Proposal would limit DOs’ access to ACGME residencies, fellowships
Proposed rule changes announced in early November by the Accreditation Council for Graduate Medical Education (ACGME) would erect barriers to DOs who wish to transfer into ACGME-accredited residency or fellowship programs from AOA-approved internship or residency programs that are not dually accredited.
AOA: ‘We will take any and all steps to resolve this’
The AOA has not stood silently by while the proposed revisions to the Common Program Requirement of the Accreditation Council for Graduate Medical Education (ACGME) have been causing unrest in the medical educational arena. Instead, we are actively working to have these proposed policies recalled or amended so that osteopathic physicians will continue to benefit from additional career opportunities.
AOA President Martin S. Levine, DO, MPH, and I have submitted several letters to ACGME leadership expressing concern about the impact these changes would have on our collective ability to train the physician workforce. We collaborated with a majority of the osteopathic specialty societies to send a joint letter echoing those same concerns as part of our specialty college communication and advocacy plan. Several leading allopathic medical organizations have joined in with their support.
Email communications to directors of osteopathic medical education, DO trainees and osteopathic medical students have rallied professionwide advocacy to prevent the proposed changes from becoming permanent. I have met via conference call with ACGME CEO Thomas J. Nasca, MD, to protest the changes. Furthermore, a meeting of ACGME and AOA leaders is being scheduled for January 2012.
We will take any and all steps to resolve this situation to the benefit of the America’s 78,000 DOs.
—AOA Executive Director John B. Crosby, JD
To be implemented in 2014 or 2015 if approved, one change would restrict ACGME-accredited fellowships to MDs and DOs who complete residencies accredited by either the ACGME or the Royal College of Physicians and Surgeons of Canada. Fear of this change coming to fruition has already started to influence osteopathic medical students’ decision-making, says Mansoor Ali Jatoi, OMS IV, the student representative to the AOA Board of Trustees.
“I’ve had a number of calls from students who are concerned that if they match into an AOA-approved residency, they might not be able to pursue an ACGME fellowship four or five years from now,” notes Jatoi, who attends the Midwestern University/Arizona College of Osteopathic Medicine in Glendale. This is especially true of osteopathic medical students planning to specialize in internal medicine, who often extend their training with subspecialty fellowships, he says.
While he is participating in the upcoming AOA match, Jatoi points out that some students who would prefer to serve AOA residencies because of their commitment to osteopathic principles and practice, program location or connections are now questioning whether that would be a sound career choice in the long run.
Another proposed change to the ACGME’s common program requirements would prevent DOs serving osteopathic internships from transferring into ACGME residency programs unless they repeat their first year of graduate training. This revision would have a major impact on the training options of DOs who intend to practice in Florida, Michigan, Oklahoma or Pennsylvania—states that require an osteopathic internship for licensure.
In addition, four specialties with training programs accredited by the ACGME—family medicine, radiology, anesthesiology and physical medicine and rehabilitation—currently give DOs full credit for serving an osteopathic internship, and many other such specialties give partial credit for completed osteopathic graduate medical education (OGME). The proposed revisions would essentially nullify previously completed OGME, reducing the career choices of DOs in AOA-approved internship and residency programs that aren’t also accredited by the ACGME, according to Stephen C. Shannon, DO, MPH, the president of the American Association of Colleges of Osteopathic Medicine.
The problem isn’t just that these DOs would need to repeat a year of graduate training. Because of funding limits on graduate medical education imposed by the Centers for Medicare and Medicaid Services, “the proposed requirements may deny some physicians access to positions because repeating and then completing residency training may exceed the maximum five years of 100% funding,” wrote AOA President Martin S. Levine, DO, MPH, and AOA Executive Director John B. Crosby, JD, in a letter to the ACGME in November.
AACOM and osteopathic specialty societies, as well as the AOA, have responded to the ACGME with letters calling for revocation of the proposed rule change, explaining both the impact the new requirements would have on DOs’ graduate medical training and the similarity in standards between AOA-approved and ACGME-accredited residency programs. In addition, many other organizations and individuals, such as residency program directors, have voiced their concerns to the ACGME, Dr. Shannon says.
“The ACGME has expressed surprise at the magnitude of the response,” says Dr. Shannon, who remains hopeful that the proposed revisions to ACGME’s common program requirements will be amended.
Comments received by the ACGME will be forwarded to its Council of Review Committee, which will decide whether to make any modifications to the proposed rule at its February 2012 meeting. The amended rule would then be sent to the ACGME Committee on Requirements, which will meet in June. Before making a final decision next year, the ACGME will hold a public hearing during which the AOA, AACOM and other organizations can submit additional testimony.
The AOA has been chronicling the profession’s initiatives to communicate with the ACGME, while AACOM is providing answers to osteopathic medical students’ frequently asked questions about the proposed rule change.
The rule change would affect foreign-trained international medical graduates, as well as osteopathic physicians. “From a number of conversations with people involved in medical education in the U.S., we believe that OGME programs were not specifically targeted for exclusion and that the impact on osteopathic medical training is largely due to unintended consequences,” Dr. Shannon says. “The ACGME did not fully analyze the reaction that would occur to the proposed changes.”
Some ACGME leaders have said they were unfamiliar with the accreditation standards governing OGME, Dr. Shannon adds.
“The ACGME is making no assumptions as to the quality of AOA-accredited residency programs in these new standards,” said ACGME CEO Thomas J. Nasca, MD, in a statement. “It is making an affirmative standard that all residents, regardless of medical school of origin or country of origin, who wish to participate in ACGME-accredited programs must participate in the complete program.”
The proposed rule change would not affect DOs training in the 20% of AOA-approved programs that are dually accredited by the ACGME. If the change is approved, Dr. Shannon expects that many more OGME programs will apply for dual accreditation.