Minding the gap: A year of listening, leading and lifting up the osteopathic medical profession

At a time when the AOA stands at the intersection of digital evolution in medicine and tradition, newly sworn-in 129th President Robert G.G. Piccinini, DO, D.FACN, is bringing a refreshingly personal and purpose-driven approach to leadership. As the first psychiatrist to ever lead the AOA, during his inauguration, he delivered a clear message: the path to a stronger osteopathic medical profession begins with stronger communication and deeply supporting members, first-generation DOs and those silently suffering under the weight of mental health struggles.

A listening leader in a time of noise

Dr. Piccinini’s background in psychiatry is more than a credential—it’s a guiding philosophy. “Psychiatry has taught me something foundational about leadership: to listen to what is said—and what is unsaid,” he stated. His presidency, he declared, is not about commanding attention, but about offering it—to members who feel unheard, unseen and underserved.

Drawing on the familiar phrase, “Mind the Gap,” from the London Underground subway—a cautionary reminder to notice the space between the train and the platform—as a powerful metaphor for leadership, Dr. Piccinini challenged the osteopathic medical profession to act with care and awareness and to examine the often-overlooked spaces between what we say we value and what we actually prioritize.

A focus on two-way communication

Central to his agenda is a comprehensive overhaul of the AOA’s communication strategy. “The best communication begins not with a message, but with an ear,” he said, noting that AOA members are craving dialogue.

The president announced a series of initiatives aimed at creating just that:

• Mega Zoom town halls for students and residents: Starting in August, bi-monthly virtual forums will give students and residents direct access to the AOA president, providing a space for honest questions and meaningful answers.
• Board-level follow-ups: Recognizing that some concerns require more than administrative answers, he committed to having AOA Trustees personally call members with complex issues—an extraordinary move in membership engagement.
• Certifying Board Services reform: Sharing his own experience going through the Osteopathic Continuous Certification (OCC) process, Dr. Piccinini pledged to improve communication and user experience within the certification system. With a vision-focused team in place, all specialty boards are being challenged to adopt early-entry certification pathways and pilot-test their messaging before release.

“Transparency is not optional,” he said. “It is a professional obligation.”

Meeting disruption with discipline

Dr. Piccinini acknowledged that disruption is inevitable—in medicine and in leadership. Sometimes disruption sneaks in quietly through outdated systems or silos. Sometimes it comes loudly, sown by division or misinformation. But rather than reacting defensively to disruption, he proposed a proactive strategy rooted in introspection.

New time-limited work groups will assess specific disruptions to ensure that future strategic plans are responsive and dynamic. “We will not overreact to noise or ignore meaningful critique,” he said. “We will do the harder thing: choose introspection over poorly timed reactivity.”

His approach to disruption is one of measured resilience because he says it offers us something valuable: a mirror. “We are not held together by convenience—we are held together by conviction. And we do not retreat when challenged. We rise.”

Lifting up first-generation DOs

Perhaps the most personal and poignant part of Dr. Piccinini’s address centered on first-generation osteopathic physicians—those who are the first in their families to become osteopathic physicians, often bearing the dreams of generations past.

As a first-generation DO himself, he spoke with conviction about the unique grit and determination these students and physicians bring to the field. “They are not just learning osteopathic medicine—they are defining it,” he said.

To support them, the AOA will:

• Build mentorship programs that include both situational and longitudinal opportunities.
• Work with the AOIA to develop tools and communities that ensure no first-generation DO is left behind.
• Offer curated programming through the VOICES workgroup to help affiliate organizations better engage residents and early-career physicians.

“In supporting first-generation members, we’re not just lifting individuals—we’re strengthening the entire profession,” he said.

Mental health at center stage

As a psychiatrist, Dr. Piccinini could not—and would not—leave mental health in the margins of his speech. Calling it, “central to our success as a profession,” he shared the sobering reality of having evaluated over 10,000 suicide attempts throughout his career. “Every one of those persons reported that at the moment of their attempts they felt alone in their world.”

Within osteopathic medicine, he said, this isolation is compounded by a culture that too often glorifies resilience while discouraging vulnerability.

“We cannot pour from an empty cup,” he said plainly. Physicians and students, often lauded as caretakers of others, are burning out—quietly and dangerously.

Under his leadership, the AOA will:

• Revamp the mental health section of its website to make it more accessible and user-friendly.
• Promote collaboration across specialties and state affiliates to create a unified mental health resource system.
• Advocate for licensing reforms to eliminate the fear many physicians face when seeking care.

“Mental health is not a luxury. It is a necessity,” he said. “Let us be the voice that says, ‘You are not alone.’”

A year of meaningful change

In his closing remarks, Dr. Piccinini returned to his central theme: this year must be about attention, clarity, and connection.

He promised to measure his success not by accolades or status, but by one simple question: Do our members feel more connected to the AOA than they did before?

The AOA, he insisted, must become the trusted, transparent and transformational force it is meant to be.

“If we want to grow stronger as a profession,” he said, “we must build stronger pathways to membership, board certification and advocacy.”

Above all, he asked members for a chance—not just to lead, but also to serve with transparency, humility and conviction.

A new chapter begins

Dr. Piccinini is not merely stepping into a new role—he’s stepping into a moment. A moment that demands connection over command, dialogue over dictation, and healing over hierarchy.

He is a president who listens first in order to lead. Who sees the person behind the professional. Who believes in mending gaps—not just measuring metrics.

With mental health at the forefront, first-generation DOs uplifted, and a renewed commitment to communication, the AOA seems poised to take a transformative leap—one rooted in remembering who we are and why we exist.

And as he concluded his speech—with a light-hearted nod to Snoop Dogg—it was clear that this presidency, while serious in mission, will not forget the value of authenticity and humility.

Let this be the year, he said, that, “we lead like DOs—with our hands, our heads and our hearts.”

Related reading:

ER meets IRL: How one DO is making medicine more human

Osteopathic medicine highlighted in recent New York Times article