Email the acgme regarding new changes!

[JonnyG]

I'd be more afraid of the feds bringing an anti-trust lawsuit.

yeeehh......................against the AOA. The AOA doesn't allow ACGME students to apply to their residencies or fellowships. This brings out the debate of the joint match, but that is a whole different thread

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[kazuma]

yeeehh......................against the AOA. The AOA doesn't allow ACGME students to apply to their residencies or fellowships. This brings out the debate of the joint match, but that is a whole different thread

I agree, I think it's rediculous that we are allowed to take ACGME spots but allopathic students aren't offered the same courtesy by the AOA.

 

[Dharma]

Has the AOA made any official statement about this? Being that the ACGME is basically saying that AOA training is not up to par, you would think this would light a fire under someone's @$$. From what I know, it seems more likely that the AOA will respond with words (i.e. excuses) instead of action (e.g. implementing legitimate measures of improvement in their programs). Hopefully this is all treated as an opportunity to improve, an the AOA steps up to the challenge with action, as opposed to a war of words alone followed by the same-ol' same-ol'.

 

[Dharma]

I agree, I think it's rediculous that we are allowed to take ACGME spots but allopathic students aren't offered the same courtesy by the AOA.

 

[Slevin]

I think the ACGME should not allow any DO students to take their spots until the AOA lets MD students take AOA spots.

It's just the common thread of the AOA wanting the whole separate but equal thing. Mostly because they don't want to be marginalized in todays world, I can't blame them, but they are thinking backwards.

 

[Spatula]

I think the ACGME should not allow any DO students to take their spots until the AOA lets MD students take AOA spots.

It's just the common thread of the AOA wanting the whole separate but equal thing. Mostly because they don't want to be marginalized in todays world, I can't blame them, but they are thinking backwards.

If you open up AOA spots to MD students then the sheer size of the MD population would drown out most of the competitive specialties which would then cause DO schools to truly become second class primary care factories.

 

[DrWBD]

There are aome fields where the training is considered inferior in an absolute sense. AOA anesthesia comes to mind. Specifically there the minimum training requorements for the aoa version is missing key techniques that are considered 'core' in the acgme training. It's said that aoa trained anesthesiologists get much fewer opportunities bcause this training deficit is known. Cases like this are few, and I personally only know of anesthesia.

There are also ones considered identical. Urology and optho come to mind. Their known to be exactly the same.

Most fall into the wide category of 'the same but dont go somewhere crappy'. Most fields (im, peds, surgery) are considered the same. I have seen completely convincing arguments to prove that in my mind the training is the same. The issue is that both acgme and aoa have good spots and crappy spots. The aoa just has a higher percent of crappy locations. So someone training at st barnabus for surgery would be as qualified as any acgme nyc surgery rotation. Barnabus is a respected site. The same cannot be said for backwater hospital 'X' in west Virginia. They may never see the same volume or difficulty of cases. But the acgme and the aoa both have these crappy surgery spots. The aoa just has *more* of them. People who say acgme is superior should be saying the median acgme is better than the median aoa. Since the median in one is still sme major academic center and only the top third or so fit that bill with the aoa.

As an actual graduate of an ACGME program I disagree with pretty much everything you said here.

 

[DocEspana]

As an actual graduate of an ACGME program I disagree with pretty much everything you said here.

Care to state a single reason? Cause you can pretty much back up everything I've said by taking a gander at any of the specialty fields on this website. The gas thread is constantly talking about how the ASA looks down on the DO gas residencies and AOA anesth trainees are blocked out of many practices because of the nature of anesthesia (the supply is generally from anesthesia groups which are spread amazingly evenly by population demand, or come directly from hospital staff. The anesthesia groups will pretty much not recognize DO training across the board as the distribution of such groups has a level of ASA oversight, leaving AOA anesthesiology to be largely relegated to hospital practice).

Urology is only based out of major hospitals in the DO world, and uses the same program requirements that the AUA does... so I cant imagine any difference existing. A glance at the ophtho forum will have plenty of posts where people assert (however they do) that the training between ACGME and AOA is identical. I've read more than enough to know that its either true, or mass hysteria that no one is willing to argue against.

That leaves my assertion that there are crappy hospitals and great hospitals in all other programs, and ACGME has fewer crappy hospitals, and the handful of good hospitals in AOA is not any different than the much larger amount of good ACGME hospitals in many fields. Not that I'm saying to compare Einstein Philly to Hopkins, but 99% of ACGME hospitals aren't on the same level as Hopkins either. I hate I have to even say that, because I doubt you're actually going to make that point. Appealing to the outlier when discussing generalities will always lead to an exception. Now if you're saying Barnabus is not a great surgery site (for any designation) you're out of your mind. Barnabus puts people into chairs of emergency and surgery depts in ACGME-training hospitals with some frequency. I know I always go back to him, but shock trauma took a barnabus trained DO only a few years back.

edit: I'm sure you'll have something that will shut me up, but I respond because I honestly do not know what it was you took issue with. Seemed like a pretty non-controversial response by my normal rabble rouser standards.

 

[user3]

If you open up AOA spots to MD students then the sheer size of the MD population would drown out most of the competitive specialties which would then cause DO schools to truly become second class primary care factories.

Wouldn't it give DO's more clout in the ACGME match, as there would be less of a reason to discriminate against them?

 

[DuxburyPembroke]

If you open up AOA spots to MD students then the sheer size of the MD population would drown out most of the competitive specialties which would then cause DO schools to truly become second class primary care factories.

Because of stigma, or because you think that DO students couldn't compete on equal ground with MD students if we were all taking the same boards?

 

[kazuma]

Because of stigma, or because you think that DO students couldn't compete on equal ground with MD students if we were all taking the same boards?

Can't answer for the person who posted that, but if they can't compete on equal ground then they don't deserve the residency position. IMO the USMLE is the gold standard and overall a better written exam than the comlex.

 

[Deceptacon]

Can't answer for the person who posted that, but if they can't compete on equal ground then they don't deserve the residency position. IMO the USMLE is the gold standard and overall a better written exam than the comlex.

agreed

 

[painmd87]

I agree, I think it's rediculous that we are allowed to take ACGME spots but allopathic students aren't offered the same courtesy by the AOA.

It's money. Money. Without DO-only residencies + fellowships, why does the AOA exist? Dues-paying members would flee in droves to the AMA (or just stop paying anyone altogether once they aren't forced to do it). No business executive anywhere is ever going to vote himself/herself out of a job without a golden parachute. This is the #1 reason that the AOA will forever push separate-but-equal.

The official explanation would be, "AOA residencies, even *insert program that barely/never uses OMM*, require X amount of time doing OMM. LCME grads don't have the pre-requisite training to safely complete this time-honored tradition."

 

[DrWBD]

Care to state a single reason? Cause you can pretty much back up everything I've said by taking a gander at any of the specialty fields on this website. The gas thread is constantly talking about how the ASA looks down on the DO gas residencies and AOA anesth trainees are blocked out of many practices because of the nature of anesthesia (the supply is generally from anesthesia groups which are spread amazingly evenly by population demand, or come directly from hospital staff. The anesthesia groups will pretty much not recognize DO training across the board as the distribution of such groups has a level of ASA oversight, leaving AOA anesthesiology to be largely relegated to hospital practice).

Urology is only based out of major hospitals in the DO world, and uses the same program requirements that the AUA does... so I cant imagine any difference existing. A glance at the ophtho forum will have plenty of posts where people assert (however they do) that the training between ACGME and AOA is identical. I've read more than enough to know that its either true, or mass hysteria that no one is willing to argue against.

That leaves my assertion that there are crappy hospitals and great hospitals in all other programs, and ACGME has fewer crappy hospitals, and the handful of good hospitals in AOA is not any different than the much larger amount of good ACGME hospitals in many fields. Not that I'm saying to compare Einstein Philly to Hopkins, but 99% of ACGME hospitals aren't on the same level as Hopkins either. I hate I have to even say that, because I doubt you're actually going to make that point. Appealing to the outlier when discussing generalities will always lead to an exception. Now if you're saying Barnabus is not a great surgery site (for any designation) you're out of your mind. Barnabus puts people into chairs of emergency and surgery depts in ACGME-training hospitals with some frequency. I know I always go back to him, but shock trauma took a barnabus trained DO only a few years back.

edit: I'm sure you'll have something that will shut me up, but I respond because I honestly do not know what it was you took issue with. Seemed like a pretty non-controversial response by my normal rabble rouser standards.

I agree with your point about anesthesiology. I disagree with your assertion that this is the only field where there is a difference in training quality. Comparing the written requirements of AOA vs ACGME programs is meaningless. AOA programs (in my n=1 experience) are more likely to not actually meet the written requirements and will graduate people anyway, while everyone sort of looks the other way to not make waves. For example, I am skeptical that the upcoming NYCOMEC surgical residency in eastern Long Island (in a 90 bed community hospital) will generate enough case volume to adequately train surgical residents.

This is the issue the ACGME appears to be addressing with the traditional rotating internship. It seems to me to be a formal acknowledgment that the ACGME feels that the AOA internship requirements aren't worth the paper they are written on, and that the graduates are entering advanced residencies with spotty clinical training. Again, in my n=1 experience as an attending in a hospital that sponsors an osteopathic TRI, this is a valid concern. I am continually amazed at how little the interns actually do in terms of patient care in this institution.

My belief is that this action by the ACGME will benefit us as a profession in the end. The AOA, and osteopathic medicine in general, has a history of improvement only after external influences force changes. Consider the Flexner Report - damaging to the profession in the short term by resulting in the closure of the substandard osteopathic schools but keeping the strong ones alive. Or, more recently, the COMLEX-PE, which was established in response to the implementation of USMLE Step 2 CS for MD programs. When the COMLEX-PE was established, many osteopathic schools were forced to take measures beef up their training to meet the new standards (my own school completely revamped their training in physical diagnosis shortly after the new exam was announced). Similarly, I feel that this measure in the long run will help rather than harm us.

 

[Wyclef]

I just read the document. It sounds as if they are accepting comments only from certain types of people, e.g. Program Directors, Site Representatives, etc., not from us peons. I'm considering asking my PD to sent a comment.

I finished a AOA approved internship and am now in an ACGME radiology residency. Would the proposed changes potentially bar me from acceptance into an ACGME fellowship?

 

[majatoi]

Hello Folks,

Good discussion. The AOA Board of Trustees is just wrapping up our meeting here in OMED. I would like to reiterate a comment that was posted earlier, the ACGME is only taking comments from "communities of interest." This is defined as:

The ACGME invites comments from the community of interest regarding the proposed requirements listed below. As specified in the ACGME Manual of Policies and Procedures, the following groups constitute the ACGME community of interest:

Member organizations of the ACGME
Appointing organizations of the Review Committee
Designated Institutional Officials
Review Committee Chairs and Executive Directors of each Review Committee
Program directors in the specialty

Furthermore, the AOA/AACOM is drafting an official statement / comments on the issue to the ACGME as we speak. This will be submitted before the November 23, 2011 deadline. The subcommittee that is reviewing this should be meeting in December and the official board of directors will be meeting in February regarding this matter.

There has already been preliminary correspondence from President Levine sent to the ACGME and other key players without any response as of yet.

A significant amount of AOA Board of Trustee and AACOM leadership meeting time was dedicated to this topic and the political arms of both associations are on this as well.

The Council of Osteopathic Student Government Presidents will soon be releasing a statement regarding how you can take action before November 23rd to help in this effort from a grassroots approach.

Intentions can be speculated, but without an official statement from the ACGME regarding their intentions, we are not sure where this is coming from.

I have read your entire post and everything mentioned in this post and much more has been discussed at our Board meeting. Just know the AOA is concerned about this and is actively trying to establish communication with the ACGME regarding the matter to discuss our concerns.

Thank you.

If you have any additional comments, please feel free to email me: [email protected].

 

[Indodo]

I feel like this action by the ACGME has been a long time coming. I don't disagree with it, although I recognize the difficulty it is going to present to osteopathic graduates who want to do ACGME advanced residencies.

The AOA has been getting away with the "separate but equal" nonsense for some time when it comes to the quality of the traditional rotating internships (their residencies too, but that is a different discussion). It seems that the he ACGME is putting their foot down and acknowledging formally that they perceive the osteopathic TRI as inferior to an ACGME TY/prelim year.

You can blame the AOA for this happening. If they spent more time improving the quality of osteopathic GME rather than green-lighting new schools and residencies of dubious quality, this might have been avoided.

If the AOA wants DOs to do ACGME residencies, raise the standard.
ACGME fellowships don't take people who have done residencies in other countries either. Why make an exception for the outdated osteopathic paradigm which allows for some really poor quality programs.

 

[Carhartt]

That makes no since. Let the PD's of MD programs make the decision about who they want to accept in their residencies and fellowships. Also people need to remember who pays for these residencies, and it ain't the ACGME.

 

[Slevin]

That makes no since. Let the PD's of MD programs make the decision about who they want to accept in their residencies and fellowships. Also people need to remember who pays for these residencies, and it ain't the ACGME.

I'm going to grad from a DO school and while the ACGME doesn't pay for the fellowships they do provide the accreditation for these programs and they have to ensure a consistent baseline with regard to the quality of applicants. If the AOA is so worried about DO's not getting residencies then make them increase their standards so that they are at parity with allo standards.

 

[lftbndlbrnchblk]

I'm going to grad from a DO school and while the ACGME doesn't pay for the fellowships they do provide the accreditation for these programs and they have to ensure a consistent baseline with regard to the quality of applicants. If the AOA is so worried about DO's not getting residencies then make them increase their standards so that they are at parity with allo standards.

Is it really the quality of the DO matriculant that gets to the ACGME or the idea that since we are dedicating 'x' amount of hours to osteopathic medicine that we are, somehow, not learning the "correct" amount of conventional medicine/basic sciences and should be held to a lower standard?

 

[Wolverines83]

Is it really the quality of the DO matriculant that gets to the ACGME or the idea that since we are dedicating 'x' amount of hours to osteopathic medicine that we are, somehow, not learning the "correct" amount of conventional medicine/basic sciences and should be held to a lower standard?

My guess would be it's not a general bias against DO matriculants as much as it's against the internship training. If it was DO matriculants as a whole they probably would have banned DOs outright, no?

Of course there's some bias but I don't believe that played as much a factor as the internship quality.

 

[toothless rufus]

...or through dual accreditation which costs some $$$.

Does anyone know how much this actually costs?

BTW this issue regarding ACGME residencies/fellowships looks to me like the beginning of politely banning DOs from both eventually and permanently. Maybe in light of increasing DO schools and enrollment. Why else even raise the issue? Truth is they can blamelessly do whatever they want.

 

[scotchtapetest]

Are you suggesting that osteopathic physicians should be a protected class, thus coming within the purview of equal opportunity laws and regulations?? So we as a society should make sure that there is no discrimination on the basis of race, sex, age, national origin, and medical degree? Please tell me you're joking.

FYI, medical degree IS protected under federal law! If a physician is otherwise fully licensed in a state, the hospital can NOT discriminate against him/her based on his/her medical degree as that would constitute "monopolizing" which is against federal antitrust laws. Look up Weiss v. York Hospital!

Doesn't apply to residency/fellowship (b/c if you are applying then you are not fully licensed/certified in that field).

That's also why osteopathic hospitals (at least in their traditional sense) no longer exist; They couldn't limit their staff to only osteopathic physicians and other hospitals couldn't refuse to hire DOs just b/c of their degree. Therefore, there was no reason to have "osteopathic hospitals" and they no longer exist !

 

[scotchtapetest]

Can't answer for the person who posted that, but if they can't compete on equal ground then they don't deserve the residency position. IMO the USMLE is the gold standard and overall a better written exam than the comlex.

Completely disagree!

I) COMLEX is the gold standard for osteopathic students/graduates/physicians.

II) If you don't like the STYLE of the exam that does NOT make it a bad exam! The exam is DESIGNED to have short ambiguous questions. This is the style which people who became DOs before you were born decided was the appropriate way to test the knowledge of their future colleagues. If you don't like it, when you grow up, you can contribute to the development/redesign of the exam.

III) For all the people who want to replace COMLEX with USMLE: Let's say we do that and 5 years down the road NBME says we are not going to let DOs take the USMLE (BTW this ACGME policy change is a great example of how things can change). Then what are you going to do? You won't even be able to get licensed!

 

[DrMaximus]

Does anyone know how much this actually costs?

BTW this issue regarding ACGME residencies/fellowships looks to me like the beginning of politely banning DOs from both eventually and permanently. Maybe in light of increasing DO schools and enrollment. Why else even raise the issue? Truth is they can blamelessly do whatever they want.

You think that they will actually shut DOs out of ACGME programs completely?

 

[sylvanthus]

Completely disagree!

I) COMLEX is the gold standard for osteopathic students/graduates/physicians.

II) If you don't like the STYLE of the exam that does NOT make it a bad exam! The exam is DESIGNED to have short ambiguous questions. This is the style which people who became DOs before you were born decided was the appropriate way to test the knowledge of their future colleagues. If you don't like it, when you grow up, you can contribute to the development/redesign of the exam.

III) For all the people who want to replace COMLEX with USMLE: Let's say we do that and 5 years down the road NBME says we are not going to let DOs take the USMLE (BTW this ACGME policy change is a great example of how things can change). Then what are you going to do? You won't even be able to get licensed!

No what makes is a ****ty exam is that it has short, ambiguous questions. Seriously, how can anyone think that an exam this poorly written is the gold standard merely because it was designed that way by ancient DOs? Did they intend to write a ****ty test? Well then mission accomplished! Doesn't mean it is a good test.

 

[koennen]

FYI, medical degree IS protected under federal law! If a physician is otherwise fully licensed in a state, the hospital can NOT discriminate against him/her based on his/her medical degree as that would constitute "monopolizing" which is against federal antitrust laws. Look up Weiss v. York Hospital!

Doesn't apply to residency/fellowship (b/c if you are applying then you are not fully licensed/certified in that field).

That's also why osteopathic hospitals (at least in their traditional sense) no longer exist; They couldn't limit their staff to only osteopathic physicians and other hospitals couldn't refuse to hire DOs just b/c of their degree. Therefore, there was no reason to have "osteopathic hospitals" and they no longer exist !

1. Can't discriminate against DOs in all hiring decisions or can't discriminate against DOs in the granting of hospital privileges? Isn't the latter what Weiss was about? Hardly informed by the same considerations as those attending the hiring of a first year resident or fellow, is it? Weiss was an anti-trust case, not an employment discrimination case. Are you suggesting that federal anti-trust law, similar to federal employment discrimination law, recognizes "protected classes" of individuals of which DOs are one? Have a case citation for that proposition?

2. Weiss is a 3rd Circuit case from the early 80s, on which the Sup.Ct. denied cert. I don't have the time or interest to Shepardize it. But, even assuming it is still good law, it is not binding outside of the 3rd Circuit (persuasive v. mandatory authority).

3. Since, as you correctly point out, Weiss does not apply to applicants for residency and fellowship positions, it has no relevance to the discussion above from which you quote me in your post.

 

[scotchtapetest]

You think that they will actually shut DOs out of ACGME programs completely?

Nobody is shutting anybody out of anything (yet). IF this policy takes effect, they are even providing extra time before implementation just to make sure nobody is shut out! Also, if you read the document, it specifically states that it doesn't affect anyone based on medical SCHOOL/DEGREE type.

No what makes is a ****ty exam is that it has short, ambiguous questions. Seriously, how can anyone think that an exam this poorly written is the gold standard merely because it was designed that way by ancient DOs? Did they intend to write a ****ty test? Well then mission accomplished! Doesn't mean it is a good test.

The purpose of COMLEX (similar to usmle) is to assess minimum competence to advance to next stage of training/licensure. So, unless you can show me a valid study that indicates that the style of COMLEX fails to accomplish this goal, it IS the gold standard for osteopathic medical education. Also, without any solid evidence (i.e. controlled study) that somehow COMLEX style is inadequate/bad/or other terms used on SDN, then you can only say that as a student, you personally do not LIKE the style of this exam (btw how students feel about the exam is not a consideration for designing an exam).

Also, It is always good to keep in mind that IF and WHEN you graduate you will have the honor to practice medicine in this country because of all of the battles/hardships these "ancient DOs" had to go through in the past 100+ years (I'm assuming you are a DO student). And as I mentioned in my previous post, once you become an "ancient DO", you can contribute to the profession and come up with a "better" style/exam to assess competence of future students.

1. Can't discriminate against DOs in all hiring decisions or can't discriminate against DOs in the granting of hospital privileges? Isn't the latter what Weiss was about? Hardly informed by the same considerations as those attending the hiring of a first year resident or fellow, is it? Weiss was an anti-trust case, not an employment discrimination case. Are you suggesting that federal anti-trust law, similar to federal employment discrimination law, recognizes "protected classes" of individuals of which DOs are one? Have a case citation for that proposition?

2. Weiss is a 3rd Circuit case from the early 80s, on which the Sup.Ct. denied cert. I don't have the time or interest to Shepardize it. But, even assuming it is still good law, it is not binding outside of the 3rd Circuit (persuasive v. mandatory authority).

3. Since, as you correctly point out, Weiss does not apply to applicants for residency and fellowship positions, it has no relevance to the discussion above from which you quote me in your post.

First of all, a court case is not a law! It is the interpretation of laws (antitrust laws in this case) by the courts. Second, such interpretations do not have expiration dates so it makes no difference if it was the 50s, 60s or the 80s UNLESS there is more recent interpretation from a higher court that contradicts an older interpretation. Third, the fact that it was in the 3rd district does NOT make it invalid in other jurisdictions, although it gives it more weight in the 3rd district. Fourth, if you are a large entity (e.g. a major healthcare facility) that has the potential to monopolize a service (e.g. health services in a region) then you can NOT discriminate against DOs or MDs in your hiring practices solely based on an individual's degree.

Now, admittedly, it would be very difficult to prove such a case and I just wanted to point out the fact that it is not as simple as people make it on SDN.

I agree with your point about anesthesiology. I disagree with your assertion that this is the only field where there is a difference in training quality. Comparing the written requirements of AOA vs ACGME programs is meaningless. AOA programs (in my n=1 experience) are more likely to not actually meet the written requirements and will graduate people anyway, while everyone sort of looks the other way to not make waves. For example, I am skeptical that the upcoming NYCOMEC surgical residency in eastern Long Island (in a 90 bed community hospital) will generate enough case volume to adequately train surgical residents.

This is the issue the ACGME appears to be addressing with the traditional rotating internship. It seems to me to be a formal acknowledgment that the ACGME feels that the AOA internship requirements aren't worth the paper they are written on, and that the graduates are entering advanced residencies with spotty clinical training. Again, in my n=1 experience as an attending in a hospital that sponsors an osteopathic TRI, this is a valid concern. I am continually amazed at how little the interns actually do in terms of patient care in this institution.

My belief is that this action by the ACGME will benefit us as a profession in the end. The AOA, and osteopathic medicine in general, has a history of improvement only after external influences force changes. Consider the Flexner Report - damaging to the profession in the short term by resulting in the closure of the substandard osteopathic schools but keeping the strong ones alive. Or, more recently, the COMLEX-PE, which was established in response to the implementation of USMLE Step 2 CS for MD programs. When the COMLEX-PE was established, many osteopathic schools were forced to take measures beef up their training to meet the new standards (my own school completely revamped their training in physical diagnosis shortly after the new exam was announced). Similarly, I feel that this measure in the long run will help rather than harm us.

I agree with your general ideas regarding OGME and how AOA is dropping the ball. AOA certainly needs to focus a lot more time/effort/resources on improving the quality of all specialties within OGME. They need to STOP opening new schools (possibly close some of them) and focus their energy and efforts on OGME. Not because they are somehow inferior to all ACGME programs*, but because our graduating students are very capable individuals (not that I'm biased or anything, lol) and they deserve to receive the best post-graduate training "in house." Currently this is not an option and AOA is at least partially to blame, IMO

*There are numerous crappy ACGME community programs, especially in primary care specialties, that have much poorer standards/quality. So, the argument that somehow ALL ACGME programs are superior to ALL AOA programs is not valid.

Having said that, you sound very much like any other attending with regards to resident education (regardless of program). This is how the conversation usually goes, "I can't believe the education these residents are receiving these days" and it is always followed by "when I was a resident ..."

 

[DOxidant]

I'm confused. I know this sounds like a dumb question but I need to get a clarification. So if this proposal gets accepted, does it mean we cannot start ACGME PGY1 (regular residency program not an internship) after one year of AOA internship? Or does it mean we cannot start ACGME PGY2 after one year of AOA internship (unless we do another year of ACGME internship after AOA one year internship)?

For example, in order to practice medicine in Michigan as an internist (in case of not doing AOA residency or dual accredited program), is the transition like 1 yr AOA Internship -> 1 yr ACGME internship -> ACGME PGY 1-3? I guess this route make us get 1-2 yrs behind.

Is one year ACGME internship considered as a first year ACGME PGY1 so that we can start as a PGY2 right after 1 year ACGME internship? I'm sorry. I'm pretty ignorant in this matter of subject.

Ugh.... this whole thing is very confusing and frustrating. AOA is opening up more DO schools while there is not enough AOA residency spots. On top of that, now there is this issue

 

[scotchtapetest]

I'm confused. I know this sounds like a dumb question but I need to get a clarification. So if this proposal gets accepted, does it mean we cannot start ACGME PGY1 (regular residency program not an internship) after one year of AOA internship? Or does it mean we cannot start ACGME PGY2 after one year of AOA internship (unless we do another year of ACGME internship after AOA one year internship)?

For example, in order to practice medicine in Michigan as an internist (in case of not doing AOA residency or dual accredited program), is the transition like 1 yr AOA Internship -> 1 yr ACGME internship -> ACGME PGY 1-3? I guess this route make us get 1-2 yrs behind.

Is one year ACGME internship considered as a first year ACGME PGY1 so that we can start as a PGY2 right after 1 year ACGME internship? I'm sorry. I'm pretty ignorant in this matter of subject.

Ugh.... this whole thing is very confusing and frustrating. AOA is opening up more DO schools while there is not enough AOA residency spots. On top of that, now there is this issue

If it goes through, it means that your AOA Internship (i.e. OPGY-I) doesn't count for anything as far as ACGME is concerned.

This is NOT an issue for Medicine, as it never counted. If you do an AOA internship and you want ACGME IM you have to start as a PGY-I (as it is currently the case). (i.e. 1yr AOA internship > ACGME PGY 1-3). You can also skip AOA internship through resolution 42, although I don't think that's allowed in Michigan until you've completed your training (I could be wrong as this may have changed recently)!

It basically, only affects "advance" residencies (e.g. gas, PM&R, etc.) which allowed DOs to satisfy their internship requirement through the AOA if they chose to do so.

Theoretically, it is also possible to do ACGME fellowship without ACGME residency (e.g. medicine subspecialties) but you were never board-eligible after the fellowship anyways (at least this was the case in medicine subspecialties). If this goes through, it closes that loophole too. BUT since very few people chose to do that, b/c they could't sit for boards anyways, it doesn't make a whole lot of difference.

Summary: If you want to do IM, it doesn't change anything for you whether it goes through or not!

 

[sylvanthus]

Nobody is shutting anybody out of anything (yet). IF this policy takes effect, they are even providing extra time before implementation just to make sure nobody is shut out! Also, if you read the document, it specifically states that it doesn't affect anyone based on medical SCHOOL/DEGREE type.




The purpose of COMLEX (similar to usmle) is to assess minimum competence to advance to next stage of training/licensure. So, unless you can show me a valid study that indicates that the style of COMLEX fails to accomplish this goal, it IS the gold standard for osteopathic medical education. Also, without any solid evidence (i.e. controlled study) that somehow COMLEX style is inadequate/bad/or other terms used on SDN, then you can only say that as a student, you personally do not LIKE the style of this exam (btw how students feel about the exam is not a consideration for designing an exam).

Also, It is always good to keep in mind that IF and WHEN you graduate you will have the honor to practice medicine in this country because of all of the battles/hardships these "ancient DOs" had to go through in the past 100+ years (I'm assuming you are a DO student). And as I mentioned in my previous post, once you become an "ancient DO", you can contribute to the profession and come up with a "better" style/exam to assess competence of future students.



First of all, a court case is not a law! It is the interpretation of laws (antitrust laws in this case) by the courts. Second, such interpretations do not have expiration dates so it makes no difference if it was the 50s, 60s or the 80s UNLESS there is more recent interpretation from a higher court that contradicts an older interpretation. Third, the fact that it was in the 3rd district does NOT make it invalid in other jurisdictions, although it gives it more weight in the 3rd district. Fourth, if you are a large entity (e.g. a major healthcare facility) that has the potential to monopolize a service (e.g. health services in a region) then you can NOT discriminate against DOs or MDs in your hiring practices solely based on an individual's degree.

Now, admittedly, it would be very difficult to prove such a case and I just wanted to point out the fact that it is not as simple as people make it on SDN.



I agree with your general ideas regarding OGME and how AOA is dropping the ball. AOA certainly needs to focus a lot more time/effort/resources on improving the quality of all specialties within OGME. They need to STOP opening new schools (possibly close some of them) and focus their energy and efforts on OGME. Not because they are somehow inferior to all ACGME programs*, but because our graduating students are very capable individuals (not that I'm bias or anything, lol) and they deserve to receive the best post-graduate training "in house." Currently this is not an option and AOA is at least partially to blame, IMO

*There are numerous crappy ACGME community programs, especially in primary care specialties, that have much poorer standards/quality. So, the argument that somehow ALL ACGME programs are superior to ALL AOA programs is not valid.

Having said that, you sound very much like any other attending with regards to resident education (regardless of program). This is how the conversation usually goes, "I can't believe the education these residents are receiving these days" and it is always followed by "when I was a resident ..."

Do you have any idea how humorous it is that you want a controlled study to prove how poor the COMLEX is when we are trained on unfounded, unproven OMT techniques with very little in the way of controlled studies? Seriously, that just made my day, thank you.

 

[DOxidant]

Thanks Bala565. That was very helpful

If it goes through, it means that your AOA Internship (i.e. OPGY-I) doesn't count for anything as far as ACGME is concerned.

This is NOT an issue for Medicine, as it never counted. If you do an AOA internship and you want ACGME IM you have to start as a PGY-I (as it is currently the case). (i.e. 1yr AOA internship > ACGME PGY 1-3). You can also skip AOA internship through resolution 42, although I don't think that's allowed in Michigan until you've completed your training (I could be wrong as this may have changed recently)!

It basically, only affects "advance" residencies (e.g. gas, PM&R, etc.) which allowed DOs to satisfy their internship requirement through the AOA if they chose to do so.

Theoretically, it is also possible to do ACGME fellowship without ACGME residency (e.g. medicine subspecialties) but you were never board-eligible after the fellowship anyways (at least this was the case in medicine subspecialties). If this goes through, it closes that loophole too. BUT since very few people chose to do that, b/c they could't sit for boards anyways, it doesn't make a whole lot of difference.

Summary: If you want to do IM, it doesn't change anything for you whether it goes through or not!

 

[toothless rufus]

You think that they will actually shut DOs out of ACGME programs completely?

Who knows. Just wouldn't surprise me. Especially in light of these current concerns.

But does anyone know about how much a program has to pay for dual accreditation?

 

[scotchtapetest]

Who knows. Just wouldn't surprise me. Especially in light of these current concerns.

But does anyone know about how much a program has to pay for dual accreditation?

It depends on the OPTI.

~20% of respondents to this study (2011) of dually accredited FM program stated that it costs them >$20,000/per year to maintain their AOA accreditation.
http://www.stfm.org/fmhub/fm2011/June/Richard387.pdf

This presentation (2004) breaks down the numbers for a PCOM OPTI:
AOA Fees:
$300 per program + $120 per trainee

PLUS OPTI fees:
$5,000 membership fee + $255 per intern + $255 per resident

PLUS extras:
AOA Dues = $60 per trainee
AOA Dues for DME = $655
AODME Dues for DME = $300
DME Travel to AODME = $2,500
COH Dues = $2,500 (optional)

This is compared to $2,500 flat fee for ACGME programs (rate in 2004)!

Totals for Geisinger's 1 program in 2004:
AOA = $5,520
ACGME = $2,500

Totals for Geisinger's 3 AOA program in 2004: $30,860
http://www.aacom.org/events/annualmtg/past/2004/Documents/Sess5_Bulger.pdf

It is amazing what a simple 1 minute Google search can reveal! I wished Google was available to everyone (maybe one of these days)!

 

[koennen]

First of all, a court case is not a law! It is the interpretation of laws (antitrust laws in this case) by the courts. Second, such interpretations do not have expiration dates so it makes no difference if it was the 50s, 60s or the 80s UNLESS there is more recent interpretation from a higher court that contradicts an older interpretation. Third, the fact that it was in the 3rd district does NOT make it invalid in other jurisdictions, although it gives it more weight in the 3rd district. Fourth, if you are a large entity (e.g. a major healthcare facility) that has the potential to monopolize a service (e.g. health services in a region) then you can NOT discriminate against DOs or MDs in your hiring practices solely based on an individual's degree.

Let me guess. You took a Business Law course in college.

Stick to medicine, my friend. Your knowledge of the law and your legal reasoning skills are sorely lacking.

 

[scotchtapetest]

Let me guess. You took a Business Law course in college.

Stick to medicine, my friend. Your knowledge of the law and your legal reasoning skills are sorely lacking.

That means a lot coming from you!

If that's your best response, I rest my case!

 

[koennen]

That means a lot coming from you!

If that's your best response, I rest my case!

Graduated law school. How about you?

 

[Deceptacon]

Graduated law school. How about you?

i love it

 

[Dharma]

Graduated law school. How about you?

Internet fisticuffs. Ha!

 

[scotchtapetest]

Graduated law school. How about you?

And obviously it didn't work out for you or you wouldn't switch careers!

But again, we don't judge on SDN!

 

[koennen]

And obviously it didn't work out for you or you wouldn't switch careers!

Yes, because as we all know the only reason people change careers is because the first one didn't work out. Right? I can't think of any other reason why one might change careers. Can you?

Ad hominem attacks. The last resort of the intellectually bankrupt. But I'm sure you feel a lot better about yourself now.

 

[scotchtapetest]

Yes, because as we all know the only reason people change careers is because the first one didn't work out. Right? I can't think of any other reason why one might change careers. Can you?

Ad hominem attacks. The last resort of the intellectually bankrupt. But I'm sure you feel a lot better about yourself now.

Wow! good one! I think you now officially hold the record for the lowest number of characters used prior to self-contradiction on SDN!

 

[PCOMSurgery]

Theoretically, it is also possible to do ACGME fellowship without ACGME residency (e.g. medicine subspecialties) but you were never board-eligible after the fellowship anyways (at least this was the case in medicine subspecialties). If this goes through, it closes that loophole too. BUT since very few people chose to do that, b/c they could't sit for boards anyways, it doesn't make a whole lot of difference.

Just a point of clarification...As a DO you absolutely can become board certified after completion of an ACGME fellowship, regardless of where you did you residency (AOA or ACGME).

 

[PCOMSurgery]

I feel like this action by the ACGME has been a long time coming. I don't disagree with it, although I recognize the difficulty it is going to present to osteopathic graduates who want to do ACGME advanced residencies.

The AOA has been getting away with the "separate but equal" nonsense for some time when it comes to the quality of the traditional rotating internships (their residencies too, but that is a different discussion). It seems that the he ACGME is putting their foot down and acknowledging formally that they perceive the osteopathic TRI as inferior to an ACGME TY/prelim year.

I think the real push behind this is more of a "protecting our own."

GME funding is going to be cut...heavily...in the next 5-10 years. There are more and more students graduating from medical school each year while the number of GME positions remains relatively constant.

You can blame the AOA for this happening. If they spent more time improving the quality of osteopathic GME rather than green-lighting new schools and residencies of dubious quality, this might have been avoided.

(smiling in agreement)

 

[DocEspana]

So I just got back from the AMA national meeting and got to discuss this with some actual acgme representatives. Officially the rep on their board said it was simply an attempt to tighten up the education tracts. That its viewed that those who want to do acgme fellowships should go through the whole system. Finally they said that the real goal is to close some loop holes that allow foreign physicians to be fellowship eligible without formal US residency if thy practice a certain number of years in a limited capacity (aka under the oversight of a licensed us physician.) That it effects DO students was accidental and exactly why they have a long review process in place.

UNOFFICIALLY, it was said that the individual person feels the DO impact was accidental, but noticed along the way and kept anyway. The feeling is that it is not actually a big deal to a huge majority of DO students who will go one pathway or the other regardless. But it may cause the AOA to actually make concessions, be it agreeing to strengthen intern training programs or allowing some debate for integration with the aoa keeping leadership if they so desire.

Again though, thqt is the unofficial personal opinion of a acgme representative.

 

[fozzy40]

So I just got back from the AMA national meeting and got to discuss this with some actual acgme representatives. Officially the rep on their board said it was simply an attempt to tighten up the education tracts. That its viewed that those who want to do acgme fellowships should go through the whole system. Finally they said that the real goal is to close some loop holes that allow foreign physicians to be fellowship eligible without formal US residency if thy practice a certain number of years in a limited capacity (aka under the oversight of a licensed us physician.) That it effects DO students was accidental and exactly why they have a long review process in place.

UNOFFICIALLY, it was said that the individual person feels the DO impact was accidental, but noticed along the way and kept anyway. The feeling is that it is not actually a big deal to a huge majority of DO students who will go one pathway or the other regardless. But it may cause the AOA to actually make concessions, be it agreeing to strengthen intern training programs or allowing some debate for integration with the aoa keeping leadership if they so desire.

Again though, thqt is the unofficial personal opinion of a acgme representative.

Thanks for the input. I can't speak for all specialties but this has a huge impact on the field of PM&R. It's still not too late to addend this proposal, so why don't they?

 

[DocEspana]

Thanks for the input. I can't speak for all specialties but this has a huge impact on the field of PM&R. It's still not too late to addend this proposal, so why don't they?

Id actually assume it has no bearing on pm&r. The AOA is fully aware it has no pm&r equivalent (it admits its inherantly different from neuromuscular medicine) and as such its a given that the exemption is (as best as I know) always given for the 4 states that require aoa internship. The state societies also seem to accept that aoa excemption.

 

[costales]

So I just got back from the AMA national meeting and got to discuss this with some actual acgme representatives. Officially the rep on their board said it was simply an attempt to tighten up the education tracts. That its viewed that those who want to do acgme fellowships should go through the whole system. Finally they said that the real goal is to close some loop holes that allow foreign physicians to be fellowship eligible without formal US residency if thy practice a certain number of years in a limited capacity (aka under the oversight of a licensed us physician.) That it effects DO students was accidental and exactly why they have a long review process in place.

That's what I was told by a knowledgeable prof. Their primary target is the FMGs.

 

[Andy2445]

Why accept Canadian then?

 

[DocEspana]

Why accept Canadian then?

canada and the usa decided a long time ago to merge the residency programs as far as acceptance qualifications go