Advancing the Osteopathic Profession
ACOFP issues position statements to articulate its stance on key issues impacting osteopathic family medicine and healthcare at large. These statements provide clear guidance on various topics, including clinical practices, healthcare policy, and professional standards, reflecting the organization's commitment to evidence-based medicine and patient-centered care. ACOFP's position statements are developed through rigorous review and input through the Congress of Delegates.
By advocating for best practices and addressing emerging challenges, these statements play a vital role in influencing public policy, advancing the osteopathic profession, and supporting the health and well-being of patients and communities.
Position statements can be read below or through the PDF.
1. Center for Medicare and Medicaid Services (CMS) [C/21, 16, 11, 06]
ACOFP opposes Medicare fraud and abuse. ACOFP encourages CMS to simplify Medicare rules and regulations as a positive approach to reducing fraud.
2. Continuing Patient Access to Osteopathic Physicians [C/21, 16, 11]
ACOFP and AOA continue to work together through their respective Washington offices to educate the United States Congress about the distinctiveness of osteopathic medicine and advocate for patient access to osteopathic medical care.
3. Coverage for Uninsured and Underinsured Minors [C/22, 17, 12]
ACOFP encourages the U.S. Congress to fully fund the State Children’s Health Insurance Program (SCHIP).
4. Formularies – Physician Consultation [C/22, 17, 12, 07]
ACOFP supports legislation that requires a physician to be available for consultation on pharmaceutical formulary decisions.
5. GME Funding for Residency Programs Using Volunteer Faculty [C/24, 19, 15, 10, 05]
ACOFP supports the enactment of Federal legislation that clarifies Congressional intent as established in the Balanced Budget Act of 1997, allowing teaching hospitals and physicians in non-hospital sites to enter into educational agreements to train osteopathic family medicine residents regardless of financial arrangement.
6. HPV Vaccination Coverage [C/22, 17, 12, 07]
ACOFP endorses the recommendation of the Advisory Council on Immunization Practices (ACIP) of the Center for Disease Control (CDC) that the HPV vaccine be made available to all eligible recipients and covered by insurance or be made available through public vaccine sources.
7. Payment for Vaccines [C/23, 18, 13, 08, 03]
ACOFP calls upon the Centers for Medicare and Medicaid Services (CMS) and other payors to ensure payments for all CDC advisory committees on immunization practices (ACIP) recommended vaccines be made to physicians to reimburse for their full acquisition cost of the vaccines plus the administration fee.
8. Payment for Physician Services [C/21, 16, 11, 06, 01]
ACOFP shall work to educate insurance and managed care plans on the ability of family physicians to provide comprehensive care to patients and assist its members in resolving payment problems with specific payers. ACOFP shall take whatever steps are necessary to ensure that osteopathic family physicians are fairly compensated for all services rendered. The ACOFP and AOA shall work with third-party payers to eliminate the practice of withholding payment for current services rendered on the basis of past disputed services, and, appropriate peer physician associations become involved in this decision process. The ACOFP encourages legislation that requires managed care companies and all third-party payors to pay for appropriate on-site testing at a rate equal to the highest rate paid for the same service to off-site providers.
9. Physician Compensation [C/21, 16, 11, 06]
ACOFP supports the adoption of national legislation that enables the osteopathic family physician to perform and be compensated for CLIA-certified, in-office laboratory tests. The ACOFP supports the adoption of national legislation that enables the osteopathic family physician to perform and be compensated for medically indicated, on-site diagnostic procedures.
10. Retail Health Clinics - Quality & Patient Safety [C/21,16,11, 06]
The proliferation of retail facilities in the United States offering in-store medical clinics with a rapidly expanding list of healthcare services requires a renewed examination of legislation and regulations governing quality and patient safety.
Lost in the shift toward retail health clinics is the fact that the retail consumer becomes a patient, necessitating that the quality and safety required in a traditional physician’s office take priority over convenience and low cost that draw consumers to retail facilities.
Threats to Quality and Patient Safety
The patchwork of state legislation and regulations governing health care services offered in retail settings raises legitimate questions regarding standards for quality and safety, especially whether the retail clinics are being held to the same requirements deemed necessary in a medical office.
a. Are OSHA regulations for safety and health being met in a retail health clinic? Many retail clinics do not have separate bathroom facilities for specimen collection.
b. Are adequate waiting room options or separate entrances available to prevent shopper exposure to sick patients and transmission of communicable diseases? Actively ill individuals will be left to roam and shop the store, potentially exposing other shoppers unnecessarily.
c. Are the non-physician providers (physician assistants or nurse practitioners) adequately supervised by physicians?
d. The ACOFP maintains that on-site supervision by a licensed DO or MD provides the necessary level of quality and patient safety. Current state regulations present a wide range for the number of non-physician providers who may be supervised by one physician at a remote site. The ACOFP questions the ability of a physician to adequately supervise multiple retail clinics.
e. Are patients being adequately informed about the educational credentials and expertise of the person providing the diagnosis and care? Perhaps they are led to believe that they are being treated by a physician when they are actually being cared for by a physician assistant or nurse practitioner who does not have the educational training to offer unlimited, comprehensive medical care.
f. Are retail clinics able to respond to someone seeking treatment for what they perceive to be a minor medical condition when it may actually be a significant medical complication? For example, a patient thinking he has indigestion could actually be experiencing a heart attack.
g. Who will the patient contact should medications cause an adverse reaction? Physicians in medical offices maintain 24-hour coverage for their patients. True medical emergencies are best handled through Emergency Departments.
h. Without a documented patient history, how can retail clinics adequately determine an appropriate course of treatment? By their nature, retail clinics cannot provide the continuity of care that characterizes the established physician-patient relationship, which includes a medical history of the patient’s allergies, a complete list of which medications the patient is currently taking, and a family history.
i. How will the storage of confidential medical records be kept to prevent identity theft in a retail store, with different employees exposed throughout the day – what safeguards will be in place?
The ACOFP supports the role of primary care physicians as the appropriate “point-of-entry” for patients to enter the health care system, leading a “team approach” to patient care.
Furthermore, the ACOFP believes that the most effective way to improve patient health is through an established, long-term relationship with a primary care physician who is the one qualified to provide unlimited, comprehensive medical care.
Concern over Economic Conflicts of Interest A traditional medical practice does not have the same economic objectives as a retail business venture. While current laws do not restrict where a prescription or over-the-counter medication can be obtained, the economic incentives of these for-profit business ventures should be closely monitored. The close proximity of a pharmacy or over-the-counter medications maximizes the likelihood that the patient will not leave the store to obtain their prescribed medications, creating the potential conflict of interest whereby the retail facility financially benefits from treatment recommendations made in the clinic.
In many states, physicians are restricted from both writing and filling prescriptions in their offices, yet a double standard exists when a patient can walk through the store to fill a prescription given at the in-store clinic.
Conclusion The American College of Osteopathic Family Physicians questions both the advisability and the need for facilities known as retail or “in-store” clinics. Although such facilities are heavily promoted by their corporate owners as “quick and convenient,” we question the real cost of circumventing the quality and continuity of care inherent in the primary care physician-patient relationship.
Osteopathic family physicians have always been required to maintain complete, 24-hour coverage for their patients, either through answering services, on-call covering physicians, or extended and flexible hours. True medical emergencies are best handled through emergency departments, while other urgent situations are properly handled through the patient’s family physician. We should not support the fracturing of patient care by encouraging the use of these facilities.
11. Tax Credits for Health Profession Shortage Area [C/24, 19, 15, 10, 05]
The ACOFP supports the establishment of tax credits for physicians who practice in federally designated health professions shortage areas (HPSAs) or Medicare physician scarcity areas. These tax credits should be available, on a sliding scale, to physicians who provide services on a part-time basis in these communities.
12. Transportation Costs for Patients [C/22, 17, 12, 07]
ACOFP encourages the CMS and third-party payors to develop a policy that pays for appropriate transportation costs to and from healthcare facilities for those patients at 200 percent of poverty level or below.
13. Vaccine Availability [C/18, 13, 08, 03]
ACOFP encourages the United States government and its regulatory agencies to ensure that an adequate supply of vaccines is available to the American public.
14. Vaccine Safety C/22,17
ACOFP supports the recommendation of The Advisory Committee on Immunization Practices (ACIP) and the declaration of the Centers for Disease Control and Prevention (CDC) that vaccines are safe. The ACOFP encourages the education of the public payors and government entities about the safety and effectiveness of vaccines.
15. Primary Care Incentive Payment [C/22, 17, 12]
ACOFP advocates for a ten percent incentive payment to all primary care physicians and Non-Physician Practitioners (NPPs), who perform Primary Care Services specified in The Affordable Care Act, Section 5501(a). ACOFP encourages the United States Congress to instruct the Centers for Medicare & Medicaid Services (CMS) to change the existing qualifications in the Affordable Care Act for the 10% incentive payment by eliminating the Physician’s Primary Care Incentive Percentage, thereby including all primary care physicians and non-physician practitioners who perform the specified primary care services.
16. Preservation of Family Medicine Department in Hospital Setting [C/23, 18, 13]
ACOFP affirms that the family medicine department is an integral part of all hospitals regarding education and the provision of continuity of patient care from the in-patient to out-patient settings. Family medicine hospital staff should remain an integral part of the medical staff structure and have an opportunity to maintain a seat on the Hospital Medical Executive Committee, particularly in hospitals that have family medicine residency programs.
17. Reporting Electronic Health Records Software Errors to Physicians [C/23, 18, 13]
ACOFP requests that vendors of electronic health records notify physician clients of reported software errors and provide software updates, in a systematic and timely fashion as is standard in other industries to enhance patient safety.
18. Hospital Privileges [C/23, 18, 13]
ACOFP will defend the rights of patients to receive care from the physician of their choice, and the rights of osteopathic family physicians to provide care in all settings for which they are trained.
19. Physician Gag Rule [C/22, 17]
20. State Adult Immunization Registries [C/22, 17]
ACOFP encourages the implementation of lifespan state immunization registries for adults and children, thereby improving continuity of care, patient safety, vaccination rates for all residents in the United States, and state/federal efforts to create interoperability between state immunization registries.
21. Cognitively Impaired Physicians [C/16]
ACOFP's basic tenets are advocacy, education, and leadership. This includes Advocacy for our members to practice osteopathic family medicine without prejudice or unwarranted restriction. It also includes Advocacy for our patients and patient safety.
The transformation of the healthcare system in the United States affords all patients an expectation of high-quality patient-centered care. This care should be delivered by competent physicians who are free from physical, psychiatric, and emotional illness or injury that inhibits their ability to deliver quality healthcare. As part of its commitment to the safe and effective delivery of patient care, the ACOFP also advocates for proactive educational opportunities for practicing physicians concerning mental and physical health and physician impairment issues. The goal of these sessions is to address the prevention, treatment, and rehabilitation of illness or potentially impairing conditions. These goals also should include the evaluation of the ability of the physician to acquire new or changing medical knowledge. The term “cognitively impaired physician” may include a variety of conditions and populations. Cognitive impairment refers to the inability of the physician to adequately gather, evaluate, and process medical information and to apply appropriate medical knowledge and skills. This may also include the impaired ability to learn new information. A cognitively impaired physician may include but is not limited to: 1.) Physicians with specific medical conditions that despite the use of assistive devices and technology, are unable to use their senses to evaluate and treat patients; 2.) Physicians suffering from uncontrolled drug and alcohol-related illnesses; 3.) Physicians with neurodegenerative disorders with impaired working memory or the ability to process and store information. This includes physicians with dementia; 4.) Physicians with medical conditions that require medications that impair their cognitive process or memory; 5.) Physicians suffer from uncontrolled mental illness which impairs their thought process or memory.
It is the policy of ACOFP that physicians should be allowed to remain in practice as long as patient safety, quality medical practice, and patient well-being are not compromised. Self-regulation is an important aspect of professionalism, but there are instances where physicians may not be aware of the significance of their own cognitive impairment. It may be the observations of colleagues, medical staff members, nurses, or employees that first notice a physician's cognitive impairment. Physician monitoring may include the following: 1.) Physicians who are members of an active medical staff at a hospital or other medical institution should be monitored by colleagues and peers on that staff. Irregularities or signs of cognitive impairment should be brought to the attention of the chief of staff, chief medical officer or their designee for further evaluation. Guidelines and standards should be an essential part of the medical staff bylaws. Routine physical examinations as required by the bylaws should include cognitive evaluation; 2.) Physicians who practice in a private group should be monitored by their colleagues in that practice. Appropriate guidelines instituted by that practice should address cognitive impairment; 3.) Physicians in large corporate practices should be governed by the guidelines of that organization. Policies concerning cognitive impairment should be well delineated as well as a method of reporting any concerns to the chief executive officer (or designee); 4.) Physicians employed in academic institutions should be monitored by colleagues, deans, and department chairs. Appropriate guidelines should be a part of the institution’s standards; 5.) Physicians who are board-certified may undergo routine evaluation through the re-certification and maintenance of certification processes. Face-to-face evaluation, such as the American Osteopathic Board of Family Physicians neuromuscular medicine testing, provides another valid avenue to assess a physician’s cognitive abilities; 6.) Physicians in solo practice who are not active members of a medical staff or who are not actively pursuing re-certification or maintenance of certification have a limited opportunity for monitoring by others. These physicians should empower their own staff to carry out appropriate monitoring; 7.) Monitoring may include psychometric evaluation to determine the clinician’s ability to safely engage in active clinical practice.
It is the duty of physicians to continually assess and evaluate their own physical and mental abilities. It is also the duty of physicians to report any significant cognitive impairment of a colleague to the appropriate hospital, or clinic authorities. Of particular concern are physicians with limited exposure to peers, who are not on active medical staff or practicing with other physicians. It is vital that these physicians have access to resources to help them in self-monitoring. These resources should be available through state and national professional societies.
ACOFP supports the adoption and implementation of the following standards by hospitals, health plans, academic institutions, and state licensing boards: 1.) The practice environment should be one that allows for confidential reporting and self-reporting of illness or other potentially impairing conditions; 2.) The identity of the person(s) reporting concerns regarding the possible cognitive impairment of a physician should be in writing and should be kept confidential. If in the opinion of the appropriate officer/administrator, the allegations are credible, an investigation should be undertaken. The physician in question shall be directly contacted and made aware of the allegations. The physician shall be given the opportunity to respond to the allegations; 3.) If the concern is deemed substantial, the physician should undergo a complete medical exam that is related to the performance and scope of practice, including psychometric evaluation; 4.) A drug test should be obtained to determine if the physician is using drugs illegally or abusing legal drugs; 5.) A physician deemed impaired should have access to professional resources such as counseling, medical treatment, or rehabilitation services for the purpose of diagnosis and treatment of the conditions of concern; 6.) If the impairment is a disability, reasonable accommodation, as defined within the Americans with Disabilities Act should be made to enable the physician to competently perform clinical duties; 7.) If the impairment constitutes a direct threat to the health and safety of patients, the physician, or other co-workers, immediate action should be taken. Every attempt will be made to reach a voluntary agreement for adjustment of the physician’s duties and privileges. If a voluntary agreement cannot be reached, the physician could be subject to the appropriate corrective action with strict adherence to any applicable medical staff by-laws, facility work rules, and state and federal reporting requirements; and 8.) If an adjustment in a physician’s duties and privileges has occurred, a process for rehabilitation and reinstatement should exist. A physician suffering from a physical, psychiatric, or emotional illness or injury shall be given the opportunity to demonstrate improvement in their condition. The facility may request reasonable proof of completion of treatment and clearance to return to practice. Upon receipt of appropriate documentation, the physician should be granted reinstatement of clinical privileges. The physician may be required to obtain periodic reports from the treating physician, attesting to the physician’s continued ability to safely provide medical care. Physicians suffering from drug or alcohol-related impairment shall be given the opportunity to demonstrate resolution of their condition. Upon receipt of appropriate documentation, the physician should be granted reinstatement of clinical privileges. The patient’s treating physician shall attest to the physician’s condition and continued treatment as appropriate. If indicated, the physician shall provide periodic reports from the physician regarding the ability of the physician to safely provide medical care. If applicable, the physician shall provide documentation of compliance with other requirements of a physician’s health/recovery committee (State or local/employer).
22. Electric Nicotine Delivery Device Use in Youth [C/22, 17]
ACOFP advocates for state and federal laws prohibiting the use of any nicotine delivery devices by persons under the age of 18, supports research to quantify the health risks of compounds in e-cigarettes and encourages prevention efforts through the development and deployment of programs to educate youth, young adults and their guardians concerning the harmful effects of e-cigarettes.
23. Scope of Practice of Osteopathic Family Physicians [C/24, 19]
The ACOFP advocates that Osteopathic family physicians be allowed to provide care and perform all procedures for which they have been trained. The ACOFP will, when necessary, educate insurers, regulators, and the public on the availability of Osteopathic family physicians to provide particular procedures and care.
24. Interoperable Electronic Health Records [C/24, 19]
The ACOFP encourages manufacturers of electronic health record (EHR) medical systems to pursue efficient interoperability of all EHRs, requiring each to participate and work with the Centers for Medicare and Medicaid Services to ensure collaboration of EHRs and ensure that participants can meet Meaningful Use requirements more efficiently.
25. Addressing Disproportionate Infant Mortality in Minority Populations and Those Experiencing Racism [C/22]
ACOFP advocates for federal legislation that increases funding for maternal and infant healthcare.
26. Establishing a National Immunization Information System (IIS) [C/22]
ACOFP advocates to the Centers for Disease Control and Prevention to create a national immunization information system documenting each patient’s immunization history that is, efficient, responsive, cross-platform compatible, user-friendly, and freely accessible by healthcare providers.
27. Supporting Prenatal Health Care Initiatives in Family Medicine [C/22]
ACOFP advocates for prenatal care early in pregnancy by encouraging third-party payors to provide enhanced reimbursement for comprehensive prenatal visits and by encouraging family medicine physicians to promote early initiation of prenatal care especially among medically vulnerable and underserved populations.
ACOFP also advocates for legislative efforts in support of expanding accessible prenatal health care education and initiatives.
28. Transgender Healthcare [C/22]
ACOFP actively encourages the use and support of inclusive language when referring to transgender and gender nonconforming persons and advocates for legislative efforts to support transgender healthcare access and quality.
ACOFP agrees that physicians of the Osteopathic profession are uniquely qualified to serve transgender patients, through compassionate care of the mind, body, and spirit and will support the ACOFP Diversity, Equity and Inclusion (DEI) Advisory Group to consider developing CME regarding LGBTQ+, gender identity, and gender transitioning to increase the knowledge of family physicians to understand and better treat their patients.
29. Access to abortion when needed to save a pregnant patient’s life [C/23]
ACOFP advocates for health policies, including those pertaining to reproductive and obstetrical care, that protect the sanctity and privacy of the physician-patient relationship and for the decriminalization of abortion in cases in which the life or health of the pregnant patient is threatened.
30. Voting as a Social Determinant of Health [C/23]
ACOFP recognizes voting as a social determinant of health.
1. Certification [C/22, 17, 12, 07, 02, 99]
ACOFP continues to recognize those physicians certified through the clinical pathway as holding board certification equivalent to certification achieved through residency training. When necessary, the ACOFP, working with the AOA, shall educate healthcare institutions and managed care programs on this issue.
2. Specialty Certification of Chairpersons [C/16, 11, 06]
ACOFP recommends that the Commission on Osteopathic College Accreditation (COCA) and AOA amend the accreditation requirements for colleges of osteopathic medicine to state that chairs of the departments of family medicine at colleges of osteopathic medicine be certified in family medicine by the AOA through the American Osteopathic Board of Family Physicians (AOBFP).
3. Certification – Reentry Pathway [C/23, 18, 13, 08, 03]
>ACOFP requests that the AOA continues to streamline and expedite the certification reentry pathway to allow returning ACGME-trained osteopathic physicians to obtain AOA certification.
4. Mandatory Recertification of Physicians [C/23, 18, 13, 08, 03]
ACOFP opposes mandatory recertification as a condition of physician licensure.
1. Continuing Medical Education [C/16, 11, 06]
ACOFP shall recommend to the AOA Board of Trustees and AOA House of Delegates that Category 1 allopathic CME programs remain and continue to be considered as Category 2 A for AOA CME accreditation in accordance with the current AOA CME guide and standards.
2. Disclosures Relevant to Potential Commercial Bias [C/16, 11]
ACOFP requires that persons planning and speaking at Continuing Medical Education (CME) events disclose any relationships that may cause, or appear to cause, a conflict of interest.
All Program Committee members, teachers, presenters, editors, authors, and staff must complete the ACOFP Full Disclosure for CME Activities form, indicating any relevant financial relationships. A relevant financial relationship is defined as a financial relationship in any amount occurring in the past 12 months that creates a conflict of interest.
Completed disclosure forms must be received in sufficient time to be reviewed by the ACOFP Program Committee, which monitors potential conflicts of interest. Planners, speakers, authors, and staff will be notified that failure to return the form in a timely manner may result in disqualification from participation in the CME activity. Those failing or refusing to complete the disclosure form in sufficient time for Program Committee review shall be disqualified from participation. Individuals who fail or refuse to disclose their relevant financial relationship(s) will be prohibited from participating in the planning, presentation, or evaluation of a CME activity.
All disclosure information will be provided to learners prior to the beginning of the educational activity. The information from the Full Disclosure Form for CME Activities form will be presented in writing in activity materials. The source and nature of all support from commercial interests will be disclosed to learners in writing in all promotional and activity materials. The following information regarding relevant financial relationship(s) of all individuals in a position to control CME content will be disclosed to learners: a.) The name of the individual; b.) The name of the commercial interest(s) with which the relationship exists; c.) The nature of the relationship that the individual has with each commercial interest.
The source of all support from commercial interests will be disclosed to learners. When commercial support is “in kind”, the nature of the support must be disclosed to learners. Disclosure must never include the use of a trade name or a product group message.
If disclosure information is not submitted prior to the deadline for printed activity materials, that information must be disclosed verbally at the live activity prior to the presentation. An ACOFP staff member must witness the communication of the information and must complete the Verification of Verbal Disclosure Form.
For an individual with no relevant financial relationship(s), the learners will be informed that no relevant financial relationship(s) exist.
3. Graduate Medical Education [C/21, 16, 11, 06]
ACOFP recommends to the AOA that it preserve elements of the osteopathic internship as an integral component within graduate medical education programs that have osteopathic recognition and preserve osteopathic distinctiveness.
4. Physician Payment [C/21, 16, 11, 06]
ACOFP supports the current AOA policy on Physician Payment in Federal Programs.
5. Pre- and Post-Doctoral Education [C/16, 11, 06]
ACOFP encourages the development of core curriculum guidelines in cultural diversity to address the issue of cultural competency and healthcare disparities throughout the lifelong continuum of osteopathic medical education, and these guidelines should be included in the Basic Standards for Residency Training and be forwarded to the AOA for referral to appropriate committees for inclusion into the Basic Standards of Pre-Doctoral and Post-Doctoral Training.
6. Opioid Education [C/24, 19]
ACOFP will continue to offer pain management continuing medical education (CME).
7. Mental Health Counselors for Medical Students [C/21]
ACOFP encourages osteopathic medical schools to have increased access to face-to-face and, when not available remote, mental health services available to students. ACOFP encourages osteopathic medical schools to continue to abide by the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) regulations in regard to counseling services provided to osteopathic medical students.
8. Use of Gender-Affirming Names and Pronouns for Patients Who Are Transgender [C/22]
ACOFP provides continuing medical educational opportunities on the use of chosen name pronouns on the health and wellbeing of patients, as resources allow and recommend members address transgender patients according to chosen name and pronouns during medical encounters.
9. Osteopathic Family Physician Competency in Delivering Reproductive Healthcare [C/22]
ACOFP encourages measures that aim to increase physician competency in patient communication regarding reproductive and sexual healthcare across all demographics and also encourages additional educational measures for medical students, residents, and physicians aimed at reducing maternal mortality and morbidity.
10. Transgender Health Education [C/23]
The ACOFP encourages continuing medical education that addresses transgender and gender-diverse healthcare that is accessible to all members and supports continuing medical education designed to create a more inclusive environment for all patients.
11. Increasing Environmental Health Education [C/23]
ACOFP engages in the promotion of environmental health education.
1. Osteopathic Oath [C/21, 16, 11, 06]
I do hereby affirm my loyalty to the profession I am about to enter. I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity, to perform faithfully my professional duties, to employ only those recognized methods of treatment consistent with good judgment and with my skill and ability, keeping in mind always nature's laws and the body's inherent capacity for recovery.
I will be ever vigilant in aiding in the general welfare of the community, sustaining its laws and institutions, not engaging in those practices which will in any way bring shame or discredit upon myself or my profession. I will give no drugs for deadly purposes to any person, though it may be asked of me.
I will endeavor to work in accord with my colleagues in a spirit of progressive cooperation and never by word or by act cast imputations upon them or their rightful practices.
I will look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for its best interests and for the interests of the students who will come after me. I will be ever alert to further the application of basic biologic truths to the healing arts and to develop the principles of osteopathy which were first enunciated by Andrew Taylor Still.
2. Osteopathic Pledge of Commitment [C/23, 18, 13, 08, 03]
As members of the osteopathic medical profession, in an effort to instill loyalty and strengthen the profession, we recall the tenets on which this profession is founded – the dynamic interaction of mind, body, and spirit; the body’s ability to heal itself; the primary role of the musculoskeletal system; and preventive medicine as the key to maintain health. We recognize the work our predecessors have accomplished in building the profession, and we commit ourselves to continuing that work.
I Pledge To: Provide compassionate, quality care to my patients; partner with them to promote health; display integrity and professionalism throughout my career; advance the philosophy, practice, and science of osteopathic medicine; continue life-long learning; support my profession with loyalty in action, word and deed; and live each day as an example of what an osteopathic physician should be.
3. Research [C/16, 11, 06]
ACOFP encourages the AOA to identify additional funding sources and increase internal funding for research identifying the therapeutic value of OMT and then continue to study the application and usefulness of OMT in maintaining health and treating diseases.
4. Osteopathic Identity [C/16, 11, 06]
The colleges of osteopathic medicine and osteopathic professional organizations are strongly encouraged to use the word osteopathic on all their signage, letterhead, marketing, and public relations material. The ACOFP supports the clear identification of these as osteopathic entities.
5. Identity and Uniqueness of Osteopathic Medicine [C/24, 19]
ACOFP actively will continue to emphasize Osteopathic Practices and Principles (OPP) and the benefits of osteopathic distinctiveness.
1. Patient Advertising [C/16, 11, 06]
ACOFP supports the AOA policy on Prescription drugs – Direct Consumer Advertising.
2. Prescription Drugs – Direct Consumer Advertising [C/24*, 19, 15, 10, 05]
ACOFP will continue to recommend that pharmaceutical company direct to consumer advertising not be product-specific. The ACOFP should work with the AOA to request that state and federal governments adopt policies or legislation to promote disease-specific public health education as the focus of direct-to-consumer advertising of prescription medicines to the general public.
*reaffirm for a year, policy to be reviewed by ACOFP Constitution & Bylaws/Policy & Organization Review Committee for presentation and consideration at the 2025 Congress of Delegates.
3. Physician-Assisted Suicide [C/21, 16, 11, 06]
The osteopathic profession shall take a leadership role in providing the public with information on alternatives to physician-assisted suicide. The ACOFP does not support legislation to legalize physician-assisted suicide.
4. Soft Drinks in Schools [C/22, 17, 12, 07]
ACOFP members shall educate and caution their adolescent patients, school superintendents, and members of school boards across our nation as to the health consequences of soft drinks and urge them to restrict sales of non-nutritional drinks. ACOFP supports the efforts of some of the soft drink producers that have already taken the initiative to provide and process more nutritious beverages.
5. Tissue and Organ Donation Education [C/22, 17, 12, 07]
ACOFP members are encouraged to provide educational materials to families, friends, and patients about tissue and organ donation programs.
6. Use of Electronic Devices While Driving [C/22, 17, 12]
ACOFP opposes the use of all handheld devices while operating motorized vehicles.
7. Recreational Cannabis-Based Products [C/24, 19, 14]
ACOFP opposes the recreational use and promotional marketing of cannabis-based products and supports increased education to both adolescent and adult populations on the harmful effects of cannabis-based products.
8. Epidemic Opioid Overdose Deaths in America [C/22, 17, 14]
ACOFP encourages the continued evaluation and availability of all interventions that prevent opioid overdose deaths, especially the increased availability and use of opioid antagonists.
9. Best Clinical Practices for Opioid Prescriptions [C/24, 19, 14]
ACOFP shall provide members with educational activities on best clinical practices and standards for opioid prescription and clinical implementation.
10. Collaboration with Organizations Advocating for the Prevention and Treatment of Prescription Narcotic Abuse and Dependence [C/22, 17]
ACOFP initiates, develops, and maintains collaborative relationships with local, state, and national organizations to provide education to physicians, patients, policymakers, and other stakeholders regarding controlled substance abuse and dependence prevention. The ACOFP advocates for appropriate, adequate, and available treatment options for those individuals suffering from controlled substance abuse disorder and dependencies.
11. Prenatal Drug Screening [C/22, 17]
ACOFP encourages prenatal drug use screening as part of prenatal care and provides education in addiction assistance to pregnant women with positive drug screens.
12. Seatbelt Usage and Endorsement of Primary Enforcement Laws [C/22, 17]
ACOFP encourages endorsing seatbelt usage in all patient populations, but especially in those with the lowest rate of seatbelt use and highest risk of death in a motor vehicle accident, and recommends that all states pass a primary seatbelt enforcement law.
13. Powdered Caffeine [C/22, 17]
ACOFP opposes the use of concentrated powdered caffeine for non-medical uses.
14. Sexual Orientation and Gender Expression Non-Discrimination [C/23, 18]
ACOFP believes that all patients should be treated equally, respectfully, and with dignity with regard to gender identity and sexual orientation, promoting quality medical care that is non-biased and provides equal care for all, thereby enabling physicians to be honorable stewards of their patient health care and creating an inclusive medical home that is welcoming to all regardless of sexual orientation or gender identity.
15. Access to Nutritious Food [C/23, 18]
ACOFP advocates for the development of and funding for programs that increase access to nutritious food options in all communities and encourages research and monitoring of nutritious food access at state and national levels.
16. Housing Effects on Health Care [C/24, 19]
ACOFP encourages all physicians to partner with their communities to understand barriers to health and improve access to health care for people living without homes. The ACOFP promotes awareness of programs that deliver primary and preventive health care to all underserved populations, including those experiencing homelessness.
17. Opposition to Patient Discrimination of Osteopathic Family Physicians [C/24, 19]
ACOFP supports osteopathic family physicians who act in life-threatening emergencies to act ethically and professionally. The ACOFP supports the education of the public that osteopathic family physicians should be evaluated by their skill and knowledge rather than by their age, race, ethnicity, religion, gender, sexual orientation, gender identity, or national origin.
18. Naloxone Availability [C/24, 19]
ACOFP supports an increase in public availability and use of naloxone.
19. Low-Cost or Free Meals for Children [C/21]
ACOFP advocates for legislative efforts in support of widely accessible, nutritionally balanced, low-cost, or free meals for all children in the US Pre-K through 12 schools.
20. Recognizing the Importance of Labeling Gluten as an Allergen [C/23]
ACOFP recognizes and supports initiatives promoting the labeling of gluten as an allergen on all consumer products, including, but not limited to food labels and pharmaceuticals.
1. Practice Guidelines [C/16, 11, 06]
ACOFP endorses practice guidelines whose conclusions are based on quality osteopathic data that has adequate osteopathic input and research.
2. Practice Management [C/16, 11, 06]
ACOFP shall encourage and promote unity and the practice rights of osteopathic family physicians, by continuing to support periodic practice management seminars to a.) Educate physicians as to the importance of compliance risk management, billing and coding, documentation, and fraud and abuse issues; b.) Assist in the establishment of guidelines to enhance these practice rights and safety in the areas of compliance, risk management, billing and coding documentation, in fraud and abuse issues; c.) Identify, supportive agencies, liability insurance companies, attorneys, and physicians with expertise in these issues; d.) Encourage government and insurance agencies to utilize only expert witnesses who are osteopathic family physicians in peer review, fraud, and abuse, civil and criminal cases involving osteopathic family physicians; e.) Develop and advise the leadership and affiliate societies on the needs, trends, and issues of concern that will encourage unity, ensure a safe practice environment, and enhance the practice rights of ACOFP members.
1. Prescription Pain Medication/Long-Acting Opioid Medication [C/22, 17, 12, 04]
ACOFP advocated for the voluntary universal education of all physicians, as well as others involved in the management of pain patients, on the proper diagnosis and appropriate treatment of pain. A well-educated, physician-led team of health care providers, following scientifically-established treatment protocols, will not only deliver quality care but will be sensitive to the problems of addiction and diversion of prescription pain medication.
2. Physician and Medical Product Manufacturer Financial Relationship Transparency [C/22, 17]
ACOFP supports public transparency, through efficient, effective reporting - inclusive of appropriate safeguards to ensure accuracy and appropriateness - of physician financial relationships with pharmaceutical and medical device manufacturers.
3. Needle Exchange Programs [C/22, 17]
ACOFP encourages the creation of needle and/or syringe exchange programs based on the Department of Health and Human Services implementation guidelines.
4. HIV Consent Form Elimination [C/22, 17]
ACOFP supports the elimination of the requirement of physicians and health care settings to have consent forms completed before an HIV test.
5. Recognizing the Ongoing Need to Support Diversity, Equity, and Inclusion in Patient Care Settings [C/22]
ACOFP continues to recognize the need to support diversity, equity, and inclusion in practice as osteopathic family physicians and will continue to deploy efforts to achieve this goal as resources allow.
1. Residency Training Programs [C/21, 16, 11, 06]
ACOFP policy and relevant communication stipulate that each specialty residency training program certified by the AOA should continue to be inspected by physicians approved by the specialty college of that discipline.
The statement is presented to clarify the position of the ACOFP on the osteopathic family medicine residency training program.
The cornerstone in osteopathic healthcare has always been the family physician. Osteopathic family physicians are physicians oriented to the delivery of healthcare to the family. They commonly use more than one of the traditional specialty fields of medicine providing the necessary training, and they are trained to coordinate the care required by reference to other physicians and allied health personnel. Training equips them to assume the responsibility for the patient's comprehensive and continuing health care, serving the family unit with skill and understanding.
Historically, the osteopathic family physicians who have completed their year of rotating internship have attained this level of competence.
However, medicine is a dynamic art and science, and the accumulation of knowledge cannot stop after an internship. Family physicians are morally obligated to pursue their own area of specialty to excellence, and then to maintain this expertise for the duration of their careers in medicine.
One of the important measures of academic excellence in the specialty of family medicine is certification. Residency training represents the avenue of preparation to attain this specific body of knowledge characteristic of a certified osteopathic family physician. It enables the resident to accumulate those skills and competencies that ordinarily require long years of practice exposure. It accelerates the usual process of specialty attainment. It develops in the family medicine resident an appreciation of the need for a life-long process of learning and encourages mastery of those disciplined habits which results in continuous scholastic development.
The osteopathic family medicine residency provides that body of knowledge that identifies the primary care most commonly required in practice. Moreover, it intensifies the understanding of both the shared-care and supportive-care roles exemplified by this responsible coordinator of the health care team.
With the increasing complexities of medical knowledge, the following characteristics emphasize some of the most important facets in the osteopathic family medicine residency training programs: a.) Emphasis on formalized outpatient and inpatient longitudinal primary care, including curriculum specific to training year and clinical service; b.) Further emphasis and integration of the practical application of osteopathic principles and practices in an ambulatory setting; c.) Encouragement of cooperation with other osteopathic specialists to accomplish osteopathic medicine's distinctive approach to patient care; d.) Expansion of humanistic or behavioral science training, e.g. family dynamics, family counseling, care for the dying patient and his family, etc.; e.) Development of competency in the art of "problem-solving" as in undifferentiated or multiple-complaint illness; f.) Teaching the strategies of interdisciplinary team approach in providing comprehensive health care; g.) Improvement of interviewing and communication skills; h.) Initiation in utilization of communication medical resources; i.) Commitment to the importance of preventive medicine in patient care; j.) Provision for the necessary training in the mechanics of office management and the economics of practice; k.) Exposure to the patient/physician responsibility of third-party medicine; l.) Development of proper office and hospital recordkeeping systems; m.) Recognition of the personal and professional needs of physicians and their families; n.) Association with the proper role model who encourages behavioral adjustments that result in the resident emulating the characteristics of the certified osteopathic family physician; o.) Provide mandatory, ongoing, and timely faculty development training for all faculty in family medicine residency training programs.
The residency program addresses the needs stated above. It provides the osteopathic family physician with the special skills and competencies necessary to provide primary, continuing, comprehensive healthcare to all members of the family, regardless of age, sex, or type of medical problem.
The osteopathic family medicine residency program reinforces what has already been taught: that the osteopathic family physician is in charge of the patient's health needs and is the primary coordinator of the entire healthcare team, both in an ambulatory and in an institutional setting.
In summary, the osteopathic family physician is the solidifying agent who captains, guides, and encourages total care which is the keystone of osteopathic medicine. To address this ongoing educational responsibility, the ACOFP shall continue to improve, develop, and encourage the residency training program in osteopathic family medicine.
2. Ambulatory-Based Family Medicine Residency Programs [C/22, 17, 12]
ACOFP advocates for the development and implementation of more ambulatory-based family medicine residency programs. The ACOFP encourages the United States Congress to strengthen its Graduate Medical Education reimbursement policies to at least equivalently fund ambulatory-based family medicine residency programs. The ACOFP encourages the AOA to continue to lobby the United States Congress to support legislation funding ambulatory-based family medicine residency programs.\
3. Telehealth/Telemedicine Training for Family Medicine Residents [C/21]
ACOFP encourages all family medicine residency programs to educate residents about the intricacies of managing patients through the use of telemedicine and encourages the American Council for Graduate Medical Education (ACGME) Family Medicine Review Committee to allow telemedicine patient encounters to count toward the 1650 total billable in-person encounters set forth under the program requirements.
4. Increasing Resident Access to Mental Health Services [C/23]
The ACOFP stresses the importance of residency programs to provide a list of resources, publicly available to all residents at the start of each academic year, for confidential and accessible mental health assessments, counseling, and treatments to assist in reducing burnout of medical trainees.
1. Stem Cell Research [C/23, 18, 13, 08, 03]
ACOFP supports biomedical research on stem cells and should monitor developments in stem cell research.
2. Telemedicine [C/19, 13, 08, 03]
Definition of Telemedicine – Telemedicine is an area of medicine that utilizes information and telecommunication technology to transfer medical information that assists in the diagnosis, treatment, and education of the patient. The provision of telemedicine requires the same skills and time as the delivery of that service in person.
Benefits of Telemedicine – Telemedicine may be an effective tool to increase access, improve the quality of care, and reduce burdens for family physicians, especially when utilized for patients in rural and/or underserved areas.
Current Barriers to Telemedicine – There are a number of barriers to the adoption of telemedicine including inadequate reimbursement that disincentivizes the provision of telemedicine as well as insufficient or limited broadband connectivity, making it difficult for both physicians and patients to leverage telemedicine. Other barriers include current payer and payment rules that were established before telemedicine existed; requirements related to the settings (i.e., facility type) and locations (i.e., rural or urban) of physicians and patients for telemedicine services to be approved; new payer and payment rules limiting the availability of telemedicine services (e.g., rules related to types of patients who may receive telehealth services, rules limiting whether a patient may receive related in-person care within a time period after receiving telehealth); and variations in statutory and regulatory requirements and payment at the state level.
Promoting Increased Use and Availability of Telemedicine – Recent federal legislative and regulatory activities have attempted to increase the availability of telemedicine within the existing Medicare payment systems by providing flexibility both on who may receive coverage for telemedicine services as well as the location of where the services are provided. More needs to be done to incentivize the widespread adoption of telemedicine and to provide adequate reimbursement for these services. Specifically, payers, including Medicare, must recognize that telemedicine does not reduce the amount of time a physician spends with patients; it provides patients with greater access to healthcare services.
The ACOFP supports federal efforts to promote the widespread adoption of telemedicine.
3. Global Medical Outreach [C/23, 18]
ACOFP advocates for the osteopathic profession to participate in international medical outreach to improve cultural competency and increase international osteopathic recognition.
1. Supports Resolutions [C/21, 16, 11, 06]
AOA Policy (ACOFP Reaffirmed)
a. ACOFP supports AOA policy to maintain osteopathic medicine as a separate and distinct school of medicine.
b. ACOFP supports AOA policy to attempt to reduce healthcare costs.
1. Sports Medicine – Team Physician Consensus Statement [C/16, 11, 06]
A team physician shall be a DO or MD in good standing with an unrestricted license to practice medicine.
2. Team Physician [C/17, 12, 07, 02]
Definition
The team physician must have an unrestricted medical license and be a DO or MD who is responsible for treating and coordinating the medical care of athletic team members. The principal responsibility of the team physician is to provide for the well-being of individual athletes – enabling each to realize his/her full potential. The team physician should possess special proficiency in the care of musculoskeletal injuries and medical conditions encountered in sports. The team physician also must actively integrate medical expertise with other healthcare providers, including medical specialists, athletic trainers, and allied health professionals. The team physician must ultimately assume responsibility within the team structure for making medical decisions that affect the athlete’s safe participation.
Qualifications of a Team Physician
The primary concern of the team physician is to provide the best medical care for athletes at all levels of participation. To this end, the following qualifications are necessary for all team physicians: a.) Possess a DO or MD degree as a licensed physician in good standing, with an unrestricted license to practice medicine; b.) Possess a fundamental knowledge of emergency care regarding sporting events; c.) Be trained in CPR; d.) Have a working knowledge of trauma, musculoskeletal injuries, and medical conditions affecting the athlete.
In addition, it is desirable for team physicians to have clinical training/experience and administrative skills in some or all of the following: a.) Specialty Board certification.) Continuing medical education in sports medicine; c.) Formal training in sports medicine (fellowship training), or board-recognized subspecialty in sports medicine (formerly known as a certificate of added qualification in sports medicine); d.) Additional training in sports medicine; e.) Fifty percent or more of practice involving sports medicine; f.) Membership and participation in a sports medicine society; g.) Involvement in teaching, research and publications relating to sports medicine; h.) Training in advanced cardiac life support; i.) Knowledge of medical/legal, disability, and workers’ compensation issues; j.) Media skills training.
Duties of a Team Physician
The team physician must be willing to commit the necessary time and effort to provide care to the athlete and team. In addition, the team physician must develop and maintain a current, appropriate knowledge base of the sport(s) for which he/she is accepting responsibility.
The duties for which the team physician has ultimate responsibility include the following: a.) Medical management of the athlete; b.) Coordinate pre-participating screening, examination, and evaluation; c.) Manage injuries on the field; d.) Provide for medical management of injury and illness; e.) Coordinate rehabilitation and return to participation; f.) Provide for proper preparation for safe return to participation after an illness or injury; g.) Integrate medical expertise with other health care providers, including medical specialists, athletic trainers and allied health professionals; h.) Provide for appropriate education and counseling regarding nutrition, strength and conditioning, substance abuse, and other medical problems that could affect the athlete; i.) Provide for proper documentation and medical record keeping.
Administrative and Logistical Duties
The following administrative and logistical duties include a.) Establish and define the relationships of all involved parties; b.) Educate athletes, parents, administrators, coaches, and other necessary parties of concerns regarding the athletes; c.) Develop a chain of command; d.) Plan and train for emergencies during competition and practice; e.) Address equipment and supply issues; f.) Provide for proper event coverage; g.) Assess environmental concerns and playing conditions.
Education of a Team Physician
Ongoing education pertinent to the team physician is essential. Currently, there are several state, regional, and national stand-alone courses for team physician education and there are also many other resources available. Information regarding team physician-specific educational opportunities can be obtained from the following sport-specific organizations: National Football League Team Physician’s Society or level-specific (e.g., United States Olympic Committee meetings; National Governing Bodies (NGB) meetings; state and/or county medical societies meetings; professional journals; and other relevant electronic medic (Web sites, CD-ROMs).
Conclusion
The Consensus Statement establishes a definition of the team physician and outlines a team physician’s qualifications and responsibilities. It also contains strategies for the continuing education of team physicians. Ultimately, this statement provides guidelines that best serve the healthcare needs of athletes and teams.
1. Non-Physician Practitioners [C/22, 17, 12, 07, 01]
The AOA Policy Statement on Non-Physician Practitioners shall be adopted as ACOFP Policy on Non-Physician Practitioners.
The DO/MD medical model has proven its ability to provide professionals with complete medical education training and testing needed to ensure patient safety. Thus, it is appropriate that the practice of medicine and the quality of medical care are the responsibility of properly licensed physicians. The AOA further supports the concepts of uniform licensure pathways for non-physician practitioners, based upon scope of practice. It opposes any legislation or regulations that would authorize the independent practice of medicine by any individual who has not completed the state’s requirements for physician licensure. As non-physician practitioners continue to seek wider roles, public policy dictates patient safety and proper patient care should be foremost in mind when the issues encompassing expanded practice rights for non-physician practitioners– autonomy, scopes of practice, prescriptive rights, liability, and reimbursement, among others – are addressed.
A. Patient Safety
The AOA supports the “team” approach to medical care, with the physician as the leader of that team. The AOA further supports the position that patients should be made clearly aware at all times whether they are being treated by a non-physician clinician or a physician. The AOA recognizes the growth of non-physician clinicians and supports their rights to practice with appropriate physician involvement within the scope of the relevant state statutes.
B. Independent Practice
It is the AOA’s position that roles within the “team” framework must be clearly defined, through established protocols and signed agreements, so physician involvement in patient care is sought when a patient’s case dictates. The AOA feels non-physician clinician professions that have traditionally been under the supervision of physicians must retain physician involvement in patient care. Those non-physician clinician professions that have traditionally remained independent of physicians must involve physicians in patient care when warranted. All non-physician clinicians must refer a patient to a physician when the patient’s condition is beyond the non-physician clinician’s scope of education, training, or expertise.
C. Liability
The AOA endorses the view that physician liability for non-physician clinician actions should be reflective of the quality of supervision being provided and should not exonerate the non-physician clinician from liability. It is the AOA’s position that non-physician clinicians acting autonomously of physicians should be held to the equivalent degree of liability as that of a physician. Within this independent practice framework, the AOA further believes that non-physician clinicians should be required to obtain malpractice insurance in those states that currently require physicians to possess malpractice insurance.
D. Educational Standards
DO’s/MD’s have proven and continue to prove the efficacy of their education, training, examinations, and regulation and physician involvement for the unlimited practice of medicine and it is the AOA’s firm conviction that only holders of DO and MD degrees be licensed for medicine’s unlimited practice. The osteopathic profession has continually proven its ability to meet and exceed standards necessary for the unlimited practice of medicine, as non-physician clinicians seek wider roles, standards of education, training, examination, and regulation and physician involvement must all be adopted to protect the patient and ensure that proper patient care is being given. The AOA holds the position that education, training, examination and regulation must all be documented and reflective of the expanded scopes of practice being sought by non-physician clinicians. The AOA recognizes there may be a need for an objective, independent body to review and validate non-physician clinician standards.
Receivers of health care should also be advised of the education and training of the PA or NP. At no time should those persons be completely independent of supervision from a fully licensed physician, in compliance with state law. Any severe or complicated medical or surgical case should be brought to the attention of their supervising physician as soon as possible.
Each PA or NP should carry their own professional liability insurance independent of their employer subject to state law. We realize that many osteopathic/allopathic physicians are employers/supervisors of PAs or NPs. The objective of this position paper is to ensure safe and effective care of the highest quality for their patients.
2. The Full, Complete, Unrestricted, and Independent Practice of Medicine by Nurse Practitioners [C/23, 18]
ACOFP will continue to work with the state and national entities of the American Academy of Family Physicians (AAFP), American Osteopathic Association (AOA), and American Medical Association (AMA) to educate and inform state and federal legislators regarding the dangers of the unsupervised, full, complete, unrestricted, and independent practice of medicine by nurse practitioners.
1. Homeland Security/War on Terrorism [C/23, 18, 13, 08, 03]
ACOFP supports the war on terrorism and the continued development of appropriate homeland security measures.