The 127^th APA Annual Convention

Attending our annual APA convention has always been “my gift to me.” Unfortunately, for the first time, I had to miss this year’s gathering in the Windy City, due to the unexpected passing of my younger brother. I understand, however, that it was as inspiring as ever. One of the symposia I was looking forward to participating in artfully combined interprofessional collaboration (IPE) and integrated RxP care. “I traveled to APA in Chicago to present on a symposium led by USU (Uniformed Services University) School of Nursing faculty Jouhayna Bajjani-Gebara and JoEllen Schimmels entitled ‘PIG in Practice: Interdisciplinary Pharmacotherapy Approaches to Treatment.’ The PIG (Pharmacotherapy Interest Group) is a collaborative model which provides an avenue to learn about pharmacotherapy and increase patient positive patient outcomes. The symposium was a collaborative approach to treatment of patients with both physical and mental health concerns. It was a privilege to participate in a conversation on approaches to treatment as a USU student in clinical psychology (Courtney Vaughan).”

A Most Appropriate and Timely Venue

On July 19, 2019, Illinois joined the growing family of psychology-friendly prescribing states with Terry Soter receiving his official approval from the State of Illinois. Beth Rom-Rymer, whose leadership and persistent dedication made this possible: “We are prescribing in Illinois! I am thrilled to announce that our second piece of Prescriptive Authority legislation was signed by Governor J. B. Pritzker this morning. This legislation: 1. Gives licensed prescribing psychologists the authority to use telehealth to prescribe in the State of Illinois. 2. Eliminates the need for ’36 credits’ for our medical rotations while leaving the requirement for 1620 rotation contact hours intact. And, 3. Gives each of four accrediting bodies authority as accreditors for our medical rotations: a. Accreditation Review Commission on Education for the Physician Assistant; or b. Commission on Collegiate Nursing Education for the Advanced Nurse Practitioner (ANP) or the Accreditation Commission for Education in Nursing for the ANP; or c. Accreditation Council for Graduate Medical Education.

“Soterios ‘Terry’ Soter became our first prescribing psychologist. He has an illustrious career that has spanned many disciplines. He received his B.A. in Political Science at the California State University at Los Angeles in 1966; his MSW at The University of Illinois, Chicago in 1974; and his Ph.D. in Psychology at the Florida Institute of Technology in 1980. In 1983, he served as a Major in the U.S. Army with the 12^th Special Forces Group, Airborne, until he retired from the military in 2001. From 1982-1993, he worked for the St. Charles, Illinois VA, conducting therapy with Vietnam Veterans suffering from PTSD. In 1995, he completed his postdoctoral analyst training at the C. J. Jung Institute in Chicago; in 1998, he received his Certificate of postdoctoral training in Clinical Psychopharmacology from the Illinois School of Professional Psychology; and in June of 2007, he received his MD from the College of Medicine and Health Sciences at the St. Lucia Rodney Bay, St. Lucia, West Indies. From 2003 until he retired in 2016, he was a sub-contractor to the Department of the Army Special Forces in Virginia.

“In 2009, Terry Soter was licensed as the 6^th prescribing psychologist in New Mexico. In 2012, he was named to the New Mexico Board of Psychologist Examiners. In 2014, he was named to the Illinois Clinical Psychologists Licensing and Disciplinary Board. Since 2007, he has provided treatment to adults in a private practice in Santa Fe, New Mexico; since 2009, he has conducted evaluation and medication management of adult patients in the Outcomes Clinic in Albuquerque; and since 2012, he has conducted evaluation and medication management for children at the Children’s Treatment Center in Albuquerque. Now, in 2019, he is licensed as the first prescribing psychologist in Illinois.

“At our Chicago Convention, at a special Sunday luncheon, we celebrated the legislative advocacy for psychologists’ prescriptive authority throughout the country, Canada, and the United Kingdom, while showcasing the education and training of prescribing psychologists in Illinois and demonstrating the invaluable APA and community partnerships that we have been able to forge, with presentations by: APA CEO Arthur Evans; APA President Rosie Phillips Davis; our legislative champion, Illinois State Senate President Pro-Tem Don Harmon; Cook County Commissioner Dennis Deer, a community activist focused on mental health access issues; and Clay Ciha, the President and CEO of Alexian Brothers Behavioral Health Hospital and Senior Vice President of AMITA Health Behavioral Medicine Institute (AMITA is the largest health system in Illinois). Also presenting were Morgan Sammons, a retired Navy officer, one of the first Department of Defense Prescribing Psychologists and currently CEO of the National Register; Mark Ishaug, CEO of the largest and oldest social service organization in Illinois; Nneka Jones Tapia, the first psychologist Chief Warden of the Illinois Cook County Jail; John Shustitzk, a prominent psychologist on the state NAMI Board; Gerardo Rodriguez-Menendez, Chair of the Clinical Psychopharmacology Program at The Chicago School of Professional Psychology, the only program in the United States that currently trains psychology graduate students for the Master’s of Science of Clinical Psychopharmacology; and Marlin Hoover, a lifelong clinician in Illinois, an extraordinary trainer of family practice physicians and residents and prescribing psychology trainees, and one of the earliest prescribing psychologists in New Mexico. The collective enthusiasm of the nearly 200 attendees was simply outstanding.”

The Nutmeg State

“In the midst of our legislative efforts this year (which ended in early June)… we were one vote away from getting out of the Public Health Committee! We were so close that Connecticut psychiatrists rallied their forces and mounted an enhanced weekend campaign of misinformation and distortions. David wrote a marvelous piece for The CT Mirror entitled ‘No one returns my calls… no one takes my insurance: Prescribing psychologists could help fill public’s need for psychiatric services.’ Here’s an excerpt:

No one even returns my calls… No one takes my insurance… Everyone I call has no openings. These are the phrases I hear from my patients, friends, and family who are trying to find psychiatric medications for a behavioral health or substance abuse concern. My office manager recently tried to find services for her daughter; she called 19 psychiatrists without one return call. Why? Maybe they’re too busy; maybe they’re full; maybe they don’t accept that person’s health insurance. Our psychiatric colleagues might argue that there are enough psychiatrists and APRNs to meet the behavioral health and addiction prescribing needs of Connecticut’s residents, but that’s not what reality shows. Our office receives numerous daily calls from frustrated patients who cannot find a prescriber, and who do not want to have two providers: one for medication and one for psychotherapy.

“Psychiatrists in Connecticut responded with a few opinions of their own and had the manpower to get the ears of the Public Health Committee. It is our understanding that the rallying cry was spearheaded by a physician committee member. They argued that there are plenty of providers to go around, though that’s not what state or national data indicates. This argument seems highly spurious in that even psychiatry cannot find a psychiatrist when they need one as expressed by a Massachusetts psychiatrist in the June 17 issue of Statnews:

In a recent study, researchers called 360 psychiatrists on Blue Cross Blue Shield’s in-network provider lists in Houston, Chicago, and Boston. Some of the phone numbers on the list were for McDonald’s locations, others were for jewelry stores. When the researchers actually reached psychiatrists’ offices, many of the doctors didn’t take Blue Cross Blue Shield insurance or weren’t taking new patients. After calling every number twice, the researchers were unable to make appointments with 74% of providers on the list. In a similar study among pediatric psychiatrists, researchers were unable to make appointments with 83% of the providers listed as in-network by Blue Cross Blue Shield. My patients regularly tell me that this is not unique and happens with most insurance providers. A 2016 survey by the Centers for Medicare and Medicaid Services showed that it’s also a problem with other medical specialties. The numbers, however, never seem as bad for other specialties as they do for psychiatry.

“In CT, psychiatry also adamantly stated that patient safety is at issue, when there is clearly no data to indicate that, and they misrepresented our training as a simplistic ‘online class’ and suggested that a prescribing psychologist is ‘… a highly confident psychologist who lacks common sense.’

“It seems the opposition’s political strategy is to speak loudly and repeat the same inaccurate message over and over again. This is what CT RxP must address. We will try to do so by utilizing the strategy that has gotten us this far, this fast: building relationships and stating the true facts (are there ‘untrue’ facts???). Our plans involve gathering more support from patients and organizations, building community and non-profit sector support, and producing educational materials that legislators can utilize to combat the distortions. It’s similar to being a good parent – warmly, yet firmly, guiding others toward understanding the best way forward as they consider their options. Onward….” (Barbara Bunk & David Greenfield, Co-chairs of the CPA Task Force on Prescriptive Authority for Psychologists.)

In the Nation’s Compelling Interest

In 2004, the then-Institute of Medicine (IOM) released its visionary report “In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce” with former APA Congressional Science Fellow and former APA Director for Public Interest Policy, Brian Smedley, serving as Study Director. As the report indicated: “The United States is rapidly becoming a more diverse nation, as demonstrated by the fact that non-white racial and ethnic groups will constitute a majority of the American population later in this century. The representation of many of these groups within the health professions, however, is far below their representation in the general population. Increasing racial and ethnic diversity among health professionals is important because evidence indicates that diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students.” From the very beginning, the IOM Committee recognized the need to answer the very important, but usually unspoken, question of how does the broader society benefit by having increased diversity among health care professionals, aside from the gratification of doing “what is morally right?” This is especially relevant in light of recent Supreme Court decisions looking closely at the rights of non-minority educational applicants.

Over the years, increasing diversity has become a significant priority within psychology. To a great extent, however, efforts to diversify health professions fields have been hampered by gross inequities in educational opportunity for students of different racial and ethnic groups. Primary and secondary education for underrepresented minority (URM) students is, on average, far below the quality of education for non-underrepresented students. Accordingly, the “supply” of URM students who are well-prepared for higher education and advanced study in the health professions fields has therefore suffered. When quantitative variables such as standardized test scores are weighted heavily in the admissions process, URM applicants, because of their generally poorer academic preparation and test performance, are less successful in gaining admission. This has led some organizations and institutions to reconceptualize their admissions policies and practices to place greater weight on applicants’ qualitative attributes, such as leadership, commitment to service, community orientation, and experience with diverse groups, as well as other factors. This shift of emphasis to professional and “humanistic” factors is also consistent with a growing recognition within the health professions fields that these attributes must receive greater attention in the admission process to maintain professional quality, to ensure that future health professionals are prepared to address societal needs, and to maintain the public’s trust in the integrity and skill of health professionals. Interestingly, although the Committee noted that the average cost of education for students in schools of psychology is less, on average, than for students in other health professions, these students tend to earn less once in practice than some other health professionals.

Equally, and in our judgment perhaps more important, is the need to assess and improve the institutional climate for diversity. These include strategies that encourage the introduction of diverse viewpoints in classroom pedagogy, attract and support URM students and faculty, and transform institutions and institutional environments to support diversity-related goals. At the same time, accreditation standards must acknowledge the importance of preserving academic freedom, which is critical to curriculum innovation. Fundamental “community benefit” notions, which have long been recognized within the nation’s tax code, possess the potential for transforming health professions education. The Committee concluded by emphasizing: “Broad support is needed among many groups – including health professionals, the HPEI (Health Professions Educational Institutions) community, health policymakers, affected communities, educators, corporate and business leaders, organized labor, and the general public – in order to create the necessary ‘push’ to support institutional and policy-level strategies to increase diversity among health professionals.” Substantive change always takes time.

“And all that Jazz.” [Chicago: The Musical].

Aloha.

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Pat DeLeon, Ph.D.

Pat DeLeon is the Distinguished Professor at the Uniformed Services University of the Health Sciences (DoD) in the School of Nursing and School of Medicine. He was elected to the Institute of Medicine of the National Academies of Science in 2008 and served as President of the American Psychological Association (APA) in 2000. For over 38 years he was on the staff of U.S. Senator Daniel K. Inouye (D-Hawaii) retiring as his Chief of Staff. He has received numerous national awards including the Order of Military Medical Merit; Distinguished Service Medal, USUHS; National League for Nursing Council for Nursing Centers, First Public Policy Award; Sigma Theta Tau, Inc., International Honor Society of Nursing, First Public Service Award; Ruth Knee/Milton Wittman Award for Outstanding Achievement in Health/Mental Health Policy, NASW; Delta Omega Honor Society Award for Outstanding Alumnus from a School of Public Health; APA Outstanding Lifetime Contributions to Psychology Award; American Psychological Foundation Gold Medal for Lifetime Achievement in the Practice of Psychology; and Distinguished Alumni Award, University of Hawaii. He has been awarded three honorary degrees. He is currently the editor of Psychological Services. He has over 200 publications.