Dear Mr. Crosby:
I am writing to you to urge the AOA to take immediate action in the interest of the profession. As a practicing osteopathic physician for over 20 years and a former AOA health policy fellow, it is clear to me that osteopathic medicine in the Untied States is in serious jeopardy and, unless we act now, it will not survive the upcoming challenges to the American health care system.
The recent initiative by Ms. Pletz at KCUMB is a poignant illustration of how close we are to a precipice that, if crossed, may end my profession. Although the issuance of a combined DO/MD degree at a single institution would set a dangerous precedent, the issues identified by Ms. Pletz are nevertheless real and should not be discounted.
COCA and the AOA, through its silence, have allowed irresponsible growth of osteopathic medical education without adequate clinical training at either the undergraduate or postgraduate levels. While allopathic schools hesitate to increase class sizes by 10% over 5 year periods, some osteopathic colleges have increased enrollment by more than 50% over one year in areas where there is a paucity of existing clerkship opportunities. Osteopathic colleges have opened numerous branch campuses, at high levels of enrollment, while barely graduating inaugural classes from the home schools. COCA accredited the first for-profit medical school in the United States in nearly a century without well-publicized and open debate and without a clearly defined rationale for the economic model. Putting aside Rocky Vista University, there is no credible for-profit medical school in the industrialized world. The vast majority of osteopathic graduates enter ACGME residency training, but there is no organized mechanism for them to return to the profession as program directors, DMEs and deans, thus perpetuating the vicious cycle of ever decreasing OGME opportunities. Category 1 osteopathic CME is so restrictive in design that is a constant source of difficulty and frequently cited as yet another reason for our graduates to leave the organized profession. Concurrently, the AAMC has called for a 30% increase in allopathic class sizes, clerkship opportunities are limited or bought and paid-for by third-world for-profits and CMS has not increased funding for residency training beyond 1997 levels. Ore economy is in its worst condition since the Great Depression and political health care reform proposals continue to limit reimbursement, decrease services and limit technology and innovation as the number of ill and elderly climb to record levels. We are fixated on primary care to the exclusion of specialties, while nurses, technician and other allied health professionals deliver the same care without well-demonstrated differences in morbidity and mortality.
Quite simply, Mr. Crosby, this profession is at crisis point. If we do not act to address these threats, then surely the US Department of Education will. Patient lives are at stake and it will only take one osteopathic Libby Zion to bring down the house of cards. I am well aware the COCA is an independent body, not controlled by the AOA, however, as you said yourself, the AOA can testify and set forth its opinion to COCA and the leadership of the AOA can use their bully pulpit to advocate for the necessary measures to protect the profession and the patients for whom we care. Surely the testimony of the AOA president and Board of Deans carries more weight than the testimony of a lone ACGME trained anesthesiologist. It should also be noted that the AOA appoints the members of COCA, so the organizations are separate, but related.
The following steps should be taken immediately:
1. A moratorium on any new osteopathic schools, branch campuses or expansion of class sizes.
2. A review of COCA standards and comparative study of LCME equivalents.
3. A prohibition of for-profit schools, including existing schools.
4. A review of all osteopathic undergraduate and graduate clinical education for standard and quality of teaching.
5. A rationalization (decrease) of class sizes in accordance with #4, above.
6. An accommodation in COCA standards, so that osteopathic physicians certified by the ACGME can serve as AOA residency program directors, DMEs and deans.
7. Acceptance of AMA CME as equivalent to AOA.
8. Development of endowment funding to increase OGME opportunities.
9. A prohibition of joint DO/MD degrees.
Mr. Crosby, I urge you and the AOA to act on this with all deliberate speed. Our profession has distinguished itself since the days of Andrew Taylor Still as offering patients a better philosophy and practice of health care. The benefit we offer to our patients has facilitated the acceptance and growth of our profession against overwhelming odds. The disappearance of osteopathic medicine would be a tragedy. Please, stand for what is ethical, stand for what is right, stand for our patients and stand for our uniquely American practice of care. If we do not police the profession, surely someone else will.
Fraternally yours,
George Mychaskiw II, DO, FAAP, FACOP
Professor and Chair, Department of Anesthesiology
Drexel University College of Medicine
