What it means to be “Keepers of the Flame”

We stand on the brink of the greatest opportunity we have ever seen to bring true osteopathic care to the forefront of medicine in America. The choices we have are:

1. Say no, it’s too much work, we shouldn’t have to change
2. Hope that someone else will do it
3. Do the work to bring our residencies into the single accreditation system of the Accreditation Council for Graduate Medical Education (ACGME).

Unfortunately, there continues to be an ongoing lack of understanding about what this transition means to our specialties.

AOA Residencies

Within the American Osteopathic Association (AOA), there are currently four pathways to obtaining board certification in osteopathic manipulative medicine.

1. Neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM) residency
2. Integrated family medicine/neuromusculoskeletal medicine (FM/NMM) residency
3. Integrated internal medicine/neuromusculoskeletal medicine (IM/NMM) residency
4. Neuromusculoskeletal medicine plus-one residency

Over the last three years, an average of 45 residents completed their programs annually and were eligible to sit for boards, with 54 more anticipated to do the same in 2017.

If all AOA postgraduate training in the specialty of NMM/OMM ended today, there would be 117 fewer physicians graduating that are qualified to meet the current Commission on Osteopathic College Accreditation’s (COCA) requirement that the chairs of the Departments of Osteopathic Principles and Practices (or their equivalent) at our schools and colleges of osteopathic medicine be board-certified in NMM or hold the certification of special proficiency in osteopathic manipulative medicine.

As we continue to open new institutions despite an apparent shortage of available faculty—evidenced by the number of schools with open positions in those departments—this becomes more crucial than ever.

ACGME Residencies

In the new system under ACGME, there is a single specialty, osteopathic neuromusculoskeletal medicine (ONMM), which leads to eligibility for certification by the AOBNMM.

On the surface, it appears the only type of program left to us is what has been referred to as the “traditional” two-year program. Digging deeper, we find this program offers the opportunity to enter that pathway in the ONMM2 level which is 12 months in length, after completing a residency elsewhere, effectively completing an NMM/OMM plus-one residency.

While the requirements are different from the AOA’s plus-one program and while it will require some flexibility and creativity on the part of program directors, the option still exists to train physicians in that model as well as in the traditional two-year model and thereby maintain the majority of our existing programs.

However, the biggest misconception, in my opinion, is that “integrated programs are going away.” If you want to speak in strictly technical terms, then you could say that is true, but it is misleading and harmful to imply that this model can’t be effectively created within the parameters available to us.

Looking Forward

While the transition might be happening at a slower pace than some might want, this is not the sign of a need to “reverse course” as suggested by some esteemed colleagues in our profession. It is a sign that we as the NMM specialists need to get our existing programs accredited in ACGME and to start new ONMM programs wherever we can.

I challenge every school to start or support an ONMM program to help train our future teachers. Physicians with C-SPOMM or NMM certification have been involved in educating nearly all of the osteopathic physicians in practice. If the current COCA requirements for OPP department chairs at colleges of osteopathic medicine remain in effect, as it must, we will be key participants in the education of 100 percent of all future osteopathic physicians.

If that doesn’t make us the “keepers of the flame” of keeping osteopathic medicine alive and flourishing, I have no idea what does.

The AOA is committed to helping our programs through this process, offering free guidance and assistance in whatever way is needed. Visit http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/accreditation-processes.aspx for further information.

If the AAO can be of assistance, let us know. As I said, we stand on the brink of the future with our three options before us. To say no and let your programs close or to just hope someone else does the work for you is to say that our profession doesn’t mean enough to do all we can to ensure its survival.

To take the responsibility of continuing old programs and the initiative of opening new ones is not only to ensure survival but to seize the opportunity to bring A.T. Still’s vision to fruition and to bring what has long been the bright future of medicine into reality, providing all patients with the opportunity to receive the benefits that only osteopathic care can give.