Dean's Update 2022-07

Advocacy for Osteopathic Medicine

During my tenure as dean, advocacy for greater parity and opportunities for our students, as well all osteopathic physicians, have been an important area of my focus.

At the recent annual American Association of Colleges of Osteopathic Medicine (AACOM) Advocacy Day, I was joined by Michigan State University College of Osteopathic Medicine (MSUCOM) students, including National Student Osteopathic Medical Association (SOMA) President Courtney Merlo (OMS-IV) and MSUCOM SOMA President Arman Fotouhi (OMS-II), to advocate on behalf of osteopathic medical education during meetings and panel discussions with a variety of state and federal government officials.

Together, during those meetings, we focused the attention of representatives and senators alike on two major issues currently facing the osteopathic profession – non-biased access to government-funded medical education (GME) residency programs, as well as addressing shortfalls in National Institutes of Health (NIH) funding for osteopathic medical schools.

Medical Residency

Consider for a moment that D.O.s make up more than 25% of physicians graduating in the U.S. today. While the nation faces a physician shortage, graduating osteopathic medical students currently face barriers when being considered for residencies within federally funded GME programs.

Residency training for physicians was consolidated in 2020 under the Accreditation Council for Graduate Medical Education (ACGME), putting graduating D.O.s and M.D.s into a single match system. Both D.O.s and M.D.s compete for the same residency programs nationally, therefore, these programs should ensure fair consideration of residency applications from both D.O.s and M.D.s. This, however, is not always the case, as many times D.O. students must take extraordinary measures when attempting to secure some residencies, including taking both the required Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), as well as the United States Medical Licensing Examination (USMLE), adding both time and expense not experienced by M.D. students.

Merlo, for example, felt compelled to sit for both the COMLEX-USA and USMLE exams because she hopes to stay in southeast Michigan to complete her residency training, where unfortunately in some programs, she said she would not be “overtly considered without those (USMLE) exams.”

“I’m hopeful changes will be made,” Merlo said. “I have a lot of skin in the game as a fourth year (D.O. student) going into the match. I’m very invested in this.”

Indeed, these realities are not only found in Michigan as multiple residency programs nationwide have also been found to have similar practices that place D.O. students in an unfair position, some of which are listed on The DO website.

As can be seen at the AACOM advocacy website, it is disheartening to learn that 36% of all U.S. residency training programs seldom or never interview D.O.s, and one-third of all residency programs impose additional requirements and burdens on D.O. students applying to their programs, as compared to M.D. students similarly applying, such as requiring the USMLE. I can assure you that as a college we continue to advocate for our students and ask if you or your institution participates in GME training programs, consider inquiring as to how D.O. applicants are considered relative to their M.D. counterparts, given these glaring realities nationwide.

NIH Funding

The second issue facing osteopathic medical schools and institutions is an absolute dearth of funding from the National Institutes of Health (NIH). Today, 40% of NIH grants are awarded to allopathic institutions, while colleges of osteopathic medicine receive only 0.1%, as just one example. While we are fortunate at MSU College of Osteopathic Medicine that we do receive the highest levels of NIH funding of all osteopathic medical schools, equity in this program is needed across the profession.

As I have noted in the past, for the greater part of the last century D.O.s had been, if not prohibited, excluded from practicing or training at primarily M.D. academic medical centers where the majority of clinical research training had been funded by the NIH. This long-standing reality contributes to the current state of inequity, despite the desires of D.O.s to conduct and participate in cutting-edge research.

According to AACOM, “Congress included language in the FY 2022 omnibus appropriations bill acknowledging that increased access to research funding for the osteopathic profession will significantly bolster NIH's capacity to support robust recovery from the COVID- 19 pandemic, address health disparities in rural and medically underserved populations and advance research in primary care, prevention and treatment. Congress directed the NIH to report on the status of funding to COMs and representation on advisory councils and study sections.”

The identified disparity between grants awarded to allopathic institutions in comparison to osteopathic institutions was only one issue. The information also showed of 3,233 NIH study section reviewers, no D.O.s were included, compared to 493 M.D. reviewers. In addition, only one D.O. was among the 462 National Advisory Council members, while 213 M.D.s were on that council.

“The information was really shocking and eye opening,” Fotouhi said. “We are advocating for senators to sign onto a letter to the NIH director advocating and promoting for more equity in funding between allopathic and osteopathic colleges, as well as more osteopathic physicians sitting on these boards.”

The MSU College of Osteopathic Medicine supports AACOM in its recommendations to:

• Enact legislation ensuring federally funded GME residency programs consider osteopathic medical graduates.
• Ask members of congress to sign on to the congressional letter led by U.S. Sens. Martin Heinrich and Roger Wicker, and U.S. Rep. Susie Lee, to NIH Acting Director Lawrence Tabak in support of osteopathic research and representation.

Finally, I can assure you that we as a college will continue to work with all of our partners to advocate for our profession, physicians and students on these and other important issues germane to the stability and continued growth of the osteopathic medical profession.