The Business of Medicine - Missouri Psychiatric Association

Eastern
hiatric
Vol 35 No. 3 3rd Quarter, 2009
Missouri Psychiatry
Newsletter of the Eastern Missouri Psychiatric Society (EMPS)
* * * A District Branch of the American Psychiatric Association * * *
Dr. Paul Simon, Independence Center
Recognized at Annual Meeting
By Rebecca DeFilippo CMP
E
MPS conducted its annual meeting
June 4 at SSM DePaul Health
Center, in Bridgeton. The dinner
program included an awards ceremony
and a CME talk featuring keynote speaker
Pedro Ruiz MD, former APA president
and current president-elect of the World
Psychiatric Association. Dr. Ruiz, who is
on faculty with the University of Texas
Medical School at Houston, discussed
“Ethnicity and Psychopharmacology:
Recent Clinical Advances
Among the 61 attendees were 38 EMPS
members. DePaul staff included Barbara
Reitz RN, director of SSM Behavioral
Health Services, who welcomed attendees
and presented a brief slide show on DePaul’s
inpatient and outpatient psychiatric services
for children thru seniors.
SSM DePaul Health Center cosponsored the program. “We are happy to
host the EMPS annual meeting this year,”
said Lawrence F. Kuhn MD, DePaul’s
medical director of behavioral health
services. “It’s an opportunity to let the
mental health community know what we’re
all about.”
EMPS President Daniel T. Mamah
MD discussed some of the legislation
debated by Missouri lawmakers this spring.
EMPS supported bills on autism spectrum
disorders, prescription drug co-payments,
prompt pay statutes, and psychiatrist
representation on the Missouri HealthNet
Continued on page 5
Learning—and Living—
the Business of Medicine
By Azfar Malik, MD, MBA, FAPA
CEO, CenterPointe Hospital
Board Chairman, Psych Care Consultants
M
Dr. Daniel Mamah (l) presents the EMPS
Award of Excellence to Dr. Paul Simon. Photo
courtesy of Barbara Anderson.
Dr. Daniel Mamah (l) presents the EMPS
Award of Appreciation to Mike Keller of Independence Center. Photo courtesy of Barbara
Anderson.
Content
President’s Column.........................2
Legislative Report...........................4
any fresh-out-of-residency physicians dream of “putting up a shingle,” signaling
their readiness to serve the community’s healthcare needs. Armed with optimism
that the past decade’s sacrifices will bring financial rewards, suddenly, the truth
comes forth: our training institutions prepare us for our clinical livelihood, but lack the
proper insight or preparation for the strategic, financial and emotional difficulties of private
practice, or…the business of medicine.
Residency Training: Working or
Learning..........................................4
What Happened?
It was nearly 20 years ago that managed care spread throughout most metropolitan
areas, and employers, in an effort to afford healthcare for their employees, signed up
with HMOs and managed care organizations. The result? Patients lost the autonomy
of choosing their own healthcare and felt “owned” by insurance companies. Insurance
panels previously open to any willing provider suddenly were “closed,” meaning: select
physicians seeing select patients. Our fees were capped, and patients paid a greater share
Continued on page 3
Member Notes.................................8
APA at a Glance...............................6
“Best Doctors 2009”........................7
Suicide Risk Formulation DVD......7
Membership Update......................10
Obituaries......................................10
Committees....................................11
Outgoing Residents/Fellows..........11
Upcoming Events..........................12
Eastern Missouri Psychiatry
3rd Quarter, 2009
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Psychiatrist-Researchers are
Fundamental to Advancing
Mental Health
Daniel Mamah, MD, MPE
EMPS President
T
he pathophysiology involved in
psychiatric conditions is arguably
more complex than that of most other
medical illnesses. It is perhaps no surprise
that, compared to other organs in the body,
relatively more needs to be studied about
the brain to achieve major advancements in
psychiatric diagnosis and treatment. Psychiatry
today draws parallels to the state of general
medicine many decades ago, before the advent
of X-rays, MRI’s and laboratory tests to
diagnose and monitor disease. Prior to using the
current tools in medicine,
evaluating
diabetes,
cancer, infections or heart
conditions were estimated
by symptoms alone. The
field of medicine has since
made significant progress
in the understanding
of disease, aided by
researcher
scientists
and physicians. In turn,
society has benefited
from this knowledge
by developing better
targeted medications and
treatments.
Psychiatry is at an important stage in
its evolution, with the potential to greatly
improve the understanding of mental disorders
and develop more effective treatments.
Advances in neuroscience, psychiatric
genetics and treatment research have occurred
at a tremendous rate over the past two
decades. Yet, during this same period, clinical
psychiatry has remained relatively unchanged.
Leaders in psychiatric research and treatment
suggest that the lack of progress in prevention
and therapeutics is due to too few physicianscientists who can translate basic science
discoveries from genomics and neuroscience
into new treatments.
Despite increased funding for mental
health research, the training of psychiatrist-
2
researchers has not kept pace with the needs
of patient-oriented mental health research.
Although there has been a general decline
in the number of physician-researchers
across medicine, the trend is most alarming
in psychiatry. One survey of faculty of U.S.
medical schools found that only 15% of
academic psychiatrists spend more than half
of their time engaged in research. Another
survey found that fewer than 2% of all U.S.
psychiatrists consider research their primary
activity. Less than 10% of psychiatric
residents
express
interest in academic
or research careers
upon entering training;
ultimately, only a small
fraction will pursue the
rigor of an independent
scientific career.
It is understandable
why some psychiatric
physicians opt out of
academia. Education
debt
and
low
compensation can deter
some from choosing
a career in research,
while others may be interested in academia
but recognize the challenges that often exist
advancing through a research career. Some
simply enjoy working in a clinical setting
full-time. Despite increased federal funds
for science, attaining consistent research
support is often arduous especially in the
early stages of one’s career. However,
without appropriate and well-targeted
training, it can seem daunting to understand
scientific concepts, conceive sound research
questions, and author scientific manuscripts
or grants.
Many residency training programs lack
research education components. Proponents
recommend that residency training require
Continued on page 9
Eastern
Missouri
sychiatric
PSociety
A District Branch of the
American Psychiatric Association
1321 Montevale Court
Fenton MO 63026-3016
(636) 343-8555
[email protected]
www.emopsych.org
EXECUTIVE COUNCIL
OFFICERS 2008-2010
President
Daniel T. Mamah MD, MPE
President-Elect
Jack L. Croughan MD
Secretary/Treasurer
Susan A. Minchin MD, PhD
APA Assembly Representative
Garry M. Vickar MD
APA Assembly Deputy Representative
Lawrence F. Kuhn MD
Immediate Past President
Jack L. Croughan MD
COMMITTEE CHAIRS
Bylaws
Jo-Ellyn M. Ryall MD
Child & Adolescent Psychiatry
Judith H. McKelvey MD
Community & Public Psychiatry
Christopher Loynd DO
Education
Arturo C. Taca Jr. MD
Ethics
Lawrence F. Kuhn MD
Forensic Psychiatry
Jose Mathews MD
Legislative Aff airs
Paul B. Simon DO
Membership
Jo-Ellyn M. Ryall MD
Members-in-Training
Moses Tabe Ambilichu MD
Ben W. Holt MD
Newsletter
Daniel T. Mamah MD, MPE
Public Aff airs Psychiatry
Collins E. Lewis MD
EXECUTIVE DIRECTOR
Rebecca DeFilippo MBA, CMP
NEWSLETTER EDITORIAL DIRECTOR
Jessica Simon
GOVERNMENTAL CONSULTANT
Richard “Mo” McCullough
Eastern Missouri Psychiatry
The Business of Medicine
Continued from Page 1
in the form of co-pay. Clinical procedures required permission
or “preauthorization” or the physician would receive the dreaded
“denial.” To avoid legal issues, insurance companies advised that
it was not a denial of “service,” but a denial of “payment.” As
providers for the insurance/managed care organizations, physicians
were “rewarded” by close scrutiny on how much they were paid,
how often they could see a patient, and virtually having a hand in
the actual treatment of patients. In essence, managing the “care”
of the patient became synonymous with managing the cost. Not
only did healthcare providers suffer financially, but managing a
practice became stressful clinically and administratively. It was
time for physicians to take financial responsibility and choose
their direction and course for the future. It was time to put on the
business hats and develop strategies to work with—and within—
this growing phenomenon.
The Reaction
While insurance companies became adept at playing the business
field—physicians, who had never had to organize or strategically
align themselves remained fragmented. As hospitals formed
alliances to compete in this new age of healthcare, physicians found
themselves fighting to maintain autonomy and, more importantly,
financial solvency in maintaining a private practice. Although
partnerships and physician groups had existed for some time, it
became evident that physicians must group together, not only for
economies of scale, but to effectively compete for the increasing
percentage of healthcare dollars now being spent on healthcare
administration instead of actual clinical care.
Simple Steps to Take
Most physicians can learn the business of medicine, but lack the
administrative skills to implement strategies and the most precious
commodity of all…T I M E. The first step? Find the time and
invest in your future by creating a business model to sustain your
practice financially.
Join or form a group practice
The benefits of group practice are many—economies of scale
and clinical coverage, to name a few—but most importantly, a
group practice with partnership potential can be the pathway to
building a tangible product from an intangible. A solo practice,
previously a marketable commodity, now is worth simply your
assets (furniture, computers, etc.). A group practice, however,
offers greater potential in building equity and negotiation power,
and the capability of investing in different ventures.
Purchase an office/building
Many physicians opt to rent from a hospital’s physician office
complex in hopes that the pool of patients will be funneled to their
offices. This can have advantages when starting a practice, but, as
part of an established group, the benefit is minimal. Make it your
goal to own a building within 15 years of starting your practice.
Analyze payer reimbursements
Physicians who take the time to check the variance on
3rd Quarter, 2009
reimbursement rates among insurance and managed care companies
often are surprised at the findings. With due diligence to the bottom
line, it’s important to know if you can actually afford to treat a
patient in your office! Some programs pay the same for procedure
codes regardless of the visit length. However, some employ a “disincentive”—reimbursing less for more time spent with the patient.
Analyze your patient population
Unless you can sustain a self-pay practice, you must know your
patient population! Traditionally, in communities in which
physicians live (middle class/more affluent) there is a higher
prevalence of HMOs. The benefit is that your clientele has
insurance and can afford co-payments. However, it may surprise
you to know that by evaluating your metropolitan area you may
find that increased reimbursement is as easy as locating your office
as few as 10 miles from the most affluent suburb. Why? Blue-collar
workers living outside the suburbs tend to have the best insurances
(higher physician reimbursement, lower co-pays).
Review your billing and collections
How often have you heard, “I didn’t bring my checkbook,” “I
don’t have any cash on me… I’ll pay you next time.” Retailers and
other businesses don’t allow those excuses, why should you?
Co-payments, have increased to as much as $40 or co-insurance
of more than 50 percent of the negotiated rate. Statements billed
out to the insurance company yield reimbursement checks of $5
and in some cases $0. Co-payments and co-insurance can account
for more than 40 percent of revenue. The co-payment collection
issue, coupled with insurance denials, emphasizes the importance
of support staff capable of developing a system of checks and
balances to ensure that all billable fees are being collected at the
time of service.
Analyze your overhead
Your most important resource is your staff. AND, your most
expensive resource (and overhead expense) is your staff. Thus,
choose wisely and make that resource efficiently and effectively
work for the good of your practice.
So, maybe we didn’t know we’d have to become businessmen
and women when we recited that Oath, completed those residencies
and set out to be the best physicians we knew how to be…
Maybe we thought that the evolution of healthcare payers and
reimbursement would come full circle…
No matter what, we thought we knew fresh out of residency,
NOW is the time for physicians to take fiscal responsibility and be
proactive in the business of medicine.
When it comes to the business of medicine, the bottom line
(main or essential point) these days is not just the good clinical
outcomes of a skilled physician; it’s the bottom line (the line in a
financial statement that shows net income or loss.) The healthcare
of tomorrow requires physicians who show good outcomes in all
respects: financial and clinical.
That means, it is our job is to take care of people—not just
patients who are ill—to intervene and even prevent illness
whenever possible, and to keep people well. It’s our job to be
cost-effective, cost-efficient and learn to use our resources to the
betterment of our business and the people we serve. That’s just
good business…and good medicine.
3
Eastern Missouri Psychiatry
3rd Quarter, 2009
Missouri Legislative Report
By Richard “Mo” McCullough
T
he 2009 legislative session is over
and all is quiet in the state. Well
except, that is, for the seemingly
endless political fundraisers going on
across the state. With term limits in
effect and an ever changing political and
economic climate the quest for money to
fund political campaigns is never ending.
This makes political action committees
more important than ever.
Even though we were once again
able to keep psychologists from gaining
prescriptive rights in the 2009 legislative
session we must continue our efforts to
address the access issue and be proactive
in 2010. The RxP issue will not go away
next year so it is up to us to provide the
legislators with a positive, workable
alternative so they will not buckle to the
pressure from those pushing RxP.
As I’m sure you are aware, the Governor
vetoed the bill that would have allowed
anyone over the age of 21 to ride their
motorcycles on certain Missouri roadways
without wearing a helmet. He rightly
concluded that this would have had a
devastatingly negative impact on the safety
of many citizens of Missouri.
The Governor also vetoed several line
items in this year’s budget because of
current and future deficits. Much of his
vetoes dealt with the federal stimulus money
because he disagreed with the legislators on
how to spend it. There has been an interim
committee set up to look at this issue and
there very well could be a special session
called to deal with it.
RxP, LPC’s diagnosing, helmets, budget
woes and other troubling issues will be
back in 2010. This is a call to get involved
in the political process, the EMPS and the
PAC. Numbers and money rule the day and
we need more of both.
Residency Training: Working or Learning
T
By Dr. Moses Ambilichu MD
Resident Physician, St Louis University School of Medicine
Co-Chair EMPS Member-in-Training Committee
he United States of America
represents the most attractive
destination for medical graduates
trained here and abroad to pursue
postgraduate medical education. We are
extremely proud to be part of this great and
unique tradition of diligence, honesty, and
decency. It is our fervent wish not only to
succeed in attaining specialized training
but also to function as resourceful elements
in the systems in which we operate.
Residency training requires taking
care of patients so that critical clinical
skills embed in the brain of the maturing
postgraduate. It also involves assimilating
key theoretical concepts, making this kind
of juxtaposition the ideal ingredients for
producing a fine medical doctor.
What proportion of workload versus
teaching will establish the right equilibrium
for the postgraduate to sail towards the
distant shore of success? A patient load that
is too low may deprive the resident of the
practical experience needed to consolidate
core concepts. However, a patient load too
high or, worse still, overwhelming may
transform the resident into a mechanical
executor of activities, excluding room
for critical thinking and making bedside
learning and intellectual interaction with
the attending impossible.
The ideal situation would be to exploit
every patient encounter as an opportunity to
4
foster knowledge as a forum for profound
thought processes and an asset to the
intellectual wellbeing of the resident. In this
terrain, the time factor plays an important
role in the way we conduct business. Any
working environment and work volume
that allows for critical thinking, and an
adequate level and quality of attendingresident interaction represents the fertile
ground upon which the flowers of medical
know-how will blossom.
As we wallow in the alleys of residency
training, working and learning should
function as interdependent variables. The
correct dose of the two should inject the
right quantity of energy to catapult the
resident out of the dark tunnel of training
into the bright light of success as an
independent professional.
From a learning perspective, it may be
beneficial for psychiatry residents to apply
their knowledge of basic medical science
to resolve their patients’ minor medical
problems, deferring only moderately and
severely ill patients to a consultant of
another specialty. It is noteworthy that
many mentally ill patients lack a primary
care physician; the psychiatrist may be the
only medical professional the patient sees.
Keeping the flame of basic medical
science burning during residency and
beyond may be an added asset that definitely
will serve some of our often-marginalized
patients’ needs. If a consultant has to be
called in to treat OM, pharyngitis, cystitis,
etc., then one could argue that this kind of
practice raises the cost of health care at a
time when this country is almost drowning
in a health care crisis.
Opinions diametrically opposed to
this may evoke liability concerns when
psychiatrists have to prescribe a nonpsychiatric medication. Within a hostile
medico-legal climate, an exaggerated
prudence and fear may set in when our
patients ask us to address some of their
other medical complaints. I refer to this
phenomenon as the “lawsuit psychosis”
and intend to talk about it in greater detail
in a subsequent article.
In conclusion, residency training should
involve exposure to and management of
patients afflicted by a variety of disease
processes. One obtains the greatest reward
when the workload allows the resident to
develop and exploit profound and critical
thinking processes that help consolidate
core concepts. Psychiatry residents, while
mastering the dexterity of a mental health
provider, should get into the habit of
utilizing their basic medical knowledge
when treating patients who present with
minor medical complaints, an attitude that
will prove of great value to some of our
patients. This behavior will also enrich and
even add flavor to our practice.
Eastern Missouri Psychiatry
Annual Meeting
Continued from Page 1
Oversight Committee. It opposed bills
to relax motorcycle rider helmet use, and
expand scopes of practice for physician
assistants, licensed professional counselors,
and psychologists.
Intense lobbying by members from
Missouri’s three APA district branches, other
physicians, and mental health advocates
convinced lawmakers to deny prescribing
authority (RxP) to non-medically trained
psychologists. Dr. Mamah encouraged
members to advocate on issues that affect
their patients and the profession. “Contact
your legislators—by phone, by e-mail, by a
personal visit,” he said. “These are effective
ways to get your message across.”
Dr. Mamah presented special EMPS
awards to Paul B. Simon DO and
Independence Center. Mike Keller accepted
an Award of Appreciation for Independence
Center’s legislative advocacy. Mr. Keller,
executive director of the rehabilitation
program for adults with severe and persistent
mental illness, said he was “honored and
humbled by the award.”
Dr. Simon received an Award of
Excellence for exemplary member
service. As Legislative Affairs chair, he
has campaigned actively against RxP bills
and co-founded the Missouri Psychiatric
Physicians Political Action Committee.
As a member and former chair of the
Members-in-Training Committee, he
helped plan networking receptions for
psychiatry residents at St. Louis University
and Washington University, and spoke at
orientation for incoming WU residents.
He personally recruited at least 10 new
APA members, which qualified him for a
3rd Quarter, 2009
100% rebate on his DB membership dues
for one year under the EMPS membership
recruitment and retention campaign. He
completed residency training at Washington
University in June and is in private practice
with St. Peters-based Advent Medical.
“Get involved in the political process,”
Dr. Simon urged members. “Legislators
want to hear from you about the issues.”
The exhibit hall featured displays
by AstraZeneca, Bristol-Myers Squibb,
Cephalon, Eli Lilly, Independence Center,
Janssen, Mental Health America of Eastern
Missouri, NAMI St. Louis, Pfizer, and the
Self-Help Center.
CHILD,
ADOLESCENT
& ADULT
BEHAVIORAL
HEALTH SERVICES
RESIDENTIAL
CHEMICAL
DEPENDENCY
UNIT
DUAL DIAGNOSIS
TREATMENT
24-HOUR
ASSESSMENT
AND REFERRAL
From left: Garry M. Vickar MD, Barbara Reitz
RN, Daniel Mamah MD, Pedro Ruiz MD, Lawrence F. Kuhn MD, Paul Simon DO, and Mike
Keller. Photo courtesy of Barbara Anderson.
Dr. Pedro Ruiz MD, keynote speaker at EMPS
2009 Annual meeting. Photo courtesy of
Barbara Anderson.
OFFERING HOPE FOR A BRIGHT FUTURE
C
enterPointe Hospital provides a
comprehensive continuum of inpatient and
outpatient behavioral health services for adults,
adolescents and children, and the area’s only
private, residential chemical dependency program.
Outpatient services also are available in West and South
St. Louis County, St. Louis City and Washington, Mo.
For a free, confidential assessment or information
on any CenterPointe service, call 636-441-7300
or 800-345-5407.
5931 HIGHWAY 94, SOUTH
ST. CHARLES, MISSOURI 63304
636-441-7300 800-345-5407
www.centerpointehospital.com
5
Eastern Missouri Psychiatry
3rd Quarter, 2009
APA at A Glance
By Rebecca DeFilippo CMP
Membership Dues to Increase
The Executive Committee of APA’s
Board of Trustees has voted to increase
the dues rates for 2010 from $540 to $565.
At its July 10-12 meeting in Washington,
D.C., the committee also increased rates
for the other categories for U.S. and
non-U.S. members, according to a July
17 memorandum distributed to District
Branch/State Association executive staff.
In addition, EMPS dues rates will increase
for 2010 from $250 to $300. At a general
membership meeting held August 28, 2007,
members voted to increase dues by $5 per
year for the next four years (2008-2011)
for Members in Training and Early Career
Psychiatrists (1st Year General Members).
Members also approved a $50 per year
increase each year for the same period for
Associate, General, Fellow, Distinguished
Fellow, Life Fellow, Distinguished Life
Fellow, and Life members.
The APA Membership year runs January
1 – December 31. Under APA’s Central
Dues Billing Service, APA invoices EMPS
members for both national and local dues.
APA will send notices for the 2010 dues
year in October and payments are due
January 1. Members who do not pay 2010
dues by October 31, 2010, will be dropped
from the APA Membership rolls. District
Branch/State Society membership is a
requirement of APA membership and vice
versa. Loss of membership in either entails
loss of membership in both.
For more information, contact the
APA Answer Center toll free at 1-888-35PSYCH or [email protected]. Contact EMPS
at 636-343-8555 or [email protected].
APA Freezes 2009 Grant Funds
In other Board action, the Executive
Committee voted to freeze District Branch
Competitive Grant funds for 2009. The
Board decided not to fund any grant
requests this year in a continuing effort
to stem revenue shortfall, according to a
July 20 e-mail from APA President Alan F.
Schatzberg MD and Medical Director/CEO
James H. Scully Jr. MD.
Two of Missouri’s three district branches
submitted grants in collaborative efforts to
address access to care. Western Missouri
Psychiatric Society planned to develop a
statewide telephone consultation service
by volunteer psychiatrists with primary
care physicians. The EMPS grant proposed
a “Find a Psychiatrist” online directory
compiled from self-reported information
provided by voluntarily participating
APA members in Missouri. Both grants
included APA-member psychiatrists from
the Western, Central and Eastern Missouri
psychiatric societies.
2010 APA NATIONAL & EMPS DUES RATES FOR U.S. MEMBERS
MEMBERSHIP CATEGORY
Member in Training*
Early Career Psychiatrist (1st Year General Member)
General Member** (1-3 Years)
General Member (4-6 Years)
APA
$105
NA
$205
$395
EMPS
$35
$35
$300
$300
General Member (7+ Years)
Fellow, Distinguished Fellow, Associate Member
Fellow, Distinguished Fellow, General Member,
Associate Member w/ at least 15 TYM & 70 years of age
Distinguished Life Fellow, Life Member, Life Fellow,
and Life Associate (1-5 Years)
$565
$565
$300
$300
$375
$200
$375
$200
$190
$100
Distinguished Life, Fellow, Life Member, Life Fellow
and Life Associate (6-10 Years)
* First year waived
** Year 1 is the actual year that one joins the APA or advances to GM status
6
In further news, APA announced that
it had “severely reduced and restricted”
CALF Grant and DB Infrastructure Grant
budgets for the remainder of 2009. The
Committee on Advocacy and Litigation
Funding (CALF) provides financial
support for projects involving legislation,
litigation, and advocacy. EMPS submitted
a CALF grant this year. The Board will
consider proposals that are in the CALF
and Infrastructure review processes.
Patients, Psychiatrists Defeat
Prescribing Bills
Nine states including Missouri debated
13 bills to expand psychologist prescribing
(RxP) authority during the 2009 legislative
sessions. None of the bills passed, failing
across the country in states as diverse as
Arizona, Hawaii, Illinois, Mississippi,
Montana, North Dakota, Tennessee, and
Texas.
“This is the largest number of states
ever to propose prescribing legislation in
a single year,” according to the American
Psychiatric Association (“Prescribing Bills
Proliferate Despite Numerous Defeats”
by Rich Daly, Psychiatric News, July 17,
2009).
Three
other
statesWisconsin,
Michigan and Ohiomay consider RxP
bills before the end of 2009.
In Oregon, legislators passed an
amended bill that replaced a psychologist
prescribing authority with an “interim work
group,” noted Psychiatric News reporter
Rich Daly. The work group will develop
“recommendations for an accredited
training program for psychologists to
prescribe medications safely for people
with mental illness.” While authorities
expect the governor to sign the bill, no
update was available at press time.
In Missouri, lawmakers halted two
bills to expand RxP authority before the
Legislature adjourned in mid-May. In fact,
prescribing bills have failed every year
here since 1996 when proponents first
introduced them.
Physicians from the state’s three district
Continued on page 7
Eastern Missouri Psychiatry
3rd Quarter, 2009
44 EMPS Members Make “Best
Doctors 2009” List
APA at A Glance
Continued from Page 6
branches and other medical specialty and
sub-specialty societies, and mental health
advocates engaged in intense lobbying
efforts that included numerous meetings
with legislators in Jefferson City and in their
home districts, public hearing testimony,
communications campaigns, and a mental
health advocacy day in January at the State
Capitol.
Advocates also spoke with lawmakers
about access-to-care problems that many
psychologists cite as an argument for
expanding their scope of practice. They
convinced legislators that options such as
increasing the number of telepsychiatry
sites, co-locating primary care physicians
and psychiatrists in practice settings, and
telephone consultation services among
others would enable more physicians to
deliver psychiatric care to more patients
without risk.
Despite an expensive 15-year national
campaign to grant psychologists prescriptive
privileges, the American Psychological
Association has succeeded in only two
states, New Mexico (2002) and Louisiana
(2004). Advocacy efforts to protect patients
have defeated RxP bills in 21 states since
1995.
In Missouri, physicians expect renewed
debate when the 2010 General Assembly
convenes in early January.
By Rebecca DeFilippo CMP
I
n its largest special medical issue yet,
St. Louis Magazine identified more than
1100 physicians across 79 specialties in
the St. Louis region that made the annual list
of “Best Doctors” as chosen by their peers.
The public does not nominate candidates to
the “Best Doctors” list. Previous “Best Docs”
on the list do so.
To determine “standout physicians,” Best
Doctors Inc., founded by Harvard Medical
School-affiliated doctors, contacts physicians
in the St. Louis region and asks them, “If
you or a loved one needed a doctor in your
specialty, to whom would you refer them?”
(“Best Doctors 2009” St. Louis Magazine,
August 2009, pp. 83-164).
The company adds only those doctors to
the list who pass its stringent vetting process,
i.e., licensing and certification requirements
and no disciplinary actions. The company
also fact-checks contact information (location,
phone number, clinical activity, etc.) for each
doctor and updates it annually.
The “Best Doctors 2009” feature named
44 EMPS members in the specialties of
Psychiatry and Pediatric Specialist/Child and
Adolescent Psychiatry. This is nearly double
the 2008 list, which included 26 peer-selected
physician members. One physician, Dr.
Kimberli McCallum, was named this year in
both specialty areas. To view a complete list
of all physicians on the 2009 list, go to http://
www.stlmag.com/media/St-Louis-Magazine/
SLM-Lists/Best-Doctors/.
Suicide Risk Formulation DVD Available
By Rebecca DeFilippo CMP
T
he American Association of Suicidology (AAS) has developed a DVD training on
“Suicide Risk Formulation: A Guide for Psychiatrists.” The program was funded by a
grant from Noven Therapeutics LLC.
The comprehensive PowerPoint presentation is meant to further educate psychiatrists
about suicide risk and its formulation, with a goal to help psychiatrists better recognize and
treat those at risk for suicide.
For 42 years, AAS has led the nation in the advancement of scientific and programmatic
efforts in suicide prevention through research, education and training, the development of
standards and resources, and survivor support services.
EMPS has a limited supply of the DVD available for free distribution to members. If you
would like to receive a complimentary copy, please contact Rebecca DeFilippo at 636-3438555 or [email protected].
Pediatric Specialist/Child and
Adolescent Psychiatry
Michael R. Banton MD
Kimberli E. McCallum MD
Daniel B. Reising MD
Adelita M. Segovia MD
Psychiatry
Laura J. Beirut MD
Charles R. Conway MD
Abhilash Desai MD
Alan R. Felthous MD
Cynthia A. Florin MD
Keith Sigmond Garcia MD
Eduardo Garcia-Ferrer MD
Luis Alberto Giuffra MD
George T. Grossberg MD
Duane Q. Hagen MD
Melissa Ann (Swallow) Harbit MD
Daniel W. Haupt MD
Barry A. Hiatt MD
Linda S. Horne MD
Richard W. Hudgens MD
William M. Irvin Jr. MD
Michael R. Jarvis MD
Saad Zia Ur Rab Khan MD
Hilary K. Klein MD
Jerold J. Kreisman MD
Lawrence F. Kuhn MD
Eric J. Lenze MD
Jothika Manepalli MD
Kimberli E. McCallum MD
K. Lynne Moritz MD
John W. Newcomer MD
Eric J. Nuetzel MD
Patrick A. Oruwari MD
Becky A. Pew MD
Andrew T. Pickens III MD
Elizabeth F. Pribor MD
John Stanley Rabun Jr. MD
Diane Rankin MD
Thomas F. Richardson MD
Eugene H, Rubin MD
Jo-Ellyn M. Ryall MD
Arturo C. Taca Jr. MD
Andrea Wilson MD
Harold D. Wolff MD
Layla Ziaee MD
Charles F. Zorumski MD
7
Eastern Missouri Psychiatry
Member Notes
 In late August, APA Immediate Past
President Nada Stotland MD will lead a
group of at least 15 travelers including
Distinguished Fellow Jo-Ellyn M.
Ryall MD on a visit to Russia as part of
a People to People Citizen Ambassador
Program focused on psychiatry. The travel
Ambassadors will meet with psychiatrists
in Moscow and Saint Petersburg, and tour
the Kremlin, Novodevichy Convent, the
Hermitage, Saint Isaac’s Cathedral, and the
Catherine Palace of Tsarskoye Selo, home
of the “Amber Room.” Considered by
many to be the eighth wonder of the world,
the magnificent Amber Room was looted
during World War II and eventually rebuilt,
finally re-opening in 2003.
This is Dr. Ryall’s second trip to
Russia since 1996, when she visited Saint
Petersburg on a Baltic Sea cruise. “It will
be interesting to see how [the country] has
changed in 13 years,” she said. “And, yes, I
can be convinced to write an article for the
newsletter.”
The People to People Citizen
Ambassador Program provides unique
opportunities for healthcare profesAsionals
to meet and share ideas with international
colleagues. Ambassador Programs travel
may be used for Category 1 continuing
medical education credit for physicians.
Healthcare professionals interested in
learning more about the programs can visit
http://www.peopletopeople.com or call
1-877-787-2000.
From left: Dr. Jo-Ellyn Ryall, Rebecca
DeFilippo, Dr. Jaron Asher, Jennifer Asher, and
baby Anna Asher (at lower right in stroller) at
the May 30 NAMIWalk in Forest Park. Photo
courtesy of Jo-Ellyn M. Ryall MD.
8
3rd Quarter, 2009
 The American Psychiatric Association
honored several EMPS members May 18
at the 53rd Convocation of Distinguished
Fellows during the APA annual convention
in San Francisco. Rolf Krojanker MD
and Nathan M. Simon MD achieved
Distinguished Life Fellow status. These
members have demonstrated exceptional
loyalty to the APA, with fifty years of
membership as of January 1, 2009.
Four
members
advanced
to
Distinguished Life Fellow: William W.
Clendenin MD, Alan R. Felthous MD,
Lawrence F. Kuhn MD, and Bharat Raj
Nakra MD. Distinguished Life Fellows are
Distinguished Fellows who have achieved
Life status, an honor bestowed on members
who, through years of active membership,
have demonstrated outstanding loyalty to
the APA.
Jothika Manepalli MD advanced
to Distinguished Fellow. Distinguished
Fellows are nationally recognized for
their demonstrated skill in administrative,
educational, and clinical settings. They are
also noted for volunteering in mental health
and medical activities of social significance
and involvement in community activities.
 The APA also recognized two EMPS
members with special awards during
the national convention. On May 19,
Distinguished Life Fellow C. Robert
Cloninger MD received the APA Judd
Marmor Award Lecture. Dr. Cloninger is
Wallace Renard Professor of Psychiatry,
Professor of Psychology and Genetics,
and Director of the Sansone Family Center
for Well-Being at Washington University
School of Medicine in St. Louis. He is
also Scientific Director of the Anthropedia
Institute, a non-profit organization
dedicated to development of human wellbeing through initiatives in health care
and education. The Institute of Scientific
Information ranks him among the most
highly cited psychiatrists and psychologists
in the world. The estate of Judd Marmor
MD endows the Marmor Award.
At an awards ceremony on May 17,
Distinguished Life Fellow Alan R. Felthous
MD received the AAPL/APA Manfred S.
Guttmacher Award Lecture. Dr. Felthous
is Professor and Director of Forensic
Psychiatry, Department of Neurology and
Psychiatry, St. Louis University School of
Medicine. He is senior editor of Behavioral
Sciences and the Law. His research,
scholarly and teaching interests focus on
clinical aggression, the psychopathology
of criminal behavior, legal requirements of
clinicians in managing potentially violent
patients, and jail and prison suicide. The
Guttmacher Award was established in 1967
to honor outstanding contributions to the
literature of forensic psychiatry presented
at any professional meeting or published in
the previous year. The American Academy
of Psychiatry and the Law cosponsors the
award.
 General Member Jaron M. Asher MD
and Distinguished Fellow Jo-Ellyn M.
Ryall MD joined nearly one thousand
mental health advocates for the 7th Annual
NAMIWalk for the Mind of America May
30 at Forest Park in St. Louis. Dr. Asher’s
team included his wife, Jennifer, 18-monthold daughter Anna, Dr. Ryall, and EMPS
Executive Director Rebecca DeFilippo
CMP. NAMI St. Louis raised $133,000 to
support its free programs and services for
the mentally ill and their families. EMPS
was one of several corporate sponsors of
the event.
 At the Area 4 Council meeting in March,
Member-in-Training Ben W. Holt MD was
elected to the APA Assembly Committee
of Members-in-Training (ACOM). ACOM
provides a voice for psychiatry residents
and fellows around the nation to the APA
Assembly and Area Councils. ACOM
Ben Holt MD
Member of APA Assembly
Committee of MIT
Continued on page 9
Eastern Missouri Psychiatry
3rd Quarter, 2009
Member Notes
Continued from Page 8
members are elected to serve two sequential one-year terms: the first
year as the Area Member-in-Training (MIT) Deputy Representative
and the second year as the Area MIT Representative with voting
privileges in the Assembly. ACOM members serve on a wide array
of committees on the national level, representing the interests of
members-in-training.
“It is a position I am excited about,” Dr. Holt said about his
election. “I hope that I can learn from my experiences to help
strengthen our DB.”
Dr. Holt, a third year general psychiatry resident at Washington
University in St. Louis/ Barnes-Jewish Hospital, also co-chairs
the MIT Committee on the EMPS Executive Council. During the
past year, he has become familiar with various aspects of the APA
at both local and national levels, and has met with government
officials regarding patient safety and statewide advocacy. He also is
a frequent contributor to Eastern Missouri Psychiatry newsletter.
In addition to Missouri, the Area 4 Council represents 11 other
Midwest states: Kansas, Iowa, Minnesota, Nebraska, North Dakota,
South Dakota, Wisconsin, Michigan, Illinois, Indiana and Ohio.
Area 4 is the second largest council in terms of voting strength.
“Member Notes” is an opportunity for members to share news
about their professional accomplishments. Please submit entries
to Rebecca DeFilippo at [email protected] or EMPS Member
Notes, 1321 Montevale Court, Fenton, MO 63026. All entries
subject to editing.
Psychiatrist-Researchers
Continued from Page 2
Membership Form
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* State law requires that we use our best efforts to collectand report the
name, mailing address and employer of individuals who contribute to
MoPPPAC.
Enclosed is my check or money order for:
$250 Capitol Club
$365 Dollar-a-Day Club
patient-oriented research literacy as a core competency. Curricula
are needed that incorporate research training across the range
and time constraints of residency programs, and trainees should
be informed about research fellowships and other training
opportunities. Without exposure to the benefits of research, many
physicians may not realize their full potential to contribute to
advancing the field.
Perhaps at no other time in the history of psychiatry has there
been so much public interest in our field. Through careful patientoriented research, our field has a chance to correct damaging
misconceptions about psychopathology and psychiatric treatments.
We must be able to translate basic and clinical science discoveries
into effective treatments. Only with sufficient numbers of both
clinicians and research-physicians will we be able to optimally
benefit those suffering from mental conditions.
$500 Speaker’s Club
$1,000 Senator’s Club
$2,500 Congress Club
$5,000 President’s Club
Other $_______ MoPPPAC Club
The amounts recommended are suggestions only. An individual or medical practice may donate more or less than the suggested amount. The
amount donated by a contributor, or the refusal to donate, will not benefit
or disadvantage you. Only U.S. Citizens or Green Card holders may
contribute. Contributions to the PAC are not tax deductible.
Make checks payable to: MoPPPAC
Return to: 1321 Montevale Court, Fenton, MO 63026
9
Eastern Missouri Psychiatry
3rd Quarter, 2009
EMPS Membership Update
New Members (1)
In July, Nezar Ali El-Ruwie MD joined the APA as a Memberin-Training. He is a PGY-1 Psychiatry Resident at St. Louis
University. He was born in Egypt and completed medical school
at Garyounis University in Benghazi, Libya.
Advancements (4)
Three members advanced to General Member from Memberin-Training in June. Alana Palomar Cox MD completed her
Psychiatry Residency at Washington University in St. Louis. Jaime
Hook MD completed a Child Psychiatry Fellowship at Washington
University. Stacy L. Neff DO completed a Psychiatry Residency
at St. Louis University.
William M. Redden MD, who completed a two-year Geriatric
Research Fellowship at St. Louis University in June, will join
the school’s geriatric psychiatry faculty in September. He will
see patients in the outpatient clinics at SLU and at the Jefferson
Barracks VA. Dr. Redden is now a General Member.
Transfers In (1)
General Member Ericka L. Goodwin MD has returned to St.
Louis and EMPS. She previously was a member of the Georgia
Psychiatric Physicians Association DB 11 and EMPS before that.
Transfers Out (3)
In July, Member-in-Training Dawn K. Brown MD moved to
Houston, Texas, where she will serve a two-year fellowship in
the Child Psychiatry Program at Baylor College of Medicine. She
completed a psychiatry residency at St. Louis University in June.
She transfer to the Texas Society of Psychiatric Physicians DB
46.
In June, General Member Erica C. Montgomery MD moved to
Houston, Texas, where she works part-time in the Post-Traumatic
Stress Disorder outpatient clinic at the Michael E. DeBakey
Veterans Affairs Medical Center. She will see returning veterans
from Operation Iraqi Freedom and Operation Enduring Freedom
(Afghanistan). While in St. Louis, Dr. Montgomery worked in
the mental health division at the St. Louis VA Medical Center Jefferson Barracks Division. She previously resided in Texas and
was a member of the Texas Society of Psychiatric Physicians DB
46 before transferring to EMPS in June 2007. “It is roasting here,
too,” Dr. Montgomery said about the hot summer weather in the
Lone Star State.
In April, Member-in-Training Michelle L. Dees MD moved to
Chicago and will transfer to the Illinois Psychiatric Society DB
13.
Psychiatry Fellowship
Member-in-Training Jeremy R. Thompson MD will serve a oneyear fellowship in Forensic Psychiatry at the University of Arkansas
for Medical Sciences, in Little Rock. He was Chief Resident in
psychiatry at Washington University in St. Louis for 2008-2009.
Deaths (2)
Maria M. Lyskowski MD died May 4, 2005 (see Obituaries
below).
José “Joe” Carlos da Silva MD died March 7, 2009 (see Obituaries
below).
TOTAL MEMBERS: 329, as of July 24 2009
OBITUARIES
In late June, the family of Maria M. Lyskowski MD reported her death on May 4, 2005, at the age of 83, in Jefferson City,
Mo. Dr. Lyskowski, who was born in Poland and spoke fluent Polish and German, completed her medical degree at the Med
Fakultaet der Universitat Hamburg, in Hamburg, Germany. She immigrated to the United States in the 1960s and served a
general psychiatry residency at the Washington University/Barnes Jewish Hospital/St. Louis Children’s Hospital program
from 1966 to 1969. She joined the APA in 1971 and was a member for 34 years before retiring in 2005 as a General Member.
APA Life Member José “Joe” Carlos da Silva MD, of St. Peters, Mo. (formerly of Sappington, Mo.), died on March 7, 2009,
at the age of 81. Dr. da Silva was born in Brazil and completed his medical degree at Federal University of Rio Grande do
Sul, College of Medicine. He immigrated to the United States in the 1960s and served general psychiatry residencies at the
former Missouri Institute of Psychiatry and the Washington University/Barnes Jewish Hospital/St. Louis Children’s Hospital
program. He was a psychiatrist with the Missouri Department of Mental Health and worked at various St. Louis area hospitals
and clinics including the former St. Louis State Hospital, Catholic Family Charities, and COMTREA. He joined the APA in
1973 and was a member for 37 years. He also was a member of the American Medical Association. He is survived by his wife
of 53 years (Gilda Kieling da Silva), 20 grandchildren and 4 great-grandchildren.
10
Eastern Missouri Psychiatry
3rd Quarter, 2009
EMPS Committee Membership
BYLAWS
Jo-Ellyn M Ryall MD (chair)
EDUCATION
Arturo C. Taca Jr. MD (chair)
CHILD and ADOLESCENT
PSYCHIATRY
Judith McKelvey MD (chair)
Meg Corrigan MD
David Duesenberg MD
Dehra Glueck MD
Adelita Segovia MD
Duru Sakhrani MD
Moisy Shopper MD
Natasha Marrus MD
ETHICS
Lawrence Kuhn MD (chair)
Aviva Raskas MD
Moisy Shopper MD
COMMUNITY and PUBLIC
PSYCHIATRY
Chris Loynd DO (chair)
Malik Ahmed MD
Jay Engelhart MD
Asif Habib MD
Duru Sakhrani MD
Melissa West MD
FORENSIC PSYCHIATRY
Jose Mathews MD (chair)
Angeline Stanislaus MD
LEGISLATIVE AFFAIRS
Paul Simon DO (chair)
Jack L. Croughan MD
Alan Felthous MD
Asif Habib MD
Azfar Malik MD
Jay Meyer MD
MEMBERS-IN-TRAINING
Ben Holt MD (co-chair)
Moses Tabe Ambilichu MD (co-chair)
Ujjwal Ramtekkar MD, MPE
Paul Simon DO
MEMBERSHIP
Jo-Ellyn M Ryall MD (chair)
Bharat Nakra MD
Edwin D. Wolfgram MD
NEWSLETTER
Daniel Mamah MD, MPE (chair)
Azfar Malik MD
Ujjwal Ramtekkar MD, MPE
PUBLIC AFFAIRS
Collins Lewis MD (chair)
David Duesenberg MD
Herb Rosenbaum MD
Angeline Stanislaus MD
Radhika Rao MD
Outgoing Residents/Fellows
Washington University
Psychiatry Residents
* Alana Cox MD, Clinical
Practice atBJC-BH and
the Washington University
Danforth Campus in St.
Louis, MO
* Michelle Dees MD, Clinical Practice in Chicago,
IL
* Wesley Dickerson MD,
Clinical Practice with
State system in Brooklyn,
NY
* Mollie Gordon MD, Academic Position at Baylor
College of Medicine in
Houston, TX
* Sarah Hartz MD, Academic Position at Washington
University in St. Louis,
MO
* Paul Simon DO, Clinical
practice at Advent Medical Group in St. Peters,
MO
* Jeremy Thompson MD,
(Forensics Fellowship)
University of Arkansas for
Medical Science, in Little
Rock, AR
Child and Adolescent
Fellows
* Mini Tandon, D.O.
* Suzanne L’Ecuyer, M.D.
* Kelly Botteron, M.D.
Saint Louis University
Psychiatry Residents
* Dawn Brown MD, (Child
& Adolescent Psychiatry Fellowship) Baylor
College of Medicine in
Houston, TX
* Lauren Flynn MD, no
decision
* Stacy Neff DO, no decision
* Amit Rathi MD, (Child
& Adolescent Psychiatry
Fellowship) Children’s
National Medical Center
in Washington, DC
* Harmeeta Singh MD, no
decision
* Rangsun Sitthichai MD,
(Child & Adolescent Psychiatry Fellowship)
Children’s Hospital - Harvard Medical School in
Boston, MA
* Sekhar Vangala MD,
Southeast Missouri
Mental Health Center in
Farmington, MO
Geriatric Psychiatry
Fellows
* Syed Akhter MD, no decision
* Pooja Sharma MD, Saint
Louis University School of
Medicine (general psychiatry)
11
Eastern
Missouri
sychiatric
PSociety
A District Branch of the
American Psychiatric Association
1321 Montevale Court
Fenton, MO 63026-3016
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Upcoming Events
Tuesday, September 22, 2009
EMPS CME Dinner Program
“Preventive Health Care, A Psychiatric Perspective:
The Role of Fitness in Mental and Physical Health”
Edwin D. Wolfgram MD
Maggiano’s Little Italy, #2 The Boulevard-Saint Louis,
Richmond Heights, MO 63117
5:30 p.m. - 9:00 p.m.
Contact: 636-343-8555 or [email protected]
Tuesday, October 20, 2009
EMPS CME Dinner Program
“Life After Residency: Options for Psychiatric Practice”
Location: To be announced (TBA)
5:30 p.m. - 9:00 p.m.
Contact: 636-343-8555 or [email protected]
October 8-11, 2009
APA Institute on Psychiatric Services
“Pride and Practice: Bringing Innovation Into Our Treatments”
Sheraton New York Hotel & Towers, New York, NY
Contact: 703-907-7300 or http://www.psych.org/ips
We strive to make content in future issues of
Eastern Missouri Psychiatry representative of
our membership and encourage our members’
participation in its creation.
For communications regarding the newsletter,
or to include articles, events or advertisements
in future publications contact:
Daniel Mamah, MD, MPE
Editor, Eastern Missouri Psychiatry
Dept. of Psychiatry, Washington University
660 South Euclid Avenue
St. Louis, Missouri 63110
or
[email protected]
Copyright © 2009 by Eastern Missouri Psychiatric Society. All
rights reserved. No part of this document may be reproduced or
used in any form or by any means, electronic, mechanical, or
otherwise, including photocopy, recording, or by an information
or retrieval system, without the prior written permission of the
publisher.