What was the motive for ACGME to merge with the AOA?

[DetectiveAlonzo]

After mulling it over, I say **** it. The DOs who didn't make it into residency wouldn't have made it regardless. Either they scored too low or aimed too high.

Weakest DO students should be cut out. Time to thin the herd baby.

If those few DO students aren't happy in IM or FM, well sucks to be them. Hit the road jack.

Some poor Caribbean sap will gladly take that position for you.

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[FourniersGreenGang]

so you're acknowledging that the DO residency programs are crap, but you expect people to think the students are equal to MD students? Makes no sense.

I don't want to start some battle but just because one went to an MD school does not automatically make them a better doctor. First of all undergraduate and graduate medical education are vastly different and fortunately, there are metrics to objectively look at applicants without looking at the name of their school, things like board scores (really the only apples to apples comparison), the interview, research, leadership, demonstration of dedication to the specialty, service, sub-i performance etc.

 

[AlteredScale]

I don't want to start some battle but just because one went to an MD school does not automatically make them a better doctor. First of all undergraduate and graduate medical education are vastly different and fortunately, there are metrics to objectively look at applicants without looking at the name of their school, things like board scores (really the only apples to apples comparison), the interview, research, leadership, demonstration of dedication to the specialty, service, sub-i performance etc.

Being an MD doesn't make them a better Doctor. But as an MD student usually have access to better resources, better research, better clinical rotations, better mentors, and innovative curriculums that allow for increased training in a clinical setting (see any of the MD programs that have moved towards a 1-1.5yr preclinical curriculum) along with longitudinal or continuity clinic training from the very first weeks.

DO programs are in many ways quite behind (outside of a few such that have been apart of the AAMC transformation of medical education consortium).

Many MD Schools have home departments in not only specialty medicine but family, community, and underserved medicine that allows these students to have direct access and gain a plethora of knowledge and skill to further hone their application come residency time. DO programs lack clinical departments and as such will usually have a more difficult time getting the sort of intimate mentorship found at MD medical centers. Obviously, a good chunk of DO students hustle their butt off to make up for it, but I'm just stating an inherent deficiency.


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[Señor S]

However, this phenomenom is not unique to DO schools. There are some MD schools without affiliated academic hospitals and residencies..

My school has affiliated "academic" hospitals and residencies and my 3rd year experience sounds identical to the horror story DO anecdotes on this board. There are a lot of MD students on this board who've experienced similar.

 

[hallowmann]

On second read through it looks like 30 of 38 AOA surgical residencies did not pass initial ACGME accreditation... Jesus.

What exactly is it based off of? Initial review of the app?

I don't know if I even buy that. Even if I did, the ACGME made applying during the transition one of the easiest things in the world (i.e. there's literally no risk in submitting an app before you conform to the requirements - you only get charged 1 fee for the whole transition so programs can submit the apps as many times as they want without additional fees), and the AOA required that programs submit an app for accreditation by a deadline depending on the length of training in order for programs to continue taking residents during the transition (i.e. it incentivized longer DO programs to apply ASAP regardless of whether they were ready to conform to the requirements).

Now that's all assuming he isn't pulling that 30/38 number out of nowhere. For one, I have no idea what he's even basing it off of. I actually looked at the ACGME reports and this is what I gathered:

GS:
-34 programs applied
-11 were evaluated and have things the RRC wants changed (continued pre-accred)
-1 received initial ACGME accreditation right away
-It doesn't look like the 22 others were even evaluated yet, which makes sense because all but a handful applied less than a year ago (most <6mos ago)

Ortho:
-28 applied
-8 have continued pre-accreditation
-5 received initial accreditation right away
-15 haven't been evaluated by the RRC yet

Ophtho:
-2 applied
-1 has continued pre-accreditation
-1 hasn't been evaluated by the RRC yet

ENT:
-10 applied
-6 have continued pre-accreditation
-4 haven't been evaluated by the RRC yet

Urology:
-10 applied
-4 have continued pre-accreditation
-6 received initial accreditation right away

NS:
-7 applied
-2 have continued pre-accreditation
-5 haven't been evaluated by the RRC yet

So out of 89 surgical residencies that applied, only 48 were evaluated, 1/3 of those received ACGME initial accreditation right away basically without changing anything, and 2/3 have things the RRC wants changed.

First off, I still have no idea where he's getting 30/38, but unless 8 out of the 10 last programs that were reviewed received accreditation right away, his numbers are a bit suspect. Second off, I've already listed 2 huge incentives for programs to submit the apps before they're ready and there's pretty much no downside to it.

Of course there'll be a ton of programs that don't automatically fulfill all the ACGME requirements. They've been established for years and have never had to (technically they don't have to for another 3-4 yrs). That's the entire point of a transition period. Depending on the sites, it takes time for changes to be implemented, especially since for practically a year there was a question of whether the merger would even happen in the first place (because a group, of whom Gevitz was a very vocal member, vehemently opposed it for claims of maintaining our "DO destinctiveness").

Some programs won't make it, sure, but the ones that can't change to fulfill ACGME requirements over a 5 year transition really don't deserve to exist. I still think it'll be nowhere near his estimate of losing 30%+ of OGME.

Here's some additional info for other specialties people were scared will close:

Anesthesia:
-6 applied
-1 has continued pre-accreditation
-2 received initial accreditation right away
-3 haven't been evaluated by the RRC yet

Derm:
-9 applied
-3 have continued pre-accreditation
-3 received initial accreditation right away
-3 haven't been evaluated by the RRC yet

EM:
-27 applied
-4 have continued accreditation
-7 received initial accreditation right away
-16 haven't been evaluated by the RRC yet

Rads:
-9 applied
-3 have continued pre-accreditation
-3 received initial accreditation right away
-3 havn't been evaluated by the RRC yet

OB/Gyn:
-14 applied
-3 received initial accreditation
-11 haven't been evaluated by the RRC yet

And overall for all residencies:

OVERALL:
-236 applied
-55 have continued pre-accreditation
-56 received initial accreditation right away
-125 haven't been evaluated by the RRCs yet

 

[Brorthopedic]

This is SDN, we don't need statistics or facts, just what your bro told you he read on reddit from a dude who overheard another dude talking to his bro in passing on the way to lunch

 

[NotAProgDirector]

Just for clarification: ACGME regulates post-graduate medical training. LCME is for medical schools.

Perhaps @aProgDirector can shed some light on the question of whether problematic residency programs are automatically given a death sentence of loss of accreditation. Even med schools get warning across the bow, and get placed upon probation.

In general, the ACGME tries really, really hard to not close programs. Programs get warnings, probation, etc, all of which can last for years while they try to address deficiencies. As long as the program appears to be making progress, they will get more time to address issues. In my knowledge, the only program actually closed by the ACGME was King/Drew, but actually reviewing the story it appears that it was actually CMMS that dropped the hammer.

If there is a link to the Gavitz paper, I'd love to see it if someone would post it.

 

[IsWhat]

@hallowmann

Yeah I don't know where he gets 38 from.

"...All osteopathic applicants in these five-year programs are vulnerable because they are only guaranteed four years of AOA accreditation status; and if their program does not achieve initial ACGME accreditation status by June 2020, they will be unable to complete their fifth year of training.

This vulnerability is real and made clear by the fact 30 of 38 AOA approved surgical programs failed their first ACGME accreditation inspection."

So basically Dr. Gevitz is pulling a "sky-is-falling" tantrum using numbers he probably knows are disingenuous.

I want to know why a PhD historian has such a loud voice in this. And why the AOA are allowing it.

 

[Dr. Death]

@hallowmann

Yeah I don't know where he gets 38 from.

"...All osteopathic applicants in these five-year programs are vulnerable because they are only guaranteed four years of AOA accreditation status; and if their program does not achieve initial ACGME accreditation status by June 2020, they will be unable to complete their fifth year of training.

This vulnerability is real and made clear by the fact 30 of 38 AOA approved surgical programs failed their first ACGME accreditation inspection."

So basically Dr. Gevitz is pulling a "sky-is-falling" tantrum using numbers he probably knows are disingenuous.

I want to know why a PhD historian has such a loud voice in this. And why the AOA are allowing it.

Gevitz has always been a little out of touch with reality. As to why people listen to him, when people speak loudly and articulately, other people listen and believe what they say. That's why Donald Trump and Hillary Clinton can spew bull feces from their face and have other people believe it.

 

[QualityProcess]

Gevitz book "the DOs" is the most dry book I have ever read

My school has affiliated "academic" hospitals and residencies and my 3rd year experience sounds identical to the horror story DO anecdotes on this board. There are a lot of MD students on this board who've experienced similar.

I really don't think its a DO vs MD thing, I think the issue is that some schools are truly, deeply committed to being great at education. It's often also an issue of resources. Some MD schools are not committed to education and some don't have resources, just like some DO schools.

My "big picture" major criticism of my school: they could be outstanding if they cut the class size from 240 to 100-120.

The fact that the class size IS 240 highlights a broad range of faults with the school's approach producing physicians in general. Quality of matriculants. Stretching of resources, clinical education resources in particular. The drive the school has for additional revenue. et cetera...

At this point, if the DO schools pulled out of the single accreditation system, it is a loud and clear admission that they are content to settle in as a degree below the MD degree. You must keep trying to get better in medicine, there is no treading water. Maintaining the AOA, without the option for ACGME fellowships, is a white flag that says "we're primary care only, and we're ok with that." As long as they are fighting to keep increasing standards, they are fighting the impression, regardless of its accuracy, of inferiority and can at least argue equivalence.

 

[hallowmann]

@hallowmann

Yeah I don't know where he gets 38 from.

"...All osteopathic applicants in these five-year programs are vulnerable because they are only guaranteed four years of AOA accreditation status; and if their program does not achieve initial ACGME accreditation status by June 2020, they will be unable to complete their fifth year of training.

This vulnerability is real and made clear by the fact 30 of 38 AOA approved surgical programs failed their first ACGME accreditation inspection."

So basically Dr. Gevitz is pulling a "sky-is-falling" tantrum using numbers he probably knows are disingenuous.

I want to know why a PhD historian has such a loud voice in this. And why the AOA are allowing it.

The bolded is basically his modus operandi with regards to all of these papers. Even if his numbers were right when he wrote them, it still doesn't mean anything when even now a greater percentage of programs have attained initial accreditation.

People listen to him for 2 reasons:
1) A ton of the older DOs actually remember when the AMA called them a cult and targeted them for elimination, even when their own committee to investigate DOs recommended against it. So they are genuinely on the defensive. The thing is, over the last 20 years many MD organizations have gone out of their way to include DOs and emphasize unity. Even if the goal is to ultimately eliminate the degree, they're not doing it by stripping us of practice rights and shunning OMT, which were attempted in the past. They're doing it by accepting OMT*, and basically accepting the profession as a whole.

2) He's kind of an authority on osteopathic history. Because of that he commands some voice in the process. The funny thing is the AOA/AACOM released a rebuttal to his last open letter, which I thought was pretty on point, and unlike his was free of emotion and absolutism. I'd like to see what their rebuttal is for this one.

*So the first NMM residency to receive initial ACGME accreditation was MSUCOM's. It is one of 3 that have applied so far. The OMM/NMM RRCs exist now under the ACGME. I've even heard current MD residents that voiced interest in doing NMM+1 fellowships unprompted. How's that for maintaining our distinctiveness? If anything, this is a move to strengthen OMM by putting it in more hands to benefit from research and practice.

 

[TheaterOfTheme]

The bolded is basically his modus operandi with regards to all of these papers. Even if his numbers were right when he wrote them, it still doesn't mean anything when even now a greater percentage of programs have attained initial accreditation.

People listen to him for 2 reasons:
1) A ton of the older DOs actually remember when the AMA called them a cult and targeted them for elimination, even when their own committee to investigate DOs recommended against it. So they are genuinely on the defensive. The thing is, over the last 20 years many MD organizations have gone out of their way to include DOs and emphasize unity. Even if the goal is to ultimately eliminate the degree, they're not doing it by stripping us of practice rights and shunning OMT, which were attempted in the past. They're doing it by accepting OMT*, and basically accepting the profession as a whole.

2) He's kind of an authority on osteopathic history. Because of that he commands some voice in the process. The funny thing is the AOA/AACOM released a rebuttal to his last open letter, which I thought was pretty on point, and unlike his was free of emotion and absolutism. I'd like to see what their rebuttal is for this one.

*So the first NMM residency to receive initial ACGME accreditation was MSUCOM's. It is one of 3 that have applied so far. The OMM/NMM RRCs exist now under the ACGME. I've even heard current MD residents that voiced interest in doing NMM+1 fellowships unprompted. How's that for maintaining our distinctiveness? If anything, this is a move to strengthen OMM by putting it in more hands to benefit from research and practice.

Is there a link to this new article? Do you think that AACOM will mostly disagree with his positions? To go back on the merger would be sort of ridiculous...

 

[hallowmann]

Is there a link to this new article? Do you think that AACOM will mostly disagree with his positions? To go back on the merger would be sort of ridiculous...

Too much time and money has been invested at this point. Unless it really was some huge percentage closing, which again I highly doubt not just because of how "great" they are but because of what aPD said, it would make no sense at this point. I'm sure they will disagree.

I honestly don't have a link to whole new report, I've just heard bits and pieces, but it sure sounds a lot like the last report he sent out.

 

[TheaterOfTheme]

Too much time and money has been invested at this point. Unless it really was some huge percentage closing, which again I highly doubt not just because of how "great" they are but because of what aPD said, it would make no sense at this point. I'm sure they will disagree.

I honestly don't have a link to whole new report, I've just heard bits and pieces, but it sure sounds a lot like the last report he sent out.

I was looking at the guidelines for the accreditation process and it isn't until early next year that most FM/IM/pscy and 4 year programs have to fill out pre-accred right? So isn't it a bit early to even make a call? Is there a site to see the updated totals of the overall amount of programs that exist and the ones that applied?

 

[Brorthopedic]

https://www.aacom.org/docs/default-...onsequences-of-the-acgme-merger-.pdf?sfvrsn=0

That's the old reply, I don't think AACOM has officially replied to his newest letter yet.

The merger is going to happen, as it should. In the meantime, let those resistant to change wail one last time before it does.

 

[hallowmann]

I was looking at the guidelines for the accreditation process and it isn't until early next year that most FM/IM/pscy and 4 year programs have to fill out pre-accred right? So isn't it a bit early to even make a call? Is there a site to see the updated totals of the overall amount of programs that exist and the ones that applied?

Its early, but of all the programs that might struggle to get ACGME accreditation, I highly doubt it'll be IM, FM, or EM, which make up like 2/3 of all the spots to begin with.

The overall total program number at the start of the merger is in the 770 range. AOA opportunities isn't the most up to date, so the NMS match statistics by program is the best resource.

Here's the ACGME report:
https://apps.acgme.org/ads/Public/Reports/Report/18

 

[TheaterOfTheme]

Its early, but of all the programs that might struggle to get ACGME accreditation, I highly doubt it'll be IM, FM, or EM, which make up like 2/3 of all the spots to begin with.

The overall total program number at the start of the merger is in the 770 range. AOA opportunities isn't the most up to date, so the NMS match statistics by program is the best resource.

Here's the ACGME report:
https://apps.acgme.org/ads/Public/Reports/Report/18

Thanks as always for your informative posts, should I say, hallowboss.

 

[Mjolner]

I say if an AOA program can't cut it let it die. If I have less choice programs, but I get quality training let's do it. I mean, I'd rather have my last choice ACGME program vs one that isn't going to get me ready to be an attending.


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[Brorthopedic]

For those interested, the AOA has released a letter in regards to Dr. Gevitz's recent paper

http://amorassoc.informz.net/inform...laWQ9NTU1MzIzNSZzdWJzY3JpYmVyaWQ9ODc3ODQyOTkw

• Surgical specialties are tracking well. We do not expect a significant loss of training opportunities for DOs in surgical specialties. Many programs have already submitted applications: general surgery (58%), orthopedic surgery (64%), otolaryngology (52%), and OB/GYN (44%). We are concerned that only two of 15 AOA ophthalmology programs have applied and are currently reaching out to these programs individually. There are currently about 50 DOs training in these programs. It’s important to note that about one-third of DOs in ophthalmology and general surgery residencies already train in ACGME programs, and more than 6 in 10 DOs in OB/GYN residencies train in ACGME programs.

 

[2021Doctor]

In general, the ACGME tries really, really hard to not close programs. Programs get warnings, probation, etc, all of which can last for years while they try to address deficiencies. As long as the program appears to be making progress, they will get more time to address issues. In my knowledge, the only program actually closed by the ACGME was King/Drew, but actually reviewing the story it appears that it was actually CMMS that dropped the hammer.

If there is a link to the Gavitz paper, I'd love to see it if someone would post it.

Is the link posted in this thread?

 

[TheaterOfTheme]

Is the link posted in this thread?

Not yet.


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[Geraltofrivia]

I spent a year as an intern at a community hospital where DO students rotated through for some of their core rotations, including IM and GS. They all told me that our hospital was coveted as the best place to work since they heard they "learned the most even if they had to work hard."

It was a complete joke.

They had almost zero clinica responsibilities, and their experience had zero resemblance to what I experienced as a medical student.

All the attendings were of course MDs. Many from prestigious Ivy League and similar institutions. But that has no bearing here. There were no other major residency programs there and the students shadowed the attendings and "helped" the interns but were essentially less than useless unfortunately. They universally suffered from a lack of basic knowledge and clinical acumen.

Further, and this can't be overstated despite your refusal to believe it, but doing many/most of your rotations at a hospital with no strong residency presence is an extreme handicap. No matter how many times you get to first assist the surgeon or whatever, you are missing an enormous fund is knowledge and experience - learning how to think like a physician. At a level that is commensurate with your experience.

It would be like an airline pilot bringing his 10 year old son into the cockpit and showing him all the shiny knows and gauges and maybe even allowing him to press a few. It makes the kid feel special and tingly, but he doesn't leave there knowing how to fly the plane. He is missing the entire foundation leading up to this.

Most of the reason M3/M4 and residency suck at times is because things take longer than you think they should, either because you yourself are not yet as efficient and effective at processing the information in useful ways, or because the day to day processes are deliberately drawn out in a way that does not occur at major teaching hospitals.

Rounding with an IM physician or team at a community hospital is often quick and the students cannot simply pick up the nuances of medical management by observing/participating in the attending's practices. He or she has spent years/decades honing his or her skills to the point where so very much of the complicated thought process (and leg work) from the time a patient enters the hospital until the time they leave is performed without your knowledge of its existence. Just because the attending might toss out a nugget of wisdom from room to room doesn't mean the student isn't missing out big time.

I shudder to think what the "average" or "lesser" rotations were like.

It's not that a difference of MCAT score means someone will be a better or worse resident or clinician. It's that the score often determines the branch point between MD and DO, and whether you like it or not, the difference in clinical education is often a sticking point for, say, Program Directors considering MD or DO students. Of course I'm not suggesting that all allopathic medical school rotations are perfect, but the trend is very real.

So this post genuinely worries me. I can take an H&P. That's the easy part. But when it comes to the assessments and plans, I feel I am not up to par at all. I work extremely hard and I try to think like a physician, but I just do not have adequate guidance on this subject. Nobody reviews my H&Ps with me. I look at my notes and I compare with my attending notes but I get concerned that I am being annoying when I ask "Why this, why that" as often as I do. I'm really scared that I'm missing out on a major part of my education and honestly, it's just bringing me down. For reference, I am a DO student and I am rotating at one of these "community hospital" settings. This is an IM month for me and outpatient, in the clinic, is literally shadowing for me.

What can I do to get better? To improve? I am concerned. Thank you.

edit: Actually I can't stop thinking now that I'm being shorted of my education and am internally having bloating and other anxious feelings about this. Somebody please give me some comfort (lol) and tell me what I can do to maximize my education. Please

 

[Mr Roboto]

So this post genuinely worries me. I can take an H&P. That's the easy part. But when it comes to the assessments and plans, I feel I am not up to par at all. I work extremely hard and I try to think like a physician, but I just do not have adequate guidance on this subject. Nobody reviews my H&Ps with me. I look at my notes and I compare with my attending notes but I get concerned that I am being annoying when I ask "Why this, why that" as often as I do. I'm really scared that I'm missing out on a major part of my education and honestly, it's just bringing me down. For reference, I am a DO student and I am rotating at one of these "community hospital" settings. This is an IM month for me and outpatient, in the clinic, is literally shadowing for me.

What can I do to get better? To improve? I am concerned. Thank you.

edit: Actually I can't stop thinking now that I'm being shorted of my education and am internally having bloating and other anxious feelings about this. Somebody please give me some comfort (lol) and tell me what I can do to maximize my education. Please

Seriously who gives a **** whether you're being annoying. You're paying $$$ to be educated, it's part of your education. Ask as many questions as you want.

 

[hallowmann]

So this post genuinely worries me. I can take an H&P. That's the easy part. But when it comes to the assessments and plans, I feel I am not up to par at all. I work extremely hard and I try to think like a physician, but I just do not have adequate guidance on this subject. Nobody reviews my H&Ps with me. I look at my notes and I compare with my attending notes but I get concerned that I am being annoying when I ask "Why this, why that" as often as I do. I'm really scared that I'm missing out on a major part of my education and honestly, it's just bringing me down. For reference, I am a DO student and I am rotating at one of these "community hospital" settings. This is an IM month for me and outpatient, in the clinic, is literally shadowing for me.

What can I do to get better? To improve? I am concerned. Thank you.

edit: Actually I can't stop thinking now that I'm being shorted of my education and am internally having bloating and other anxious feelings about this. Somebody please give me some comfort (lol) and tell me what I can do to maximize my education. Please

Sounds like you have an anxiety issue.

My biggest recommendation is to do some electives in inpatient IM at a large ACGME program that takes numerous MD student rotators early in the process. You'll be rough at first, but it will be a huge boost to both your knowledge/skill and confidence in general. While there is a clear difference and it takes getting used to, don't assume it's so much bigger than it actually is. You're talking about a few months at best of missed learning.

 

[FourniersGreenGang]

Here you guys go, enjoy. These are the official documents to which everyone is referring.

 

[Geraltofrivia]

Sounds like you have an anxiety issue.

My biggest recommendation is to do some electives in inpatient IM at a large ACGME program that takes numerous MD student rotators early in the process. You'll be rough at first, but it will be a huge boost to both your knowledge/skill and confidence in general. While there is a clear difference and it takes getting used to, don't assume it's so much bigger than it actually is. You're talking about a few months at best of missed learning.

I will not have an opportunity to rotate through until 4th year. Will that really restrict me? Thank you for the kind response