Expanding OGME - Shared Resources ... Shared Responsibility

There was an interesting article in the New York Times on June 17^th that discusses Medicare’s claim that CT scanning is overused in many of the nation’s hospitals.  This was especially apparent in non-academic centers.  “Double scanning” means ordering both a contrast and non-contrast scan of the same body part on the same patient.  This is part of Medicare's new "use of medical imaging core measures" on their Hospital Compare site.

Also of interest was the fact that, as with most Medicare data, there were wide disparities both locally and nationally.  For instance, the rate of “double scanning” was only 1% in Massachusetts and was 13% in Oklahoma.

So what does this have to do with OGME you ask??

Well, if one follows the link to the article, they will see that there is a wonderful interactive map attached.  While this map is intended to give the viewer an idea of the CT problem spots, it also provides a wonderful interactive look at ever hospital in the United States that does CT scans (and every hospital in the US that sponsors OGME).  A quick glance and the reader will note that most of those hospitals are on the East Coast.  The reader will also note that there are relatively fewer West of the Mississippi.

Much like OGME programs…

Much like ACGME programs…

The geographic misdistribution of AOA accredited OGME programs is a real problem that gains much air time in educational debates.  There is an excellent map showing this data published in the recent education edition of the JAOA. 

As noted, this is not unique to OGME.  When I ran the data in 2006, the distribution of OGME shared significant correlations with both US population and ACGME programs by state (California and Texas being the glaring exceptions).  While I have not run the data recently, I see no reason to suggest that this has changed in a negative way.

I want to be clear – I’m not suggesting that there is not an OGME distribution problem.  There are clearly issues in the West and some of the South.  There are also discrepancies in New England as well, but we rarely here about this.  I make the comment because I believe that we should resist the temptation to focus only on areas of perceived need.  When we worry about the size of the slices of pie, we simply get in our own way and do not move forward to accomplish our ultimate goal - making the OGME pie bigger.

The solution is to build programs – anywhere that we can build them – anytime we can build them.

It seems synergistic to build these programs in areas that are geographically contiguous with our Colleges of Osteopathic Medicine, but … we need programs anywhere that we can make them happen. 

It seems to make sense to have Osteopathic Postgraduate Training Institutions (OPTIs) involved in building programs – many have done a superb job – but … we can’t afford to limit our scope to just OPTI generated growth.

Maybe we should look to virgin hospitals (those without any current GME)?  Maybe we should look to dual accredit programs that are already ACGME accredited?  Maybe we should look to alternative sites like Federally Qualified Health Centers (FQHC)?  The answers to these questions??  YES, YES and YES!!

Should we build specialty programs or primary care programs?  I think that by now you know my opinion...

To increase the size of the OGME pie – our ultimate goal to train our COM grads and provide value to the public – we cannot be parochial in our means to meet the end.  Any time, any where and by anyone.  In the words of Harry Truman:  It is amazing what you can accomplish when you do not care who gets the credit.