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Continued...
August 2003 ? Volume 42 ? Number 2
Education/Residents ' Perspective
Osteopathic physicians in emergency medicine
Joseph A Pollard, DO [MEDLINE LOOKUP]
Eric A Leveque, DO [MEDLINE LOOKUP]
Matthew R Lewin, MD, PhD [MEDLINE LOOKUP]
Fresno, CA
Despite the risk of not matching in the allopathic postgraduate pathway, nearly half (45.9%) of all osteopathic medical college graduates did not register to participate in the 2002 osteopathic match.14,15 Furthermore, in the 2001 to 2002 osteopathic interns match program, approximately 35% of 1,989 funded positions did not fill.15 To our knowledge, the reasons for this have not been closely examined in the academic literature until recently.15
A difficult issue that osteopathic students may face is the decision to take the United States Medical Licensing Examination in addition to the College of Osteopathic Medicine Licensing Examination, which is the equivalent examination for osteopathic trainees. A student performing very well in his or her respective osteopathic medical college may wish to have an objective demonstration of academic accomplishment that can be directly compared with that of an allopathic graduate. Yet, by taking an additional examination, that student is risking nullification of academic accomplishments in the osteopathic system that might have been adequate to gain admission to an allopathic emergency medicine program. Allopathic emergency medicine residency directors may hesitate to invite an applicant without United States Medical Licensing Examination data.
Another issue that may perplex osteopathic students and residency directors is AOA approval of ACGME-approved programs. In order to practice in several states (OK, FL, MI, WV, and PA), an osteopathic physician must have completed an AOA-approved internship.16 Furthermore, the American Osteopathic Board of Emergency Medicine (AOBEM) requires an AOA-approved internship year for board certification.17 Osteopathic physicians accepted to ACGME-approved residency may apply to the AOA to have their internship year approved. There are no charges or fees for the approval process and virtually automatic approval is given to residents fulfilling military or public health service obligations. In addition, the AOA will consider any resident with a ?special? circumstance such as family location and disability. Because of the decreasing number of funded internships and the increasing number of osteopathic graduates, the AOA passed Resolution 42, which took effect in July 2001.18 Resolution 42's purpose is to streamline the application process and ?broaden what can be considered a special circumstance? for AOA approval of an allopathic internship. Until recently, osteopathic medical graduates wanting to practice emergency medicine in one of the aforementioned states, or any graduate planning to hold a faculty position at an osteopathic medical college, had to weigh doing an AOA-approved internship into the residency training decision. The reason for this is that many allopathic emergency medicine residencies do not offer an intern year that is considered broad enough to fulfill the requirements of AOA internship requirement.15
Another related issue is that of CMS funding. If an osteopathic graduate completes an AOA-approved internship and then matriculates into an osteopathic emergency medicine residency program, CMS will fund all 3 years of the emergency medicine residency. If the osteopathic graduate, after completing an AOA-approved internship, matriculates into an allopathic emergency medicine residency program, then CMS will not fund all 3 years of the residency. The rationale for this is the American Medical Association and the American Board of Emergency Medicine (ABEM) do not require separate internships for emergency medicine, and these residents should not receive the additional funding. This forces allopathic programs to provide their own funding for osteopathic residents, for one year, if they plan to complete an osteopathic internship.16
The American College of Osteopathic Emergency Physicians (ACOEP), which was founded in 1975, oversees and accredits osteopathic emergency medicine residencies and fellowships in emergency medical services, and jointly accredits combined programs. In addition, ACOEP provides continuing education opportunities, including conferences, review courses, and a review oral board course. Although allopathic physicians can join ACOEP as associate members, they cannot obtain active membership.7,19 In contrast, osteopathic residents completing AOA-approved training may obtain active status in the American College of Emergency Physicians (ACEP). AOBEM provides board certification for osteopathic physicians.
AOBEM administered its first certification examination in 1980. Recertification is required every 10 years for osteopathic emergency physicians who are granted board certification after January 1, 1994. In addition, AOBEM provides certification for osteopathic physicians completing fellowships in toxicology, emergency medical services, and sports medicine.17
Doctors of osteopathy who complete at least 36 months of ACGME-approved emergency medicine may qualify to be certified by ABEM. However, ABEM does not recognize AOA-approved residency training not already recognized by ACGME.20
Despite their nearly parallel evolution, there is little overlap between national organizations governing the emergency medicine practiced by doctors of osteopathy and doctors of medicine. For example, in December 2002, only one doctor of osteopathy was on the board of directors of ACEP (Table).
--------------------------------------------------------------------------------
Table. Census data for national emergency medicine organizations comparing the numbers of doctors of osteopathy to doctors of medicine in each. The last column shows the number of board members of major allopathic emergency medicine organizations who are doctors of osteopathy and the number of board members of major osteopathic emergency medicine organizations who are doctors of medicine.*
--------------------------------------------------------------------------------
Organization Membership (DO+MD) DOs, No. (%) MDs, No. (%) Current Board Members With the Opposite Degree?
ACOEP 1,726 1,726 (100) 0? 0
FACOEP 319 319 (100) 0
AOBEM 1,188 1,188 (100) 0 0
SAEM 5,321 468 (8.8) 4,853 (91.2) 0
AAEM 3,233 45 (1.4) 3,188 (98.6) 0
ACEP 21,989 2,137 (9.7) 18,430 (84) 1
FACEP 8,582 750 (8.7) 7,832 (91.2)
ABEM 19,174 1,068 (5.5) 18,106 (94.4) 0
EMRA 3,570 484 (13.5) 3,042 (85.2) 0?
DO, Doctor of osteopathic medicine; MD, doctor of medicine; FACOEP, Fellow of the American College of Osteopathic Emergency Physicians; SAEM, Society for Academic Emergency Medicine; AAEM, American Academy of Emergency Medicine; FACEP, Fellow of the American College of Emergency Physicians.
*Membership data as of February 5, 2003. Some totals may not equal 100% because of members with ambiguous affiliation.
?For example, MD instead of DO.
?MDs are not allowed full membership. However, there are 41 ?associate members.?
?There have been 3 DOs who served as EMRA president and 1 EMRA president-elect who died before entering office. Eleven DOs, not including these presidents, have served on the EMRA board of directors.
--------------------------------------------------------------------------------
Other than this individual, we were unable to identify any doctors of osteopathy on the editorial board of any major emergency medicine journal or organization (eg, the Society for Academic Emergency Medicine, AAEM). Similarly, we were unable to identify any doctors of medicine in leadership positions in any national doctor of osteopathy organization or journal (eg, AOBEM or Journal of the American Osteopathic Association).
Of ACEP's more than 21,000 members, approximately 10% are osteopathic physicians. Osteopathic physicians contribute in leadership roles on both the state and national level. In 2001, ACEP presented Douglas M. Hill, DO, with the James D. Mills award for his outstanding contributions to emergency medicine. Dr. Hill was also the first osteopathic physician to sit on the ACEP board of directors.21 Currently, Robert E. Suter, DO, MHA, sits on the ACEP board of directors.22 To date, there have been 11 doctors of osteopathy who have served on the Emergency Medicine Residents Association (EMRA) Board of Directors and 3 past presidents. One doctor of osteopathy who was elected president of EMRA died before entering office.
Osteopathic medical students and residents face unique challenges in choosing their course of postgraduate training compared with their allopathic-trained counterparts. Decisions about the matches are complicated by risky examination-taking strategies and applying to allopathic emergency medicine training at the risk of not matching in either an osteopathic or allopathic program. In addition, the osteopathic education system produces more graduates than it can accommodate in postgraduate training. Thus, a better understanding of the origins and organization of osteopathic training may help students, residents, and administrators make more informed decisions about their options for emergency medicine training and its trainees.
August 2003 ? Volume 42 ? Number 2
Education/Residents ' Perspective
Osteopathic physicians in emergency medicine
Joseph A Pollard, DO [MEDLINE LOOKUP]
Eric A Leveque, DO [MEDLINE LOOKUP]
Matthew R Lewin, MD, PhD [MEDLINE LOOKUP]
Fresno, CA
Despite the risk of not matching in the allopathic postgraduate pathway, nearly half (45.9%) of all osteopathic medical college graduates did not register to participate in the 2002 osteopathic match.14,15 Furthermore, in the 2001 to 2002 osteopathic interns match program, approximately 35% of 1,989 funded positions did not fill.15 To our knowledge, the reasons for this have not been closely examined in the academic literature until recently.15
A difficult issue that osteopathic students may face is the decision to take the United States Medical Licensing Examination in addition to the College of Osteopathic Medicine Licensing Examination, which is the equivalent examination for osteopathic trainees. A student performing very well in his or her respective osteopathic medical college may wish to have an objective demonstration of academic accomplishment that can be directly compared with that of an allopathic graduate. Yet, by taking an additional examination, that student is risking nullification of academic accomplishments in the osteopathic system that might have been adequate to gain admission to an allopathic emergency medicine program. Allopathic emergency medicine residency directors may hesitate to invite an applicant without United States Medical Licensing Examination data.
Another issue that may perplex osteopathic students and residency directors is AOA approval of ACGME-approved programs. In order to practice in several states (OK, FL, MI, WV, and PA), an osteopathic physician must have completed an AOA-approved internship.16 Furthermore, the American Osteopathic Board of Emergency Medicine (AOBEM) requires an AOA-approved internship year for board certification.17 Osteopathic physicians accepted to ACGME-approved residency may apply to the AOA to have their internship year approved. There are no charges or fees for the approval process and virtually automatic approval is given to residents fulfilling military or public health service obligations. In addition, the AOA will consider any resident with a ?special? circumstance such as family location and disability. Because of the decreasing number of funded internships and the increasing number of osteopathic graduates, the AOA passed Resolution 42, which took effect in July 2001.18 Resolution 42's purpose is to streamline the application process and ?broaden what can be considered a special circumstance? for AOA approval of an allopathic internship. Until recently, osteopathic medical graduates wanting to practice emergency medicine in one of the aforementioned states, or any graduate planning to hold a faculty position at an osteopathic medical college, had to weigh doing an AOA-approved internship into the residency training decision. The reason for this is that many allopathic emergency medicine residencies do not offer an intern year that is considered broad enough to fulfill the requirements of AOA internship requirement.15
Another related issue is that of CMS funding. If an osteopathic graduate completes an AOA-approved internship and then matriculates into an osteopathic emergency medicine residency program, CMS will fund all 3 years of the emergency medicine residency. If the osteopathic graduate, after completing an AOA-approved internship, matriculates into an allopathic emergency medicine residency program, then CMS will not fund all 3 years of the residency. The rationale for this is the American Medical Association and the American Board of Emergency Medicine (ABEM) do not require separate internships for emergency medicine, and these residents should not receive the additional funding. This forces allopathic programs to provide their own funding for osteopathic residents, for one year, if they plan to complete an osteopathic internship.16
The American College of Osteopathic Emergency Physicians (ACOEP), which was founded in 1975, oversees and accredits osteopathic emergency medicine residencies and fellowships in emergency medical services, and jointly accredits combined programs. In addition, ACOEP provides continuing education opportunities, including conferences, review courses, and a review oral board course. Although allopathic physicians can join ACOEP as associate members, they cannot obtain active membership.7,19 In contrast, osteopathic residents completing AOA-approved training may obtain active status in the American College of Emergency Physicians (ACEP). AOBEM provides board certification for osteopathic physicians.
AOBEM administered its first certification examination in 1980. Recertification is required every 10 years for osteopathic emergency physicians who are granted board certification after January 1, 1994. In addition, AOBEM provides certification for osteopathic physicians completing fellowships in toxicology, emergency medical services, and sports medicine.17
Doctors of osteopathy who complete at least 36 months of ACGME-approved emergency medicine may qualify to be certified by ABEM. However, ABEM does not recognize AOA-approved residency training not already recognized by ACGME.20
Despite their nearly parallel evolution, there is little overlap between national organizations governing the emergency medicine practiced by doctors of osteopathy and doctors of medicine. For example, in December 2002, only one doctor of osteopathy was on the board of directors of ACEP (Table).
--------------------------------------------------------------------------------
Table. Census data for national emergency medicine organizations comparing the numbers of doctors of osteopathy to doctors of medicine in each. The last column shows the number of board members of major allopathic emergency medicine organizations who are doctors of osteopathy and the number of board members of major osteopathic emergency medicine organizations who are doctors of medicine.*
--------------------------------------------------------------------------------
Organization Membership (DO+MD) DOs, No. (%) MDs, No. (%) Current Board Members With the Opposite Degree?
ACOEP 1,726 1,726 (100) 0? 0
FACOEP 319 319 (100) 0
AOBEM 1,188 1,188 (100) 0 0
SAEM 5,321 468 (8.8) 4,853 (91.2) 0
AAEM 3,233 45 (1.4) 3,188 (98.6) 0
ACEP 21,989 2,137 (9.7) 18,430 (84) 1
FACEP 8,582 750 (8.7) 7,832 (91.2)
ABEM 19,174 1,068 (5.5) 18,106 (94.4) 0
EMRA 3,570 484 (13.5) 3,042 (85.2) 0?
DO, Doctor of osteopathic medicine; MD, doctor of medicine; FACOEP, Fellow of the American College of Osteopathic Emergency Physicians; SAEM, Society for Academic Emergency Medicine; AAEM, American Academy of Emergency Medicine; FACEP, Fellow of the American College of Emergency Physicians.
*Membership data as of February 5, 2003. Some totals may not equal 100% because of members with ambiguous affiliation.
?For example, MD instead of DO.
?MDs are not allowed full membership. However, there are 41 ?associate members.?
?There have been 3 DOs who served as EMRA president and 1 EMRA president-elect who died before entering office. Eleven DOs, not including these presidents, have served on the EMRA board of directors.
--------------------------------------------------------------------------------
Other than this individual, we were unable to identify any doctors of osteopathy on the editorial board of any major emergency medicine journal or organization (eg, the Society for Academic Emergency Medicine, AAEM). Similarly, we were unable to identify any doctors of medicine in leadership positions in any national doctor of osteopathy organization or journal (eg, AOBEM or Journal of the American Osteopathic Association).
Of ACEP's more than 21,000 members, approximately 10% are osteopathic physicians. Osteopathic physicians contribute in leadership roles on both the state and national level. In 2001, ACEP presented Douglas M. Hill, DO, with the James D. Mills award for his outstanding contributions to emergency medicine. Dr. Hill was also the first osteopathic physician to sit on the ACEP board of directors.21 Currently, Robert E. Suter, DO, MHA, sits on the ACEP board of directors.22 To date, there have been 11 doctors of osteopathy who have served on the Emergency Medicine Residents Association (EMRA) Board of Directors and 3 past presidents. One doctor of osteopathy who was elected president of EMRA died before entering office.
Osteopathic medical students and residents face unique challenges in choosing their course of postgraduate training compared with their allopathic-trained counterparts. Decisions about the matches are complicated by risky examination-taking strategies and applying to allopathic emergency medicine training at the risk of not matching in either an osteopathic or allopathic program. In addition, the osteopathic education system produces more graduates than it can accommodate in postgraduate training. Thus, a better understanding of the origins and organization of osteopathic training may help students, residents, and administrators make more informed decisions about their options for emergency medicine training and its trainees.
