There are two issues currently in the process of implementation at the AOA that have come to our attention. The OCA Board feels that both these issues, each in their own way, may pose an existential threat to the future of osteopathy. If you have similar concerns, we urge you to contact the AOA with your input.
Issue #1: Requiring Presenters Be Board Certified to Qualify for Category 1A CME
This is a formal proposal to be considered by the Board of Trustees and comments on this proposal are open until Dec 19. Please send your comments to Vbhala@osteopathic.org. You are free to use any of these points in your comments to the AOA, and we encourage you to adapt them to fit your own personal perspective.
In Appendix D of the AOA’s CME Guide for Osteopathic Physicians – 2019-2021 the following is proposed policy for categorizing different levels of CME (see p. 21 here). In part, it says
“In order to be deemed acceptable as Category 1-A or 2-A CME, all educational content must be presented by an AOA or ABMS board certified physician. The BOS recognizes that some topics may be appropriately presented by other qualified professionals (e.g. licensed psychologist, physical therapist, etc.). Therefore, CME lectures may also qualify for Category 1-A or 2-A credit if presented by an individual who meets one or more of the criteria listed below: …
2) Non-physician presenters – non-physician presenters should have reached the appropriate terminal degree in the field for which they are presenting in order to receive Category 1-A or 2-A CME credit. …”
Some of our objections to the proposed policy include:
- The policy as written creates the perverse situation where in chiropractors (DC) and physical therapists (DPT) with “terminal degrees” would qualify to teach manual manipulation for 1A credit, but non-boarded DOs with many years of clinical osteopathic experience would not qualify for 1A credit.
- Many of our senior physicians trained under the paradigm of traditional rotating internship, then straight into general practice. This discriminatory policy diminishes the valuable and seasoned clinical practice and didactic expertise of these educators. More than many other areas of medicine, the highest level of clinical and teaching expertise in OMM exists in our most senior physicians.
- These requirements for Category 1-A credit are more stringent than those imposed by ABMS organizations (e.g., AAFP), thereby creating yet another incentive for young physicians to do their Board certifications through ABMS specialty societies rather than through AOA specialty societies. Creating these adverse incentives does not bode well for the future of osteopathic medicine as a distinct and separate discipline.
- This policy hinders the ability of Osteopathic Cranial Academy, as well as other providers (e.g., state societies, other component societies) to continue providing the highest quality hands-on training, as many of our senior faculty (and best teachers) do not have current board certification.
- This policy lands heaviest on AOBNMM-boarded physicians, as they have higher requirements of 1A-level CME than other specialties (see pp 4-5 here)
- Entering an era of voluntary AOA membership, it is foolish to create “second class citizens” of many of the AOA’s natural constituency.
- Osteopathic manipulation is the most important differentiator between DOs and MDs, and is more and more valued by the public as a part of their health care. These requirements would gut the profession’s ability to continue to teach, develop, and advance high quality OMM skills in our students and our doctors.
- This proposal is not about maintaining standards, in fact it does just the opposite by pushing students to study with lesser-trained and/or lesser-experienced teachers.
In addition to sending comments to Vikas Bhala, Director, AOA Bureau of Osteopathic Specialists at Vbhala@osteopathic.org (312-202-7191), you may want to send a copy to Dr. Dan Williams, VP of AOA Certifying Board Services at email@example.com. In addition, you can reach out to everyone you know involved with AOA leadership, our specialty organizations, and state societies. It is especially important to advocate with state societies and specialty organizations as they all send voting members to the AOA House of Delegates and have significant influence on the AOA Board of Trustees, who will receive the public commentary.
Please make all commentary professional and constructive given the delicate phase were are in with the progressing ACGME single pathway. The profession is under a microscope and it is up to us to maintain the osteopathy within the osteopathic medical profession.
This is a sample letter sent to BOS by Dr. Daniel Shadoan, Immediate Past President of the OCA
Issue #2: Removing Osteopathy from Specialty Board Certification Tests
The second is a change being quietly implemented to implement a pathway system for many of the AOA board certifications that would make optional the inclusion and testing on osteopathic philosophy and principles as well as osteopathic manipulative medicine on AOA specialty boards.
The AOA has not made members or component societies aware of this proposed change, announced the policy change, nor opened up a period of discussion, but individuals involved at several levels have confirmed that these changes are in the works. AOA needs to know many people care about this. Your best line of communication is to email the VP of certifying board services at firstname.lastname@example.org
Our concerns include:
- Osteopathic recognition in a residency should mean that the graduates are osteopathic. Making board certification based solely on specialty-specific knowledge negates any value from having osteopathic recognition.
- MDs are clamoring for training in osteopathic manipulation (OMT) as well as osteopathic principles (OPP). Making osteopathic knowledge optional in these residencies means that GME programs will feel less compulsion to invest in high-quality OMT training. MDs in osteopathically recognized residencies should have no problem passing board exams with osteopathic content given appropriate post-graduate training.
- The general public is demanding greater access to OMT, as well as doctors who approach care holistically, following osteopathic principles. They will, and should, rightly expect that a specialist graduating from a residency with “osteopathic recognition” will in fact have osteopathic training.