this would allow APA to develop a MOC program which would be administered by the APA and be fully recognized by ABPN for meeting MOC requirements. The Board of Trustees voted to approve a feasibility study of what would be involved in APA developing its own certification and MOC programs, separate from ABPN and NBPAS. This study will include an examination of financial, legal, and ethical aspects of establishing its own certification board. In order to support the continued development of MOC products for members and to support the PsychPRO registry, the Board of Trustees voted to accept $2,000,000 in unrestricted educational grants from ABPN. These grant funds will be used for the benefit of APA members. A similar unrestricted grant was awarded to the American Academy of Neurology (AAN) for this same purpose. These funds will be used to create new and low-cost MOC products which will support APA members who choose to participate in MOC to meet program requirements and continue to support the APA PsychPro Registry. This decision is consistent with the acceptance of previous unrestricted grants from ABPN in 2016, 2018, and 2020. The Board opined that the potential benefits to members were significant and that voting to take these unrestricted grant funds was in the best interest of APA members who participate in MOC. The acceptance of these grant funds will not dampen or interfere with the several ongoing activities and negotiations to improve the ABPN MOC process or to create and recognize alternative professional boarding processes. These funds are accepted as an unrestricted educational grant from the ABPN to the APA and, as such once granted to the APA, cannot be influenced by the ABPN.
The Board of Trustees acknowledges that MOC is a complex issue and that there are not simple answers to questions about the current status of maintenance of
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APA Position Statement on MOC certification. APA’s elected leadership will continue to fight for MOC reform, including seeking program changes with ABPN and examining alternatives to ABPN’s MOC process. In the larger view, many specialties have had concerns with the current American Board of Medical Specialties (ABMS, the parent organization of ABPN) and like other medical specialties, the APA and psychiatry are awaiting a revision of the standards of the ABMS. It was the ABMS that mandated that ABPN design and implement the MOC process. The Board of Trustees hopes that APA members will stay engaged in the debate regarding how specialist competency is best recognized and certified.
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RESIDENT UPDATE Luke D. Piper, MD PGY-4, Penn State Health Department of Psychiatry If there has been any lesson learned during this pandemic, it is that the forces of healthcare can, and will, persevere through even grave adversity to continue carrying out its mission, including a pandemic of significant gravity. So too has the cycle of medical education overcome the myriad changes of the past year, including the efforts leading up to the recent annual NRMP Match. I do not think anyone expected this to be a “typical match season.” The changes wrought from the pandemic changed entire dynamics of interview days, perhaps most notably in the form of virtual interviews. While I will not put words in any program’s mouth, it is my general understanding that at least most psychiatry programs vastly prefer in-person interviews. We have also seen – or are seeing – changes to medical student examinations, with Step 2 CS being canceled, and more medical schools moving to “pass/fail” grading schemes, including during their clinical clerkships (and, if I am correctly informed, on Step 1 in the coming years). So, programs are presented with candidates that they may have difficulties distinguishing between prima facie, which are then further compounded with a less robust interview experience. Admittedly, this is hardly a problem unique to psychiatry, but I think our programs certainly felt it during this interview cycle. And we should not forget what this issue looks like from the perspective of medical students, who have toiled for ways to make themselves uniquely attractive to programs. In this unique setting, what did the numbers tell us? As a broad overview, we saw 38,106 positions this match (an increase of 850 compared to 2020), for which 42,508 applicants applied (2,424 more than 2020). Perhaps expectedly, this resulted in a match rate of 78.5%, down 2.3% from last year, and including a match rate drop of 0.9% for US allopathic seniors, and 1.6% for US osteopathic seniors. The numbers are bit more encouraging, I think, for the field of psychiatry itself. As I suspect many of us are becoming aware of, psychiatry programs across the country collectively filled all but 3 of their offered positions, a decline from 20 unfilled positions in 2020. This is despite the fact that the 1,907 psychiatry positions offered in the 2021 match is an increase of 49 positions compared to 2020. Interest in psychiatry shows little sign of slowing down, with 2,948 applicants this year (150 more than last year). Reflecting on these figures as a field, psychiatry is well positioned. Interest in psychiatry is increasing, and our position fill rate this year was exceptional despite there being more slots available than years prior. But these numbers do reflect an ongoing issue with supply and demand (that is, supply of residency positions against the demand from prospective applicants), which we see replicated in the Match-at-large, and with psychiatry specifically. At this point, I think it is too early to offer grand conclusions as to what these numbers mean, but as I sit here about to move into my early career phase, I wonder what lies in store for the field and for the medical students who hope to pursue it, especially in the context of a pandemic that has warped the field of medical education and residency application. I would certainly be encouraged by the ongoing interest in psychiatry, though I hope in the years to follow, the supply of psychiatry training programs continues to grow to meet that need. In the meantime, congratulations to all incoming PGY-1 psychiatry residents, to all programs for weathering the storm of this unique interview season, and to all for endeavoring toward a convincingly successful match.
PaPS Chapter Updates Lehigh Valley Chapter
Pittsburgh Chapter
Courtney Chellew, MD The Lehigh Valley Psychiatric Society held a Virtual Advocacy Update in September of 2020, which discussed an overview of the commonwealth’s government structure, detailed the Society’s legislative priorities for the current legislative session and how residents can be involved at the chapter and state level. It was well attended by the Chapter’s psychiatric residents.
Amita Mehta, MD The Pittsburgh Psychiatric Society held our Symposium on March 13, 2021. The meeting was well attended—54 attendees. The event provided 4 CME credits and 2 self-assessment credits. It was attended by an international member of the Society—Dr. Barry Fisher. We had great speakers and everyone had a positive experience.
Michael Chen, MD, one of the Chapter’s residents, was awarded first place in the Abstract Contest at the CPPS Virtual Resident Night that took place in September. The Chapter plans to hold a virtual Grand Rounds with a legislator in the spring.
We are currently planning our next event— Resident Research and Awards Night—which is slated for late fall.
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PaPS New Members —October 1, 2020 to March 1, 2021 Central
Pittsburgh
Western
Members in Training Sanjay Chaudhuri, MD Melissa Free, MD
Members in Training Gira Salahuddin Borad, MD Patrick Buckley, MD Julia Farquhar, MD Ryan Wasilchak, DO
General Members Syed K. Raza, MD Philip G. Talarico, DO
General Members Andrea Favini, MD Anna Brown Jolliffe, DO Roshan Koozekanani, MD Michael J. Manasterski, MD Java Praveen K. Penagaluri, MD Sarah Schmidhofer, MD
Philadelphia
General Members Ramnarine Boodoo, MBBS Suliman S. El-Amin, MD Jeffrey Mufson, MD Leopoldo M. Vocalan, MD
Lehigh Valley Members in Training Anthony Bucca, DO Kunal Chaudhary, DO Jerica Gerena, DO Franzes A. Liongson, MD Jordon Miller, MD Patrick A. Shields, MD Diyor Suyumov, MD General Members Amir Loghmani, MD
General Members Aaron Bloch, MD Brijae Chavarria, MD Lauren Dubner, MD Julia E. Hannigan, MD Adam C. Holstein, DO Yunichel Joo, MD Ashby A. Mammen, MD Rebecca Montana, MD Noah Schwartzman, DO Emily P. Sudhakar, MD Jacob Weiss, MD Winifred Wolfe, MD Matthew S. Dinovitz, MD Vinu M. George, MD Gayathri A. Mahendiran, MD Rayek Nafiz, MD Jasmine Sawhne, MD Samantha Zwiebel, MD Distinguished Fellow John Lauriello, MD Luciano Lizzi, MD
Pennsylvania Psychiatric Society
OFFICIAL NOTICE OF ANNUAL BUSINESS MEETING Date: Saturday, May 15, 2021 Location: Zoom Conference Call The meeting is scheduled for Saturday, May 15, 2021 and will be held via Zoom Conference Call. Please RSVP to the PaPS office no later than 5 pm on Friday, May 1, 2021. Pennsylvania Psychiatric Society Proposed Slate of Officers 2021-2022 President Elect: Hope S. Selarnick, MD, DFAPA Vice President: Kavita Fischer, MD, FAPA Treasurer: Usman Hameed, MD, DFAPA Secretary: Kawish Garg, MD, FAPA Immediate Past President: Richard R. Silbert, MD, DLFAPA ECP Representative: Heather John, MD Resident Representative: Michael Chen, MD APA Assembly Representatives: Maryanne Albaugh, MD, DLFAPA; Daniel Neff, MD, FAPA Dhanalakshmi Ramasamy, MD, DFAPA will assume the position of President
