American Osteopathic Association Installs New President

Thomas Ely says doctors of osteopathic medicine are helping to address physician shortages in rural and underserved areas of the country.

The new president of the American Osteopathic Association has prescriptions for U.S. healthcare.

Thomas Ely, DO, assumes his leadership role at the AOA with several momentous challenges facing physicians, including the deadliest pandemic in a century, high burnout rates, and a looming physician shortage.

An Army veteran, Ely served as an aeromedical evacuation pilot early in his military career. He worked for the Army Surgeon General before earning his doctor of osteopathy degree from what is now Kansas City University of Medicine and Biosciences College of Osteopathic Medicine.

He cofounded a private practice in Clarksville, Tennessee, that later helped form a large physician-led multispecialty medical group. He has experience in hospital leadership, including working as chief of medical staff, director of medical affairs, and chief medical officer. When Ely was installed as AOA president last month, he was working as a healthcare consultant.

Ely recently talked with HealthLeaders about the goals of his AOA presidency and the challenges facing U.S. physicians. The following is a lightly edited transcript of that conversation.

HealthLeaders: Besides the coronavirus disease 2019 (COVID-19) pandemic, what are the top priorities of your AOA presidency?

Ely: I have three major goals.

I want to continue the expansion of our osteopathic community. I want to enhance the American Osteopathic Association's and osteopathic medicine's public health mission. And I want to continue to secure the future of our profession.

When I say expansion of the osteopathic community, osteopathic medicine is the fastest growing healthcare profession in the country. We have grown 63% in the past decade, and more than 300% over the past three decades. Despite this growth, many regions of the country are suffering from physician shortages, particularly in rural and underserved areas.

With respect to the public health mission, I would like to focus on vaccination and immunization. Everyone must get the flu vaccine this fall. And we must encourage families to continue the routine care and immunizations that protect them from disease. When there is a vaccine ready for COVID-19, we need everyone to get that, too.

With the potential combination of influenza virus on top of COVID-19, both could kill you. People need to avoid the risk of having that combination.

To secure the future of our profession, I think a lot about our students. One of the great things that has come to fruition is the transition to a single graduate medical education system in this country. Osteopathic physicians and allopathic physicians all now are competing for quality, post-graduate training under a common system.

HL: What are the top challenges facing physicians?

Ely: The first challenge is related to independent physician practices, especially primary care practices because they have experienced devastating economic effects from the pandemic.

The established parameters of physician compensation must be addressed. Physicians should be compensated for their judgment and their outcomes. Payers must recognize that physician practices are different, depending on their specialty, the type of practice, the location of practices, and, most importantly, the makeup of their patients.

The second challenge is personal wellness and self-care. If physicians can schedule patients, they can schedule self-care for themselves and their families. They must take care of themselves if we are going to get through this pandemic.

The third challenge is to make sure that our patients continue to be seen for their chronic medical conditions such as diabetes, heart failure, chronic obstructive pulmonary disease, and renal failure. Most importantly, we need to make sure our patients keep their children current on vaccinations and immunizations.

Finally, the opioid crisis has not gone away. We need to continue to provide care and support for patients impacted by this crisis. Many communities in this country are reeling from the double blows of the opioid epidemic and the COVID-19 pandemic. In 2018, there were more than 67,000 people who died from drug overdoses, and in 2019 that number was higher.

HL: What are the primary ways to address physician burnout?

Ely: Healthcare professionals are showing significant rates of post-traumatic stress, anxiety, insomnia, and depression, according to new National Institutes of Health research. Not only are our physicians faced with unprecedented levels of death and suffering during this pandemic, many are losing their colleagues and family members. This is truly a devasting time for the entire healthcare community.

There is one thing I tell every graduating medical student that I see and that I tell osteopathic physicians on an ongoing basis: They must take care of themselves. Significant numbers of physicians will—at some time in their practice life and especially during this pandemic—have periods of dysthymia. If that ever occurs, I advise them to reach out to another physician. Don't sit there alone because there is a strong likelihood that any physician they reach out to has encountered the same thing in his or her life, and can give advice on immediate and best steps to take.

Fortunately, there are some good resources available. I would encourage anyone on the frontlines of the pandemic to reach out to the Physician Support Line. It is a free, confidential service that supports the mental health of doctors and medical students.

HL: The Association of American Medical Colleges is predicting there will be a shortage of as many as 139,000 physicians by 2033. How can the physician shortage be addressed?

Ely: When I applied to medical school in 1976, there were only eight osteopathic medical schools. We now have 38 medical schools located on 59 campuses. We are the fastest growing healthcare profession in the country. One out of four medical school students in the United States are in osteopathic medical school.

I am excited about the future growth of osteopathic medicine and how we can help meet the needs of our nation. We are graduating from 7,000 to 8,000 new osteopathic physicians a year. Over the next decade, that is at least 70,000 new physicians. We are projected to rise to as much as 22% of the U.S. physician population by 2030; whereas, right now we are only representing 12% to 13%. That is growth for us.

Our osteopathic medical schools are situated in health deserts—rural health areas and other underserved areas. Almost 60% of osteopathic physicians practice in primary care specialties—family medicine, internal medicine, pediatrics, obstetrics, and gynecology. We tend to go where the need is.

We have medical schools in East Tennessee, Idaho, West Virginia, Alabama, Mississippi, Louisiana, New Mexico, East Texas, and Kentucky. These schools are mainly in rural areas. Our students will do some of their practice training in those areas; and we hope to recruit many of our students from those areas, so they will practice there.

We also have ways of expanding care. The main way is through physician-led, team-based care.

To meet the healthcare needs in our country, we support a team-based approach to medical care, with the physician as the leader of that team. A physician-led, physician-directed model recognizes the growth and expertise of nonphysician clinicians. We totally support their rights to practice within their scope of practice and the scope of practice they are allowed under state statutes, with appropriate physician involvement. Healthcare professionals can work together at the top of their skill sets.