Dean's Update 2021-11-15

November 15, 2021

As the dean of one of the nation’s most prominent osteopathic medical colleges, my role is to advocate for greater parity and opportunities for osteopathic medical students and physicians. At the recent annual American Association of Colleges of Osteopathic Medicine (AACOM) Advocacy Day, members of our College of Osteopathic Medicine executive leadership team—including myself, Dr. Kirsten Waarala, and Dr. Katie Ruger, along with our SOMA President Briana Cervantes (OMS-II)—advocated on behalf of osteopathic medical education during meetings and panel discussions with government officials.

Driven by the AACOM mantra that “the consequences of federal policy that affect osteopathic medical education cannot be ignored,” we surfaced issues that impact all osteopathic medical schools with the offices of several members of Congress, including Michigan Senators Debbie Stabenow and Gary Peters, and U.S. Representatives Elissa Slotkin (MI-8) and Haley Stevens (MI-11).

Significant professional obstacles

While the discussions went well and we made our voices heard, what was striking to me were the significant professional obstacles we continue to face as osteopathic physicians, and how these obstacles plague our profession in several ways that may not be immediately obvious.

For example, one topic of discussion was the need to increase the rural physician workforce by raising the caps on the number of Medicare-funded graduate medical education (GME) positions in rural areas. (Our Statewide Campus System currently has two members in rural areas, Mercy Health in Muskegon and Munson Medical Center in Traverse City, representing a total of 74 residents.) Practicing in underserved rural areas has always been important for osteopathic physicians, so this topic is particularly germane.

More specifically, we also recommended improved parity of GME opportunities overall to DOs, since multiple federally funded GME residency programs continue to outright exclude DOs or impose discriminatory practices against DOs seeking training in these programs. Strikingly, AACOM reports that up to 20 percent of medical GME programs will not accept DO graduates, or they impose costly and burdensome requirements for DO participation, such as mandating that DOs take the USMLE despite the fact that all DO students have already taken the COMLEX-USA exams. The AOA is also suing the American Board of Internal Medicine, which pushes programs to seek ABIM-certified physicians as residency program directors, essentially disenfranchising physicians who are certified by the American Osteopathic Board of Internal Medicine to serve in such roles.

During our discussions, we emphasized that taxpayer-funded GME programs should not be allowed to continue to professionally discriminate against DOs in any way, shape or form. Moreover, these tactics are not congruent with state licensing requirements, and they also exacerbate physician shortages and limit access to training for DOs. Investigating this further, the website The DO recently listed some of the residency programs that had been conducting these sorts of discriminatory practices until advocacy efforts by the AOA corrected them. The DO also noted several other discriminatory practices that target our profession, including examples of offensive advertising and media misrepresentations of what we do. (I previously wrote a piece concerning the latter in response to media attacks on our profession.)

Another topic we touched upon during our Advocacy Day discussions was the disparity in National Institutes of Health (NIH) funding that colleges of osteopathic medicine receive relative to our allopathic counterparts. While MSUCOM leads all osteopathic medical schools in research output and support, including NIH funding, this is not enough to address the lack of NIH funding that our nation’s osteopathic medical schools receive as a whole. While some may suggest this is due to the profession’s lack of desire to conduct research, I would counter this notion by pointing out that for the better part of the 20th century, osteopathic physicians were actively denied entry into many, if not most, academic medical centers—the same centers where most of the NIH-funded research and training programs currently reside. Couple this decades-long discriminatory practice with the osteopathic profession’s foundational desire to train primary care physicians to serve in rural and underserved areas of the nation, and we begin to understand the scope of the long-standing problem. For example, it has often been noted that primary care specialties in general have great difficulty in receiving NIH funding, let alone osteopathic medical schools in particular.

Additional constraints that primary care-focused specialties might face include “potential NIH biases against generalist inquiry, and the makeup of review committees.” Regarding the review panels, investigators are typically required be a past recipient of NIH funding before they are invited to participate, so one can see how this catch-22 set of circumstances is perpetuated over time.

Our recommendations to policymakers

Personally, I feel that many contemporary medical problems our society faces may only be overcome with the active involvement of osteopathic primary care researchers and their unique understanding of health preservation and wellness. As part of our Advocacy Day efforts, we suggested that NIH establish a research fund, targeting principal investigators employed by colleges of osteopathic medicine, who will conduct research to help address health disparities in rural and underserved populations, and advancing treatments in primary care.

We also strongly suggested the prioritization of research focused upon the tenets of osteopathic philosophy, including osteopathic manipulative treatment, as well as increasing DO representation on NIH National Advisory Councils and study sections to bolster NIH support of DO researchers. [EDIT:  We are thrilled to see that as a direct result of our advocacy efforts, AACOM secured language in the Explanatory Statement of the Senate FY22 Labor, Health and Human Services, Education and Related Agencies spending bill urging the NIH to report on the status of NIH funding to COMs and the representation of DOs on NIH National Advisory Councils and study sections.]  To that end, our college’s recent application for an NIH grant to support our long-standing DO-PhD training program is attempting to further address this situation.

We welcome and encourage your involvement in our osteopathic advocacy efforts, either on behalf of the college or the greater osteopathic profession. To get started, you might visit AACOM’s action center. Meanwhile, wish us luck!

Andy Amalfitano