SIGNIFICANT CHANGE IS IN THE WINDS
APA’s 126th Annual Convention: San Francisco is always a delightful place to visit. This year I was particularly pleased to see the extent to which active duty colleagues were actively participating in the convention, especially those from the Uniformed Services University (USU). Jeff Goodie, CAPT. USPHS, gave a wonderful APF Rosalee G. Weiss Award Lecture on “Integrated Behavioral Health in Primary Care and in Communities Following Tragedies: Lessons Learned.” A former USAF psychologist, Jeff vividly described how interprofessional teams were making a real difference in the lives of those impacted by Sandy Hook, Hurricane Katrina, and the utter devastation of Puerto Rico. Under his leadership, third year and higher psychology students at USU observe Family Medicine clerkship students during their interview with standardized patients and then provide structured feedback to the medical students about their communication skills. Personally, I was especially honored to be asked by former Division 19 President Sally Harvey to participate in her symposium “The Many Faces of Operational Psychology.” My message was quite straightforward: APA should honor these colleagues who are willing to “place themselves in harm’s way” and appreciate their critical and lasting contributions to the nation.
Transforming the Profession: The Departments of Defense (DOD) and Veterans Affairs (VA) have an impressive history of initiating transformational change within the nation’s federal health care system. Whether one reflects upon former Army Surgeon General Patty Horoho’s emphasis upon wellness and behavioral health, the importance of team-based integrated care as described by Jeff, the decision by former VA Secretary David Shulkin to establish a national scope of practice for Advanced Practice Registered Nurses (APRNs), or the utility of prescribing psychologists (RxP), each of these initiatives has foreshadowed visionary developments occurring within our nation’s overall health care environment.
In many ways, the demonstrated federal commitment to developing effective telehealth capacities will ultimately revolutionize the delivery of quality care to those living in austere environments worldwide. As is always the case with major change, advances are built upon foundations established over time. Former Army Surgeon General, and now USU Professor, Eric Shoomaker: “The visionaries in telehealth were Alcide LaNoue as Army SG, Tripler Army Medical Center with Akamai, and the folks at the Telemedicine and Advanced Technology Research Center in USAMRMC – especially Ron Poropatich. Ron placed telemedicine in the Balkans, into Iraq, into Afghanistan and gave us the experience/confidence for me to start up the Hawaii-Ft. Lewis tele-mental health project. The real impetus there was provided in around 2009-2010 by then-BG Steve Jones (now MG [ret]) who demonstrated the ready utility and acceptance of using psychologists and psychiatrists in interviewing redeploying soldiers across thousands of miles. It set a new large-scale practice, in some ways similar to that initial tele-counseling program between WRAMC (‘Walter Reed Classic’) and outlying posts like Carlisle Barracks, decades before.” As one might imagine, telemedicine has had considerable Congressional support over the years.
Significant Change Is Coming: Included in this year’s DOD reauthorization and VA appropriations legislation are a number of provisions which signal that the Congress clearly expects readiness-oriented, interprofessional, and increasingly joint efforts to provide timely quality care. Traditional, isolated “silo” approaches will no longer be acceptable.
· The Secretary of Defense shall, acting through the Defense Health Agency, implement an organizational framework for the military healthcare system that most effectively maximizes interoperability and fully integrates medical capabilities of the Armed Forces to enhance joint military medical operations.
· Mental Health -- The conference provides an increase of $16,128,000 above the budget request for mental health programs, including suicide prevention outreach. The conferees urge VA to increase support for primary care-mental health integration and recovery models, expand telemental health services, build on success of evidence-based psychotherapy initiatives, and guide treatment decisions by measuring the outcomes of interventions.
· The VA is directed to work with OPM to create an Occupational Series for Licensed Professional Mental Health Counselors and Marriage and Family Therapists and to create a staffing plan to fill such open positions and assess shortages.
· VA is encouraged to consider the expanded use of doctors of osteopathic medicine, physician assistants, and nurse practitioners to help address any rural health provider gap. Any such gap may be further mitigated through the use of telehealth for medical services.
· Telemedicine – The conference agreement includes $30,000,000 above the budget request for telehealth capabilities and expects a report specifying measures being taken to expand telehealth and telemental health capabilities in rural areas, including ongoing collaboration with other Federal agencies.
· Women’s health – The conferees note that the number of female veterans continues to increase and provide $10,000,000 above the budget request for gender-specific care and for the continuing redesign of VA’s women’s healthcare delivery system and facilities to ensure women receive equitable, timely, and high-quality care.
· Advanced Practice Registered Nurses – The Secretary is urged to work with facilities that have not yet implemented VA’s final rule granting full practice authority to advanced practice registered nurses to ensure quick implementation. And,
· VA is directed to ensure that any non-VA physician contracted to conduct medical disability examinations have a current unrestricted license to practice as a physician and is not barred from practicing in any State, DC, etc.
Intriguing Potential for Qualitative Change: At least eight Democratic physicians are running for the U.S. Congress as first-time candidates this election cycle. Of the 11 Democratic physicians running for office, all but one is seeking a seat in the House of Representatives. Currently, there are 14 physicians serving in the Congress, 12 of whom are Republicans. Today only 19% of federal lawmakers are Veterans – the same percentage that are women – with at least 28 female Veterans seeking House seats and four vying for the Senate. A graduate of the USU School of Medicine will be on the ballot, a former Navy radiologist. The Psychology Times recently highlighted the candidacy of Tammy Savoie, a licensed Louisiana psychologist and retired USAF Lt Col. who is seeking to join Representatives Judy Chu and Alan Lowenthal. With Honor, a super-PAC focused on electing Veterans to Congress, recently received a $10 million contribution. This year APA lost one of its true visionaries with the passing of Past President Ron Fox. Ron dedicated his life to psychology and APA. Hopefully, members of the Division will seriously consider running for elected office within APA and the public sector in the near future in furtherance of his vision. Aloha,
Pat DeLeon, former APA President – Division 19 – September, 2018
