Advocacy Continues Apace On Behalf of Our Subspecialty

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Advocacy Continues Apace On Behalf of Our Subspecialty

ACLP Board director and secretary Paul Desan, MD, PhD, FACLP, takes us behind the scenes

Paul Desan, MD, PhD, FACLP

ACLP undertakes a substantial amount of regulatory advocacy working with multiple organizations on behalf of our members. All advocacy is supervised and approved by the Board of Directors.

For example, the Academy regularly provides comments to the American Council on Graduate Medical Education (ACGME) about regulations which govern fellowship training. This work is carried out chiefly by the Fellowship Education Subcommittee, with support from other committees.

This year we opposed a decrease in the administrative protected time for program directors, from 0.25 full-time equivalent (FTE) for programs of 1-2 fellows and 0.375 FTE for programs with >2 fellows to 0.2 FTE for programs with <7 fellows.

We supported a proposal to require 0.5 FTE for a program coordinator, but noted that closely related fellowships might be able to share coordinator time. For example, an institution with a Consultation-Liaison, Geriatric, Addiction, and Forensic Fellowship with one trainee each likely could be managed with less than 2 FTE of coordinator time.

We also provided feedback comments on proposed revisions to ACGME Milestones, the evaluation standards for fellow performance. The workgroup revising these standards consists largely of ACLP members.

As the COVID-19 situation worsened, it was apparent that in-person interviewing for fellowship applications would be inadvisable.

The Coalition for Physician Accountability—a coalition of the major organizations overseeing medical education, including the AMA, ACGME, National Residency Matching Program (NRMP), American Board of Medical Specialties (ABMS), and many others— decided in the spring of 2020 that interviewing for all residency and fellowship positions would be virtual.

Last spring, the Coalition did not act, but the ACLP and virtually all medical specialty groups decided in favor of virtual interviewing. In fact, the feeling was widespread that virtual recruitment went well in fall 2020 and 2021. A wider range of applicants was able to interview with more programs, without the constraint of having to pay for travel for each interview. This is good for our field and surely encourages recruitment.

The Fellowship Education Subcommittee issued guidelines about virtual recruitment and is now working on provisions to ensure a fair process involving both in-person and virtual interviewing in the future.

The ACLP also works with the NRMP to assure a smooth Match for applicants. All program directors senior enough to recall the mad scramble of the pre-Match years will agree that the new system is a vast improvement.

We are also investigating using the American Association of Medical Colleges’ (AAMC) ERAS system to manage applications to fellowship training. As the number of candidates applying grows, this approach might streamline the process. Addiction Psychiatry recently initiated use of ERAS and reports excellent satisfaction.

This year, the ACLP also attempted to influence educational policy regarding the Maintenance of Certification (MOC) process. We partnered with the American Psychiatric Association (APA), which initiated a thoughtful process in response to the request for comment from the ABMS. We argued that requirements should be evidence-based, shown by research to improve performance, and we argued that time and effort involved should be considered, and demonstrated to be proportionate to benefit.

Few psychiatrists appear pleased with the current system. C-L psychiatrists who need to fulfil their three-year PIP MOC requirement may wish to consider using the ACLP’s own unit which entails reviewing five of your own addiction charts now and at a future timepoint. The unit is available here.

The ACLP also provides input on policy on a national level. We provide a representative to the AMA’s Specialty and Service Society (SSS) and a representative to the APA’s Assembly Committee of Representatives of Subspecialties and Sections (ACROSS): both these connections help coordinate our advocacy.

To give an example, our most recent efforts related to the situation that encephalopathy is reimbursed more generously by the Centers for Medicare and Medicaid Services (CMS) than delirium, even though most providers would find these equivalent. We provided input, along with multiple other medical groups, requesting a reconsideration of this policy.

This is only one example of the many issues the ACLP advocated on this year. ACLP members should be aware that their organization is working constantly for our specialty in many different regards.


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