Why is the professional organization of osteopathic medicine offering two pathways to certification?

Our profession has grown 300% in 30 years, and DOs practice in every specialty and in all geographies. Some train in programs and practice in settings where they do not use osteopathic methods, and they seek an exam more relevant to their practice. AOA recognizes the diversity of 114,000+ DOs and is offering dual pathways to provide options for all.

We will continue to offer osteopathic specialty board certification for DOs who wish to certify their mastery of osteopathic principles and practice. The osteopathic specialty board certification exams will continue to serve DOs who wish to validate their expertise in osteopathic principles and practice.

We are also adding an option of becoming board certified in a specialty only by taking an exam without formal osteopathic content. The specialty only exam will embrace osteopathic medicine’s unique holistic thinking, but will not evaluate candidates’ skills in the principles and practice of osteopathic medicine.

Exams for both pathways will be developed by practicing osteopathic physicians, and distinct certificates will be awarded for each.

What other changes are coming in certification?

Based on extensive research and physician feedback, we are implementing changes to make certification more convenient, physician-friendly, relevant to practice, and recognized. That includes:

  • Improving the clarity and relevance of exam questions.
  • Piloting and implementing technology to deliver exams and developing platforms (including mobile access) that support continuous and longitudinal assessment.
  • Using technology for remote proctoring of OCC oral exams.
  • Providing shorter intervals for osteopathic continuous certification as an alternative to the traditional 10-year recertification exam cycle (see below).
  • Actively promoting AOA certification to residents, students, and those verifying certification, and making sure program directors are informed and prepared to discuss options with residents.
What specialties will be able to attain certification with osteopathic content?

Physicians across all specialties who have an interest in OMT will be able to pursue certification by taking a written exam with content assessing osteopathic principles and practices.

How does this affect Osteopathic Continuous Certification?

We also plan to offer options in osteopathic continuous certification. In place of the traditional high-stakes recertification exam offered at eight- or 10-year intervals, we are reimagining osteopathic continuous certification as an ongoing process designed to provide relevant content to practitioners at scheduled intervals.

What are the cost implications of making all these changes? Will exam and/or OCC fees increase? Would we have to pay extra to take osteopathic portions of the exam?

We are still determining the exact fees. We believe DOs should not have to pay more to be certified as an osteopathic physician and are committed to keeping costs competitive.

Can you tell us more about the process of developing the osteopathic content exam, who will be involved, and how you will validate it?

AOA President William S. Mayo, DO, has convened an initial workgroup with members from the American Academy of Osteopathy, American College of Osteopathic Family Physicians, American Osteopathic Board of Family Physicians, the American Osteopathic Board of Neuromusculoskeletal Medicine, and the AOA to start this process. Other boards will be included as the process unfolds. Details of the process will be guided by these contributing groups and are not yet confirmed. Certifying Board Services will ensure that the highest psychometric standards and best practice models are actively engaged to assure the validity of test development processes.

Why does the AOA consider osteopathic content optional?

We don’t consider it optional. Rather, we view this realignment as providing options that DOs want. The fast-growing osteopathic profession is increasingly diverse, and DOs train and practice differently. The profession is comprised of:

  • DOs who practice osteopathically and perform OMT.
  • Those who practice osteopathically, but do not perform OMT.
  • Those who trained in ABMS residencies who haven’t studied osteopathic principles or practiced OMT since medical school.

By providing options, we can attract the full range of DOs who are interested in practicing osteopathically or just value a strong specialty board exam, conveniently and efficiently administered and relevant to their practice. With options, we encourage those DOs to remain within the osteopathic medical profession and community. We can also provide a certification pathway for MDs, especially those trained in osteopathically-recognized programs, who seek quality specialty certification, delivered conveniently and efficiently. Providing options allows us to serve a larger pool of diplomates, embrace all who value osteopathic philosophy, and certify more physicians committed to holistic, patient-centered care.

How will patients be able to distinguish DOs who are boarded with distinctly osteopathic content versus those who are AOA boarded without osteopathic content?

Distinctive certificates will be awarded for each certification pathway. Those taking osteopathic exams will receive a certificate of board certification in their specialty (i.e., board certified in osteopathic internal medicine). Those taking specialty-only exams will be certified in the specialty alone (i.e., board certified in internal medicine.) Exact certification nomenclature has not been finalized.

Physicians can include and explain that specialization in their bios and their profiles in provider directories. The AOA will work to educate patients, providers, and employers about the meaning of new certification types.

Osteopathic philosophy embraces the concept that structure (anatomy) and function (physiology) are interrelated at all levels, and that rational treatment is based on these principles. How are these principles not applicable to all specialties?

Osteopathic principles are indeed applicable to all specialties. However, DOs who enthusiastically accept and practice these principles may not use osteopathic methods in their practices, and prefer not to continually be assessed in this area.

The stated mission of the American Osteopathic Association is "to advance the distinctive philosophy and practice of osteopathic medicine." How does this change advance this mission?

The AOA is committed to advance the distinctiveness of osteopathic medicine. We are funding a multi-year, multi-million dollar campaign to inform and educate the public on our distinctiveness. We have significantly increased our investment in osteopathic focused research and enhanced our engagement in and influence on public policy. And we are working to expand international recognition of US-trained DOs. At the same time, we are responding to the changing health care landscape and the evolving needs of our growing and diverse osteopathic family. The goal is to serve all DOs by providing them with a range of tools to achieve their professional goals and to give them opportunities to engage in the osteopathic community. More engagement can advance our mission by driving membership in AOA and osteopathic specialty colleges and state societies; increasing participation in osteopathic CME; driving attendance at events; growing support for foundations and COMs, etc.

How does this change affect the reputation of the certification that DOs have held for years?

Changes for the future do not affect past certifications. We will continue to promote the value of AOA certification to employers, health care providers, payers, and patients. Providing an opportunity for all physicians licensed in the US to obtain specialty certification through the AOA only strengthens our reputation as a provider of reputable, high-value professional credentials for physicians.

What will make AOA certification different from allopathic specialty boards?

AOA certification reflects a physician’s commitment to ongoing evidence-based education that results in high-quality, whole-person care. It is distinctive because it demonstrates a physician’s dedication to advance the standard of osteopathically-focused medical care that improves patient outcomes and satisfaction. It is also distinctive because our board exams are written by practicing physicians for practicing physicians. For physicians considering AOA and ABMS certification, the determining factors will be how they wish to practice, and which certification “product” offers the best quality, value, convenience and service.

Who had input on this decision?

This has been an extensive process involving significant input from the AOA Board of Trustees, Bureau of Osteopathic Specialists and individual boards, extensive market studies and analysis, and DO leaders across the country.

AOA hired Boston Consulting Group (BCG), one of the world’s preeminent consulting firms with extensive experience in health care strategy, to help us understand the market opportunity to attract DOs and MDs not satisfied with their current board offering. BCG conducted extensive surveys with more than an extremely robust sample of 1,200 physicians, including residents with AOA, ABMS and dual certification as well as MDs. They also interviewed program directors—who are the top influencing factor in residents’ certification choice—and students. Data collection included in-depth interviews, focus group discussions, and interviews with external stakeholders, such as insurance executives.

Respondents told us what their perceptions, needs and preferences were and how they would respond to changes. We continue to consult with stakeholders and a newly formed steering committee and it is very much an ongoing effort, with decisions and details still being worked out. To be clear, the Board of Trustees has final decision authority.

Was there evidence that showed osteopathic students and residents do not feel well enough trained to be prepared for an osteopathic exam?

Students did not feel like they lacked training. Residents who preferred optional osteopathic content told us they would need to refresh their skills, either because they are not training in an osteopathic residency or do not regularly use osteopathic methods.

Why is the AOA moving forward so quickly with these major changes?

We face a clear window of opportunity to enhance our certification and attract new diplomates in the next certification cycle. We know that residents already have a choice, and there is a lot of work to do to implement changes and communicate them to diplomates and key stakeholders and influencers, such as program directors.

Recently the ABMS, facing diplomate challenges to its MOC program, announced in March 2019 that it will take immediate action on an independent commission’s recommendations to make continuing certification more meaningful, relevant and of value to key stakeholders. Like us, they are responding to market needs and expectations. We must innovate to be the certification provider of choice.

Are you concerned that offering a specialty-only exam will further weaken student resolve to study OMM/OMT and take COMLEX exams?

No. We will continue to offer an exam that allows diplomates to signal their excellence in osteopathic methods and practices. As for students, OMM/OMT will continue to be required curriculum at COMs. The distinctive components of osteopathic education are clear when students consider a medical school. The explosive growth of enrollment in COMs suggests that students are choosing to apply, enroll, and learn those skills. According to AACOM research, about 7 in 10 third-year students indicate a preference to train in an osteopathic focused residency. We know that NBOME is deeply committed to preserving osteopathic distinctiveness within its exams and is actively seeking ways to better define and articulate that distinctiveness in licensure.

Is there a concern that the loss of osteopathic content may undermine our push for encouraging all programs to gain ACGME Osteopathic Recognition?

The osteopathic content is not lost, but rather strengthened and amplified in distinctive osteopathic certification signaling skill and competency, just as Osteopathic Recognition is a marker of additional, specialized training in residency.