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The DO | Special Coverage | AOA House of Delegates 2013

AOA, AACOM support continued discussions on GME

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AOA Trustee Boyd R. Buser, DO, announces to the House that the AOA and AACOM have not reached an agreement with the ACGME on a unified GME system. (Photo by Patrick Sinco)

Early Friday afternoon, AOA Trustee Boyd R. Buser, DO, made a long-awaited announcement before the AOA House of Delegates that eased the fears of many experienced members of the profession. Rejecting a “take it or leave it” memorandum of understanding issued by the Accreditation Council for Graduate Medical Education (ACGME), the AOA and the American Association of Colleges of Osteopathic Medicine (AACOM) have not reached an agreement with the ACGME on a unified system of accrediting graduate medical education.

“The AOA Board of Trustees and the AACOM Board of Deans determined that the memorandum of understanding transmitted to us by the ACGME does not include adequate recognition of our core principles,” said Dr. Buser, noting that the AOA and AACOM remain open to continuing discussions with the ACGME on a unified accreditation system.

The AOA House greeted Dr. Buser’s presentation with applause and approved a motion to unanimously support the AOA and AACOM’s decision.

During a town hall meeting on GME the night before and in four resolutions submitted to the AOA House, delegates expressed frustration about a lack of transparency in the negotiations, as well as concern that the proposed unification could jeopardize the profession’s distinctiveness and long-term viability. Dr. Buser and AOA Executive Director John B. Crosby, JD, explained then that the AOA and AACOM had entered into confidentiality agreements with the ACGME and could not divulge the details of the negotiations or the ACGME’s memorandum of understanding.

Back to square one

After Dr. Buser’s presentation to the House, several delegates voiced their gratitude that the AOA and AACOM’s representatives stood fast in championing the profession’s principles. Many questions remain, however.

“Will DOs training in osteopathic residencies be able to enter ACGME fellowships?” asked Trevine Albert, OMS II, who attends the Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla.

Because no agreement has been reached, responded Dr. Buser, the ACGME might go ahead with previously planned changes to its common program requirements that would prevent ACGME-accredited programs in all specialties from recognizing previously completed osteopathic GME. This would bar DOs in osteopathic residencies that aren’t dually accredited from pursuing ACGME fellowships and DOs in traditional rotating internships from entering ACGME residencies as second-year residents. New DO graduates would still be able to enter ACGME residencies as first-year residents.

Dr. Terry

New York delegate Richard Terry, DO, raises a question on the ACGME issue during the AOA’s town hall meeting Thursday evening. (Photo by Patrick Sinco)

“It still remains a goal of ours to ensure that this does not adversely affect the choices of our graduates,” Dr. Buser said. “In the short term you still have the choice of AOA or ACGME programs. I’m telling you that we remain committed to working to the solution that would preserve access for our graduates.”

Andrew Schleuning, OMS II, told The DO that the student leaders he knows at the House are “very confused” about the outcome of the negotiations with the ACGME. He said he isn’t sure how his classmates at the Kansas City (Mo.) University of Medicine and Biosciences College of Osteopathic Medicine will react to the news that the proposed unification of accreditation is not likely to come to fruition.

Developing new osteopathic programs

This year, osteopathic medical schools graduated 4,900 new DOs, but the profession has only 2,900 approved and funded first-year positions. Today, more than 60% of DO graduates are training in ACGME programs, Dr. Buser pointed out during his presentation.

“The problem we have long-recognized in the AOA is that we don’t have the capacity to train our graduates,” he said.

But the profession has made progress in developing new OGME programs and will redouble its effort in this regard, according to Dr. Buser.

Outgoing AOA President Ray E. Stowers, DO, noted in a statement to members that 1,100 OGME slots were added this past year in 75 new AOA-approved programs.

“We had a record year for DO GME programs—almost a full 10% growth in just one year,” Dr. Stowers stressed at the town hall meeting.

New York delegate Richard Terry, DO, feels strongly that the profession must dramatically increase the number of its training programs, especially subspecialty fellowships. “It’s OK that some of our graduates go to ACGME. But we need to expand and provide OGME so that all of our graduates potentially have an osteopathic spot,” Dr. Terry told The DO.

“The bottom line is that the vast majority of hospitals are not teaching hospitals,” said Dr. Terry, the chief academic officer of the Lake Erie Consortium for Osteopathic Medical Training. “There is potential to create programs in these hospitals if we have collaboration on the part of osteopathic medical schools to do so. There has to be an investment by the schools to make this happen.”

Correction: This article has been updated to note that the osteopathic medical profession has 2,900 approved and funded first-year graduate medical education positions, not 2,900 total GME positions.

cschierhorn@osteopathic.org

64 Responses

  1. Jay on July 21, 2013, 1:23 a.m.

    “zero” comments huh? I wonder how many posts have been pulled down already.

  2. Sad on July 21, 2013, 10:02 a.m.

    Sad day for the osteopathic community!

    Good job AOA for mortgaging my future

  3. aldous on July 21, 2013, 10:23 a.m.

    Adding more residency seats is not really a solution to this issue. It is important in the grand scheme of healthcare but it does not address the underlying problem. “Treat the root cause not the symptom”.

    The only DO residency programs that repeatedly fill are the competitive programs. The DO primary care seats are desperately unfilled and since we do not allow foreign graduates to fill those seats like in the ACGME we’re basically wasting taxpayer money. I don’t understand why the AOA is so intent on putting their interest ahead of the public health interest.

    Recent graduates are often afraid to speak out in fear of retaliation but the phrase “actions speak louder than words” I think applies here. Why would so many people go out of their way to not train in DO residency programs?

    People are slowly but surely starting to ask difficult questions. I’d ask anyone with a vote to put emotion and self interest aside and to do what is right for the people we take care of. It’s time to take the lead in managing our own internal conflict.

  4. Jay Marlor on July 21, 2013, 10:52 a.m.

    Future DOs will have to pay for the poor leadership that we call AOA when these hippies kick the bucket.

  5. jay on July 21, 2013, 1:34 p.m.

    More than 60 percent of DO graduates pursue acgme residencies. Hmm I wonder why. It’s not a lack of AOA residency spots. It’s a lack of quality AOA residency spots.

    And why on earth is the complex considered a core principle of the aoa? How is the osteopathic profession defined by a test!!??? Seems completely motivated by money. If we are so considered with testing for OMM, which we should be, then create a supplemental test to the USMLE. Don’t be so dramatic as to deny the merger of the medical educational.

    The board would rather perpetuate an unfair and unequal educational system rather than compromise. DOs won’t come out winners in a merger situation, but we will come out equals.

    We as a nation have gone to the effing moon, but we can’t unify our medical educational system? Wow.

  6. jay on July 21, 2013, 1:40 p.m.

    *excuse my spelling I’m on a tablet. COMLEX not complex

  7. caniswitchtoMDplease on July 22, 2013, 11:44 a.m.

    Get your act together AOA, pride comes before the fall! And you know what will happen when you fall outside the umbrella of the ACGME (actual high quality residency programs not AOA programs where you train on a farm)? You will be left with no osteopathic medical schools. They will be obsolete, a thing of the past. Do you know how easy it is for an MD to complete an OMM course? IT WOULDN’T TAKE VERY LONG. No the comlex is really a “complex” for anyone in the AOA HOD. Everyone KNOWS KNOWS KNOWS that the USMLE and ACGME are THEE Gold Standards for Medical Education. Osteopathic “distinction” is hardly a distinction at all. Plenty of students of are going to leave the DO world and interested students will never enter a program. GET THE MERGER DONE! Adapt the core principles of the ACGME if you want to remain a profession. Good Lord.

  8. caniswitchtoMDplease on July 22, 2013, 12:23 p.m.

    DO should be in addition to MD, not an alternative to MD.

  9. caniswitchtoMDplease on July 22, 2013, 12:31 p.m.

    WE ALL WANT A MD!!!!!!!!!!! GIVE IT TO US!!!!!!! THE DO CAN BE ADDITIVE

  10. Mansoor Jatoi, DO on July 22, 2013, 12:33 p.m.

    If you are so passionate, get involved, and make the changes yourself instead of sitting back and watching. Call your state society to get involved with the House of Delegates and apply to the AOA’s B/C/Cs.

  11. caniswitchtoMDplease on July 22, 2013, 1:08 p.m.

    ALL health professionals are and should be holistic and take the patient as a whole into their diagnosis and treatment. It has always befuddled me as to why the waste of 2 separate governing boards, national board exams, hospitals, residencies and accreditation bodies. Medicine and its doctors should continue this path of evolution to its seemingly logical conclusion- one universally recognized degree (MD) with the fellowship designation (DO) for those who pursue this additional training; take one board exam USMLE with an OMM section. That, I believe, will elevate those who hold the DO fellowship to a higher standing amongst peers and patients and allow recognition they deserve for this advanced training akin to fellowships in other medical specialties.

  12. William Lancaster on July 22, 2013, 6:09 p.m.

    I love the passion of our leaders and am proud they are making the tough decisions. As none of us know all the details we can only speculate as to their full reasoning. These men and women did not get where they are today by taking our profession and our future for granted. Having said that I think it is obvious our profession has room to grow and improve.

    The Osteopathic community is in dire need of more residencies. Even with a 10% increase in slots this year (and thank you to everyone involved for getting such a big bump) this is only putting a bandage on a gunshot wound. We need a massive push from our schools to help create teaching hospitals at already established (DO friendly) hospitals.

    No one can say (other than personally) why DO students graduate and go to an ACGME over AOA residency. A national poll might tell a very different story than that of a few vocal residents. It could be quality of residency yes, or it could be location, or it could be specialty based. I doubt you can find anyone that chose a residency based on one single aspect alone. Do not automatically assume that this decision is based solely on ‘quality’ and that the ACGME is better than AOA residencies across the board.

    I do not want an MD. I am proud of my DO heritage and wouldn’t have it any other way. We are taught to approach a patient in a holistic way compared to MD students. Yes an infection still needs antibiotics and a broken bone still needs a cast, but a DO knows more can be done to help recover from an infection or aid in a bone fracture than antibiotics and casts alone. If you want to make the DO degree a capstone by making it a fellowship you’ve missed the point. The osteopathic philosophy isn’t only an additional tool we have, it is the very foundation of our medical education.

    I look forward to the continued collaboration with our peers in the Allopathic community. I hope the AOA and ACGME continue to work together to build bridges between our two professions in the years to come. There is a win-win-win agreement out there and I have faith that our leaders will find it in due time.

  13. Concerned on July 22, 2013, 7:33 p.m.

    There does seem to me a striking disconnect between the older leaders and the young students, residents, fellows, and program directors they supposedly represent. I think the AOA leaders should come to the front lines (osteopathic residences) to find out what is really going on and what the students, residents, fellows, and program directors really think before making such a decision. This is a decision that disproportionately affects young physicians in graduate medical education, thus, these members should have a greater say in the matter.

    I’m not sure why the memorandum of understanding is confidential, but the AOA looks pretty awful from my standpoint. I suspect they offered little at the negotiating table and were extremely rigid in their demands. The failure of the AOA to make this deal happen is a sad day and one which will haunt the profession for years to come.

  14. disgusted on July 22, 2013, 9:25 p.m.

    What an absolute disgrace. The DO stigma is perpetuated not by MDs, but by sanctimonious, outdated “osteopaths” that cling to an embarrassing shell of an anachronistic view of osteopathic medicine. I am absolutely appalled to wear the letters “DO” behind my name, and I blame family practitioners and OMM “doctors” who think they have the slightest clue of what it means to practice medicine in the 21st century.

  15. Change is Needed on July 22, 2013, 10:27 p.m.

    “Let us not be governed today by what we did yesterday, nor tomorrow by what we do today, for day by day we must show progress.”

    Those were the words of Andrew Taylor Still. With this move, we do not show progress. A.T. Still did not found osteopathic medicine out of a desire to remain firm in tradition, it was a vital and substantial change from the status quo to serve a need in medicine which had not been filled. We live in a different era now, thankfully. Treating the patient as a whole, and attending to all of their needs is no longer a DO’s to claim as their own.

    I want to be proud to be a DO. I am proud to have in my clinical armamentarium the skillful use of OMT. But what continues to drag me back from my MD colleagues is the vestigial leadership of our governing bodies. Progress and negotiation are intertwined. 60% of DO students matching applied ACGME. That is not “some.” That is a majority. Survey all you want – it is a matter of specialty choice, it is a matter of quality and geography within that – but it is a matter of training and philosophy.

    A.T. Still was once the voice of the forefront – the voice of introducing something vital and new into the medical sphere. And what we have become as a profession seems to be holding onto past fights and clinging to vestigial structure. Let us be governed today by what is best for our profession – and that means, with respect to this process, affording our young DOs the ability to apply wherever they will train best, in whatever field they choose to practice, without the added burden of having to choose between the letters after their name and where their heart tells them they will receive the most appropriate training.

  16. Change on July 22, 2013, 10:46 p.m.

    Mansoor Jatoi, DO– We need you to step up and represent the opinions of the younger generation. You are our voice

  17. Research on July 22, 2013, 10:52 p.m.

    Keep in mind if the door is closed there will be little to no opportunity for students, residents, fellows to get involved in bench research and other high quality research that is basically only present at major academic centers.

    Not everyone wants to to practice OB/GYN, Family med, and peds in rural areas of Kentucky

  18. residenct on July 22, 2013, 11:07 p.m.

    Osteopathic distinctiveness?

    maybe ill get that when the OGME starts CREATING new residency spots (that MATCH school EXPANSIONS)and has PROPER fellowships- that will not force me to the ACGME side

    …in the mean time ill wait… first in line with my 65$

    I will officially depart from the AOA (membership included)– you do not represent me!Greed and power controls is what you represent~

  19. $ dictates common sense on July 22, 2013, 11:23 p.m.

    this is terrible. we continue adding millions of dollars into the pockets of schools via expansion, yet we cannot compete and provide proper GME for all these students.
    Why should these poor students suffer limitations in their educational choices?
    I mean what is this? brown vs. the board of education? separate but equal? the AOA has no foresight, and the only people that will suffer are the students.

  20. notveryhappy on July 23, 2013, 9:11 a.m.

    As a DO medical student, at least allow us to purchase a M.D. license when we get out of this school goverened by “osteopaths” who cannot see that the distinction is away with and real western medicine is being practiced. You are ruining our future for your, and i must emphasize the quotes, “pride.” You want pride? Go to Zambia for OMM, let us practice evolving medicine in the U.S. For the love of God. You self-perpetuate the stigma, honestly a monkey could govern this better. I think I’m going to drop out and apply to an allpathic medical school and community that knows what they’re doing and how do give their students the best chance at residencies. I don’t want to practice OMT in a Kentucky village. I, as well as half of my class, want to specialize and practice and train in wonderful academic centers. Please, put your “distinction” and pride away so we don’t suffer. Either allow us to purchase a license, change the degree, or combine the two, couldn’t care any less. We deserve to be a level playing ground and I am SO sick of the uphill battle, SO SO SICK of it.

  21. ijr18 on July 23, 2013, 10:50 p.m.

    2 sides to every story but here is the ACGME’s response:

    http://www.acgme.org/acgmeweb/Portals/0/PDFs/Nasca-Community/NascaLetterGMECommunityJuly232013.pdf

  22. Well there goes my medical career on July 24, 2013, 10:28 a.m.

    I pursued osteopathic medicine for the holistic view of the body not the OMM. I am a medical student and I find it very frustrating that our representing leaders continue to hold on to traditions as oppose to following scientific evidence and general logic. Dr. Still fought to be allowed to practice and I believe he would be extremely disappointed to find out that when given the opportunity practice as an equal arrogant leaders turned it down. After turning down the ACGME, they have all but given up on us and if the ACGME choose to make their residencies exclusive to allopathic students over 60% of osteopathic students will not have a residency position at all and the likelihood of the other remaining 40% matching into what they want is extremely low unless of course they want to do OMM in by a river in Kentucky somewhere. This unfortunately may be the end of the D.O. not because they combined with the MD, but rather because they became unrecognized and obsolete.

  23. AT on July 24, 2013, 10:40 a.m.

    Maybe it’s time the leaders of the AOA go back to the words of Andrew Taylor Still as a source of inspiration. Me thinks he would be quite disappointed in today’s leadership:

    “My father was a progressive farmer, and was always ready to lay aside an old plough if he could replace it with one better constructed for its work. All through life, I have ever been ready to buy a better plough.”

  24. AT on July 24, 2013, 10:43 a.m.

    How come the ACGME response sounds much more straight forward? It appears as if the powers that be in the AOA are serving us up a dish of distraction and lies. The merger failed NOT because of a “take it or leave it deal” nor were osteopathic distinctiveness and principles at risk, at least according to the following (please do take the time to read):

    http://www.acgme.org/acgmeweb/Portals/0/PDFs/Nasca-Community/NascaLetterGMECommunityJuly232013.pdf#sthash.GxvIkCsi.dpuf

  25. A hurt medical student on July 24, 2013, 5:57 p.m.

    I am ashamed and disappointed in the AOA “leadership”. This is nothing more than “pride and ego” on their part – it’s only going to hurt us students.

    The ACGME leadership was able to provide us with descriptive, honest, and detailed explanations in their letter, why can’t our leaders do the same?

  26. Sad on July 25, 2013, 8:14 a.m.

    everyone take the time to:
    A. abolish your membership to the AOA and provide 0 funding
    B.write the usmle,get an acgme residency and don’t give a penny to these morons!incl licensing exams….. Do your part to leave these guys

    And have the lowest caliber students stay in AOA programs

    C.do everything in your power to avoid and support the AOA and osteopathic bs that has 0 scientific backing

    D. Wait for the takeover by MDs

  27. leavingDO4MD on July 25, 2013, 11:06 p.m.

    I guess if the merger were to happen, MD’s could just watch Harry Potter to learn the spells for OMT non-evidence based pseudoscience.

  28. leavingDO4MD on July 26, 2013, 9:21 a.m.

    i as well as several friends are leaving the DO school. i want nothing to do with the AOA. Ever. Whomever keeps taking down this comment needs to realize the reality in this.

  29. Robby on July 29, 2013, 4:40 p.m.

    I feel sick at my stomach knowing these people are in charge of my future as a physician. I do not know how we have allowed such incompetent beings to lead us.

  30. Joe on July 29, 2013, 9:06 p.m.

    After hearing this news, I immediately went to the AOA website and tried to cancel my student membership, even though it was free. I want nothing to do with such a backwards organization, nor do I want them representing me and controlling my future. The AOA doesn’t represent the interests of students and rising physicians, they represent the interests of themselves, their egos, and their positions of power. If they truly cared about our interests, they would have done all they could to ensure that this merger happened because losing the ability to go to an ACGME fellowship is NOT in our best interests.

    And the COMLEX is not part of any philosophy, it’s part of a scheme to make money. I would be ashamed to have that pathetic excuse of a test be part of any “philosophy” as it was the worst standardized exam I have ever taken, riddled with typos and glaring mistakes that even the SAT would never have. An exam I paid hundreds of dollars for should never in a million years show me a stem that was missing the question.

    AOA, get your act together. This is our future you are playing with.

    – An 3rd year DO student

  31. KVegas on July 30, 2013, 2:11 p.m.

    How does the AOA hold our best interests at heart by canceling this merge? Does the AOA feel that having less DO specialists will improve our standing in the medical community? Maybe, it is the AOAs goal to relegate our entire profession to Primary Care. I recently heard a speech given by an AOA spokesman telling a brand new DO class that the mission of our generation is establishing DO distinctiveness. I feel that everyday that we state we are separate is another day we state we are inferior. I do not believe we are inferior. I took the USMLE this year and scored a 247 and many of my classmates were above the national average (227). My classmates are smart, caring, and talented people. Regardless, I feel many MDs look down on us because of the DO after our name. Our schools are not inferior, but its hard to demonstrate that when we insist on a separate board exam and accrediting body. MDs would be hard pressed to discriminate against us if we all passed the same exam. Literally the rest of the world uses the initial MD to mean doctor. In Peru I met a “doctor” who only completed three years of school after what would be equivalent to our high school and had no residency. That “doctor” still puts an MD after her name. A.T. Still and his son George Still also carried an MD, DO. Merge the systems , let us become physicians without the stigma. It is sad that a simple two letter initial holds back many talented people from becoming the physician they have the capability of being.

  32. BirdDO on July 31, 2013, 1:20 p.m.

    I honestly couldn’t have said it better myself KVegas.

  33. leavingDO4MD on July 31, 2013, 9:55 p.m.

    Just got into the carib!!!!!!! I can finally be a MD w/ no stigma!!!!!!! so glad to leave this system

  34. futuredoc on July 31, 2013, 10:43 p.m.

    hi leavingDO4MD…

    I was just wondering if you can provide specifics on what students/staff are saying at your school regarding the cancellation of the merger. I’ve read the articles that AOA and ACGME have put out, but would like more of a personal opinion on certain things.

    My email is jayp1722@gmail.com Thanks

  35. subtleDO on Aug. 1, 2013, 2:34 p.m.

    Just get rid of the COMLEX for God’s sake! USMLE+additional OMM section if needed. Jeeeeze

  36. leavingDO4MD on Aug. 1, 2013, 11:34 p.m.

    the comlex is the worst written test. what do you do for carpal tunnel? no you don’t pull out your harry potter wand and do the figure eight ligamentous release. YOU DO REAL SURGERY. Train us to be better doctors. Not idiots.

  37. OldDOinanMDworld on Aug. 2, 2013, 3:09 p.m.

    I am a DO, MD trained, Pediatrics and Anesthesiology, both MD residencies. I am Currently faculty at The Ohio State University Medical School. These arguments have been going on since I graduated in 1977 from what is now DMU. We could not then train our own, and we cannot not now train our graduates. We have neither the facilities, faculty, adequate patient population, research capabilities, specialists, access to funding, or even a plan to acquire any of these. Most of our “flagship” hospitals are smaller than the smallest parking garage alone here on the campus of The Ohio State Medical Center.

    For God sake, let our young physicians train where they want and in fact where they must in order to maintain any viability at all for the profession. Residency training programs at 42 bed Backwoods General Community Hospital (Osteopathic of course) didn’t cut it when I was a young graduate 30 years ago and it is even more ridiculous today. Come on, how long do we need to flog ourselves proclaiming our “uniqueness” as we draw every bit of medical knowledge from the allopathic profession and in fact are defined by our similarities to our MD brethren, not our differences.

    My biggest fear is not that we merge our training accreditation apparatus, or even our schools for that matter. My biggest fear is not merger, but that the MD’s will some day shut our young graduates out. When that day comes we will exist no longer.

    OMM is no more an adequate principle upon which to base a school of Medicine than alchemy was to advance the science of Chemistry.

  38. DO anesthesia resident on Aug. 2, 2013, 3:57 p.m.

    I am very proud of being a DO. I only applied to DO medical school an only applied to DO residencies. That was on purpose. But now it appears I will not be able to complete an anesthesia fellowship because the AOA is unwilling to compromise on anything that would actually lead to a true unification in residency training (the same entrance exam for example).

    The AOA is making it impossible for me to be the osteopathic physician specialist I’d like to be. Plain and simple.

  39. Dustin on Aug. 2, 2013, 4:20 p.m.

    What is osteopathic distinctiveness? Can we really say that OMM is what makes us distinct when only a small minority of DOs use it? Look to the future at those of us who are just starting school/residency/practice. Represent us and see where medicine is going. Don’t try to represent your own interests. Come to the front lines at training hospitals. See what we want from our AOA. Don’t come off as a stodgy board of retired practitioners who maintain an illusion that sticking to your guns will make more of us use OMM. Such a view will be unhealthy for the organization. If the AOA is truly interested in self preservation you should really be willing to listen to those of us who you’re asking to pay AOA dues for the next 30 years.

  40. HateThese2lettersDO on Aug. 2, 2013, 4:26 p.m.

    I agree with everything that’s been said at this thread. We need to do is take over the leadership of the AOA. We need to force people to accept the acgme standards. I am a practicing physician and I can tell you right now that the continuing education in my sub specialty which is diagnostic radiology is 100x better than the AOA version. Just merge the specialties already. Have a referendum which involves all the registered DOs. Why can’t that happen!!!!

  41. Peter on Aug. 2, 2013, 5:57 p.m.

    Disgraceful. A bunch of old men who will do anything to hold on to the “power” that they now have.
    I haven’t been a member of the AOA for years. I support my fellow DOs, but largely because I know the real or hidden discrimination they have had to deal with. Not because I want to embrace the good ol’ boys’ club.
    Anyone with half a brain will hop to the allo ship as soon as they get out of school. Unlike the above old men, we cannot live in a delusional little bubble. We have to survive in the real world of medicine. That requires adapting.

  42. 2828 on Aug. 2, 2013, 6:05 p.m.

    I love the AOA’s solution to create more residency positions. That’s right, create a half hazard abundance of crappy residencies to send our graduates to. That will really help out our profession.

    The DO double standard needs to go. We strive for equality, but are unwilling to budge when it comes to our “precious” heritage. The AOA want their graduates to have full access to ACGME residencies, but won’t let MDs into AOA residencies. Who could blame the ACGME if they want to limit our access to their programs.

    The unification plan was a step in the right direction. Thanks AOA for stopping it dead in its tracks.

  43. joe belsito on Aug. 2, 2013, 6:06 p.m.

    why did you go to a DO school?

  44. 2828 on Aug. 2, 2013, 6:31 p.m.

    I went DO because, like many others I wanted to be a physician, plain and simple. I applied wide both MD and DO, and ended up at AZCOM. I have received an excellent education thus far, however if someone had explained to me how the AOA could severely limit my career opportunities I might have reconsidered.

  45. OsteopathicKid on Aug. 2, 2013, 7:15 p.m.

    The DO’s next big headline: Surprise! Internet Serves as Echo Chamber For Insecure Young People.
    Relax, your future is shiny and bright and might even involve serving something bigger than your own self interest.

    Our residencies are excellent. Don’t forget AGCME was just about ready to accredit all of them. Why would they want to put their brand at stake endorsing subpar programs? Why do their students desparately want to apply for your school’s “crappy” Derm spot? They wouldn’t.

    And to all those who like to compare OMM to Harry Potter: All physicians refer patients to Physical Therapists who (guess what) use OUR techniques! Look it up. PT’s use Muscle Energy, Strain Counterstain, HVLA, FPR, etc. Are DO’s dumber because we can do this stuff ourselves? Were our predecessors dumb for coming up with these widely used techniques? No! They were highly intelligent, highly trained professional with the fortitude to trust in their hands.

    Bottom Line: You’re an Osteopathic kid, respect yourself or no one else will respect you either.

  46. futuredoc on Aug. 2, 2013, 7:31 p.m.

    “Don’t forget AGCME was just about ready to accredit all of them”…….BUT they didn’t. They don’t want to put their reputation at stake so that’s probably why they didn’t end up accrediting them!

    Also, I’m sure not ALL of the AOA residencies are subpar, but most of them probably are compared to the ACGME ones!

  47. 2828 on Aug. 2, 2013, 7:51 p.m.

    It has nothing to do with being insecure. I’ll best serve my patients in a career I have passion for, and no one wants to be limited in that regard. The decision of the AOA to reject MOU can potentially have adverse consequences for many aspiring DOs. It fair to be frustrated about that.

  48. OldDOinanMDworld on Aug. 2, 2013, 8:18 p.m.

    OsteopathicKid,

    If you are in fact a kid, I will give you some leeway. If you are not a kid, shame on you. There is no indication whatsoever the “AGCME was just about ready to accredit all of them”. They were willing to accredit all of them that met the ACGME standards and guidelines. The fact is, many DO programs would NOT have met those guidelines, just as several each year in the MD specialties do not meet guidelines and are de-accredited if you will and/or placed on probation. I have done a quick survey and find no such actions by the DO’s in regards to any DO graduate medical education program in recent history.

    I doubt you have even looked at the ACGME guidelines. If you had you would realize that many DO programs in many specialties do not provide even close to enough clinical cases (i.e. patient material) in all the years of their training to adequately meet the current ACGME guidelines. Many allopathic programs provide in just one year of specialty training more cases than Osteopathic residents receive in all the years of their training combined. The fact is many of our premier training programs hold their vaunted rankings in our profession in large part because they are affiliated with MD institutions and offer considerable periods of their resident training at these same institutions. The irony of course is that it is this very fact, portions of their training at MD institutions, which makes these programs so desirable to Osteopathic student applicants.

    As regards referrals to Physical Therapists, there may be some truth to what you say. But Physical Therapy is not a school of Medicine and they do not provide therapies to “cure” disease based on their treatments and therapies. If in fact a Physical Therapist was promoting themselves and their treatments as curative, as many OMM practitioners do, they would find themselves in serious conflict with their licensing boards and any Medical Board under whose jurisdiction they practiced. Physical therapists and physicians, apples and oranges sir, apples and oranges.

    Were our predecessors dumb, no. The poor gentlemen simply had nothing else to offer, times were different. MD’s offered snake oil, strychnine laced medications and swamp root poultices too. That’s what they had. Times were different. But because they were in fact intelligent they progressed, and thank goodness most all of us, DO and MD alike did also.

  49. D'Oh on Aug. 2, 2013, 10:08 p.m.

    I am thankful I have a good job and feel good about the work I do, and I am grateful to have been given the opportunity to go to a medical school and residency in my chosen field. I went to a DO school solely because I only got into those programs. I never enjoyed any of the OMM stuff, but tolerated it — to each their own. I trained in an osteopathic residency, primarily because I switched my field of interest late in the game and scrambled for what was left. The didactics at the program were terrible, but I do feel I had a large volume of patients and pathology that made up for some of that.

    Here’s a fact if you didn’t know it: If you train in a DO program, to continue with your board certification you MUST be a member of the AOA, or you will lose your board certification in your specialty. I really resent that, because I wouldn’t support the AOA otherwise. I suspect that money is often the root of these silly decisions like blocking a healthy merger like this. Because I went to an osteopathic training program I was required a transitional year, where my allopathic counterparts did not have this requirement. Besides the written and oral boards, I was required to do an additional “chart review” which was totally insulting and worthless (but it did give the board more money). I feel that I have had to jump through so many more hoops than my MD counterparts. There have been SO many hassles that have come just from being on the DO side of the fence. My son is interested in medicine–do you think I will encourage him to be a DO? Only as a last resort. If I could do it over again, I would probably have waited another year and applied again rather than go this route.

    Despite the DO profession being around for so many years, SO many people still don’t even understand what they are, and I hate being asked — I really don’t have a good answer (the scripted answers of “approaching the patient, not the disease” is ridiculous, as all good doctors do this (yes, they do).

    I am sure that in limited situations and a couple specialties OMT can be helpful occasionally, but it is definitely the minority. Why is this profession rooted in this practice? Make OMT a fellowship or something. I have never used it in clinical practice. I can’t imagine what poor radiologists think–how useless of a requirement to continue for them! The old guard in the AOA needs to be uprooted. Unfortunately, I suspect that those younger physicians who are replacing them are already indoctrinated into the propaganda and will continue to propagate this cycle.

    Make the degree an MD with a DO degree as an addition. Merge all board certifications into one. Have the OMM section an add-on for the boards for those who want to continue to carry the DO certification. I

    As much as I love my job, I am definitely ashamed to be coming out of such a dysfunctional system. I would NEVER recommend a future doctor go either to a DO school or residency except as last resort — it just isn’t worth it. You will have more hassles, fewer opportunities, and have to be the most exceptional student to make it in any competitive field such as research or a surgical subspecialty.

  50. 808 on Aug. 2, 2013, 11:10 p.m.

    Like most students, I was very disappointed that this fell through. If such a unified accreditation is not possible, I hope they might consider having the Osteopathic match after the allopathic match. I feel this gives us students the best chance to become the physicians we want to become. It kind of feels like they’re trying to intimidate us into osteopathic residencies a little. On a side note, there seem to be many fine DO residencies, but they are sparse (geographically), and honestly location is a big deal for young families.

  51. MD+Sense=DO on Aug. 3, 2013, 8:42 a.m.

    Wow. First, I want to say — I got into allopathic schools. My plan was to get an MD then go get a DC because I didn’t know what a DO was. I appreciated the added benefit of doing manual medicine and not just throwing medications at a disease and not dealing with a person. Just Wow. If you are in a DO school and have your panties in a snit and want to “buy” an MD then why the heck didn’t you get into an Allopathic school? You are basically saying that we are less, which disgusts me. If you are a DO student and doesn’t want to learn OPP or think it has any value — AGAIN WHY did you choose an DO school? If you weren’t smart enough, test well enough or whatever enough to get into an allopathic school — then maybe we just need to make our DO school standards tougher because perhaps you shouldn’t be a doctor anyway.

    It is OPP — that extra information and tool belt in our training that makes us distinctive. It is NOT something that can be learned in a two week course by someone if they have any plans to be proficient in it.

    If you do NOT believe in manipulation or its potential as an extra tool — then by all means get the hell out of the profession. If you have a complex that you aren’t as good because you are a DO — by all means get the hell out of the profession. Stop whining and start doing something.

    I had a choice. I choose an osteopathic school — and am forever appreciative for my training. Even if there were MANY bumps in the road. I don’t think all DO’s MUST do OPP because let’s face it, not everyone “has the hands” for it. But to poopoo it — I just don’t get why those people are in osteopathic school in the first place.

    I agree that schools are expanding far too quickly and it is related to money. I agree that more programs should just go ahead and be dual accredited. But at some level — doesn’t it make anyone stop and think about the ACGME and the fact that they included DOs in the proposal to stop training? Doesn’t it scream of “old guys” with “old misconceptions” trying to perpetuate old prejudices.

    The reason doctors are so hard to get to agree on things is because they are intelligent vibrantly independent beings who basically are like “herding cats” to get anything accomplished.

    The point — if you don’t want to be an osteopathic get OUT! Don’t take the school seat of someone that wants to be there. If you are in a position of making change — then start pushing for dual accrediting of programs. Stops fighting each other and work to make this thing work — we are different BUT equal and that is OK!!

    Just think about it — stop complaining and start making some positive change in the world. If you can’t do that then bow out gracefully — stop undermining what we do and are capable of doing.

  52. Joe on Aug. 3, 2013, 12:35 p.m.

    Manipulation is a FRACTION of what osteopathic physicians learn. This attitude of “if you don’t like OMM then get out!” is absurd as it is relatively insignificant compared to everything else we are taught. People don’t go to DO schools to learn OMM, we go to DO schools to be physicians, first and foremost. It’s like saying “You think psychiatry is stupid? Then get out of medical school!”

    I was optimistic staring out learning OMM as I did see it as being potentially useful, but the more I was taught, the less sense it made. I think that is how most DO students are. We don’t go to DO school thinking OMM is stupid, we realize how stupid it is when we start to learn it. And how could we not? Very little of what we are taught has any evidence backing it up, and what little there is come from tiny studies with little merit. Cranio-sacral, which is the big thing DO schools like to teach, has virtually NO evidence behind it, yet we spend almost an entire year of school being forced to accept it. We are literally being taught things that have not been proven to do anything and that literally go against basic principles of anatomy and physiology. How is that even allowed?

    If you got to a DO school just because of OMM, then you would be better off as a PT or even a chiropractor. Manipulation does not make osteopathic physicians unique because the vast majority of them do not even use it. How, then, can this be said to distinguishes us? It can’t. Like it or not, we are not unique and we are not distinct. Those are just the buzzwords that the AOA likes to tout around.

  53. absurd on Aug. 3, 2013, 3:02 p.m.

    Let me personally congratulate every one in who had a say in this decision. Because after so many years you still choose to bury your heads in the sand rather than learn to play nice with others, you have severely limited the future and options of thousands of young present and future DOs. I went to an osteopathic residency, and was fortunate enough to match into an allopathic fellowship. This may not be a choice in the near future, thanks to all of you. Were it not to maintain my board certification, I would have no reservations about leaving the AOA and never looking back. Shame on every last one of you.

  54. Jon Schriner D.O. on Aug. 3, 2013, 3:21 p.m.

    Well I am an “old D.O.” who was proud to be a respected D.O., for Fifty years of continuing practice. I am now at an MAOFP meeting in Traverse City Michigan, and the most impressive lecture was given by David Strobl D.O. Who fellowship trained at Cleveland Clinic in Cardiology. He teaches at MSUCOM and is an excellent example of what young D.O.’s Want. The opportunity to train at stellar Allopathic residencies and fellowships not contrived substandard “osteopathic” programs. We, and the public demand quality not contrived quantity. The Osteopathic profession did not loose Strobl to Alliopathy, we gained by his training. The ” ten finger do’s”an the leaders of the ” association of good old Boys” who do not want to loose control of the power, will sink our profession by their Iron Grip. I teach M.D.’s and a few D.O.’s and I don’t see the threat of combining our programs. Wake up AOA and join this Century!!!!
    Jon Schriner, D.O.,FACSM

  55. TheBallz on Aug. 3, 2013, 3:57 p.m.

    I will be short and sweet. I have experience with AOA and ACGME training.
    AOA training was not as strong as ACGME.

  56. Louis J Moran, DO on Aug. 4, 2013, 10:30 a.m.

    Dr. Buser is the consumate DO and I am proud that he is a representative of our profession. Thank you Boyd for negotiating with the ACGME. The distinctiveness of our profession makes us great physicians. Most of our allopathic friends want to include us in their hospitals and training programs. We equally need to respect their competence and establishment. Be proud of your degree and realize that both MD’s and DO’s have a common goal of quality patient care. Continuing discussions with our allopathic brothers and sisters will hopefully allow ample opportunities for young DO graduates. Physicians must maintain a sense of identity and profession in a climate that wants to re-name us as “providers.” I think we can overcome parochial differences and maintain our identity. I cannot think of anyone more qualified than Dr. Buser to continue this mission. LJM

  57. Alan B Schorr, DO on Aug. 4, 2013, 4:06 p.m.

    I was trained 32 years ago in an Osteopathic hospital for internship and residency. Because I went to an allopathic fellowship after 2 years residency, I had to have my fellowship approved to sit for the boards. I was told that I had to pay for an inspector to fly from LA to “inspect and approve the program”. I didn’t have the funds, declined and was certified by another board (AMA).

    However, the AMA and the ACGME is no better in its attitude. What you have is a bunch of children running both organizations who do not represent practicing physicians or future physicians. Most of us are very busy trying to practice medicine in an enviornment of regulation, diminishing reimbursement and lack of respect by the general population.

    I am of the opinion that what needs to happen is the existing “management” of both need to get out of the way, allow fresh voices and thinking to take hold and improve communication between the entities. There does not need to be a merger, just a cooperation. We are all in the same boat. The take or leave it attitude is reminiscent of a Middle East negotiation. However, the AOA needs to understand that its position is somewhat difficult as there are not enough subspecialty programs. We do not have the resources to establish them at the moment.

    Both organizations need to realize that they are not mutually eclusive in the world of medicine in 2013 and OBAMACARE. As our founding fathers stated: We will stand together or fall separately.

  58. njdoc on Aug. 4, 2013, 7:26 p.m.

    This whole issue is smoke and mirrors. There is an even graver problem. There are 5000 graduates at Osteopathic Colleges with only 2900 post-graduate spots available. So, we are unable to train 42% of our graduates. WE NEED the ACGME to train our graduates!!! YET we have the unmitigated gall to dictate terms to the ACGME!!!!! The AOA needs to take stock of itself. Our leaders need to be called to task and may need to be replaced in total (Yes you were the captains of the ship as the situation developed and you were fully aware of the situation). All we need is the ACGME to stop taking our 1st year graduates and we may just see the AOA on CNBC’s American Greed.

  59. Justleftdoschool on Aug. 5, 2013, 4 p.m.

    So happy I dropped out and reapplied to a MD school and got in!!! No more BS!!! The weight has been lifted! I will be treated with much more respect heading into the best GME, ACGME!!!

  60. CurrentDOStudent on Aug. 6, 2013, 7:08 p.m.

    Well I must say this is a bummer. I, like everyone else, was excited by the possibility of having just one match to worry about and having more unity with our MD colleagues.

    That being said I am absolutely appalled with is how vicious some of the students are at attacking the AOA. You are not sure what was said in those meetings or what was in the memorandum of understanding. Also I am annoyed by all of you who say you wish you were MDs or who seem ashamed to be DOs. If you didn’t want to be a DO and weren’t interested in OMT and more holistic treatment modalities then shouldn’t have went to DO school(even if you couldn’t get into an allopathic program).

    At the end of the day essentially nothing has changed. There are still two matches you can apply to (unlike our allopathic colleagues) and if you keep a good attitude, study your ass off and kill it on boards you will be fine. On the other hand if you keep spending your time attacking our leadership and whining about what someone did to you, well then you may actually end up hosed.

  61. Tom on Aug. 7, 2013, 1:14 p.m.

    A big thankyou to the AOA from all us IMG’s. We have MD’s, the USMLE and now much less competition for ACGME fellowships.

  62. KVegas on Aug. 14, 2013, 4:09 p.m.

    Tom, the acgme core requirements require completion of an ACGME residency to enter fellowships. I am not sure how you see this as positive for IMGs. If anything it makes it more difficult for IMGs who completed their residency elsewhere and attempt to take usmle for license. Now IMGs will be forced to redo their residency in the states to apply to fellowships. I believe this was the acgme’s true intention. The only thing the AOA has done is encourage more DO students to enter acgme residencies. Which will increase DOs in acgme fellowships.The current program stipulates only 15% of acgme fellowship spots can be filled by non ACGME applicants. That restriction is removed from any DOs completing an acgme residency. In the long run you may see an increase in DOs in acgme fellowships, when viewed in light of the previous restriction.

  63. WishIrejected DO on Aug. 29, 2013, 1:19 a.m.

    In 2015, we AOA programs lose access to ACGME fellowships.

    The AOA, has done nothing to bolster their fellowship programs, but rather invest in making more school and expanding campuses and feeding the ever growing bureaucracy that the AOA has become. They have become so desperate in these last months that they are mortgaging the futures of students, in an effort to hold their power and keep “O.M.T” – i still wonder what that is- in schools.

    Dear “leaders of the aoa”, do you believe anyone of us/future osteopathic doctors..will be here to support you. When the time comes, todays events will not be forgotten!

  64. WishIrejected DO on Aug. 29, 2013, 1:22 a.m.

    Dear CurrentDOStudent,

    it is people like us, the scientifically backed students that has given life to osteopathic education. Not the ghosts of AT Still MD,DO and “O.M.T”

    you are are not aware of the bigger issues at play, including being locked out of fellowship programs. You seem to be proud of being a DO, yet with these bills, we will not be up to par with MDs. We will continue being lesser medical doctors. Thank you AOA

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