Historic trends, current strengths, and the importance of certifications for osteopathic physicians

In the history of American medicine, there have been attempts to limit scopes of practice for osteopathic physicians.

But the profession remains a vital and growing part of U.S. health care, with osteopathic physicians providing patient care at the highest levels. It’s exciting to see for the profession, said Robert G.G. Piccinini, DO, D.FACN. He spoke to Medical Economics about a lawsuit filed by the American Osteopathic Association (AOA) against the American Board of Internal Medicine (ABIM) contesting a policy that stops osteopathic physicians from serving as program directors for residencies and fellowships.

The time and expense involved on maintenance of certification sometimes prompts strong feelings from physicians. Here, Piccinini also gives his perspective on the importance of certification for osteopathic physicians.

Medical Economics: The complaint did touch on some of the historic attempts to limit medical practice of osteopathic physicians. Can you talk about what those are briefly and whether you think there may be some continuing bias against osteopathic physicians in some medical or health care settings?

Robert G.G. Piccinini, DO, D.FACN: History shows that what we don't know, we often fear or have problems with, and I think that might be some of the that history in the past. I think what's more important is focusing on what we can do today with this current policy, how it's unlawful and unfair to our current osteopathic physicians. As to biases, you know, we're currently 28% of all graduates are osteopathic, 28% of all medical graduates. We’re 38% of the military's medical corps. We're at the highest level, the last three presidential administrations have been osteopathic physicians. The head physician of NASA is an osteopathic physician. So I think we're beating down barriers in all aspects of life, but I don't disagree that there may be small pockets of still, people just are not aware of what the osteopathic physician offers to society, and I think in time we're going to be knocking those barriers down also. But I think we've made huge strides so what may have happened in the past is in the past. I think we need to focus on the future and this unlawful policy that exists. And I think by changing this unlawful policy, and that's our hope, is that the courts see that this policy is unfair and unlawful, or ABIM decides to change this policy, so that osteopathic medicine can continue to beat down those walls of just not knowing who we are and maybe the biases that individual, small pockets have.

Related coverage: AOA president: ABIM policy about internal medicine program directors is unlawful, disruptive

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Osteopathic physicians, residency leadership, and the ABIM dispute

Medical Economics: When you mention some of the positions that osteopathic physicians have really risen to, it's an impressive list. It's got to be exciting for the profession.

Robert G.G. Piccinini, DO, D.FACN: It is, it really is, and they're great physicians and they're doing great work for their patients and their constituents, and that's the story we want to tell. And that's the story that we want to emphasize, that osteopathic positions, osteopathic-certified board-certified physicians are a crucial part of the health care landscape and this policy being as unlawful as it is, is limiting, is limiting that full goal of that whole aspect of what an osteopathic physician can do.
Medical Economics: In big picture terms, physicians may have strong feelings about licensure and certification and how that affects their ability to practice. Does AOA have a position on the benefits and drawbacks of certification for physicians?

Robert G.G. Piccinini, DO, D.FACN: The AOA position is that osteopathic continuous certification is important. We continually review our exams, we continually update them, make sure that they’re a high-quality, high-standard system. Osteopathic continuous certification is a way to maintain your level of excellence through a certification process. But I am aware that some physicians feel that it's overreach. I think ultimately it's really, what is the best way to protect our patient, our patient population? And I think every patient out there, I know myself, I would want to see a physician who is making sure that they're up to date on the literature and the best treatments and practices of that. And if I see a DO I want to make sure that they're up to date on any osteopathic principles and philosophies and incorporating that in their exam process. Because I know that the osteopathic physician offers a unique perspective on my health care, so to me, that certification is a way to kind of continue the stamp, the seal of approval, in that regards.