In the form of an analogy, I want you to consider for a second the formation of a family company (or in our case the POMA). Think of the original company founders whose work, struggles, and risks led to the formation of the company, and to the company gaining a foothold in market share.

In Erie, POMA presidents like Dr. Dale Pierson (1939-40) and Dr. Richard Cooney (1957-58) fit into the end of this phase. While I did not have the pleasure of knowing them, they were several of the founding physicians of Erie Osteopathic Hospital (now Millcreek Community Hospital). The POMA and its members at that time were instrumental in gaining the acceptance of both patients and other medical professionals (not an easy task at the time). Their relevance was obvious. Strength and relevance in that phase were primarily with the individual physician, as compared to the hospitals. Our company was off to a good start.

The second phase of an organization, that of acceptance and growth, would relate to our imaginary company being handed down to the founders' children. They grew up watching the sacrifices of the founders, inherited the founders' work ethic, learned of the ongoing perils threatening their company, and they fought to maintain market share. They were generally well-equipped to guide the company's continued success and rapid growth.

In the 1970's and 80's, the POMA and its members gained and maintained prominence at the state and national levels during this second phase. Spheres of influence/relevance combined the continued relevance of the strong-willed individual physician and melded it with the growing influence and strength of osteopathic hospitals. Each region in Pennsylvania can name both the most relevant D.O.s and the D.O. hospital sphere that they represented. In Erie, POMA presidents Dr. Joseph Namey (1972-73) and Dr. Ron Esper (1980-81) exemplify this second phase.

Dr. Joe Namey had relevance. He had a strong personality and, love him or not, he could get things done.

As an aside, Dr. Joe had the ability to make those around him yield to his wishes and to return "owed" favors. If he wanted something from us "young" physicians, he would frequently remind us that we got into medical school only because of him. The fact that I had grown up around Philadelphia and had not met or heard of Dr. Namey until I presented to Erie for my internship was a petty detail to Dr. Joe. As a matter of fact, he mentioned so many times that he had gotten me into medical school that even I started to believe it. Dr Namey was relevant.

Dr. Ronald Esper had and has relevance. He was a regional leader in Erie prior to his attaining a leadership role at the state and later national levels. He was and is always professional in his interaction with young physicians. He never resented being called to the ER at any hour, even for cases that ultimately did not need a surgeon. He would instruct us with respect no matter how insignificant the case ended up being. His personal strength and political savvy served the POMA well. He was relevant.

The last phase of an organization, that of strengthening or disintegration, would relate to our fictitious company being put into the hands of the grandkids/nieces/nephews. They have grown up with all of the advantages and successes of the company. Life has been good for them without the need, or even possibly the knowledge, of the sacrifices of those before. Some will maintain their diligence to see that the company continues to strengthen. Others, unfortunately, will just enjoy the benefits and allow the company to wither/be bought out/ or to ultimately disintegrate.

In Erie, as all over, the relevant players have changed. Regional influences have switched from the individual physician, or even the regional osteopathic hospital, to other groups such as the OPTI system with greater integration of other health professionals, including allopathic health care systems, nurse practitioners, pharmacists, physician assistants, etc.

While we need to work with other health professionals, we need to ensure that we maintain our relevance as an organization. Pennsylvania has a significant percentage of osteopathic physicians. We need to use our numbers to the benefit of the POMA and not be swept over by the needs of relatively small factions within the AOA or by non-physician health care provider groups.

I know politics is important, but I am tired of yielding to the wishes of the few. For example, states with a minimal number of practicing D.O.s, whose number, if they go up at all, will probably be non-AOA D.O.s, seem to dictate a disproportionate level of decision-making within the AOA. They should have a voice, but not to our detriment.

Another example — there are those nonphysician groups, pharmacists, etc., that would allow for immunizations (of adults and children) to be given at locations outside of a physician's office (like they now do for flu shots). There are groups within our own profession that, if allowed, would permit non-D.O.s to be directors of osteopathic medical education — overseeing D.O. programs, D.O. program directors, D.O. residents and students — as to how to train osteopathic physicians.

Should those states still requiring internships (Pennsylvania among them) yield and give up the holistic philosophy that makes us a distinctive profession?

Should Pennsylvania family physician D.O.s who fulfilled their requirements and were granted lifetime family physician certification be compelled to now take the recertification exam?

We need to maintain our relevance by maintaining our strength. Compromising with other groups is fine, as long as it is to our — our company's — benefit.

Teddy Roosevelt had said (with slight editorial changes)... If we forget that in the last resort we can only secure peace (our place/relevance) by being ready and willing to fight for it, we may someday have bitter cause to realize that a rich nation (organization) which is slothful, timid, or unwieldy is an easy prey for any people (group) which still retains those most valuable of all qualities, the soldierly virtues (those that remain aggressive for their own goals).

To allow further encroachment into the domain of osteopathic physicians in the name of compromise or to "make nice" will ultimately erode the relevance of the POМА, and ultimately the AOA, much like that third phase company owner who does not continue to be diligent.

The POMA must, and I am sure will, in its third phase, maintain its relevance. The PОМА must continue to use its collective strength to be an advocate for D.O.s at the state and national levels. While working with other nonosteopathic organizations, the POMA must maintain its mission by helping Pennsylvania D.O.s first. If, by helping ourselves, we help other organizations, fine — but we must be ever vigilant as to their goals, which may be contrary to ours.

Acceptance of osteopathic physicians within allopathic hospitals and medical groups has been attained, but our continued unique identity and philosophy remain in jeopardy and problematic.

To conclude, if we are relevant, news organizations and civic organizations should be looking to POMA for its opinions, information and medical leadership.

I am sure that the POMA will continue to fight for the interests of osteopathic physicians. Therefore, I am confident that POMA and osteopathic physicians (our phase three family company, if you will) are in good hands and will continue to be strengthened and to thrive. We will have continued relevance.

Thank you and enjoy the conference.