All Things ACGME/AOA Merger

[AlteredScale]

There are many questions and concerns regarding the AOA and ACGME merger. Please use the information compiled below to gain a solid understanding of what is occurring and what the overall process is before creating a "merger" thread. I have provided links to many documents and websites that further expand on the information given below.

October 2019 UPDATE:
- Please see this thread to see list of AOA program status in the merger, including fellowship status. (Special thanks to @Dr.Bruh for collating this)

AUGUST 2019 UPDATE, important points below:
- As of July 1, 2019 730 AOA programs have applied for ACGME accreditation, 636 have achieved accreditation (92% of AOA programs)
- 117 of these programs are subspecialties. 182 are surgical programs.
- Of the 636 accredited programs, 23 have received warnings.
- 200 programs have received osteopathic recognition (this does NOT mean that you must do OMM, just that they offer a track for additional OMM training)
- June 30, 2020 is when the merger ends. Any program that still has pre-accreditation (NOT continued pre-accreditation) status will receive a review committee decisions of either initial accreditation or accreditation withheld. Programs given a withheld decision will be given a 30-day period to appeal the decision.


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MARCH 2019 UPDATE:
https://osteopathic.org/students/resources/single-gme/single-gme-student-faq
AOA Residents and Medical Students


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Definitions
ACGME: Accreditation Council for Graduate Medical Education. This group governed residency programs, in general, from hospitals affiliated with MD-granting institutions.
AOA: American Osteopathic Association. This group governed specifically osteopathic residency programs.
LCME: Liaison Committee for Medical Education: This group governs the accreditation process of MD-granting institutions.
COCA: Commission on Osteopathic College Accreditation. This group covers the accreditation process of DO-granting institutions.
MOU: Memorandum of Understanding.

----
Timeline:

• 2013 - announcement was made by Dr. Nasca (CEO of the ACGME) regarding the ACGME Board of Directors approval of a single accreditation system MOU. Simply, the ACGME was making the decision to bar AOA graduates from ACGME fellowship and ACGME advanced residencies)
• July, 2013 - MOU rejected by AOA and AACOM.
• February, 2014: announcement was made about the merging of the ACMGE and the AOA. The executive summary of discussion and outcomes was presented here.
• March, 2014 - MOU officially approved by AOA, AACOM & ACGME

A general breakdown of how the merger process will proceed/is proceeding:

• AOA residency programs will submit an application to ACGME. This grants the program the status of Pre-Accreditation which allows the AOA program to begin the process of Initial Accreditation though the ACGME. Initial Accreditation is granted upon the contingency of ACGME Review Committee approval that the program is compliant to ACGME standards which will entail a site visit from the ACGME (Source: Single GME Accreditation System).

• AOA programs must reach the status of "Pre-Acredditation" by June 30, 2020. Those who do not reach this status will not be allowed to recruit any more residents for their program.

• You can view reports of AOA programs ACGME status here. You can also view which AOA programs are planning to apply for ACGME accreditation here. Please note that some AOA programs have not provided such information about their decisions to apply. It is difficult to translate this as a decision to not apply, please contact the program directly should you have concerns reading these specific programs.

• Starting July 1, 2016, fellowship eligibility requires graduates to have completed training from an ACGME, RCPSC, or CFPC. Exceptions to this have been categorized by specialty here (please note, this was updated in 2015 and these response may have changed). Those that provide exceptions will consider graduates of AOA programs however the methods and rules governing these exceptions will vary across specialties.

• Sitting for the USMLE is not a hard requirement to apply for ACGME programs however, there will be programs that do not accept COMLEX scores in lieu of USMLE scores. Additionally, specific fellowship programs will require USMLE scores. Please contact the program directly to determine specifics or utilize the AMA Frieda software program.

• Board exams (taken to become board certified in the specialty you trained in) will still be administered by both the NBME and the AOA, there are no announcements of change.

• Graduates of US, MD-granting institutions will be allowed to apply to ACGME accredited programs once AOA. AOA programs receiving ACGME Initial Accreditation will be listed on the NRMP (software system utilized to apply for residency). Programs with Osteopathic Recognition (provided by newly formed ACGME committees) will have specific OMM requirements and, in general, will be limited to students graduating from DO-granting institutions. However, exceptions of eligibility to applying for OR-approved ACGME programs will be provided by program directors (source: page 6 of the ACGME osteopathic recognition FAQ).

*Source: http://www.acgme.org/Portals/0/PDFs/Nasca-Community/FAQs.pdf

---

Frequently asked questions:

Will AOA programs close down because of the merger?
Yes, many have elected not to apply for ACGME accreditation for one reason or another.

How many AOA programs will close down because of this?
As of data from October 2016, around 200 programs will close for a multitude of reasons (source: http://www.une.edu/sites/default/files/UNECOM_10072016 Shannon.pdf). As noted by @hallowmann "It should be clarified that only 3 programs that closed cited not wishing to apply for ACGME accreditation, the rest that closed all seemed unassociated with the merger. There are 75 others that hadn't responded as of that presentation though, and another 50 or so are up in the air."

What will happen to the AOA in 2020?
The AOA will still be a governing body but will cease to play a role in the realm of residency accreditation, providing the reigns to ACGME.

What does this mean for DO students applying for residency?
Prior to the completed merger, DO students were able to apply to the AOA match and the ACGME match. If they matched into AOA they were required to forfeit from the ACGME match. The AOA match occurred earlier than the ACGME match. If a DO student forewent the AOA match and could not find placement in the ACGME (primary match, SOAP, or scramble) the student could still apply for open AOA positions to secure a spot for graduate training. The single accreditation system will pipeline the process of applying for residency into one program so that all match results occur in the same timeline, MD or DO.

Will this effect my chances as a DO student towards getting into a competitive specialty?
Prior to the merger, DO students applying to competitive specialties like ortho or neurosurgery utilized the AOA system due to decreased competition and decreased risk of going unmatched in the ACGME process. With the merger in play, MD applicants will have the opportunity to apply to newly accredited ACGME programs that were once limited to DO applicants. The logistics and specifics of whether a program director would favor MD or DO applicants from a previous AOA program is largely varied amongst programs and thus, a homogenous answer is difficult to provide. Anecdotally, a PD of an AOA orthopedic program in MO with ACGME accreditation has stated they will still prefer DO applicants over MD applicants.

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UPDATE (Feb 2018):
As of December 2017 -

• 62% of all AOA programs (82% of residencies, 39% of fellowships, & internships) have been accredited (~40%) OR have submitted an application for ACGME accreditation (~20%).
• 10-15% of AOA programs have closed or are planning to close.
• Of programs that have applied for osteopathic recognition (OR): 53% were dually accredited (AOA & ACGME). 15% were ACGME accredited. 32% were AOA programs.
• OR requirements include designated faculty who will incorporate and apply osteopathic principles and practice into the six cores of ACGME residency training. It is important to note that despite being OR recognized, a program may choose to only have a select cohort of residents per class to gain formal training in OMM depending on resident interest and career prospects (link).
• Programs have until June of 2020 to apply for pre-accreditation. Pre-accreditation does not equate to ACGME accreditation (initial accreditation), only that the program has submitted an application.
• The deadline for three-year residencies (IM, FM) to have submitted an application to ACGME was Dec. 2017.
• Those who graduate from an AOA program with ACGME pre-accreditation will fall underneath less restrictive eligibility requirements for those who wish to pursue ACGME fellowship. Please see the provided link as each board has determined eligibility at their own discretion.

Osteopathic matching outcomes.
Orthopedic surgery program specific information regarding the AOA-ACGME merge.
AOA regarding the merger.

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[235009]

• AOA programs must reach the status of "Initial Accreditation" by June 30, 2020. Those who do not reach this status will not be allowed to recruit any more residents for their program

The deadline is actually for them to get to the "pre-accreditation" stage (applying for accreditation) the year they're scheduled to recruit the class that will graduate after 2020. If they don't take this step they're not allowed to recruit new residents and it likely means that they will shut down. The final deadline (for 3 year residencies) is coming up.

Also probably worthwhile to add in your sticky the reason the AOA was basically forced to agree to this (that the ACGME threatened to cut off access to fellowships to AOA residency graduates).

 

[AlteredScale]

The deadline is actually for them to get to the "pre-accreditation" stage (applying for accreditation) the year they're scheduled to recruit the class that will graduate after 2020. If they don't take this step they're not allowed to recruit new residents and it likely means that they will shut down. The final deadline (for 3 year residencies) is coming up.

Also probably worthwhile to add in your sticky the reason the AOA was basically forced to agree to this (that the ACGME threatened to cut off access to fellowships to AOA residency graduates).

Thanks MT. Will go ahead and change and add these things.


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[hallowmann]

The deadline is actually for them to get to the "pre-accreditation" stage (applying for accreditation) the year they're scheduled to recruit the class that will graduate after 2020. If they don't take this step they're not allowed to recruit new residents and it likely means that they will shut down. The final deadline (for 3 year residencies) is coming up...

That deadline isn't actually a stipulation of the merger, that's a requirement the AOA placed on programs to get them to apply and accept residents in a responsible manner. @AlteredScale's wording was appropriate, all AOA programs must attain initial accreditation by June 30th, 2020 in order to remain accredited, as AOA accreditation will end on that date.

The final deadline is actually Jan 1, 2019 for 1-2 yr programs (the final AOA match being in Feb of 2019), and for 3 yr programs its Jan 1 2018, as you alluded to.

This is an important distinction, because just because a program is pre-accredited doesn't actually mean it will remain open, because it still must attain initial accreditation by 2020.

...Will AOA programs close down because of the merger?
Yes, many have elected not to apply for ACGME accreditation for one reason or another.

How many AOA programs will close down because of this?
As of data from October 2016, around 200 programs will close for a multitude of reasons (source: http://www.une.edu/sites/default/files/UNECOM_10072016 Shannon.pdf)...

It should be clarified that only 3 programs that closed cited not wishing to apply for ACGME accreditation, the rest that closed all seemed unassociated with the merger. There are 75 others that hadn't responded as of that presentation though, and another 50 or so are up in the air.

...What will happen to the AOA in 2020?
The AOA will still be a governing body but will cease to play a role in the realm of residency matching, providing the reigns to ACGME...

The bolded should be changed to accreditation.

...What does this mean for DO students applying for residency?
Prior to the completed merger, DO students were able to apply to the AOA match and the ACGME match. If they matched into AOA they were required to forfeit from the ACGME match. The AOA match occurred earlier than the ACGME match. If a DO student forewent the AOA match and could not find placement in the ACGME (primary match, SOAP, or scramble) the student could still apply for open AOA positions to secure a spot for graduate training. The single accreditation system will pipeline the process of applying for residency into one program so that all match results occur in the same timeline, MD or DO.

Will this effect my chances as a DO student towards getting into a competitive specialty?
Prior to the merger, DO students applying to competitive specialties like ortho or neurosurgery utilized the AOA system due to decreased competition and decreased risk of going unmatched in the ACGME process. With the merger in play, MD applicants will have the opportunity to apply to newly accredited ACGME programs that were once limited to DO applicants. The logistics and specifics of whether a program director would favor MD or DO applicants from a previous AOA program is largely varied amongst programs and thus, a homogenous answer is difficult to provide. Anecdotally, a PD of an AOA orthopedic program in MO with ACGME accreditation has stated they will still prefer DO applicants over MD applicants.

--

Please continue to ask questions regarding this topic below and pertinent questions will be added to the FAQ.

The rest of this makes it sound like the purpose/main effect of the merger was for a combined match, when in reality it has to do with residency accreditation, and the combined match is actually more of consequence of the changes to accreditation. I feel this might need to be clarified, but it's up to you.

 

[Major]

Thanks for making this AS!

 

[AlteredScale]

That deadline isn't actually a stipulation of the merger, that's a requirement the AOA placed on programs to get them to apply and accept residents in a responsible manner. @AlteredScale's wording was appropriate, all AOA programs must attain initial accreditation by June 30th, 2020 in order to remain accredited, as AOA accreditation will end on that date.

The final deadline is actually Jan 1, 2019 for 1-2 yr programs (the final AOA match being in Feb of 2019), and for 3 yr programs its Jan 1 2018, as you alluded to.

This is an important distinction, because just because a program is pre-accredited doesn't actually mean it will remain open, because it still must attain initial accreditation by 2020.



It should be clarified that only 3 programs that closed cited not wishing to apply for ACGME accreditation, the rest that closed all seemed unassociated with the merger. There are 75 others that hadn't responded as of that presentation though, and another 50 or so are up in the air.



The bolded should be changed to accreditation.



The rest of this makes it sound like the purpose/main effect of the merger was for a combined match, when in reality it has to do with residency accreditation, and the combined match is actually more of consequence of the changes to accreditation. I feel this might need to be clarified, but it's up to you.

Thanks for the clarification Hallowman, I've edited the post and added the corrections.

 

[2021Doctor]

The deadline is actually for them to get to the "pre-accreditation" stage (applying for accreditation) the year they're scheduled to recruit the class that will graduate after 2020. If they don't take this step they're not allowed to recruit new residents and it likely means that they will shut down. The final deadline (for 3 year residencies) is coming up.

Also probably worthwhile to add in your sticky the reason the AOA was basically forced to agree to this (that the ACGME threatened to cut off access to fellowships to AOA residency graduates).

The AOA put themselves in a weak position by expanding school enrollments far beyond the number of available AOA residency spots. The AOA thus became dependent on ACGME spots for residency for their graduating students.

 

[hallowmann]

Adding this info courtesy of @Skynnyrd: Basically DOs in AOA programs that fail to attain ACGME accreditation by June 2020 will still be able to finish and be AOA board eligible by their programs getting some sort of provisional accreditation from the AOA to finish resident training.

New Agreement Addresses Residents' Needs in the Transition to the Single GME Accreditation System

and

No Resident Left Behind

 

[medschoolplease123]

There are many questions and concerns regarding the AOA and ACGME merger. Please use the information compiled below to gain a solid understanding of what is occurring and what the overall process is before creating a "merger" thread. I have provided links to many documents and websites that further expand on the information given below.

----

Definitions
ACGME: Accreditation Council for Graduate Medical Education. This group governed residency programs, in general, from hospitals affiliated with MD-granting institutions.
AOA: American Osteopathic Association. This group governed specifically osteopathic residency programs.
LCME: Liaison Committee for Medical Education: This group governs the accreditation process of MD-granting institutions.
COCA: Commission on Osteopathic College Accreditation. This group covers the accreditation process of DO-granting institutions.
MOU: Memorandum of Understanding.

----
Timeline:

• 2013 - announcement was made by Dr. Nasca (CEO of the ACGME) regarding the ACGME Board of Directors approval of a single accreditation system MOU. Simply, the ACGME was making the decision to bar AOA graduates from ACGME fellowship and ACGME advanced residencies)
• July, 2013 - MOU rejected by AOA and AACOM.
• February, 2014: announcement was made about the merging of the ACMGE and the AOA. The executive summary of discussion and outcomes was presented here.
• March, 2014 - MOU officially approved by AOA, AACOM & ACGME

A general breakdown of how the merger process will proceed/is proceeding:

• AOA residency programs will submit an application to ACGME. This grants the program the status of Pre-Accreditation which allows the AOA program to begin the process of Initial Accreditation though the ACGME. Initial Accreditation is granted upon the contingency of ACGME Review Committee approval that the program is compliant to ACGME standards which will entail a site visit from the ACGME (Source: Single GME Accreditation System).

• AOA programs must reach the status of "Pre-Acredditation" by June 30, 2020. Those who do not reach this status will not be allowed to recruit any more residents for their program.

• You can view reports of AOA programs ACGME status here. You can also view which AOA programs are planning to apply for ACGME accreditation here. Please note that some AOA programs have not provided such information about their decisions to apply. It is difficult to translate this as a decision to not apply, please contact the program directly should you have concerns reading these specific programs.

• Starting July 1, 2016, fellowship eligibility requires graduates to have completed training from an ACGME, RCPSC, or CFPC. Exceptions to this have been categorized by specialty here (please note, this was updated in 2015 and these response may have changed). Those that provide exceptions will consider graduates of AOA programs however the methods and rules governing these exceptions will vary across specialties.

• Sitting for the USMLE is not a hard requirement to apply for ACGME programs however, there will be programs that do not accept COMLEX scores in lieu of USMLE scores. Additionally, specific fellowship programs will require USMLE scores. Please contact the program directly to determine specifics or utilize the AMA Frieda software program.

• Board exams (taken to become board certified in the specialty you trained in) will still be administered by both the NBME and the AOA, there are no announcements of change.

• Graduates of US, MD-granting institutions will be allowed to apply to ACGME accredited programs once AOA. AOA programs receiving ACGME Initial Accreditation will be listed on the NRMP (software system utilized to apply for residency). Programs with Osteopathic Recognition (provided by newly formed ACGME committees) will have specific OMM requirements and, in general, will be limited to students graduating from DO-granting institutions. However, exceptions of eligibility to applying for OR-approved ACGME programs will be provided by program directors (source: page 6 of the ACGME osteopathic recognition FAQ).

*Source: http://www.acgme.org/Portals/0/PDFs/Nasca-Community/FAQs.pdf

---

Frequently asked questions:

Will AOA programs close down because of the merger?
Yes, many have elected not to apply for ACGME accreditation for one reason or another.

How many AOA programs will close down because of this?
As of data from October 2016, around 200 programs will close for a multitude of reasons (source: http://www.une.edu/sites/default/files/UNECOM_10072016 Shannon.pdf). As noted by @hallowmann "It should be clarified that only 3 programs that closed cited not wishing to apply for ACGME accreditation, the rest that closed all seemed unassociated with the merger. There are 75 others that hadn't responded as of that presentation though, and another 50 or so are up in the air."

What will happen to the AOA in 2020?
The AOA will still be a governing body but will cease to play a role in the realm of residency accreditation, providing the reigns to ACGME.

What does this mean for DO students applying for residency?
Prior to the completed merger, DO students were able to apply to the AOA match and the ACGME match. If they matched into AOA they were required to forfeit from the ACGME match. The AOA match occurred earlier than the ACGME match. If a DO student forewent the AOA match and could not find placement in the ACGME (primary match, SOAP, or scramble) the student could still apply for open AOA positions to secure a spot for graduate training. The single accreditation system will pipeline the process of applying for residency into one program so that all match results occur in the same timeline, MD or DO.

Will this effect my chances as a DO student towards getting into a competitive specialty?
Prior to the merger, DO students applying to competitive specialties like ortho or neurosurgery utilized the AOA system due to decreased competition and decreased risk of going unmatched in the ACGME process. With the merger in play, MD applicants will have the opportunity to apply to newly accredited ACGME programs that were once limited to DO applicants. The logistics and specifics of whether a program director would favor MD or DO applicants from a previous AOA program is largely varied amongst programs and thus, a homogenous answer is difficult to provide. Anecdotally, a PD of an AOA orthopedic program in MO with ACGME accreditation has stated they will still prefer DO applicants over MD applicants.

--

Please continue to ask questions regarding this topic below and pertinent questions will be added to the FAQ.

so doesn't this somewhat limit the opportunities for matching into competitive specialties for DOs? I know that the PD will decide on the candidate and some might favor MDs over DOs and vice versa, but won't it be harder since MDs are competing with DOs for the already limited (now even more limited) number of competitive residency spots?

 

[AlteredScale]

so doesn't this somewhat limit the opportunities for matching into competitive specialties for DOs? I know that the PD will decide on the candidate and some might favor MDs over DOs and vice versa, but won't it be harder since MDs are competing with DOs for the already limited (now even more limited) number of competitive residency spots?

It's very hard to tell since it's up to the discretion of the PD to overlook MD applications to keep it a DO only program. But IMHO yes it will be more competitive now to get into certain specialties.


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[medschoolplease123]

It's very hard to tell since it's up to the discretion of the PD to overlook MD applications to keep it a DO only program. But IMHO yes it will be more competitive now to get into certain specialties.


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Yeah that's what i figured. How would you rank "competitive specialites" would you consider anesth, obgyn, gen surg, or neurology as competitive?

 

[AlteredScale]

Yeah that's what i figured. How would you rank "competitive specialites" would you consider anesth, obgyn, gen surg, or neurology as competitive?

I can't really say as I don't dabble much in specialties outside of IM. All in all, obtaining a residency in any of the listed above at a university medical center are quite difficult to obtain as a DO. Anesthesiology at the moment is a bit less competitive now.


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[235009]

Yeah that's what i figured. How would you rank "competitive specialites" would you consider anesth, obgyn, gen surg, or neurology as competitive?

Anesthesia and neurology aren't competitive. Essentially all programs are open to DOs.

OB is more competitive and surgery is the most competitive out of that list.


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[Goro]

Yeah that's what i figured. How would you rank "competitive specialites" would you consider anesth, obgyn, gen surg, or neurology as competitive?

Gen Surge has been moderately to very competitive for MDs. For DOs it will be very competitive plus. Only 5% of my grads have ever gone into it.

 

[AnatomyGrey12]

Gen Surge has been moderately to very competitive for MDs. For DOs it will be very competitive plus. Only 5% of my grads have ever gone into it.

Gen surg is moderately competitive across the board. It isn't "very competitive." Very average to below average MDs find spots in high percentages and for DOs in the previous AOA match for the last year we have data there were only like 1.7 applicants per seat with a COMLEX average of low 500s. The reason so few grads go into it is because of lifestyle considerations and the residency is brutal. On top of that you don't have the same salary ceiling that the surgical subs have. It turns a fair number of students off, particularly a lot of DO students who came in with the mindset of "well surgery could be cool" and then they go through their surgical rotation and get that stamped out real quick. Most people who want it actually end up matching it.


With the merger gen surg will probably become more competitive for DOs however, but will never reach the competitiveness of the subs. For MDs they probably still won't consider it a very competitive field. It's one of those fields whose competitiveness waxes and wanes every few years, with it currently on an uptick. The future of DOs and general surgery competitiveness probably hinges on how many programs ultimately make the merger.

 

[ThreeCheers]

I believe that statistic from charting outcomes only applies to DOs that participate in the ACGME match. DOs that participate in the Gen Surg AOA match (which it seems will still exist in some capacity at least for 2018) probably have much better success rates than that.

At my school there was less than 10 out of 205ish (and only 2 were ACGME). Completely agree with you Goro. Charting outcomes has 50% of DOs who applied for Gen Surg actually matched last year. I expect that number to go down when we lose our dedicated spots and everyone is forced ACGME. I have so many students in my class whose parents are surgeons etc who only want surgery and yet we end up with something like 88-90 percent primary care match when its all done.

 

[Goro]

I believe that statistic from charting outcomes only applies to DOs that participate in the ACGME match. DOs that participate in the Gen Surg AOA match (which it seems will still exist in some capacity at least for 2018) probably have much better success rates than that.

This is true, but completely irrelevant to the discussion at hand. Further, it will be moot post-merger.

 

[ThreeCheers]

Ah I see. Sorry for misunderstanding, right now I have tunnel vision on how the merger will affect the 2018 match(es) in particular. There's still a lot up in the air in terms of which programs will be transitioning to NRMP and whether that means those programs will become unattainable for DO's.

I agree that matching surgery will become substantially more difficult once the merger is complete. Mercy Hospital in Iowa for example started taking a lot of MD's as soon as they switched from NMS to NRMP, so that's probably not a great sign.

 

[NurWollen]

Ah I see. Sorry for misunderstanding, right now I have tunnel vision on how the merger will affect the 2018 match(es) in particular. There's still a lot up in the air in terms of which programs will be transitioning to NRMP and whether that means those programs will become unattainable for DO's.

I agree that matching surgery will become substantially more difficult once the merger is complete. Mercy Hospital in Iowa for example started taking a lot of MD's as soon as they switched from NMS to NRMP, so that's probably not a great sign.

And then Mercy hospital got their ACGME accreditation yanked.

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[BorntobeDO?]

And then Mercy hospital got their ACGME accreditation yanked.

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Not related to them taking MD's tho. They surely would continue doing so if it had not been pulled.

 

[Thumpar]

So let's say in 2021 I match into a program that reached "pre-accreditation" status, but they never achieve full accreditation. What happens to me?

 

[AlteredScale]

So let's say in 2021 I match into a program that reached "pre-accreditation" status, but they never achieve full accreditation. What happens to me?

All AOA programs must reach initial ACGME accreditation by that time so that's unlikely to happen.


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[Thumpar]

All AOA programs must reach initial ACGME accreditation by that time so that's unlikely to happen.


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I guess I'm mixing up some of my terms here.

"Initial Accreditation" isn't considered fully accredited, correct? So I guess to reframe my question, if I were to match into a program with Initial Accreditation, there's a possibility that it won't become fully accredited, if it's unable to reach ACGME standards. What happens if I'm I'm a program that never becomes accredited? Is my residency training worthless? Do I have to try to transfer to another program?

Sorry for all the questions, I just want to get this straight.

 

[Thumpar]

While I'm at it, are all former-AOA residencies going to be Osteopathic Recognition by default? Or is that something that individual residencies have to apply for?

If that is the case, it sounds like the "osteopathic perspective" is going to vanish from post-doctoral education except for a handful of programs.

 

[AlteredScale]

I guess I'm mixing up some of my terms here.

"Initial Accreditation" isn't considered fully accredited, correct? So I guess to reframe my question, if I were to match into a program with Initial Accreditation, there's a possibility that it won't become fully accredited, if it's unable to reach ACGME standards. What happens if I'm I'm a program that never becomes accredited? Is my residency training worthless? Do I have to try to transfer to another program?

Sorry for all the questions, I just want to get this straight.

Initial accreditation is considered "official ACGME accreditation" and the next site visit is within the next 2 years to approve for continuing accreditation status. There are multiple outcomes from there but "pulling the plug" on programs immediately is unlikely. Programs will usually receive a warning or put on probation and are given time to fix the deficits. If worse comes to worse and your program cannot get its act together then you must transfer to a different residency program. Usually there is assistance from the governing residency bodies and the program to move you into a program in such a way that you do not have to start over.

https://www.acgme.org/Portals/0/PDFs/ab_ACGMEPoliciesProcedures.pdf

 

[hallowmann]

So let's say in 2021 I match into a program that reached "pre-accreditation" status, but they never achieve full accreditation. What happens to me?

You can't match to a pre-accredited program in 2021. All programs that fail to attain Initial Accreditation will not be allowed to continue taking residents. Also, by 2021 there will no longer be a NMS match, and only ACGME accredited programs can participate in the NRMP match.

I guess I'm mixing up some of my terms here.

"Initial Accreditation" isn't considered fully accredited, correct? So I guess to reframe my question, if I were to match into a program with Initial Accreditation, there's a possibility that it won't become fully accredited, if it's unable to reach ACGME standards. What happens if I'm I'm a program that never becomes accredited? Is my residency training worthless? Do I have to try to transfer to another program?

Sorry for all the questions, I just want to get this straight.

Initial accreditation is full accreditation. Its the type of accreditation that programs that are accredited for the first time by the ACGME receive. Its just like a new program becoming ACGME accredited. Continuing accreditation is what happens after that point.

If you are in a program that receives initial accreditation, you are in an ACGME accredited program. If at a point during your residency it gets its accreditation withdrawn, then at that point you would need to transfer to another program. This doesn't happen frequently though, it is a rare occurrence and is usually preceded by probation. You will also likely get some support from the ACGME for transferring to a different program.

While I'm at it, are all former-AOA residencies going to be Osteopathic Recognition by default? Or is that something that individual residencies have to apply for?

If that is the case, it sounds like the "osteopathic perspective" is going to vanish from post-doctoral education except for a handful of programs.

Osteopathic recognition is something programs must independently apply for once they attain ACGME accreditation (i.e. initial accreditation or continued for current ACGME programs). It has been said that this will be an easy process for formerly AOA accredited programs, but it will still be up to them to apply for it.

As far as osteopathic perspective goes, its all but already vanished from the majority of GME, except in the case of NMM, FM & OMT, and the handfuls of programs that actually strive to teach and incorporate OPP into their training. That will probably remain about the same after the merger.

 

[gamerEMdoc]

Osteopathic recognition is something programs must independently apply for once they attain ACGME accreditation (i.e. initial accreditation or continued for current ACGME programs). It has been said that this will be an easy process for formerly AOA accredited programs, but it will still be up to them to apply for it.

As far as osteopathic perspective goes, its all but already vanished from the majority of GME

I think there were 32 AOA EM programs that got initial accreditation by this point. There has been one (ONE!) that applied for osteopathic recognition. That was Doctors in Ohio. Otherwise, no one has applied for it.

The facts are, EM programs aren't going to go to the bother of creating an OMM curriculum, do OMM scholarly activity, etc. It's just not a big part of EM. I'd be shocked if more than 5 EM programs have "osteopathic recognition" by the time its all said and done. Almost 2/3 of the programs have switched over the ACGME, and 1/33 has applied.

 

[AlteredScale]

I think there were 32 AOA EM programs that got initial accreditation by this point. There has been one (ONE!) that applied for osteopathic recognition. That was Doctors in Ohio. Otherwise, no one has applied for it.

The facts are, EM programs aren't going to go to the bother of creating an OMM curriculum, do OMM scholarly activity, etc. It's just not a big part of EM. I'd be shocked if more than 5 EM programs have "osteopathic recognition" by the time its all said and done. Almost 2/3 of the programs have switched over the ACGME, and 1/33 has applied.

Any worry about a swatch of the EM programs not getting initial accred?


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[gamerEMdoc]

I mean its certainly possible. How many don't make the cut I don't know. But I doubt every single program will.

 

[8404HMFMF]

I mean its certainly possible. How many don't make the cut I don't know. But I doubt every single program will.

Will the 4 year AOA EM programs be condensed to 3 years as part of the merger?

 

[CoomassieBlue57]

Will the 4 year AOA EM programs be condensed to 3 years as part of the merger?

The one at my school will still be 4 years. I'm not sure if there are options to move from 4 to 3 years, start as a 3 year program, or move from a 3 to a 4 for existing programs.

 

[hallowmann]

Will the 4 year AOA EM programs be condensed to 3 years as part of the merger?

The EM RRC requires that programs that are 4 yrs have to offer "additional" training to justify being longer than 3 yrs. A lot of AOA programs around here are transitioning to 3 yrs, and the process involves transitioning 1st and 2nd years, but not 3rd years (i.e. 2nd yrs and 3rd years would graduate at the same time).

The thing is that osteopathic focus may actually be used to justify a 4th year, or at least that's what some DOs are talking about.

gamerEMdoc obviously knows way more about all this though. What I'm saying is only what I've heard from a couple AOA EM PDs and what I gathered from following the merger.

 

[The Duck Knows]

.

 

[gamerEMdoc]

Will the 4 year AOA EM programs be condensed to 3 years as part of the merger?

Some will, some won't. 90% of ACGME EM residencies are 3 year programs. 4 year programs have to justify the educational value of their fourth year. When a program applies for ACGME accredidation, they have to choose to apply as either a 3 or a 4 year program.

4 year programs traditionally tend to be in big name places in general. And most medical students prefer 3 years (duh). But many still go the 4 year route because they either want an extra year or they want to go to a bigger name program. There are very few community EM programs that are 4 years in the ACGME. So its going to be VERY interesting to see how the community EM programs that were former AOA programs that chose to stay as four years do as four year programs in a few years when they can no longer lean on the crutch that is the AOA match. I have a feeling many will quickly apply to switch to 3 year programs after a year or two of a combined match, because otherwise I think they'll really struggle with being competitive in the match.

Choosing to go 3 vs 4 has advantages from a match standpoint for residencies:
- 3 years. Going three years means you can't match in the AOA match anymore. AOA doesn't accredit 3 year programs. So once you go that route, you give up the option for the earlier AOA match and have to match all your spots in the ACGME match. So up front, you have to compete with the big boys right out of the gate without the crutch that is the AOA match
- 4 years. Can still participate in AOA match until it goes away having the option to participate in either match for the next few years until its combined. This is a huge short term advantage. But once its combined, they run the risk of being very uncompetitive as 4 year community programs.

 

[gamerEMdoc]

Thanks for the posts. Great information that clears up quite a few questions. So, when will these programs begin participating in the NRMP match? Should I start looking into programs that gained initial accreditation 7/2016 if I'm applying this upcoming year?

All of the programs that got initial accreditation are eligible to participate in the NRMP match. The ones that stayed four years have the option to participate in both matches, and logically will try to match as many as their spots as they can in the NMS (AOA) match because its less competitive from the programs standpoint rather than compete in the NRMP (ACGME) match.

The ones that are now 3 year programs will be matching all their spots in the NRMP match.

 

[BorntobeDO?]

All of the programs that got initial accreditation are eligible to participate in the NRMP match. The ones that stayed four years have the option to participate in both matches, and logically will try to match as many as their spots as they can in the NMS (AOA) match because its less competitive from the programs standpoint rather than compete in the NRMP (ACGME) match.

The ones that are now 3 year programs will be matching all their spots in the NRMP match.

I may be misunderstanding the situation here but I had a few questions:
Just the way I read your statement, it seems like programs can still use NMS match as long as they have ACGME accreditation, so does that mean it could keep going beyond the AOA (i.e to 2020 and beyond)?
How long do you see the NMS match going (whether or not the above is true)?

Thanks

 

[DrFutureDO]

Feb 2019 is the last NMS AOA match

 

[AlteredScale]

Feb 2019 is the last NMS AOA match

Is this from an announcement?


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[hallowmann]

I may be misunderstanding the situation here but I had a few questions:
Just the way I read your statement, it seems like programs can still use NMS match as long as they have ACGME accreditation, so does that mean it could keep going beyond the AOA (i.e to 2020 and beyond)?
How long do you see the NMS match going (whether or not the above is true)?

Thanks

Programs can use the NMS match as long as they have AOA accreditation and have have at least applied for ACGME accreditation by the time outlined in the AOA requirements (Jan 2017 for 4yr+ programs, Jan 2018 for 3 yr programs, etc.).

AOA accreditation will end in June 2020, so after that programs won't be able to participate in the NMS match.

 

[BorntobeDO?]

Programs can use the NMS match as long as they have AOA accreditation and have have at least applied for ACGME accreditation by the time outlined in the AOA requirements (Jan 2017 for 4yr+ programs, Jan 2018 for 3 yr programs, etc.).

AOA accreditation will end in June 2020, so after that programs won't be able to participate in the NMS match.

So is the last NMS match Feb 2019, or Feb 2020? I didn't know the former AOA programs could still use NMS till 2020, I thought the only programs that would remain in it were the ones that didn't have ACGME so it would end in 2019 (cause no program shorter than 2 years etc). This dynamic described above means there may still be a decent amount of programs in NMS, even in 2020 if I understand correctly (cause as long as they were accredited thru 2020 by AOA, and they have initial ACGME, they are allowed to still use it right?)

So basically there will still be a NMS match in 2020, but it will only be dual accredited programs, is that the deal?

 

[hallowmann]

So is the last NMS match Feb 2019, or Feb 2020? I didn't know the former AOA programs could still use NMS till 2020, I thought the only programs that would remain in it were the ones that didn't have ACGME so it would end in 2019 (cause no program shorter than 2 years etc). This dynamic described above means there may still be a decent amount of programs in NMS, even in 2020 if I understand correctly (cause as long as they were accredited thru 2020 by AOA, and they have initial ACGME, they are allowed to still use it right?)

So basically there will still be a NMS match in 2020, but it will only be dual accredited programs, is that the deal?

So there's a little bit of further explanation needed for some this.

They have not officially said when the final NMS match will be. That said, I expect that it will be in Feb 2019. The reason I say this is because TRIs (and other 1 yr programs) have until Jan 2019 to apply for accreditation in order to participate in the Feb 2019 AOA match.

By Sept. 2019, all programs that have not applied or aren't in the process of moving forward with their ACGME accreditation (i.e. programs that don't look like they'll get accredited by June 2020) are not going to be able to accept any more residents, and they'll only maintain their accreditation provisionally to allow for their current residents to finish.

All of this points to the greatest likelihood being that the last AOA match will be in 2019.

Former AOA programs, provided they still have their AOA accreditation (which will end in June 2020), can participate in the NMS match for as long as it exists. Even programs that have not attained ACGME accreditation, but have at least applied can still participate through 2019.

As the rules stand right now, if the AOA decides to maintain an NMS match for 2020, it is very possible for programs that have AOA accreditation as well as initial ACGME accreditation to participate in that match (now whether any programs would participate in both matches is anyone's guess). So yes to your last sentence, if there was a match it would only include dual-accredited programs that choose to participate. The real question is whether or not the AOA will have an NMS match in 2020 at all. I think its unlikely, but they haven't officially said anything (as far as I know).

 

[BorntobeDO?]

So there's a little bit of further explanation needed for some this.

They have not officially said when the final NMS match will be. That said, I expect that it will be in Feb 2019. The reason I say this is because TRIs (and other 1 yr programs) have until Jan 2019 to apply for accreditation in order to participate in the Feb 2019 AOA match.

By Sept. 2019, all programs that have not applied or aren't in the process of moving forward with their ACGME accreditation (i.e. programs that don't look like they'll get accredited by June 2020) are not going to be able to accept any more residents, and they'll only maintain their accreditation provisionally to allow for their current residents to finish.

All of this points to the greatest likelihood being that the last AOA match will be in 2019.

Former AOA programs, provided they still have their AOA accreditation (which will end in June 2020), can participate in the NMS match for as long as it exists. Even programs that have not attained ACGME accreditation, but have at least applied can still participate through 2019.

As the rules stand right now, if the AOA decides to maintain an NMS match for 2020, it is very possible for programs that have AOA accreditation as well as initial ACGME accreditation to participate in that match (now whether any programs would participate in both matches is anyone's guess). So yes to your last sentence, if there was a match it would only include dual-accredited programs that choose to participate. The real question is whether or not the AOA will have an NMS match in 2020 at all. I think its unlikely, but they haven't officially said anything (as far as I know).

Appreciate the insight. I just thought it was guaranteed to be gone after 19, but now I see it may not be. I think the basic question comes down to is does the AOA have a monetary incentive to keep the match alive, and will DO students still use it if it is there? If the answer is yes (and I think it might be), then I think it will be around.

 

[hallowmann]

Appreciate the insight. I just thought it was guaranteed to be gone after 19, but now I see it may not be. I think the basic question comes down to is does the AOA have a monetary incentive to keep the match alive, and will DO students still use it if it is there? If the answer is yes (and I think it might be), then I think it will be around.

Yeah, its really hard to tell at this point. I think next year will be more telling. This year saw a greater percentage of DOs choosing the NRMP match over the NMS match (51% of NMS non-participants in 2017 vs. 46%-47% in 2012-2016), but this was also the last year where the majority of applicants would graduate in programs by 2020. Also though, the absolute number of DO participants in the NMS match didn't change much compared to previous years due to school expansion.

In other words, it's not yet clear based on the data we have whether a sizeable number of DO students would still use the NMS match in the future. I think we'll get a better idea next year.

 

[gamerEMdoc]

Former AOA programs, provided they still have their AOA accreditation (which will end in June 2020), can participate in the NMS match for as long as it exists

Just to clarify so there is no misunderstanding, while this is generally true, EM is special because of the difference in years between AOA and ACGME programs. EM programs that switch to ACGME as 3 year EM programs can not match in the NMS since the AOA doesn't accredit 3 year programs. Yet they may main accredited by the AOA. Seems like a contradiction, but its not. Because those programs will still have residents in the old four year curriculum at the time of the transition, so they can keep their AOA accredidation for those residents in the four year tract. But if they are matching new residents into a three year program, it has to be via the NRMP match.

 

[Arkteryx]

So, I've kept my eye on this topic since being accepted to medical school. I guess I don't understand the point of continuing the COMLEX exams. The idea that (as a DO) I have to learn the same coursework, OMM, while studying for both exams... but I have to score better than an MD counterpart to be considered equal...is annoying. If AOA decided a merger with ACGME was prudent (so DOs could be eligible for ACGME fellowships), Why are they not advocating for systemic changes to licensure in the best interest of the upcoming DOs. To clarify, why don't they streamline it, by making it USMLE only and perhaps have an additional/optional section on OMM. This would give students better quality of life, by not having to stress about taking two different exams. Forgive my ignorance, if they don't have the authority to do that.

 

[AnatomyGrey12]

So, I've kept my eye on this topic since being accepted to medical school. I guess I don't understand the point of continuing the COMLEX exams. The idea that (as a DO) I have to learn the same coursework, OMM, while studying for both exams... but I have to score better than an MD counterpart to be considered equal...is annoying. If AOA decided a merger with ACGME was prudent (so DOs could be eligible for ACGME fellowships), Why are they not advocating for systemic changes to licensure in the best interest of the upcoming DOs. To clarify, why don't they streamline it, by making it USMLE only and perhaps have an additional/optional section on OMM. This would give students better quality of life, by not having to stress about taking two different exams. Forgive my ignorance, if they don't have the authority to do that.

Why you a$k? The an$wer i$ becau$e of the obviou$ o$teopathic di$tinction COMLEX provide$....

 

[redrosesfi]

1) When I'm looking at a current DO school match list, I see there are DO residencies in IM, Ob/Gyn, optho, ortho, peds, psyc, gen surg, etc.
My question is: what are the current differences in these DO residencies compared to allopathic residencies in the same specialties in terms of what you learn? Tell me if I'm wrong, but my thinking is that current DO residencies implement OMM in their training just like DO schools, correct?

2) And since MD and DO residencies are merging in the future, what effect would that have on how you train or what you learn in the residency? They wouldn't teach/implement OMM I presume?

Thank you.

 

[Arkteryx]

Why you a$k? The an$wer i$ becau$e of the obviou$ o$teopathic di$tinction COMLEX provide$....

Interesting...I guess my thought would be...doesn't that distinction still present itself with a) D.O. b)the additional and/or optional OMM section to the USMLE exam

I'm incredibly bad with sarcasm...so what you're really saying is: money. Got it, sorry i'm slow : (

 

[mandym00]

I may be completely off here (this is a bit confusing for me especially for a first year that doesn't know much about the licensing exams and matching), but I will be the class of 2021. Will I still need to take both licensing exams to be able to apply to ACGME programs? (I planned too anyways, 90%+ of the students at my school do). From what I understand the residency programs will be stream-lined but the licensing exams not? Just trying to clarify from what I read in previous posts.

 

[AlteredScale]

I may be completely off here (this is a bit confusing for me especially for a first year that doesn't know much about the licensing exams and matching), but I will be the class of 2021. Will I still need to take both licensing exams to be able to apply to ACGME programs? (I planned too anyways, 90%+ of the students at my school do). From what I understand the residency programs will be stream-lined but the licensing exams not? Just trying to clarify from what I read in previous posts.

There is no encompassing requirement to take the USMLE when applying for ACGME. Around 70% of ACGME programs already consider the comlex in light of the USMLE. Now that doesn't state preference as many PDs may still prefer DO applicants who take the USMLE but there is not study to back that claim.

If you go to a DO program, the comlex will be required no matter what. I am only aware of one 1 school (RVU) requires their students to take both Step 1 and Level 1.

The AOA and the group that will represent the AOA within the ACGME are trying very hard to provide all program directors with the tools to help quantify and learn the scores of the comlex.


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