Changes to health care delivery as a result of the Affordable Care Act will require improvement in quality of care, while at the same time reducing costs. With an increasing national focus on quality and cost, the opportunity to leverage clinical registries to improve outcomes and appropriate utilization has never been greater. The AMA believes that the establishment of a registry will assist members in meeting these new requirements and is an investment for the future of the profession of psychiatry.
 
Establishing a registry will also help members comply with Physician Quality Reporting System (PQRS) & Merit-Based Incentive Payment System (MIPS) requirements and avoid penalties, which began in 2016 (2%) and will increase to 9% in 2022. A registry would also allow members to submit performance and practice data from the registry for Maintenance of Certification (MOC) Part IV credit.  A registry will provide a national research data base with aggregate de-identified data to help improve patient outcomes, develop new diagnostics and therapeutics, develop practice guidelines, identify gaps in care and inform APA educational programs, and support advocacy initiatives.  It will also allow the APA to develop new psychiatric quality measures (with funding from CMS until 2019).

In 1964 Marshall McLuhan made the bold declaration that “the medium is the message.”  For McLuhan, it was the medium itself that governed “the scale and form of human association and action.”  As an example, McLuhan argued that the way a film manipulated conceptions of speed and time transformed “the world of sequence and connections into the world of creative configuration and structure” and therefore the message of the film medium demonstrated the transition from “lineal connections” to “configurations.”  The Digital Age has shown us that configurations are merely the foundation for understanding the complex processes by which we understand and interact with the world around us.  As I write this, social media and news outlets are filling up my little iPad with news articles, listicles, opinions, personal stories, birthday wishes, fireworks photos, and cat videos.  At the very same time, I’m “liking” posts, receiving ads tailored to the “likes,” and surfing Amazon for a good tourist guide to Berlin.  A prominent political figure has posted a political attack image that create public outrage, was withdrawn, quickly edited to remove a “dog whistle,” and re-posted, all within hours as I “watched” the event unfold online and discussed it with my son in real life.  We are all influencing others and being influenced by others in a constant state of simultaneous, multidirectional change and response.
 
As we approach the final year of the Decade of the Brain, our understanding of neural networks has converged with the idea of complex configurations that are constantly influencing and being influenced as the medium (the brain) and the message (the content of our brain, i.e., thoughts, emotions, and behaviors) interact.  As applied brain scientists, we have come to understand that neural networks function in the context of genetic expression, the internal bio environment of the brain, socioeconomic influence, and physical factors.  We now know that, through a complex and biodynamic dance, these networks respond by influencing the very factors that shaped them.  The notion that there is a linear relationship between cause and effect is long dead in the primary biophysical sciences.  Advances in our understanding of neurobiology, the effects of environmental stress, substance use, and biological vulnerabilities have shown us that improvements in mental health must address factors that were traditionally seen as “biological” and “environmental”  It is now time to fully recognize that the notion of “biology versus environment” and the ontological dualism of “mind” and “matter” are paradigms that are outdated and ineffective in advancing the wellness of our patients, our colleagues, and ourselves.
 
Why am I writing about this as the 2016-2017 President of the OPPA?  Let me tell you why: we cannot be isolated from the changes in health care occurring all around us because these changes are influencing how we practice psychiatry.  Our understanding of this model of complex, interrelated networks I the means by which we, as organized psychiatrists, can advanced the practice of modern psychiatry.  As an organization, we must continue our work in creating our own form of an advanced “neural network,” a network that extends its reach to elected officials, law enforcement, state and federally regulated health care organizations, social services, education, and other entities.  Congruent with this model, we also must be willing to be influenced within this network.  At times, the influence does not feel welcome.  Some influences that are a special challenge to psychiatrists are Meaningful Use/MACRA, mental health and criminal justice laws that create barriers to emergency care, laws allowing the practice of medicine without a medical degree, and pharmacy benefits coverage rules and practices that fly in the face of standards of care and expedience.  But this influence is not unidirectional if we are willing to use the power of our organization’s complex network.  For example, the OPPA cannot call a judge and ask him to change a law that he did not write, vote for, or sign, but we can influence legislators to make changes in the law, both through our direct relationships with them and our indirect relationships with other organizations that influence lawmakers, such as journalists, allied organizations, and policy makers.
 
Along with many great leaders within our organization, Dr. Craig Zarling has helped lead a year of expansion of our sphere of influence.  In addition, this year we were joined by an excellent lobbyist, Katy King, who tirelessly works to create personal relationships with key lawmakers.  Patrick Sieng and Ms. King have both made great advances in ensuring that our presence is felt at national and local meetings.  In the coming year, I plan to extend outreach efforts to our rural members, strengthen relationships with policy makers, public health leaders, and other key entities.  Now is the time to further enhance our network, both within our organization and with the larger community that bears so much influence upon us, so that we may, in turn, improve our larger community of care.
 
In closing, I want the membership to know that I am very proud to be affiliated with the OPPA.  During my 8 years with the organization, I have been inspired by many of our members who have shown extraordinary dedication to good patient care, public advocacy, and collegiality.  I wish to extend special recognition to Dr. Henry Grass, who has devoted his entire career making the lives of other psychiatrists better.  I have deep gratitude for his many contributions to psychiatry in Oregon.  When you see him, please take a moment to thank him for his service.  I will never be the giant that he is, but I can try to further things along.  I want to hear your ideas about actions to take for the coming year.  You can email me at stephaniemayalopez@gmail.com.
 
Thank you for being an OPPA member.  Your participation is appreciated and if I have not met you in person yet, I hope to meet you at one of our upcoming meetings.
 
Warm regards,
Stephanie Maya Lopez, MD, FAPA

As you know, the end of the APA Annual Meeting marks the new year for the APA and also for the district branches such as the OPPA.  As I complete my term as president, we welcome Stephanie Lopez. MD as our 2016 president.
 
As I am finishing my year as president, our Member Assistance chair, Hank Grass,MD and our Public Education chair, Danny Bristol, MD, are also bringing their active involvement in their committees to a close. I hope you can join me in thanking them for their service to our organization.
 
Dr Grass is taking a hiatus from his longtime and passionate leadership on the Member Assistance committee because of health reasons.  His involvement in physician health from the epics of medical student and resident through practice has been remarkable, as has his advocating for support of physician health with the Oregon Medical Board.  Following his efforts will be a challenge, and we will need to keep Hank’s energy and purpose in mind to do so.
 
 Dr Bristol has been especially active this year, traveling to Roseburg to represent the OPPA in the wake of the shooting tragedy there, and also regularly discussing mental health issues on radio to bring and keep awareness of our profession’s concerns in the public discourse.  Also, he helped organize our Access Awards and  an Access Awards dinner that raised funds for our new resident’s education fund. Our dinner took place during the Winter meeting, and a light-hearted auction event inspired our members to purchase a number of tickets;  the winners were our residents who now can apply for funding the OPPA has dedicated to help them attend CME events.
 
 This year our Access Awards honored Project ECHO, a CME program based at OHSU that provides education on psychiatric topics to rural primary care physicians.  More than 600 hours of education were provided, and a gap in mental health treatment was addressed by this new bridge.
 
Also, we recognized Dave Mowrey, who’s creative program, “Stand Up for Mental Health”, uses stand up comedy to help people address social anxiety and stigma.
 
This year our CME meetings, the function of our district branch most familiar to our members, continued to provide lively educational and also social opportunities, with a transition of the Program Committee chair to Jon Betlinski, MD.  Also, lead by Drs Micheal Yao and Daniel Towns, for the second year we added a program addressing the interplay of psychiatry and public safety just prior to our Winter meeting.  Dr. Towns also is the new chair of our Public Psychiatry committee, and welcomes interested members to contact him as he considers new ideas and directions for the committee’s work.
 
In the upcoming year we hope to evolve  the OPPA, and in addition to evolving our Member Assistance and Public Education Committees, we have the opportunity to more actively engage in our state’s legislative process, working with our new lobbyist, Katy King.It will be interesting to see what ideas  Dr.David Conant-Norville has for member recruitment, and Dr Towns has for Public Psychiatry, and we can, as usual look forward to interesting educational programs.  Stay tuned, check the meeting dates on our website, contact a committee chair (or Stephanie or myself) if you would like to become more active, and have a good Summer.

Craig Zarling, MD
President 2015-2016

Your OPPA Membership Committee competed a survey of OPPA members this Spring and is studying the results in order to help the OPPA to continue to deliver value to members.  We surveyed members by e-mail and received 112 responses, approximately a 25% return.  We thank all of you who took the time to complete and return the survey.  Tan Ngo M.D. was the lucky winner of the respondents’ lottery and won a free registration at an OPPA conference during the next year. Congratulations.

Apart from simple demographic information we asked 3 questions: 1) Why did you join OPPA? 2) What do you value most about membership? 3)What could OPPA do to add more value to your membership?  Members were welcome to give multiple answers to each question.  We hope the information from the survey will give the OPPA Executive Committee and other OPPA committees more guidance in developing future OPPA activities and initiatives.  In general, we learned that over 50% of members joined in order to part of a psychiatric organization (APA, OPPA, APPL) and 50% joined because of opportunities to network with peers.  25% joined because of educational opportunities (CME, journals) and 10% joined due to the organizations advocacy work (legislative activities, public service). 

Members find value in membership in many ways.  55% of respondents identified networking with peers as and important value, while 39% cited educational activities, 23% noted advocacy and only 4% indicated organizational membership as a value of membership in OPPA.  Suggestions to increase value of membership were varied and focused most on improving networking options (including bringing back the printed OPPA roster for members), enhancing the OPPA newsletter, building mentorship opportunities, and delivering educational materiel across several platforms, and in different areas of the state.

The committee is breaking down the responses based on the phase of the respondent’s career.  We will be looking at the following groups to see if we can identify unique values of membership for each demographic group: 1) psychiatric residents and fellows, 2) early-career psychiatrists (1-7 yrs. post training, 3) mid-career psychiatrists (8-15 yrs. post training), 4) peak-career psychiatrists (16-25 years post training), 5) senior psychiatrists (25+ years post training), and 6) retired psychiatrists.  Our committee has started working on activities for “members in training”.  At the end of June, we hosted a lunch during the orientation for all new psychiatry interns at OHSU and helped all of them to become APA/OPPA members.  This October we will sponsor our 2nd annual Resident/ OPPA “mixer” as an opportunity for residents from both the OHSU and Good Samaritan (Corvallis) training programs to meet off the hill (at the Mind Matters P.C. office) to give the trainees a chance to meet OPPA members in practice and talk about psychiatric practice after residency regarding many different specialties and types of psychiatric practice.  This evening was very successful last year and hope for it to become a highlight of each resident’s engagement with the OPPA. 

Our committee would now like to identify specific activities that would be a special interest and value to early career psychiatrists (ECPs).  Unfortunately, we now do not have any ECPs on our committee, as the 2 ECPs previously on our committee, needed to resign due to family and practice commitments.  For ECPs, this challenge of finding time for OPPA committee work, while balancing it with a new career, possibly new family, new home, and new community can be overwhelming. Any early career psychiatrist (and any other OPPA member as well) who might be interested in becoming more active in building more member value in the OPPA, please consider joining the OPPA Membership committee.  We are a fun and committed group of mainly senior psychiatrist.  We will have Skype video conference capability for those that cannot travel to our meeting site (Beaverton/ Hillsboro area).  For those that could come to a meeting in person, free dinner is provided (and not paid for by OPPA dues).

We welcome all suggestions and particularly hope some of you will join our committee.  Contact Dave Conant-Norville MD (drdave@mindmatterspc.com) or call 503-352-0468 for more information.  Alternative contact is our committee staff person, Jennifer Boverman (jennifer@oregonpsychiatric.org).

​Dave Conant-Norville MD
Chair, OPPA Membership Committee