Medical regulation: AAOE president speaks out on osteopathic medical education, advocacy and regulation

Alexios Carayannopoulos, DO, MPH, president of the American Association of Osteopathic Examiners (AAOE), first became interested in medical regulation as a public health graduate student at Johns Hopkins University.

“Hopkins had a very strong relationship with Capitol Hill,” he said. “During my training, my exposure led to a strong interest in health policy and management as I recognized the need for improved access to public health, medical and mental health services for many Americans in need as well as the importance of reducing health care costs and improving outcomes. I was very fortunate to be able to participate in health care legislation and regulation reform on Capitol Hill.”

Later, after he became a physiatrist and pain medicine subspecialist, Dr. Carayannopoulos was able to put his advocacy skills to work when he was appointed to the State Medical Board in Rhode Island, where he has been serving for nearly five years. He was also elected to a position with the Federation of State Medical Boards (FSMB).

As AAOE president, Dr. Carayannopoulos leads a consortium of osteopathic physicians who sit on state licensing boards. There are 13 osteopathic boards and 38 combined boards that license DOs and MDs. The AAOE works to ensure that the distinct training of osteopathic physicians is appropriately recognized and that DOs’ right to practice is protected.

Dr. Carayannopoulos recently spoke with The DO about the AAOE and its upcoming goals. Here’s an edited version of that conversation.

What is the American Association of Osteopathic Examiners, and what does it do for the profession?

The AAOE represents physicians in the medical regulatory arena. It has several priorities, the first of which is advocacy, meaning collaboration between the AAOE, the AOA, the FSMB, and of course, our colleagues at the American Medical Association. We look at continuing medical education after training, and we have very strong relationships with the American Association of Colleges of Osteopathic Medicine and with the National Board of Osteopathic Medical Examiners.

Of course, we’re interested in leadership development of osteopathic physicians in medical regulation and advocacy as well as education and support of students in colleges of osteopathic medicine. We also strive to help the public better understand what osteopathic medicine is, sharing our proud history, helping the public to understand both the similarities and differences between MDs and DOs.

Given the long tradition of DOs who practice in primary care settings, we can assert and leverage the value of DOs in a health care system. We have a proud tradition. Why have we held on to a degree instead of being swallowed up by the allopathic profession? Keeping our traditions and degree enhances our unique identity and emphasizes how we deliver health with care, focusing on compassion, accountability, respect and excellence.

As we distinguish ourselves from allopathic physicians, we will attract more and more capable students and young physicians who want to really take the osteopathic profession to the next level.

Why is osteopathic medical regulation important?

It’s critically important to protect patients, but also to protect providers. What we’re trying to do is promote safe medical care. I’m passionate about patient safety, ensuring quality health care and securing appropriate medical regulation. The AAOE has a special interest in protecting and promoting those regulatory issues, whether it be through licensing, continuing education, undergraduate education or training of DO students or DOs in allopathic training programs.

What are some of the issues medical regulators are grappling with right now?

Because of COVID, there have been a lot of restrictions on DOs in many domains, and with osteopathic training programs and MD training programs. One requirement of students is that they have an in-person exam to ensure appropriate clinical and evaluative skills. The restrictions imposed by COVID in terms of being available in person affected osteopathic students, who had licensure and matriculation requirements for individual state license boards and residency programs.

One of the challenges was the waiving of renewal requirements to enact emergency licensure in states where physicians were in great demand as well as facilitating reciprocal licensure across state lines. For instance, I live in Rhode Island. If there was a need for me to help with a Massachusetts health care issue, whether it be with COVID care or just to serve as a backup, it would be more challenging if some of these pre-COVID restrictions were maintained.

I also think COVID and added administrative responsibilities on clinicians are leading to burnout. To that end, we are working with our regulatory partners and state boards is to provide physicians with an opportunity for self-care. Some manifestations of burnout include behaviors detrimental to one’s health and well-being. So being able to identify those issues early and provide physicians an opportunity to heal and seek treatment is very important.

And those issues are not unique to osteopathic physicians. We look for opportunities to raise awareness, availability of information, and resources for addressing physician burnout and improving wellness. We align ourselves with the Federation of State Medical Boards to effectively support physicians and to protect patients in the face of circumstances that lead to burnout, which is ultimately a patient safety issue.

Why did you get involved in the AAOE, and why is it important for you to donate your time?

I give my time because I want to make a difference. It gets harder and harder the further along I get in my career because I have more and more responsibilities with my primary job. Early on, I got involved just to network and to have a seat at the table. Now, I’m much more selective with the organizations for which I volunteer and focus my efforts. The ones I work with now are true to my heart, organizations I can contribute to, but also organizations that make a difference. From my perspective, there’s an obvious clinical responsibility of being a physician, but there are other opportunities to advocate for patients and educate society at large.

Why did you choose medicine for your career, and how did you choose your specialty?

I am a specialist in physical medicine and rehabilitation. My sub-specialization is in pain medicine. There are many physicians in my family, and I was always encouraged to pursue a medical career. As a kid, I had no interest in going to medical school. I wanted to do something else, so I joined the military. Through a lot of hard work, I qualified as a Navy submarine officer and a Navy diver.

I was injured in the line of duty and spent a fair amount of time getting rehabilitated through the military medical system. A little bit later, it dawned on me that rehabilitation medicine and pain management might be my true calling.

So, I pursued medicine and chose physical medicine and rehabilitation because I know what it’s like to be limited functionally and be “out of the game.” I truly understand and empathize with patients having impairment, handicap, and disability, which has made me a better physician and a better person.

What’s the role of the AAOE internationally?

The AAOE is a national organization representing DOs in our country. It’s important to note that we advocate for osteopathic physicians around the globe. I recently attended a conference of the International Association of Medical Regulatory Authorities (IAMRA), which has a close relationship with the Osteopathic International Alliance (OIA). It was an excellent reminder that DOs in the U.S. have a very different identity, scope of practice, and overall role in health care as compared to osteopaths around the world.

Through our international collaboration, the AAOE has an important role in differentiating and distinguishing who U.S.-trained osteopathic physicians are and reminding our colleagues and the public at large that not all osteopaths are the same.

Where can people learn more about what the AAOE does?

We post quarterly newsletters to our website, which also shares more information on our organization. I can be reached through that site, or you can contact the AOA staff liaison to the AAOE, Raine Richards, JD, AOA senior director of State Government Affairs, at [email protected]. One of our main priorities currently is to strengthen AAOE’s alliance with the AOA, growing strategically in a complementary way to support the missions of both organizations.

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