Osteopathic physicians, residency leadership, and the ABIM dispute

Osteopathic physicians say they should be able to serve as fellowship and residency program directors, posts can lead to greater leadership roles and to great influence over young physicians.

Meanwhile, young doctors need program directors to attest to program completion if they hope to move to board certification, a vital step in their medical careers.

So why did the American Board of Internal Medicine change its policy to not accept attestations of program completion from osteopathic physician program directors? The American Osteopathic Association (AOA) has filed a federal lawsuit to find out, said AOA President Robert G.G. Piccinini, DO, D.FACN.

Here he continues his discussion about the case. This transcript has been edited for style and clarity.

Medical Economics: The lawsuit complaint does note, the position as a program director is important in and of itself, but it also can serve as a training ground in itself for even larger leadership duties down the line. Can you talk about that?

Robert G.G. Piccinini, DO, D.FACN: Yes, I mean it's not unusual for program directors to become department chairs and then potentially faculty at major universities. But I think the most important thing is, you know, at the level of the program chair, you're limiting the osteopathic principles, the philosophy that we're able to bestow because the program chair is a huge source of mentorship to the residents. We’re basically limiting that philosophy, the osteopathic perspective, the osteopathic concepts and practices from really being a valuable mentorship of the next generation of both osteopathic physicians and allopathic physicians. Because we believe in osteopathic medicine, our story is one of whole person care, we look at nutrition and health, we look at many aspects of the person's life that they're going through, things that are really necessary for today's health care environment in the best treatment of our patients. Because when you get right down to it, it's all about the patients, and it's all about the value of osteopathic medicine to the patients and what we can do. You spoke earlier in your intro about our position shortage. Well, you know, you're also limiting the ability of programs starting, if you're limiting the ability of people who can be program directors and saying that our training is not good enough, our boards are not substantive enough to start a new program. If somebody just has AOBIM board certification, they can’t be a program director in a new program. That is limiting the answer to some of the health care crisis that we're facing. Our growth shows that the society at large is picking osteopathic medicine, to become osteopathic physicians, but to treat patients in the osteopathic philosophy. Or else we wouldn't be growing as much as we have been.

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

ABIM monopoly hurts osteopathic physicians overseeing residency, fellowship programs, lawsuit says

Medical Economics: Can you talk about the importance of having that attestation of completion of a medical student or a resident? If they don't have that, it sounds like that's going to be stopping their career potentially.

Robert G.G. Piccinini, DO, D.FACN: Well, it does, because the attestation basically states that you have reached the qualifications and the minimum requirements to proceed to the next phase of certification to be able to eventually get your license, to be board-certified. And that’s, I mean, that's the linchpin in this day and age of being able to be paneled by insurance companies, being able to move forward, and being able to basically practice.

Medical Economics: How did the American Board of Internal Medicine come to have the lion's share of market, so to speak, for certification of internal medicine physicians?

Robert G.G. Piccinini, DO, D.FACN: If you look at the single accreditation system, which we entered into 2015, the majority of programs at the time were ABIM. But to answer the question of why, after seven years, they suddenly changed their policy? That's my question, too, because they've not been able to clearly articulate a transparent or consistent rationale for their policy. I don't have the answer to that. I can tell you, you know, the lion's share as you put it, when we entered into the agreement, they had the majority of programs. But for seven years our AOBIM-certified physicians were high-quality, and they still are high-quality, and adequate to serve in that role. And why they changed, I don't know.