As the ACOI celebrates its 75th year of existence, external events are playing a prominent role in how the future will unfold. The impact of these events will be particularly important for residents and students. For most of its past, the College has focused on the education of internists from residency throughout the years of practice. A concerted effort initiated by the College leaders in the early part of this century resulted in dramatic growth of the number and quality of osteopathic internal medicine and graduate medical education programs. There are now four times as many trainees in osteopathic programs as there were 15 years ago.
The decision by the American Osteopathic Association to give up its authority to approve GME programs in favor of a single accreditation system means that the ability of the ACOI to influence the postdoctoral training of DO internists will be sharply curtailed, if not eliminated.
Even without the GME accreditation transition that will be completed by 2020, the ACOI Board of Directors would be engaged in ongoing strategic planning discussions to move the College forward. The impact of the single accreditation system has pushed these discussions into a higher gear. Beginning in June, 2015, the Board embarked on a process known as continuous planning. This means that facilitated planning discussions are taking place at least twice a year and will continue for the foreseeable future.
The Board has spent much of this time trying to identify what is distinctive about osteopathic internal medicine. The ACOI believes that DO internists share a common approach to health and healthcare that: begins with compassion, listening and a deep desire to understand; focuses on health first (not disease first); embraces the whole patient; views and considers each patient individually; emphasizes empathy; includes a 21st century way of incorporating the four tenets of osteopathic medicine, and recognizes and honors the interrelatedness of structure and function at both the micro and macro levels. It is acknowledged that other physicians and healthcare providers embrace many of these approaches, but the ACOI believes that the combination of these traits is what distinguishes osteopathic internists from all others.
A major strategic initiative of the ACOI is to assist all of our training programs to achieve ACGME accreditation. This effort has been remarkably successful as 32 of the 33 programs reviewed by the ACGME to date have been granted accreditation. This is a tribute to the quality of our training programs. The ACOI also has committed significant resources to assisting programs to achieve osteopathic recognition from the ACGME—a separate process from internal medicine accreditation. We believe that osteopathic recognition will assure the availability of those added osteopathic elements that have been of such benefit to the patients you serve.
As the College embarks on its next 75 years, the Board sees an opportunity to return to the roots and traditions of osteopathic medicine in a thoroughly 21st Century way. Internists have long been the leaders in osteopathic education and the ACOI is ready to meet this challenge. More information about the ACOI’s vision for the future will be shared as the planning process continues. Your views on these issues are welcome.
Brian J. Donadio, FACOI
Brian J. Donadio, FACOI, is the Executive Director of the American College of Osteopathic Internists. He may be reached via email at firstname.lastname@example.org.
I hope that this New Year finds everyone well and excited for the coming year. This can be one of the most interesting and stressful times of the year for many of us. In addition to the regular stresses of the holidays that everyone must deal with, you as residents and students have some things on your minds that everyone else in the world has no idea about.
As physicians and physicians in training, there really is no holiday break in the work schedule. People continue to be sick and hospitalized. Many of us will be working, caring for the ill or on rotation trying to learn, while missing our families. Many of you are away from your childhood homes and groups of family or friends. This time of year also brings other life-changing events. Third-year residents will be interviewing for first employment positions, or making final preparation for Fellowship or setting up practices. Students will be finishing up interviews for residency positions and starting to make lists for the Match. All of these things, in addition to short days, little sunlight, less chance to get outside, and the stress of long workdays can build up.
I want to let you know that you are not alone out there. This can be a tough time of year and many people want to help you get through it and enjoy it. There may be some things that we can do to get through the winter season.
Now is probably not the time to set stressful or overly ambitious resolutions. It is not the time to add more stress and obligations to your life; but it is a good idea to make sure you do something for yourself each day. Find something that can give you 30 minutes of pleasure for yourself. This should not be work related. Work out, walk, or talk on the phone, anything where you do not think about work at all. Try to do this each day.
Stay active. Exercise is a natural antidepressant. You can't make the sun shine, but you can get 30 minutes of activity each day. This will help with your mood, it will boost your immune system and for me, a run where I am sweating and breathing hard helps me put the rest of life's smaller issues in perspective. The key here is to do something active that brings you pleasure; don’t make this another obligation or burden.
Take time with loved ones. Our time at home is limited, but keeping our relationships strong will make us feel better and also keep our safety net in place. Take a walk with your significant other. Instead of eating at work, wait until you get home and eat with your family, or check in a couple of times a day by phone if you are away on rotation.
Do nothing. Physicians tend to be intense, driven people. To take time out of your day purposely to do nothing seems like a foreign concept. As I have matured, I have found that a few minutes a day to breath and clear my head is very helpful for keeping things from becoming more stressful than they need to be and to keep things in perspective.
Talk to someone. Doctors—we tend to be a high-achieving, independent group of people. It can be hard for us to recognize when we need help and even harder to ask for it. Depression can sneak up on you with the increased stress and the lack of sun. Talk to family; talk to your program director; talk to a medical professional; talk to someone. It is not a sign of weakness. You will feel better and you deserve to allow yourself to get help and be happy.
It is an exciting time! Enjoy every second of it.
Scott Girard, DO, FACOI
Scott Girard, DO, FACOI, is a hospitalist. He completed his internal medicine training at Geisinger Medical Center in Danville, PA in July, 2008, and now serves as a member of the ACOI Board of Directors. He may be reached at email@example.com.
I have learned so much while serving my time representing residents and fellows on the ACOI Board of Directors. My eyes have been opened to the inner workings of this great College. I have learned a great deal about both the personal and professional lives of my fellow Board members and osteopathic colleagues. Yet, one of the most valuable lessons they have taught me is that the first step in making change is to speak out.
I have personally witnessed this as the ACOI interacts with groups such as the AOA and AOBIM. I have seen them argue for changes and progress throughout the ACGME single accreditation transition. I have seen them fight for new osteopathic board certifications. Throughout, they remain dedicated and passionate about the osteopathic internal medicine profession and their patients. They have inspired me.
For some, speaking out comes naturally. For many, this is not so. Many feel hesitant about voicing their opinions, thoughts and beliefs to a mass audience in fear of rejection or criticism. But be assured there are many are like you. I, myself, deal with the overwhelming battle between courage and fear when speaking my mind to a large group. But, I encourage you to speak out. At times I have been afraid my voice would not be heard and ideas rejected. Fortunately, in those times when fear was winning the battle, my colleagues pushed and at times forced me to voice my opinion. They truly wanted to hear what I had to say and they listened. At times, to my relief, progress was made.
Of course there is nothing new or groundbreaking about the power of speaking out. Yet, given the political climate that has been evident throughout our nation’s recent presidential race, I feel that this topic cannot be ignored. Our nation is at a great divide. It has been very apparent that we as young people and physicians, have much to say. This is continuously exemplified through social media, television and radio reporting. It is taking place throughout virtually all encounters of daily life. I am sure many of us had interesting and even heated discussions at the dinner table during the holidays. I personally feel that this enthusiasm, debate and protest is exciting and important for the development of our nation.
If you think the above is a bunch of fluff and are rolling your eyes, HERE IS WHERE I NEED YOU TO PAY ATTENTION.
I encourage each of you to speak out as American citizens; however, the positions for which you stand will be left to your individual discretion. Yet, I believe that it is imperative that we speak out collectively as physicians in regard to the congressional and presidential intent and method to repeal the Affordable Care Act (ACA). In speaking with friends, family, colleagues and patients, there is unanimous agreement that the ACA is not perfect. Many are extremely thankful for the opportunity the ACA has provided to obtain health insurance. Many others are enraged that their premiums have increased substantially, or that they have been forced to decide between purchasing coverage or paying a fine. Acknowledging that the above is an understatement and simplistic analysis of others’ views, I truly empathize for all sides.
Because of this spectrum of viewpoints, it may or may not surprise you that there is much thought and discussion by Congress to repeal parts, if not all, of the ACA. Problematically, Congress does not have a replacement plan or even a consensus that one will be put in place prior to ACA repeal. It is possible that a repeal without replacement could leave nearly 20 million people uninsured. This would impose great financial stress on the insurance market, potentially resulting in higher premiums and deductibles for those able to afford coverage. Additionally, this could pose a major threat for patients with pre-existing conditions. If Congress decides to repeal without having a replacement plan, the effect that this could have on many patients we see every single day would be devastating. After much, much reading and discussion, I am at a loss as to how to speak with my patients that face these threats.
As physicians, we are viewed as pillars of society. We are the protectors of our patients’ health and well-being. We are the leaders of our communities. As young doctors, it was not long ago that we stood with our hands raised and swore an oath to “be mindful always of [our] great responsibility to preserve the health and the life of [our] patients.” In case you have forgotten, this was our Osteopathic Oath and the modern version of primum non nocere — first, do no harm. And with that comes the responsibility to try to prevent any harm imposed on our patients. So regardless of what you believe politically, and regardless of whether you think the Affordable Care Act is garbage or gold, to repeal without replacement poses a great threat to our patients.
With that, I urge you to contact your representatives and senators. Urge them to develop and reveal a health insurance replacement plan prior to any ACA repeal. Take that energy that has been filling Facebook and Twitter feeds. Take that energy that has been prompting marches and debates. Take that energy and begin to fill the mailboxes and inboxes of your representatives. Take that energy to flood the phone lines of your state senators. For these are the people that have been put in positions to represent you. Let them hear your concerns, questions, and explanations. Educate them. Put the pressure on. Speak out on behalf of our patients that it is imperative that a replacement plan be developed prior to any repeal of the Affordable Care Act. Never forget our oath and continue to speak out to your representatives in the future regarding any potential harm our patients may face. We are now and will continue to be the leaders of our profession. The future depends on our speaking out. We must find the courage to do so and maintain the energy that will allow our voices to be heard.
Chris Sciamanna, DO
Chris Sciamanna, DO, is the Resident Representative to the ACOI Board of Directors. He a cardiology fellow at Botsford Hospital in Farmington Hills, MI. He may be reached via email at firstname.lastname@example.org.
This is an incredible time to be practicing medicine. We are training in an era that some refer to as “The Fourth Industrial Revolution,” citing automation and cyber physical systems to come. In this article, we will focus on the extraordinary medical advances on the horizon, rather than the economic impact of the reform. These medical innovations will transform the way we practice, and as Residents and Fellows, our generation of physicians will be leading the charge.
This year, England’s National Health Service (NHS) will begin a long-awaited trial of “synthetic blood” on human volunteers. The blood is made from stem cells extracted from donated umbilical cord blood of newborns, or from the blood of adult donors. The first trials will focus on safety and adverse events. The immediate goal is to create large quantities of blood for patients who require regular transfusions, such as those with thalassemia or sickle cell anemia. If the trials are successful, the long term impact of this technology could be life saving.
A powerful targeted immunotherapy called CD19 chimeric antigen receptor (CAR) T-cell therapy may change the way we treat blood cancers like leukemia and lymphoma. Trials in children and adults with relapsed and refractory acute lymphoblastic leukemia (ALL) have reported complete remission rates as high as 90%. CD19-targeted CARs are paving the way for engineered T-cell immunotherapy. It is likely that the potential uses for these therapies will continue to expand in the coming years. If the U.S. Food and Drug Administration (FDA) approves this medication, CAR T-cell therapy will be made available to major cancer centers around the world in 2017.
Dysbiosis has been linked to many gastrointestinal disorders and may play a role in other areas of medicine such as obesity, cancer, psychiatric illness and immunology. The White House Office of Science and Technology Policy (OSTP) announced the National Microbiome Initiative (NMI) in May of 2016 to support research of microbiomes across different ecosystems. The combined Federal agency investment of over $121 million in 2016 and 2017 will focus on research, technological advancement and workforce expansion. The initiative may shed even more light on the important role of the microbiome in 2017.
Medical 3D Printing
In 2016, a three-year-old girl from Northern Ireland became the first human to receive a 3D printed kidney transplant at London’s Guy's and St Thomas' and Great Ormond Street Hospital. 2017 will bring more advances in this field, especially with centers like Wake Forest’s Institute for Regenerative Medicine, whose special focus is research and development on tissue and solid organ engineering. Along with advances in 3D printing of tissues, organs and prosthetics, we also saw FDA approval of the first ever 3D-printed drug, Spiritam (levetiracetam) by Aprecia Pharmaceuticals. Layers of powdered medication are stitched together with fluid to create a readily dissolvable water-soluble matrix, or “fast-melt” pill. The 3D technology allows for easy dose adjustment, and could lead the way in personalized medicine.
The ACOI will see an exciting year ahead in 2017. The ACOI will host the Internal Medicine Board Review Course in Las Vegas, March 24-27 and the Annual Congress on Medical Education for Resident Trainers and Chief Residents in San Diego May 4-6. The in-depth symposium for future Chief Residents and emerging leaders will focus on leadership and career advancement. And finally, the 2017 Annual Convention and Scientific Sessions will be held October 17-21 in the Washington, DC area. Residents and Fellows will have the opportunity to present personal research and attend lectures from esteemed experts in the field. We look forward to your attendance at a future ACOI event.
With so much research, development and possibility ahead, our profession has a lot to look forward to in 2017. We are privileged to offer such innovative care to our patients. Without a doubt, this truly is an amazing time to be a physician.
Sara Ancello, DO
ACOI Council on Education and Evaluation Resident Representative, Sara Ancello, DO, is a gastroenterology fellow at Mountain Vista Medical Center in Mesa, AZ. She may be reached via email at email@example.com
TALKING SCIENCE AND EDUCATION
ACGME Osteopathic Recognition Update
The Osteopathic Principles Committee has updated the Application Instructions for Osteopathic Recognition (OR) to reflect recent changes to the Osteopathic Recognition application. The application will no longer contain common program application questions or questions related to duty hours, patient safety, and learning environment. This does not in any way change our strong recommendation that programs consider OR as they are applying for ACGME accreditation. Issues such as scholarly activity, program evaluation and others can be developed in a manner that will meet the needs for both the ACGME Internal Medicine review and the review for OR by the Osteopathic Principles Committee.
African-American patients with diabetes are under-represented in US drug trials….still!
Even though diabetes rates are almost twice as high in African-American people as in whites, African-American patients may be far less likely to be included in drug safety trials, a recent study suggests.
Since 2008, the U.S. Food and Drug Administration has required that new glucose-lowering medications for diabetes be tested for cardiovascular safety, which may differ based on patients’ race or ethnicity, researchers note in The Lancet Diabetes and Endocrinology (12/21/16).
When researchers looked at seven diabetes drug trials done since then to test cardiovascular safety, they found that in five of the trials, African-American people made up less than five percent of the patients.
“In the United States the burden of diabetes and the serious complications associated with it fall unfairly on minorities, particularly African-Americans, yet it appears that they are under-represented in clinical trials of new therapies and devices,” said study co-author Dr. David Kerr of the William Sansum Diabetes Center in Santa Barbara, CA.
“If they are excluded they may be exposed to therapies which may not work or could cause harm,” Kerr added. “The therapies are also likely to be expensive and ineffective.”
About 13 percent of African-Americans in the U.S. have diabetes, compared with 7.6 percent of white Americans. Death rates from cardiovascular disease are also disproportionately high among African-Americans, the researchers point out.
When it comes to drug effectiveness and safety, self-identified race doesn’t necessarily predict response to a treatment, or suggest that outcomes would be similar among patients of different races. Still, the reality is that the majority of cardiovascular studies in recent decades have focused on white heterosexual males. The Lancet study confirms the notion that African-American subjects are poorly represented in large cardiovascular outcome trials in particular.
When drug trial participation isn’t balanced across gender, race, ethnicity and socioeconomic status, it can be easy to miss critical distinctions in how treatments may work in different types of people. Certain groups of patients may respond differently to the same therapies.”
There are examples beyond just diabetes. For example, studies have found two types of blood pressure medications (ACEs/ARBs) don’t work as well in African-American patients as in other people, and one medicine for heart failure (BiDil) works very well in African-American patients but not in white patients.
For some time we have known high-risk minority populations have been underrepresented in clinical trials. This major issue is not limited to diabetes studies but also cancer and clinical trials in a number of therapeutic categories.
Donald S. Nelinson, PhD
Donald S. Nelinson, is the Chief Science and Education Officer of the American College of Osteopathic Internists. He may be reached via email at firstname.lastname@example.org.
Process to Repeal ACA Is Underway
The House and Senate recently approved a budget resolution along party lines to begin the process of repealing the Affordable Care Act (ACA). The resolution directs the House Ways and Means and Energy and Commerce Committees and the Senate Finance and the Health, Education, Labor and Pensions (HELP) Committees to report out legislation that achieves at least a $1 billion deficit reduction from fiscal years 2017 through 2026. It is important to note that the package does not impose any penalties should the committees fail to act by January 27 as directed by the reconciliation instructions contained in the resolution. Utilization of this process allows the Senate to advance legislation to repeal the ACA with a simple majority and without the need to overcome the threat of a filibuster by the minority. Legislation to repeal the ACA previously was vetoed by President Obama.
In addition to the budget reconciliation process undertaken by Congress, one of President Trump’s first official acts was to issue an executive order directing the Secretary of Health and Human Services and the heads of all other executive departments and agencies with authorization under the ACA to “take all actions consistent with law to minimize the unwarranted economic and regulatory burden of the Act….” The executive order was issued providing Congress time to proceed with its efforts to advance legislation that repeals and replaces the ACA. The actual impact of the executive order remains unclear as do the next steps that will be taken by Congress. Progress has been slowed by concern that ill-conceived legislation could result in adverse impacts to insurance markets and currently insured individuals. The ACOI continues to monitor this matter closely as it impacts physicians and the patients they serve.
CBO Report Examines Repeal of ACA
According to a new report released by the non-partisan Congressional Budget Office (CBO), repealing the ACA could initially result in an additional 18 million uninsured Americans. Further, the CBO estimates that the number of uninsured Americans could grow by more than 32 million by 2026. The estimate was based on ACA repeal provisions contained in legislation vetoed by Present Obama during the previous Congress. The CBO analysis does not consider the impact of replacement legislation that could be enacted at the time of repeal. While the Trump administration and Republicans in Congress have identified repeal of the ACA as a priority, details have yet to be released on legislation to repeal and replace the ACA. As such, the impact of repealing the ACA on the number of uninsured remains uncertain if done through a comprehensive “repeal and replace” process. The CBO analysis serves as a reminder of the potential impact of modifying existing law. You can view the CBO report in its entirety at www.cbo.gov.
Tim McNichol, JD
Timothy W. McNichol, JD, is the Deputy Executive Director of the ACOI and is responsible for the College's advocacy efforts. He may be reached via email at email@example.com.
2016 Resident Research Abstract Contest Winners
A record number of residents and students entered the 2016 ACOI Research Abstract Poster Contest at the 2016 Convention and Scientific Sessions in Palm Desert, CA. From among these, three finalists were selected to present their original research during a plenary session. In addition three case presentations were selected by the judges. All finalists received cash prizes.
The ACOI congratulates all of the trainees who entered the contest, and in particular, the following prize winners:
NHSC WILL ACCEPT 2017 LOAN REPAYMENT APPLICATIONS UNTIL APRIL 6
The National Health Service Corps (NHSC) Loan Repayment Program (LRP) is accepting applications for fiscal year (FY) 2017. The program offers eligible clinicians up to $50,000 in student loan repayment in exchange for a two-year service commitment to work at an approved-NHSC site in a high-need, underserved area.
The NHSC LRP is open to licensed primary care medical, dental, and mental and behavioral health providers who are employed or seeking employment at NHSC-approved service sites. To be eligible, applicants must:
For any questions regarding the NHSC LRP, call 1-800-221-9393, Monday through Friday (except federal holidays) from 8:00 AM to 8:00 PM ET.
NHSC ZIKA LOAN REPAYMENT PROGRAM
The National Health Service Corps (NHSC) Zika Loan Repayment Program is accepting applications for fiscal year (FY) 2017. The program offers eligible clinicians up to $70,000 in student loan repayment in exchange for a three-year service commitment to work at an approved-NHSC site affected by the Zika virus. Three years of half-time clinical service is an option for awardees, where the maximum amount of loan repayment assistance is $35,000.
Priority will be given to applications from Puerto Rico, U.S. Virgin Islands, and American Samoa, as these are currently the only U.S. Territories in which the Centers for Disease Control and Prevention has confirmed widespread local vector-borne transmission of active Zika virus. However, applications from clinicians intending to practice in all other U.S. territories are eligible to apply.
The NHSC Zika LRP is open to licensed primary care medical providers and others who are employed or seeking employment at NHSC-approved service sites. To be eligible, applicants must:
For questions regarding the NHSC Zika loan program individuals may contact the Customer Care Center at 1-800-221-9393, Monday through Friday (except federal holidays) from 8:00 AM to 8:00 PM ET.
ACOI STAFF RESOURCES FOR RESIDENTS AND FELLOWS
The ACOI staff and the Council on Education and Evaluation are important sources of information and assistance for osteopathic internal medicine residents and fellows. Two staff members are available on a daily basis to address questions and concerns. Kara Kerns serves as postdoctoral training coordinator and can answer questions about general training requirements and specific individual training issues. Katie Allen is the ACOI certification liaison. Residents and other certification candidates are urged to contact her to clarify questions about completion of certification requirements.
ACOI policy is that all phone calls and e-mails are acknowledged and returned within 24 hours of receipt. Please take advantage of these resources available to you.
MOBILE ACCESS TO TRAINING STANDARDS, ANNUAL REPORTS AND MORE NOW AVAILABLE
The ACOI recently introduced an app that provides access to newsletters, meeting materials, training documents and other vital information via smart phones and tablets. The ACOI app allows instant access to the basic standards guiding all specialties, annual report forms required to be completed each year by all residents and fellows, curriculum information and more.
The app is compatible with Apple, Android, Blackberry and Windows devices and is easy to download. Access it here http://eprodirect.com/ema-sites/acoi/ and let us know what you think.
For more information, contact Ms. Susan B. Stacy (firstname.lastname@example.org)
John R. Sutton, DO
Martin C. Burke, DO
Christopher Sciamanna, DO
Board of Directors Resident Representative
Brian J. Donadio, FACOI
Timothy W. McNichol, JD
Deputy Executive Director
Donald S. Nelinson, PhD
Chief Science and Education Officer
Susan B. Stacy, FACOI
Director of Administration and Finance
Post-Doctoral Training Specialist
Member Services Specialist/
COUNCIL ON EDUCATION & EVALUATION
Susan Enright, DO, Chair Email
Joanne Kaiser-Smith, DO, Vice Chair Email
Frederick A. Schaller, DO Email
Andrew Z. Filiatraut, DO Email
Rick A. Greco, DO Email
Mathew R. Hardee, DO Email
Joanna R. Pease, DO Email
Sara Ancello, DO - CEE, Resident Representative Email