Creating a New Specialty — Correctional Medicine — A CALL

TO ACTION

David Thomas, M.D., J.D.Dianne Rechtine, M.D.

Nova Southeastern University School of Osteopathic Medicine

Previously

• NSU Created a 2 year fellowship including an MPH leading to a Board Certification in Correctional Medicine

• This effort began in 2005• It has a unique- non-CMS funding source• In 2011 the AOA accepted the concept of

Correctional Medicine as a specialty• In 2012 the Fellowship was approved by the

AOA. as a pathway to Board Certification

Brief Re-Cap

• Much of this material was presented at this conference previously– 1. Initial Step- 4th year student rotation in a prison– 2. Student rotation led to Correctional Fellowship – 3. Success of Fellowship led to Psychiatry

Residency– 4. AOA accepts the concept of both– 5. Board Certification in Correctional Medicine– 6. Board Certification in Psychiatry

On the HORIZON

• In 2012 the Accreditation Council for Graduate Medical Education reached out to the AOA to create a joint/mutual certification process with each organization recognizing the other’s training programs

• Oct. 24, 2012 – The AOA entered into an agreement with ACGME and AACOM to pursue a single, unified accreditation system for graduate medical education programs in the United States beginning in July 2015.

Numbers

• Currently, the ACGME accredits over 9,000 programs in graduate medical education with about 116,000 resident physicians, including over 8,900 osteopathic physicians.

• The AOA accredits more than 1,000 osteopathic graduate medical education programs with about 6,900 resident physicians, all DOs.

Seamless transition for GME

• The transition to a unified system would be seamless so that residents in or entering current AOA-accredited residency programs will be eligible to complete residency and/or fellowship training in ACGME-accredited residency and fellowship programs.

For Us

• Modification of ACGME accreditation standards to accept AOA specialty board certification as meeting ACGME eligibility requirements for program directors and faculty;

• Programs in graduate medical education currently accredited solely by the AOA will be recognized by the ACGME as accredited by the ACGME; and

• Participation by the AOA and AACOM in accreditation of programs in graduate medical education accreditation to be solely through their membership and participation in the ACGME.

WHY

A year ago both organizations were at one another’s throats- AOA was going to sue ACGME and ACGME was going to bar DO’s from all Fellowship programs

WHAT HAPPENED????1991 while in Fl Leg- Gail Wilensky (GHW Bush

Sr Health Advisor) Cardiologist - 1 Million training – refuses to see poor - this has to change

Cost differences between programs

• Former CMS Director Don Berwick- 10.5 Billion dollars on GME and what are we getting for it???

• Push from HHS and CMS for accountability and reduction in costs

• Cost and quality comparisons of GME approaches

What does this mean for us in corrections

• Within 2 years- before your Fellow finishes their program ACGME and AOA will both be recognizing correctional medicine as a specialty

• You need to create programs in your institutions now

• Acceptable programs will be 2 years with an MPH or equivalent master’s degree

YOU

• By about 2015 or so will be able to be grandfathered into the specialty

• Will need to create a program– Willing to share our curriculum and mechanisms– Three are in the process of starting now- Larkin

Hospital; Univ of N. Texas- Dallas; Univ of Oklahoma- Tulsa

• Will need to create a funding mechanism for your program- seek out corrections- they can use you

Don’t be left behind

Current Situation

• The Graying of Corrections- An Issue for Both Inmates, and Staff

• Not only are inmates trending to be older, but staff is as well.

• Need to encourage newcomers into the field

Note the ages of the attendings on a volunteer mission to a Jamaican Prison

BURNOUT- Very Stressful Environment

• Many physicians do not fit well into corrections- Used to having facilities designed for and built around the PHYSICIAN and his interactions- Corrections is NOT this way

• While health care is a Constitutional requirement- it is NOT the reason jails and prisons exist- unlike other areas of our life

• This Creates STRESS on the physician

Stress Tony Snow- 2006-2008

Training Program

• Lets the neophyte understand the environment and their position in that environment

• Lets the neophyte understand that correctional medicine is more than “seeing your patients”

• Lets the neophyte understand how they can contribute to the field

• Creates a Career track

Correctional Medicine

• Correctional medicine will never rise to the level recognition of competence and quality that it deserves without a Specialty certification. The feeling will always pervade that any doctor can cover a jail or prison just as the feeling was in the 1970’s that any doctor can cover an emergency room.

Not ANYBODY Can DO THE JOB

It is essential that

• We work together to get Correctional Medicine as a Specialty designation and create a cadre of specialists in the field

• Why-– Get young physicians to make a career in field– Keep physicians in the field– Create real continuity of care– Improve the care for our patients