Dr. Gudeman's Web Site

Professor and Co-Chair, Department of Psychiatry, Medical College of Wisconsin

Medical Director (former CEO), Milwaukee County Mental Health

Chair, Joint Information Service, APA, 1977-78

President, Massachusetts Psychiatric Society, 1982-83

APA Assembly Representative, 1991-93, 1995-

Representative to JCAHO Professional and Technical Advisory Committee, Behavioral Health, 1998-

Chair-Elect, Section for Psychiatry and Substance Abuse, American Hospital Association, 2000-

APA Awards: Hospital and Community Psychiatry, 1985; Hospital Psychiatric Research Award, 1987

Private Practice, Adult Psychiatry and Psychoanalysis

Psychiatrists are experts in the integration of the biologic, psychologic, psychosocial, rehabilitative, and existential understanding and treatment of people with mental disorders. We have a fine profession, but we have been devalued. We cannot allow this to continue.

APA is at a crossroads. We are a low-pay specialty. Dues are among the highest of any specialty. Each year APA enrolls up to 1,000 members but loses up to 2,000. The most common cause for member attrition is high dues. Members must know they receive true value for their dues dollars. APA must better represent all of psychiatry. With an aging society, demand will change; with a diverse society, we must focus on underrepresented minorities; people will have more diagnostic and treatment information; neurobiology and psychopharmacology will change our knowledge; patients will want more choices; we must recruit the best and brightest; there will be virtual organizations linked by information; and employers may move toward defined benefits or salaries without health benefits. As president of APA, I would work with Dr. Steven Mirin, our medical director, and staff to bring psychiatry back into the mainstream of medicine and create a powerful future.

APA must reinvent its governance. I propose that we downsize the Assembly, the committees, and other components. We should move from a House of Representatives to a Senate, but with special status for underrepresented and subspecialty groups. Presidents or presidents-elect of the state associations should form the Senate to ensure a working partnership between the membership and central office. A small number of committees should replace the current structure. I would return ethics complaints to societies and medical boards. Downsizing could save $3 million to $4 million, which would (1) be used to enhance needed services to members and (2) provide much needed dues relief.

•Advocate:

Our unique training and role-specific competence is to help the most complex patients by offering biologic and psychologic care. Nonphysician prescribing must not be extended: it would jeopardize patient care. APA must work with medical colleagues to reject prescribing authority for nonphysicians. This is our absolute highest priority. APA must lobby for national and state parity bills. Preserving privacy and the sanctity of the patient/therapist relationship is essential. The patients’ bill of rights must be supported.

•Demonstrate Value:

The amount of the mental health treatment benefit as a proportion of the health care dollar has declined. We must deal with managed care organizations; they will not go away, but they will change. We must demonstrate that integrated treatment by psychiatrists, with the right mix of psychotherapy and pharmacotherapy, is our unique competence. We must replace cost with value. The APA initiative on business and industry, designed to identify alternatives, is an important step for our future. Practice guidelines and standards of care that identify core competencies should be supported.

•Educate/Train:

APA can play a vital role in education. Academic departments of psychiatry are hard hit by the unwillingness of payers to fund the cost of training. The Medicare graduate education pass-through, which helps fund resident training, must be strongly supported. Training directors, as well as beginning residents, must be recruited into APA. APA should support fellowships, especially for women, minorities, and gay and lesbian psychiatrists; international medical graduates; and underrepresented APA groups. The annual meeting is highly successful, but the fall Institute on Psychiatric Services needs reevaluation.

•Research/Investigate:

The American Hospital Association estimates the cost of psychiatric disorders is $147.8 billion. There is a body of evidence that psychiatric disorders have adverse life consequences. The task is to demonstrate that treatment can reduce the burden of illness. APA’s brand new American Psychiatric Institute for Research and Education is a unique opportunity to conduct health and clinical service research. APA must be a source of health information for payers, industry, business, and consumers. The development of DSM-V will incorporate knowledge of cause, treatment, and outcome into this manual.

Reduce dues, reorganize, advocate, demonstrate value, educate, and investigate is the agenda. Our goal is to help our patients achieve their highest level of functioning. We offer quality of service to our patients and community. I am a strong and seasoned leader with a very broad background who will serve with dignity and passion. I ask for your vote.

Work: 60%—Medical director, public hospital leadership, supervision, and clinical oversight

20%—Medical college teaching, administration, and clinical investigation

20%—Clinical practice—general psychiatry and psychoanalysis

Income: 60%—Psychiatric hospital

20%—Medical college

20%—Private practice of psychiatry