Why is the professional organization of osteopathic medicine eliminating osteopathic content from certification exams?

We are not eliminating osteopathic content. We will continue to offer osteopathic specialty board certification for DOs who wish to certify their mastery of osteopathic principles and practice. In fact, we are developing a stronger, more comprehensive component for those DOs. Proposed options include a core exam plus osteopathic written exam, and a core exam with both written and practical test of osteopathic knowledge and OMT skills.

We will be working with certification boards open to exploring a new specialty exam option without osteopathic content. Comprehensive market research revealed there are DOs interested in this option. These are DOs who chose an allopathic residency and/or those who do not use osteopathic techniques in their practice or specialty. (This does not apply to NMM.)

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 with this component, and we are enhancing the process.

How does this affect recertification? Will DOs have the option of taking the non-osteopathic content board exams and recertification or will they have to take the board certification with OMM content?

We also plan to offer options in osteopathic continuing certification. We currently envision 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 are committed to developing a fee structure that keeps the total cost of certification in line with allopathic certification. We believe DOs should not have to pay more to be certified as an osteopathic physician.

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, is convening an initial workgroup with members from ACOFP, AOBFP, AAO, AOBNMM, and AOA to start this process. Other boards will be included as the process unfolds. Further information will be forthcoming in the new year after the group begins to meet. Details of the process will be guided by these contributing groups and are not yet confirmed. Certifying Board Services will apply our highest psychometric standards to assure the validity of new exam content.

Why does the AOA consider osteopathic content optional? If the majority of the DOs want osteopathic distinction, why do we need an exam that has no or little osteopathic content?

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; and
  • those who trained in ABMS residencies who haven’t studied osteopathic principles or practiced OMT since medical school.

By providing options—a specialty exam with a separate osteopathic written exam—we can attract the full range of DOs (as well as MDs) 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 allow and encourage those DOs to remain within the osteopathic profession with certification relevant to their practices. These new pathways to certification also open the door to MDs seeking quality specialty certification, delivered conveniently and efficiently.

If osteopathic content is removed from the core exam, will the term "osteopathic" remain or be removed from the certification title? How can you call this “osteopathic” certification? Isn’t this just “physician certification?”

With or without osteopathic content, our certification will attest that diplomates are highly trained, competent physicians. While exact nomenclature has not been finalized, those taking osteopathic content exams will receive a certificate stating that they were board-certified with additional osteopathic recognition.

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

Those taking osteopathic content exams will receive a certificate clearly stating that they were board certified with additional osteopathic recognition. Physicians can include and explain that specialization in their bios and 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 tested on knowledge they do not have and skills they do not use.

The stated mission of the American Osteopathic Association is "to advance the distinctive philosophy and practice of osteopathic medicine." Please explain how removing osteopathic content from core AOA board certification examinations advances 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? Doesn’t this erode the value of existing certificates or render them meaningless if MDs are allowed to take exams?

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. Having MDs 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? In the long run why would there be any need for the AOA if we are just the same as MDs?

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 osteopathic 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. Why AOA? We offer a unique product in the professional association space. We are the only national, non-specialty association dedicated to advancing the science and practice of osteopathic medicine. Learn more about our member benefits and services.

Who had input on this decision?

This has been a long, 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. We held surveys and focus groups with more than 1,000 recently certified and potential diplomates, and they told us what their needs and preferences were, what features were important, and how they would respond to change. We continue to consult with stakeholders, 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.

Can you provide more detailed demographics on the groups surveyed in your market research?

AOA hired Boston Consulting Group, 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.

BCG used a unique methodology that asked respondents for their preferences among choices and how they would respond to specific changes. The results gave us very solid data on what diplomates want and need. It revealed that we could make significant gains and attract new diplomates if we made changes to test convenience, quality, and components. If we did not make these changes, we will lose diplomates.

Why is the AOA not sharing this information openly and widely and seeking input from all DOs?

We received the final recommendations from the research only in early November. We needed to share and discuss it with AOA certifying boards before sharing it more broadly, with appropriate background and context. It began circulating prematurely, without context. We always intended to share it as soon as we could. As plans evolve in what will be an ongoing and iterative process, we will continue to do so.

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.

Can you share what the timeline is for the decoupling of certification from membership?

Decoupling is one of the provisions in the lawsuit settlement agreement. The effective date for implementing the settlement is 30 days after the settlement is fully approved by the court. The effective date is expected to be in late-December 2018 if there are no further appeals or delays.

Are you concerned that removing osteopathic content will further weaken student resolve to study OMM/OMT and take COMLEX exams?

No. First, we are not removing osteopathic content. In fact, we are enhancing and strengthening osteopathic content in a separate osteopathic written exam. 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 additional certification signaling skill and competency, just as Osteopathic Recognition is a marker of additional, specialized training in residency.

Have you considered that this plan might backfire and prompt current AOA members to depart from the organization?

Yes, we have considered the impact on membership, and analysis indicates we will not see a significant loss in membership. By decoupling membership and board certification, and investing in and strengthening the value of both, we have the opportunity to gain in both segments.