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Letter From Dr. Burke

Mission Critical: Continue to Innovate Osteopathic IM Education and Certification

The ACOI is looking forward to an innovative and creative 2018 that results in substantial transformation into a physician services organization. As I have previously mentioned, a primary ACOI service strategy is to expand our Osteopathic Internal Medicine education activities beyond the traditional destination CME and case-based Osteopathic Continuing Certification (OCC) modules. This expansion is already taking place under the direction of the ACOI Board and our able staff.  New initiatives in online learning will soon be unveiled. Programs that provide educational content for our Cardiologists, Hospitalists and Residency Program Directors will be offered in Chicago in April concurrently with our usual high-value Internal Medicine Board Review Course.  The April meeting is shaping up to be an osteopathic internal medicine tour de force so please consider joining us.
The ACOI is looking to position our College strategically as a leading provider of online IM education products, using our brand of patient-centric, clinically-relevant, cutting-edge content. We are is investing resources to create an online platform that provides smooth access to higher-level new content that is web and video-based no matter what type of device it is accessed from. The content and delivery are a critical piece of innovation designed to ensure that our members, both current and future, have the tools necessary to easily keep up-to-date and maintain private time for ourselves and our families. 
American Osteopathic Board of Internal Medicine Update
Brian Donadio and I had the pleasure of meeting this month with the members of the American Osteopathic Board of Internal Medicine (AOBIM).  It is important to recognize this board for its superb leadership and volunteer effort in determining what it means to be an osteopathic IM-certified physician, and for delivering the highest quality metrics to insure an outstanding physician class for patient care worldwide. The history and high-end output of this board situates it for a bright future.  Our shared vision is to maintain the continuum of osteopathic education and certification, while expanding opportunities to like-minded, qualified internists, both osteopathic and allopathic. As I mentioned last month, the ACOI is a devoted partner with the AOBIM and, as our face-to-face meeting supports, we are committed to making this work for our members and all diplomates. The AOBIM wants to innovate two-steps ahead. Consequently, the two groups have agreed to remain in constant communication. As the AOBIM (and the AOA) settles on the evolving criteria for OCC, we will relay details and progress to your. 
Professional Stewardship and Wellness
Physician wellness and life are key components considered today in every initiative created by the ACOI and the Board of Directors. In this light, internists need to build or further their leadership “mojo” back into the clinical setting in order to preserve the profession. Physicians lead naturally as the stewards of health and well-being on behalf of humankind, and, we together, need to protect this very aspect while not killing ourselves in doing so.  Our Osteopathic oath dictates such patient-oriented stewardship and leadership.  Patient care operationally needs to be rationalized to allow for more organizational time for us to lead (whether employed, or independent) our clinical infrastructure into more equitable, patient-focused models that are traditionally osteopathic (In other words, an administrator should never be allowed to utter that “you spend too much time with patients.”).  Historically, A.T. Still’s frustrations have created a sustained and important movement in American Medicine through his vision and leadership. Let’s pick up that banner for the entire medical profession, which is currently meandering. 
To start small with a few hinge points, the wellness of our profession and colleagues depends on addressing some of the following:
  1. We can no longer accept the metric that physician salaries have been flat for the last 10 years when it is completely untrue!!  A critical shift of the “Affordable Care Act” (tongue in cheek emoji here) has been volume, despite the introduction of electronic access to test results, order sets and catching up on notes 24/7.  Our 12-hour work day has doubled and the salaries have remained flat while hospital networks and insurance companies have seen colossal gains at the expense of our profession and wellness. This is unsustainable and we must stop staring at it.  Physicians manage risk with fewer and fewer resources, which in a capitalist market is unsustainable. Historically, physicians are more likely to direct resources to limit the risk to patients through systems and techniques in a progressive way, because we feel the risk (that’s how medicine progresses).  It is not easy to be well when being taken advantage of consistently.
  2. We have to balance access points to continuity of care while rewarding all forms of care by valuing Osteopathic tenets of human care. There can be a happy medium here where value and expertise are valued equally to quality of life.  If we do not take charge to lead us out of this market reality, then patient care will eventually be managed only by the ER, urgent care centers and hospitalists because there will be too few physician-led ambulatory systems to which to transfer care. The current clinical care resource distribution is not sustainable. 
  3. We need to control our clinical outcomes and care data in order to direct and re-invest resources back into local clinical care systems.  The care of patients is very local. It requires physician leadership and analysis in order to protect it and advance it. This begins with systematic data collection and analysis that is regionally unique and quantified. Currently, this data is being collected without reference and used as a commodity by hospitals and insurance companies with no re-investment in patient care. In fact, the least amount of resources are returned to physician-lead care systems. A profession is defined by the health of its client list.  We are losing control of our patient lists for various reasons, but we can control the data and categorize the way patients are treated in order to improve care. You already do these calculations in your practice.
The ACOI is a place where we can begin to address and craft strategies together for the initiatives or facts described above and beyond. Whether independent or employed, we need to start small and rebuild leadership into the clinical operation that is patient-focused.  As an association, the ACOI can assert more collective interest in our member’s well-being, as well as promote the survival of the osteopathic profession, even when the entire American medical profession is on its heels.  Please share your personal or professional strtegies and examples of patient-focused leadership with me or the ACOI staff so that we may craft best practices in gaining local leadership.  I cannot think of a better resource than our members, as you are most likely to find ways to lead every day. 


Martin C. Burke, DO, FACOI