NBOME survey of leaders gauges views on changes facing profession

Leaders in the realms of osteopathic undergraduate and graduate medical education, competency assessment, board certification and medical licensure express both concern and optimism regarding proposed changes to OGME and other issues facing the profession, according to survey results released earlier this month by the National Board of Osteopathic Medical Examiners (NBOME).

The survey respondents, who attended the NBOME’s first U.S. Medical Regulatory Summit in December, agree on the need to align their priorities to ensure that the osteopathic medical profession remains distinctive at a time when the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and the Accreditation Council for Graduate Medical Education (ACGME) are working toward establishing a unified system for accrediting GME by 2015.

With the profession grappling with the proposed unification of GME accreditation, as well as unprecedented growth and the impact of health system reform, the NBOME decided to host the half-day summit in conjunction with its 2012 Annual Board Meeting in Philadelphia. The NBOME asked the summit’s 40 participants (see accompanying list) to complete a survey after the meeting.

The survey explored whether changes in GME, undergraduate medical education and medical care during the next three to five years are likely to benefit or harm the profession or diminish the DO difference.

Of the survey’s respondents, 96% agree that changes in the GME environment could threaten the distinctiveness of osteopathic medicine, and 80% are concerned that such changes will negatively affect the profession. Among the worries is that osteopathic GME might become less distinguishable from allopathic GME if the ACGME accredits all postdoctoral training programs.

That said, 88% of the respondents agree that GME changes will produce great opportunities to advance the profession, and 84% are optimistic that such changes will benefit the profession. One benefit of unified accreditation would be expanded training prospects for DO graduates, as well as greater recognition of DOs in the broader medical community.

It is not surprising that the survey respondents have high expectations amid concerns, say some of the summit’s attendees.

“Among the groups who attended the summit, there is broad support for going toward a unified accreditation system for GME,” says AOA Trustee Boyd R. Buser, DO, one the AOA’s four representatives at the Dec. 8 meeting. He points out that the summit’s participants understand that the proposed unification plan reflects months of negotiations after the ACGME announced a plan to no longer recognize previously completed OGME as qualifying applicants for entry into advanced ACGME training.

That yet-to-be-implemented proposal would have prevented DOs in AOA-approved but not dually accredited residencies from pursuing ACGME-accredited fellowships. It also would have made it necessary for those in a traditional osteopathic rotating internship to repeat their first year of training if they enter an ACGME-accredited residency.

A unified accreditation system would broaden training opportunities for DOs, as well as keep the proposed change to the ACGME’s common standards from adversely affecting osteopathic graduates, explains Dr. Buser, who has represented the AOA Board of Trustees in negotiations with the ACGME.

One issue raised during the summit and reflected in the survey results is the future role of AOA certifying boards if GME accreditation becomes unified.

“I’m optimistic that DO graduates of ACGME programs will still be able and want to obtain AOA board certification,” says Stephen M. Scheinthal, DO, who chairs the AOA Bureau of Osteopathic Specialists, which he represented at the summit. “We know that the majority of osteopathic graduates who currently complete an ACGME program come back to take the AOA boards. So there is a lot of osteopathic pride in our profession.”

Still, for AOA board certification to remain viable, the ACGME would need to agree that it is equivalent to American Board of Medical Specialties (ABMS) certification, Dr. Scheinthal says.

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Summit participants discussed how osteopathic continuous certification, which is being fully implemented this year, must remain a distinct process, not become a carbon copy of the maintenance of certification requirements issued by allopathic ABMS certifying boards, Dr. Scheinthal says.

Unlike the ABMS specialty boards, which are independent, the AOA oversees the osteopathic specialty certifying boards. Among other advantages, this allows AOA-board-certified DOs greater flexibility in completing continuing medical education requirements, according to Dr. Scheinthal.

“It is a uniquely osteopathic process whereby physicians can cross their specialty board silos to take modules appropriate to their practice,” he says. For example, Dr. Scheinthal, who is a geriatric psychiatrist, could take a CME module on dementia sponsored by the American College of Osteopathic Internists even though he is certified by American Osteopathic Board of Neurology and Psychiatry.

Separate and unique

“We are really in a time of unprecedented change in medicine,” says geriatrician Janice A. Knebl, DO, who chairs the NBOME and has practiced internal medicine for 30 years. “With everything hitting at once, that’s why the NBOME decided to hold the summit.”

Besides GME and board certification, summit participants discussed the potential impact of the Affordable Care Act and other health system changes on the osteopathic medical profession. The survey shows that 56% of those who attended the meeting strongly agree that great opportunities to advance the profession will grow out of the changing medical care environment.

The federal government’s emphasis on primary care, for example, gives the profession a chance to showcase one of its key strengths. And the growing number of new osteopathic medical schools means that the profession will play a major role in alleviating the physician shortage, expected to worsen when the Affordable Care Act is fully implemented in 2014 and millions more Americans have health insurance.

The majority of surveyed summit attendees also strongly agree that the following “universally recognized and distinctive” processes are critical to maintaining a separate and unique osteopathic medical profession:

• 96%—osteopathic competency assessment for licensure (the NBOME’s Comprehensive Osteopathic Medical Licensing Examination of the United States, known as COMLEX-USA).
• 84%—osteopathic medical school education.
• 80%—osteopathic medical school accreditation.
• 60%—osteopathic specialty board certification.

The NBOME reports that summit participants agree unanimously on one consensus statement: “Because of the substantial contributions of osteopathic medicine to health care and the entire house of medicine in America over the last 138 years, a distinctive osteopathic medical profession is valuable to the health of the American public.”

“In other words,” says Dr. Knebl, “patients are best served by seeking care from osteopathic physicians who are uniquely educated, assessed, trained and credentialed.”