Passion Beats Diplomacy

March 24, 1995|By John Fairhall | John Fairhall,Sun Staff Writer

America's psychiatrists have fired a warning shot at insurance companies, electing a combative new national leader from Maryland who has declared war on "sharks" and "parasites" he believes are destroying his profession and harming patients.

Dr. Harold I. Eist of Bethesda upset Dr. Steven S. Sharfstein, president of Sheppard and Enoch Pratt Hospital in Towson, in a hard-fought race for president-elect of the 39,000-member American Psychiatric Association.

Dr. Eist, who practices out of his home, beat the better-known Dr. Sharfstein by 371 votes out of 15,153 cast, the association announced yesterday.

Dr. Eist successfully tapped the fear and resentment many psychiatrists feel toward growing "managed care" programs that control mental services to more than 50 percent of all insured Americans. Although insurers say these programs provide good quality at the lowest possible price, critics charge that they undermine patient care and doctors' authority.

Managed-care programs are cutting the number of days patients spend in psychiatric hospitals and the number of visits to psychiatrists' offices.

Worried about their future, psychiatrists increasingly are being forced to accept reduced roles and less money as these programs refer patients for psychotherapy to less expensive psychologists, social workers and nurse specialists. "They ravage health care for profit, particularly psychiatric care," Dr. Eist said of the programs.

During the campaign he accused Dr. Sharfstein of promoting managed care at Sheppard Pratt, a charge that exasperated Pratt's chief executive and provoked him to denounce "this kind of smearing."

Also a critic of managed care, Dr. Sharfstein nevertheless said that psychiatrists must learn to live with and lead the changes sweeping the health-care industry.

Dr. Eist, 57, who becomes APA president for one year beginning in May 1996, said he will fight for state and federal legislation limiting the scope and power of managed-care programs, educate the public about the issues and file lawsuits as necessary against insurers.

"We've attempted a negotiation strategy" with insurers "and it hasn't worked," Dr. Eist said yesterday between congratulatory calls and sessions with patients. "Things have gotten worse for our patients, things have gotten worse for our profession. Now we're going to have to be more active and forceful."

Dr. Sharfstein, 52, said he will work with Dr. Eist. "I think the organization and psychiatry are facing a great challenge in the future with the changes in the medical marketplace," Dr. Sharfstein said, cautioning that there will be limits to what Dr. Eist can do during his term. "The president is only one person."

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