2020-21 President Inaugural Speech

Posted 10:19 AM

Paul R. Rennie, DO, FAAO, of Henderson, Nevada, was installed as the president of the American Academy of Osteopathy (AAO) on March 14 during the AAO’s 2020 annual Convocation in Colorado Springs, Colorado. Before becoming president, Dr. Rennie served for one year as the president-elect of the AAO, the nation’s largest medical society devoted to fostering neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM).

Paul R. Rennie, DO, FAAO, is the 2020-21 president of the AAO. A graduate of the Des Moines College of Osteopathic Medicine in Iowa, Dr. Rennie has chaired the Department of Osteopathic Manipulative Medicine at the Touro University Nevada College of Osteopathic Medicine (TUNCOM) in Henderson for 11 years. He is board certified in NMM/OMM and in osteopathic family medicine. Dr. Rennie has dedicated himself to preserving the ideals of osteopathic medicine, and he is very active in the profession nationally.

He previously served on the AAO’s Board of Governors and Board of Trustees, and for more than 16 years, he has worked with the Educational Council on Osteopathic Principles, a national collaboration dedicated to developing curriculum for osteopathic principles and practice. He has also served with the National Board of Osteopathic Medical Examiners since 1997, developing assessment services for the osteopathic profession. In addition, he has spent 12 years as a member of the NMM/OMM certifying board, the American Osteopathic Board of Neuromusculoskeletal Medicine.

As the OMM department chair at TUNCOM, Dr. Rennie coordinated with faculty to develop a curricular database for the undergraduate OMM program that employs a Regional Anatomic and Methodology Progressive System (RAMPS) approach. In addition, he is the author of Counterstrain and Exercise: An Integrated Approach, which outlines a more learnable anatomical approach to the counterstrain methodology, and he is a coauthor of the strain-counterstrain chapter for the second through fourth editions of Foundations of Osteopathic Medicine, the most widely used textbook in the field.

His vision for the AAO is to work with the Academy and its members in advancing the best interests of the osteopathic philosophy and unique osteopathic approaches for the care of our patients, and to strengthen the role of the Academy to meet the current challenges in academic, economic, regulatory and organizational management needed to promote and maintain the osteopathic profession.

Dr. Rennie delivered his inauguration address at the president’s banquet on March 14 at The Broadmoor in Colorado Springs, Colorado. His address has been edited for the AAO Member News:

Respect, Awareness, Recognition and Appreciation

As I pondered the status of our profession today, these attributes reflect my focus: respect, awareness, recognition and appreciation.

Respect: to listen, to follow, to hold in high esteem; but also, to refrain from interfering with.

I remember my first Convocation; it was held here at the Broadmoor in 1985, thirty-five years ago. The theme was “Gravity: Friend and Foe.”

Speaking of firsts, my first steps were performed on the British ship Mauritania, which was of the Cunard Line of ships that crossed the Atlantic Ocean, including the most notable, The Titanic. I’m glad that I learned to walk and not drown. And navigating me along my first journey into the world of the AAO and the Convocation experience was Dr. Sally Sutton, there to open my eyes to not only what there was to learn about OMM, but how students could contribute to the governance process. It was a breakthrough point for our school to encourage more students to go to Convocation. Look how far the students have come today! 

And, it was during that time that I, as a second-year medical student, asked Dr. Larry Jones, the founder of the counterstrain model, if he would be willing to come to our school to do a counterstrain workshop, and the rest is history.

I realized then that the American Academy of Osteopathy was THE place if you wanted to really master your osteopathic skills. Just look at the brain trust this organization has maintained throughout the years. Look at the reach of our members both domestically and internationally. Changing the world with the osteopathic philosophy.

We, the members of this Academy Body, serve many roles. In my role as an academician, Chair of the OMM Department at Touro University Nevada since 2008, I see the spark in our students when they understand and apply osteopathic principles with their fellow students and in their clinical encounters. 

In a world so disconnected from the values of one-on-one care, their spark is the light of osteopathic medicine being shared with those who are so fortunate to receive this care. Our students are the future, the ones who will change the world.

To learn the disease that has the patient is tough. To learn the health of the patient is also tough. To learn both is the distinction our students receive, the distinction of becoming an osteopathic physician, the best of all worlds.

Our Academy is a family of experts who share many talents. We start as students and learn from the best to become the best, as we do here at our annual Convocation Program and our other educational programs.

But now, let me discuss the next two attributes, which go together.

Awareness: knowledge or perception of a situation or fact; the opposite – misunderstanding. Recognition: to acknowledge the existence, validity, or legality of; the opposite – to ignore.

How is osteopathic medicine recognized, or ignored, in the healthcare industry?

Maybe we need to start with how physicians and medical students, DO and MD, have been recognized in the healthcare industry, OR, how they have been ignored.

Apart from the most recognizable actions on physicians that include time with electronic health records and potential denial of reimbursement claims, how physicians are recognized, OR NOT, was also expressed by Dr. Gail Wilensky, former administrator of HCFA (which is now known as CMS), in a 2012 meeting before the U.S. Senate Committee on Finance Round Table when she said the following:

“It is urgent that CMS devote more time than appears it has to redesigning how physicians are paid. It was disappointing to me that so little attention was paid to physicians in the ACA (Affordable Healthcare Act) and it is even more disappointing that the early pilot studies from the Innovation Center are so focused on the hospital or are relatively limited in their scope. Physicians don’t directly account for a large part of the health care dollar, but they have a disproportionate impact on how the health care dollar gets spent. It is hard for me to imagine reforming the health care delivery system until we figure out a better way to reimburse physicians - rewarding them for the kind of behavior we want to see.”

Unfortunately, despite her concerns at the time, for the period between 2006 and 2017, the average yearly increase in the Medicare Physician Fee Schedule (MPFS) was 0.24%. When contrasted with an average yearly rate of inflation of 1.88%, the cumulative effect resulted in a greater than 20% decrease in the Medicare Physician Fee Schedule (MPFS) when adjusting for inflation. It is interesting to also note that during the same time period, Medicare rates for hospital inpatient and outpatient services, ambulatory surgical centers and clinical laboratories were nearly equal to or greater than the rate of inflation.

And, to further compound this reduction in physician compensation, in the article “In the Shadow of a Giant: Medicare’s Influence on Private Physician Payments,” authors Jeffrey Clemens and Joshua D. Gottlieb remark that:

“Our findings counter the conventional wisdom in many health policy discussions. This conventional wisdom, often labeled “cost shifting,” holds that reductions in Medicare’s payment rates will be partially offset by private payment increases.” 

However, they later conclude that “Medicare exerts widespread and quantitatively substantial influence over the rates that private insurers pay.  A $1 change in Medicare’s payments for one service relative to another, or in one geographic region relative to another, drives a change of just over $1 in private payments. These payment changes reorient billions of public- and private-sector health dollars across locations and types of care. In aggregate, our estimates imply that Medicare’s pricing decisions can appreciably move both health sector and overall inflation.

So, what is in a name? What is it to be recognized? If our institutions are poorly recognizing our physicians, what about our future physicians and our students?

Will future reimbursements keep pace with the expenses of undergraduate medical education (UME)?

Why does this matter? Because, in order to build the Osteopathic Recognition component in the residency (GME) system, it will take financial and personnel resources.

Where will these resources come from? Making the colleges of osteopathic medicine responsible for the development, delivery and even the budgetary aspects for Osteopathic Recognition (which is COCA accreditation Standard 10.3), will not adequately address the finances and personnel that is needed. 

Undergraduate tuition is already a challenge, while at the same time it is difficult to find enough faculty for the undergraduate level. A February 2020 JAOA article that surveyed the Deans of COMs and OMM Department Chairs about their attitudes toward Osteopathic Recognition concluded that while there is an opportunity for improvement of their understanding of osteopathic recognition, the real issue is much bigger in scope.¹ This recognition needs to be primarily achieved at the graduate level where the residencies are housed.

Osteopathic Recognition requires help from the medical specialties that run each respective residency. And first, until it is finally determined what specific elements there will be to AOA Distinctive Osteopathic Certification, the specific components needed for each medical specialty will need to be determined. As each specialty board reviews its standards with respect to osteopathic content, program directors and specialty boards will need assistance to lead to a distinctive certification path.

Contributing to the resources that will be needed, under the leadership of Past President Mike Rowane and many Academy volunteers and contributors, educational materials are being developed to assist with part of this enormous undertaking. The Academy welcomes your support in any way you can to build the resources needed for these goals in development of Osteopathic Recognition.

The other part of the Academy effort will come from an expanded collaboration with our medical specialties to improve communications and build programs to address these needs. Recognizing our common challenges and collective strengths, this past year marked a wonderful turn furthering medical specialty collaboration which will help in strengthening our profession.   

In addition, the theme for our next Convocation Program will be “OMM for the Medical Specialties” where we hope to build on the value of OMM and OMT in the full scope of specialty applications. This program will be chaired by Dr. Barb Zajdel. With all the changes in our profession, this program comes at a very pivotal time, especially in the development of Osteopathic Recognition.

As I stated last year, my vision is to strengthen the role of the Academy to meet the current challenges in academic, economic, regulatory and organizational management needed to promote and maintain the osteopathic profession. With your help, we can make this happen.

Appreciation: recognition and enjoyment of the good qualities of someone or something.

Despite all the challenges before us, we need to remember that it is our love of this profession, the care we give to our patients, and the education we give to our students that inspires us to give our best. The knowledge and hand skills you have learned and continue to learn make you one of the most valuable practitioners in the world. No one is trained the way you are. However, we must think smarter, not work harder.

  1. Dougherty JJ, Bray NN, Vanier CH. Attitudes Toward Osteopathic Recognition Under the Single GME Accreditation System: A Survey of Deans at Colleges of Osteopathic Medicine and Chairs of Osteopathic Manipulative Medicine Departments. J Am Osteopath Assoc. 2020;120(2):81–89. doi:10.7556/jaoa.2020.018.