National Health Care Reform is for American physicians, including psychiatrists, the challenge of our professional lifetime. We are challenged to respond to the call for reform with openness to the need for innovation and change while safeguarding the maintenance of our professional identity and integrity through ensuring that high quality, ethical, scientifically-based patient care is not compromised for cost control and profits in any organizational structure of care delivery, corporate or governmental.

As pressures to achieve universal access to health care and a defined benefits package mount, the threat of fragmentation and escalating "turf wars" is real.

We are a highly diverse profession. Our members' practices, professional interests, subspecialization, personal/cultural backgrounds reflect the contemporary American landscape. In our 150 year history, we have struggled through decades of alienation from our medical colleagues, with public stigma and discrimination against our patients. Now, in the Decade of the Brain, we are integrating the hard-won knowledge and experience of 100 years of dynamic psychiatry (the bio-psycho-social integration) with knowledge from the emerging neurosciences. We are improving our diagnostic criteria for the various psychiatric illnesses, dysfunctions and disorders, including substance abuse. We are developing practice guidelines and a practice research network, further demonstrating the efficacy and effectiveness of our treatments. We have an established leadership in identifying ethics as the foundations of clinical practice. We have a tradition of decades of interdisciplinary work with a variety of non-medical limited license practitioners in the service of improving care for our patients.

Demand for our services is enormous. Psychiatric knowledge and expertise are essential to survival and adaptation. We are the only true integrative medical specialty. Yet, our members' practices are threatened. Members are consumed with apprehension, pessimism and apathy while corporate America has invaded American medicine and is imposing its language, techniques, priorities, and ethos. We are told that we are providers in the Health Care Industry that accounts for 15% of GNP. We are at risk of being assigned the role of sergeants in charge of an army of non-medical providers to process patients like so many items on a conveyor belt under the direction of Corporate Generals who are not even physicians, let alone psychiatrists. We are promised non-discriminatory coverage for our patients in the next century (after life?), while the doctor-patient relationship, the right of patients to contract with the physician of their choice and the continuity of patient care are all threatened with extinction by managed competition and cost control. Psychiatric training and research will be compromised under the dictates of central planning, children and adolescents will have even less of a chance of ever seeing a psychiatrist. 150 years of work to achieve bio-psycho-social integration in psychiatry will be lost to medication management.

It is wake-up call time for psychiatrists and the APA. If we lose the fundamentals of our identity and integrity, even getting non-discriminatory coverage before the next century will mean little. While I wholeheartedly endorse the 12 APA Principles as guides for Health Care Reform, I feel that, unless we mobilize to advocate for the fundamentals of quality patient care, the compromises to our professional integrity and the defusion of our identity will threaten the survival, not only of solo private practice, but of the profession as we know it.

APA is challenged to become a unifying force for the diverse mosaic of our field. The various psychiatric subspecialties must be formally included in APA and a dues formula should be developed for multiple subspecialty membership. Uniting the psychiatric subspecialties will make APA the voice of our profession for legislative advocacy on behalf of our patients.

APA can serve as the forum to address our conflicts, differences and work for constructive solutions in order to improve care to our patients regardless of setting or type of practice. A public relations and legislative advocacy priority list should be developed, be widely disseminated, debated, agreed upon and implemented. Among the issues to be included are (1) advocacy for differential reimbursement based on licensure, certification and demonstrated clinical effectiveness; (2) advocacy for research into the psychiatric needs of minorities, domestic violence, racism and prevention of psychiatric illness, disability and dysfunction; (3) advocacy for the development of a primer in psychiatric prevention for public education.

I'm deeply honored by this nomination. I'm ready to serve with enthusiasm and seek your support.