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Single GME update: Successes, challenges and a solution

Get the latest information on the transition to a single accreditation system, including updated stats and details about a new assistance program.


Nearly a year into the five-year transition toward a single graduate medical education accreditation system, AOA President-Elect Boyd R. Buser, DO, says much progress is being made as the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) work to achieve milestones.

“ACGME has been an excellent partner for the osteopathic medical profession as we work through all the issues that arise when you’re dealing with a transition of this magnitude,” he says. “That’s a very positive thing.”

However, no undertaking of this scale is without bumps in the road. Dr. Buser recently spoke with The DO about recent successes and challenges, as well as a new resource the AOA is offering to assist osteopathic program directors.


One highlight of the transition process so far, Dr. Buser notes, is that osteopathic residency programs from 11 different specialties have obtained initial accreditation.

In addition, osteopathic residency programs are taking steps to preserve their osteopathic heritage, he says.

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“Programs have begun applying for osteopathic recognition and have been successfully achieving initial recognition from the ACGME’s Osteopathic Principles Committee,” he says. “And that includes some programs that previously were accredited only by the ACGME. It’s historic.”

Osteopathic recognition is vital to the future of osteopathic GME (OGME), Dr. Buser stresses.

“The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME,” he says. “We know our students want to train in GME programs with osteopathic recognition.”

Last year, an AACOM survey found that 7 in 10 third-year osteopathic medical students are interested in residency programs with osteopathic recognition.


There are differences between the AOA and ACGME accreditation processes, and educating residency programs on these variations has been challenging, Dr. Buser says.

“Some of the language that we speak in AOA accreditation and ACGME accreditation is not exactly the same,” he says.

For instance, the two organizations have different methods for accrediting joint programs.

This and other differences can lead to confusion and misunderstandings when residency programs complete and submit applications for ACGME accreditation.

A solution

To further assist residency programs with accreditation applications, the AOA rolled out a Single Accreditation System (SAS) Application Assistance Program in early May. The program is free. Program directors can contact the AOA to use the application assistance program. Program participants will have access to advice from AOA staff experts and consultants who are familiar with single GME transition processes—and they can continue using the assistance program to receive guidance through each step of the application cycle.

“I hope programs will take advantage of this application assistance program,” Dr. Buser says. “I’d like to see programs reach out to us for the help that we’re ready to give. All involved parties want our programs to succeed. We want to facilitate that. That’s been the goal from day one.”


  1. Ghost of Still

    What, if anything, is being done to address the problem concerning Joint Accredited programs still leaning heavily towards Step 1 vs Level 1? It seems this joint venture was made to reduce the need for taking multiple tests, but if ones results are not readily comparable, or accepted, what if anything is gained? Thanks

    1. James Swartwout, AOA Senior Vice President of Education and Accreditation

      The GME Accreditation process does not mandate a specific licensure examination for US DOs or MDs as a qualification to enter a GME program. In fact, neither COMLEX-USA nor USMLE were created as a tool to evaluate a student’s readiness to enter residency training. However, over time, it has become common for program directors use the national exams as a way to compare applicants. Over 77% of ACGME program directors currently accept COMLEX scores for osteopathic applicants. This percentage has been steadily increasing over the years. The NBOME continues to educate ACGME program directors about the interpretation of COMLEX exam scores. Over time, we expect more and more program directors to accept COMLEX scores as DOs become more integrated in all specialties’ training programs.

      James Swartwout
      AOA Senior Vice President of Education and Accreditation

  2. Sally

    I hope that part of the merger will involve doing away with the outdated and unnecessary 4-state rule (Resolution 42). Most states have gotten rid of it already, and we need to work on removing it from the few remaining stubborn states (FL, MI, PA, OK). It is just burdensome paperwork. Allopathic residency training is just as good as osteopathic, so let’s recognize it as such. And now with the merger, all training will be under the same umbrella anyways.

    1. James Swartwout, AOA Senior Vice President of Education and Accreditation

      Medical Licensure is under the authority of the individual states. The AOA has informed the four states that require an internship year for licensure that AOA will no longer be accrediting internship programs after June 30, 2020. We have also advised them that ACGME programs with osteopathic recognition will constitute “AOA approval.” Until such time as the individual states update their licensure requirements, AOA will continue to offer a pathway (such as Resolution 42) to those DOs who need it.

      James Swartwout
      AOA Senior Vice President of Education and Accreditation

  3. Concerned AOA Board Certificate Holder

    Whats being done to either 1.) ensure the international recognition of AOA board certificates or 2.) allow AOA certified doctors who took AOA residencies to sit equally for ABMS boards.

    Unfortunately i know from first hand experience AOA board certificates are not reconized in many places internationally. Many international health authorities now look for ABMS Certificates to qualify you for your specialty… The international practice rights summary for DOs that is published by the AOA is misleading. In some places it states DOs are allowed to practice but what the summary glaringly leaves out is that only DOs with ABMS certificates can practice…. So in the future… Why would a DO who can sit for either board take the AOA BOARDS? Its a long process and nobody wants to sit for two boards when they find out they cant practice internationally. When word gets out to the younger DOs how weakly AOA certificates are accepted internationally they will gravitate towards ABMS boards which is fine. But what happens to us older DOs who find our colleges and our certificate holders dwindling? We are loosing clout to negotiate and the time to negotiate for older DOs is now. We should also be allowed to sit for ABMS boards since this merger has hurt the clout and significance of the AOA boards.

    This is a reality that should not be ignored

    1. Political Relations

      The number problem is the bilateral relationship and policies with the Canadian medical system. Doctors with internship from Canada can get a license in the USA. But, a doctor with full OGME residencies or fellowships and an AOA board certification cannot even get a license in Canada. This is a good place to start and strike an equal blow to physicians trained in Canada trying to work in the USA to protect the Osteopathic Physicians’ interests. The DO schools and residency programs are graduating more medical students and residents that the Canadian system. Yet, the sad feature is that the Canadian graduates have a more powerful political power in the our own turf in the USA. Also, in Canada, the MDs are not spared, they do not recognize ABMS board certifications when applying for unlimited licensing privileges.

    2. Jeff Weaver, AOA Vice President of Certifying Board Services

      We are not aware of any issues with recognition of AOA certification in any specialty, in any nation. AOA certification has been recognized as substantially equivalent to ABMS certifications in the U.S., and osteopathic physicians currently have unlimited practice rights in more than 65 countries. Please advise if you are aware of any problem with recognition in any specific nation, and we will respond accordingly.

      We disagree that moving to single accreditation has hurt the “clout and significance” of AOA boards. In fact, the AOA Board of Trustees see this as an opportunity to expand the market for AOA certification to both DOs and MDs, and has made this one of its strategic priorities.

      Jeff Weaver
      AOA Vice President of Certifying Board Services

  4. BG

    This whole unification process was supposed to involve GME/OGME only. Now AOA says MDs can take osteopathic boards. So – it doesn’t only involve GME/OGME -but extends forward to board certification.

  5. G Rozenfeld

    Another issue not mentioned is CME. It stems from the fact that some DOs graduate from ACGME programs and are boarded through ABMS. If the state that such DO is practicing in has two boards or two different requirements for DOs and MDs, one has to maintain AOA Category 1-A or 1-B CMEs and from my experience it is not pleasant. Yes it is not GME issue but it will face DOs soon after we have single GME.

  6. CG

    30: Percent of AOA programs that have applied or are already ACGME-accredited (including dually accredited programs).
    How many programs have applied for ACGME accreditation that are not dual accredited?
    How many were dual accreditated?

    100: Percent of residency programs who applied for osteopathic recognition that have received initial recognition.
    How many of our programs have applied?
    How many non-osteopathic programs have applied?

  7. Michael Forness

    I am very concerned that in the surgical subspecialties there will be a quiet prejudice involving MDs being picked over DOs. This can have long-term implications for our profession. Fellowships are also an issue in the subspecialties.

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