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<p class=MsoNormal><span style='font-family:"Tw Cen MT","sans-serif";
color:#0033CC'>Dear Students,<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Tw Cen MT","sans-serif";
color:#0033CC'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Tw Cen MT","sans-serif";
color:#0033CC'>If you are interested in a career as a physician, especially in
primary care, the following article is helpful in describing possible efforts to
reduce student indebtedness. It might also be a prompt to learn more
about careers as a doctor of osteopathic medicine.</span><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'><o:p></o:p></span></p>
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<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span
style='font-family:"Arial","sans-serif"'>Dear Advising Colleagues,<o:p></o:p></span></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span
style='font-family:"Arial","sans-serif"'>We thought you and your students
would find AACOM President, Dr. Shannon’s <i>Inside OME</i> column,
“<i><span style='color:black'>Could New Programs Eliminate Debt for
Tomorrow’s Osteopathic Primary Care Physicians?” </span> </i>of
interest. <strong><span style='font-family:"Arial","sans-serif";
font-weight:normal'>You may view the column and more <i>Inside OME</i>
content on-line at: </span></strong><a
href="http://www.aacom.org/resources/ome/2010-06/Pages/president.aspx"><span
style='color:windowtext'>http://www.aacom.org/resources/ome/2010-06/Pages/president.aspx</span></a><o:p></o:p></span></p>
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<p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial","sans-serif";
color:black'><img border=0 width=150 height=25 id="_x0000_i1027"
src="cid:image002.png@01CB1CFF.64BC95B0" alt="Inside OME logo"><o:p></o:p></span></p>
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<p class=MsoNormal><span style='font-size:7.5pt;font-family:"Arial","sans-serif";
color:black'>June 2010 - Vol. 4, No. 6 </span><span style='font-size:
9.5pt;font-family:"Arial","sans-serif";color:black'><o:p></o:p></span></p>
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<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><!--[if gte vml 1]><v:shapetype
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</v:shapetype><v:shape id="Picture_x0020_2" o:spid="_x0000_s1027" type="#_x0000_t75"
alt="Steven C. Shannon" style='position:absolute;margin-left:0;margin-top:0;
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</v:shape><![endif]--><![if !vml]><img width=100 height=141
src="cid:image003.jpg@01CB1CFF.3D7CAC10" align=left hspace=10 vspace=6
alt="Steven C. Shannon" v:shapes="Picture_x0020_2"><![endif]><b><span
style='font-size:9.5pt;font-family:"Arial","sans-serif";color:black'>Stephen
C. Shannon, DO, MPH<br>
President</span></b><span style='font-size:9.5pt;font-family:"Arial","sans-serif";
color:black'><o:p></o:p></span></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span
style='font-size:12.0pt;font-family:"Arial","sans-serif";color:black'>Could New
Programs Eliminate Debt for Tomorrow’s Osteopathic Primary Care
Physicians?</span></b><span style='font-size:9.5pt;font-family:"Arial","sans-serif";
color:black'><o:p></o:p></span></p>
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<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>This
is the time of year when osteopathic medical school graduates celebrate the
culmination of their undergraduate medical studies and transition to their
residencies. But even as they celebrate, many find that they also are under
considerable financial stress. On average, today’s medical school
graduate is shouldering more than $151,000 in educational debt. And in some
cases, this debt is serving to drive graduates away from primary care career
choices (osteopathic medicine’s traditional emphasis) and toward more
lucrative medical specialties.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Nevertheless,
osteopathic medical school graduates continue to pursue primary care fields
(internal medicine, family medicine, pediatrics) in proportions significantly
surpassing those of their allopathic colleagues. Forty percent of those that
matched in the 2010 AOA residency match will be entering osteopathic primary
care programs. And of the 1,444 DO graduates participating in the <a
href="http://www.nrmp.org/data/resultsanddata2010.pdf">2010 ACGME match</a>, 55
percent will be entering primary care programs. In contrast, just 34 percent of
U.S. MD graduates matched into primary care training. More telling is family
medicine. This year (and in recent years), only 7 – 8 percent of U.S. MD
graduates have matched into that specialty, whereas around 20 percent of DO
graduates select family medicine programs, whether choosing AOA or ACGME (or
combined) programs.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>However,
the trend among osteopathic medical graduates has been away from primary care
(56 percent of U.S. DOs are primary care physicians; 41 percent are family
practitioners). What makes this important? Why is there concern about primary
care specialty selection? What is the impact of educational debt? <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Today,
about 32 percent of the U.S. physician workforce consists of primary care
physicians, and most health policy experts suggest that in a well-functioning
health care system, that percentage should be 40 – 50 percent. If current
trends continue, rather than growing the number and proportion of primary care
physicians necessary for our health care infrastructure, there is a real chance
that the current numbers will in fact shrink over the next two decades. Similar
trends away from primary care practice among physician assistants and nurse
practitioners challenge the notion that the contribution of these two
professions will offset primary care physician shortages.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Although
the issue is more complicated than debt alone, we should explore what might
happen if the prospect of significant debt were removed from the primary care
choice picture. Would new DOs surge in greater numbers to the primary care
fields? Could the nation meet its increasing needs in this critical area if it
were to provide enough help that an entire cadre of primary care physicians had
their student loans repaid in full? Although much remains to be done in this
regard, myriad new efforts nationwide provide incentives for medical students
to pursue careers in primary care.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>In
addition to provisions that provide bonus payments and other incentives for
primary care physicians in the recently enacted health reform law, the Patient
Protection and Affordable Care Act, a variety of scholarship and loan repayment
programs have been greatly enhanced. <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Funding
provided by the American Recovery and Reinvestment Act of 2009 (ARRA) allowed
the <a href="http://nhsc.hrsa.gov/">National Health Service Corps (NHSC)</a> to
expand its already extensive programs. The NHSC recruits health care
professionals to practice in underserved communities through scholarships and
loan repayments. Through ARRA, the NHSC received $200 million in addition to
regularly appropriated funds, permitting the doubling of its field strength.
Primary care clinicians who currently work in or are interested in working in
underserved communities may be eligible to receive up to $50,000 in medical
education loan repayments each year. And, if the Congress appropriates above
the FY 2008 level, the health reform law mandates $1.5 billion over five years
(FY 2011 to FY 2015) for the NHSC to provide service-based debt relief to
encourage more physicians to go into primary care and work in areas
experiencing physician shortages. In addition, new provisions that allow
graduates to receive loan repayments for half-time NHSC service provide
flexibility to those seeking nontraditional positions while they attend to
family needs or other clinical work.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Many
other federal and organizational loan repayment programs also have been
established or expanded. And, in an effort to shore up the primary care
workforce in their underserved areas, many states have enacted legislation that
provides loan repayment to medical school graduates who commit to in-state
primary care practice for a number of years. For available student loan
repayment programs, see our <a
href="http://www.aacom.org/InfoFor/students/finaid/Documents/VCOM_Loan_Repayment_Programs.pdf">online
list</a> (compiled by the Edward Via College of Osteopathic Medicine), which
provides links to program details.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>The
health reform law also addressed federally supported student loans for students
willing to commit to primary care service. To increase the appeal of the <a
href="http://bhpr.hrsa.gov/dsa/pcl.htm">Primary Care Loan Program</a>, the act
eased current criteria for schools and students to qualify for loans and
shortened the length of the primary care practice requirement. It also lowered
the additional interest rate that students failing to comply with their loan
agreements must pay from 18 percent to 2 percent.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>And,
the establishment and funding of teaching health centers (THCs) and community
health centers will bolster opportunities for new primary care physicians. The
health reform law authorized a grant program in which THCs may receive
three-year grants for up to $500,000 to establish or expand primary care
residency programs. The funds may be used to cover costs for curriculum
development; recruitment, training and retention of residents and faculty;
accreditation; and faculty salaries during the development phase. The law
authorized $25 million for fiscal year (FY) 2010, $50 million for FYs 2011 and
2012, and such sums as are necessary for each subsequent FY. Importantly, the
law also authorized and appropriated funding in the amount of up to $230
million over five years (FY 2011 to FY 2015) for payments to qualified THCs for
direct and indirect costs of training residents. If these programs
develop as hoped, they will be training a cadre of primary care physicians
specifically oriented to practice within community health centers and other
locations serving underserved populations and qualifying for NHSC or other loan
repayment designation. <o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Both
ARRA and the health reform law allocated significant funding to beef up the
nation’s community health centers, providing both expanded opportunities
for new primary care physicians and greater access to primary care services for
those most in need. Nine months after receiving $2 billion in ARRA funding,
health centers had served an additional 1.8 million patients, representing the
largest annual growth in the history of the <a href="http://bphc.hrsa.gov/">Health
Center Program</a>. As with the NHSC, if the Congress appropriates above the FY
2008 level, the health reform law mandates $11 billion over five years (FY 2011
to FY 2015) for community health centers.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Of
course, all of these programs are aimed at expanding access to primary care and
mitigating the nation’s primary care physician workforce shortage, which
is expected to reach critical proportions over the next decade. Nevertheless,
they represent a potential win-win for the nation and osteopathic medical
students who may find a pathway to primary care practice.<o:p></o:p></span></p>
<p><span style='font-size:11.0pt;font-family:"Arial","sans-serif";color:black'>Recently,
I heard one health policy expert say he believes that if every one of the many
opportunities these programs collectively present were taken advantage of by
medical students, an entire generation of primary care physicians would face no
debt at all. I am not sure that is yet the case. However, working toward such a
goal, training the physicians we need (which osteopathic medical education does
so well), providing them an opportunity for service in exchange for debt
forgiveness or loan repayment, and improving reimbursement and the overall
atmosphere for primary care practice could go a long way toward helping to
solve this long-term and complex problem.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>___________________<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:9.0pt'><o:p> </o:p></span></p>
<p class=MsoNormal><a
href="http://www.facebook.com/pages/Chevy-Chase-MD/AACOM-The-American-Association-of-Colleges-of-Osteopathic-Medicine/49933236324"><span
style='font-size:9.0pt;text-decoration:none'><img border=0 width=72 height=26
id="Picture_x0020_1" src="cid:image004.jpg@01CB1CFF.3D7CAC10"
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width=65 height=84 id="Picture_x0020_0"
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<p class=MsoNormal><b><span style='font-size:9.5pt;color:#004080'>2011
Osteopathic Medical College Information Book Now Available<br>
</span></b><span style='font-size:9.5pt;color:black'>Includes descriptions
of all of the osteopathic medical colleges, admissions criteria, minimum
entrance requirements, supplementary application materials required, class
size or enrollment, application deadlines, and tuition. <u><a
href="https://www.netforumondemand.com/eweb/shopping/shopping.aspx?site=aacom&prd_key=7065bd53-d4cc-43f1-91c3-4ac25b5c51d1">Get
more info.</a></u></span><span style='font-family:"Courier New"'><o:p></o:p></span></p>
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