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 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.

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.

Striving for a More Equitable, Unbiased Approach to Training Our Future Psychiatrists Spring forward:

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.

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.

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. 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).

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.

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.

Fall back:

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.

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