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The DO | Special Coverage | AOA House of Delegates 2013

AOA House calls for protections in any unified GME accreditation system

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During an AOA town hall meeting Thursday evening, AOA Trustee Boyd R. Buser, DO (right), discusses some details of negotiations between the AOA and AACOM and the ACGME. Looking on are 2012-13 AOA President Ray E. Stowers, DO (center), and AOA Director of Government Relations Ray Quintero. (Photo by Patrick Sinco)

Citing concerns that a memorandum of understanding issued by the Accreditation Council for Graduate Medical Education (ACGME) did not sufficiently recognize the osteopathic medical profession’s core principles, AOA Trustee Boyd R. Buser, DO, announced yesterday that the AOA and the American Association of Colleges of Osteopathic Medicine (AACOM) face barriers to unifying GME accreditation and have been unsuccessful thus far in reaching an agreement with the ACGME.

Nevertheless, the AOA and AACOM will continue negotiating with the ACGME, he said.

To safeguard the profession during the continuing negotiations, the AOA House of Delegates today approved a policy stating that any unified GME accreditation system “protect and preserve the unique distinctiveness of osteopathic medicine, osteopathic medical education, COMLEX-USA, osteopathic board certification, osteopathic divisional societies, osteopathic specialty affiliates, the AOA and the osteopathic medical profession.”

The new policy also calls on the AOA to work toward developing AOA-approved subspecialty fellowships in case negotiations with the ACGME remain unsuccessful.

Underlying issues

The resolution, one of several that address the ACGME issue, reflects perceptions that the AOA has not solicited sufficient feedback on the proposed unification, as well as concerns that negotiations with the ACGME have not been transparent.

The Florida Osteopathic Medical Association (FOMA), which submitted the resolution, broached several potential consequences of unification, including increased costs to osteopathic programs in instituting ACGME standards and loss of training opportunities for DOs if MDs are allowed into OGME programs.

“People in our state were asking questions that nobody seemed to be able to answer,” said FOMA President Gregory J. James, DO, MPH, before the House meeting began. “With the little bit of information we’ve been given, there has been a lot of concern that the proposed unification could potentially lead to a takeover of the DO profession by the MD profession.

“There has been almost no transparency in this process other than reports that the AOA, AACOM and the ACGME are moving forward with unification.”

During an AOA town hall meeting Thursday night, Dr. Buser and AOA Executive Director John B. Crosby, JD, explained that confidentiality agreements prevented them from disclosing the details of negotiations with the ACGME.

To keep the profession apprised of developments to the extent allowed, Crosby previously discussed the unification plan in The DO in videos posted in March and October 2012 and in his December 2012 column.

Dr. Buser, who represented the AOA in negotiations with the ACGME, explained the reasoning behind the move toward unification in the December 2012 issue of The Journal of the American Osteopathic Association.

If the AOA, AACOM and the ACGME do not agree on a unified accreditation system, the originally proposed change to the ACGME’s common program requirements could go into effect. Per this proposal, ACGME-accredited programs in all specialties will be barred from recognizing previously completed OGME.

The change would primarily affect DOs who pursue ACGME-accredited fellowships after completing AOA-approved residencies. The proposal would also have an impact on DOs in traditional rotating internships who plan to enter ACGME residencies that require a transitional year. DOs would still be able to match into ACGME residencies from their fourth year of medical school.

During an AOA Board of Trustees’ reference committee meeting before the House convened, Jeffrey S. Grove, DO, questioned whether the number of DOs that would be affected by the ACGME’s original proposal is large enough to justify a sweeping overhaul of GME accreditation.

“How many people do osteopathic residencies and then go on and do allopathic fellowships?” asked Dr. Grove, the president of the American College of Osteopathic Family Physicians (ACOFP), which submitted a resolution resembling FOMA’s. “We believe that number to be 250 people or less. So we are jeopardizing the profession for that segment of people.”

Speaking as a member of the Pennsylvania Osteopathic Medical Association, which submitted one of the resolutions on unified GME accreditation, Carol L. Henwood, DO, stressed that the osteopathic medical profession should identify the specific ACGME subspecialty fellowships that osteopathically trained residents are pursuing. “If we need more of these training programs, it is the responsibility of organized medicine to create them,” she said at the AOA Board reference committee meeting.

“What better place to invest capital than in programs that make future members?” agreed Joseph P. McNerney, DO, of Michigan.

5 Responses

  1. Joe on July 22, 2013, 10:52 a.m.

    Creating additional redundant residencies hardly seems more responsible than merging GME. If we have defend the Osteopathic identity so fiercely, does that imply we don’t believe it can survive on its own merits?

  2. Martha on Aug. 2, 2013, 4:16 p.m.

    The ACGME fellowship limitations, while it may only affecting a subset of DO residents will have MAJOR consequences on the residency positions DO students choose to enter. Why complete a DO residency if it will limit your ability to subspecialize? More and more students (our brightest and most driven) will not limit themselves, leaving the DO community to enter MD residencies. I understand wanting to maintain our osteopathic roots and principles, but no matter how one looks at it, backing out of this merger is only hurting ourselves. It is time our profession focused on our future, as opposed to our past.

  3. JDS on Aug. 3, 2013, 5:44 a.m.

    Well, I was one as well as the other classmates in my residency class that went on to an allopathic residency. I would disagree with the number of 250. I would believe that number to be higher. It sounds as if Dr. Grove, from his statement did not check his facts. What it the true number of people that go on to fellowships? The AOA must remember that not every DO goes into primary care. The AOA needs to stop trying to demonize people that decide to go on either do fellowships or to do allopathic residencies.

    Doesn’t seem to make much sense to me that the number of schools has exploded over the past several years, while the AOA has done nothing to increase either the number of osteopathic residency positions or the quality of osteopathic residencies. I can remember at my residency (osteopathic), that I and my fellow residents were there to increase the volume of cases that could be performed. We were used to help make someone a great deal of money. It seems that perhaps this may be all about the AOA making more money. Remember this, I only maintain my AOA membership in order to maintain board certification. Besides what exactly do I get with my AOA membership fee, yeah that’s right – nothing.

  4. Victor on Aug. 13, 2013, 2 a.m.

    As a new program director of an osteopathic family medicine residency, I applaud the efforts of our osteopathic leaders who have made the wise decision to forestall this ridiculous merger. As osteopathic physicians we do not need a pathway into ACGME fellowships, we need our own fellowships that embrace the principles of osteopathic medicine. I chose to become an osteopathic physician and every day I am thanked by my patients that I care for them differently than my MD colleagues. Although I did an osteopathic internship, I made the choice to then complete a full 3 year ACGME family medicine program in which half of the program were DOs. Now I am double boarded by the ABFM and the AOBFP and I am grateful to both colleges that have educated me in my profession as a physician. However, the only reason I entered a ACGME program was because it was better funded and offered more resources to learn. Sadly, most of our osteopathic graduates are having to make that same choice 20 years later, as not enough well funded osteopathic residencies exist. The solution is to fund more osteopathic residencies in primary care which eventually spawn fellowships in appropriate numbers. Our nation needs primary care physicians now and CMS should increase its investment in training physicians best able to meet those needs, the osteopathic family physician.

  5. KVegas on Aug. 14, 2013, 3:54 p.m.

    That is fine, the AOA can make more fellowships! I wish them luck. That said, I will not be utilizing the AOA match. The idea of being restricted from acgme fellowships is a non-starter. I am afraid that for me and many of my class mates our membership in the AOA ends at graduation, unless something changes.

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