[June 1996; Vol. 23 No. 2]
by Neil E. Warres, MD
I first became active in the Maryland Psychiatric Society because I believed action was necessary to oppose those forces and trends which were destructive to our patients and our profession. I felt that the only way to be effective was to act as part of a large group, and that it was the Maryland Psychiatric Society which most effectively represented our psychiatric community. My experience in the Society over the years has confirmed that belief. For example, we have been extremely effective in obtaining mental health parity legislation, significant managed care regulation, and have begun to address confidentiality concerns.
We, as a Society, have collectively learned much from this process. We are much better advocates for our patients and profession than we were a decade ago. But our problems have obviously not gone away. There are still difficulties with utilization reviewers imposing seemingly arbitrary limits to necessary care. There are still confidentiality concerns. There is great uncertainty about the form and impact of proposed Medicaid reform and reorganization. Soon we will be dealing with HCACC’s proposals for “payment reform”, and its impact on allowed charges for psychiatric services. Psychiatric nurse clinical specialists, and perhaps psychologists, will be pushing for prescribing privileges and attempting to blur the boundaries between their practice and clinical medicine. Absurdly, we still are threatened with disciplinary action if we fail to report even deceased child abusers to authorities. There still is discrimination against the mentally ill, and misunderstanding about what we do - even among our non-psychiatric physician colleagues. Our time for professional activities such as patient care, teaching or research is increasingly encroached upon by demands for paperwork, or lengthy phone calls to obtain treatment authorization. There are increasingly complex ethical, professional and economic issues which emerge as we become more involved in capitated programs, HMO’s and Community Health Networks.
At times we will clearly have a rough road to travel. But we have already traveled a great distance, and with considerable skill. Your outpouring of letters against nurse prescribing, and expressing your support for patient control of private medical data has been wonderful. Our collective ability to make the public aware of these issues has been considerable. We have already won our Medicare-Medicaid QMB suit against the state and federal government - which is a significant victory (although, of course, it is being appealed).
Many of our members have worked very hard for these achievements. But one important, practical fact which has become increasingly obvious is that our Society absolutely needs the input and volunteered time of all of its members in order to remain effective. This was highlighted during our testimony in Annapolis regarding the nurses’ prescribing bill. There were three psychiatrists who testified. This contrasted with the nurses who had over 10 witnesses, had other visible supporters in the audience, and later brought 70 of their colleagues to lobby Senators on the Senate floor. If we are going to be effective, we need to be able to equal or surpass this. People in our Society need to be willing, if necessary, to give up an afternoon or two a year to work in Annapolis to promote our common cause.
While I have alluded to managed care, legislative and political issues, the scope of Society activities is much broader, and the same need exists in other important, often crucial areas. The Maryland Psychiatrist and MPS News can’t function if members don’t help staff the Editorial Advisory Board and write articles. The activities of the Peer Review and Ethics committees are unfortunately extremely labor-intensive. The creative ideas, and public awareness of mental health issues is crucial. The Geriatric Committee is struggling with how to address new, restrictive and unfair Medicare treatment limitations, as well as with the QMB suit appeal. Significant time, work and creative input are needed not only for these committees, but for others whose focal points range from CME Program development, Membership and Fellowship, to Public Psychiatry, Women’s Issues, Residency, Child Psychiatry, and International Medical Graduate Issues.
Throughout the years our Society has been blessed with many wise, generous and dedicated individuals who have worked tirelessly for our common good. I ask each of you to continue in their tradition, to join their ranks, to be very active in Society matters, to work hard, to help each other and help our patients.