AOA, AACOM, and the ACGME agree to unified accreditation system

[Postictal Raiden]

No that wasn't what I was saying. I said that if MDs do become program directors they aren't going to shut out DOs. The institutions that these programs are at are primarily DO. The directors of GME are DO.

Exactly. If anything, these soon to be acgme programs will be considered very DO friendly.

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[Dr. Zombie]

It's kind of loony to insinuate that someone is going to take a position at a primarily DO hospital to shut DOs out of programs.

Loony are also those who listens and is convinced by this flawed ideology.

 

[DrEnderW]

No that wasn't what I was saying. I said that if MDs do become program directors they aren't going to shut out DOs. The institutions that these programs are at are primarily DO. The directors of GME are DO.

Gotcha - I see what you're saying. Personally, I agree with you and it isn't something I'm overly worried about.

However, there are those that have a real concern of this. Many MD students I have heard think this will be the case too.

 

[Postictal Raiden]

We are also forgetting that in the very immediate future, there won't be a combined match. This means that MDs who want to apply to AOA residencies will have to participate in the nms match before undergoing the nrmp match. From their prospective, doing so can risk one's chances of matching acgme residencies. This prompts me to believe that competitive MDs won't "risk" their chances of matching desirable acgme programs by participating in the aoa match. Therefore only those who think they are not up to par with acgme standards will be tempted to undergo the nms match. Even then, these applicants won't pose a large threat to competitive DOs.

This is my thought, so what do you guys think?

 

[NurWollen]

We are also forgetting that in the very immediate future, there won't be a combined match. This means that MDs who want to apply to AOA residencies will have to participate in the nms match before undergoing the nrmp match. From their prospective, doing so can risk one's chances of matching acgme residencies. This prompts me to believe that competitive MDs won't "risk" their chances of matching desirable acgme programs by participating in the aoa match. Therefore only those who think they are not up to par with acgme standards will be tempted to undergo the nms match. Even then, these applicants won't pose a large threat to competitive DOs.

This is my thought, so what do you guys think?

That is an excellent point that I hadn't thought of before.

 

[hallowmann]

Yes, and what's stopping the DO hospitals from hiring ACGME trained DO PDs? Like others have mentioned prior, there are ACGME trained DO surgeons, derms, rads etc in practice already. I'm sure there will be some that will be willing to be a PD.

The truth is that there aren't many dual-boarded DOs out there. In order to run an AOA residency as a PD you have to be boarded through AOA boards, and to be a PD for an ACGME residency, you have to be boarded by the MD boards. For a DO to be a PD for an ACGME board with an AOA-focus, they most likely will need to be dual-boarded. A realistic alternative hospitals will take (as opposed to hiring 2 PDs) will be to hire 1 MD and drop all AOA focus. Without a grandfather clause, this is a realistic risk.

That said, just because an MD PD is hired doesn't mean all of a sudden a hospital filled with DOs is going to drop all DOs. Heck, as it is >70% of ACGME PDs rank DOs (someone correct me if that's off based on the ACGME PD survey, its as high as like 96% for DO friendly fields like PM&R), and that percentage is increasing. The idea that MDs moving in will suddenly not take any DOs is ridiculous.

I think you misread what I was trying to say. I was refuting someone else's point.

What I was trying to say is that if the current ACGME regulations stand that say PDs must be board certified by the ACGME, AOA trained PDs would be ineligible. I don't think this will happen and isn't my idea but others were discussing it as a potential drawback. My opinion is that if this happened, it would not be a "power move" to fight this because must of the most competitive AOA residencies (essentially all surgs and derm) are ran by AOA trained PDs.

I hopefully agree this won't happen.

Its absolutely reasonable, and should be sorted out, but its not a reason to pull out of the merger (something apparently a lot of POMA members wanted to do).

I am sure that everyone will be grandfathered into acgme certification. If not, there would be a huge number of DO grads who are in the "transition phase" of the re-accreditation process who would be AOA certified and then ineligible for fellowships. I am purely speculating here, but that would be a huge oversight if they didn't grandfather in the past AOA grads.

As far as I understand it, as long as your program applies for pre accreditation by the ACGME while you are there (i.e. if you're in the transition), you will have the opportunity to sit for both boards (provided your program eventually becomes accredited), and you're program will count as equal to an ACGME program for applying to fellowships, etc.

The issue right now is that currently there are DO that have been around for a while and are only AOA boarded. Most AOA PDs are like that. As of yet, there hasn't been a mention of them being grandfathered in. That is in my opinion the strongest argument anti-merger people have.

That said, like I mentioned above, its something that should be negotiated, but shouldn't be a reason to pull out of the merger from the get-go (i.e. before any real negotiation attempts).

Just wondering, why are you saying "if the merger goes through"? I thought the merger has already been agreed on and it will take effect gradually starting next match. It's the matter of when, rather than if, I think. Some AOA residencies will be more resistant than others and will do their best to hold the status quo until the last minute (2020), but we should start seeing the conversion of AOA programs into ACGME within the next 2 years.

Nothing is guaranteed before it happens. The whole reason the thread started up again is because I noticed in the recent POMA (PA Osteopathic Med Association) newsletter that the POMA House of Delegates had a bunch of proposed resolutions essentially asking the AOA to withdraw from the merger. The final resolution they agreed upon basically requests that the AOA put the vote up to the AOA House of Delegates whether or not to continue the merger based on the MOU, and that no action be taken by the AOA for or against the merger (but a non-action in a transition really is an action against it).

If it is put up to the House of Delegates, a group of AOA boarded DOs most of whom are older, it may or may not pass.

We are also forgetting that in the very immediate future, there won't be a combined match. This means that MDs who want to apply to AOA residencies will have to participate in the nms match before undergoing the nrmp match. From their prospective, doing so can risk one's chances of matching acgme residencies. This prompts me to believe that competitive MDs won't "risk" their chances of matching desirable acgme programs by participating in the aoa match. Therefore only those who think they are not up to par with acgme standards will be tempted to undergo the nms match. Even then, these applicants won't pose a large threat to competitive DOs.

This is my thought, so what do you guys think?

My guess is, handfuls of MDs will match AOA positions initially (prior to a combined match), and most will likely take positions that go unfilled. This may be bad for the DOs who fail to match ACGME and were hoping to scramble AOA after the ACGME match, but as a whole DOs have been doing better and better every year in the ACGME match (~73% match in 2013, ~75% in 2014, both of which were record highs). I wouldn't be surprised if it continued up to at least 80%.

 

[Postictal Raiden]

Nothing is guaranteed before it happens. The whole reason the thread started up again is because I noticed in the recent POMA (PA Osteopathic Med Association) newsletter that the POMA House of Delegates had a bunch of proposed resolutions essentially asking the AOA to withdraw from the merger. The final resolution they agreed upon basically requests that the AOA put the vote up to the AOA House of Delegates whether or not to continue the merger based on the MOU, and that no action be taken by the AOA for or against the merger (but a non-action in a transition really is an action against it).

If it is put up to the House of Delegates, a group of AOA boarded DOs most of whom are older, it may or may not pass.

So, when is it supposed to happen? Are the AOA and ACGME planning to meet again to finalize their agreement?

 

[hallowmann]

So, when is it supposed to happen? Are the AOA and ACGME planning to meet again to finalize their agreement?

The first agreement was a preliminary one. According to AACOM & AOA, they plan to have many meetings from now until the beginning of the transition, and through the transition to iron out the details (not sure how frequently they will be meeting each year). The AOA is a membership organization though, so if enough members want to bring the issue to the House of Delegates, it may delay things.

So far AACOM & the AOA have been asking for patience while they work these things out with the ACGME. I think the best course of action right now for any DOs, students, etc. is to voice any concerns you have to the AOA and AACOM through your representatives, but to make it clear that you stand by the goal for the merger. Organizations in the middle of transitions need time, but if you give them constructive feedback, they'll know what to work on from the beginning. .

 

[user3]

The first agreement was a preliminary one. According to AACOM & AOA, they plan to have many meetings from now until the beginning of the transition, and through the transition to iron out the details (not sure how frequently they will be meeting each year). The AOA is a membership organization though, so if enough members want to bring the issue to the House of Delegates, it may delay things.

So far AACOM & the AOA have been asking for patience while they work these things out with the ACGME. I think the best course of action right now for any DOs, students, etc. is to voice any concerns you have to the AOA and AACOM through your representatives, but to make it clear that you stand by the goal for the merger. Organizations in the middle of transitions need time, but if you give them constructive feedback, they'll know what to work on from the beginning. .

people on these forums were so thrilled and confident after the announcement. seems like many of us forgot that it was still (entirely?) tentative

 

[IMDoc607]

Dude, take your scores a shove it up your a$$.....My patients don't ask me what my score were in the middle of a STEMI.

What a tool....there's just no other way to describe you.

 

[ChrisGriffen]

Dude, take your scores a shove it up your a$$.....My patients don't ask me what my score were in the middle of a STEMI.

What a tool....there's just no other way to describe you.

Yea?

 

[IMDoc607]

Yea?

Yep....they don't.

 

[NontradCA]

Yep....they don't.

Who are you talking to? Are you ok?

 

[IMDoc607]

Who are you talking to? Are you ok?

Sanj.....I haven't posted on here in a while and quoted him without clicking reply or are you trying to be a wisea$$ to?

 

[NontradCA]

Sanj.....I haven't posted on here and a while and quoted him without clicking reply or are you trying to be a wisea$$ to?

No, I was genuinely confused because you didn't quote and you're replying to something from months ago. Thanks for clarifying, and for the lulz.

 

[IMDoc607]

No, I was genuinely confused because you didn't quote and you're replying to something from months ago. Thanks for clarifying, and for the lulz.

My bad....lol

I just caught up on this thread. I think we should just see how everything goes. I don't think it will be as bad or as good as people are making it out to be. We may not like the AOA but I don't think they are dumb as we make them out to be.

 

[NurWollen]

My bad....lol

I just caught up on this thread. I think we should just see how everything goes. I don't think it will be as bad or as good as people are making it out to be. We may not like the AOA but I don't think they are dumb as we make them out to be.

I kind of see what you're saying. The AOA was pushed into this because they realized that the new ACGME policies would severely limit some DO's fellowship options. If the merger was as cut-and-dry bad as some suggest (all the DO PD's are going to be replaced by DO-hating MD's and we're going to be be severely restricted in residency access) the AOA would realize that that is even worse for DOs than the new ACGME requirements.

 

[wjs010]

I kind of see what you're saying. The AOA was pushed into this because they realized that the new ACGME policies would severely limit some DO's fellowship options. If the merger was as cut-and-dry bad as some suggest (all the DO PD's are going to be replaced by DO-hating MD's and we're going to be be severely restricted in residency access) the AOA would realize that that is even worse for DOs than the new ACGME requirements.

So have they realized that or is that not true and the merger is still going full force?

 

[NurWollen]

So have they realized that or is that not true and the merger is still going full force?

As far as I or anyone on this thread knows, the merger is still going full force. The idea that DO PD's might all lose there jobs is based on the fact the so far, it doesn't appear the ACGME has guarunteed that AOA-boarded PD's will be eligible to be PD's once their programs are ACGME accredited. Some organizations (Pennsylvania Osteopathic Medical Association, and the American College of Osteopathic Family Physicians) seem to be fighting the merger (so far to no avail) based on their interpretation that the PD stuff and other aspects of the merger will spell the end of osteopathic GME.

 

[Apprands31]

As far as I or anyone on this thread knows, the merger is still going full force. The idea that DO PD's might all lose there jobs is based on the fact the so far, it doesn't appear the ACGME has guarunteed that AOA-boarded PD's will be eligible to be PD's once their programs are ACGME accredited. Some organizations (Pennsylvania Osteopathic Medical Association, and the American College of Osteopathic Family Physicians) seem to be fighting the merger (so far to no avail) based on their interpretation that the PD stuff and other aspects of the merger will spell the end of osteopathic GME.

OK, now I'm confused. PA and FM are the most DO friendly state and specialty respectively. If anything those two organizations will benefit with the merger. Correct if I'm wrong but doesn't POMA and ACOFP do more than OGME? Their opposition does not seem logical. Anyone care to explain.

 

[Apprands31]

I've been looking at other threads about the merger (specifically OB, derm and ED). The general consensus is that AOA residencies are not up to ACGME standards. There's also a consensus that these residencies will be forced to close because of lack of resources and funds. Any thoughts?

 

[SnowDoggy44]

We are also forgetting that in the very immediate future, there won't be a combined match. This means that MDs who want to apply to AOA residencies will have to participate in the nms match before undergoing the nrmp match. From their prospective, doing so can risk one's chances of matching acgme residencies. This prompts me to believe that competitive MDs won't "risk" their chances of matching desirable acgme programs by participating in the aoa match. Therefore only those who think they are not up to par with acgme standards will be tempted to undergo the nms match. Even then, these applicants won't pose a large threat to competitive DOs.

This is my thought, so what do you guys think?

MDs can't participate in the NMS match, because NMS match only deals with AOA residencies and DO graduates. It's off limits to them. MDs can only apply for ACGME residencies through the NRMP. There will be a transition period (2015-2020) where AOA residencies apply and are granted immediate preliminary ACGME accreditation. Until a program applies for the accreditation, it remains AOA-accredited and is matched through NMS with only DO graduates. There are separate matches until all programs have transitioned.

OK, now I'm confused. PA and FM are the most DO friendly state and specialty respectively. If anything those two organizations will benefit with the merger. Correct if I'm wrong but doesn't POMA and ACOFP do more than OGME? Their opposition does not seem logical. Anyone care to explain.

They are worried DOs boarded in their specialty by only the DO specialty board (not the ABMS) will not be eligible for sole Program Director (PD) status at ACMGE programs, even if the program has osteopathic focus. There would have to be a co-director system where one of the PDs is boarded through the ABMS boards. While we think the merger needs to go on and is necessary, it is concerning for many of us here that trained and experienced DOs might be discriminated against in the regulations based who they board certified through. Losing DO PDs is not good for the advancement of osteopathic medicine nor the osteopathic presence in GME. The DO-friendliness of the Pennsylvania region has nothing to do with this issue.

 

[SnowDoggy44]

I've been looking at other threads about the merger (specifically OB, derm and ED). The general consensus is that AOA residencies are not up to ACGME standards. There's also a consensus that these residencies will be forced to close because of lack of resources and funds. Any thoughts?

Some serious changes and new program affiliations will need to be made for some programs. For others, not as much. For example, the Aspen Dermatology residency in Spanish Fork, UT looks to be really weak and only pays residents $20,000. Assuming the information on http://opportunities.osteopathic.org/search/search.cfm is correct (no journal club, research opportunity, formal curriculum in managed care, etc), some changes would need to be made. Hopefully the AOA will help out these programs in the transition so they can maintain their ACGME accreditation when review time comes around.

 

[Apprands31]

Some serious changes and new program affiliations will need to be made for some programs. For others, not as much. For example, the Aspen Dermatology residency in Spanish Fork, UT looks to be really weak and only pays residents $20,000. Assuming the information on http://opportunities.osteopathic.org/search/search.cfm is correct (no journal club, research opportunity, formal curriculum in managed care, etc), some changes would need to be made. Hopefully the AOA will help out these programs in the transition so they can maintain their ACGME accreditation when review time comes around.

Thanks, you've been very helpful. I have some more questions if someone can answer .
1. In the ED forum, they say the problem in AOA ED programs is that there are not enough residents. Apparently, ACGME requires 6 spots/year and AOA ED residencies are only funded for 4-5. The logical answer is to increase the spots. But my understanding is that these spots are funded by Medicare and Medicare isn't increasing positions. Also, there is a problem with full time attending to residents ratio ( ACGME requires 3 residents to one attending). Assuming that the PD is a full timer, the logical answer is to hire another full time attending. But from what I understand is that most hospitals are already cash strapped and may not be willing to do this. Do you think the AOA will put up the funds to correct these deficits?
2. From the derm and OB forum and a thread on this forum concerning optho, it appears the problem is the lack of cases and pathology. In derm's case it seems most of these residencies are run in private offices. Do you think these residencies will be absorbed by existing ACGME programs? Or worse, do you think they will be forced to close?
Any responses will be appreciated.

 

[GUH]

I think there will be MDs admitted to the programs with DO or MD PDs. It's kind of loony to insinuate that someone is going to take a position at a primarily DO hospital to shut DOs out of programs.

Not what I said.

OK, maybe I'm slow , but reading this thread and other threads on the merger, I'm lead to believe that everyone will be *grandfathered* into ACGME.

As stated in other posts on this thread, there is no such guarantee given by either the AOA or the ACGME.

 

[Spikebd]

I've been looking at other threads about the merger (specifically OB, derm and ED). The general consensus is that AOA residencies are not up to ACGME standards. There's also a consensus that these residencies will be forced to close because of lack of resources and funds. Any thoughts?

If it's true that they aren't up to par then it is in our best interest that these programs close. We don't want "Osteopathic" residencies to be considered second tier.

 

[GUH]

If it's true that they aren't up to par then it is in our best interest that these programs close. We don't want "Osteopathic" residencies to be considered second tier.

Whether MD's consider osteopathic training inferior is irrelevant. There are still many MD's who believe that DO's are all inferior physicians simply because they are DO's.
Outcomes matter.

 

[Spikebd]

Whether MD's consider osteopathic training inferior is irrelevant. There are still many MD's who believe that DO's are all inferior physicians simply because they are DO's.
Outcomes matter.

I didn't say it was just MD's who would hold that view. Potential patients might, other DO's might, hospital administrators might. Those things matter too.

 

[Dr. Zombie]

I didn't say it was just MD's who would hold that view. Potential patients might, other DO's might, hospital administrators might. Those things matter too.

Potential patients know the differences between osteopathic residencies vs allopathic ones in regards to the doctors they see?

 

[DrEnderW]

Whether MD's consider osteopathic training inferior is irrelevant. There are still many MD's who believe that DO's are all inferior physicians simply because they are DO's.
Outcomes matter.

I think there's some truth to this. Just because a program can manage 3 but not 5 EM residents or the GS PDs aren't publishing research doesn't necessarily mean you'd receive inadequate clinical training (especially for the small community or PP setting).

There are, of course, some programs that should be shut down. No doubt about that. However, there's going to have to be some flexibility in size and research standards simply because most AOA programs are not University programs.

 

[OCDEMS]

Notes from the field, sort of:

I've noticed an appreciable change in the enthusiasm for this merger within my school. The opposing parties seem to be better organized and we've heard multiple faculty speak against the merger. Students seem to be more or less 50/50 evenly split in support or opposition, whereas it was clearly 70/30 in favor when it was first announced.

The big hang-up seems to be the DO program director issue, straight up. If the word on the street is worth anything, the AOA needs to solidify a written grandfather clause for those docs who are AOA boarded or I wouldn't be surprised if this agreement ultimately fails...again. I hear a lot of students speaking about this issue from a central point of fairness. Many have been convinced, perhaps correctly, that it wouldn't be in their best interest to see lots of AOA program directors loose their positions, regardless if that is a likely scenario. I'd like to hear what others are experiencing at their schools.

 

[NurWollen]

Thanks, you've been very helpful. I have some more questions if someone can answer .
1. In the ED forum, they say the problem in AOA ED programs is that there are not enough residents. Apparently, ACGME requires 6 spots/year and AOA ED residencies are only funded for 4-5. The logical answer is to increase the spots. But my understanding is that these spots are funded by Medicare and Medicare isn't increasing positions. Also, there is a problem with full time attending to residents ratio ( ACGME requires 3 residents to one attending). Assuming that the PD is a full timer, the logical answer is to hire another full time attending. But from what I understand is that most hospitals are already cash strapped and may not be willing to do this. Do you think the AOA will put up the funds to correct these deficits?
2. From the derm and OB forum and a thread on this forum concerning optho, it appears the problem is the lack of cases and pathology. In derm's case it seems most of these residencies are run in private offices. Do you think these residencies will be absorbed by existing ACGME programs? Or worse, do you think they will be forced to close?
Any responses will be appreciated.

For what it's worth, the AOA reports that the ACGME will not be denying accreditation to AOA programs based on the size of the program.

http://osteopathic.org/inside-aoa/Pages/faq-program-directors-training-programs.aspx

 

[Spikebd]

Notes from the field, sort of:

I've noticed an appreciable change in the enthusiasm for this merger within my school. The opposing parties seem to be better organized and we've heard multiple faculty speak against the merger. Students seem to be more or less 50/50 evenly split in support or opposition, whereas it was clearly 70/30 in favor when it was first announced.

The big hang-up seems to be the DO program director issue, straight up. If the word on the street is worth anything, the AOA needs to solidify a written grandfather clause for those docs who are AOA boarded or I wouldn't be surprised if this agreement ultimately fails...again. I hear a lot of students speaking about this issue from a central point of fairness. Many have been convinced, perhaps correctly, that it wouldn't be in their best interest to see lots of AOA program directors loose their positions, regardless if that is a likely scenario. I'd like to hear what others are experiencing at their schools.

I agree that there should be an AOA boarded PD grandfather clause. However, it would look so lame to keep flip flopping on this issue. Last I saw more than half of DO's go into ACGME residencies. We have A LOT to lose as current students if they close off fellowships to us. So far I think the sentiment is still in favor of the merger at my school, but all this SDN chatter seriously concerns me. There is no more STATUS QUO on this issue, the writing is on the wall. We'd be smart to take this deal before it's too late.

 

[meliora27]

There was an AOA meeting in Chicago last week on 5/4 where they discussed the Unified Accreditation/MOU/Letter of Clarification. Has anyone heard any updates from that meeting?

 

[BMSc2DO]

In my opinion, this is why the merger is happening: If there is a limited amount of funding for residencies, where do you think it is going to go? To more AOA programs? Hell no... not when they have lower accreditation standards. It's going to the ACGME. Somewhere on the AOA website it stated the allocation of residency funding as a reason to proceed with the AOA/ACGME merger. The AOA knows their residency programs are subpar, and that the money funding residency programs is best put to programs that are ACGME accredited (ie. generally better programs). Honestly, the ACGME could argue that funding towards AOA programs should be relocated to ACGME programs, since they are better programs in general. The AOA has no choice but to meet ACGME standards, or they will lose their funding in the future. This is my opinion...

 

[hallowmann]

In my opinion, this is why the merger is happening: If there is a limited amount of funding for residencies, where do you think it is going to go? To more AOA programs? Hell no... not when they have lower accreditation standards. It's going to the ACGME. Somewhere on the AOA website it stated the allocation of residency funding as a reason to proceed with the AOA/ACGME merger. The AOA knows their residency programs are subpar, and that the money funding residency programs is best put to programs that are ACGME accredited (ie. generally better programs). Honestly, the ACGME could argue that funding towards AOA programs should be relocated to ACGME programs, since they are better programs in general. The AOA has no choice but to meet ACGME standards, or they will lose their funding in the future. This is my opinion...

This would all be well and good, but it makes the assumption that all AOA programs are subpar compared to ACGME programs. That's not true. In my state there are tons of parallel and dual accredited programs that are virtually identical and in big well-known university hospitals. Sure there are some AOA programs that are worse in my state, but there are definitely great ones that rival some of the ACGME programs.

Second, it makes the assumption that if a program is better than it will cost the same as a worse program, and that the government/politicians would know/understand the difference. If anything, AOA has been able to start a higher percentage of GMEs (and get funding for them) than the ACGME in recent years. This is probably because it is cheaper to establish them, and there are more small hospitals that have no GME that could start establishing AOA programs. If I were a politician, I would pick the cheaper option that makes pretty much the same doctor.

In any case, the value of the merger with regard to allocating more funding for GME is that a united voice is stronger than a divided one. Dealing with 2 different organizations is more costly than dealing with one. If the ACGME was responsible for all GME, it has a stronger position in asking for more money and setting the cost/value of GME. Ultimately, its a better position for the profession to be in.

 

[Dharma]

Anyone read Norman Geitz's presentation "The Unintended Consequences of the ACGME Merger" yet? If not, do so now. Wear shoes with good traction while doing so though; the slopes are slippery. Looks like he's pointing to the beginning of the end of osteopathic medical education. Fear does seem to be the choice motivator to stir up a frenzy in the flock...

While reading it, I couldn't help but think of one major point, that could apply to many of the warnings he made in the piece: had the world of osteopathic medical education focused more on quality in terms of both undergraduate medical education and postgrad training in the past couple of decades and less on explosive growth in numbers (i.e. grads) that relied very much on ACGME training and the lure of such to attract students (the so-called MD wannabes that the insecure like to rip on), they would not find themselves where they are today.

Think about that as you read these statements made concerning the student-to-faculty ratios, tuitions, number of available residency positions, etc. I laughed through most of it… not because what he says is any stretch of the imagination, but more because it is quite obvious the osteopathic medical education world finds itself where it stands today by its own doing, but would still rather point to elsewhere as the source of the problem. Maybe I'm just too jaded by all this, but count me in as someone in favor of the merger, even that means me facing more competition. I say toughen and so something to improve if competition scares you. Regardless… too much inertia to stand in front of this thing without getting barreled over… even with a fancy PhD presentation that preaches to the choir.

 

[Dharma]

for your reading "pleasure" http://www.oucom.ohiou.edu/hpf/pdf/...intended Consequences of the ACGME Merger.pdf

 

[OCDEMS]

Anyone read Norman Geitz's presentation "The Unintended Consequences of the ACGME Merger" yet?... Regardless… too much inertia to stand in front of this thing without getting barreled over… even with a fancy PhD presentation that preaches to the choir.

I've read his book and some of his thoughts on the merger. Personally, I don't think this merger is a slam dunk. I've heard way too many rumblings in my own school to think otherwise. I would not be surprised if the merger fails. I would not be surprised if the AOA, forced by an overwhelming and loud group of internal critics with varying motivations, pulls back and plays brinksmanship with the ACGME over the fellowship and residency issues. I've heard a number of alternative theories of how to address that problem, although I have reservations about how successful they would be.

 

[Dharma]

I've read his book and some of his thoughts on the merger. Personally, I don't think this merger is a slam dunk. I've heard way too many rumblings in my own school to think otherwise. I would not be surprised if the merger fails. I would not be surprised if the AOA, forced by an overwhelming and loud group of internal critics with varying motivations, pulls back and plays brinksmanship with the ACGME over the fellowship and residency issues. I've heard a number of alternative theories of how to address that problem, although I have reservations about how successful they would be.

There's a bit too much us-against-them polarization in his piece for me to take it too seriously, but that's just my opinion. If the merger fails (and here is my attempt at slicking up the slopes that be) the next step is closing the doors of residencies to non-LCME grads and those who do not meet the "exceptional candidate" qualifications, just like they are planning with fellowships and PGY2 spots. Or (and/or)… this finds its way to the public platform where the argument will be that tax payer dollars are at play and a unified system is needed, while in the process making the medical profession look like a bunch of whiney in-fighters. Politicians will have a field day with that one.

I don't think the answer is creating more of a divide then there already is.

 

[OCDEMS]

There's a bit too much us-against-them polarization in his piece for me to take it too seriously, but that's just my opinion. If the merger fails (and here is my attempt at slicking up the slopes that be) the next step is closing the doors of residencies to non-LCME grads and those who do not meet the "exceptional candidate" qualifications, just like they are planning with fellowships and PGY2 spots. Or (and/or)… this finds its way to the public platform where the argument will be that tax payer dollars are at play and a unified system is needed, while in the process making the medical profession look like a bunch of whiney in-fighters. Politicians will have a field day with that one.

I don't think the answer is creating more of a divide then there already is.

I believe a previous court decision stops them from blocking non-LCME grads from residency positions. I think it's a different issue for fellowships, but there is a group within the osteopathic profession who think that a lawsuit would be successful, although I've heard others say the opposite.

I do agree that physicians would look line a bunch of whiners, but I'm not sure that DOs would be the losers in the battle. Where I'm from, people love DO physicians. Every soccer mom with money wants their kid to go to the "holistic" doctor. Not sure they even know what that means, but that's a different story. DOs produce a disproportionate number of primary care docs and rural America still speaks with a large number of voting elderly. I honestly think the government would tell the ACGME to cut it out and you'd just end up with the status quo. That's not necessarily progress though and it would be a long battle fraught with lots of anxiety for DO students and residents.

Edit: Let's not forget that the DO story is one that is highly marketable. Eccentric guy from Missouri...or Kansas...or Virginia, you pick one, who wears a funny hat and hung out with Mark Twain...did you hear me? MARK F'ing TWAIN. This guy bumps up against the vicious MD oppressors and forms an alternate form of medicine. Then, BAM!, everyone decides to do both traditional medicine and manipulation (code word for complementary alternative medicine, which Americans LOVE!!!). Did we say that we educate physicians cheaper? And that they're more holistic? AND, AND...most of our people go into primary care? That's right America, we work for you. Insert random photos of Still holding a femur and wearing a cowboy hat and the argument is over.

 

[hallowmann]

...I laughed through most of it… not because what he says is any stretch of the imagination, but more because it is quite obvious the osteopathic medical education world finds itself where it stands today by its own doing, but we'll rather point to elsewhere as the source of the problem...

This is EXACTLY what I thought while reading it. So you're saying we're in a position to be devoured, well congrats, you can thank the powers that be for not establishing more OGME while expanding schools. So you say our resources aren't comparable to MD schools, huh, who's fault is that? We are sure as heck paying just as much if not more for our education.

Set aside the ridiculous correlation he makes between the supposed downfall of the osteopathic profession and the dismantling of homeopathy (which quite frankly we should be thanking the AMA for), the rest of his argument is purely slippery slope, and based on a few very questionable assumptions. The example doesn't even fit. At the time the homeopathic schools were trying to confer the same degree, MD, so you better believe they were made to adhere to the standards of the other MD schools.

Secondly he makes the statement that the LCME would not establish two separate rulings for MD schools and DO schools, with literally nothing but "believe me" to back that up. Even if we assume like he does that the next step will be the LCME forceably taking over AACOM (a pretty big assumption), last I checked these schools confered different degrees, and its not that strange to have two sets of rules for schools that confer two separate degrees.

Oh and, stop acting like DO schools are the answer to the PCP shortage or that that is real goal of DO school admins. As if the DO curriculum is responsible for making better PCPs. Its probably more a combination of less opportunity for specialties and more interest in PC. My classmate who wants to go into rural med would want to go into it whether he went here or whether he went to an MD school. All you need to do is look at MD schools in rural/underserved areas. Surprise surprise the percentage of their graduates going into primary care are almost the same as they are at DO schools.

Oh and the AOA might lose membership and no longer be able to claim that they represent osteopathic physicians. Maybe they should not require membership to maintain AOA board certification and see how many of the people they represent opt to keep sending in their membership dues. The only reason the AOA can make the claim that they represent osteopathic physicians now is because they force AOA boarded docs to be members. You think the majority of those docs are paying attention to whether or not they are represented accurately?

He could also make an attempt to suggest an alternative, rather than copping out and saying, yeah the status quo is no longer possible, but the only proposed move so far is the wrong one.

 

[Dharma]

Oh and, stop acting like DO schools are the answer to the PCP shortage or that that is real goal of DO school admins. As if the DO curriculum is responsible for making better PCPs.
.

I couldn't help but think his rhetoric sounded a bit like the NP propaganda I see spewed all over the place.

 

[hallowmann]

I couldn't help but think his rhetoric sounded a bit like the NP propaganda I see spewed all over the place.

Don't you know? NPs only practice in rural and underserved areas, because they truly care, not like those greedy physicians.

...Edit: Let's not forget that the DO story is one that is highly marketable. Eccentric guy from Missouri...or Kansas...or Virginia, you pick one, who wears a funny hat and hung out with Mark Twain...did you hear me? MARK F'ing TWAIN. This guy bumps up against the vicious MD oppressors and forms an alternate form of medicine. Then, BAM!, everyone decides to do both traditional medicine and manipulation (code word for complementary alternative medicine, which Americans LOVE!!!). Did we say that we educate physicians cheaper? And that they're more holistic? AND, AND...most of our people go into primary care? That's right America, we work for you. Insert random photos of Still holding a femur and wearing a cowboy hat and the argument is over.

Thanks for this, I absolutely love it! Lol

On a serious note, its definitely a VERY marketable approach.

 

[Dharma]

Hahaha… I like the Mark Twain reference there, nice! Good points… the stains from the $hit show that could go down on the Hill may not be as bad on the D.O. coat relative to that of our M.D. brethren. These two groups need to work together to arrive at the best solution for the sake of medical care in general. Attempts at polarization and fear mongering do not lend towards cooperation and the improvement that could come of it. That piece by Geitz serves to spread the fear amongst those easily persuaded…

and I have to do this:

 

[OCDEMS]

Don't you know? NPs only practice in rural and underserved areas, because they truly care, not like those greedy physicians.



Thanks for this, I absolutely love it! Lol

On a serious note, its definitely a VERY marketable approach.

Anytime. I mean, that is basically the manifesto of my school's introduction to osteopathic medicine. It's funny, because I really feel like the DO profession is in this weird pseudo twilight zone. In one corner you have the group of DOs who would, I think, literally put on chain mail and fight the MD oppressors in open battle. Then, there is the group who straight up wants to forget they're unique in anyway. The reality is that there is this nice, sane middle ground ripe to exploit. Realize that, functionally, we're the same as our MD counterparts. We have a different history and we learn some neat things on the side. That does create a distinct identity, but it's more like Army vs. Navy. I mean, common, only DO students can read my little joke above and get a good chuckle.

I've said it before: DOs should drop the defensiveness and create a niche as America's "Doctor's Doctor." Because of this schizophrenic way we all view ourselves, we're our own worst enemy. If we embraced the "together and distinct...ish" mentality and properly advertised our unique training, we'd be in better shape. That's not to say we aren't doing well. Let's be honest with ourselves: our forbearers developed a profession that now produces 1/5 of all medical students. The real success for osteopathic medicine would be such a wide adoption of positive viewpoints by the American public that MD schools would be forced to teach, however reluctantly, some of our tricks. In the meantime, we'd be best to recognize that MDs are our colleagues AND equals, most of which are too busy to bother with fighting us when we're both being threatened by mid-level encroachment.

 

[OCDEMS]

Hahaha… I like the Mark Twain reference there, nice! Good points… the stains from the $hit show that could go down on the Hill may not be as bad on the D.O. coat relative to that of our M.D. brethren. These two groups need to work together to arrive at the best solution for the sake of medical care in general. Attempts at polarization and fear mongering do not lend towards cooperation and the improvement that could come of it. That piece by Geitz serves to spread the fear amongst those easily persuaded…

and I have to do this:

This is the perfect transition. Have you ever noticed the following?

"Well, the Force is what gives a Jedi his power. It's an energy field created by all living things. It surrounds us and penetrates us; it binds the galaxy together." - Obi Wan Kenobi

On Fascia: “…sheathes, permeates, divides and sub‐divides every portion of all animal bodies; surrounding and penetrating every muscle and all its fibers—every artery, and every fiber.” -A.T. Still, Philosophy of Osteopathy

Further, I submit:

Thus, the only logical conclusion is that all DOs are Jedi Knights and DO students are Padawan Jedi apprentices. Logic seems sound.

 

[hallowmann]

Anytime. I mean, that is basically the manifesto of my school's introduction to osteopathic medicine. It's funny, because I really feel like the DO profession is in this weird pseudo twilight zone. In one corner you have the group of DOs who would, I think, literally put on chain mail and fight the MD oppressors in open battle. Then, there is the group who straight up wants to forget they're unique in anyway. The reality is that there is this nice, sane middle ground ripe to exploit. Realize that, functionally, we're the same as our MD counterparts. We have a different history and we learn some neat things on the side. That does create a distinct identity, but it's more like Army vs. Navy. I mean, common, only DO students can read my little joke above and get a good chuckle.

I've said it before: DOs should drop the defensiveness and create a niche as America's "Doctor's Doctor." Because of this schizophrenic way we all view ourselves, we're our own worst enemy. If we embraced the "together and distinct...ish" mentality and properly advertised our unique training, we'd be in better shape. That's not to say we aren't doing well. Let's be honest with ourselves: our forbearers developed a profession that now produces 1/5 of all medical students. The real success for osteopathic medicine would be such a wide adoption of positive viewpoints by the American public that MD schools would be forced to teach, however reluctantly, some of our tricks. In the meantime, we'd be best to recognize that MDs are our colleagues AND equals, most of them are too busy to bother with fighting us when we're both being threatened by mid-level encroachment.

Can I like this more? Like 1000 times more? This is EXACTLY what I've been trying to say/thinking just in much clearer words.

 

[Apprands31]

for your reading "pleasure" http://www.oucom.ohiou.edu/hpf/pdf/bios april 2014/2014-AODME Presentation The Unintended Consequences of the ACGME Merger.pdf

Wow, Dr Gevitz answered my question and then some. Law2Doc wrote earlier in this thread that the competitive residencies will be sacrificed with the merger . And, I think, it was OCDEMS who wrote on another thread that this was a concern of some of the opposition . If Gevitz's prediction is correct and the merger will ultimately lead to the extinction of the DO degree, I wonder what the public and other physicians( ie MDs) would think of the holders of the DO degree? I wonder if there will be any distinction made between those DOs who received degrees under COCA accreditation versus those under LCME? Any thoughts are welcomed.

 

[Apprands31]

While reading it, I couldn't help but think of one major point, that could apply to many of the warnings he made in the piece: had the world of osteopathic medical education focused more on quality in terms of both undergraduate medical education and postgrad training in the past couple of decades and less on explosive growth in numbers (i.e. grads) that relied very much on ACGME training and the lure of such to attract students (the so-called MD wannabes that the insecure like to rip on), they would not find themselves where they are today.

Think about that as you read these statements made concerning the student-to-faculty ratios, tuitions, number of available residency positions, etc. I laughed through most of it… not because what he says is any stretch of the imagination, but more because it is quite obvious the osteopathic medical education world finds itself where it stands today by its own doing, but would still rather point to elsewhere as the source of the problem. Maybe I'm just too jaded by all this, but count me in as someone in favor of the merger, even that means me facing more competition. I say toughen and so something to improve if competition scares you. Regardless… too much inertia to stand in front of this thing without getting barreled over… even with a fancy PhD presentation that preaches to the choir.

Dharma, could you point out the page number that Gevitz wrote this? Thanks.