Getting to Know the American Association for Psychiatric Administration and Leadership

Beaunitta Van Wyk/peopleimages.com/AdobeStock

Psychiatric Times is proud to be a Strategic Alliance Partner with the American Association for Psychiatric Administration and Leadership (AAPAL). We had the pleasure of sitting down with the AAPAL leaders to learn more about the organization.

PT: Can you tell us a bit about the AAPAL—what it is, what it does, and when and why it was founded?

Frances Bell: The AAPAL, established in 1961 (formerly known as the American Association of Psychiatric Administrators (AAPA)), is the premiere educational, networking, and support resource for psychiatrists interested in leadership and psychiatric administration. The AAPAL is an affiliate organization with the American Psychiatric Association and promotes medical leadership and medical excellence in behavioral health care systems, including services for mental illness, substance use disorders, and developmental disabilities. With the ultimate aim of enhancing the effectiveness, efficiency, and humanity in service delivery, the AAPAL seeks to promote the professional development of psychiatrists as leaders.

PT: What are some of the accomplishments of the AAPAL? What is the AAPAL working on now?

Tobias Wasser, MD: The AAPAL has been hard at work over the last several years to expand our educational and national networking footprint. Below is a list of just some of our accomplishments:

-Presented courses and workshops at the APA Annual Meeting each year on leadership development for residents, fellows, and early career psychiatrists

-In collaboration with the APA, presented the annual Administrative Psychiatry Award and award lecture

-Held our annual membership reception in conjunction with the APA Annual Meeting

-Requested by the APA to develop their Physician Leadership Program, available free online to APA members as part of the APA Learning Center

-Hosted multiple online webinars for residents, fellows, and medical students on leadership topics within psychiatry

Right now, the AAPAL is working to hone our strategic plan and vision for continuing to build upon this work and grow our membership and potential to help future leaders in psychiatry.

PT: What do you think most psychiatrists do not realize about the AAPAL?

James Rachal, MD: The AAPAL is an excellent resource for those interested in leadership with many benefits that most psychiatrist do not know are available. We provide access to a listserv that allows our members to discuss challenging leadership issues and obtain support and advice. We also offer a mentorship program to help develop new and mid-career leaders. We have sponsored several leadership courses and created a leadership curriculum for the APA. Our members have an opportunity to learn from administrators who have been in the field for decades. Additionally, we offer opportunities to develop speaking and writing skills and valuable ways to help build CVs. Perhaps the greatest asset to AAPAL is the opportunity to be in a network of like-minded psychiatrists, who are your friends and colleagues throughout your career. They are always available to discuss challenges as they emerge, and also offer support and advice as one navigates their leadership journey.

PT: What is your background? How did you first get involved with the AAPAL?

Tobias Wasser, MD:As the current President of AAPAL, I am an adult and forensic psychiatrist. I attended medical school at the University of Connecticut School of Medicine. I completed all my psychiatry training at Yale, including the psychiatry residency program and fellowships in forensic and public psychiatry. After training, I worked for a few years as an inpatient psychiatrist in private-public partnership setting between Yale and the state of CT mental health system. I then moved into a leadership role as the Chief Medical Officer of CT’s state forensic hospital for several years. While serving in this role I remained a faculty member and served in academic leadership roles for the public psychiatry fellowship and then the residency program. My work as a clinician-educator has focused on research, education, and leadership at the intersections of forensic and public-sector mental health systems. I currently serve in clinical and academic leadership roles at Yale-New Haven Hospital and in the medical school’s psychiatry department.

I first got involved with AAPAL as a public psychiatry fellow when I submitted a manuscript for the organization’s “Best Paper by a Resident/Fellow Award.” I was fortunate enough to have my article selected for the award and was invited to join the AAPAL annual executive council meeting. I was so excited to learn about leadership from a distinguished group of national experts and immediately became hooked by the organization’s commitment to training, development, and support of the next generation of psychiatric leaders. I continued to stay involved in the organization and moved my way up the ranks until being nominated for the post of President in 2022.

PT: What does leadership mean to you?

Layla Solimon, MD: Typically, leadership gets associated with certain titles, such as executive, director, or vice president. In large organizations, leadership and administration often get used interchangeably. While an administrative title may confer some authority, it only goes so far. Leaders often have as much authority as the individuals that they are trying to lead give them, and this authority translates to the amount of influence leaders have in their organization. In the long run, sustained authority and influence come from building trust.

Leaders build trust with consistent presence. The presence does not necessarily have to be physical, though that is ideal for clinical leaders who oversee in-person work. Accessibility and responsiveness can be expressed through multiple communication mediums. If leaders have a working knowledge of daily operations and position themselves as a resource for process improvement, those in their service line will want to keep working in that environment. If leaders see themselves as separate and not a part of the team, trust will be eroded.

A culture in which physicians do not trust their leaders will be vulnerable to high turnover, which already plagues many organizations. That makes maintaining trust, authority, and influence a critical component of leadership. A leader’s influence, including how they carry themselves and how they talk about the organization, similarly shapes culture and morale. This impacts providers’ investment in the organization, and how individual physicians lead their multi-disciplinary teams. This also impacts staff turnover across disciplines. Ultimately, good leadership looks more like a cycle of feedback, process improvement, and reinforcement, as opposed to a hierarchy.

PT: What is the biggest challenge facing the field of psychiatry today? Facing individual psychiatrists? (And, if appropriate, what is AAPAL doing to help?)

Luming Li, MD: There are several challenges facing psychiatry, including workforce shortages for the field, and payment and quality challenges for individual psychiatrists. Specifically, workforce shortages are projected to be significant across the next 10 years, as demand for services rises with a retiring population as well as challenges in producing well-trained psychiatrists. For individual psychiatrists, reimbursement has been historically low to psychiatric providers, leading to several psychiatrists providing cash only private practice, and growing populations not having access to mental health specialty care through insurance. Finally, quality of care is a significant challenge facing psychiatry, especially as psychiatric practice is measured by a majority process measures instead of outcome measures. For those in organized medicine, individual psychiatrists are faced with needing to fulfill more documentation and oversight requirements as part of payment and regulatory compliance.

AAPAL is helping to provide broader awareness of the challenges facing psychiatry through our strategic planning process, educational investment, and mentorship, as well as the work we do to help develop future psychiatric leaders. We hope to help support individuals and the field in overcoming and addressing the challenges through our ongoing commitment toward excellence in practice, knowledge about systems-based care, and focus on quality standards.

PT: What are you most excited about for the field of psychiatry?

Sebastian Acevedo: Psychiatry is exploding as a field! From interventional treatments, psychedelics and telepsychiatry, we are seeing enormous growth and we will continue to see exponential opportunities in the years to come. It will be so important for psychiatrists to be at the forefront of this movement and serve as leaders in this complex and nuanced field. We hope to help continue to support our field’s commitment to this leadership!

Ms Bell is the point of contact for the AAPAL administration and leadership. Dr Wasser is the president of the AAPAL, and assistant professor of psychiatry at Yale with faculty appointments in both the public psychiatry and law and psychiatry divisions. He is one of the associate program directors for the Yale Psychiatry Residency Program and works clinically and administratively as the Chief Medical Officer of Whiting Forensic Hospital. Dr Rachal is the president-elect for the AAPAL, as well as an associate professor of psychiatry and academic chair for the Department of Psychiatry at Atrium Health. He also serves as the medical director for the Behavioral Health Charlotte campus. Dr Solimon is a councilor for the AAPAL, and a psychiatrist in Charlotte, North Carolina. She is affiliated with Atrium Health Carolinas Medical Center. Dr Li is the secretary-treasurer for the AAPAL, and is an assistant professor at the Yale School of Medicine, Department of Psychiatry. She also serves as the associate medical director of quality improvement of the Yale New Haven Psychiatric Hospital. Mr Avecedo is the medical student representative for the AAPAL, and is a current third year MD/MPH student at Rutgers New Jersey Medical School and the Rutgers School of Public Health.