The DO | Opinion | Executive Director's Desk

AOA’s commitment: Boosting the workforce to meet nation’s needs

In contrast to the floodwaters that rose along the Mississippi River and the terrible storms that devastated some of our members’ homes and practices, our profession blossomed this spring as we welcomed many new graduates into the fold. I was honored to give two commencement addresses, to 188 graduates of the A.T. Still University of Health Sciences–Kirksville (Mo.) College of Osteopathic Medicine and to 216 at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif. My remarks focused on what it would take for these new DOs to truly become osteopathic physicians, which I said are embodied in the Osteopathic Pledge of Commitment.

John B. Crosby, JD

John B. Crosby, JD

(Photo by John Reilly Photography)

At the AOA, we pledge our commitment to new DOs from graduation day, through their internships and residencies, and onto their arrival in the practicing workforce.

We also have obligations to patients, who experts predict may soon face a dramatic physician shortage. If these projections are correct, our physician supply will soon be far too low to meet our nation’s health care needs.

Seizing the initiative

The AOA is committed to creating a strong physician workforce to provide accessible, osteopathic medical care that Americans need. When DO graduates pursue osteopathic graduate medical education (OGME), they forge even stronger bonds with the osteopathic principles and practices they embraced during osteopathic medical school. But it’s alarming to see the growing number of DO graduates who pursue allopathic graduate medical education, especially in light of increasing MD class sizes and ongoing competition from international medical graduates. Such trends indicate that gainful allopathic residencies may soon become scarce for DO graduates.

These developments, along with our desire to keep our professional family surging and strong, led 2008-09 AOA President Carlo J. DiMarco, DO, to create the OGME Development Initiative in 2008. In three years, the OGME Development Initiative has resulted in at least 650 new or expanded graduate medical training positions for DOs. Through this initiative, the AOA assists nonteaching hospitals in establishing osteopathic internship and residency programs, helps incorporate OGME into existing programs, and offers assistance to programs that need it.

To stress the critical importance of this initiative, AOA President Karen J. Nichols, DO, transformed it into a standing AOA bureau. In addition, President Nichols has challenged each osteopathic specialty college that has filled 85% of its OGME slots to increase its number of positions by 15% annually. In response to this challenge, we have had a net gain of 15 residency programs and 334 positions in the past year. A report card on our progress has been sent to every osteopathic specialty society and state osteopathic medical association in hopes that they will embrace the advice of W. Edwards Deming, PhD: “Improve constantly, forever.”

Boosting the U.S. workforce

Increasing the number of OGME training positions does not solve the problem of the cap on GME positions created by the Balanced Budget Act of 1997. The consequences of restricting our nation’s graduate training capacity are plain to see. The Association of American Medical Colleges projects a physician workforce shortage of 91,500 physicians by 2020. Fewer physicians mean fewer patients see their doctors, which drives demand and, therefore, costs even higher.

The shortage is not solely a numbers game. Both DO and MD graduates lean toward careers in nonprimary-care specialties. Many factors account for this migration, among them student debt, inequitable Medicare payments for primary care services, the burden of professional liability insurance, and the fact that some 50 million Americans don’t have health insurance to pay for preventive care.

As a result, America is producing too many specialists and subspecialists. Physicians who do choose primary care are often too restrictive in the services they provide, fearing the burden of liability insurance and malpractice lawsuits. In turn, patients are making hard decisions, such as skipping medical visits altogether or visiting emergency departments and retail health clinics instead of primary care physicians.

Ensuring access to physicians

The drought in OGME is compounded by the rising ocean of new medical schools and a veritable flood of graduates. Ten years ago, the profession had 20 osteopathic medical schools and branch campuses. Today, that number has jumped to 34 schools, branch campuses and additional locations. Many of these new schools have opened in regions with existing physician shortages, such as Harlem in New York City, Yakima, Wash., Harrogate, Tenn., and Hattiesburg, Miss. What’s more, our profession is expected to grow from more than 78,000 DOs today to 110,000 by 2020.

The osteopathic medical profession is not letting these alarming trends arise without taking action. In 2008, the AOA and the American Association of Colleges of Osteopathic Medicine developed a “Joint Statement of Principles on the Relationship Between Undergraduate and Graduate Osteopathic Medical Education,” our philosophy on the necessary linkage of the two educational phases. The AOA Commission on Osteopathic College Accreditation in turn has established an ad hoc OGME study group to incorporate this philosophy into the commission’s standards.

A great deal of the AOA’s advocacy agenda for the 112th Congress is devoted to the issues noted here: expanding our nation’s GME training capacity; promoting primary care; and ensuring access to physician services for all Americans, regardless of socioeconomic status or geographic location. Our state advocacy buttresses these efforts to protect patients by limiting the expansion of nonphysician clinicians’ practice rights that are not commensurate with their education and training. These clinicians will not solve our access problems simply by providing care to patients. Patients deserve to see physicians. In a perfect system, physicians would lead teams of health care professionals delivering coordinated care in patient-centered medical homes. Instead, we face a perfect storm.

Great tasks before us

While the storm is brewing, there are some bright skies peeking through the clouds. The storm may yet peter out if the AOA and the rest of organized medicine navigate health care to safety:

  • We must persuade Congress to enact more reforms that recognize the irreplaceable role primary care physicians play in keeping our citizens healthy.
  • We must get our elected leaders to fund the National Health Care Workforce Commission.
  • We must advocate for Medicare and private insurers to revise their payment structures to reward primary care physicians and lower their emphasis on specialty care.
  • We must work to ensure that teaching hospitals are free to start new GME programs without facing caps on the number of positions.
  • And we must encourage patients to refuse to settle for care from nonphysicians when they need to see physicians.

This is a moment when we must come together to save this profession and protect patients. To borrow from President Barack Obama, let us resolve that we will not leave our students a world “where the oceans rise and famine spreads and terrible storms devastate our lands.” Instead, let us turn to the great tasks before us. These tasks require teamwork—not just within the osteopathic medical profession, but from every health care stakeholder in the country—to make dramatic, necessary change. The work ahead is momentous, but I have confidence that, together, we can DO it!

3 Responses

  1. Ed on June 16, 2011, 10:41 a.m.

    As a 4th year osteopathic student, the AOA needs to stop patting itself on the back for how many DO graduates schools are pumping out. As schools are quickly add 25-50-100-150 students to existing the class size and making large increases in their revenue the quality of education is dropping. Students are getting pushed into smaller hospitals without quality educators, without good institutional support, and without depth of pathology to be prepared for the real world. It’s become supper competitive just to schedule complex test dates in the rush to flood the world with DOs. Students clamor to ACGME residencies because most have good educational infrastructure something lacking in their clinical years of osteopathic training. Many of the DO residencies are straw-houses. Now we’re clamoring to make new osteopathic residencies in the tradition of osteopathic education – throw up a tent and a sign, and call it a program, it will get fill with students because they have few choices and the residents will spend their residency like their medical school time calling ACMGE programs and try to get a couple months rotation so that they can get the skills needed to complete the program.

    Across the spectrum osteopathic education needs to get a well working model *before* expanding. In part that mean getting costs down. I will be a half million in debt when I graduate next year. Tuition has gone up 20% over my 4 years of medical school. No 2% boost to primary care doctors by medicare is going to make a dent in my debt. No one in there right mind would fathom going into a $160,000 salary pediatric or FM practice with $500,000 of debt on their shoulders. I’ll let my state-schooled allopathic friends who are paying a third the tuition I am go into primary care. I’m going into a specialty (one that has a shortage as bad as primary care as many specialties do) so that hopefully I can make enough money one day to pay my dues to the AOA.

  2. robert migliorino,d.o. on June 23, 2011, 6:54 p.m.

    The article & response both have one glaring omission.A few years ago,those of us who were non be/bc were welcome in practices & hospitals.Now,we are pariahs,or worse,locked into staffs,as another facility will not accept them.The usual reason is”the insurance companies won’t accept a non be/bc physician”.Will this reduce complaints & suits?The answer is ,NO!Studies have shown that these rates have increased over the past number of years.I remember when we had the ACGP & were proud of the name.I am not anti residency or specialization but,politics & bean counting should have never been allowed to influence the profession as much as it has.

  3. T.D'Ambra on July 1, 2011, 4:26 p.m.

    Primary care sounds just great on paper.But in reality,has this profession considered the rising and important roles that PAs,and NPs are providing in primary care specialties at present ?.

    What will happen to future DOs and current DOs already in primary care ?. Will they have to re-train in another specialty ?

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