The Challenges of Rapid The Challenges of Rapid Growth: Examining the Growth: Examining the Quality of Our Schools Quality of Our Schools

and Educational and Educational MethodsMethods

George Mychaskiw II, DO, FAAPGeorge Mychaskiw II, DO, FAAPVice Chairman Department of AnesthesiologyVice Chairman Department of Anesthesiology

Professor of Anesthesiology, Surgery, Pediatrics, Professor of Anesthesiology, Surgery, Pediatrics, Neurosciences and Physiology/BiophysicsNeurosciences and Physiology/Biophysics

University of Mississippi School of MedicineUniversity of Mississippi School of MedicineAOA Health Policy Fellow, 2006-2007AOA Health Policy Fellow, 2006-2007

1910 All Over Again1910 All Over AgainGeorge Mychaskiw II, DO, FAAPGeorge Mychaskiw II, DO, FAAP

Vice Chairman Department of AnesthesiologyVice Chairman Department of AnesthesiologyProfessor of Anesthesiology, Surgery, Pediatrics, Professor of Anesthesiology, Surgery, Pediatrics,

Neurosciences and Physiology/BiophysicsNeurosciences and Physiology/BiophysicsUniversity of Mississippi School of MedicineUniversity of Mississippi School of Medicine

AOA Health Policy Fellow, 2006-2007AOA Health Policy Fellow, 2006-2007

The Future ?The Future ?

2008 – Rocky Vista 2008 – Rocky Vista COM opens as the COM opens as the first for-profit first for-profit medical school in medical school in the US since the US since intentional closure intentional closure of such institutions of such institutions by 1935by 1935

2009 – Robert Ross 2009 – Robert Ross opens the Ross opens the Ross University COM in University COM in MiamiMiami

2010 – Online COM 2010 – Online COM opens at multiple opens at multiple sites by the sites by the University of University of PhoenixPhoenix

2010 – CMS halts 2010 – CMS halts all funding to all funding to Osteopathic GME, Osteopathic GME, citing citing underutilization (by underutilization (by 2009, only 1400 of 2009, only 1400 of 3500 slots filled).3500 slots filled).

2011 – 6 new 2011 – 6 new proprietary COM’s proprietary COM’s open. 3 established open. 3 established COM’s convert to for-COM’s convert to for-profit status.profit status.

AMA issues a AMA issues a resolution condemning resolution condemning for-profit medical for-profit medical education and education and declares association declares association with such ventures at with such ventures at any level unethical. any level unethical.

2012 – FSMB places 2012 – FSMB places moratorium on moratorium on COMLEX for COMLEX for licensure and licensure and orders orders investigation, citing investigation, citing irregularities with irregularities with testing procedures testing procedures at new COM’s. at new COM’s. Over the next year, Over the next year, 34 states mandate 34 states mandate USMLE for all DO’s.USMLE for all DO’s.

2013 – After the 2013 – After the deaths of over 200 deaths of over 200 patients patients nationwide, the FBI nationwide, the FBI arrests 16 DO’s who arrests 16 DO’s who purchased degrees purchased degrees and COMLEX and COMLEX answers from the answers from the Golden State COM Golden State COM (for-profit) in (for-profit) in Fresno, CA.Fresno, CA.

2013 – After public 2013 – After public outcry related to the outcry related to the “Fresno 16” the “Fresno 16” the Department of Department of Homeland Security Homeland Security orders complete orders complete investigation of all investigation of all COM’s and practicing COM’s and practicing DO’s. CMS suspends DO’s. CMS suspends reimbursement for any reimbursement for any claims filed by DO’s claims filed by DO’s trained after 2008.trained after 2008.

2014 – President 2014 – President Obama signs Obama signs Executive Order Executive Order 4111, limiting the 4111, limiting the practice of all DO’s practice of all DO’s trained after 2008 trained after 2008 to OMM. 45 States to OMM. 45 States now require now require USMLE.USMLE.

2015 – All practicing 2015 – All practicing DO’s required to sit DO’s required to sit for Special for Special Relicensure Exam Relicensure Exam (SREX). Those who (SREX). Those who pass are granted pass are granted MD degree by HHS. MD degree by HHS. Those who fail are Those who fail are limited to OMM. limited to OMM. 70% of COM’s close.70% of COM’s close.

2020 – 3 COM’s 2020 – 3 COM’s open. DO’s open. DO’s restricted to OMM restricted to OMM only. Less than only. Less than 1000 DO’s still in 1000 DO’s still in practice.practice.

The ProblemThe Problem

Shortage of primary care physiciansShortage of primary care physicians Predictions vary from 39% to 63% Predictions vary from 39% to 63%

undersupply in the next 15 years.undersupply in the next 15 years. Shortage also in specialty areasShortage also in specialty areas

The Osteopathic SolutionThe Osteopathic Solution

Primary care disproportionate to Primary care disproportionate to overall numberoverall number

Of 144 American medical schools, Of 144 American medical schools, the top 12 producing primary care the top 12 producing primary care physicians were COM’s. 4 others physicians were COM’s. 4 others were in the top 20.were in the top 20.

COM’s rapidly expandingCOM’s rapidly expanding

Medical Education in 1910Medical Education in 1910

Wide variety of Wide variety of schoolsschools

Non-standard curriculaNon-standard curricula Variable admissions Variable admissions

criteriacriteria Proprietary, for-profit Proprietary, for-profit

schoolsschools Owned by investors, Owned by investors,

no connection to no connection to established established universitiesuniversities

Flexner ReportFlexner Report

Commissioned by Commissioned by the AMA in 1908the AMA in 1908

Flexner – Flexner – professional professional educatoreducator

Severely criticized:Severely criticized:

-For-profit schools-For-profit schools

-Part time faculty-Part time faculty

-Limited hospital -Limited hospital facilitiesfacilities

The Profit MotiveThe Profit Motive

““Such exploitation of medical Such exploitation of medical education is strangely inconsistent education is strangely inconsistent with the social aspects of medical with the social aspects of medical practice. The medical profession is practice. The medical profession is an organ differentiated by society for an organ differentiated by society for its highest purposes, not a business its highest purposes, not a business to be exploited” to be exploited”

Abraham Flexner, Abraham Flexner,

19101910

Osteopathic Medical Osteopathic Medical EducationEducation

1982 – 15 colleges1982 – 15 colleges 2010 - >30 colleges2010 - >30 colleges Class size increasing. Classes of over 250 Class size increasing. Classes of over 250

routineroutine Unusual geographic arrangementsUnusual geographic arrangements 2 COM’s in Phoenix + U of AZ2 COM’s in Phoenix + U of AZ OGME – Does anyone care? Self-fulfilling OGME – Does anyone care? Self-fulfilling

problemproblem OCME - BrokenOCME - Broken

For-Profit SchoolsFor-Profit Schools

Permitted by COCAPermitted by COCA Prohibited by LCMEProhibited by LCME Illegal in some Illegal in some

states (Kansas)states (Kansas) Research? NIH Research? NIH

funding?funding?

The 1910 InitiativeThe 1910 Initiative

Commission a 21Commission a 21stst century survey of century survey of osteopathic medical education, a new osteopathic medical education, a new “Flexner Report.”“Flexner Report.”

Reevaluate COCA standards. Special Reevaluate COCA standards. Special attention to membership, boards of attention to membership, boards of COM’s and conflicts of interest.COM’s and conflicts of interest.

Moratorium on all for-profit COM’s and Moratorium on all for-profit COM’s and any not associated with universities.any not associated with universities.

Consequences of InactionConsequences of Inaction

1910 – FFS system1910 – FFS system 2007 – Mostly 2007 – Mostly

third-party payersthird-party payers Someone will Someone will

regulate thisregulate this

HOD ResolutionHOD Resolution Whereas the Flexner Report of 1910 is widely regarded as having helped reform both Whereas the Flexner Report of 1910 is widely regarded as having helped reform both

osteopathic and allopathic medical education and has served as a continuing osteopathic and allopathic medical education and has served as a continuing reference for judging the quality of contemporary medical schools, andreference for judging the quality of contemporary medical schools, and

Whereas Abraham Flexner was highly critical in his Report of for-profit medical Whereas Abraham Flexner was highly critical in his Report of for-profit medical education, noting : “Such exploitation of medical education, is strangely inconsistent education, noting : “Such exploitation of medical education, is strangely inconsistent with the social aspects of medical practice. In modern life the medical profession is with the social aspects of medical practice. In modern life the medical profession is an organ differentiated by society for its highest purposes, not a business to be an organ differentiated by society for its highest purposes, not a business to be exploited.",1 and exploited.",1 and

Whereas all for-profit schools of osteopathic and allopathic medicine in the U.S. were Whereas all for-profit schools of osteopathic and allopathic medicine in the U.S. were either converted into not for profit institutions, or were forced to close by 1935, andeither converted into not for profit institutions, or were forced to close by 1935, and

Whereas osteopathic medical education should be held to a standard at least equal Whereas osteopathic medical education should be held to a standard at least equal

to, if not exceeding, allopathic medical education, andto, if not exceeding, allopathic medical education, and

Whereas the accreditation standards of the Liaison Committee on Medical Education Whereas the accreditation standards of the Liaison Committee on Medical Education (LCME) explicitly prohibits for-profit medical schools2, therefore be it resolved that, (LCME) explicitly prohibits for-profit medical schools2, therefore be it resolved that,

The House of Delegates strongly disapproves the establishment of any college of The House of Delegates strongly disapproves the establishment of any college of osteopathic medicine operated on a for-profit basis. osteopathic medicine operated on a for-profit basis.

I DISAPPROVE!I DISAPPROVE!

DOCTORS DOCTORS NOT NOT

DOLLARSDOLLARS