Found this today, we have some supporters in state chapters, now the question is how do we leverage this to our benifit.
CHICAGO -- The American Osteopathic Association's House of Delegates weighed in at its annual meeting on a number of hot topics in medicine, including medical liability reform, the use of placebos in end-of-life care, and a proposal for a joint match with allopathic residency candidates.
The group debated whether to pursue some type of collaborative process to match both osteopathic and allopathic residency positions at the same time.
With opinions divided, the AOA House of Delegates voted to send the resolution back to the drawing board.
But the issue is unlikely to go away, said Dr. Karen J. Nichols, a member of the AOA board of trustees and dean of the Chicago College of Osteopathic Medicine. In fact, AOA has already been studying the match process and has had discussions with the National Resident Match Program (NRMP), which administers both the allopathic and osteopathic matches, she said.
A possibility discussed at the meeting was a collaborative process in which osteopathic students would participate in the same Match Day as allopathic students but osteopathic students would be given priority to match with osteopathic programs.
The concept of a unified match was also introduced by the California delegation at the American Medical Association's House of Delegates meeting in June. The proposal, which was part of a larger effort to reform the NRMP process, was sent back to the AMA board of trustees for further review and a report is expected next year.
Osteopathic programs and students are disadvantaged by the current two-match system, said Dr. Bruce P. Bates, president of the Maine Osteopathic Association and chair of family practice at the University of New England College of Osteopathic Medicine.
Some students are skipping the osteopathic match and many dually accredited programs may not offer all of their available positions to osteopathic students due to the separate nature of the match, he said.
Currently, there are two matches--one for allopathic residency slots that takes place in March and one for osteopathic residencies at the end of January.
Osteopathic students can choose to participate in the osteopathic match, but if they match to a program they cannot go through the allopathic match. However, if they fail to match, they can choose to participate in the allopathic match.
AOA should work with the NRMP to design a collaborative process that maximizes the opportunity for osteopathic students and osteopathically approved programs to preferentially match with each other, Dr. Bates said.
"Whether we like it or not our profession has grown so large that we need to expand training opportunities to our students," he said.
But some of the resident delegates at the meeting disagreed. Dr. Lilibeth C. Sanchez, a general surgeon in New Mexico and a recent resident, said that a collaborative match would not help osteopathic students or the profession in general.
She estimated that about half of student DOs are already choosing to participate in the allopathic match, and a joint match would only serve to increase the number of osteopathic students in allopathic residencies.
Instead of working on designing a collaborative match, AOA's focus should be on improving the osteopathic intern and residency programs available by increasing options geographically and within specialties, Dr. Sanchez said at the meeting.
There's no need for a combined match, said Dr. Kasey Nelson, a resident in emergency medicine at Michigan State University, East Lansing, and a recent participant in the match. Today, osteopathic students have access to both matches, making all positions open to osteopathic students, he said.
In other action at the meeting, the House of Delegates voted to partner with other groups, such as the American Medical Association, to explore additional reform options to decrease the frequency and severity of medical liability claims including arbitration, prelitigation panels, and insurance reform.
"We have agreed that collaboration is the way to go," said Dr. Darryl Beehler, immediate past president of the AOA.
They will also work on getting their patients involved in urging reform, commented Dr. Kevin V. de Regnier, a family physician from Iowa. "It's ultimately about the patients."
The group also voted to tackle problems in Medicare physician payment. AOA delegates voted to work with the Centers for Medicare and Medicaid Services, Congress, and the Medicare Payment Advisory Commission to reform the Medicare physician reimbursement formula.
They plan to pursue a long-term fix to the sustainable growth rate formula that has resulted in cuts to physician payments in recent years.
The House of Delegates also voted to support federal legislation that would give patients more avenues to sue HMOs. The group voted to support reforms to the Employee Retirement Income Security Act of 1974 to ensure that patients are able to sue in state court.
A recent Supreme Court decision (Davila v. Aetna U.S. Healthcare et al.) denies patients the right to sue self-insured health plans in state courts and instead grants jurisdiction to federal courts where the patient can only be awarded the value of the benefits denied.
But Dr. Robert S. Maurer, a family physician in New Jersey, said he sees a conflict in calling on Congress to limit lawsuits against physicians through medical liability reform legislation but at the same time urging more legal avenues to sue HMOs.
The House of Delegates also addressed clinical issues such as the use of placebos and musculoskeletal research. The group issued a white paper that comes out against the use of placebos in pain assessment at the end of life. The use of placebos in place of effective pain medication is unethical, ineffective, and potentially harmful, according to the white paper. The only circumstance when it is appropriate to use placebos is in an approved clinical research study in which the participant is informed on the use of placebo, according to the new AOA document.
BY MARY ELLEN SCHNEIDER
Senior Writer
