P R E S I D E N T I A L A D D R E S S

Looking Forward, Looking Back: A CelebrationRICHARD M. SARLES, M.D.

I want to thank the Academy for the opportunity toserve as President. There are so many talented, hard-working, deserving members of this wonderful organi-zation that to serve as its President is a true privilegeand honor for which I am deeply appreciative. For thepast 2 years as President-elect, I served on the ExecutiveCommittee and experienced a steep learning curve.The Academy is a complex and extraordinary organi-zation. It supports research, produces outstanding ed-ucational programs, publishes an internationallyacclaimed professional journal, and is a champion ad-vocate for children and adolescents. It is an excellentexample of a volunteer-based organization with an out-standing productive membership, supported by a tre-mendous permanent staff led by Ginger Anthony.Thank you for all you do!I also want to acknowledge and thank my family:

Lois, my wife and best friend, my daughters Kristenand Karen, their husbands, Fernando and Michael, andour grandsons, Chase and Connor.Our meeting this year continues the tradition of

outstanding educational programs, thanks to LarryGreenhill, Bennett Leventhal, and the very hardwork-ing Program Committee.This year’s meeting initiates our yearlong celebration

of the Academy’s 50th Anniversary. Intertwinedamong our scientific program are many special presen-tations and events highlighting our history, with trib-utes to our founders, leaders, and members. Specialthanks go to Norb Enzer and the “50th” Committeewho assembled all the marvelous posters you will see on

display and created our “Web book” of history and allof the various special presentations and events.A celebration is by definition a special occasion to

mark the date of a notable event. Celebrations fre-quently involve ceremonies, solemn or festive, and areoften on holidays when people refrain from ordinarybusiness. In many ways, our annual meeting is a recur-ring celebration of our work as child psychiatrists. Wecome together refraining from our everyday ordinarybusiness to learn, share, and have fun.Most celebrations involve looking backward and for-

ward. Our celebration this year will do just that. Wewill look back at our history, follow the growth of theAcademy, note the evolution of our identity, and sur-vey our plans and hopes for the future. Our plans forthe future are ambitious and critical for the health andwell-being of the children, adolescents, and families inour country.As we begin our next 50 years, we have committed

ourselves to three major initiatives: (1) our Campaignfor Kids, (2) manpower shortages, and (3) maintenanceof certification. Each of these initiatives is well under-way and each group has made considerable progress.There exist an energy, enthusiasm, and focus that willmake these initiatives successful. The Assembly, Coun-cil, our Workgroups, Task Forces, and Committees areworking diligently, but we need every member’s com-mitment for these initiatives to come to fruition. Look,listen, and learn at this meeting, in our newsletter, atyour regional organizations. The Academy is ready tochallenge the future. We need everyone’s help, support,and contributions.In keeping with the theme of celebration, let me

reflect on our history. Our Academy began in 1953 asa small, exclusive group of academic child psychiatrists.Membership was later opened to all child psychiatristsso that by our 25th Anniversary in 1978, the Academyhad grown to about 3,000 members. Today we havemore than 7,000 members.Our annual meeting began as a 1- or 2-day event

that included six papers, six workshops, and one panel,

Accepted May 27, 2004.Dr. Sarles is with the Division of Child and Adolescent Psychiatry, University

of Maryland, School of Medicine, Baltimore.Reprint requests to Dr. Sarles, Division of Child and Adolescent Psychiatry,

University of Maryland, School of Medicine, 701 W. Pratt Street, Baltimore,MD 21201; e-mail: rsarles@psych.umaryland.edu.0890-8567/04/4311–1315©2004 by the American Academy of Child

and Adolescent Psychiatry.DOI: 10.1097/01.chi.0000136564.02126.df

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with a hundred or so attendees. This meeting consistsof 5 days packed with numerous papers, forums, work-shops, institutes, and posters, with more than 2,000attendees from every state and dozens of foreign coun-tries.Our Journal, which was established in 1962, was

initially limited to four issues annually and consistedprimarily of case reports focused on intrapsychic andfamily dynamics. Today, our monthly Journal is thepreeminent publication in the world representing childand adolescent psychiatry and is available online.As part of my personal celebration of becoming

President of our Academy, allow me to trace my owntimeline.I was an only child in a working-class family in

Newark, New Jersey. Life was uncomplicated then. Wewalked to and from school and came home for lunch—safety was not a consideration. My elementary schoolclass was made up of 9 girls and 4 boys—school wasfun! My great aunt was a nursing director at a localhospital, so I heard lots of stories about doctors andmedicine. An 8th grade exercise about careers led me tolist medicine, law, and acting as my top three choices.(I’m not sure in which order, however.) My highschool years were spent in Columbia High School inSouth Orange, New Jersey. I was on the track team,performed in school plays, and was active in electedpositions in school government. I remember studyingLatin and German on the advice that these languageswould be helpful if I decided to pursue a medical edu-cation. My senior term paper was on the life of SirWilliam Osler. I also wrote a special paper on Freud’sInterpretation of Dreams. I can’t remember why. I reallyliked school and found that I had a special interest inscience, especially biology and chemistry.Weekends and holidays were spent working in the

local ice cream store, our teenage gathering spot. Sum-mers were spent at the Jersey Shore as a lifeguard (par-enthetically, our summer home was only 10 miles fromAsbury Park, New Jersey, where our Academy had itsearly organizational meetings). The biggest and bestthing about high school was that I met Lois, my wife.We dated for the next 7 years and married after mysophomore year of medical school. My college yearswere spent at Georgetown University in Washington,DC. Washington at that time was a quiet, unexcitingprovincial town mired in post--World War II buildingsand mentality. I entered a premedical curriculum that

was tightly lockstepped and heavily loaded with scienceand philosophy, as per the Georgetown tradition of thetime.My summers at the Jersey Shore were replaced by a

job in a toy store in South Orange—a great job for afuture pediatrician and child psychiatrist. My employ-ment as a toy salesman was soon followed by work ina funeral home. My wife’s family owned a very largefuneral business that also served as a county morgue, soI was able to participate in several autopsies each week.This was great preparation for medical school, butquite a contrast from the toy store.My medical school years were at the University of

Maryland. In retrospect, I realize that one of the rea-sons that I chose Maryland was because of the warm,friendly family environment that I perceived in myadmission interviews with the chairs of urology andpediatrics. Both of these men were to become impor-tant role models and mentors for me as marvelous clini-cians, scholars, excellent teachers, and true gentlemen.Medical school preclinical years were a real grind.

The summer after sophomore year Lois and I marriedwith a small reception for 22 people. We decided to usethe money not spent on the wedding to travel through-out Europe for almost 3 months; our only reservationbeing for the opera at the Bayreuth Opera Festival.Interestingly, I was admonished by the chair of medi-cine for not spending the summer working in medi-cine. Yet, this was a decision I never regretted andreinforced my personal philosophy to work hard buthave fun and enjoy life. This summer adventure alsoreinforced our desire to travel and to experience diverselands, cultures, and food. Maintaining this balance ofworking hard but having fun has been important tome. I constantly remind myself that everything in life isa trade-off!In my clinical years, I enjoyed all of my rotations,

even surgery and obstetrics/gynecology. I was sure,however, that I did not want to be a surgeon. Mystruggle was between internal medicine and pediatrics.During my internship of 8 months of internal medi-cine and 4 months of pediatrics, I became convincedthat I wanted to work with children. After my 2-yearpediatric residency, I was offered the opportunity toremain an additional year as chief resident/junior fac-ulty in a teaching and administrative role. It was thisyear that convinced me that my goal was to remain inacademic medicine.

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Following that were 3 years in the U.S. Air Forcestationed in Germany as a pediatrician. These weresome of the best years of our lives. I worked very hard.Fortunately, I love patient care, and that was goodbecause I was the only pediatrician for the 8,000 de-pendent children and adolescents on our base.As luck would have it, I had a very supportive hos-

pital commander who facilitated and encouraged me inmy endeavors to expand services beyond my officepractice. I set up a weekly school consultation program,a consultation service to the Judge Advocate General’sOffice, a school-based sex-education program, a con-sultation service to the medical corpsmen in our remoteradar sites, and a weekly hour television programMemos on Medicine on Armed Forces TV in Germany.Life and pediatrics were very exciting and enriching,

but what became abundantly clear to me were the sig-nificant mental health issues confronting the schoolsand courts and my relative lack of understanding ofmental health diagnostic and treatment options. Un-fortunately, my pediatric training did not adequatelyprepare me for these aspects of practice. Once again myhospital commander responded to my concerns andallowed me to seek supervision and consultation fromthe two military child psychiatrists stationed at thenearby Landstuhl Army Hospital, and the rest—as thesaying goes—was history. I was hooked on child psy-chiatry. I was fascinated by the workings of the mindand how talk and play could be so powerful.When my tour of duty in Germany was completed,

we returned to the United States and I started mysecond full residency training program, this time ingeneral and child psychiatry. My goal remained to joinan academic setting and to work in a child psychiatry–pediatric liaison service. I particularly wanted to trainpediatricians to recognize mental health problems intheir patients, to utilize office-based pediatric counsel-ing, and to learn how and when to refer to a childpsychiatrist. At that time, there were fewer than 3,000child psychiatrists in the United States and more than30,000 pediatricians.Even then I was aware of the paucity of child psy-

chiatrists in America and the unmet needs of children,adolescents, and their families.Interestingly, the Federal Government acknowl-

edged the child psychiatry manpower shortage even 30years ago and offered special financial incentives forphysicians already trained in one specialty to enter psy-

chiatry under an NIMH Family Practice Grant—a sig-nificant financial boast, which realistically allowed meto take another residency. At this time, 25% of all childpsychiatrists had already trained in pediatrics.This financial incentive given by the government is

relevant to our manpower shortage in child psychiatrytoday. Medical students are frequently carrying a$70,000–$80,000 debt from medical school and fre-quently are influenced to enter higher-paying medicalfields than child psychiatry.My own personal experience of retraining with cer-

tain flexibility in training and financial incentives isrelevant to the major Academy initiative of workforceand manpower shortages. The Academy has set an am-bitious goal of increasing recruitment into child psy-chiatry by 10% per year, because without an increase inthe number of child psychiatrists, there will remaincountless children, adolescents, and families who willreceive inadequate or no mental health care; that isunacceptable for our country. Child psychiatrists arethe most broadly and comprehensively trained mentalhealth practitioners who work with children. To bestserve the mental health needs of our patients and fami-lies, there must be access to child psychiatrists. But inmany parts of our country there are large geographicareas without any child psychiatrists at all. In otherareas, child psychiatry staff positions go unfilled andmany private practitioners have long waiting lists. Thisis an unacceptable condition for our country. Numer-ous surveys over the past several decades have repeat-edly documented the paucity of child psychiatrists andthe resultant unmet needs of children.Two Academy groups have worked diligently and

successfully on this problem. The Task Force on Man-power Issues has developed broad recommendationstargeting recruitment strategies. These include financialincentives and methods for using legislative advocacychannels. Examples would be in establishing loan debtforgiveness for those who enter child psychiatry and byenhancing reimbursement for child mental health ser-vices to encourage recruitment.The Task Force on Education and Training has de-

veloped recommendations for alternative portals of en-try and pathways for training in child psychiatry.Again, the goal is to make entering child psychiatryeasier and more enticing.Both of these groups have done their work well.

Both have been reformed as Workgroups and, now, the

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really tough work begins as our Academy reaches out tolocal and federal legislative groups and to other profes-sional organizations, such as the American Board ofPsychiatry and Neurology, the Accreditation Councilfor Graduate Medical Education Residency ReviewCommittee, the American Association of Directors ofPsychiatric Residency Training, and the American Psy-chiatric Association. We are committed to our initia-tives and our advocacy for the rights of our childrenand families.During my career, I have always tried to maintain a

balance of patient care, consultation, administration,teaching, and working with professional organizations.This balance is what made child psychiatry such anexciting, enriching, and fun specialty for me. My fa-vorite group of patients are adolescents; their normaldevelopmental phase of separation/individuation, theiropenness to new ideas and experiences, and their needto have a neutral adult anchor to support them in theiremancipation from home make them fun for me towork with. Adolescents can be fun, especially if youdon’t have one in your family.Consultation also provided me with a great diversity

of experiences and challenges. In addition to my uni-versity academic position of directing a child psychiatrypediatric liaison service, where I made weekly roundson the pediatric units with pediatric residents, childfellows, and medical students for 30 years, I have es-tablished consultation programs to the MarylandSchool for the Blind in Baltimore and am currentlydoing so at the Maryland School for the Deaf. Themost challenging consultative service to establish waswith the Hospital for the Mentally Retarded. There, Ihad to educate and convince the medical director thata child psychiatrist could far better understand and dealwith the developmental problems of the adult retardedpatients than could our adult psychiatrist colleagues.I have been fortunate to have served on the ABPN

Committee on Certification in Child and AdolescentPsychiatry, the American Board of Medical Specialties,and currently on the Residency Review Committee forPsychiatry.All of these groups are variations of quality assurance

organizations intent on assuring the public (our pa-tients) of the highest quality medical care.The Residency Review Committee for Psychiatry

sets and monitors training standards and the ABPNcertifies competency. Our Academy is one of the major

organizations that have a reciprocal relationship withthese organizations. Many members of our Academyhave served volunteer assignments with these groupsand on our own Academy committees. This is criticaland provides an important service to our field and thepublic.I recall when recertification was first introduced. I

personally balked at the idea of another exam; I wastired of exams. However, as a member of these qualityassurance groups and as training director and divisiondirector, I was well aware that lifelong learning was theonly way to practice good medicine. I was convincedthat to assure the public of high-quality, up-to-datemedical care, the recertification process was essentialand would eventually be linked to licensure.Our Workgroup on Maintenance of Certification is

working closely with the ABPN to develop methods ofmaintaining competencies and testing these competen-cies to reassure the public. The Workgroup will alsorecommend avenues for self-study and methods for re-view by our Academy, for example, journal supple-ments, special review courses, and bibliographies. Thiswill be a tremendous member benefit.Which leads to a perfect segue to my last topic—our

Campaign for Kids. We have embarked on an ambi-tious fund-raising initiative to generate 15 million dol-lars to endow and sustain the Advocacy Institute forChild and Adolescent Mental Health. This AdvocacyInstitute will champion the needs of children and ado-lescents with mental illness. The Institute will supportseveral centers. First, it will support the GovernmentAffairs Center, which will focus on methods to per-suade government officials at the local, state, and fed-eral levels that they play a critical role in the fightagainst childhood mental illness and in the promotionof research in this area. Second, it will support thePublic Information Center intended to raise parentaland public awareness about child and adolescent men-tal health issues and to emphasize that, similar to otherphysical disorders and diseases, most mental illnessesare identifiable and treatable. Third, it will supportthe School Mental Health Service Center, which willaim to educate teachers and provide tools for them andothers associated with education. A particular focus willbe to those with a critical vantage point for early de-tection with an eye to prevention and to encouragetreatment for youngsters with psychiatric disorders. Ifirmly believe that through this Advocacy Institute we

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can change the way America provides for the psychi-atric needs of our children, and each of us, every mem-ber of the Academy, is responsible for the success of thiscampaign.It is very important that each and every member

financially contribute to the campaign at their owncomfort level. We recognize that membership alonecannot meet our 15 million dollar goal, but large do-nors and philanthropic foundations place high impor-tance on the percentage of members who contribute.This makes sense, for why should foundations supportour campaign if our members do not? Our centraloffice staff already has a 100% contribution rate, and itis not unreasonable for our Academy to boast a 100%membership contribution.I gave personally because I believe in the Advocacy

Institute concept. We need this to move forward withour mission—this is the way to go! We are more than7,000 strong, but we cannot do it alone.I also gave as a way to give back to the Academy for

all the things it has given to me. One of our memberssaid this very well in a letter to some of his childpsychiatry colleagues as he donated his honorariumfrom a recent lecture he had given, challenging othersto do likewise. He said “I wouldn’t be able to pursue

these activities without the opportunity provided bythe Academy to share my work and learn from mycolleagues at our Annual Meeting, familiarize myselfwith cutting edge research through the Academy’s jour-nal and develop professional relationships that makeme a better physician for my patients.”The Academy has come a long way in the past 50

years, and we still have far to go.Our commitment to recruitment is clear, focused,

and poised to move ahead decisively. We are going toget the word out to medical students and general psy-chiatry residents that child psychiatry is exciting, re-warding, and fun. We are working with legislators, andwe are working on the development of alternative por-tals of entry and innovative training tracks to encourageand facilitate entry into child psychiatry. We are forg-ing ahead with plans to create methods to aid ourmembers in lifelong learning and with the ongoing taskof maintenance of certification.Our research productivity in child psychiatry is at an

all-time high; neuroscience holds the promise for thefuture and also provides a new venue to attract the bestand brightest students toward child psychiatry.Our Academy is ready for the next 50 years. It will

be an exciting and challenging time.

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