Creating a New Specialty — Correctional Medicine — A CALL TO ACTION

1. 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

2. 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

3. 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

4. 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 other’s 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.

5. 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.

6. 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.

7. 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.  

8. WHY A year ago both organizations were at one another’s throats- AOA was going to sue ACGME and ACGME was going to bar DO’s 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

9. 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

10. 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 master’s degree

11. 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

12. Don’t be left behind

13. 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

14. Note the ages of the attendings on a volunteer mission to a Jamaican Prison

15. 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

16. Stress Tony Snow- 2006-2008

17. 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

18. 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 1970’s that any doctor can cover an emergency room.

19. Not ANYBODY Can DO THE JOB

20. 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