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.

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: • 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

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

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.