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.
“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.