Student's Concerns

1. Student's Concerns Bureau of Interns and Residents American Osteopathic Association Jennifer Howell, D.O.

2. Who We Are • The American Osteopathic Association is the second fastest growing association in the country! Of all DO’s nationwide (~56,000), 63% of them belong to the AOA. • For 109 years, the AOA has fought hard to protect and promote the osteopathic profession

3. AOA Websites • One site for professionals, the other for consumers and media • D.O. Advocacy Action Center

4. AOA History • 1800’s • 1828 - A.T. Still, M.D. born in Virginia • 1874 - First enunciation of osteopathic principles and philosophy • 1892 - First school opens in Kirksville, MO • 1896 - Vermont is the first to license osteopathic physicians • 1897 - The American Association for the Advancement of Osteopathy (AOA now)

5. AOA History • Early 1900’s • 1917 – A.T. Still, M.D. dies • 1918 – Great Swine Influenza Pandemic • 1918 - Fryette’s Physiologic Motion published • 1940’s – Surgeon General of US refuses to accept DO’s in the Army

6. AOA History • Mid 1900’s • 1966 – DO’s commissioned into Army and Medicare program accepts AOA as an accrediting agency • 1969 – AMA changes bylaws to allow DO’s to train in allopathic residencies • 1970 – AOA approves AMA post-graduate training to augment our existing educational system

7. AOA History • Late 1900’s • 1973 – Mississippi last state to grant D.O.s full practice rights • 1992 – Centennial Celebration • 1998 – Campaign for Osteopathic Unity • 2001- Louisiana last state to recognize the COMLEX

8. What Have We Done Lately? • In the 21st century, the AOA has: • Been invited to the White House four times due to our support for the Patient Bill of Rights • Exposed 20 Million Americans to osteopathic medicine through public relations and promotion • Helped graduating students find AOA-approved internships and residencies

9. Making D.O. A Household Word • AOA has launched a new advertising program • “I Go to a D.O.” campaign has appeared in several magazines found in patient waiting areas this fall, including • Redbook • Oprah Magazine • Reader’s Digest • American Baby

10. Bureau of Interns and Residents • Andrew Farber, DO Chair • Jennifer Howell, DO Vice Chair • W. Ashley Hood, DO AOA Board of Trustees, Region III • David Pucci, DO Region II Trustee • Larry Northorn, DO Region I Trustee • Thurman Alvey, DO ACGME Member-at-Large • Christine Estrada, DO Osteopathic Member-at-Large • Edward Loniewski, DO BOT Advisor • Andrew Adair, DO Council on Young Physicians • Victoria Hutto, OMS IV Student Liaison

11. Statement of Purpose • Promote the mission of the American Osteopathic Association • Maintain high standards and improve educational programs for osteopathic postdoctoral physicians • Promote and facilitate communications among members of our osteopathic family

12. Statement of Purpose • Promote and encouragement membership • Promote and enhance osteopathic professional standards • Encourage the professional and personal development of osteopathic postdoctoral physicians

13. Statement of Purpose • Reach out to the osteopathic student organizations to encourage early involvement in student, intern and resident issues • Commit to the preservation of basic osteopathic principles at the student, intern and resident level

14. What to do in your clinical rotations. • Third year- “Get your hands dirty” • Pick your rotations at the hospitals that will give you the most experience and volume for that primary care, or specialty rotation. • Work hard, be assertive and motivated. You will make a good impression on your preceptor, and who knows – maybe earn a great recommendation letter!

15. What to do in your clinical rotations • Fourth year- Be smart • Schedule your elective rotations at the program that would be a potential match for you when considering post-graduate education. This rotation will serve as an “audition”, and may help your chances for the match. • This is your moment to shine. Use the knowledge and skills obtained from your other rotations to show off your abilities.

16. The Time Line • June of the OMSIII year Agreement forms for participation in the AOA Intern Registration Program (the Match) are distributed via the medical schools. Students must return their agreement forms to National Matching Services, Inc. with fees by early October, OMSIV year.

17. The Time Line • OMS IV year – “to do list” Students will contact the programs by submitting an application to ERAS, and selecting all the programs to send that application to. Programs receive applications off of the ERAS system, and contact the student for an interview. The new ERAS system will start July 2005.

18. The Time Line • Interviews • October – January, OMS IV year Each program that receives an application, may or may not grant you an interview. If the program contacts you for an interview, you will schedule this with the individual program. You will need to schedule your “interview trail” efficiently.

19. The Time Line • November before graduationBy this date, registered students and programs will receive instructions for submitting Rank Order Lists and obtaining match results. • January before graduationFinal date for submission of student Rank Order Lists.

20. The Time Line • February before graduationResults of the Match are released to all participants in the Match. • Institutions will also receive a standard contract from the AOA for each matched student. The student must sign and return the contract to the institution within 30 days.

21. The Time Line • This is the one of the few professions where you feel like you are playing the lottery to find out where you are going to work. • However, it is a fact of life. AND you must learn how to play the game.

22. The Time Line • The ACGME match (sometimes called the AMA match) will finish approximately one month after the AOA match. • You may register for both match processes. However, if you match in the AOA match, you will be dropped from the ACGME match.

23. Match Alternatives:AOA Internship • Traditional Match • Combined Match • Consist of both a PGY-1 intern position beginning July 2006 followed by a PGY-2 residency position July 2007 • Offered as a single program on the Match applications • Usually called “Fast-Track.” Do not confuse with “Specialty Track” or “Specialty Emphasis Internship.” • Not all programs have this procedure.

24. Match Alternatives:AOA Internship • After completing an AOA Internship year, you can: • Proceed onward to an AOA approved PGY-2 residency program. • Proceed onward to an ACGME approved PGY-2 residency program unless that program requires special rotations that weren’t completed in your internship.

25. Match Alternatives:AOA Internship • Why do an AOA approved internship? • Continuing in an osteopathic program with other osteopathic physicians. • Osteopathic physicians are required to have completed an AOA-approved internship in order to be licensed in Florida, Michigan, Oklahoma, Pennsylvania, and West Virginia.

26. Match Alternatives:AOA Internship • Why do an AOA approved internship? • Completion of an AOA-approved internship is required for application to an AOA-approved residency, and for entrance into the AOA board eligibility and certification process. • AOA board certification is required to become a Director of Medical Education (DME) or a Program Director in AOA-approved postdoctoral programs.

27. Match Alternatives:AOA Internship • The AOA understands that our students now lack the number of internships and residency slots needed for every graduating senior • What is the AOA doing about it?

28. AOA Initiatives • AOA/ACGME Collaboration Taskforce • Started in 2003 under direction of Anthony Minnissale, DO, former AOA President. • Goals: • Improve collaboration between AOA and ACGME • Evaluate AOA accreditation for ACGME programs – making them dually-accredited. • Evaluate getting ACGME programs to inquire about AOA accreditation. • The overall goal is to try to retain DO’s in the profession, and to maintain quality osteopathic education, even if some of the education is obtained in an ACGME program.

29. OPTI • Osteopathic Postgraduate Training Institutions are institutions combining the forces of the osteopathic school and the post-graduate training institutions (hospitals and their programs) and community based programs. They are designed to create and maintain available spots from the time of matriculation to the last day of residency – a “seven year continuum of osteopathic training”.

30. OPTI • While students don’t have to STAY in the OPTI, the number of spots available nation-wide should support the number of students who are graduating. • This is great in theory. The hard part is delivering the goods.

31. Resolution 42 • This is the guideline to be used in order to allow AOA approval of the PGY-1 year in an ACGME program. (There is a separate process for obtaining AOA approval of your residency. This is done by contacting the respective specialty college.) • Full details available on www.do-online.org. • An application must be filled out. • A graduate must apply within 90 days of the beginning of his/her PGY-1 year in an ACGME program.

32. Resolution 42 • The following criteria must be maintained. • The applicant maintains intern/resident membership status in the AOA • The D.O. must document limitations to entering an AOA-approved internship.

33. Resolution 42 • Limitations: • Physical or mental disability or handicap which precludes the satisfactory completion of an AOA-approved internship. • Legal restrictions which require the D.O.’s physical presence in a state or local area where AOA-approved programs are not located. • Acceptance of a non-AOA accredited primary care training position based on a federally designated health profession shortage area (HPSA) where no AOA-approved programs exist.

34. Resolution 42 • Limitations (cont): • Participation in a medical specialty or subspecialty in which no available AOA-approved programs or positions exist. • Unusual or exceptional circumstances which limit AOA-approved training opportunities.

35. Resolution 42 • The applicant must: • Complete all AOA-approved traditional internship requirements (2-IM, 2-FP, 1-ER) within the ACGME program. • Participate in at least one of the following osteopathic medical education activities during the ACGME training: Attend an AOA Convention or AOA-affiliated specialty society meeting in that year, participate in an OMT/OPP program hosted by an OPTI or participate in another approved osteopathic activity (including research).

36. Resolution 42 • The application will be evaluated by the AOA Postdoctoral Training and Review Committee of the Council on Postdoctoral Training. • The staff will use the previously mentioned criteria plus take into account other circumstances including: financial hardship, spouse or child illness, lack of available local AOA-approved positions and relocation limitation due to spousal employment in an established professional career or full-time higher education.

37. What should I do about Internship and Residency? • Become the best osteopathic physician you can regardless of where you do your training. • We welcome you to stay in the osteopathic track of post-graduate education. But, regardless of where you train – you will always be a DO. Stay in the family! • The AOA has also approved quality ACGME programs – dually accredited programs.

38. Let’s get rid of the myths • “If I don’t take the USMLEs, I can’t practice as a physician” • “If I do an osteopathic residency, I can’t do an allopathic fellowship” • “The AMA is my friend and will look after our osteopathic problems”

39. And after residency …more Boards • Certifying Boards • These are examinations completed in the spring/summer of your final year of residency. • Certifying boards are required to become “Board Certified Physicians.”

40. So, what is the BIR doing now? Congress of Interns and Residents • October 16, 2006 8:00am-12:00pm. Resident Research Conference • October 16, 2006 12:00pm-5:00pm & October 17, 2006 8:00am-5:00pm Residency Work Hours • In 2003, the BIR was intensely involved in advocating for the 80 hours work week, which became a federal mandate on all post-graduate training.

41. So, what is the BIR doing now? Student Loan Interest Deduction • Our efforts in last Spring’s D.O. Day on the Hill were rewarded. Post-Graduate Training in Non-hospital and Rural Areas • D.O. Day on the Hill held September 9, 2004 focused on preserving rotations in non-hospital settings were volunteer preceptors train interns/residents. COM Visits • The reason we are here today – to help with education and communication for osteopathic medical students.

42. So, what is the BIR doing now?Upcoming issues • Standardization of Vacation Hours, Sick Policy, Leave Policy, etc.., in all post-graduate programs. • Leadership conference: spring 2007 • Increasing awareness and effectiveness of the BIR, and its purpose. • Enhancing opportunities for osteopathic medical students, interns, and residents. • Starting local intern/resident committees.

43. Communication • Postdoctoral Physicians Network • Leave me your e-mail address and we will sign you up. • Bureau of Interns and Residents Web page (under the AOA web site www.do-online.org)

44. How to get involved • COSGP & SOMA place students on AOA Bureaus, committees, councils. The BIR does this for Interns/Residents. • DO Day on the Hill • Congress of Interns and Residents • BIR Ambassadors • OPTI representatives • State and Specialty Societies • Let us know your interests, we will get you plugged in!

45. Contacts AOA 1.800.621.1773 • Jennifer Howell, DO • Cell: (918) 269-1665 • Pager: (918) 643-5408 • jennhowell@hotmail.com • Joyce Obradovic, PhD. • Director of Postdoctoral Training • Verna Bronersky • Director of Student, Intern, and Resident Affairs

46. What should I do right now? • Do your best to have a good knowledge base, and strive to be the best osteopathic physician you can be. • Get involved in the leadership of this profession. SOMA, UAAO and the COSGP – your student government association are excellent sources of knowledge for you. • Finally, if you decide to participate in an ACGME program, come back to the AOA. No other organization will look out for DOs like the organization formed by DOs.

47. Thank you very much for your attention. Questions?