AOA Residencies No Longer Allowed to Accept Trainees w/o ACGME App in Place

[Mad Jack]

Updated Aug. 28, 2015: The AOA Board of Trustees last month approved several key postdoctoral standards to protect residents during the transition to the single GME accreditation system.

Standard 10.5(a) states, “AOA programs that do not apply for ACGME accreditation cannot accept new trainees after July 1 of the year in which the resident can complete their training by June 30, 2020.” This means that AOA-accredited residency programs that have not entered into the ACGME accreditation process cannot accept a resident if the resident’s expected training completion date is after the AOA ceases its accreditation functions (June 30, 2020).

The purpose of the standard is to protect the resident by giving some assurance they would complete their training in an accredited training program. For example, family practice programs are three years in length. Residents accepted on or before July 1, 2017, would be expected to complete their training by June 30, 2020. Residents accepted after July 1, 2017, would be expected to complete residency training after June 30, 2020.

AOA programs that do not apply for ACGME accreditation cannot accept residents if the resident’s expected training completion date exceeds June 30, 2020. If an AOA-accredited family practice training program entered into the ACGME accreditation process on or before June 30, 2017, it would be able to accept residents on July 1, 2017. If the residency program planned to not recruit residents in 2017 but planned to accept students in July 1, 2018, the program could satisfy Standard 10.5(a) by entering into the ACGME accreditation process before July 1, 2018.

It is important to note that five-year and seven-year programs have not violated this policy. They accepted trainees before the policy was approved. The policy does not apply retroactively. Thus, Standard 10.5(a) does not apply retroactively to seven-year programs that accepted residents in 2014 or 2015, nor does it apply retroactively to five-year programs that accepted residents in 2015. However, the Standard does apply to these programs moving forward. Five-year and seven-year programs will need to enter into the ACGME accreditation process to accept residents henceforth.

What does this mean for you? Well, if you intend on applying to AOA programs in the next couple of years, it means that you can't apply to one that hasn't at least begun the steps toward ACGME accreditation. The downside is, this measure only means they have to apply- not be approved- by the ACGME when they accept residents. Many AOA programs might not make the cut, but at least this gives us some measure of protection by forcing programs to at least get the ball rolling. Hopefully by the time I'm matching, this will all be sorted out...

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[NMDO]

Sure hope something changes before match day, hardly any five year programs have applied for accreditation at this point, which would mean that none of them could take residents this year.

 

[YankeeCandle1141]

100% of aoa programs will apply for ACGME accreditation. There isn't a single reason why they wouldn't. They either apply, or get shut down. This is really a non-issue.

Now, getting approval is going to be an issue for a good amount of programs, but thats a different conversation.

 

[Dr. Hopeful]

100% of aoa programs will apply for ACGME accreditation. There isn't a single reason why they wouldn't. They either apply, or get shut down. This is really a non-issue.

Now, getting approval is going to be an issue for a good amount of programs, but thats a different conversation.

This isn't true at all. There are many programs that have clearly stated "We have no plans to apply for ACGME accreditation, we will be accepting residents through AOA until 2020 and will close after the merger."

 

[user3]

This isn't true at all. There are many programs that have clearly stated "We have no plans to apply for ACGME accreditation, we will be accepting residents through AOA until 2020 and will close after the merger."

Well according to what MJ posted, any ortho Uro GS NS or rads programs that don't apply would not be able to accept any new residents for the 2016 class.

 

[Dr. Hopeful]

Well according to what MJ posted, any ortho Uro GS NS or rads programs that don't apply would not be able to accept any new residents for the 2016 class.

Right. Which sucks.

 

[GUH]

Sounds like the ACGME is getting impatient and put some pressure on the AOA. As has been stated, preaccreditation absolutely does not mean that a residency will gain ACGME accreditation so the reason provided in the statement does not make sense.

Does anyone know whether programs which are in ACGME pre-accreditation will still participate in the AOA match?

 

[user3]

Sounds like the ACGME is getting impatient and put some pressure on the AOA. As has been stated, preaccreditation absolutely does not mean that a residency will gain ACGME accreditation so the reason provided in the statement does not make sense.

Does anyone know whether programs which are in ACGME pre-accreditation will still participate in the AOA match?

I don't think they can enter the NRMP match (or accept MD students) until they receive full ACGME accreditation.

 

[NurWollen]

This isn't true at all. There are many programs that have clearly stated "We have no plans to apply for ACGME accreditation, we will be accepting residents through AOA until 2020 and will close after the merger."

Which ones?
And are they really openly admitting that they're going to accept new residents in February of 2020, and then close that summer?

 

[Mad Jack]

100% of aoa programs will apply for ACGME accreditation. There isn't a single reason why they wouldn't. They either apply, or get shut down. This is really a non-issue.

Now, getting approval is going to be an issue for a good amount of programs, but thats a different conversation.

There will be a number of them that do an honest assessment and realize they cannot meet ACGME standards and voluntarily allow their accreditation to sunset. The application is not cheap- programs that know they stand no chance of being up to snuff will likely close down rather than waste tens of thousands of dollars (or more) on trying to meet standards that they will never achieve.

 

[YankeeCandle1141]

This isn't true at all. There are many programs that have clearly stated "We have no plans to apply for ACGME accreditation, we will be accepting residents through AOA until 2020 and will close after the merger."

Such as?

 

[YankeeCandle1141]

Hospitals make between 150-200k per resident per year. Your argument is that hospitals cant afford the 10k application? And program directors are just going to voluntarily fire themselves?

Ive seen a lot of stupid arguments on SDN over the years....but this might actually be the true dumbest thing I have ever seen.

 

[Mad Jack]

Sounds like the ACGME is getting impatient and put some pressure on the AOA. As has been stated, preaccreditation absolutely does not mean that a residency will gain ACGME accreditation so the reason provided in the statement does not make sense.

Does anyone know whether programs which are in ACGME pre-accreditation will still participate in the AOA match?

Applying isn't free, and I highly doubt that programs will disingenuously fill out applications if they feel they will not be up to standard. Most are looking at facility costs, conference fees in regard to the process, and ACGME fees (which average $16,500 if only one site visit is required), all of which have to be approved by the hospital. Most hospitals aren't willing to flush tens or hundreds of thousands of dollars down the toilet if there's no real chance of something fruitful coming of it. It would be a foolish waste of money, and appealing if they are not approved will cost them even more (the basic fee for an appeal, without additional site visit costs and such, is $10,000).

 

[Mad Jack]

Hospitals make between 150-200k per resident per year. Your argument is that hospitals cant afford the 10k application? And program directors are just going to voluntarily fire themselves?

Ive seen a lot of stupid arguments on SDN over the years....but this might actually be the true dumbest thing I have ever seen.

Residents don't actually make the hospital that much money. That is what the hospital gets as a net payment by the government. Residents have substantial costs associated with them, including the costs of the PD's salaries (and the limited amount that can be billed overall), the residents' salaries, the costs of resident inefficiencies (the average discharge at a teaching hospital is 6.2% more costly to the hospital, per patient), etc. Smaller hospitals tend to have worse reimbursement for their services, and tend to fall on the costlier end of the scale so far as resident costs due to the inherent inefficiency of having a smaller program. DO programs tend to be small. They tend to be in community hospitals. They tend to be in primary care. Overall this puts them on the losing end of the "do my residents make me money or cost me money" scale.

http://www.rand.org/content/dam/rand/pubs/research_reports/RR300/RR324/RAND_RR324.pdf

Here's a pretty thorough dissection of the net cost of residents. They can do anything from lose you money to make you a good net profit, but the amount of money they make is tied into a lot of factors that is not conducive to the ways in which small community programs operate.

 

[NMDO]

Hospitals make between 150-200k per resident per year. Your argument is that hospitals cant afford the 10k application? And program directors are just going to voluntarily fire themselves?

Ive seen a lot of stupid arguments on SDN over the years....but this might actually be the true dumbest thing I have ever seen.

It is going to cost places more than $10k. I know some really good programs that have to hire many new faculty in order to comply with ACGME.

Which ones?
And are they really openly admitting that they're going to accept new residents in February of 2020, and then close that summer?

With this new mandate, programs won't be able to take residents if they won't finish by 2020 if the program does not first apply for ACGME accreditation. So after 2017 no program will be able to take residents unless they have applied for ACGME. From people I have talked to, this mandate snuck up on most programs, and it sounds like not many 5+ year programs are ready to apply, which means they won't be able to take any residents this year.

 

[Mad Jack]

It is going to cost places more than $10k. I know some really good programs that have to hire many new faculty in order to comply with ACGME.



With this new mandate, programs won't be able to take residents if they won't finish by 2020 if the program does not first apply for ACGME accreditation. So after 2017 no program will be able to take residents unless they have applied for ACGME. From people I have talked to, this mandate snuck up on most programs, and it sounds like not many 5+ year programs are ready to apply, which means they won't be able to take any residents this year.

I think some people are insinuating that the PDs will be sneaky and disingenuously apply for pre-accreditation status in order to keep a supply of freshly matched residents on board each year that they will simply abandon once their accreditation sunsets in 2020. Very few hospital boards would be on board with something like that, and most PDs are both ethical and realistic about their chances moving forward. They will keep their jobs until 2020 regardless, so why would they apply for pre-accred status just to dump their residents at the deadline? That's evil, unethical, and largely pointless.

 

[NMDO]

I just hope these 5 year programs start applying....quickly

 

[YankeeCandle1141]

This thread is so misinformed and just plain asinine that I need to walk away now. Anyone reading this....please realize that zero...and I mean zero programs are going to roll over because of a 10k fee and standards that they cant meet in 5 years.

This is idiocy.

 

[mesmerazopam]

This thread is so misinformed and just plain asinine that I need to walk away now. Anyone reading this....please realize that zero...and I mean zero programs are going to roll over because of a 10k fee and standards that they cant meet in 5 years.

This is idiocy.

It’s actually the most informed I’ve seen in awhile. There are those of us out in our rotations who are hearing the story from real people trying to make this work within the current framework and time constraints.

I’ve heard the term “millions of dollars” thrown around in the case of one community hospital’s cumulative projected costs, mainly because it would involve making potential systemic changes to the hospital system, hiring/credentialing new faculty, providing research opportunities, and ensuring case volume through new collaborative relationships (code speak for throwing money at other hospitals to guarantee the kind of exposure necessary for some of the surgical specialties).

At first, this might seem insane to some people, but if you know anything about how large bureaucracies work (virtually any American hospital), then you realize this is probably accurate when the total direct and indirect costs are tallied over several years. The problem seems to come when hospitals have multiple residencies and some of them need disproportionate resources. From what I’ve heard, these tend to be the more competitive procedural fields. It’s not any single issue so much as it’s the totality of trying to ensure adequate training facilities and hiring/retaining faculty. The ACGME standards for some of these types of programs revolve around large academic institutions, which some community hospitals are decidedly not. As @Mad Jack has alluded to, this basically comes down to cost vs. benefit for a lot of these institutions. From my understanding, the costs may be so insurmountable for some hospitals as to make filing the paperwork a waste of money.

 

[NurWollen]

Slight tangent here but does anyone know how long accreditation takes once they've applied for pre- accreditation?

 

[abolt18]

Slight tangent here but does anyone know how long accreditation takes once they've applied for pre- accreditation?

Sounded like minimum 1 year.

 

[W19]

There will be a number of them that do an honest assessment and realize they cannot meet ACGME standards and voluntarily allow their accreditation to sunset. The application is not cheap- programs that know they stand no chance of being up to snuff will likely close down rather than waste tens of thousands of dollars (or more) on trying to meet standards that they will never achieve.

So there will be a reduction in residency spot then when it's all over...

 

[YankeeCandle1141]

It’s actually the most informed I’ve seen in awhile. There are those of us out in our rotations who are hearing the story from real people trying to make this work within the current framework and time constraints.

I’ve heard the term “millions of dollars” thrown around in the case of one community hospital’s cumulative projected costs, mainly because it would involve making potential systemic changes to the hospital system, hiring/credentialing new faculty, providing research opportunities, and ensuring case volume through new collaborative relationships (code speak for throwing money at other hospitals to guarantee the kind of exposure necessary for some of the surgical specialties).

At first, this might seem insane to some people, but if you know anything about how large bureaucracies work (virtually any American hospital), then you realize this is probably accurate when the total direct and indirect costs are tallied over several years. The problem seems to come when hospitals have multiple residencies and some of them need disproportionate resources. From what I’ve heard, these tend to be the more competitive procedural fields. It’s not any single issue so much as it’s the totality of trying to ensure adequate training facilities and hiring/retaining faculty. The ACGME standards for some of these types of programs revolve around large academic institutions, which some community hospitals are decidedly not. As @Mad Jack has alluded to, this basically comes down to cost vs. benefit for a lot of these institutions. From my understanding, the costs may be so insurmountable for some hospitals as to make filing the paperwork a waste of money.

There are a lot of words here, but no substance.

 

[YankeeCandle1141]

Actually, rather than engage...... I promise I will delete my account and never visit SDN again if anyone can cite 5 programs that refuse to apply for accreditation over costs.


Edit: that includes every specialty, and every state. A total of 5, and I wont even respond to the post. I will just disappear.

 

[mesmerazopam]

Actually, rather than engage...... I promise I will delete my account and never visit SDN again if anyone can cite 5 programs that refuse to apply for accreditation over costs.


Edit: that includes every specialty, and every state. A total of 5, and I wont even respond to the post. I will just disappear.

You and I both know no one here is going to do that. These hospitals are in the midst of making a highly personal decision about this issue and it would be unproductive to air that business on this forum.

I have a better idea: if a student doesn’t believe what those of us are saying, then just ask the PD at your hospital. They’re plugged into what’s happening within their individual OPTIs. See what they say. Don't take the word of some people on an internet forum. It's not an unreasonable question to ask, especially about something that is so critical to your future. Truly, I hope we’re wrong. None of us win when any residency closes down. My personal desire would be to see 100% of all osteopathic residencies successfully navigate the merger.

 

[Mad Jack]

Actually, rather than engage...... I promise I will delete my account and never visit SDN again if anyone can cite 5 programs that refuse to apply for accreditation over costs.


Edit: that includes every specialty, and every state. A total of 5, and I wont even respond to the post. I will just disappear.

Deal. I know of at least two in my school's OPTI alone.

 

[Mad Jack]

So there will be a reduction in residency spot then when it's all over...

Yes. 10-30% of AOA programs will close, depending on who you believe. There is no chance they will all make it.

 

[YankeeCandle1141]

Deal. I know of at least two in my school's OPTI alone.

Then I will chop it down to 2. Show me 2 programs that close for accreditation costs and I will be history.

 

[YankeeCandle1141]

Screw it. If you make it 10, i Will record a music video.

 

[IslandStyle808]

Yes. 10-30% of AOA programs will close, depending on who you believe. There is no chance they will all make it.

Would that also mean less rotations with OPTI's in this current flux?

 

[Mad Jack]

Would that also mean less rotations with OPTI's in this current flux?

You can still rotate with them. Just be aware of which ones might or might not be approved for ACGME accreditation and which ones have opted out of the pre-accreditation process in a manner that has made them unable to match residents.

 

[DO2016EM]

This thread is so misinformed and just plain asinine that I need to walk away now. Anyone reading this....please realize that zero...and I mean zero programs are going to roll over because of a 10k fee and standards that they cant meet in 5 years.

This is idiocy.

Programs won't roll over for the fee; the fee is the easy part. Programs will shut down because they realize they can't live up to ACGME standards. There is one DO EM program that is reported to be doing just this. A few more may follow. It's just the nature of this transition to ACGME, some programs will not make the cut. Most will be just fine.

 

[NontradCA]

Actually, rather than engage...... I promise I will delete my account and never visit SDN again if anyone can cite 5 programs that refuse to apply for accreditation over costs.


Edit: that includes every specialty, and every state. A total of 5, and I wont even respond to the post. I will just disappear.

Lol

 

[YankeeCandle1141]

Programs won't roll over for the fee; the fee is the easy part. Programs will shut down because they realize they can't live up to ACGME standards. There is one DO EM program that is reported to be doing just this. A few more may follow. It's just the nature of this transition to ACGME, some programs will not make the cut. Most will be just fine.

No.

Medicare funded residency positions are some of the most valuable assets a that a hospital could ever have. Programs, and specifically program directors arent just flying white flags because of the big tough ACGME regulations. Some of the ACGME rules are actually softer than AOA rules.

Ie: AOA rules mandate that IM residents need 1 month of pulm, gi, endocrine, hemeonc, neuro, id,rheum. Acgme has no such requirement. They require "exposure to IM subspecialties".

That is called an example.

Rather than all this "my friend told me that his dad heard about this FM program in nevada closing over regulations" , feel free to use examples of programs that are actually not applying for accreditation.


I will wait here and hold my breath.

 

[YankeeCandle1141]

I know. Some programs wont meet requirements.

The notion that programs are just giving up is hilarious though.

 

[Elevencents]

I know. Some programs wont meet requirements.

The notion that programs are just giving up is hilarious though.

You've said the same thing like 5 times. We get it.

 

[Siggy]

No.

Medicare funded residency positions are some of the most valuable assets a that a hospital could ever have. Programs, and specifically program directors arent just flying white flags because of the big tough ACGME regulations. Some of the ACGME rules are actually softer than AOA rules.

I understand a lot of the issues are administrative issues. The hospital I did my TRI at was having to hire new attendings because there were limits for EM for how much an attending could work. Similarly, at my community IM program (5/year), our program director is part time. Apparently the PD needs to go full time and needs more publications to meet ACGME standards.

 

[YankeeCandle1141]

I understand a lot of the issues are administrative issues. The hospital I did my TRI at was having to hire new attendings because there were limits for EM for how much an attending could work. Similarly, at my community IM program (5/year), our program director is part time. Apparently the PD needs to go full time and needs more publications to meet ACGME standards.

The acgme has nothing to do with attendings. I assume you mean the limits on how much a resident can work.


There are acgme regulations that cap interns. For IM it is 5 admissions per night per intern, and a total of 10 admissions per night per supervising resident. (Aka a typical night team of 2 interns and 1 resident is capped when both interns have 5 admissions and the resident is capped because of the supervising limit).


This is an issue at a lot of programs, because there currently no aoa cap on admissions. Some programs have individual caps, but most dont. That means that some hospitals need to have an attending/PA on call when the cap is reached, or, add short call every night so the night team admits for 2 less hours, or add a PA to the night team. There are a lot of creative ways to address this.......and all programs have 5 years to figure it out.

When the new duty hours kick in, this is going to probably be resolved on its own.


And as far as a part time PD, thats allowed. They need to dedicate "20 hours" per week to the residency happenings. If the program has more than 24 residents, they need to hire an associate program director, but for small programs its totally allowed

 

[Dr. Death]

I hope a bunch do close. less residencies = less doctors. Less doctors = less saturation = more jobs for me! I don't want to see physicians going the way of vets. . . and lawyers. . . and dentists . . . and nurses. . . and architects . . . and computer science majors . . . and many other professions in this country. So many new med schools opening up, the bubble will burst if there isn't another choke point in the process.

 

[phenobb]

I can only speak to this in terms of surgery and the surgery subspecialties, but the notion that taking residents is a net negative for hospitals is laughable. It is particularly laughable for any program that has already invested in the infrastructure necessary to train residents.

Without residents, think of the number of midlevels that would be needed to make some of these practices work efficiently. At least a one for one replacement at a six figure cost, with no reimbursement from medicare. Then you have the restrictions on things that midlevels can/cannot do that residents can.

This is a non event. Move on folks. The real story is how accommodating the ACGME is being in trying to make this process as easy as possible.

 

[NMDO]

The acgme has nothing to do with attendings. I assume you mean the limits on how much a resident can work.

If you read the ACGME program requirements, there are actually a lot of requirements of attendings. Including that at least one full time faculty member devotes 45 hours a week to the program for every 4 residents they have (that is for Ortho at least, I'm sure others have similar requirements). Many DO surgical programs are run by private practice guys who don't want to spend 45 hours a week devoted to the program. Also, for 5 year programs, they don't have "5 years to figure it out." They have a few months, because if they don't apply this year then they can't take new residents, and why would a program apply if they don't meet the standards yet?

I agree with you that programs won't just give up or not apply because of the cost, but I would expect programs to wait until they meet ACGME requirements before submitting an application. I highly doubt all of these surgical residencies that are five years will meet ACGME requirements this year, which means they won't apply this year, which means they won't be able to take residents this year. Do you realize how few programs have applied so far? Zero of 44 ortho and 6 of 60 general surgery programs..

I think at the end of the transition period in 2020, most of this will be sorted out and it won't be a big deal. My only concern is how many programs won't be able to take residents this year if they don't apply.

 

[phenobb]

Devoting 45 hours to the program is a pretty nebulous requirement. What does this mean? How do you prove you did/didn't?

Does OR time with residents count? If so- I cannot imagine that the requirements won't be met.

 

[NMDO]

Devoting 45 hours to the program is a pretty nebulous requirement. What does this mean? How do you prove you did/didn't?

Does OR time with residents count? If so- I cannot imagine that the requirements won't be met.

No clue what it means or how you prove it, I was just refuting the above post that said "ACGME has nothing to do with attendings." I have also had direct conversations with program directors who have said they need to bring in more attendings to meet ACGME requirements. Again, I agree with you guys that most programs will be able to meet the requirements - eventually. I'm just concerned about this year, selfishly, because I graduate this year and want to do a 5 year residency.

 

[Siggy]

The acgme has nothing to do with attendings. I assume you mean the limits on how much a resident can work.

Emergency Medicine accreditation standards:
"
II.A.4.a).(1).(a)
The program director must not work more than 20 hours per week clinically, on average, or 960 clinical hours per year.

II.B.6.
There must be a minimum of one core physician faculty member for every three residents in the program."


https://www.acgme.org/acgmeweb/Port...uirements/110_emergency_medicine_07012015.pdf

"Citations Related to Failure to Achieve Initial Accreditation Review Committee for Internal Medicine"

2. The program director does not dedicate sufficient professional time to the program (at least 20hours per week).
4. There is inadequate key clinical faculty member scholarship ( either productivity or participation)

https://www.acgme.org/acgmeweb/Port...sources/140_Citations_Related_to_Withhold.pdf

Internal Medicine Program Requirements:
I.A.2. The sponsoring institution and participating sites must:
I.A.2.a) provide at least 50% salary support (at least 20 hours per week) for the program director

https://www.acgme.org/acgmeweb/Port...quirements/140_internal_medicine_07012015.pdf

 

[YankeeCandle1141]

If you read the ACGME program requirements, there are actually a lot of requirements of attendings. Including that at least one full time faculty member devotes 45 hours a week to the program for every 4 residents they have (that is for Ortho at least, I'm sure others have similar requirements). Many DO surgical programs are run by private practice guys who don't want to spend 45 hours a week devoted to the program.



Also, for 5 year programs, they don't have "5 years to figure it out."
I agree with you that programs won't just give up or not apply because of the cost, but I would expect programs to wait until they meet ACGME requirements before submitting an application.

In context, I was referring to a post that said a hospital had a limit on how much an attending can work.

The five years to figure it out refers to the fact that you dont have to meet requirements to apply for preaccreditation. There is a five year transition period to meet the requirements, where the program remains "preaccreditated" but wont be "accredited" until they do. Functionally the terminology means the same thing.

I also can tell you that more than zero ortho programs have applied. I was physically present when one of them was getting inspected by the acgme people. The information on the AOA website isnt updated very often.

 

[hallowmann]

Sounds like the ACGME is getting impatient and put some pressure on the AOA. As has been stated, preaccreditation absolutely does not mean that a residency will gain ACGME accreditation so the reason provided in the statement does not make sense.

Does anyone know whether programs which are in ACGME pre-accreditation will still participate in the AOA match?

I don't believe this is actually pressure from the ACGME. If anything its a move made by the AOA that puts all the work of protecting residents on the programs themselves. Otherwise, it would be the AOA's responsibility to find spots for all the residents that are caught without an accredited program in July of 2020.

...With this new mandate, programs won't be able to take residents if they won't finish by 2020 if the program does not first apply for ACGME accreditation. So after 2017 no program will be able to take residents unless they have applied for ACGME. From people I have talked to, this mandate snuck up on most programs, and it sounds like not many 5+ year programs are ready to apply, which means they won't be able to take any residents this year.

I wouldn't be surprised if this forces a lot of those programs to make the decision one way or the other. And, I wouldn't be surprised if it nudged those on the fence to apply, but only time will tell.

They honestly should have already been poised to do that. They've known about the merger for over a year and they were just sitting by. What was their plan, to accept residents, who could never finish, without deciding whether or not to actually apply to stay accredited? According to Mad Jack, that's unthinkable, because all PDs are honest, ethical, and organized.

I think some people are insinuating that the PDs will be sneaky and disingenuously apply for pre-accreditation status in order to keep a supply of freshly matched residents on board each year that they will simply abandon once their accreditation sunsets in 2020. Very few hospital boards would be on board with something like that, and most PDs are both ethical and realistic about their chances moving forward. They will keep their jobs until 2020 regardless, so why would they apply for pre-accred status just to dump their residents at the deadline? That's evil, unethical, and largely pointless.

You give PDs a lot more credit than I think is warranted. I've seen PDs repeatedly lie to applicants just for the program to be ranked higher. I'm sure many are honest and ethical, but many also aren't, and are looking out for themselves above all. Then of course you've got a whole slew of ones that are just disorganized or lazy that will delay things until someone forces their hand.

PDs are people, they have the same flaws as others. Many have probably convinced themselves that giving residents even 1 year of training is doing a service to them, regardless of whether those residents will ever be eligible for board certification.

Slight tangent here but does anyone know how long accreditation takes once they've applied for pre- accreditation?

It varies depending on the specific specialty committee. 6mos-1yr minimum is what's being projected. Programs need to apply ASAP. The sooner they apply, the sooner they'll know what they need to do to be accredited. With that info, they can actually decide whether or not it's worth it.

People keep assuming every ACGME program is held to the same standard. They aren't. While there are "some" universal standards, there are always programs that get waivers or have rules bent for them. In addition, some rules on paper can be interpreted in many different ways (what does "devotion to research" mean, "x hrs devoted to program activities", etc. etc. - the wording is purposefully vague). It's the nature of the beast when you're dealing with thousands of programs in very different settings. The only way for AOA programs to really know what they need to do is to apply in the first place. If this policy makes them do it faster, I'm all for it.

I actually agree with YankeeCandle (which blows my mind in and of itself) on the idea that most programs will be willing to fork over the application fee just to see what's going to happen. $10-$15k is actually nothing for almost all of these hospitals. Now will they all spend the millions to be accredited for those that require it, probably not, but they probably want to know how much it'll actually cost. Some won't, but most will.

Also, I wouldn't be surprised if the programs willing to throw in a towel this early in the game, are hospitals that were already considering dropping their residency program. Residency programs are constantly in flux. Some are fragile and collapse pretty quickly at the first sign of trouble or change. One example is the LECOM ophtho program. When the PD passed away, they tried to briefly find a replacement, and then decided it wasn't worth it, sending all the current residents packing. This stuff unfortunately happens.

So there will be a reduction in residency spot then when it's all over...

Its hard to tell. Residency programs on average increase spots by 1-2%/yr. In 5 years that will be close to 5-10%. We'll have to see just how many AOA spots close/open in that time to know what the net spots will be. Even if we assume 30% of AOA spots will disappear (I honestly think that's high), that's only about 900-1000 spots, which is only about 3-4% of the total residency spots.

...I have a better idea: if a student doesn’t believe what those of us are saying, then just ask the PD at your hospital. They’re plugged into what’s happening within their individual OPTIs. See what they say. Don't take the word of some people on an internet forum. It's not an unreasonable question to ask, especially about something that is so critical to your future. Truly, I hope we’re wrong. None of us win when any residency closes down. My personal desire would be to see 100% of all osteopathic residencies successfully navigate the merger.

From what my director of GME has said, all of my hospital's programs intend to apply for accreditation. I also know that 3 of them are already in the process of filling out the paperwork (I know because they're making a few residents do it - ridiculous).

Programs won't roll over for the fee; the fee is the easy part. Programs will shut down because they realize they can't live up to ACGME standards. There is one DO EM program that is reported to be doing just this. A few more may follow. It's just the nature of this transition to ACGME, some programs will not make the cut. Most will be just fine.

I agree.

 

[YankeeCandle1141]

I dont want to quote that^ because its really long, but I think the main reason people assume programs will just give up is the concept of these million dollar changes that they would need to make.

Yes, programs will have to adjust, but under what scenario would it cost millions of dollars?

 

[NMDO]

I also can tell you that more than zero ortho programs have applied. I was physically present when one of them was getting inspected by the acgme people. The information on the AOA website isnt updated very often.

https://apps.acgme.org/ads/Public/Reports/Report/18

Here ya go. Zero ortho programs have applied, there are programs (in other specialties) listed that applied as recently as 8/28/15, so it is up to date. And I was told the same thing by a PD who sits on the ACGME RRC. ACGME people might have been there for an institution review, but not a program review. The earliest they could have applied was 7/1/2015, you think ACGME was that quick in going to do a review?

 

[Mad Jack]

I dont want to quote that^ because its really long, but I think the main reason people assume programs will just give up is the concept of these million dollar changes that they would need to make.

Yes, programs will have to adjust, but under what scenario would it cost millions of dollars?

Minimal teaching staff levels, teaching facilities, call rooms, etc really add up. Most programs are looking at six to seven figure investments to be in compliance. When hospitals are already in the red (as many community hospitals tend to be these days), convincing the board that your program is worth saving versus, say, hiring a dozen midlevels for the same yearly cost, becomes difficult.

 

[Mr. Mojo Risin]

I also can tell you that more than zero ortho programs have applied. I was physically present when one of them was getting inspected by the acgme people. The information on the AOA website isnt updated very often.

I also know of 2 Ortho programs that have applied anecdotally from my friend who has rotated at these programs.