Real talk time. And this is in no way extensive.... just a few points that I think need a big ol' dose of "admit-the-damn-truth"
- Anyone who says this is anything other than fantastic for those who wished to apply to both ACGME and AOA (As DO students) is completely wrong. You need to have witnessed the unique pain that is interview season and ranking to understand the very visceral way in which you are wrong. Being able to list off all of your preferences in numeric order regardless of what training affiliation they are is an immeasurable win for anyone who would be applying AOA+ACGME or even ACGME only. It lets the former rank the list exactly how they truly prefer and lets the former have a safety net that they previously had to make the hard choice to exclude. And there is no DO student in the history of "insert esoteric timeframe here" that wouldnt sleep better at night with a few AOA residencies tacked onto the end of their rank list.
- Biases exist. Period. On both sides. I know anecdotally from my friends trying for AOA ortho that some of the program directors are bitterly anti-MD. I can tell you first hand that *most* of the AOA urology programs are bitterly anti-MD. Not all, but numerically most. Any discussion of dual accreditation at those sites is met with venom and "why the hell would I want an MD when there are qualified DOs who want the spot." Integrating programs will not lead to the tsunami of MDs taking AOA spots in high demand fields because degree bias does go both ways.
- It goes both ways. A program that didn't take DOs on principle before, isnt gonna change either.
- Both of the above points will mellow (not erase) with time as this gives huge legitimacy to DO students (not PGY spots... but students) as these programs that always accepted DO students will be shown to have identical standards as the ones who only accepted MD students. Vis-A-Vis the applicants can be compared based on merits without a stigma (though it will never change that neither a DO school nor a low level MD school is ever gonna be a high level MD school)
- Some AOA programs will close. It will probably be 10 years from now. It will probably be very few. this number will be smaller than the number of new AOA and ACGME programs that will open in the same time period.
- This is in no way going to cripple the AOA nor bring about the end of its existence and prominence in our lives, and all of our glorious complaints about them will not change in the next 3-10 years barring an unexpected massive change. (this, for example, was an unexpected massive change)
- You will still have to pay the AOA all your fun licensing fees. Thats actually one of the other non-negotiables of the AOA's deal. They get to keep their membership fees from people trained under their residencies past and future.
- IM, FM, Peds. These are fields with many many unfilled spots nationwide if counting only american students. American student will still > american, foreign trained > foreign long term physician > foreign recent graduate. That won't change. IMGs will not be a serious threat to any AOA position except in cases of nepotism or insanely overqualified applicant, which is the only times they are threats to ACGME positions that are desired by american grads.
- This actively opens a world of education to DOs. Previously DO graduates could not be core faculty or program directors at an ACGME residency unless they both went to an ACGME residency AND jumped through a few arduous hoops (ACGME residency was not enough). This has entirely been abolished and any american residency graduate can now be core educational faculty. AOA has agreed to loosen their standards on this too to allow ACGME trained DOs to be core faculty and program directors and MDs to be core faculty without jumping through hoops, though I have not heard confirmed that MDs can be program directors.
- This is good news if ONLY because so many people had accepted the fellowship futures as limited/dead. Those who negatively rip on it here are not being pragmatic, are not being prophetic, are not being intuitive. They are being antagonistic and purposely ignoring the situations that surrounded this debate in months immediately prior to the announcement. AOA programs were having educational series on how to handle the loss of ACGME fellowship access as recently as August (I sat through one). The most nefarious thing here is (the fact) that some AOA residencies wont make it to 2022. But none of us will even BE in residency in 2022 (only exception, current 1st years who become neurosurgeons will be chief residents.... all 13, maximum, of you given current training numbers)
- At this moment there is zero acceptance of MDs into AOA programs. But the fact of the matter is they should be allowed in. Hell they should be allowed in without OMT training unless the program can prove they utilize OMT. But they will all claim they do and make up **** to prove it. So that last part is neither here nor there. But the fact is that the integration of MD students into AOA programs is entirely under debate and most of the details here have been accepted with this being one of the major "still under discussion" parts. The AOA is not opposed to it, but they are resistant. Real talk: they will lose that debate and the residencies will open. But under what time frame? Probably closer to the 10 year window set for all changes, than the 3 year window set for the single match.
- Haven't we all moaned on and on about how combining matches/degrees/diplomas/chromatin/lunchbox contents would lead to more respect for DO's? I know of only a very small number of you who have ever argued against that. They're excused from this comment. The rest of you, show some balls and embrace the fact that this is y/our chance to prove respect is deserved and parity exists by becoming one with the mother organization.
- The whole "ACGME will never be neutral because AAMC is a part of it". Well.... big deal. The AMA is a part of it too. As are about 4 other organizations. so 5 out of 6 (or 4 out of 5, i forget) controlling organizations represent both groups of physicians and of those groups its fair to argue that the AAMC has one of the lowest vested interest in residency. Unlike the AMA or the associated state medical societies.
- P.S. score one for DocE. First to break this on the internet (though i think someone else actually beat me, no one believed them)