Comprehensive Study Guide and Meeting Minutes: Colorado Society of Osteopathic Medicine (CSOM) Governance and Strategic Planning

Meeting Overview and Leadership Introductions

• Executive Director Jennifer Flannery convened the meeting on a Saturday morning at Rocky Vista University (RVU) to address critical decisions regarding the future, direction, and viability of the Colorado Society of Osteopathic Medicine (CSOM).

• Meeting venue logistics at RVU: Restrooms and drinking fountains are located down the main hallway from the meeting room.

• Attendees included in-person members, online participants via Zoom, board members, faculty, and osteopathic medical students.

• CSOM Leadership Introductions:

  • Dave Ross: Current President of CSOM and meeting moderator; has served as President for approximately $6$ years.

  • Dr. Ann Traywick: Board member; works full-time at RVU directing the Principles of Clinical Medicine course; previously practiced family medicine for $25$ years.

  • Dr. Joey Stacio: Board member; works full-time at RVU as Chair of the Department of Primary Care; Immediate Past President of CSOM.

  • Dr. Sarah Bulos: Board member; emergency medicine physician working full-time in the RVU simulation department.

  • Dr. Gregory Holler: Board member; clinical practitioner.

  • Dr. John Lynch: CSOM member; retired radiation oncologist living in Golden, CO, who spent the majority of his career practicing in Arkansas.

  • Dr. Elise Goldberg (online): Current Secretary-Treasurer and Past President of CSOM.

  • Dr. Bill Mandel (online): Board member for $16$ years and Past President; family practitioner; Medical Director with UnitedHealthcare since $2009$ (retiring the week of the meeting).

• Primary Question for the Meeting: "Should CSOM stay or should CSOM go?" The meeting aimed to evaluate whether CSOM needs to pivot its mission, identify unfulfilled needs for DOs in Colorado, or disband if member needs are fully served elsewhere.

Historical Evolution and Financial Landscape of CSOM

• Thirty-Year Historical Trajectory (presented by Dr. Bill Mandel):

  • CSOM historically maintained approximately $500$ active paying members.

  • CSOM conducted two major Continuing Medical Education (CME) conferences per year: a summer meeting in Vail or Breckenridge, and a winter ski meeting in Breckenridge, Keystone, or Copper Mountain, attracting hundreds of attendees.

  • Primary Drivers of Operational Decline:

  • Changes in mandatory state CME requirements and a widespread decline in Osteopathic Manipulative Treatment (OMT) utilization.

  • Transition of physicians from independent private practice into employed roles with hospitals, healthcare systems, or insurance entities.

  • Shift in osteopathic career specialties: Historically, $90\%$ of osteopathic graduates entered primary care, which declined to approximately $50\%$.

  • The $2012$ Financial Insolvency Crisis:

  • CSOM reached bankruptcy in $2012$ during Dr. Bill Mandel's presidency.

  • Action taken: The Board terminated the executive director and executive secretary, and secured a $\\text{100,000}$ emergency loan from the American Osteopathic Association (AOA) to maintain operations.

  • The AOA temporarily provided an executive director to manage operations.

  • Outcome: CSOM fully repaid the $\\text{100,000}$ loan plus interest and re-established cash reserves.

• Additional Historical Factors (presented by Dr. Elise Goldberg):

  • Historical membership peaked near $500$ due to a discounted malpractice insurance rate offered to CSOM members by COPIC.

  • COPIC revoked the CSOM member discount approximately $15$ years prior and has repeatedly refused to reinstate it.

  • The loss of pharmaceutical sponsorship revenue and the growth of corporate medicine further eroded financial streams.

  • Historic Legislative Impact: In $1992$, former CSOM President Dr. Tom Toll addressed the University of Colorado (CU) when CU refused to accept DO residents. Toll informed CU leadership that denying DO residencies put their federal funding at risk, successfully securing DO residency access.

• Current Financial Status and Budget Projections (presented by Dr. Dave Ross):

  • Historical cash reserve baseline: Approximately $\\text{100,000}$.

  • Recent fiscal trend: Steady annual net losses over $3$ to $4$ years due to declining membership dues.

  • Year-to-date budget deficit (through July $2024$): Projected net income of negative $\\text{10,000}$, reducing cash reserves to approximately $\\text{90,000}$.

  • Active dues-paying membership: Currently stands at approximately $30$ to $35$ members out of an estimated pool of $3,000$ to $3,362$ DOs residing or practicing in Colorado.

  • Breakeven Operational Threshold: Requires approximately $100$ members paying full dues (at the current rate of $\\text{395}$) or $200$ to $300$ members at a discounted rate (representing roughly $10\%$ of Colorado DOs).

  • Membership Dues Tiers: CSOM currently maintains $8$ to $9$ distinct membership categories, creating administrative complexity.

  • AOA Dues Partnership Details:

  • CSOM partners with the AOA to include CSOM membership dues billing on AOA's annual dues renewal statement (running from October 1 through January 31).

  • CSOM pays AOA a $15\%$ processing fee on collected dues.

  • AOA dues check-offs are restricted to full-dues AOA members and exclude members receiving military, retired, or resident discounts.

  • CSOM must formally confirm its annual partnership renewal with the AOA by September 10.

  • Executive Director Turnover History: CSOM has employed $4$ Executive Directors since ~$2012$/$2018$ (one AOA-supplied until ~$2018$, one for $4$ years, one for $1$ year, and currently Jennifer Flannery).

  • Lobbying Expense Adjustments:

  • Pre-COVID lobbying expenditure: $\\text{18,000}$ annually.

  • COVID period adjustment: Lobbyist offered zero-cost service; CSOM paid $\\text{5,000}$ annually.

  • Current lobbying fee: $\\text{7,500}$ annually.

Key Organizational Functions and External Partnerships

• CME Revenue and Operational Model:

  • Recent CMEs were moved to RVU in a hybrid format to eliminate facility rental fees.

  • $2024$ CME attendance: Total of approximately $30$ attendees ($10$ to $15$ in-person, $15$ to $20$ online).

  • Net profit per CME session: Typically generates $\\text{2,000}$ to $\\text{3,000}$.

  • Operational costs: RVU provides room space in-kind; speaker honoraria are capped at $\\text{250}$ per speaker; zero travel mileage or hotel costs are reimbursed.

• Denver Osteopathic Foundation (DOF) and Colorado Springs Osteopathic Foundation (CSOF):

  • DOF Origin and Capital: Created from the sale proceeds of the former Denver Osteopathic Hospital, maintaining an escrow investment endowment of approximately $\\text{2,000,000}$.

  • DOF Core Mission: Fiduciary oversight of endowment investments to provide scholarships to osteopathic medical students in Colorado (primarily at RVU, as well as Colorado residents attending out-of-state osteopathic schools).

  • DOF Philanthropic Activities: Hosts an annual charity golf tournament; Helmet Heads pediatric safety education; high school sports physicals; and an annual student-physician networking night (scheduled for September 24 at RVU; Executive Director Julie Collette officed at RVU).

  • CSOM-DOF Financial Relationship: CSOM pays DOF $\\text{1,500}$ annually for a golf tournament hole sponsorship, while DOF provides a $\\text{1,000}$ grant back to CSOM to support CME delivery (resulting in a net CSOM expenditure of $\\text{500}$).

  • CSOF Mission: Operates independently in Southern Colorado providing local scholarships and osteopathic community programs.

• Comparative Membership Context:

  • Colorado Medical Society (CMS) currently has approximately $400$ to $500$ DO members out of its total ~$\text{7,000}$ members, largely driven by access to the COPIC malpractice discount.

  • AOA House of Delegates Representation: CSOM provides the sole mechanism for Colorado to send an official voting delegation to the national AOA House of Delegates in Chicago every July. Without a active state society, Colorado DOs lose their voting voice at the national level and their pipeline for AOA Board of Trustees leadership.

Perspectives from Attendees and Interactive Discussion

• Kelly Glaser (online):

  • Highlighted that past CMEs partnered with the AOA under the "Rome Conference" structure, where AOA assumed financial liability risk.

  • Noted that CSOM has failed to issue routine annual reports, newsletters, or legislative updates to its members.

  • Criticized leadership for failing to issue annual calls for board nominations per organizational bylaws over the preceding $5$ years (with only one call issued $2$ years prior).

• Sylvie (RVU Student):

  • Asked what specific strategies CSOM is employing to recruit out-of-state DOs moving to Colorado.

  • Emphasized that students and young physicians seek local mentorship, networking directories, and community support over expensive away CMEs.

• Dr. Wanda Goode & Specialist Attendees:

  • Expressed strong desire for a centralized, searchable online CSOM directory of Colorado osteopathic physicians to facilitate specialist-to-primary care intra-osteopathic patient referrals.

• Avita (RVU Student & SGA Representative):

  • Reported meeting Dr. Elise Goldberg at the July AOA House of Delegates in Chicago, noting that RVU students were unaware of CSOM's existence prior to that event.

  • Offered student assistance: Participation in AACOM Advocacy Day on Capitol Hill, establishing student representation on the CSOM board, and co-hosting an SGA/SOMA advocacy event in September/October.

• Dr. Beth Longnicker (Dean/Faculty, UNC):

  • Announced the matriculation of the inaugural medical class at UNC and an upcoming campus visit by the AOA President on October 12.

  • Called out CU Anschutz for listing DO surgical residents as "MD" on official department websites.

  • Reaffirmed that CSOM is essential to maintain Colorado's voting seat at the AOA House of Delegates and national board trustee pipeline.

• Dr. Bush:

  • Recommended pivoting CSOM's mission toward integrative medicine, functional health, practice management, and cash-based service models.

  • Suggested co-sponsoring events with existing specialty organizations rather than standalone CMEs, and scheduling events during shoulder seasons (April–May or late September–November) instead of peak summer vacation periods.

• Dr. Hager (RVU OPP Faculty):

  • Inquired about DOF collaboration and suggested partnering with the American Academy of Osteopathy (AAO) during their triennial convocation at the Broadmoor in Colorado Springs.

• Student Doctor Mirza (SOMA President):

  • Presented a resolution proposal for a $3$-year primary care track (modeling programs at LECOM, Rowan, and the OUHCOM/Cleveland Clinic $3+3$ pilot) to mitigate medical student debt burdens (which reach $\\text{700,000}$ to $\\text{800,000}$ including undergraduate private loans) by tying track enrollment to mandatory post-graduation CSOM membership.

Formal Motions, Bylaws Compliance, and Governance Decisions

• Debate on Organizational Dissolution vs. Continuation:

  • Initial Motion: Dr. Gregory Holler moved to take a formal vote on whether to continue or disband CSOM.

  • Procedural Discussion: Questions were raised regarding quorum requirements and the bylaw rule requiring $30$ days' advance notice to membership for special voting meetings.

  • Bylaw Requirement for Dissolution: Dissolution of CSOM explicitly requires a two-thirds ($\frac{2}{3}$) affirmative vote of the entire active membership.

  • Leadership Offer: Dr. Ann Traywick offered to step into the CSOM Presidency to work alongside Executive Director Jennifer Flannery, contingent upon members stepping up to fill supporting committees.

  • Outcome: Dr. Holler withdrew his initial motion.

• Motion for Organizational Continuation:

  • Motion: Offered by Dr. Richard Book; Seconded by Dr. Chris LaFontano: "To establish a formal consensus recommendation from the assembled meeting body to continue the operations and mission of CSOM."

  • Vote Outcome: Passed unanimously by voice and show-of-hands vote ($100\%$ affirmative; zero opposed; zero abstentions).

• Bylaws Structure for Nominating Committee Formation:

  • Article Requirements: The bylaws mandate a $7$-person Nominating Committee consisting of:

  • Chair: Immediate Past President (Dr. Joey Stacio).

  • Six members elected by the general membership: $2$ Board members, $1$ Student member, $1$ Intern/Resident/Fellow member, and $2$ Members-at-Large.

• Motion to Elect Nominating Committee:

  • Motion: Offered by Dr. Beth Longnicker; Seconded by Dr. Richard Book: "To appoint the slate of individuals who volunteered during the emergency membership meeting as the official CSOM Nominating Committee."

  • Elected Nominating Committee Members:

  • Dr. Joey Stacio (Chair / Immediate Past President)

  • Dr. Kelly Glaser (Member-at-Large)

  • Dr. Richard Book (Member-at-Large)

  • Dr. Neha Valleja (Board Representative)

  • Dr. Sarah Bulos (Board Representative)

  • Avita (Student Representative)

  • Vote Outcome: Passed unanimously.

• Resolution of Procedural Debate:

  • Dr. Wanda Goode voiced concern that rigid procedural debate over bylaws during the meeting's final minutes risked alienating prospective volunteers and suppressing broader committee participation.

  • Dr. Neha Valleja suggested postponing Nominating Committee actions until outreach committees were formed.

  • Clarification provided by Dr. Ross, Dr. Longnicker, and Dr. Mandel: The Nominating Committee's election satisfies AOA compliance rules and operates in parallel with member outreach, without restricting the Executive Director from issuing membership surveys or forming operational working groups.

• Executive Leadership Transition and Authorizations:

  • President Dr. Dave Ross agreed to remain in office for a transition period of $3$ to $6$ months until formal candidate slates and membership elections are completed.

  • Unanimous Consensus Granted to the Board and Executive Director Jenniferu Flannery to:

  1. Confirm the AOA dues renewal contract by the September 10 deadline.

  2. Issue direct dues renewal invoices to current and prospective members.

  3. Rebuild and launch the official CSOM website.

  4. Form operational committees focused on CME planning, membership value proposition, and student engagement.

• Adjournment: Motion to adjourn moved, seconded, and passed unanimously.