A new direction

DOs form task force with eye toward revamping AOA board certification

AOA board certification is here to stay—and AOA leadership is re-assessing all aspects of certification to pinpoint ways to better serve physicians.

As the osteopathic medical profession transitions to a single system of graduate medical education accreditation, many DO residents and osteopathic medical students are wondering if the AOA board certification process will change.

During and after the transition to a single accreditation system, AOA board certification will continue to be available to DOs trained through either AOA- or ACGME-accredited residency programs. In addition, the market for AOA certification will expand to include MDs interested in osteopathic training opportunities through ACGME, says AOA President Boyd R. Buser, DO.

“AOA board certification signifies the highest quality standard for physicians trained to practice through osteopathic principles,” he says.

Innovation on the horizon

Board certification is an important quality marker for patients, employers, insurers and regulators.

The AOA recently convened a Certifying Board Services Task Force and will hold a Board Certification Summit this weekend, July 30-31, in Chicago. At the summit, members of all 18 AOA certifying boards, task force members and AOA leadership will discuss ways to realign board certification, including simplifying osteopathic continuous certification and improving the customer experience, to respond to advances in technology, physician demand, and health care environmental dynamics.

“We want to look for opportunities to innovate board certification and OCC to meet the evolving needs of today’s practicing physicians,” says AOA CEO Adrienne White-Faines, MPA. “The focus should be on providing high-value lifelong learning opportunities in ways that are convenient, yet cost effective for physicians.”

AOA board certification is the only certification that enables DOs to fully reinforce and continue their osteopathic training. It allows DOs to reaffirm their dedication to the osteopathic philosophy and holistic, whole-patient care.

“By choosing AOA board certification, physicians are demonstrating their commitment to a high standard of excellence, quality patient care and sustained competency,” Dr. Buser says.

In a recent article on osteopathic ophthalmology residency programs, resident Austin Bach, DO, MPH, told The DO why he plans to pursue osteopathic board certification.

“DOs were given the opportunity to become physicians through the osteopathic specialty colleges and osteopathic medical schools,” he said. “I think everybody should choose osteopathic board certification.”

63 comments

  1. We have been sold down the river and what we are witnessing is the demise of Osteopathy. Do not be fooled. First the loss of our hospitals then the training programs. Next step clearly then is the loss of the profession. Our failed leadership did not recognize this coming. Sadly the fight of the early osteopaths is for naught. Read Norman Gevitz book The Osteopath and appreciate just how far we came now to be defeated as our leaders conform to the allopathic world.

    1. Osteopathic training is something instilled during medical school. Those principles learned there carry us forward. A single accreditation system for residency will open doors that were still otherwise closed.
      So while the profession has come a long way, I see the move by the AOA administration as a move to preserve the principles learned in medical school and to open those principles to the medical field as a whole and ensuring the survival of osteopathy.

    2. Guys! Let’s be honest most of you practice as MD;s do.Most of you seldom use OMT. Lets quit the feel-good rhetoric about distinctiveness.

      1. Hormoz SaBer –

        Let me preface by saying that I am not attacking you personally; rather, I wish to point out one of the (many) traps that we in Osteopathic Medicine set for ourselves.

        We have an unfortunate disconnect in our profession between being ‘Osteopathic’ and being an Osteopathically trained physician. There is a minority in our profession who have decided that be be Osteopathic is to eschew all treatments other than manipulation. This minority too often chooses to look with disdain on those who approach clinical practice different.

        Practicing manipulation does not make a physician Osteopathic. Never has, never will. Manipulation as a treatment modality results logically from extension an Osteopathic Principle (the interrelationship of structure and function) to its obvious conclusion.

        Osteopathic Principles are what define Osteopathic Medicine, not OMM. It’s time that we stopped bashing one another for how ‘Osteopathic’ we may or may not be.

        Again, I hope that you will not take offense; my comments are to all of my fellow DO’s.

  2. I agree with your comments and point of view commpletely, eventhough we are changed but we should stay with our philosophy, principle and pratice.

  3. The other problem is if you don’t stay an AO. Member you lose your certification even if you recertified and supposedly are good for 10 years, what a scam.

    1. I agree, you should not lose certification because you do not pay dues to the AOA. Certification is based on passing a rigorous examination not an annual fee!

      Donald P. Underwood D.O.

  4. The current process is shameful. First, if we do not pay our AOA dues, our board certification is mysteriously absolved. Being board certified has absolutely nothing to do with the act of paying AOA dues. Second, as one who has recently completed (and passed) a 10 year re-certification exam, the exam was not pertinent to my day to day practice of medicine or competency as a physician. Part of the OCC is to participate in a “Practice Performance Improvement” module- again, it had no application to how my practice is run and the only available modules were for geriatric safety, chronic kidney disease and medication communication. Modules I have already completed on medication safety through my hospital were not accepted. Why should I pay another $200 to complete this again? Because the AOA wants more money. The OCC site randomly assigns “points” to incorrect areas and it is a battle to keep track of where your CME activity points go. (ex. I have all of my CME in my specialty, Infectious Disease, yet I cannot get any points assigned to the ID ‘required’ section, only IM). None of the CME modules offered on the OCC site apply to my specialty (too basic for a board certified ID physician) nor my practice situation. The AOA and ACOI do not communicate with each other and CMEs have to be filed at least twice. I will be seriously considering dropping AOA certifications (and the mandatory AOA membership dues) in place of more modern, applicable certifications that actually encourage improving clinical knowledge if major changes are not made.

    1. Physicians are, by nature, self-motivated, lifelong seekers of knowledge. We view presentations, have informal discussions, read copious journal articles, not for any credit but to keep ourselves updated. We demand this of ourselves because of who we are. I see the CME situation as a major difficulty. Most of my 1-A credits are obtained at the annual ACOP Spring conferece. I was unable to attend this year due to the cost of transportation and lodging. Same next year. Most of the presentations consist of a power point with a narrative by the presenter and some Q & A. And, while I enjoy the comradery attending these events, I fail to discern the difference in the learning experience between sitting in a large room with a group, and viewing the recorded presentation on my MacBook at a time and place convenient for me. I would be happy to pay “tuition” for these presentations if 1-A credit was granted and, thereby, avoid the travel, lodging,and meal expenses in addition to the burdens of time away from practice and family.

      1. Several of my MD, colleagues get their cme credits entirely on line.Only DO’s are required to attend seminars. It is all about money.

      2. Thank you for raising these concerns, Dr. Callisto. The AOA is working to provide DOs with increased opportunities for high-quality online CME. During the 2016-2018 CME cycle, DOs may earn up to 15 credits (half of the required 30 Category 1-A credits) through real-time, interactive online CME activities. This is a substantial increase from the previous cycle, and we will continue efforts to add more options for flexible and convenient continued learning.

    2. I am in complete agreement. As a Radiologist of more than 20 years, with subspecialty training in peds, ed and neuro, over 300 cme credits in my specialty and subsecialty areas, fail to meet AOA cme requirements. This is just insane ! Has nothing to do with my practice or competency !!! All POLITICS ! It was my CHOICE to attend Osteopathic medical school rather than Allopathic, because i believe in the principles and practices, however the POLITICS is constantly driving me away and iust remind myself why i chose this pathway…

    3. I agree. As a physician practicing hospital medicine, module medidicine is neither applicable to how I practice on a daily basis is clearly set up as an income generating scheme for the AOA and fully negates the CME I participate in that is applicable to what I do daily for my patients because the credits are not recognized nor can I continue to afford AOA membership, boards OCC, CME, state licensing and the individual educational requirements of our state.

      1. Money speaks…..residents will look at how much it costs to do OCC and seek ACGME programs which have less expensive ABMS MOC costs

    4. Here’s the great thing about the requirement to be an AOA member to hold AOA subsidiary board certification:

      Those of us in the recertification category now outnumber the grandfathered category. If we choose to do so, we can hijack the agenda of the House of Delegates and impose radical change on the profession.

      If we choose to.

  5. The current process of OCC is evolving and only as good as the input provided by those that are certified by thier specialty board. If you do NOT like the current process and feel the it is not meeting your needs (such as the commenter who said the OCC process didn’t do anything to evaluate her current practice), then get involved, email your certifying board and let them know.

    1. They won’t listen until each state enacts a law banning OCC/MOC recertification from being a requirement for hospital privileges, licensure, or insurance reimbursement – better to do like they did in OK with recent law that passed in April. These specialty societies have too much $ to lose to really listen to you or me. Get involved with doctors on your state legislature.

      1. Agree wholeheartedly. AOA and, in my case, ABOFP are robbing our check books for no good reason. OCC is a joke. AOA is essentially inferring that unless you are board certified with U-T- D OCC you may not be all that good a physician while grandfathered physicians who need no certification are fine. Am in initial stages of pursuing a law in Ohio that would mirror Oklahoma and tell the admin’s to stick it. Board cert is voluntary, has never been mandatory, but one is made to feel as if it is because hospitals, ins co’s, etc have forced it. Enough is enough. Seriously looking at going the NBOMS route and waving bye-bye to AOA.

    2. There are no data that demonstrate superiority of recertification processes (whether by exam or continuous certification) over lifetime certification with respect to standard of care. I have looked. Hard.

      I have been able to find 2 studies that address the question of recertification by exam vs. lifetime certification. No differences were found between groups. There are no studies that look at continuous certification vs. lifetime.

      I have been in contact with my certifying board, state organization, BOT of my certifying board, Bureau of Specialties of the AOA, as well as Immediate Past President John Becher DO and current President Boyd Buser DO.

      Stonewalling is all that you get by approaching these monolithic entities.

    3. They don’t listen. And OCC as a concept is fundamentally broke. There’s no way to fix a concept that is wrong to begin with. Board certification was not meant to be time limited. THAT is the problem. It’s all about the AOA wanting money, artificial power, and manufactured relevance.

  6. I feel I had an excellent osteopathic education . Did my IM residency at Brown an MD program which was superb. My board certification is AMA. Not as complicated as AOA but was still costly. Also don’t have to be AMA member to retain certification. John

    1. The AMA is NOT in the business of board certification. The ABIM is part of the ABMS, American Board of Medical Specialties. DO’s can choose AOA or ABMS certification in thier specialty. The AOA which is governed by the Board of Trustees, certifies osteopathic specialists in thier specialities through thier oversight of the Bureau of Osteopathic Speicalists. Entirely different structure.

    2. Did you know that Europe a doctor is certified once for life and all the seminars he choses to attend is his and his pride.? Here in America, only the DO;s have to keep paying the vultures in . Osteopathic organizations in order to practice medicine. Scam!.

  7. I am still waiting for someone to explain “our philosophy, principle and pratice.” As for “whole-patient care” who actually practices that? If we are talking about family medicine then how does that differ between MD and DO? It’s time to simply have one unified system of education and training and stop pretending that DO’s offer anything different.

    1. The original philosophy espoused by AT Still is clearly holistic, vitalistic and spiritual. The AOA and the colleges should remove any reference to a holistic approach because that approach does not exist universally in our profession. Perhaps a class action lawsuit by students who didn’t get a holistic approach to patient care will motivate the AOA to either reform itself or fold.

    2. I said the same thing for forty years until i turned blue on the face. I got old and retired but the cult of Osteopathy prevails. Youg doctors you need to rise.There is no difference between an MD and a Do,in their daily practice of Medicine.

      1. You are correct.

        We need to dump the adulation of AT Still and our love of oral tradition.

  8. The current system is terrible for maintaining family medicine board cert. The time away from office for the OMT portion, the cost of attending the AOA conference, the lodging costs, cost of flight, having only two expensive locations available (Puerto Rico or Anaheim), not being able to do the written test at the same time, the cost of the modules ($1k each with two required this year) all contribute to a very expensive waste of time that does not impact the quality of care at all for my patients. This is compounded by the fact that we are a 2 DO family which means we also bring our children. We are both planning on doing the alternate certification so we can avoid this in the future. We are both staunch supporters of the Osteopathic profession and have been adjunct instructors and mentors. This process seems to be money and/or “for show” driven, not patient oriented.

  9. In the wake of the revamping of the osteopathic boarding process, one question still remains, how does the AOA explain the fact that they have a recognized Osteopathic Addiction Medicine Fellowship without a pathway to provide a board certification?

    Those of us that have participated and graduated from the Larkin/NSUCOM fellowship program have been summarily locked out of the process by administrative fat cats within the AOA that

    1- refuse to acknowledge that addiction is a problem for our nation and,

    2- refuse to legitimize an AOA approved fellowship program that now has graduated 12 fellows in the past 3 years with a board exam.

    With the passing of CARA by the Obama administration and the highlighted interest of addiction medicine as a specialty nationally, I feel that it is a reasonable expectation for the AOA to recognize and validate its own Addiction Medicine Fellowship by providing a board certification for its fellows. I, unlike my AOA colleagues that are specialty trained, cannot actively participate in insurance reimbursements, hospital appointments, and adequate recognition for our specialty interest without the establishment of a full board. As a result of inaction by AOA, I will lose my current position within my organization due to a lack of board certification and/or process, as the American Board of Addiction Medicine is no longer providing a pathway for entry-level certification.

    I would gladly invite conversation from any executives of the AOA to explain why a pathway and/or board examination does not exist, especially since the AOA is the only boarding entity to have a recognized and approved Addiction Medicine Fellowship program within the United States.

    Without a board examination available at the completion of the fellowship this effectively hampers the advancement of the Addiction Medicine specialty while rendering its graduates as bastard children without recognition and support from their parenting organization.

    1. The answer is to create a Board specifically for Addiction Medicine. The process in the AOA is straightforward and outlined in the Bylaws.

      The hardest part is to come up with a good acronym. :o)

  10. How’s about graduates from AOA-residency want to pursue allopathic board certification? Is it allowable? I could not find much information on that.

    1. It is currently not allowable. The ABMS boards will not let you certify in thier pathways without ACGME residency. Even if you take anAOA residency and do an ACGME fellowship. I don’t know if that will cha be once the SAS occurs because the actual certification process is NOT governed by the ACGME.

      1. I did an aoa internship and then acgme two year residency to complete my internal medicine training. My ACGME residency assured me they would accept all of my traditional rotating internship credits and admit me as a PGY -2’…which they did. BUT when I approached the end of my residency, I was informed that I could NOT sit for the MD certifying boards because they would not accept my first year of internship. Bam! Suddenly I was tossed into the “DO boards only” track and that’s where I find myself today, six years later, still waiting for the long promised revisions to the process. Alternative boards are looking better and better!!

  11. There is a growing field of Advanced Heart Failure and Transplant. Many of our DO cardiology fellows are interested in pursuing this new field of cardiology. At this time the AOA does not have a certifying pathway for these physicians. What are the plans of the AOA to rectify this. As it stands now the AOA has locked our cardiologist that are AOA trained from this field. When are we going to be proactive not reactive in this burgeoning field of cardiology.

  12. There are quite a few concerns in the comments about preserving the osteopathic tradition. As someone who is currently moving through a well-known osteopathic program, these concerns are well founded but far too late. Osteopathic philosophy is long gone, both in the student body and in the vast majority of faculty. The vast majority of students graduating from my school know nothing of the philosophy or history of osteopathy, and will be allopaths in every meaningful sense of the term. From this perspective, combining accreditation is absolutely appropriate and long overdue, for we are allopaths and should be recognized as such.

    As someone who came to school looking to learn medicine in a traditional osteopathic tradition, this has been a difficult and disappointing experience. It is clearly up to older doctors to find the minority of students who are looking for traditional osteopathic training and try to pass it on outside of the “osteopathic” medical school system.

    1. If you have not already, please look into the AAO and attending the annual convocation. This is an excellent way to become more fully immersed into traditional Osteopathic Medicine.

  13. I completed a very prestigious “GPM-PH” residency program in 2000. It was a combined program at UCSD-SDSU. Upon completion, I was informed by the “AOA” that my program was not approved, and therefore, I was not eligible to challenge the Osteopathic boards. Really!
    I have a degree from the “University of California, Sam Diego” indicating my Preventive Medicine completion!
    To this day, I have not, and will never, give the AOA one dime!!!!!

  14. We have an issue in California that complicates our license. I finished my 10 year recert via Abim but California requires at least 60 AOA credits and many of them category 1-a. I paid for all my cme my dea my ca liscense and my board fees only to have to scramble and pay AOA membership to get enough credits for the cycle. Way too much money and in the end I had to pay u of Michigan more money just to get enough category 1-a units without having to go for a conference. Stressful year made worse by lack of AOA approval of ama approved units. I wouldn’t care as much if it wasn’t for the fact that I redid the same topics in both ama and AOA because there weren’t enough different offerings on the AOA side. I wouldn’t mind if there was something unique about the offerings but I just got credit for doing it twice.
    Bottom line: in California being ABIM certified does not allow you any licensure benefits in regard to cme

  15. This will come to nothing. The oligarchy comprised by the BOT, elected officers and administrative leadership of the AOA are viscerally incapable of reversing directions and admitting error, particularly as error pertains to the sham called Osteopathic Continuous Certification (OCC).

    Young in career physicians – those in thrall to the whims of the AOA and compelled to recertify – outnumber grandfathered, lifetime certified physicians in every aspect of the AOA (except the BOT and elected officership). It is time for this to change. It is morally and ethically outrageous for grandfathered physicians – who have no dog in the OCC fight because they exempted themselves from OCC – to impose standards on the rest of us.

    As a general rule, Delegates to the AOA House of Delegates tend to be younger in career, as the HOD is the natural place for new leaders to get a start. Since these physicians are in the time-limited certification category, we out number the OCC exempt in the HOD.

    In other words, we can assume control of the HOD if we choose to do so. Ascension to the AOA aristocracy is nothing more or less than a well choreographed beauty contest. That generation has had its turn. We have the Combined Pathway and OCC to thank them for. They need to step down or be ushered from the podium.

    I have no compunction whatsoever in saying this to any of the AOA “leadership.” Assuming they have the stuff it takes to stand up and be identified.

  16. DO’s did this in the 70’s in California and it was a disaster. Call me what you will but if you think the MD profession is going to usher the DO’s in you are mistaken. I see this as being the demise of the profession I love. I am a general surgeon and I can tell you that while I bail out my Vanderbilt trained colleague on every colon resection he does, he and his type will never see me as anything but second best. The good thing for me is that the nurses in my small town know who they want to operate their family. It’s me.

  17. I am now a retired DO–I graduated from Kansas City Osteopathic Medical School in 1962–interened at the then Oklahoma Osteopathic Hospital in Tulsa–practiced general medicin in Albuquerque for 13 years-then I volunteered for the Naval Flight Surgeon Program in Pensacola FLorida–spent 21 years in the US Navy. I practiced as a Physician along side of many MD brethern–you didn,t practice any different than a MD did. Medicine is Medicine–wherever you practice. I have long felt that having two separate medical practicing physicians is a farce and should not exist.It is good to have practiced almost 45 years–never one malpractice claim and now in my eighties–I see the young DO dealing with the same problems that we did in the 70,s-80,s

  18. It is definitely all politics with the totally out-of-touch AOA in Chicago. As a DO anesthesiologist, the AOA has NEVER represented me nor lobbied for me in Washington, DC nor anywhere. I took a DO residency so the AOA “owns” my board certification. Certification is FROM THE AOA AND NOT THE OSTEOPATHIC ANESTHESIA BOARD! When I was deployed in Iraq with the US Army, all the docs tried to give weekly presentations. I kept the certificates-sent them into the AOA and the AOA refused to grant me the “AOA 1A” CME! (No “prior AOA approval!!”)-Cut me a break…. I did not have another available lecture given by DOs in Baghdad, Iraq, a combat zone! Disgraceful!

    1. Thank you for your Service!
      The AOA is concerned only about making money to protect their fat salaries.
      The truth is no one cares about the AOA it is not respected and serves only to meet hospital /insurance bylaws.

    2. Dear Dr. Blok,

      The AOA membership department would like to know more about your experience to see if they can help you. Please contact Gayle Irvin, MPH, AOA Customer Resource Center Director, at 312-202-8079. Many thanks.

      1. I think it is also demeaning to me as an osteopathic nephrologist to complete CME via the American Society of Nephrology (ASN) NephSAP which is a book published 5-6 times a year and you must answer 30 questions at the end of it and pass with 75% or better to obtain CME credit, to only receive category 2B credit when my allopathic counterparts receive Category 1A. I could better understand if there was equivalent osteopathic CME in my speciality but the NephSAP published by ASN is the toughest CME I have ever done. It makes me feel like I am being treated by a second class citizen. I want to be just as competitive and up to date as my MD counterparts so to do that I must do more CME because the CME I deem worthy of my time is down graded by the AOA.

    3. Dr. Blok
      All of the Boards under the BO’S should have a person who individually reviews special CME requests. That person would be separate from the AOA CME office and associated only with the anaesthesiology board. While you might not get Cat 1 A CME, you certainly should be able to get specialty specific. There is also dispensation for those military active duty from needing to accrue CME while serving overseas. I would certainly call the office the prior respondent mentioned.

  19. Adding to the fray, fit these of us at the mercy of the AOBIM, our cme credits must ching from THEM, and them only! So lay last year I couldn’t attend the “big” aoa convention, even though the AOBIM did some sessions there they did NOT count toward their own CME credits?!?! Nope, you have to attend an actual AOBIM convention…not the combined convention, that would be too cost effective and convenient. And you have to attend an AOBIM convention at least every three years or your can’t be a member…so you can’t keep your board cert. A giant scam! last year I had to go to Florida, just ten days before the “big” AOA convention, just a city away from the Orlando Aoa convention, to give $1000 to AOBIM specifically. And YES, I resent it and their constant grabbing into my pockets all the while saying they know what I’m up against in practice. Who’s my enemy here???

  20. It’s a little disheartening to read all the negative comments. I can honestly say I just returned from the AOA HOD with the most optimism I have experienced in a long while.
    What I saw in the reference committee that I was on was many very strong personalities who in the past would have tried to “win” their point at all cost , but we worked in a truly professional manner and with give and take and honest well prepared and thoughtful dialogue came up with resolutions that reflected the perceived best solution to the problem. If any of the committee members felt a point not addressed properly ,they used the democratic process available to all and presented it to the house and let all the delegates vet the point.
    My point being, is that as individuals we need to use the processes available to us and write to the members of the task force or board member that represents you with your comments, objections and concerns.
    I can truthfully say that I have found the leaders open and receptive and honestly wanting to be “Good Leaders”. But they can’t do it in a vacuum or try to address problems that they don’t know exist .
    Even though I know I am always right and others are stupid or just ignorant, the truth of the matter is I may be wrong and it is only in listening to the other fellow do we really become educated and usually address the needs of the majority. Thank you for the opportunity to comment.

  21. Only two “revamps” needed to fix things:

    1) Get rid of time limited certification. Board certification was not intended to be renewed. You don’t have to renew your college degrees or your high school diploma.

    2) Bring back alternative pathways. If someone can demonstrate the knowledge, experience, and applicable skills in a specialty to at least a minimum standard, there’s no reason they should have to go through a residency or fellowship. The unfair restriction of trade you’re engaging in just further bogs down the already short number of residency spots and harms both your physician forced paid members, and our patients. It also just benefits noctors.

  22. Dr. Wes Fisher has already presented many of the same arguments and done the investigative leg work when he discussed the failed MOC to the AMA in June 2016. Our MD colleagues feel the same as most of us with regard to the money grab that is re-certification.
    Below is a link to the article and video.

    http://news.doximity.com/entries/3917803

  23. What’s the problem? The term osteopath is outdated rhetoric.Osteopathic Philosophy is not. Allopath is also outdated. As a DO name one “Path” we don’t use. It seems we are all on the same path. 40 Yrs ago this was the goal.
    Fighting to show the Public how we were like the MD , now fighting to show how we differ. IDenity has always been our goal.We have followed the Path and reached the Y, as Yogi stated when you come to the Y take it.Certification on both sides has always been a financial or ego centered plan. The AOA needs to let the Speciality Colleges Certify and Control it , AOA membership should not be Mandatory .I have trained on both sides, from a Doc standpoint , no difference ,

  24. In a way a lot of MD’s are really trying to cross over and adopt a similar philosophy toward holistic medicine and the ideals of Osteopathy more than DO’s are going their way or at least their older methods and ways. You can never rest on your laurels but I do not feel the profession is dying or being taken over by MD’s.

  25. As I have stated earlier, the AOA has been nothing but adversarial to me in my quest to gain acceptance. At this point in my career however, my fight with them is over.

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