By Mark Lebwohl, MD, September 01, 2015
In my August column, I emphasized how important it is for dermatologists to team up with other specialties in advocating on our common issues. Working with like-minded physician groups and joining as a unified force has proven successful on some of the most pressing issues facing our specialty and our patients. However, while we have played in the sandbox with the greater house of medicine, we also need to consider how well we work together within our own specialty — particularly among DOs and MDs.
At the Academy, DOs and MDs are not in the same membership classification. MDs enjoy full Fellow membership status, yet DOs are considered Affiliate members and as such are not eligible to serve in an Academy elective office. However, the AAD Ad Hoc Task Force on Doctors of Osteopathic Medicine has proposed an amendment to our Academy bylaws that would give our DO colleagues full Fellow status. You would think this amendment would pass without much concern — almost every other medical specialty group classifies DOs as fellows. However, we have voted on this amendment twice before (2004 and 2010) and although 59 and 62 percent of you voted in favor of the amendment respectively, we cannot change our bylaws without a two-thirds majority vote.
Resistance to this amendment in the past has stemmed from the concern that DO dermatology residency programs are not on par with those of the MD side in terms of standards, requirements, certification, etc. However, we can rest assured that the programs accredited by the American Osteopathic Association (AOA) are legitimate. Just recently, the Accreditation Council for Graduate Medical Education (ACGME), the AOA, and the American Association of Colleges of Osteopathic Medicine announced that they will adopt a single, unified accreditation system for all graduate medical programs. Clearly, the discrepancies in training are a misnomer.
My perception of DOs changed more than 10 years ago when I was testifying at the AMA Specialty Society Relative Value Scale Update Committee (RUC) for an increase in phototherapy reimbursement. Phototherapy was on the brink of disappearing because the reimbursements were so low. To make my case, I needed data from 40 dermatologists on how long it takes to conduct every single activity associated with the provision of phototherapy — cleaning bulbs, applying mineral oil, etc. I called about 80 people, and while every DO came through with flying colors, our MD colleagues were only a fraction as good. It became very clear to me that not only do DOs want to be accepted as part of the dermatologic community — they clearly want to be involved in protecting our patients and our specialty as a whole.
We have so much to gain from elevating the DO membership status. The American Osteopathic College of Dermatology has 523 current Board-Certified members, yet there are only about 400 DO affiliate members of the Academy. Perhaps if the DOs were granted fellowship status, we would have a more robust population of DO members, and henceforth, a larger membership. Additionally, DOs currently play a valuable role in many of our Academy committees and initiatives. Elevating their status will surely only benefit us as a more well-rounded and powerful specialty. I encourage everyone to learn more about DOs at the Academy’s Doctors of Osteopathic Medicine Resource Center. As we move forward on tackling many new and pressing issues — such as the current workforce shortage, narrowing networks, payment reform, medical research, and access to care — it would behoove us as a specialty to come together with one unified voice and vote in favor of this bylaw amendment.