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