Dr. Larry Faulkner: Enduring Effort from Northwest Forests to Chicago Lights

Oregon Health & Sciences University

Dr. Faulkner’s academic career flourished at OHSU with his involvement in public psychiatry and forensics and his opportunity to shape a residency training program whose emphasis on community psychiatry and public service remains to this day. I can personally attest to his excellence as a program director because I was beginning my career as a junior faculty member under his and Dr. Joseph Bloom’s leadership. Dr. Faulkner’s significant contributions to the scientific literature grew during the 10 years he spent at OHSU through collaboration with mentors, colleagues, and mentees.

Contributions to the Literature

Dr. Faulkner has published well over 100 peer-reviewed publications, presented at every major national meeting in psychiatry and neurology, and provided educational presentations on the ABPN certification and maintenance of certification process to multiple audiences. Early in his career, Dr. Faulkner published significant articles describing how relationships between community mental health centers,² state hospitals,³ and academic psychiatry departments could produce improved educational experiences for psychiatry residents. He also published extensively on civil commitment, pointing out the variations in process and results of the process between local jurisdictions⁴ and states.⁵ He continued to write extensively on these topics during his career at Oregon and in South Carolina. He also addressed curricular topics in psychiatric education, publishing a guideline for comprehensive formulation⁶ and various descriptions and guidelines for components of psychiatric training.⁷ His scholarly work while at the ABPN focused on physician competence,⁸ board certification,⁹ maintenance of certification, and lifelong learning. Most recently, he and his colleagues have described the results of the shift from a summative exam format to the article-based pathway for maintenance of certification.¹⁰

American Academy of Psychiatry and the Law

During his tenure at OHSU, Dr. Faulkner became very active in AAPL, where he has made extremely valuable contributions. He has continuously served on the organization’s committees and was elected as vice president in 1995. As president of AAPL in 1999, his presidential address and subsequent paper¹¹ outlined requirements that the organization would need to fulfill to thrive. He encouraged forensic psychiatrists to take on leadership roles in medical organizations and certainly served as a role model in this regard. He advised collaboration with other medical specialties and participation in medical systems of care, such as the development of specialized forensic services within state hospitals.^12,13 He also recommended that AAPL formulate guidelines for forensic training and that it foster research. AAPL established the Institute for Education and Research in 2003 to 2004 following his recommendation. He served as president of the institute until 2017 and remains on its board of directors. He also chaired the Committee on Long-Range Planning following his presidency in 2001 to 2002. AAPL guided the Accreditation Council for Graduate Medical Education (ACGME) in establishing the original curriculum for forensic psychiatry training.¹⁴ AAPL has played a significant role in formulating recommendations to the ACGME on the curriculum of forensic psychiatry training programs,¹⁵ the ACGME Milestones for those programs, and the forensic psychiatry curriculum in general psychiatry residency training.¹⁶

University of South Carolina SOM

Dr. Faulkner was recruited from Oregon to serve as chair of the Department of Psychiatry at USCSOM in 1990. In 1995, following service as an interim, he was appointed dean. His accomplishments during the subsequent 12 years were important to the success of that university. He expanded graduate science programs, improved infrastructure for education and research, and laid the ground work for the university’s school of medicine in Greenville. His efforts enhanced the school’s reputation in community health care innovation and research. He was honored by the USCSOM alumni association with the Recognition Award for Vision and Leadership in 2006.

American Board of Psychiatry and Neurology

Dr. Faulkner became a director of the ABPN while at USCSOM and was selected as CEO of the organization in 2006. He was named president and CEO in 2009. Larry’s accomplishments at the ABPN have been of enormous importance to the field of psychiatry. When he became CEO of the ABPN, it was in difficult financial straits. His superb fiscal management saved the organization, putting it on sound fiscal footing and enabling the many innovative projects that have significantly benefited the profession. Under his leadership, the ABPN became fully insulated from financial troubles in the stock market, inflation, and other exigencies that threaten many large organizations. That stability has been important to the profession and to individual diplomates. The cost of becoming board certified actually decreased during the 16 years of Larry’s tenure. The cost of maintaining certification from the ABPN is now just a fraction of licensure cost or of American Psychiatric Association (APA) membership.

Larry initiated and managed the transition of the certification process for psychiatrists to its current form. Previously, as many readers of this journal will remember, certification required completion of residency training requirements, passing a written examination, and passing an oral examination that required interviewing two patients, presenting the case, and answering the questions of examiners. The validity of oral exams in medicine had been questioned repeatedly,^17,–,19 leading to doubts about whether the exam should be revised. Emotional appeals by candidates who had repeatedly failed produced pressure for revision of the exam process. Additionally, the oral examination was a very expensive proposition involving, as it did, the travel of hundreds (in its heyday) of examiners, recruitment of multiple sites in large cities, and payment of patients. This task completed four times each year was an extremely expensive, logistical challenge that led to escalating examination costs for the aspiring diplomates. The ABPN created the current process to address these concerns by moving the skills examination as a requirement into residency training and revising the written examination. The current written examination is a very reliable examination with longitudinally consistent content that addresses realistic clinical topics through written and video vignettes. The last oral examination for adult psychiatry was conducted in Portland, OR at OHSU, and the final child and adolescent psychiatry oral was completed at Northwestern in Chicago.

During Larry’s tenure, the ABPN was also faced with transforming the recertification process. Until 1994, passing the certification exams granted lifetime certification. Multiple studies accumulated, demonstrating that physician competence, absent continuing education and training, deteriorated over time.²⁰ This led the American Board of Medical Specialties (ABMS) to formulate requirements for maintaining specialty certification. Responding to a mandate from the ABMS, the ABPN began requiring diplomates certified after that date to take a recertification examination every 10 years. In 2012, again responding to ABMS initiatives, the ABPN revised its recertification process to include a three-year cycle of requirements for continuing medical education (CME), self-assessment (SA), and performance in practice (PIP). These new requirements were unpopular with many members of the profession and led to criticism from the APA and a class action lawsuit that was dismissed in 2023.²¹ Throughout these trying times, Larry led ABPN’s efforts to explain the new requirements to the profession, amend the requirements to make them as reasonable as possible, and minimize the expense to diplomates. His and the board’s efforts culminated in establishing the Article-Based Continuing Certification Pathway (ABCC) for continuous certification as an alternative to the recertification examination. The ABCC quickly became the preferred option for the majority of diplomates. This transition from an outdated certification system to one that encourages continuous education allows flexibility, reduces stress, and minimizes expense and was one of Larry’s greatest accomplishments at the ABPN and for the profession.

Mentorship

Another area of tremendous contribution is in Larry’s mentorship of trainees and colleagues. Having experienced those qualities of his early in his and my careers, I have always been impressed by his abilities in this regard. His many contributions in this arena have been informal, known only to those who have benefited from his advice. His establishment of the Faculty Fellowship Programs at the ABPN is a concrete example of his belief in the importance of mentorship. Larry established a personal mentorship program for neurology and psychiatry residents nominated by their training programs. The selected fellows spent time at the ABPN, participating in its meetings, traveling with Dr. Faulkner to the meetings he attended, and receiving personal mentorship from him. Larry also established, in 2014, two grant award programs to promote the advancement of residents and faculty. The Faculty Innovation in Education Award selects creative educational projects that improve residency training. The Dorthea Juul, PhD Education Research Award enables research in educational methods improving residency training and lifelong learning. These grant programs funded more than 50 projects, given to multiple institutions. Recent examples include “Legislative Advocacy in Psychiatry Education” by Jennifer Piel, JD, MD at the University of Washington and “Integrating Reproductive Psychiatry into Residency Training” by Jennifer Severe, MD at the University of Michigan.

American College of Psychiatrists

Larry has remained active in many professional organizations, particularly the American College of Psychiatrists. Dr. Faulkner has been a member of the college since 1993, and his committee work for the college began soon after. He served on the Committee on Finance from 1996 to 1999. He has played a key role during that committee service and afterward in assuring the college’s financial footing has remained sound. He was a member of the Committee on Long Range Planning from 2000 to 2003 and served as a consultant to the college’s Work Group on the Future of Psychiatry from 2009 to 2010. He was appointed as chair of the Committee on Bylaws in 2010, serving until 2013. In 2011, he was selected for that year’s program committee. In 2013, he joined the Committee on Nominations and Leadership Development. In the subsequent year, he was elected to the Board of Trustees, serving until 2017 and then again in 2018, after his election as second vice president.

His service on the board has been extraordinarily valuable. He chaired the Task Force on Strategic Planning from 2019 to 2020 and then again during his presidential year in 2022 to 2023 and afterward. Under his leadership, the college conducted an extensive strategic planning exercise involving multiple committees and many members that produced its current strategic plan and a revised set of bylaws that are crucial to the college’s future success.