Creating a New Specialty

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Creating a New Specialty Correctional Medicine
A CALL TO ACTION

• David Thomas, M.D., J.D.
• Dianne Rechtine, M.D.
• Nova Southeastern University School of
  Osteopathic Medicine

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Previously

• NSU Created a 2 year fellowship including an MPH
  leading to a Board Certification in Correctional
  Medicine
• This effort began in 2005
• It has a unique- non-CMS funding source
• In 2011 the AOA accepted the concept of
  Correctional Medicine as a specialty
• In 2012 the Fellowship was approved by the AOA.
  as a pathway to Board Certification

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Brief Re-Cap

• Much of this material was presented at this
  conference previously
• 1. Initial Step- 4th year student rotation in a
  prison
• 2. Student rotation led to Correctional
  Fellowship
• 3. Success of Fellowship led to Psychiatry
  Residency
• 4. AOA accepts the concept of both
• 5. Board Certification in Correctional Medicine
• 6. Board Certification in Psychiatry

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On the HORIZON

• In 2012 the Accreditation Council for Graduate
  Medical Education reached out to the AOA to
  create a joint/mutual certification process with
  each organization recognizing the others
  training programs
• Oct. 24, 2012 The AOA entered into an agreement
  with ACGME and AACOM to pursue a single, unified
  accreditation system for graduate medical
  education programs in the United States beginning
  in July 2015.

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Numbers

• Currently, the ACGME accredits over 9,000
  programs in graduate medical education with about
  116,000 resident physicians, including over 8,900
  osteopathic physicians.
• The AOA accredits more than 1,000 osteopathic
  graduate medical education programs with about
  6,900 resident physicians, all DOs.

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Seamless transition for GME

• The transition to a unified system would be
  seamless so that residents in or entering current
  AOA-accredited residency programs will be
  eligible to complete residency and/or fellowship
  training in ACGME-accredited residency and
  fellowship programs.

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For Us

• Modification of ACGME accreditation standards to
  accept AOA specialty board certification as
  meeting ACGME eligibility requirements for
  program directors and faculty
• Programs in graduate medical education currently
  accredited solely by the AOA will be recognized
  by the ACGME as accredited by the ACGME and
• Participation by the AOA and AACOM in
  accreditation of programs in graduate medical
  education accreditation to be solely through
  their membership and participation in the
  ACGME.  

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WHY

• A year ago both organizations were at one
  anothers throats- AOA was going to sue ACGME and
  ACGME was going to bar DOs from all Fellowship
  programs
• WHAT HAPPENED????
• 1991 while in Fl Leg- Gail Wilensky (GHW Bush Sr
  Health Advisor) Cardiologist - 1 Million
  training refuses to see poor - this has to
  change

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Cost differences between programs

• Former CMS Director Don Berwick- 10.5 Billion
  dollars on GME and what are we getting for it???
• Push from HHS and CMS for accountability and
  reduction in costs
• Cost and quality comparisons of GME approaches

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What does this mean for us in corrections

• Within 2 years- before your Fellow finishes their
  program ACGME and AOA will both be recognizing
  correctional medicine as a specialty
• You need to create programs in your institutions
  now
• Acceptable programs will be 2 years with an MPH
  or equivalent masters degree

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YOU

• By about 2015 or so will be able to be
  grandfathered into the specialty
• Will need to create a program
• Willing to share our curriculum and mechanisms
• Three are in the process of starting now- Larkin
  Hospital Univ of N. Texas- Dallas Univ of
  Oklahoma- Tulsa
• Will need to create a funding mechanism for your
  program- seek out corrections- they can use you

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Dont be left behind
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Current Situation

• The Graying of Corrections- An Issue for Both
  Inmates, and Staff
• Not only are inmates trending to be older, but
  staff is as well.
• Need to encourage newcomers into the field

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Note the ages of the attendings on a volunteer
mission to a Jamaican Prison
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BURNOUT- Very Stressful Environment

• Many physicians do not fit well into corrections-
  Used to having facilities designed for and built
  around the PHYSICIAN and his interactions-
  Corrections is NOT this way
• While health care is a Constitutional
  requirement- it is NOT the reason jails and
  prisons exist- unlike other areas of our life
• This Creates STRESS on the physician

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Stress Tony Snow- 2006-2008
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Training Program

• Lets the neophyte understand the environment and
  their position in that environment
• Lets the neophyte understand that correctional
  medicine is more than seeing your patients
• Lets the neophyte understand how they can
  contribute to the field
• Creates a Career track

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Correctional Medicine

• Correctional medicine will never rise to the
  level recognition of competence and quality that
  it deserves without a Specialty certification.
  The feeling will always pervade that any doctor
  can cover a jail or prison just as the feeling
  was in the 1970s that any doctor can cover an
  emergency room.

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Not ANYBODY Can DO THE JOB
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It is essential that

• We work together to get Correctional Medicine as
  a Specialty designation and create a cadre of
  specialists in the field
• Why-
• Get young physicians to make a career in field
• Keep physicians in the field
• Create real continuity of care
• Improve the care for our patients