When will the ACOFP decide to start advocating for physicians?

Dr. Henwood:

I just read the email report about the future of physician payments:

Will you be discussing how performance measures takes time and energy away from patient care?

Will you be discussing how it is third party performance measures that you are endorsing which takes away from patient care and raises greatly the cost of business in a practice?

Will you be discussing how many physicians are terminating their contracts with insurers and working directly with patients to avoid the intrusions into patient care?

Will you be discussing how many physicians are planning to retire early because they are tired of dealing with third parties and just want to be physicians who treat their patients?

If you do not discuss any of the above issues then you are missing the boat.

As an Osteopathic physician, and as my father who was an Osteopathic physician before me, we did not go into practice to work for government or third parties.

When will the ACOFP decide to start advocating for physicians, instead of abdicating our authority and treatment choices to third parties?

I would be happy to discuss any of the above matters with you at any time.

Please call me at my office.

Dr. Steven Horvitz


Letter to AOA on ACGME merger: Problem & new solution

Dear AOA Pres. Dr. Vinn, et al.

This letter is in regard to, “Single accreditation for MDs and DOs by 2020,” in family practice news this month. We have been told by former AOA President Dr Ray Stowers that in recent years Osteopathic schools proliferated too quickly and created the need for more residencies than AOA could supply and government could fund. We were then told last year that the only solution would be to combine our Osteopathic GME with allopathic MD ACGME. In the article Dr. Vinn states, “… But Osteopathic training programs will still retain their unique focus.” He goes on to say, “this is an opportunity to both reinforce and proliferate or principles.” The question I raise is how is it possible to train, reinforce our principal teachings, philosophy and skills while not experiencing the potential disaster of the California experience of 1960?

As a product of, and believer in Osteopathic principles, schools, internships, residency training, postgraduate fellowships and CME, I believe our programs offer unique and distinct advantages over the other possibilities that exist. This unique Osteopathic approach to training, education and practice must be maintained for the betterment of human health. Under the plan to merge osteopathic graduate medical education with ACGME we would be absorbed, overrun and thereby changed to accommodate only the allopathic practice model.

Osteopathic graduate medical education has always strived for independence and excellence. This merger of programs would be a catastrophic mistake in the history of osteopathic medicine. Our DO distinctiveness would disappear from the practice of medicine of the merger goes to completion. The logical sequellae of the merger would be the loss of Osteopathic Medical philosophy in practice, as well as, all of our DO program directors will lose their jobs by the merger completion date of 2020.

I offer the DOs COMITT alternate plan to save Osteopathic training programs: The first step would be control of and smart steady growth of osteopathic schools, not uncontrolled proliferation. Osteopathic training programs produce diverse physicians with a large number of primary care specialty physicians including family medicine, pediatrics, gynecology, etc. The second step is the AOA to bring the data of our current primary care programs’ output to the government authorities and Congress that authorizes money for training programs. If we can mount a organized and cogent movement to convince the Congress and government leaders to champion the cause of primary care specialty training, they will support it for the good of the country’s health and their own political goals. Please consider this approach previous to your acceptance of the ACGME merger program which would destroy our osteopathic integrity.


Best wishes for good health,
Craig M. Wax, DO
Family physician, Editorial Board of Medical Economics
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax
Independent Physicians For Patient independence @IP4PI


330 East Algonquin Rd. Ste. 6
Arlington Heights, IL 60005

142 East Ontario St.
Chicago, IL 6061
October 31, 2012

Dear Osteopathic colleagues,

As actively practicing Osteopathic Family Physicians, we all believe in lifelong learning from our patients, experience, readings and personalized elective coursework. Traditionally, our process has included 4 years of college, 4 years of osteopathic medical school, 1 year of internship (PGY I) and at least 2 years of additional residency(PGYII, PGYIII) or a minimum 3 years residency post graduate training. After completion of the academic and practical curriculum, a physician passes a board exam to gain lifelong board certification with no expiration. For every three year cycle after that, a physician had to complete CME credits to indicate hours of practice experience, teaching students and residents, home reading study and personal choice of formal CME programs. This curriculum allowed flexibility, personalization and relative economy for each practicing physician as they could choose the courses within the AOA categories.

Osteopathic family medicine residencies developed in the 1970s. In the 1980’s, physicians who didn’t complete a family medicine residency were allowed to be “grandfathered in,” and become board certified without having completed 3 years of residency training. They gained all the rights and privileges of board certification and continued with their 3 year CME cycle.

Starting for ABOFP/ACOFP family medicine completing residency in 1997, each physician now had to be recertified by taking another board exam every 8 years (time limited certification). This cost physician’s additional time and money. Physicians board certified previous to 1997, even those “grandfathered in,” were still lifetime certified and never had to spend their time and money pursuing board recertification. This is discrimination against those who rightfully completed family medicine residency by those in leadership positions who themselves were “grandfathered in,” and not actually residency trained. Their previous training, although at least 3 years less than those who were residency trained, apparently have omnipotent superior lifetime skills and don’t require additional testing to maintain their board certification.

Starting for this same group of ABOFP/ACOFP board certified family physicians who completed residency in 1997, there is an additional maintenance of certification/osteopathic continuous certification (MOC/OCC) procedure that becomes mandatory on January 1, 2013. MOC/OCC now demands that in addition to all the foregoing time, retesting procedures and expenses, residency trained physicians must additionally enter patient data on two time periods to somehow measure a physician’s skill and participate in an online procedure requiring many hours and cost an additional $3,000 at minimum. This is burdensome, expensive and not statistically proven to improve care. Further, it does stand to generate significant money profit for the ABOFP, ACOPF and AOA which makes it a conflict of interest. Furthermore, once again, those board certified previously to 1997 in osteopathic family medicine, remain lifelong board certified without additional testing or the requirements of MOC/OCC. This too is discrimination against those who have spent the time, effort and money pursuing residency training and initial testing for board certification.

All requirements for all practicing DOs should be consistent throughout and not required for some but not others. All MOC/OCC roads seem to lead to MOL – maintenance of licensure and the regulatory capture of osteopathic medicine. As a practicing osteopathic family physician, I refuse to participate in MOC/OCC and time delimited certification as they are:

1. MOC/OCC and time delimited certification are only required for those board certified finishing residency on or after 1997 and not required for those board certified finishing residency prior to 1997.

2. MOC/OCC and time delimited certification are not required for those who did not complete residency, but “grandfathered in,” to board certification.

3. MOC/OCC and time delimited certification are burdensome in practice by taking time away from disappearing patient care time.

4. MOC/OCC and time delimited certification takes time away from disappearing personal health and family time.

5. MOC/OCC and time delimited certification are not statistically proven to improve care.

6. MOC/OCC and time delimited certification are based on a discriminatory procedure that exempts residency trained physicians who completed training before 1997.

7. MOC/OCC and time delimited certification are based on a discriminatory procedure that exempts non-residency trained, “grandfathered in,” physicians who were in practice prior to 1997.

8. MOC/OCC and time delimited certification are financially burdensome to practicing osteopathic family physicians.

9. MOC/OCC and time delimited certification creates and maintains new procedures the ABOFP, ACOPF and AOA will gain significant sums of money from and is therefore a conflict of interest.

10. MOC/OCC may be used by insurance companies to discriminate against DOs on payments and network participation

11. MOC/OCC may be used by hospitals to discriminate against DOs for staff privileges.

12. MOC/OCC may lead to MOL and the regulatory control of osteopathic medicine.

13. MOC/OCC and time delimited certification are unreasonably burdensome in a physician’s time and money that is threatens their rightful practice of Osteopathic family medicine. This violates the Osteopathic oath of Andrew Taylor Still, DO that we all pledged to uphold, that even the AOA, “never by word or by act cast imputations upon them (DOs) or their rightful practices.”

Best wishes for good health,

Craig M. Wax, DO

Residency trained, Osteopathic Family Physician

Host of Your Health Matters on Rowan Radio 89.7 WGLS FM

Medical Economics Editorial Board Member