ACGME Brings the Hammer Down on the AOA

[cliquesh]

Systems wih low traffic, low acuity, and low complexity supply you with a minimum level of training. But the difference in the skill of a clinician that graduates from a place like this and one who sees everything there is to see and learns to do it all, quickly is vast. One accrues bonuses from academic variety in the institution but the substrate for clinical training is the patients. It's not pivotal that the AOA fails to deliver on the latter. But the former is indepensible. Failing it means graduating a 2nd, 3rd, or 4th rate clinician.

I guess this is ultimately my biggest concern with your proposals, mad jack.

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[user3]

This is the fear mentality that holds DOs back. Our best and brightest should not be limited to AOA residency training in competitive fields.
If the AOA were actually negotiating in good faith, this would be an issue that could be dealt with in may ways that would benefit us (an example off the top of my head would be ensuring that highly qualified DOs would be adequately represented in competitive ACGME programs, through a quota. Residencies demonstrating bias could be sanctioned in some way.

I remember reading some interesting insight that someone in pre-osteo posted regarding the merger-

"This was addressed at my ACOM interview. We were told that the ACGME wanted to take all DO residencies under the new merger and all the "power". That the AOA asked about DO students being treated as equal as MD and having rights to top programs. ACGME said they couldn't promise anything. They told us this is why the merger fell through, AOA did not feel that DO students would be treated fairly and they would loose all power to help."

http://forums.studentdoctor.net/thr...e-aoa-residency-merger.1037902/#post-14551140

 

[Law2Doc]

I remember reading some interesting insight that someone in pre-osteo posted regarding the merger-

"This was addressed at my ACOM interview. We were told that the ACGME wanted to take all DO residencies under the new merger and all the "power". That the AOA asked about DO students being treated as equal as MD and having rights to top programs. ACGME said they couldn't promise anything. They told us this is why the merger fell through, AOA did not feel that DO students would be treated fairly and they would loose all power to help."

http://forums.studentdoctor.net/thr...e-aoa-residency-merger.1037902/#post-14551140

Yeah, I think you guys have to appreciate that this wouldn't ever be a merger of equals. The AOA wasnt going to get to set terms or mke demands. There are more then twice as many MD programs as DO programs, and they are rapidly growing to ultimately fill 100% of the ACGME residency spots. DO needs a merger to not ultimately also feel the same crunch that offshore grads will soon feel. So you need to look at it less like a give and take discussion and more like a hostage negotiation. The AOA walked away from the table for now, but ultimately it's clear they will have to come back, probably at even less favorable terms. Really no choice. Will a merger ultimately be better for DO grads? Absolutely. Will the AOA and separate residencies have to go by the wayside as they get assimilated into (not merged eqully with) the allo collective? Yes, I think that's what we are talking about. There really isn't an opportunity to negotiate here, just delay the inevitable.

 

[Nasrudin]

Yeah, I think you guys have to appreciate that this wouldn't ever be a merger of equals. The AOA wasnt going to get to set terms or mke demands. There are more then twice as many MD programs as DO programs, and they are rapidly growing to ultimately fill 100% of the ACGME residency spots. DO needs a merger to not ultimately also feel the same crunch that offshore grads will soon feel. So you need to look at it less like a give and take discussion and more like a hostage negotiation. The AOA walked away from the table for now, but ultimately it's clear they will have to come back, probably at even less favorable terms. Really no choice. Will a merger ultimately be better for DO grads? Absolutely. Will the AOA and separate residencies have to go by the wayside as they get assimilated into (not merged eqully with) the allo collective? Yes, I think that's what we are talking about. There really isn't an opportunity to negotiate here, just delay the inevitable.

Indeed. Furthermore, it's not like there's gauranteed parity among allopathic programs for residency consideration either, so making that demand is ridiculous. How could it even be mandated? Clearly, it will always matter to some extent where you went to school.

 

[Law2Doc]

Indeed. Furthermore, it's not like there's gauranteed parity among allopathic programs for residency consideration either, so making that demand is ridiculous. How could it even be mandated? Clearly, it will always matter to some extent where you went to school.

Right. You don't really want a quota or mandate. At most, some very subtle incentive for maybe just the first year or two. Although a preference for historically allo schools would probably persist at some programs initially, going forward, as residencies had better or worse experiences with grads of certain med schools, a pecking order would work itself out naturally over time and certain osteo programs would leapfrog certain allo programs, particularly with respect to certain specialties. Over time, this benefits the high achieving osteo schools and grads, and at least keeps the less achieving ones above the offshore crowd, so it's probably a win. But don't kid yourself that the AOA had any teeth in this "negotiation".

 

[DrWBD]

I remember reading some interesting insight that someone in pre-osteo posted regarding the merger-

"This was addressed at my ACOM interview. We were told that the ACGME wanted to take all DO residencies under the new merger and all the "power". That the AOA asked about DO students being treated as equal as MD and having rights to top programs. ACGME said they couldn't promise anything. They told us this is why the merger fell through, AOA did not feel that DO students would be treated fairly and they would loose all power to help."

http://forums.studentdoctor.net/thr...e-aoa-residency-merger.1037902/#post-14551140

I don't believe this for a second, and neither should you. This is more fear mongering by the AOA and school faculty hardliners.
Even the AOA statement on the merger failure doesn't mention this point specifically, because it likely is not true (otherwise why not say it outright?). The available statements suggest that the ACGME was willing to meet the AOA on all of the supposed negotiation points.

 

[babdoc]

Not to mention that an administrator or admissions officer at an interview is unlikely to be privvy to this information. It's all second-hand information at best, spun in a fashion to help recruitment at the interview.

 

[Mad Jack]

I guess this is ultimately my biggest concern with your proposals, mad jack.

That's why I was encouraging it only for fields that could be adequately trained in such a setting. You can be a fairly well trained EM doc in a moderate volume community setting. FM can train basically anywhere. Primary care IM would be doable, and rads would be doable with reads from multiple institutions feeding to one residency program. You'll see a good amount of neuro pathology just about anywhere, as many neurological issues are not acute and end up being treated at the community level, plus strokes and neuro emergencies will be seen. Even some more competitive specialties like derm could be done in the community, as a derm residency might be the only provider of dermatological care within 100 or more miles in some remote areas, opening up a large patient population and giving you a good range of pathology. I'm not saying we should be opening programs that fall below the standard of current community medicine residencies, but rather, that we should open new community residencies that are equal in quality and outcome to those that already exist. This is an entirely reasonable proposition.

This thread should have been called, "AOA Brings the Hammer Down on Itself" by the way, because that's the essence of what happened.

 

[preDoGuy24]

That's why I was encouraging it only for fields that could be adequately trained in such a setting. You can be a fairly well trained EM doc in a moderate volume community setting. FM can train basically anywhere. Primary care IM would be doable, and rads would be doable with reads from multiple institutions feeding to one residency program. You'll see a good amount of neuro pathology just about anywhere, as many neurological issues are not acute and end up being treated at the community level, plus strokes and neuro emergencies will be seen. Even some more competitive specialties like derm could be done in the community, as a derm residency might be the only provider of dermatological care within 100 or more miles in some remote areas, opening up a large patient population and giving you a good range of pathology. I'm not saying we should be opening programs that fall below the standard of current community medicine residencies, but rather, that we should open new community residencies that are equal in quality and outcome to those that already exist. This is an entirely reasonable proposition.

This thread should have been called, "AOA Brings the Hammer Down on Itself" by the way, because that's the essence of what happened.

I agree with this BUT I think there should be parity in cases seen between community and academic centers as a minimum requirement for graduation. I have seen multiple patients who have been transferred from community hospitals (with residences) to the quartenary care center I am at-I think following these complicated sick patients is extremely important in residency and should be a part of community programs education (through out rotations etc.) This is my biggest gripe with aoa residencies...a lot of them don't do this, residents will be adequate at bread and butter but it's the experience at the high acuity stuff that can make the biggest difference in patient care...in my opinion.

/end rant

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[premed1001]

are all D.O. spots supposed to be retained through this transition or is this not clear yet?
how is situation for IMG's in 5 years?

 

[Apprands31]

are all D.O. spots supposed to be retained through this transition or is this not clear yet?
how is situation for IMG's in 5 years?

Gevitz gave a speech ( there's a link to speech in one of the threads, I forget which, on this forum) a few days ago that about 20% of AOA residencies will close. The consensus here is that this is just further fear mongering from the AOA.

Depending on who you ask the merger may hurt IMGs since all DOs will now be under ACGME or help IMGs since now the DO programs will be opened to them. Any further comments are welcomed.

 

[premed1001]

Gevitz gave a speech ( there's a link to speech in one of the threads, I forget which, on this forum) a few days ago that about 20% of AOA residencies will close. The consensus here is that this is just further fear mongering from the AOA.

Depending on who you ask the merger may hurt IMGs since all DOs will now be under ACGME or help IMGs since now the DO programs will be opened to them. Any further comments are welcomed.

Thanks!