Frequently Asked Questions
A balanced budget is one where the revenue you bring in is equal to the amount you spend on expenses of operations. Over the years, APA’s operating costs have risen to be more than the revenue it generates from its three main revenue sources: publishing, membership, and education including the Annual Meeting. Because APA’s investment reserves are healthy, the Board initiated a reserve funding policy several years ago to make sure we are stewarding our resources to meet our mission rather than building up an increasingly large endowment. This policy stipulates that APA can use up to 5 percent of the reserves over an average 5-year period to subsidize operating costs – a sensible strategy for a nonprofit like us. APA budget expectations for 2023 include a budget deficit close to $3M after we apply a $4.5M Board-approved withdrawal from our reserves. That means that APA’s operating deficit before the use of reserves is $7.5 million in 2023. Many factors influenced this shortfall, the most significant being: a drop in DSM sales, lower-than-expected attendance at the 2023 Annual Meeting, reductions in grant funding, and the return to in-person meetings such as the Assembly, components, and legislative fly-ins. Our expenses have also been hit hard by inflation, especially the increasing costs of staff salaries and benefits, meetings, and travel. Additionally, APA staffing has grown by nearly 10 percent since 2020 to support the needs of our membership. Our revenues have simply not kept pace to offset the cost increases.
All indications are that the factors that led to the 2023 budget shortfall will persist into 2024 and likely beyond. After making deep cuts to the 2024 proposed budget, including hiring freezes, we still faced a $2M budget deficit, over and above the $4.8M approved funding from the reserves. The Administration cut what it could from the budget without impacting staff but could not find a way to close this gap.
APA reserves are still healthy, but living off these reserves at this rate is not sustainable.
No. Given the financial situation above and the fact that a new CEO/Medical Director will join APA mid-year, the Finance and Budget Committee, after much deliberation, recommended on November 6 that the Administration cut $2M in staff salary expense so that it did not leave a significant budget deficit in 2024 for a new CEO to deal with.
Based on the direction of the Finance and Budget Committee at their November 6 meeting, and with the holiday season fast approaching, Dr. Levin and a team of other senior staff explored ways of eliminating redundancies and consolidating functions that would result in reduction in staff number without loss of function. They came up with a thoughtful and thorough plan that was implemented just after Thanksgiving but before the holiday season. Dr. Levin did not discuss this plan with the Board. While the CEO/Medical Director has the authority to hire and terminate staff, he acknowledges that he should have consulted with the Board before implementing a reduction in force of this size and importance. The Board has addressed this matter with Dr. Levin to ensure it does not happen again.
On December 9, 2023, the Board approved the revised 2024 budget that stays within the policy on spending limits from the reserves and will allow the new CEO/Medical Director to begin their tenure without having to tackle a significant budget deficit.
No department was targeted for reductions. Other departments lost a higher percentage of staff than DGR. The following table shows the number of positions eliminated by APA division/department. Departments that did not lose any staff and remaining employees will pick up portions of the work previously done by employees impacted by the reduction in force.
| Division/ Department | 2023 Position Count | Position Eliminations | % of Division Staff |
|---|---|---|---|
| CEO Office | 5 | 2 | 40% |
| Communications | 19 | 2 | 11% |
| DB & Int’l Relations | 2 | 1 | 50% |
| Diversity & Health Equity | 10 | 2 | 20% |
| Education | 22 | 1 | 5% |
| Finance | 10 | 0 | 0% |
| General Counsel's Office | 3 | 0 | 0% |
| Governance | 5 | 1 | 20% |
| Government Relations | 13 | 3 | 23% |
| Human Resources | 5 | 1 | 20% |
| Information Technology | 13 | 1 | 8% |
| Marketing | 7 | 1 | 14% |
| Meetings | 6 | 1 | 17% |
| Membership | 13 | 1 | 8% |
| Operations/Facilities | 4.5 | 0 | 0% |
| Policy, Programs, and Partnerships | 12 | 1 | 8% |
| Publications | 49 | 1 | 2% |
| Registry | 4 | 1 | 25% |
| Research | 8 | 1 | 13% |
The 10 staff members from DGR will be combined with the Policy, Programs, and Partnerships (PPP) Division to create a new unified division under a highly qualified leader. The APA Administration strongly believes that this combined division will work more efficiently to meet the members’ and APA’s needs. Advocacy at APA is a broad term. It covers regulatory, judicial, and legislative advocacy. DGR principally covered legislative advocacy at the federal and state level. PPP covers regulatory, payment, practice, and the Administration (e.g., White House) issues. Legal covers judicial advocacy. While the three groups currently consult each other, the new structure will foster increased implementation of cohesive strategies across these arenas.
With respect to federal and state legislative advocacy, APA has very experienced staff continuing to work on our legislative agenda with our state DBs and on Capitol Hill. Many of these staff are not as well known to the members as those who were part of the reduction in force, but they have been essential to APA’s advocacy successes. We have four federal lobbyists who also have significant state experience. In addition, we have three regional state directors working directly with the District Branches, some with significant federal experience.
We took a deep look into the remaining staff of DGR to ensure we had the expertise in place to continue supporting our members’ advocacy efforts and determined that APA’s bipartisan position would not be negatively impacted by the reduction in force. The legislative team has a great deal of experience at both the federal and state levels:
The Federal Legislative Team
Managing Director, Government Relations provides direction for the development of both state and federal advocacy strategies and resources. She has more than 20 years of political, campaign, advocacy, fundraising, strategy, and management experience and has driven successful campaign & fundraising strategies for numerous Democratic federal and state-wide campaigns. Her political management experience at the Democratic Congressional Campaign Committee included overseeing, advising, and assessing campaign fundraising operations for democratic congressional races across the country.
The Director, Federal Relations has been a boots-on-the-ground lobbyist and legislative strategist since 1997, and before that was a policy analyst. He spends his days on Capitol Hill where he is the source of APA’s bipartisan contacts and many of our recent advocacy successes. He has also held positions in federal legislative, PAC, and state affairs at large medical associations where he fought, and won scope battles, managed outside lobbying firms, and organized their advocacy days.
The Deputy Director, Federal Relations has been a boots-on-the-ground lobbyist and federal legislative strategist since 2014. He was the Director of Government Relations and chief lobbyist at a mid-size medical association where he was the government relations face to their board and CAGR equivalents. He has led fights on issues such as reimbursement and prior authorization. He also has bipartisan contacts and can work seamlessly with both sides of the aisle.
The Associate Director, Federal Relations worked at one of the largest private lobbying firms in DC where she was a federal policy strategist, managing national coalitions, fly-in conferences, and grass roots outreach. She previously worked on Capitol Hill and is still active in current local, state, and national Democratic campaigns.
The Manager, Federal Relations is our most junior lobbyist and came to us directly from Capitol Hill after having worked for four members of the House of Representatives.
In addition to our in-house strength, APA retains an outside federal lobbying firm that assists with additional access to Members of Congress and strategy, as needed. With this group, all relevant Members and Committees are well covered.
State Regional Directors
The State Regional Directors responsibilities are to assist District Branches (DB) in developing and executing their legislative agenda.
The East Regional Director has been leading both federal and state legislative and policy issues for medical organizations and serving as boots-on-the-ground lobbyist in the federal and state arena since 2006. She has deep ties to the NY and NJ state houses.
The Central/South Regional Director is a legislative attorney with a history of leading and managing state government relations coalitions, analyzing legislation, preparing testimony, managing advocacy conferences, and grass roots campaigns.
The West Regional Director has been a health policy strategist since 2011, with experience planning fly-ins, coalition management, and executing many federal and state health policy campaigns.
APA also provides between $250,000-$300,000 per year to District Branches to hire local lobbyists with connections and ties in the state government and to be the face of the District Branch in the state houses. Our state regional directors work in conjunction with the lobbyists on strategy and work with the policy and other APA departments to develop educational materials for legislators on specific issues.
The Division of Policy, Programs, and Partnerships which is and had been responsible for our Federal regulatory advocacy and practice policy development, such as coding and reimbursement, quality payment reform, mental health parity, and practice guideline development, will merge with the Division of Government Relations. The oversight of legislative and regulatory activities is often paired together in most medical societies.
The new division will be called the Division of Advocacy, Policy, and Practice Advancement. The Director of Federal Relations will become APA’s Government Relations Officer (GRO) and continue to serve as the lead lobbyist representing APA’s position before Congress and state governments. He will be responsible for the development and coordination of APA’s federal and state legislative strategic initiatives including analyzing, formulating, and lobbying on APA’s legislative priorities in order to achieve the policy objectives and goals set out by the CEO and Medical Director and APA’s Board of Trustees. The GRO collaborates with the Managing Director, Government Relations to achieve the strategic goals and initiatives of the APAPAC and overall mission of APA, in collaboration with the Chief of Advocacy, Policy, and Practice Advancement.
The Managing Director, Government Relations will work in alignment with the GRO to provide high-level support in the management, advancement, and execution of APA’s federal and state advocacy and legislative agenda, priorities, grassroots, and political programs. She will continue to be responsible for managing APAPAC and managing the Department of Government Relations' political & legislative grassroots network. She will also manage the cross-collaboration within the new Division, including regulatory advocacy, as well as among other divisions/departments within APA.
See new organizational chart below:
No. In human resources terms, the positions were terminated due to a reduction in force. This is not a reflection of performance and is not seen as a negative when seeking future employment.
The purpose of a reduction in force is to permanently eliminate positions. In total, 21 positions were permanently eliminated. Eleven involved cutting unfilled positions, but 10 required layoffs. They will be eligible for unemployment and APA is providing additional assistance to help them secure future employment. The process was detailed, complex, and thoughtful and had undergone a legal review by internal and outside counsel. At the outset it focused on reviewing job descriptions to identify redundancy, synergy, and areas that could be logically consolidated. The identity of the person in the position was not a factor in this analysis. The following list describes, at a high level, the decision framework followed to identify positions for elimination.
- Goal to reduce salary expenses by $2M.
- Focus elimination selections based on positions and job descriptions.
- Consolidate divisions and departments that have overlap and shared responsibilities.
- Share the pain across the organization.
- Do not eliminate APA Foundation positions, grant funded positions or positions directly tied to a board initiative (i.e., Future of Psychiatry, Social Determinants of Mental Health, grow and diversify revenue).
- Eliminate vacant positions when possible.
- When there is a choice of positions to eliminate, APA seniority will be used to determine the position to eliminate.
No. Federal and state laws recognize that employers must hold the details of an employee’s employment in confidence. APA could not discuss the specifics of a plan that affected an employee with members. The Administration carefully considered the impact on our service to members when identifying candidates for the reduction in force and is in a position to understand the synergies and talent in each department.
The State Regional Director positions were established, and have existed, for the District Branches to have an APA contact to work with on state advocacy. District Branches should contact their Regional Director for assistance with state advocacy. Below is their contact information and the states they cover:
- Robin Levy [email protected]: MD, ME, MA, CT, NY, NJ, PA, RI, DE, VA, DC, NC, SC , GA, FL
- Amanda Chesley Blecha [email protected]: ND, SD, MN, IA, WI, IL, MO, AR, LA, MS, AL, TN, KY, WV, OH, IN, MI
- Kathy Orellana [email protected]: CA, WA, OR, HI, ID, NE, WY, AZ, NM, CO, AZ, TX, OK, UT, KS, NV, Western Canada, MT, AK
DBs should contact their State Regional Director. The CALF grant process will not change.
No. Employees have a right of privacy in employment matters, and APA will not publicly share their names. However, the staff will be available through December 31, 2023. APA’s policy is to keep former staff’s email active for approximately six weeks so that people who contact them will receive a return email explaining that the person is no longer employed by APA and providing an alternative contact. If that does not provide the information you need, kindly contact APA’s COO, Michael Savelli, at [email protected].
This situation is very difficult for everyone involved, including staff, members, and APA’s leadership. APA can be successful only with the support of its membership, and we ask that you support the staff in carrying out their work on your behalf. All of APA staff are incredibly talented and will continue to be here to serve our members and carry out the great mission of APA. Our advocacy is strong and will continue to bring about successes.
It has also brought to light how active and engaged our membership can be. We encourage you to bring that enthusiasm to elections, to nominate exceptional candidates, to vote in our elections, and to participate in advocacy opportunities through the APAPAC, the Congressional Advocacy Network, and in state opportunities in your District Branch.