DOs Residency Merger with ACGME

[GUH]

This compels me to think that there exists a back door policy for such well-established programs. Arrowhead is the best AOA surgical program, by far. I doubt it will ever shut down.

Minor point of clarification, I think Arrowhead gen surg is ACGME since they have MDs. Neurosurg is AOA.

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[IslandStyle808]

I don't understand what the obsession with top tier residencies is; city life sucks.

If you're the type of student that would have matched Hopkins neurosurgery at an MD school, you'll still have no problem becoming a neurosurgeon as a DO even after the merger. You'll be discriminated against -- so what? Be the doctor you want, and enjoy a comparable salary with a much lower cost-of-living.

Fellowships and academic tracks pretty much. Some top tier residency programs are even in small cities, for example Mayo Clinic. It's not so much the prestige, but more will this give one a chance to match where one wants. If I wanted a fellowship for instance, I could care less what tier the fellowship is, but I do care about the tier of the residency.

I do agree with the over all message, a doctor is a doctor whether neurosurgery or family medicine.

 

[Drrrrrr. Celty]

I don't understand what the obsession with top tier residencies is; city life sucks.

If you're the type of student that would have matched Hopkins neurosurgery at an MD school, you'll still have no problem becoming a neurosurgeon as a DO even after the merger. You'll be discriminated against -- so what? Be the doctor you want, and enjoy a comparable salary with a much lower cost-of-living.

The people on SDN tend to by in large by more proactive and more aspiring to higher ranking positions and or residencies. We power a collective atmosphere of arbitrary tiers and competitiveness. Before it used to be acgme is the standard, now it's mid tier or university programs is the important place to be.

Obviously it's worth mentioning that some people do want to do competitive specialties and those do require being in the best places. And that's fine, but we should evaluate whether this is applicable to everyone or even a sizable minority of ppl in DO schools.

 

[NurWollen]

So surgery programs basically need to be applying very soon if they plan on taking residents this year. Since these programs are likely finishing up interviews and putting together rank lists now, it's really coming down to the wire for some.

Then again, a program could easily put acceptance of new residents on hold for a year while they get their stuff together and then start accepting them again later, right?

Also, I imagine there are at least a few programs who have applied and for whom the AOA simply hasn't processed the application yet.

 

[GUH]

So surgery programs basically need to be applying very soon if they plan on taking residents this year. Since these programs are likely finishing up interviews and putting together rank lists now, it's really coming down to the wire for some.

Then again, a program could easily put acceptance of new residents on hold for a year while they get their stuff together and then start accepting them again later, right?

Also, I imagine there are at least a few programs who have applied and for whom the AOA simply hasn't processed the application yet.

I couldn't imagine how a large teaching service in gen surg would get by without an intern class. Plus they'd be 25% down in senior residents for the four years after internship.

 

[AnatomyGrey12]

We power a collective atmosphere of arbitrary tiers and competitiveness.

This is such a nice way of describing the phallus measuring contest we have here every couple of days. Exhibit A: the thread that was just closed.

I agree, the SDN community is not representative of the majority of Pre-meds or med students. The standards here for "success" are quite a bit higher and different than the reality. A common example of this is the way we talk about some DO matches:
A- "oh someone matched ACGME surg"

B- "yeah but it wasn't a university match"

A- "oh look someone matched university surg!"

B- "yeah but it wasn't top tier"

A- "oh look someone match Derm at Mayo!"

B- "yeah but it wasn't Harvard"

I see comments like this all the time. It just seems like we are always eager to point out that there is always something better that didn't happen.

This line of thinking permeates most threads in pre-allo/osteo and allo/osteo

 

[IslandStyle808]

This is such a nice way of describing the phallus measuring contest we have here every couple of days. Exhibit A: the thread that was just closed.

I agree, the SDN community is not representative of the majority of Pre-meds or med students. The standards here for "success" are quite a bit higher and different than the reality. A common example of this is the way we talk about some DO matches:
A- "oh someone matched ACGME surg"

B- "yeah but it wasn't a university match"

A- "oh look someone matched university surg!"

B- "yeah but it wasn't top tier"

A- "oh look someone match Derm at Mayo!"

B- "yeah but it wasn't Harvard"

I see comments like this all the time. It just seems like we are always eager to point out that there is always something better that didn't happen.

This line of thinking permeates most threads in pre-allo/osteo and allo/osteo

So true!

 

[Drrrrrr. Celty]

This is such a nice way of describing the phallus measuring contest we have here every couple of days. Exhibit A: the thread that was just closed.

I agree, the SDN community is not representative of the majority of Pre-meds or med students. The standards here for "success" are quite a bit higher and different than the reality. A common example of this is the way we talk about some DO matches:
A- "oh someone matched ACGME surg"

B- "yeah but it wasn't a university match"

A- "oh look someone matched university surg!"

B- "yeah but it wasn't top tier"

A- "oh look someone match Derm at Mayo!"

B- "yeah but it wasn't Harvard"

I see comments like this all the time. It just seems like we are always eager to point out that there is always something better that didn't happen.

This line of thinking permeates most threads in pre-allo/osteo and allo/osteo

It in many ways belittles the validity of training at community acgme facilities and university affiliated programs. It also really again pushes this belief that just because 10 ppl in a DO class were screwed from the start from getting into Derm or Acgme Ortho that the entire class was matching into defeat with grace.

I think at my school even with the high number of gunners we're all going to be generally happy with our match and what we choose.

 

[Azete]

The people on SDN tend to by in large by more proactive and more aspiring to higher ranking positions and or residencies. We power a collective atmosphere of arbitrary tiers and competitiveness. Before it used to be acgme is the standard, now it's mid tier or university programs is the important place to be.

Obviously it's worth mentioning that some people do want to do competitive specialties and those do require being in the best places. And that's fine, but we should evaluate whether this is applicable to everyone or even a sizable minority of ppl in DO schools.

My overall point was that in the RARE circumstance that someone is attending a DO school, that otherwise would have been a top tier MD student, they won't be limited in their choice of specialty. The frustrating part is this almost never happens, yet it dominates the daily discussions on SDN.

Sure, some residencies are off limits as DO -- who cares? As you pointed out, the prestige of these programs is really only known within our community; the average patient you treat won't even have any idea what residency is. Nor will the hot blonde you're trying to pick up at the bar.

 

[TOKOY90]

This is such a nice way of describing the phallus measuring contest we have here every couple of days. Exhibit A: the thread that was just closed.

I agree, the SDN community is not representative of the majority of Pre-meds or med students. The standards here for "success" are quite a bit higher and different than the reality. A common example of this is the way we talk about some DO matches:
A- "oh someone matched ACGME surg"

B- "yeah but it wasn't a university match"

A- "oh look someone matched university surg!"

B- "yeah but it wasn't top tier"

A- "oh look someone match Derm at Mayo!"

B- "yeah but it wasn't Harvard"

I see comments like this all the time. It just seems like we are always eager to point out that there is always something better that didn't happen.

This line of thinking permeates most threads in pre-allo/osteo and allo/osteo

Love it!!!! since this is a great example of how some people have that depressing gunnerish mentality and feel happy by shixxxxing into someone's life. Hope those ppl grow up


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[Ho0v-man]

Honestly, time will tell. They will have a lot of updates for us come the AOA Annual Meeting in late June. People on this forum may hear speculation from program directors or from leaders within AOA who are affiliated with their school, but it's tough to get a reliable estimate as there are so many variables. Someone who sits on these actual RRCs might know best, but I personally don't have connections to these people.

Early in the single accreditation system planning, the AOA, particularly Boyd Buser, DO, has told us students through webinars and public speaking events that they anticipate that most/majority of programs will successfully make the transition; unfortunately, I don't have any sources to provide you on that as those webinars aren't available any longer as far as I can tell. The ACGME of course doesn't like closing programs so it is in the ACGME's interests to help AOA and borderline programs to meet standards with substantial compliance during the transition.

Keep in mind, that to gain initial and continuing accreditation, programs need only to be "in substantial compliance with the applicable Program Requirements and/or the Institutional Requirements." http://www.acgme.org/acgmeweb/Portals/0/PDFs/Nasca-Community/FAQs.pdf Substantial compliance means they don't have to meet all requirements at 100%. Some requirements are much more important than others (core req vs detail requirement) and is a bit of a subjective judgment. They look at the whole package and make a decision. Again, I think someone who actually actively sits on a RRC would be the best resource on answering your question reliably.

I can tell you of some specific programs saying they intend not to apply based on their AOA Opportunities entries:

Family Medicine/Emergency Med at McLaren Oakland in Pontiac, MI
Otolaryngology in Wyoming, MI
Ophthalmology in Wyoming, MI
Dermatology in Cuyahoga Falls, OH
Ophthalmology in Las Vegas, NV
Emergency Medicine in Portsmouth, OH
Family Medicine in Portsmouth, OH
​

Interesting link pointing out the most common reasons of citation for withheld accreditation:
http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/default.aspx

Thanks a lot. I was more so concerned about the overall number of residency slots being depleted than having MDs steal them away lol.


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[SnowDoggy44]

Also, I imagine there are at least a few programs who have applied and for whom the AOA simply hasn't processed the application yet.

I think you are partially mistaken. The AOA is not processing any applications for accreditation; they haven't been since July 1st, 2015. All applications for medical/surgical GME accreditation in the United States go through the ACGME now.

You are correct, there may be more who are awaiting the pre-accreditation status, but it seems like they have been pretty fast on the turn around for that step (as it is automatic and doesn't require any review). There are many programs who have applied and have pending applications. If you look back at my original post from yesterday, you'll see the link https://apps.acgme.org/ads/Public/Reports/Report/18. This shows that there are 21 surgery programs awaiting their application for review and/or a site visit. There were 53 general surgery programs in the AOA match last year. This year there are 50 general surgery programs participating the in AOA match.

Summary of some specialties (4 or more years) as of today:
General Surgery

21 ACGME Pre-accredited
53 programs participating in AOA match 2015
50 participating in AOA match 2016​

Neurosurgery

3 ACGME P-A
8 in AOA match 2015
7 in AOA match 2016​

Otolaryngology & Facial Plastic Surgery

6 ACGME P-A
15 in AOA match 2015
13 in AOA match 2016​

Orthopedic Surgery

15 ACGME P-A
39 in AOA match 2015
40 in AOA match 2016​

Urological Surgery

3 ACGME Initial Accreditation, 8 P-A
10 in AOA match 2015
11 in AOA match 2016​

OB/GYN

3 ACGME P-A
31 in AOA match 2015
30 in AOA match 2016​

Anesthesiology

3 ACGME P-A
13 in AOA match 2015
13 in AOA match 2016​

2015 Match Statistics: https://www.natmatch.com/aoairp/stats/2015prgstats.html
2016 Participating Programs: https://www.natmatch.com/aoairp/instdirp/aboutproglist.html

It seems like there has been a drop off in programs so far for Gen Surg, Neurosurgery, ENT & Plastics, and OB/GYN. Programs for Ortho, Urology, and Anesthesiology have remained stable or grown. These specialties accounted for 431 OGME-1 positions in 2015, and if successful in transition, would hopefully remain DO-friendly as we move in to the single match model.

 

[NurWollen]

I think you are partially mistaken. The AOA is not processing any applications for accreditation; they haven't been since July 1st, 2015. All applications for medical/surgical GME accreditation in the United States go through the ACGME now.

You are correct, there may be more who are awaiting the pre-accreditation status, but it seems like they have been pretty fast on the turn around for that step (as it is automatic and doesn't require any review). There are many programs who have applied and have pending applications. If you look back at my original post from yesterday, you still see the link https://apps.acgme.org/ads/Public/Reports/Report/18. This shows that there are 21 surgery programs awaiting their application for review and/or a site visit. There were 53 general surgery programs in the AOA match last year. This year there are 50 general surgery programs participating the in AOA match.

Summary of some specialties (4 or more years) as of today:
General Surgery

21 ACGME Pre-accredited
53 programs participating in AOA match 2015
50 participating in AOA match 2016​

Neurosurgery

3 ACGME P-A
8 in AOA match 2015
7 in AOA match 2016​

Otolaryngology & Facial Plastic Surgery

6 ACGME P-A
15 in AOA match 2015
13 in AOA match 2016​

Orthopedic Surgery

15 ACGME P-A
39 in AOA match 2015
40 in AOA match 2016​

Urological Surgery

3 ACGME Initial Accreditation, 8 P-A
10 in AOA match 2015
11 in AOA match 2016​

OB/GYN

3 ACGME P-A
31 in AOA match 2015
30 in AOA match 2016​

Anesthesiology

3 ACGME P-A
13 in AOA match 2015
13 in AOA match 2016​

2015 Match Statistics: https://www.natmatch.com/aoairp/stats/2015prgstats.html
2016 Participating Programs: https://www.natmatch.com/aoairp/instdirp/aboutproglist.html

It seems like there has been a drop off in programs so far for Gen Surg, Neurosurgery, ENT & Plastics, and OB/GYN. Programs for Ortho, Urology, and Anesthesiology have remained stable or grown. These specialties accounted for 431 OGME-1 positions in 2015, and if successful in transition, would hopefully remain DO-friendly as we move in to the single match model.

Yeah, sorry. I meant current existing AOA programs that are applying for accreditation with the ACGME.

 

[QueenJames]

I don't understand what the obsession with top tier residencies is; city life sucks.

If you're the type of student that would have matched Hopkins neurosurgery at an MD school, you'll still have no problem becoming a neurosurgeon as a DO even after the merger. You'll be discriminated against -- so what? Be the doctor you want, and enjoy a comparable salary with a much lower cost-of-living.

No no no... shhh.. let them go to the city!

 

[deleted564680]

Just to add a thought to this... I know that there are some surgical subspecialty programs that are "merging" with existing ACGME university programs to survive. This won't be taken into account for pre-accreditation status.

 

[Siggy]

Minor point of clarification, I think Arrowhead gen surg is ACGME since they have MDs. Neurosurg is AOA.

Pretty much. The Arrowhead AOA Gen Surg's last intern class started in 2012.

This brings up another issue that's a good example from ARMC. ARMC currently has an ACGME IM residency and an AOA IM residency. For all intents and purposes, it's largely treated as one program, but it's not a dual accredited program. As such, I don't know if the AOA program is going to be transitioning or not. However, it doesn't really make a difference because if the AOA side closes down, then the ACGME side will just get all the spots anyways making the entire thing a wash.

I wonder how many other programs are in the same situation, thus giving a false idea of how many programs are actually "closing."

 

[Postictal Raiden]

Pretty much. The Arrowhead AOA Gen Surg's last intern class started in 2012.

This brings up another issue that's a good example from ARMC. ARMC currently has an ACGME IM residency and an AOA IM residency. For all intents and purposes, it's largely treated as one program, but it's not a dual accredited program. As such, I don't know if the AOA program is going to be transitioning or not. However, it doesn't really make a difference because if the AOA side closes down, then the ACGME side will just get all the spots anyways making the entire thing a wash.

I wonder how many other programs are in the same situation, thus giving a false idea of how many programs are actually "closing."

Yeah, I think that what's going to happen. The AOA IM program will be absorbed by the parallel ACGME IM program. The FM program is dually accredited so it'll be fine. However, the EM, OBGYN, Psych, and NSG programs are purely AOA, and it doesn't look like they have submitted an application for the accreditation yet. EM, psych and OBGYN can still apply and get accredited before the deadline, but NSG has already passed the deadline, so I'm not sure what's going to happen.

 

[Siggy]

Yeah, I think that what's going to happen. The AOA IM program will be absorbed by the parallel ACGME IM program. The FM program is dually accredited so it'll be fine. However, the EM, OBGYN, Psych, and NSG programs are purely AOA, and it doesn't look like they have submitted an application for the accreditation yet. EM, psych and OBGYN can still apply and get accredited before the deadline, but NSG has already passed the deadline, so I'm not sure what's going to happen.

The point I was trying to make was that in the score card of residency survival post merger, the IM program at ARMC is going to be counted as a closed program, even if the total aggregate number of spots doesn't change.

 

[hallowmann]

I wonder what will happen to Arrowhead neurosurgery. The program is 7 years long and they have yet to submit their accreditation application, so according to the new policy they have passed the deadline and can't accept new residents.

The decision to make this a requirement by the AOA to match future residents was made this year (fall 2015). As a result any programs that had already accepted residents who will finish after 2020 were given until the end of this year (June 2016) to apply for ACGME pre-accreditation.

Essentially we should see the majority of longer programs applying for pre-accreditation within the next 5 months. If they don't, they may never (although a few might delay for a year, but I doubt this would be the majority that don't apply).

So surgery programs basically need to be applying very soon if they plan on taking residents this year. Since these programs are likely finishing up interviews and putting together rank lists now, it's really coming down to the wire for some.

Then again, a program could easily put acceptance of new residents on hold for a year while they get their stuff together and then start accepting them again later, right?

Also, I imagine there are at least a few programs who have applied and for whom the AOA simply hasn't processed the application yet.

They have five months. See above.

 

[hexane19]

This is such a nice way of describing the phallus measuring contest we have here every couple of days. Exhibit A: the thread that was just closed.

I agree, the SDN community is not representative of the majority of Pre-meds or med students. The standards here for "success" are quite a bit higher and different than the reality. A common example of this is the way we talk about some DO matches:


This line of thinking permeates most threads in pre-allo/osteo and allo/osteo

After all... does size really matter?

 

[gamerEMdoc]

This has always frustrated me as an attending looking at students decisions on where to match. When I was graduating and going into EM 8 years ago, I had a top tier application (top 2% board scores, honors on all rotations but one, AOA as a 3rd year student) and got interviews at some of the biggest name programs in the country. I cancelled many of them in the end. I found University based rotations in the ED to be quite inferior to the experiences I was getting in community EM. In the end I chose to go to a community based ED program. It paid well, had great training, and it wasn't in a city. It was exactly what I was looking for and looking back 8 years now, I wouldn't have done anything any differently. Our residents there were recruited all over the country because we had a reputation as being actual functioning EM docs when we got out. Unless you are planning on doing academic University based medicine, noone cares about your research when you are looking for a job. They care about your RVUs, patient satisfaction, and your ability to bill well. Most University programs have no focus on this.

Dont get me wrong, I'm not bashing on University based programs. They are what they are. They train residents to work in a large University based system, which is fine. We need academicians to drive the research in our field and continue to educate. But they don't train them adequately to go out on their own in the community with less resources, and thats a major problem once those residents graduate if they decide to go to a busy community ED.

Its always interesting to me to ask the Locum tenens docs we sometimes get in where they trained. Almost all of them see less patients than our intern class does in the ED, and yet almost all were University trained. One gentlemen loves to tell everyone he trained at Yale (he mentions it 10 times a shift) and he sees 6 patients a shift. I rarely see less than 30.

In the end, choosing a residency is not about the name of the hospital you are going to, its got to be about your post residency plans. If you are going into IM or Gen Surg, and your plans are 100% to do a fellowship or academic medicine, then by all means, I would look for the best academic residency you can find. That's a no brainer. If you want to be a community EM doc (with or without a residency), consider that you'll actually have to know how to practice without a fellow in every subspecialty at your beck and call. If you want to be a community FM doc, go wherever that pays the best that you want to live. The name is completely meaningless when it comes time to find a job in clinical medicine. Doctors in many fields are so in demand now that hospitals are tripping over themselves to try and interview.

I assure you, you could go to the worst residency in existance, and you'd have an unlimited number of hospitals trying to hire you when you are done. Noone cares at all where you trained if you are trying to get a job being a community physician.

 

[Rekt]

This has always frustrated me as an attending looking at students decisions on where to match. When I was graduating and going into EM 8 years ago, I had a top tier application (top 2% board scores, honors on all rotations but one, AOA as a 3rd year student) and got interviews at some of the biggest name programs in the country. I cancelled many of them in the end. I found University based rotations in the ED to be quite inferior to the experiences I was getting in community EM. In the end I chose to go to a community based ED program. It paid well, had great training, and it wasn't in a city. It was exactly what I was looking for and looking back 8 years now, I wouldn't have done anything any differently. Our residents there were recruited all over the country because we had a reputation as being actual functioning EM docs when we got out. Unless you are planning on doing academic University based medicine, noone cares about your research when you are looking for a job. They care about your RVUs, patient satisfaction, and your ability to bill well. Most University programs have no focus on this.

Dont get me wrong, I'm not bashing on University based programs. They are what they are. They train residents to work in a large University based system, which is fine. We need academicians to drive the research in our field and continue to educate. But they don't train them adequately to go out on their own in the community with less resources, and thats a major problem once those residents graduate if they decide to go to a busy community ED.

Its always interesting to me to ask the Locum tenens docs we sometimes get in where they trained. Almost all of them see less patients than our intern class does in the ED, and yet almost all were University trained. One gentlemen loves to tell everyone he trained at Yale (he mentions it 10 times a shift) and he sees 6 patients a shift. I rarely see less than 30.

In the end, choosing a residency is not about the name of the hospital you are going to, its got to be about your post residency plans. If you are going into IM or Gen Surg, and your plans are 100% to do a fellowship or academic medicine, then by all means, I would look for the best academic residency you can find. That's a no brainer. If you want to be a community EM doc (with or without a residency), consider that you'll actually have to know how to practice without a fellow in every subspecialty at your beck and call. If you want to be a community FM doc, go wherever that pays the best that you want to live. The name is completely meaningless when it comes time to find a job in clinical medicine. Doctors in many fields are so in demand now that hospitals are tripping over themselves to try and interview.

I assure you, you could go to the worst residency in existance, and you'd have an unlimited number of hospitals trying to hire you when you are done. Noone cares at all where you trained if you are trying to get a job being a community physician.

As an associate PD, what are your thoughts on the future of matching into EM as a DO? How will the merger affect DO students chances? Do you anticipate many programs closing/not receiving ACGME accreditation?

 

[gamerEMdoc]

As an associate PD, what are your thoughts on the future of matching into EM as a DO? How will the merger affect DO students chances? Do you anticipate many programs closing/not receiving ACGME accreditation?

I'm not sure. I think the merger will benefit the top and mid tier DO students who currently decide to do the AOA match now to "play it safe" and match at a solid EM program rather than risk the ACGME match. It will open up a ton of other opportunities for them to match at obviously, and I think they'll do fine no matter what. Also, it takes the gambling away. We have a resident who is quite good, had a good application, and skipped the AOA match and didn't match in the ACGME match, and had to do a transitional year prior to coming to us the following year in the AOA match. Someone like him would have been saved by a single match system.

I do worry about less competitive students, because now they have to compete with a much much bigger pool of candidates. I think it will take a few years before we see the full impact honestly. I don't see EM getting any less competitive anytime soon. Demand and salaries just keep going up, and many people still view it as a "lifestyle" specialty because of the shift work and number of work days (big misconception though, there is a reason it has the highest burnout rate despite one of the lowest hours worked of any specialty, its a grueling field with the constant shift work and crazy environment).

I truly wish I had a better answer to this one but I don't. I'm both excited and scared at the same time of the merger. I cant wait till its all simplified, but I have no idea how it's going to effect our match rate success, and I don't like unpredictability when it comes to the match.

As for programs closing, there will be a few. The 6 per class requirement may clip off a few programs. But I doubt that will make a significant dent in the overall number of spots. Those GME spots that are lost there will just be offset by new programs that crop up. I do think new DO schools are popping up at a staggering rate, which will obviously flood more candidates into the match, which I think may be a bigger threat to match chances than anything. Time will tell.

 

[basikfx]

Speaking of ARMC, you guys notice there is a newly proposed privately funded (by some Indian doctor) nonprofit LCME school physically right next to ARMC? I think they are planning to forge a partnership with ARMC for their clerkships. I wonder what this might mean for students at WesternU.

 

[GUH]

Speaking of ARMC, you guys notice there is a newly proposed privately funded (by some Indian doctor) nonprofit LCME school physically right next to ARMC? I think they are planning to forge a partnership with ARMC for their clerkships. I wonder what this might mean for students at WesternU.

Yeah they've been talking about it for years. Currently the web site indicates that they plan to start accepting students in 2017, but they have in the past already pushed back the timeline. However, they now appear on the LCME list of candidate schools, which it wasn't before, so progress is being made. If they stick to the current timeline, their first class of 60 students will hit third year starting in the summer of 2019 and I imagine that they will take up a lot of the slots at ARMC, and that some of those slots would have otherwise gone to COMP third-years.
Dr. GnanaDev has already started the process of crowding out COMP by bringing in a bunch of SGU students... there's a whole story behind that but it would probably be best to avoid discussing it at length here. I suspect that COMP will still send students to ARMC but that the number will be reduced in the future.

 

[sunealoneal]

I'm not sure. I think the merger will benefit the top and mid tier DO students who currently decide to do the AOA match now to "play it safe" and match at a solid EM program rather than risk the ACGME match. It will open up a ton of other opportunities for them to match at obviously, and I think they'll do fine no matter what. Also, it takes the gambling away. We have a resident who is quite good, had a good application, and skipped the AOA match and didn't match in the ACGME match, and had to do a transitional year prior to coming to us the following year in the AOA match. Someone like him would have been saved by a single match system.

I do worry about less competitive students, because now they have to compete with a much much bigger pool of candidates. I think it will take a few years before we see the full impact honestly. I don't see EM getting any less competitive anytime soon. Demand and salaries just keep going up, and many people still view it as a "lifestyle" specialty because of the shift work and number of work days (big misconception though, there is a reason it has the highest burnout rate despite one of the lowest hours worked of any specialty, its a grueling field with the constant shift work and crazy environment).

The gamble is such a raw deal. I suppose scheduling the AOA match after the ACGME match openly admits that candidates might prefer ACGME programs over AOA.

Unfortunately, I think it'd be hypocritical of us to be upset about DO discrimination while we have protected residency spots.

 

[GUH]

The gamble is such a raw deal. I suppose scheduling the AOA match after the ACGME match openly admits that candidates might prefer ACGME programs over AOA.

Unfortunately, I think it'd be hypocritical of us to be upset about DO discrimination while we have protected residency spots.

We have agreed to give up our protected slots even though they have made no guarantee to stop discrimination against DOs. I suspect that people will still try to justify that behavior even after the merger is complete. People who oppose equal treatment for DOs aren't going to suddenly change their minds due to the merger.

 

[Drrrrrr. Celty]

We have agreed to give up our protected slots even though they have made no guarantee to stop discrimination against DOs. I suspect that people will still try to justify that behavior even after the merger is complete. People who oppose equal treatment for DOs aren't going to suddenly change their minds due to the merger.

I think time will change things. It's clearly done us many favors as is.

 

[gamerEMdoc]

We have agreed to give up our protected slots even though they have made no guarantee to stop discrimination against DOs. I suspect that people will still try to justify that behavior even after the merger is complete. People who oppose equal treatment for DOs aren't going to suddenly change their minds due to the merger.

While I agree with this sentiment, I'm pretty sure the current AOA programs that are being transitioned to ACGME are still going to be predominately DO residencies. They'll still be affiliated with a DO medical school, have most of their medical students be DO's who rotate, and will likely still match almost all Dos.

Will that change over time? Sure. And so will some ACGME programs biases.

 

[TheaterOfTheme]

How do you think this will affect rotations?

 

[TheaterOfTheme]

Yeah they've been talking about it for years. Currently the web site indicates that they plan to start accepting students in 2017, but they have in the past already pushed back the timeline. However, they now appear on the LCME list of candidate schools, which it wasn't before, so progress is being made. If they stick to the current timeline, their first class of 60 students will hit third year starting in the summer of 2019 and I imagine that they will take up a lot of the slots at ARMC, and that some of those slots would have otherwise gone to COMP third-years.
Dr. GnanaDev has already started the process of crowding out COMP by bringing in a bunch of SGU students... there's a whole story behind that but it would probably be best to avoid discussing it at length here. I suspect that COMP will still send students to ARMC but that the number will be reduced in the future.

In regards to this post, I mean.

 

[GUH]

While I agree with this sentiment, I'm pretty sure the current AOA programs that are being transitioned to ACGME are still going to be predominately DO residencies. They'll still be affiliated with a DO medical school, have most of their medical students be DO's who rotate, and will likely still match almost all Dos.

Will that change over time? Sure. And so will some ACGME programs biases.

Time will tell. It's encouraging that we have an associate PD who is saying this though!

How do you think this will affect rotations?

Hard to know for sure without knowing what affiliations COMP will create to compensate for the gap. It may increase your commute time if the hospital is far away. It may result in less exposure to a teaching hospital environment if the replacement slots are not at teaching institutions. Best case scenarios (if you want to rotate at teaching hospitals) would be if there were no rotations lost to COMP at ARMC (unlikely but possible if they elbow out SGU instead) or if those rotations were replaced by rotations at other local teaching hospitals.

I wouldn't consider it a huge loss to be pushed out of ARMC FM and Pediatrics and to replace them with non-teaching hospital rotations since while they are good learning opportunities in some ways, they are entirely inpatient and don't give a realistic basic exposure to those fields. Surgery, IM, and OB would be good rotations to try to keep there since replacing them with preceptorships or rotations at non-teaching facilities could leave students less prepared for internship. That's entirely my own opinion, though. The good news is that we have other teaching hospital sites for those rotations, although many of them are smaller than ARMC.

 

[TheaterOfTheme]

Time will tell. It's encouraging that we have an associate PD who is saying this though!

Hard to know for sure without knowing what affiliations COMP will create to compensate for the gap. It may increase your commute time if the hospital is far away. It may result in less exposure to a teaching hospital environment if the replacement slots are not at teaching institutions. Best case scenarios (if you want to rotate at teaching hospitals) would be if there were no rotations lost to COMP at ARMC (unlikely but possible if they elbow out SGU instead) or if those rotations were replaced by rotations at other local teaching hospitals.

I wouldn't consider it a huge loss to be pushed out of ARMC FM and Pediatrics and to replace them with non-teaching hospital rotations since while they are good learning opportunities in some ways, they are entirely inpatient and don't give a realistic basic exposure to those fields. Surgery, IM, and OB would be good rotations to try to keep there since replacing them with preceptorships or rotations at non-teaching facilities could leave students less prepared for internship. That's entirely my own opinion, though. The good news is that we have other teaching hospital sites for those rotations, although many of them are smaller than ARMC.

Interesting perspective--I certainly do hope it is the best case and SGU gets the boot. Isn't Arrowhead the main teaching hospital for COMP?

 

[GUH]

Interesting perspective--I certainly do hope it is the best case and SGU gets the boot. Isn't Arrowhead the main teaching hospital for COMP?

From what I've observed, Arrowhead has a plurality but not the majority of third-years from COMP at any given time. So it seems to be the most common but doesn't host the majority of core rotations.

 

[TheaterOfTheme]

From what I've observed, Arrowhead has a plurality but not the majority of third-years from COMP at any given time. So it seems to be the most common but doesn't host the majority of core rotations.

I see. Who would I talk to for more on this?

 

[GUH]

I see. Who would I talk to for more on this?

You could try the clinical education office at the school. But they may not be able to respond. You could also try to find a second-year since they recently did their rotations lottery.

 

[TheaterOfTheme]

You could try the clinical education office at the school. But they may not be able to respond. You could also try to find a second-year since they recently did their rotations lottery.

I couldn't find the school on the LCME website...

 

[GUH]

I couldn't find the school on the LCME website...

The LCME is not involved with the accreditation of DO schools.
If you're talking about the proposed MD school in Colton, look under the candidate schools section.

 

[heroes31]

Hey does anyone have any update on resolution 42 and if we still have to apply if we are doing an acgme intern year in one of those 4 states? Currently doing acgme intern yr in Florida. Thanks!

 

[meliora27]

Hey does anyone have any update on resolution 42 and if we still have to apply if we are doing an acgme intern year in one of those 4 states? Currently doing acgme intern yr in Florida. Thanks!

I called the AOA last year (when I was an M4) shortly after I matched and asked about this in case it would impact my intern year schedule (I'm in an ACGME program) and I was told on the phone to just hold off for the moment because it may not even be a thing anymore. I certainly hope so!

 

[hallowmann]

I know I'm bumping this older thread, but: Last count based on pre-accredited at the end of Feb 2016 is 137 programs in varying fields from FM to NS. So basically that's an average of >15 programs per month since the beginning of the transition period. There are ~800 AOA programs. As far as I can tell, programs are applying at a good rate. We still have to see how quickly they get initial accreditation.

 

[TheaterOfTheme]

I know I'm bumping this older thread, but: Last count based on pre-accredited at the end of Feb 2016 is 137 programs in varying fields from FM to NS. So basically that's an average of >15 programs per month since the beginning of the transition period. There are ~800 AOA programs. As far as I can tell, programs are applying at a good rate. We still have to see how quickly they get initial accreditation.

Thank you for the update. How long do they have for pre-accredidation?

 

[Roxy17]

I know I'm bumping this older thread, but: Last count based on pre-accredited at the end of Feb 2016 is 137 programs in varying fields from FM to NS. So basically that's an average of >15 programs per month since the beginning of the transition period. There are ~800 AOA programs. As far as I can tell, programs are applying at a good rate. We still have to see how quickly they get initial accreditation.

How should you plan for audition rotations this year for next years match? Would the programs already know if they will continue to be in the AOA match or can they change at any time once they are accredited?

 

[hallowmann]

Thank you for the update. How long do they have for pre-accredidation?

They can be pre-accredited at any time from now to June 2020. Initial accreditation is supposed to take anywhere from a few months to a year after pre-accreditation status is attained, assuming the program fulfills the ACGME requirements for accreditation. That said, programs that fail to attain initial accreditation can continue to reapply while maintaining pre-accreditation status until 2020.

How should you plan for audition rotations this year for next years match? Would the programs already know if they will continue to be in the AOA match or can they change at any time once they are accredited?

Programs cannot participate in the NRMP match until they are ACGME accredited (Initial accreditation). That can happen anytime, but usually happens somewhere 6-12 months after they apply, assuming they fulfill the ACGME accreditation requirements. Its really up to them which match they participate in after they get accredited (they can choose to participate in either), so I'd ask them directly.

 

[allantois]

Does anyone have any estimates for the projected number of residency programs in total after the merger (obviously current NRPM ones plus the AOA ones that survive the merger)?
How about the projected number of MD and DO graduates going forward?

Correct me if I am wrong, but it seems like over the course of the next 5 years the total number of residencies (ACGME and AOA up until they all become ACGME) is going to be contracting, while the number of graduates is on the rise every year with COCA listing a number of schools in the pre-accredited or applicant status on their website. I am wondering how many more US graduates the GME system will be able to bear before it reaches a 1:1 ratio of graduates to residency positions.

 

[SnowDoggy44]

Does anyone have any numbers for the projected number of residency programs in total after the merger (obviously current NRPM ones plus the AOA ones that survive the merger)?
How about the projected number of MD and DO graduates going forward?

I don't think anyone has reliable data or projections right now for the end number of successfully transitioned programs. I haven't heard of any that are recent, but it was expressed early on that it is anticipated a majority of programs will be successful. Largely, all we have is tracking the progress so far. https://apps.acgme.org/ads/Public

As of March 14th, 15 programs have successfully gained initial accreditation, 124 residencies have pre-accreditation. Of the AOA programs, 163 were already dual-accredited and won't need to worry about the transition (except to obtain/maintain osteopathic recognition if they so desire). So you are looking at 302 AOA residency programs that already have or are in the process of gaining ACGME accreditation.

There were 704 AOA non-TRI, residency programs that participated in the 2016 match. This doesn't include the small number of programs that conduct a pre-match selection method.

I am sure the AOA will have some more data, updates, and outlooks in a report to be presented at the AOA Annual Business Meeting, July 17-24. Stay tuned.

NOTE: Only one fellowship program has earned pre-accreditation. It remains to be seen how the fellowships will fare compared to the residencies.

 

[madb0x]

This might be a silly question but I thought I'd ask anyways... Will MD and DO's now share the same MATCH date and same reveal process?

 

[JoeUSA]

Traditionally osteopathic programs with largely osteopathic PDs will likely favor DOs, it's not rocket science. Programs that had previously gone unfilled will likely fill with IMGs though.

I am no so sure that this is true. Take a look at the surgical residents at Mercy. Previously, they were DOs. Now that they are an ACGME program, all of the first year surgical residents are MDs. The new Plastic Fellow is also an MD. Previously, they were DOs.

http://www.mercydesmoines.org/surgery-residency

 

[TheaterOfTheme]

I am no so sure that this is true. Take a look at the surgical residents at Mercy. Previously, they were DOs. Now that they are an ACGME program, all of the first year surgical residents are MDs. The new Plastic Fellow is also an MD. Previously, they were DOs.

http://www.mercydesmoines.org/surgery-residency

Do you think all top level AOA spots are out for DOs now?

 

[hallowmann]

This might be a silly question but I thought I'd ask anyways... Will MD and DO's now share the same MATCH date and same reveal process?

Not really sure what you mean by "reveal process", I'm guessing you mean the date of the "reveal" (the Friday of match week, with everyone finding out on Monday whether they matched), because even among MD schools not all have a "Match day" ceremony with the opening of envelopes or announcing of positions. By 2020, there should be no reason for the DO and MD matches to be separate, as all AOA programs will either become ACGME accredited or lose accreditation, so all will likely be run by the NRMP match. That said, nothing official has been stated about when that will take place or whether it even will, but its been implied that there would be no reason to have two matching systems, as all programs would be open to all applicants.