New Possibilities

Q&A: Straight talk with AOA leaders about the new single GME system

Looking for more details about the plan to form a single system of GME accreditation? The AOA’s president and president-elect open up.


In February, the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and the Accreditation Council for Graduate Medical Education (ACGME) agreed to form a single, unified system of graduate medical education accreditation.

This historic undertaking raises many questions. How will the agreement affect osteopathic medical students? Under what circumstances will MDs enter osteopathically focused residency programs? How might the profession preserve the distinctiveness of osteopathic medicine?

To answer these queries, AOA President Norman E. Vinn, DO, and AOA President-Elect Robert S. Juhasz, DO, recently spoke with The DO. They touched on the AOA’s vision for the future, their personal opinions and the profession’s efforts to maintain osteopathic principles and practice during the development of this new endeavor. Both leaders expressed a desire to engineer a smooth transition, and they shared their excitement about the possibilities opened by the new single GME accreditation system.

“I expect DOs to continue to elevate and distinguish themselves,” Dr. Vinn said. “That has been our legacy and our performance pattern in the past and present.”

Following is an edited interview.

Let’s say you’re an osteopathic medical student in 2020. What advantages do you have that your forebears did not?

Dr. Juhasz: You can train in the best program of your choice. This agreement preserves that opportunity for our residents. Any graduate entering a residency program that is pre-accredited for ACGME accreditation will then be able to apply to any residency program, whether it is AOA or ACGME.

The agreement also opens up the opportunity for all residency programs to have a better understanding of OPP, as well as our testing and our progress examinations.

Paint me a picture of the best outcome you can imagine coming from a single GME accreditation system.

Dr. Vinn: I can envision a world with a higher level of public awareness of osteopathic medicine and a world attuned to the attractiveness of osteopathic clinical practice. I see increased demand for osteopathic medicine and osteopathic services, and increased demand for opportunities for both MDs and DOs to train in osteopathically focused programs because of the clinical and competitive advantages this practice style affords them. I see broad awareness of osteopathic principles in the MD community and a greater desire on the part of MDs to work collaboratively with DOs, to ensure that their patients have access to osteopathic techniques.

Dr. Juhasz: The best outcome would be for us to take the bushel basket off of the lamp of osteopathic medicine and really create the awareness that most osteopathic physicians have desired. We will do that by sharing who we are, how we teach, what we do and what difference it makes. We have the opportunity to contribute to the care of all patients by becoming more influential in the medical community.

What, regarding the single GME system, are you most excited about?

Dr. Juhasz: A single GME system creates the opportunity for us to speak about the contributions we make to care and the fact that we have been very good about creating primary care physicians in underserved areas.

Dr. Vinn: I’m most excited about having an opportunity to repeat our historical legacy of leading from within—to take what appears to be a challenge and exploit it as a true opportunity to preserve our profession, to preserve our legacy and to proliferate our principles not only nationwide but worldwide.

How will the new system ensure that DO residents can practice their osteopathic medical skills?

Dr. Juhasz: Residency review committees will set up the standards for any ACGME programs that are osteopathically focused to make sure they include standards on OPP. Our current AOA residency programs will also have new standards regarding OPP.

For residents in neuromusculoskeletal medicine, there will be a separate residency review committee just for that specialty, which will be a completely new residency review committee at the ACGME.

Also, for the first time, MD graduates who have an interest in osteopathically focused residency programs would be allowed to enter those programs after meeting prerequisite qualifications.

What will the prerequisites be?

Dr. Juhasz: They aren’t finalized yet, but they will be substantial. We want to make sure that MD graduates entering osteopathically focused programs have a good understanding of both OPP and osteopathic manipulative treatment.

DOs have been able to serve MD residencies for some time. Now, MDs will be able to do DO residencies. How will this help the profession?

Dr. Vinn: It will, in a sense, fulfill the grand vision of Andrew Taylor Still, MD, DO, who hoped that everyone would want to practice according to osteopathic principles. When MDs actively seek out access to our philosophy and techniques and want to apply them on a daily basis, their interest will raise the bar internally within our own profession and create renewed appreciation for the value of OPP.

Religious converts are often more zealous than those who were born into the religion. We may create a whole community of outspoken advocates and evangelists speaking literally from outside of our profession because they are now a part of it.

Dr. Juhasz: I see more opportunities for research opening up. I see the whole medical community taking a look at how we developed our programs, how we’ve increased the number of our schools so quickly, and how we produce so many primary care physicians.

If MDs will be in DO residencies, will they also be able to become full members of the AOA?

Dr. Vinn: Yes. We’ve mapped out a process by which MDs prequalify to enter our training programs. Through that pathway, and once governing documents are revised, they can take our boards, and they can join the AOA and be welcomed members of our association. We need to keep in mind that MD societies, such as the American Academy of Pediatrics and the American Medical Association, have welcomed DOs in unrestricted membership. It’s time we responded to that challenge and created some reciprocity. We don’t want to keep ourselves a walled-off stakeholder on the margins in the house of medicine. We need to welcome some cross-pollination for the health and future of our own profession. We envision significant numbers of MDs wanting to join the AOA, just like a number of DOs have chosen to join the AAP and the AMA.

Currently, there’s an undeniable yet hard-to-define difference between MDs and DOs. How might a single accreditation system impact this difference?

Dr. Vinn: We face the ongoing challenge in an outcomes-driven world to clearly measure the distinctiveness of OPP. In this unified system, which is going to be quite metrics-driven, we have a chance to provide better objective evidence of the advantages of osteopathic principles, and therefore further enhance our distinctiveness.

Dr. Juhasz: The best opportunity for awareness is well-published research. We’ll be working with our colleagues in medicine to take a look at some of the systems we’ve created, such as our osteopathic postdoctoral training institutions, which are clearly an example of a disruptive innovation that helps us work together with disparate institutions for the good of education.

How do you personally feel about a single system of GME? What are your own thoughts, hopes and reservations?

Dr. Juhasz: Personally, I have had the experience of being a program director in an AOA-accredited program in internal medicine for 12 years. I have also practiced for the last 16 years in a largely allopathic environment at the Cleveland Clinic, where I work every day with allopathic colleagues. I’ve never felt concerned about sharing what I do as an osteopathic physician or being a mentor to MDs and DOs alike. A single GME system opens up the opportunity for us to continue to grow in this way.

Dr. Vinn: We’ve established a historical pattern of coming into a challenging situation and creating disproportionate influence. But my biggest concern is that we won’t take full advantage of the opportunity to not only define our distinctiveness but also live our distinctiveness on a daily basis. We run the risk of suffering from a weakness within rather than a weakness from outside forces. I worry that we won’t believe enough in ourselves and in our ability to work inside these systems while maintaining our strong cultural distinctiveness. But we have done this in the past, so I am confident that we will excel once again.

What past changes in the osteopathic medical profession would you compare the single GME accreditation system to? And what happened following those transitions?

Dr. Vinn: Historically, when the osteopathic medical profession has faced changes, DOs have triumphed, becoming leaders in their new spheres. For instance, when DOs were finally eligible to receive military commissions, we came in as peripheral players, mostly in field assignments in the Vietnam War. However, we quickly rose to distinction. Many of our physicians were promoted to significant positions of authority and influence. For instance, Ronald R. Blanck, DO, served as surgeon general of the U.S. Army from 1996 to 2000.

The merging of state medical boards was another big challenge for the profession. However, once again we led from within and distinguished ourselves. DOs have ascended to leadership positions in the Federation of State Medical Boards. Donald H. Polk, DO, is the chairman of the FSMB. Humayun Chaudhry, DO, is the FSMB’s CEO. And Jacqueline Watson, DO, runs the combined Washington, DC, board.

The transition period is five years. What do you see happening in that time frame?

Dr. Juhasz: We’re going to get osteopathic representation on the residency review committees. We’ll create an OPP committee that will be responsible for developing the standards for all of the residency programs in which we currently train DOs.

Next spring, institutions will be able to apply for pre-accreditation status, which essentially establishes their intent to seek ACGME accreditation. Residents who graduate from pre-accredited programs will be treated as if they have graduated from ACGME-accredited programs. That will really open up their opportunity to apply for ACGME programs that are osteopathically focused, or any ACGME program.

Dr. Vinn: We will have a voice at the governance level within ACGME to help shape how this process evolves. We also anticipate that as with any process of change, there will be some bumps in the road. As we move through the transition, we’re going into a period where it is crucial that all stakeholders not extrapolate from specific events that the whole process is flawed. We need to give ourselves some time to measure, to build relationships and work collaboratively to structure what will be the new accreditation system of the future.

We are already getting a significant number of inquiries from hospitals that would like to develop osteopathically focused programs in new locations and markets. We anticipate seeing many osteopathic programs develop during this transition period. We also expect that with better awareness and understanding of the quality of our education, new training opportunities will open up for our residents in institutions that have not previously accepted or welcomed DOs into their programs.

We also see opportunities for net growth in osteopathic CME programs. We will work closely with our state and specialty organizations to make our CME programs more attractive and convenient for our members so that they prefer to take osteopathic CME over other alternatives. We will also see re-engagement from a number of ACGME-trained DOs who, in the past, felt disenfranchised by the profession. They will feel welcomed home.

What can osteopathic medical directors, state society leaders and board certification officials do to ensure their continued success during this transition?

Dr. Juhasz: Stay engaged as the standards are developed. The AOA, AACOM and the ACGME are forming an education committee, which will be tasked with keeping program directors and directors of medical education informed.

Be aware that these standards for residency programs will be new to the ACGME as well. The whole world of GME will have to be educated on these new standards and any new protocols or procedures that are developed.

Dr. Vinn: Live and breathe OPP on a daily basis. Have some faith in your own competencies and contributions to health care delivery. Accept the uncertainties that lie within any significant change, and embrace the opportunity to help shape the future.

Our readers—DOs, medical students, program directors—want to know that AOA leadership understands their concerns and will take them into account when moving forward in creating a single GME system. What would you say to assure them of this?

Dr. Juhasz: We’ve been traveling the country to meet with specialty societies, state societies and many of the AOA’s bureaus, councils and committees. We’re capturing their concerns, and we’re keeping a dialogue going. We’re advocating on behalf of our osteopathic program directors and faculty. We also understand, though, that each residency review committee has the opportunity to make decisions about the program directors within each specialty. We’ll continue to monitor that as well.

Dr. Vinn: We recognize that, at the outset, we couldn’t get everything we wanted in this emerging relationship with the ACGME. Everyone should be aware that the ACGME also didn’t get everything they wanted in the new system. We need to collectively understand that this is an ongoing process and we are building something new. Innovation will drive the evolution of the processes of creating, funding, operating and measuring all GME. It’s important to focus on the opportunities that this transition is going to create as it moves forward.

Dr. Vinn, you just returned from visiting the World Health Organization in Switzerland. How will the single GME accreditation system affect international awareness of DOs?

Dr. Vinn: Currently, osteopathic physicians are eligible for full practice rights in 66 countries around the world. ACGME is an internationally known organization. ACGME accreditation of our programs will open more opportunities for expanded licensing for DOs in more countries around the world. Other countries are well aware of the ACGME and what it means for a physician to graduate from an ACGME program. When more people internationally are aware that our graduates are coming out of ACGME-accredited programs, we will be more successful in our ongoing quest for full scope of practice in other countries.

More broadly speaking, we have made great strides in achieving international recognition of osteopathic medicine and the differentiation of American osteopathic medicine, which is full scope of practice rather than osteopathy’s scope of practice, which centers on osteopathic manipulation.

We have been working on establishing a WHO collaborating center at one of our schools. Collaborating centers conduct research in partnership with the WHO. The first step will be for one of our schools to work with the WHO on clinical research in osteopathic medicine. We met with Dr. Zhang Qi, the WHO’s coordinator of complementary and traditional medicine, to share research proposals from three of our schools and get the process started. Once we launch this initiative, it will create further awareness of osteopathic medicine internationally.

I am a firm believer in the adage, ‘If you want to control the future, you need to help shape it.’ This is our window of opportunity to help shape our future. We need to take full advantage of it.


  1. Concerned DO

    The AOA leadership paints a picture that is overly optimistic. What many fail to understand is that this agreement actually limits osteopathic students choices. What will the incentive be for osteopathic programs to maintain an osteopathic distinction? There will be no incentive. Specialty Fellowships and residencies that are currently only open to osteopathic students will no longer be. If you want to become a dermatologist or ophthalmologist, have fun trying to get a residency. There is no optimistic picture here.

    AOA leadership shoved this agreement through the back door without consulting the AOA membership. This agreement will pave the way for the loss of DO identity.

  2. Doc

    Sure. I’ll not comment at this juncture on the AOA. But let’s see if they are willing to engage in open discussion about OCC. Not that it will make any difference, and they know that. Another “back-door” “open up and swallow” move. Anything new there?

  3. This Stinks

    I love how the osteopathic leadership is trying to put lipstick on a pig. No matter how you slice it, it’s still pork. I wish we could impeach the entire AOA leadership.

  4. Doc

    I am an AOA member because I am board-certified through them, and for no other reason. When my current certification runs out at the end of 2015, I have no plans whatsoever to participate in that bald-faced scam known as “OCC.” To what depths will these people not sink? I guess we need to remember that the AOA is, first of all, a corporation. Do they really think we buy all of this drivel?

    Once my board-certification lapses, I can find no other justification for paying this corporation in order to practice my craft.

    I recognize that I am slightly off-topic, but perhaps not so much so. The topic of OCC, and the topic of a gradual merger of the two professions both concern the selling out of Osteopathic physicians. Any discussion of OCC is relegated to relatively obscure websites. Does anyone think they would dare to open up the topic on this site?

  5. MDs have CC

    My colleagues have to do continuous certification, so why shouldn’t DOs? I don’t have to, bc I grandfathered in – Board certified 1999. How is the CC different for DOs from MDs, I am just curious. I know both are expensive.

  6. MR

    It is unfortunate that Dr. Vinn likened the inclusion of allopathic physicians to a type of ‘[r]eligious’ conversion. Although I understand the metaphor, it is not sensitive to the historical accusations against our profession, accusing us of being ‘cultist’ and OPP being more about ideology than evidence. Osteopathy beautifully exemplifies one manifestation of the “art of medicine;” however, at the end of the day I want my allopathic colleagues and the public at large to be compelled by rationale evidence based medicine, not “outspoken advocates and evangelists…”

  7. Doc

    Of the details of OCC vs. the allopathic scheme I am not aware. Frankly, I have not yet spoken with a DO who fully understands OCC.

    Yes it is costly, and that is an important point. Who benefits?

    I would submit that there is no objective evidence to support the assertion that board certification somehow results in superior care.

    Whether we are discussing allopaths or osteopaths, CC is a scam. It is a lot of silly busy-work and it is a way for these boards, which are private corporations motivated by pecuniary self-interest, to generate more revenue. I would suggest that if the MDs were required to stand on their heads and whistle “Dixie” that would be no plausible argument in favor of DOs meeting the same requirement. I intend no disrespect with that analogy.

  8. Doc

    With all respect I submit the following. I suggest that these people are not fools. I suggest that their own interest and their own motivations are so very different from that of the working doctor, that when we see this sort of action we incorrectly interpret it as some sort of “mistake” on their part. I think if we look at all this from the perspective of their agenda instead of our own, it all makes absolutely perfect sense.

    Our own failure to understand is a result of our assumption that we working doctors and these people who have worked themselves into positions of “leadership” have similar agendas. These people represent a certain interest, but that interest is not that of the doc in clinic. I suggest that the California outcome is precisely what they desire, not something they wish to avoid.

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