Osteopathic Medical Education: Osteopathic Medical Education: State of the “Union”State of the “Union”

Karen Nichols, DO, MA, FACOI, CSKaren Nichols, DO, MA, FACOI, CSMedical Education Summit II ChairMedical Education Summit II Chair

Medical Education Summit Progress Task Force, Medical Education Summit Progress Task Force, ChairChair

Osteopathic Medical Education Osteopathic Medical Education Conference PresentationConference Presentation

Osteopathic Medical EducationOsteopathic Medical Education(Spheres of Influence)(Spheres of Influence)

SpecialtyColleges’

RESCAACOM(COMS)

AOA EducationDivisions

Residency StandardsAnd Program Approvals

UME Admission, Curriculum And“Pipeline Issues”

OPTI AdministrationAnd Oversight

Bureau of Education

COPTPTRC

COPTI

COCA

The VisionThe Vision

To have a proactive on-going “think tank” on medical education involving all the osteopathic profession stakeholders.

The PlanThe Plan

Series of sessions 5 over 10-14 years MES I – January, 2006

Global Medical Education Issues MES II – November, 2007

Osteopathic Graduate Medical Education

Successes Successes

Analyze the relevance of the Analyze the relevance of the osteopathic internship for OGMEosteopathic internship for OGME

Restructured the osteopathic internship Restructured the osteopathic internship July 2008 July 2008

SuccessesSuccesses

Enforce “Opportunities” and Enforce “Opportunities” and TIVRA reportingTIVRA reporting

COPT imposed penalties in 2007 for COPT imposed penalties in 2007 for incomplete or non-completion of TIVRA and incomplete or non-completion of TIVRA and OPPORTUNITIESOPPORTUNITIES

SuccessesSuccesses

Revise and enhance GME Revise and enhance GME standards standards

COPTI and COPT have extensively revised COPTI and COPT have extensively revised the OPTI standards.the OPTI standards.

PTRC and COPT have extensively revised PTRC and COPT have extensively revised specialty college standards.specialty college standards.

Innovative programs Innovative programs ORCA project ORCA project Promote rapid approval processes for programs Promote rapid approval processes for programs

without compromising GME quality standards.without compromising GME quality standards.

SuccessesSuccesses

Remove barriers and streamline the Remove barriers and streamline the OGME accreditation processesOGME accreditation processes

PTRC PTRC new administrative process new administrative process April 2007 April 2007

SuccessesSuccesses

AACOM and AOA with state societies AACOM and AOA with state societies should lobby to ease federal UME loan should lobby to ease federal UME loan restrictionsrestrictions

AOA supports legislation AOA supports legislation Student loan deferment legislation (HR 2583)Student loan deferment legislation (HR 2583)

AOA supports PHS loan forgiveness or AOA supports PHS loan forgiveness or payback incentives for UME traineespayback incentives for UME trainees

SuccessesSuccesses

Promote mentoring and Promote mentoring and professionalism competency programs professionalism competency programs in UME curriculum in UME curriculum

AACOM has multiple programingAACOM has multiple programing The AOA OME conference has significant The AOA OME conference has significant

programmingprogramming

SuccessesSuccesses

Increase Medicare CMS funding for GME Increase Medicare CMS funding for GME The AOA has testified before the Senate The AOA has testified before the Senate

committees on workforce and GME funding committees on workforce and GME funding issuesissues

Many advocacy initiatives in placeMany advocacy initiatives in place The AOA and AACOM have a representative on The AOA and AACOM have a representative on

the COGME the COGME COGME lobbies for increases in CMS and other funding COGME lobbies for increases in CMS and other funding

for GME for GME

SuccessesSuccesses

Dual and parallel GME/OGME training Dual and parallel GME/OGME training programs should be studied and programs should be studied and policies developed to maximize policies developed to maximize OGME positions. OGME positions.

A ‘white paper’ A ‘white paper’ Completed and updatedCompleted and updated

SuccessesSuccesses

Increase the number of OGME Increase the number of OGME programs and funded FTEs programs and funded FTEs

The AOA OGME Development Initiative The AOA OGME Development Initiative Michael Murphy, DO, ChairMichael Murphy, DO, Chair Four new hospitals in the pipelineFour new hospitals in the pipeline

Not all issues addressedNot all issues addressed

Osteopathic Graduate Medical Osteopathic Graduate Medical EducationEducation

On to……On to……

Medical Education Summit II

“ Framing the Future”November 10-12, 2007

The Problem:The Problem: HHS/HRSAHHS/HRSA

““ Physician Supply/Demand: Projections Physician Supply/Demand: Projections 2020”2020”

AAMC/Center for Workforce StudiesAAMC/Center for Workforce Studies Edward Salsberg, DirectorEdward Salsberg, Director ““ The State of the Physician Workforce”The State of the Physician Workforce”

L.Davis Institute/Health Care Econ., U. L.Davis Institute/Health Care Econ., U. Penn Richard Cooper, MDPenn Richard Cooper, MD

““ I t ’s Time to Address the Problem of I t ’s Time to Address the Problem of Physician Shortages: Grad Med Ed is Physician Shortages: Grad Med Ed is the Key”the Key”

How we got here:How we got here: Downward Pressure on SupplyDownward Pressure on Supply

Medical SchoolsMedical Schools Graduate Medical EducationGraduate Medical Education Downward Trend of Physician Work Downward Trend of Physician Work

EffortEffort

Genesis of the Problem:Failure to Sustain Growth in GME

0

5,000

10,000

15,000

20,000

25,000

1950 1960 1970 1980 1990 2000

Total PGY-1 (ACGME + AOA)

MD Graduates

IMGs in PGY-1

DO Graduates

BBA of 1996

MD Schools, 1980

Source: Richard Cooper, MD

Nor even will increasing residency positions by 10,000over ten years starting in 2010

200

250

300

350

400

1980 1990 2000 2010 2020

Year

Phy

sici

ans

per

100,

000

of p

opul

atio

n

.

Demand

Supply

+1,000/year 2010-2020

No change

Source: Richard Cooper, MD

…and the gap will continue for decades.

200

250

300

350

400

1980 1990 2000 2010 2020 2030 2040 2050

Year

Phy

sici

ans

per

100,

000

of p

opul

atio

n

.

Demand

Supply

+1,000/year 2010-2020

No change

Source: Richard Cooper, MD

19801980 17000 med students17000 med students MD 91%MD 91% DO 9% (1500)DO 9% (1500)

2012-132012-13 24974 med students24974 med students MD 79%MD 79% DO 21% (5227)DO 21% (5227)

“… “… an increase in allopathic medical an increase in allopathic medical school graduates will almost certainly school graduates will almost certainly mean that mean that fewer graduates of fewer graduates of osteopathic medical schoolsosteopathic medical schools and and non-US schools non-US schools wil l be accepted wil l be accepted into residency training programs.”into residency training programs.”Michael Whitcomb, Acad Med, 82, #9, Sept 2007, pp. 825-6Michael Whitcomb, Acad Med, 82, #9, Sept 2007, pp. 825-6

GlobalIssues

How do we ensure that osteopathic graduate medical education maintains the essence of what makes it

osteopathic?

MD’s should take DO residencies

Resources/Structure

How do we ensure that there are sufficient resourcesand an appropriate structure for the graduate

medical education needs of osteopathicmedical students?

OGME slot for every UME grad

Specialty Mix

How do we approach the issues of specialty mix?

Specific goal per specialty

Structural Overview

1. Understanding ourselves Studying the definit ion of “osteopathic”

graduate medical education Referred to Osteopathic History/Identity Committee

Identifying what we do best and reformulating OGME based upon the societal needs of the 21st century

360 degree study RFP being prepared

Structural Overview

2. Improving infrastructure Improve quali ty

2 pilot surveys Newly graduated MS IV students in Ohio Being assessed for the broader audience

Enhancing and enforcing standards Improving the inspection process Improving the internal processes Enhancing the educational structure

Analysis in process COPT Subcommittee AODME BOSS – presentation at next meeting

Structural Overview

2. Improving infrastructure Improving the OPTI concept and

implementation 360 degree study RFP being prepared

Structural Overview (continued)

3. Improving support for OGME Promoting clinical and education research

Referred to Research Bureau Advocating for increased funding for OGME

Ongoing Advocacy

Structural Overview (continued)

4. Dealing with three special issues Studying admitt ing MD’s into DO

residencies BOE subcommittee Ken Johnson DO, Chair Survey in process

The proper approach to OGME capacity (related to UME/OGME collaboration)

AACOM/AOA Statement of Principles Dealing with the issues in primary care,

including mid-level providers Working with ACOFP, ACOI, ACOP

Oversight and Follow-up:Medical Education Summit Progress Task Force

PresentationsPublicationsReport to AACOM, AOA, OHFSuccession Plan

The “Real” Outcomes1. Getting all the stakeholders in the same room.

The “Real” Outcomes1. Getting all the stakeholders in the same room.2. Developing the data repository.

The “Real” Outcomes1. Getting all the stakeholders in the same room.2. Developing the data repository. 3. Creating a process for dialogue/interaction/follow-up.

The “Real” Outcomes1. Getting all the stakeholders in the same room.2. Developing the data repository. 3. Creating a process for dialogue/interaction/followup.

4. Developing a joint Statement of Principles about osteopathic medical education.

Where do we go from here?

Where do we go from here?Medical Education Summit III

“Think out 25 years. What does the profession look like in 2032 after we made good decisions at these summits?”

Anonymous

“If you keep doing what you are doing, you will keep getting what you got.”

Yogi Berra

“Choose change before change choose you.”

Anonymous

Osteopathic Medical Education: Osteopathic Medical Education: State of the “Union”State of the “Union”

Karen Nichols, DO, MA, FACOI, CSKaren Nichols, DO, MA, FACOI, CSMedical Education Summit II ChairMedical Education Summit II Chair

Medical Education Summit Progress Task Force, Medical Education Summit Progress Task Force, ChairChair

Osteopathic Medical Education Osteopathic Medical Education Conference PresentationConference Presentation