Letters to the Editor  |   December 2012
OCC: Will It Never End?
Author Affiliations
  • J. Tod Sylvara, DO
    La Plata, Missouri
Article Information
Medical Education / Practice Management / Professional Issues
Letters to the Editor   |   December 2012
OCC: Will It Never End?
The Journal of the American Osteopathic Association, December 2012, Vol. 112, 768-769. doi:
The Journal of the American Osteopathic Association, December 2012, Vol. 112, 768-769. doi:
To the Editor: 
For the past 20 years, my wife, Karen A. Sylvara, DO, and I have had the distinct privilege of providing competent and compassionate care to a rural, underserved population in northern Missouri. Thanks in large part to the excellent osteopathic medical education I received and the clinical mentors who advised me along my career path, my life's work and mission of providing rural primary care has been successful. 
However, I have grave concerns about the continued survival and success of this endeavor. Ever-increasing overhead, flat or declining reimbursement, greater and greater intrusions, demands from insurance and governments, and the constant threat of malpractice suits are just a few of my concerns. Dark clouds on the horizon are many, and I hope the country doctor can survive. 
I certainly hope that implementation of Osteopathic Continuous Certification (OCC) is not so onerous that it results in lost time, extra travel, missed work, and emotionally stressful, constant test-taking, all so that I can comply and maintain my certification with the American College of Osteopathic Family Physicians (ACOFP). 
I cannot speak for my family practice brothers and sisters across the country. In the trenches in this section of flyover country, however, my peers and I taking care of patients and business here feel pretty squeezed, pressured, and stressed. We are growing weary of complying with mandate after mandate, great ideas from people who, for the most part, have no idea what we do. I have serious concerns about the primary care work force, especially in rural areas. 
As ever, I strive to stay up to date with continuing medical education, audio digests, journals, and board recertification criteria. I feel these things have been sufficient up to this point. 
At age 50 years, I am exactly the mean age of a typical family physician, to my knowledge. Obviously, that means half of the family physicians are older than I am. 
Would you like to venture a guess at what most of them think about a bunch of new mandates to maintain board certification? More and more demands are being placed on an understaffed and aging family practice workforce. 
Has board certification been beneficial to me up to this point? Here are a few of my thoughts on the matter:
    I have not had a patient ask me if I was board certified.
    I have not received higher reimbursement from insurance, government, or private payers because of current board certification.
    Board certification was not required to staff the various rural emergency departments and clinics I have worked, nor was it required in my private practice.
    Being board certified does little to protect against malpractice suits (an unfortunate event that, thankfully, I have never faced).
There is an ever-increasing demand for primary care services, coupled with a work force shortage. The primary care population includes many licensed, practicing physicians who are not board certified or eligible. In this context, why would states worsen the primary care workforce shortage by tying board certification to state licensure? 
Removing thousands of practicing noncertified family physicians from inner city and rural communities that desperately need their services would be tragic. 
To the ACOFP certification board, some friendly, collegial, and unsolicited advice: When formulating new mandated hoops for the rest of us to jump through to maintain board certification, please do not overestimate the perceived value of board certification to the primary care workforce, especially in the context of even greater costs, mandates, time, and stress.