The American Psychiatric Association has held contested elections for national officers since 1972. In the past decade, the race for President-elect has grown more and more elaborate and expensive. Candidates cross the country campaigning, speaking at professional meetings and other gatherings. Supporters write and mail letters recommending their candidates to friends, colleagues, and members of demographically designed mailing lists. The race has become so expensive that candidates for our leadership have taken second mortgages.

There are rules for the elections. They cover the period for campaigning, the number of personal appearances a candidate may make, and the number of letters a supporter may write. E-mail is now unlimited, as are phone calls discussing the election and candidates. The Elections Committee and the Board view the rules as reasonable, yet candidates have been recently accused of breaking them.

Campaigning has generated complaints and charges of unfair practices. The Elections Committee reviews these complaints, and a few years ago an Elections Oversight Committee was established to review more serious complaints and to levy sanctions or penalties. The EOC is composed of three past presidents, one of whom is also a past speaker of the assembly. Serious complaints go beyond supporters writing more than the allotted number of letters; some candidates have had unusually high publicity because reprint collections of papers have been mailed to APA members during the election season.

There are problems with the sanctions process. For one, there are potential legal expenses of a candidate challenging the decision, and the costs of implementing a remedy such as a mailing to all members explaining a candidate's misbehavior. The entire Board has to review each case, because of its fiduciary responsibility to the APA and membership. This results in many sanctions being reversed or reduced. In other words, the Elections rules cannot be enforced for practical, legal and financial considerations.

For several years, APA held debates for the President-Elect candidates. These were videotaped and distributed to district branches. During my time in the Assembly, I found that few DBs used the videos and that average audiences for the videos were well under 5 percent of the DB membership. Yet in elections over the past 20 years, top voter turnouts have been only 40 percent of eligible APA members.

How can the APA election become more reasonable and more affordable, while APA members get the information they need about the candidates and the APA? How can we get members to vote thoughtfully, so that they feel they are participating in choosing the APA's direction and policies?

A former APA president surveyed the 12 largest specialty societies. Only three of these medical groups (pediatrics, otolaryngology, dermatology) have contested elections with the full membership eligible to vote. Four others conduct a contested election in which the House of Delegates or national council casts votes. And five (Internal Medicine, Ophthalmology, Orthopedic Surgery, Pathology and Surgery) do not have contested elections for top offices.

There is little or no campaigning in several of the societies; in others, campaigning is carefully prescribed. Typically, candidates attend Area or District meetings, where they present position statements or engage in debates. Newsletters publish detailed statements by the candidates; who may write a single letter. Otherwise, members learn about candidates through informal discussions in person and by phone. Time and energy appear to go into running the society, not into electioneering.

In 1997-98 the Elections Committee presented to the Board a proposal to change election procedures, stating that the election has become an economic contest, shutting out members who cannot spend large sums on campaigning. It stated that travel to meetings across the country, which are often poorly attended despite advance publicity, used up most of the costs. The report also pointed out that other professional societies do not have elaborate, costly campaigning for their top offices.

The 1998 recommendation was for a shortened campaign period of 60 days and a 30 day voting period. During the 60 day period before ballots are mailed, the candidates would not be allowed to present lectures, CME presentations, or professional presentations. The Board discussed these recommendations for a shortened and limited campaign, and then voted them down.

President Allan Tasman has appointed an Ad Hoc Committee to Review APA Election Policies and Procedures, to study APA elections and to recommend changes. It includes leadership from Board and Assembly, two past Presidents, and a president of a District Branch. They met at the fall component meetings, and reported their early thoughts to the Elections Committee. They will report their final recommendations directly to the President and Board of Trustees.

Members and APA staff have discussed ideas about approving elections for several years. One model would be no campaigning by letter or e-mail, no personal appearances, only statements in the Psychiatric News and on APA's Web Site. Time between nomination and ballots being mailed needs to be sufficient for candidates to prepare a statement for Psychiatric News. Contested elections are still favored by Elections Committee and many APA leaders, rather than a single candidate slate.

Your APA representatives and leadership will be debating proposals for our elections this year. We welcome suggestions from APA members, and from DB councils and leadership.