1. The Challenges of Rapid Growth: Examining the Quality of Our Schools and Educational Methods George Mychaskiw II, DO, FAAP Vice Chairman Department of Anesthesiology Professor of Anesthesiology, Surgery, Pediatrics, Neurosciences and Physiology/Biophysics University of Mississippi School of Medicine AOA Health Policy Fellow, 2006-2007

2. 1910 All Over Again George Mychaskiw II, DO, FAAP Vice Chairman Department of Anesthesiology Professor of Anesthesiology, Surgery, Pediatrics, Neurosciences and Physiology/Biophysics University of Mississippi School of Medicine AOA Health Policy Fellow, 2006-2007

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

5. 2009 – Robert Ross opens the Ross University COM in Miami 2009 – Robert Ross opens the Ross University COM in Miami

6. 2010 – Online COM opens at multiple sites by the University of Phoenix 2010 – Online COM opens at multiple sites by the University of Phoenix

7. 2010 – CMS halts all funding to Osteopathic GME, citing underutilization (by 2009, only 1400 of 3500 slots filled). 2010 – CMS halts all funding to Osteopathic GME, citing underutilization (by 2009, only 1400 of 3500 slots filled).

8. 2011 – 6 new proprietary COM’s open. 3 established COM’s convert to for-profit status. 2011 – 6 new proprietary COM’s open. 3 established COM’s convert to for-profit status. AMA issues a resolution condemning for-profit medical education and declares association with such ventures at any level unethical. AMA issues a resolution condemning for-profit medical education and declares association with such ventures at any level unethical.

9. 2012 – FSMB places moratorium on COMLEX for licensure and orders investigation, citing irregularities with testing procedures at new COM’s. Over the next year, 34 states mandate USMLE for all DO’s. 2012 – FSMB places moratorium on COMLEX for licensure and orders investigation, citing irregularities with testing procedures at new COM’s. Over the next year, 34 states mandate USMLE for all DO’s.

10. 2013 – After the deaths of over 200 patients nationwide, the FBI arrests 16 DO’s who purchased degrees and COMLEX answers from the Golden State COM (for-profit) in Fresno, CA. 2013 – After the deaths of over 200 patients nationwide, the FBI arrests 16 DO’s who purchased degrees and COMLEX answers from the Golden State COM (for-profit) in Fresno, CA.

11. 2013 – After public outcry related to the “Fresno 16” the Department of Homeland Security orders complete investigation of all COM’s and practicing DO’s. CMS suspends reimbursement for any claims filed by DO’s trained after 2008. 2013 – After public outcry related to the “Fresno 16” the Department of Homeland Security orders complete investigation of all COM’s and practicing DO’s. CMS suspends reimbursement for any claims filed by DO’s trained after 2008.

12. 2014 – President Obama signs Executive Order 4111, limiting the practice of all DO’s trained after 2008 to OMM. 45 States now require USMLE. 2014 – President Obama signs Executive Order 4111, limiting the practice of all DO’s trained after 2008 to OMM. 45 States now require USMLE.

13. 2015 – All practicing DO’s required to sit for Special Relicensure Exam (SREX). Those who pass are granted MD degree by HHS. Those who fail are limited to OMM. 70% of COM’s close. 2015 – All practicing DO’s required to sit for Special Relicensure Exam (SREX). Those who pass are granted MD degree by HHS. Those who fail are limited to OMM. 70% of COM’s close.

14. 2020 – 3 COM’s open. DO’s restricted to OMM only. Less than 1000 DO’s still in practice. 2020 – 3 COM’s open. DO’s restricted to OMM only. Less than 1000 DO’s still in practice.

15. The Problem Shortage of primary care physicians Shortage of primary care physicians Predictions vary from 39% to 63% undersupply in the next 15 years. Predictions vary from 39% to 63% undersupply in the next 15 years. Shortage also in specialty areas Shortage also in specialty areas

16. The Osteopathic Solution Primary care disproportionate to overall number Primary care disproportionate to overall number Of 144 American medical schools, the top 12 producing primary care physicians were COM’s. 4 others were in the top 20. Of 144 American medical schools, the top 12 producing primary care physicians were COM’s. 4 others were in the top 20. COM’s rapidly expanding COM’s rapidly expanding

17. Medical Education in 1910 Wide variety of schools Wide variety of schools Non-standard curricula Non-standard curricula Variable admissions criteria Variable admissions criteria Proprietary, for-profit schools Proprietary, for-profit schools Owned by investors, no connection to established universities Owned by investors, no connection to established universities

18. Flexner Report Commissioned by the AMA in 1908 Commissioned by the AMA in 1908 Flexner – professional educator Flexner – professional educator Severely criticized: Severely criticized: -For-profit schools -Part time faculty -Limited hospital facilities

19. The Profit Motive “Such exploitation of medical education is strangely inconsistent with the social aspects of medical practice. The medical profession is an organ differentiated by society for its highest purposes, not a business to be exploited” “Such exploitation of medical education is strangely inconsistent with the social aspects of medical practice. The medical profession is an organ differentiated by society for its highest purposes, not a business to be exploited” Abraham Flexner, 1910 Abraham Flexner, 1910

20. Osteopathic Medical Education 1982 – 15 colleges 1982 – 15 colleges 2010 - >30 colleges 2010 - >30 colleges Class size increasing. Classes of over 250 routine Class size increasing. Classes of over 250 routine Unusual geographic arrangements Unusual geographic arrangements 2 COM’s in Phoenix + U of AZ 2 COM’s in Phoenix + U of AZ OGME – Does anyone care? Self-fulfilling problem OGME – Does anyone care? Self-fulfilling problem OCME - Broken OCME - Broken

21. For-Profit Schools Permitted by COCA Permitted by COCA Prohibited by LCME Prohibited by LCME Illegal in some states (Kansas) Illegal in some states (Kansas) Research? NIH funding? Research? NIH funding?

22. The 1910 Initiative Commission a 21 st century survey of osteopathic medical education, a new “Flexner Report.” Commission a 21 st century survey of osteopathic medical education, a new “Flexner Report.” Reevaluate COCA standards. Special attention to membership, boards of COM’s and conflicts of interest. Reevaluate COCA standards. Special attention to membership, boards of COM’s and conflicts of interest. Moratorium on all for-profit COM’s and any not associated with universities. Moratorium on all for-profit COM’s and any not associated with universities.

23. Consequences of Inaction 1910 – FFS system 1910 – FFS system 2007 – Mostly third- party payers 2007 – Mostly third- party payers Someone will regulate this Someone will regulate this

24. HOD Resolution 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 reference for judging the quality of contemporary medical schools, and 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 reference for judging the quality of contemporary medical schools, and Whereas Abraham Flexner was highly critical in his Report of for-profit medical education, noting : “Such exploitation of medical education, is strangely inconsistent 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 exploited.",1 and Whereas Abraham Flexner was highly critical in his Report of for-profit medical education, noting : “Such exploitation of medical education, is strangely inconsistent 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 exploited.",1 and 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, and 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, and Whereas osteopathic medical education should be held to a standard at least equal to, if not exceeding, allopathic medical education, and Whereas osteopathic medical education should be held to a standard at least equal to, if not exceeding, allopathic medical education, and Whereas the accreditation standards of the Liaison Committee on Medical Education (LCME) explicitly prohibits for-profit medical schools2, therefore be it resolved that, Whereas the accreditation standards of the Liaison Committee on Medical Education (LCME) explicitly prohibits for-profit medical schools2, therefore be it resolved that, The House of Delegates strongly disapproves the establishment of any college of osteopathic medicine operated on a for-profit basis. The House of Delegates strongly disapproves the establishment of any college of osteopathic medicine operated on a for-profit basis.

25. I DISAPPROVE! DOCTORS NOT DOLLARS DOCTORS NOT DOLLARS