I wish to comment on the latest proposals for a change in The American's by-laws to eliminate the waiver requirements for the psychoanalytic training of certain categories of nonmedical candidates. I do so because of the far-reaching effects of those changes, which I think all members need to consider very seriously. My vantage point is that of a Fellow of the BOPS in the years that the Gaskill proposal on nonmedical training was discussed and adopted by the Board and, later, by The American.
A few basic aims, standards, and safeguards were embodied in the Gaskill Report and in the lengthy discussions of it in the Board, on the basis of which it was eventually adopted.
The proposal aimed to enrich psychoanalysis by broadening the pool of applicants to include qualified nonmedical people from related fields.
Natural concerns for the maintenance of educational and professional standards were addressed by the principle of striving for approximate equivalence of education and training. The implementation of this principle, in turn, was importantly embodied in the eligibility requirement for a doctorate.
Preservation of the medical character of The American and its training programs was considered overridingly important from the first, and explicit safeguards to implement it were constructed. The Gaskill Report stipulated that the “selection criteria for nonmedical applicants will continue to be based on excellence, with the goal of maintaining the [medical] ambiance of the current educational programs and the medical identity of the Association” (italics added).
The waiver mechanism was introduced both to maintain national standards and to preserve the aforesaid medical identity. No local institute alone could fulfill this latter national goal. According to the Gaskill report “the BOPS would create a waiver committee to review … applicants and the selection process … with the goal of insuring that all selected candidates, both medical and nonmedical meet equivalent standards. … Both the national waiver committee and the individual institute selection committees should carefully consider the balance between medical and nonmedical candidates so as to maintain the current [medical] perspective of the organization” (italics added).
This waiver procedure is no different in principle from that of CORST, but it is applied at different stages—entry rather than progression—and with different criteria.
To permit nonmedical applicants holding doctorates the same direct entry into training as medical applicants are accorded would destroy the medical character of our organization. Candidates without doctoral degrees are already at our gates. To require waiver of the medical requirement in selectively defined instances is fair to applicants and maintains our medical identity. The importance of the waiver and the preservation of the medical identity of the organization has been frequently reiterated.
Richard Simons, President, and Shelley Orgel, Chairman of the BOPS, commenting in a memorandum to members in September 1986, wrote, “The Gaskill Committee … in essence … emphasized the need to preserve the medical-psychiatric prerequisite for training as stated in the by-laws.”
Carl Davis, the first chairman of the CNMCT, said in a memorandum to institutes and in a report to the BOPS in 1986, “Fellows are informed of the need for full collaboration of all the committees of the Board and the institutes in monitoring the medical identity of the organization.”
The Gaskill goals of broadening the pool while maintaining a medical identity were not temporary ones. While the proceduress to effect these aims are not immutable, it would be a serious distortion of their intent to treat the mechanism for their implementation as provisional and temporary, dispensable as local experience accumulates. The waiver safeguard is in principle as inseparable from the original and adopted Gaskill intentions as it is from CORST.
To dispense with a special admission requirement for nonmedical applicants—the waiver of medical training—is to dispense with the medical character of our organization. Do the majority of members of The American wish to do that? I doubt it. We should resist the strong pressures for the rapid erosion of the Gaskill intention, safeguards, and standards and simultaneously defend and uphold the vital standard-setting function of the BOPS.
Jerome Ennis, MD
New York, NY