90 years strong—Celebrating the NBOME’s role in professional self-regulation for our patients

Granite is the stone that symbolizes a 90^th anniversary, and for good reason: it’s strong. Stronger than concrete and even steel, granite is used in structures meant to withstand the test of time. As we celebrate the 90^th anniversary of the National Board of Osteopathic Medical Examiners (NBOME) this year, I am reminded of the strength of our profession, and how the NBOME was built on a foundation of strong professional self-regulation for our patients.

When NBOME was founded in the 1930s, osteopathic medicine was a smaller subset of the medical community, considerably less than the 11% of all currently licensed physicians that DOs comprise in the U.S. today.

Backing up to the 1910s, a group of DOs, led by several former presidents of the AOA, had stood up at AOA meetings and outlined a vision and rationale for why strong professional self-regulation for the osteopathic medical profession was critically important for building patients’ trust, and for the future growth and success of the profession.

The founding of a national board for the profession

The plan mentioned above ensured that osteopathic medicine would establish defensible professional self-regulation standards while also securing the young profession’s distinctive contributions in health care for the patients. Many of NBOME’s founders were graduates of the American School of Osteopathy (ASO) and had trained directly under A.T. Still, DO, MD, founder of the profession. They called for an independent national board that stood up for patients by creating a means to standardize assessments and entry into osteopathic medical practice, with a goal of protecting the public.

Charles Hazzard, DO, Arthur G. Hildreth, DO and Asa Willard, DO, were among the leaders—all former presidents of the AOA. Other prominent NBOME founders include Samuel V. Robuck, DO (president from 1948-1963), who was later a founder and president of the American College of Osteopathic Internists in 1941, and a founding member of the American Osteopathic Foundation in 1927; W. Curtis Brigham, DO, who helped form the American College of Osteopathic Surgeons in 1926; and John E. Rogers, DO, who also chaired the AOA’s Bureau of Professional Education and Colleges (later renamed the Commission on Osteopathic College Accreditation, which accredits DO-granting medical schools). Three of the founders were also graduates of Northwestern University (undergraduate degrees being less common as a prerequisite than today).

The actions of these individuals acknowledged osteopathic medicine’s social contract with patients, and NBOME was initially incorporated as the National Board of Examiners for Osteopathic Physicians and Surgeons (NBEOPS) in 1934, formed from its precursor, the Association of Osteopathic Examining Boards.

The founding of the NBEOPS followed the growth of regulation for public protection across the field of medicine and other elements of society in that era. Paul Starr, a sociology professor at Princeton University, credits elevated standards for physician licensure in the United States with building public trust in his Pulitzer Prize-winning book, “The Social Transformation of American Medicine: The Rise of a Sovereign Profession & the Making of a Vast Industry.”

“The profession’s mastery of itself was the precondition of public sentiment,” he writes, describing the importance of professional self-regulation. Starr cites the importance of licensure standards for having the most substantial impact on the quality of medical education and of care by doctors in the first half of the 20th century.

NBOME co-founder and two-time AOA president Dr. Hildreth described his vision at the 1910 AOA Convention, stating: “The only just safeguard to the public, or the practice of medicine, lies in each school of medicine having its own board of examiners … for who can be so well-qualified to know?”

Creating change in pathways

Dr. Hazzard, a member of the New York State Medical Board, outlined how taking a valid and reliable national exam for osteopathic medicine would reduce the burden of widely variable individual state-based exams, the most common path for licensure in that era, and promote trust in (as well as expansion of) the profession.

Dr. Willard spoke at the AOA convention in 1932, stating, “With independent regulation and the natural numerical expansion it allows, we will ultimately get every right for ourselves and those to come. If we lose the vision we have shown in the past, yield to expediency … we will take care of the present, but there will be no future.”

Since then, through its work with colleges of osteopathic medicine (COMs), its peer organizations—including the AOA and the American Association of Colleges of Osteopathic Medicine (AACOM), the Association of Societies of Osteopathic Medical Regulation (ASOMR, formerly the American Association of Osteopathic Examiners) and the Federation of State Medical Boards (FSMB)—and individual state medical and osteopathic medical boards, the NBOME has continued to develop and administer assessments that ensure osteopathic physicians are qualified to deliver safe and effective osteopathic medical care to their patients.

The NBOME’s National Faculty, now more than 850 members strong, has grown over the years and has become essential to the development and continuous quality assurance for assessments that are valid, reliable, defensible and fair.

The NBOME continues to evolve its assessments with the changing practice of osteopathic medicine, as evidenced by the work of the Special Commission on Osteopathic Medical Licensure Assessment and published research about our assessments. The NBOME also continues advocacy work to educate and inform other stakeholders about the value of the COMLEX-USA credential, particularly for uses in graduate medical education, and the importance of osteopathically distinctive assessments.

Celebrating our past while looking forward

At the NBOME Board of Directors midyear meeting in June, we celebrated our 90^th anniversary by honoring those who have made a difference to our organization and the osteopathic medical profession. Our staff and board members gathered for a professional development program to learn more about the history of the NBOME, which included a panel discussion with former NBOME leaders William G. Anderson, DO (also a past president of the AOA) and John E. Thornburg, DO, PhD. Both Dr. Anderson and Dr. Thornburg shared their thoughts on the evolution of the organization. A celebration dinner welcomed past NBOME board chairs and other instrumental leaders, including Joseph Willet, DO, board member of FSMB, and Alexios Carayannopoulos, DO, president of ASOMR and newly elected FSMB board member, to commemorate our 90 years and all the patients and other stakeholders the organization’s efforts have impacted.

Additional initiatives to celebrate throughout 2024 include “90 Years, 9 Voices,” a video series of interviews with NBOME board members past and present, and a 90^th video tribute. This summer we will begin a social media campaign called “9 Weeks of NBOME Trivia,” which will include opportunities for DO students and residents to win free COMAT Self-Evaluation examinations.

We celebrated with our fellow DOs at the AACOM Annual Educating Leaders Conference in April as well, and will celebrate with the AOA in conjunction with the concurrent 150-year celebrations of the osteopathic medical profession.

We also look forward to our 100^th year and beyond. Innovating to continue to enhance the test-taking experience with COMLEX-USA and COMAT programs is a key element of the NBOME’s Strategic Plan. We hosted a COMLEX-USA Planning and Innovation Retreat in May, to ensure that COMLEX-USA remains the gold standard for osteopathic physician licensure for the next 90-plus years.

We celebrate 90 years of history, resilience, surmounting challenges both external and internal, and always adapting and reaching to continue to thrive in the ever-changing environments of today’s society, medical education and health care. We are achieving excellence in assessment and advocating for our patients and the distinctive philosophy of patient care called osteopathic medicine. The strength of granite. Here for good.

Learn more

For more 90^th anniversary content or to learn more about the history and our key milestones, visit the NBOME’s website.

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