AOA RESOLUTIONS!!

[yogi]

I just received this email:

URGENT INTERNSHIP/RESIDENCY UPDATE

1874 (the birth of osteopathic medicine); 1892 (opening of the first
osteopathic medical school); February 11, 2000. What do these dates
have in common? Good question. The first 3 have obvious importance
to the osteopathic medical student, but what is that last one?

The AOA Board of Trustees meeting was held from February 10-12, 2000
in sunny Waikiki, at the Halekulani Hotel. On the agenda ?
osteopathic internship and residency concerns. The AOA is highly
concerned about student?s inability to train in areas where there
are few or no osteopathic internship and residencies. The
Council on Osteopathic Postgraduate Training (COPT) has identified
that there are 600+ too few funded internship positions currently,
with that number expected to grow to 800+ with addition of graduating
classes from PCSOM and TUCOM.

Dr. Eugene Oliveri has declared this year as ?The Year of the
Student?, and has pledged to listen to student concerns. At the
start of the Board meeting, he reaffirmed his commitment, and urged
the Board members to be proactive. The Board identified student
concerns; the desire for quality training in all areas of medicine,
the need for strong osteopathic components to our training, and the
im-portance of allowing students to train in any geographic area that
they desire.

To accomplish this Herculean feat, the COPT presented three
resolutions to the Board that directly impact students.

Resolution 28:
RESOLVED, that in collaboration with ACGME, a six-year pilot
project be approved to develop AOA-approved internship programs
within existing ACGME Transitional Year Residency programs, in which
the required core clinical experiences are offered for osteopathic
interns for the training year beginning July 1, 2001. The AOA-
approved positions would be offered as osteopathic allocated
positions from within the ACGME approved programs and selected and
approved by AOA ECCOPT based on quality and such other factors that
the COPT determines to be appropriate.

This resolution creates a great number of dual-approved internship
slots for the class of 2001 and beyond, particularly in geographic
areas of osteopathic shortage. Stay tuned for details of this program
? as presented by COPT.

Resolution 29:
RESOLVED, that osteopathic graduates applying to fulfill AOA
matching internship requirements through the collaborative AOA/ACGME
pilot project track may be permitted to enter and be selected through
the NRMP (?match program?) after registering with an AOA Intern
Registration Program.

This states that in order to take advan-tage of these new internship
positions above, a student must register with the AOA, and then may
go through the MD match.

Resolution 37:
RESOLVED, that the following revisions to the Basic Documents
for Postdoctoral Training be APPROVED.

XI. Protocol For Approval Of Intern Training

C. APPROVAL OF AOA INTERNSHIP REQUIREMENTS FROM ACGME TRAINING: ANY
COM GRADUATE, BEGINNING POSTDOCTORAL TRAINING AFTER MARCH 6, 1999,
FOR A PERIOD OF 6 YEARS, SATISFACTORILY COMPLETING THE REQUIRED CORE
ROTATIONS OF THE AOA ROTATING INTERNSHIP TRACK WITHIN AN ACGME
ACCREDITED
PROGRAM WILL BE APPROVED AS MEETING AOA INTERNSHIP
REQUIREMENTS DURING THAT PGY1 TRAINING YEAR WITH THE FOLLOWING
CONDITIONS MET:

1. MUST MAINTAIN AOA MEMBERSHIP
2. MUST BE REGISTERED WITH AOA POSTDOCTORAL DIVISION (AT NO COST TO
THE TRAINEE)
3. MUST PARTICIPATED IN OSTEOPATHIC INTERACTIVE OR CME EDUCATION
WHICH MAY INCLUDE ANY OF THE FOLLOWINGT OPTIONS:

A. REGISTRATION WITH A REGIONAL OPTI AND PARTICIPATE IN AN OSTEOPATHIC
EDUCATIONAL COMPONENT GENERATED AND OFFERED BY THE OPTI
TO INCLUDE OPP/OMM TRAINING AND ANY OF THE FOLLOWING:
1.) CLINICAL ELECTIVE ROTATIONS OR
2.) INTERNET/DISTANCE LEARNING OR
3.) CLINICAL/OMM-OPP TRAINING MODULES.

B. ATTENDANCE AND PARTICIPATION AT AOA-APPROVED CATEGORY 1-A CME OF
TWENTY-FIVE (25) HOURS WITH AT LEAST EIGHT (8) HOURS OF OPP/OMT

4. MUST MAKE AN ANNUAL OSTEOPATHIC CLINICAL PRESENTATION TO THEIR
RESIDENCY PROGRAM AND SUBMIT A WRITTEN COPY TO THE AOA OR SUBMIT A
PAPER TO THE AOA SHOWING THE APPLICATION OF OPP/OMT TO THEIR SPECIALTY.

5. IN THOSE CASES COM-PLETED THROUGH THE OPTI, MONITORING AND
REPORTING WILL BE CON-DUCTED BY RESPECTIVE OPTI?S AND REPORTED TO THE
AOA

6. IN THOSE CASES COM-PLETED THROUGH AOA/CME, MONITORING WILL BE
CONDUCTED BY AOA/CME.

This is a big one, folks. The AOA Board of Trustees has come forward
and said that they have faith that we will continue our osteopathic
training. In the spirit of Unity, the Board has just stated that
they believe that we are the future of osteopathic medicine, and they
have put the reigns for that future squarely in our hands.

Ok, so what does this mean now? Well, it states that students who
can not do osteopathic training FOR WHATEVER REASONS, may do ACGME
training and get AOA Approval for that training. This has
tremendous implications for students, particularly those in the small
or emerging states. Many students have been feeling the crunch of
having to do AOA training in areas where there is none. No more.

But there is a price. Most obviously is the task of completing the
requirements above. These requirements are no walk in the park.
Time is limited, particularly in the internship/residency years. The
requirements will ensure that we get a solid osteopathic training at
ACGME sites, but we will have to complete this additional training on
our own, in addition to our residency requirements. We still need
to do the rotations required of the rotating internship, i.e. FP, IM,
Peds, Surg, and Women?s Med/OB. And the burden is on the student to
ensure that all of the applications and proof of completion are done
to the satisfaction of the AOA. In areas that have sufficient AOA
internships and residencies, the AOA route is certainly preferable.

More subtly are the expectations that the Board has now placed on
us. We students need to keep our osteopathic distinctiveness
alive. That means that we need to continue filling our osteopathic
training positions. In the spirit of Dr. Oliveri?s osteopathic
unity, we must increase our levels of involvement. The AOA has
challenged and invited us to be leaders in our organization, and we
need to accept the challenge. We need to support the Unity Campaign,
not just monetarily but with our actions. We also need to support
OPAC, the osteopathic political action committee in order to ensure
that we stay viable with the changing political environment.

We are now partners in the osteopathic profession. We can?t think of
ourselves as students any longer, we have to see of ourselves as part
of the larger picture. The AOA has made its commitment to us ? let?s
make our commitment to the AOA and to the osteopathic profession.

Incidentally, the Board of Trustees also approved yet another
Resolution, one that students did not even request.

Resolution 60:

RESOLVED, that a Task Force with representation of all affected
parties be appointed to study the issues related to acceptance of
ACGME training as an osteopathic internship and report back to the
AOA Board of Trustees within one year; and be in further

RESOLVED, that the special exception policy be reinstated for a
period of one-year, or until such time as the AOA Board of Trustees
approves an alternative.

This states that the Board has also rein-stated the old hardship
resolution 19 as yet another avenue for students to get AOA approval
for ACGME training.

I implore you all to think carefully on all that I presented here. I
can?t explain the feeling that I had when the Board unanimously
approved Resolution 37 ? it was an unprecedented event. Its up to us
now to take the trust that they have shown in us and to do our part
to unify the profession.

Please continue to support the AOA and Osteopathic Unity.

Please continue to give our training facilities every consideration,
whenever even remotely possible.
And please do everything in your power to strengthen osteopathy in
every way that you can ? locally and globally.

As always, if you have ANY questions or considerations, please
contact your student government president. This is a heavy topic,
please discuss it liberally.

Respectfully Submitted,


Kevin J. Mulroy
Chair, Council of Student Council Presidents
Student Representative to the Board of Trustees

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[yogi]

When will we find out which programs are available? Does this mean
that I
can apply to a rotating internship at Harvard and it will get approved?
Will I still have to provide proof that I have a hardship that prevents
me
from going to an AOA program? This type of information is essential to
MIIIs as we plan our electives at institutions we would like to train at.
As I am interested in doing an AOA
internship (so that I can get liscenced in in the 5 states) followed by an ACGME
IM residency, I currently will have to do an extra year unless I go to a
dually approved program. Now, as I see it, I could go practically
anywhere and fulfill the AOA reqirement and probably be accepted as a
PGYII in an ACGME IM program. The opinion is stated in the message that the osteopathic part of the training will be no easy task, but it sounds like a breeze compared to
doing an extra year. Why would I bother going to an osteopathic program
when I could go to some big-name allopathic institution. Plus, it sounds
like the osteopathic training will be very comprehensive via CME. I just spent 7
months doing rotations at an osteopathic institution and I only saw
OMM
used once, and did not receive any OMM education whatsoever-again what's
the point? If the amount of Osteopathic priciples and manipulation
emphasized is so minimal at OPTIs, then what are their selling points?
Our future is on the line, and why should we settle or have to do an
extra
year of training (which means mega bucks of extra interest added to my
mega loans).

 

[RollTide]

This is the single most important post I have read here at studentdoctor.net and I am trying to hold back my excitement long enough to post my views on the subject. Although I will only be a first year student next year I have spent a great deal of time looking into internship and residency programs and even contacting and speaking with a couple of residency directors at local programs. My primary concern has been in following the guidelines set forth by the AOA in order to both further my understanding in osteopathy and also remain loyal to the AOA in order to obtain board certification and stay active in the issues of our profession. My secondary concern was in eventually returning to my state of residence where there is a small but dedicated group of osteopathic physicians but zero AOA approved residency positions. This news, if true, may give me the opportunity to both mantain my osteopathic distinctiveness and return to the state that I wish to practice medicine in for residency. I am of the opinion that the AOA has always attempted to look out for the best interest of its members and I have heard whisperings of this news for some time but had no idea of how large these changes where going to be.

osteopathically proud,

-Joshua

 

[drusso]

If the AOA passes these resolutions, it will demonstrate that the folks in Chicago trust DO students with their own career decisions, a novel concept. Let's hope that they do. Being an osteopathic physicians means many things to many people, it shouldn't only mean having trained in an osteopathic hospital.

 

[turtleboard]

Something I didn't expect from the "old guard" AOA. Looks like things are a-changin' for the osteopathically-inclined. Good stuff.


Tim of New York City.

 

[DO Boy]

Forgive me for my ignorance about all this blah blah residency stuff but...

Does this mean that within ACGME programs there will be a development of more residency slots that are AOA approved in areas where there aren't many AOA residencies (like Texas)? For example, if Baylor Neurosurgery takes one resident/yr, it would now take two (one AMA and one AOA) as a result of these resolutions?

OR...Does this mean that DOs must still go through the allopathic match (with all its discrimination against DOs -- don't tell me this doesn't exist in many residencies), and if accepted, the residency will be approved by the AOA and the AMA at the same time pending completion of AOA requirements?

This whole dual-accreditation, ACGME to AOA residency approval process via the AMA NMRP "match program" by direct petition and completion of AOA requirements for areas deprived of AOA approved osteopathic residencies pilot program is so frickin complicated.

Why don't they just approve more AOA slots (e.g. new AOA slots or approve more AOA slots alongside allopathic residencies -- no one really uses OMT anyway even in osteopathic hospitals. Don't get mad at me about that.)?

I don't know whether I should be cheering "hoooray! one step further for DOs!" or grumbling "more extra steps DOs have to do to remain accredited. All this besides deicding on AOA rotating internships, AOA approval to practice in at least 5 states and teach, dealing w/two state medical licensing boards and not to mention taking the USMLE and COMLEX back to back"

What in the world is going on?


Still confused about my future as a DO,
DO Boy

 

[PCSOM2002]

What this means is that if you match into an ACGME program, you can get your first year of that program AOA approved as an internship if you meet criteria listed in the resolutions. This does not mean that the ACGME program will add more slots just for the DO students. You will still go through the NRMP Match just like before. This was implemented to give students who wanted to practice in states that had no osteopathic training programs an opportunity to do residencies in those states yet still have an avenue to be active members in the AOA with full benefits. This does not mean that it is only for those students. It can be used by anybody, but if this gets abused, I see the AOA going back to the old way very quickly. I am from a state, and want to practice in a state that has no osteopathic programs whatsoever, and there are only 3 programs with a total of 8 positions available for osteopathic students in a 5 state surrounding area. This is excellent for me and others in my situation. I would be exstatic if I had the opportunities that are available in Texas, internship-wise, of course.
The AOA cannot just create more internship and residency positions at will. First, the number of residency positions are tightly controlled by the federal government, after all, they will pay the majority of your salary. Postgraduate training is funded primarily through Medicare. Second, the hospitals must be willing to have residency programs affiliated with them and more and more hospitals are being controlled by managed care which somtimes does not want that extra burden of a "training hospital." These are only a few reasons for the limited number of AOA positions.
I personally think the AOA has taken a very good step in this resolution. It will only continue to show the allopathic profession that we are just as capable as they are of delivering good quality healthcare. If you look back into the history of the profession, the osteopathic profession really started gaining acceptance when allopathic programs began taking DO students in earnest. They saw then that our training was equal to theirs, and once again this new avenue will only continue to increase that awareness. However, we must not abuse it.


[This message has been edited by PCSOM2002 (edited 02-16-2000).]

 

[siulrc]

I think this is an step inthe right direction. It gives us the opportunity gain a more diverse clinical experience. It makes me very happy that AOA has recognize the need for more opportunities and choses in intership and residencies. Now is up to all of us to be responsable to the profession that its giving us this wonderful opportunities to do what we want as professional to enhance the osteopathic field and put it in the forefront of healthcare. We have to be committed to keep our distintion as osteopathic physicans ann go crazy with the allopahtic field that we might loose track of our roots in the osteopathic filed. This a great opportunity to show to everybody that we are excellent physicians. Thank you AOA for taking our claims seriously and more so doing something about it. This is a great day for osteopathic medicine.

------------------
siul

 

[DO Boy]

Well, yes I agree, these new resolutions must not be abused.

I figured someone would tell me that it's not up to the AOA to increase the number of AOA residency slots but rather the federal gov't. I guess I was a little too optimistic.

Well, I guess, I should be saying, "Great". So, way to go AOA! Let's keep up the the good work and dedication to the students -- the future of osteopathic medicine!

DO Boy

 

[supyo]

This is my first time replying to this forum, but I often read the responses posted. This new resolution as well as my rotations have raised many questions about internship/residency. I am a third year student. I plan to do res/intern in Michigan, where there are plenty of internship opportunities. Does this new resolution mean that even programs in this area that are ACGME approved will be approved by the AOA (if you do these other things specified) or is this only for areas which have limited osteopathic opportunities?

A second question that I have is regarding ACGME residency. Lets say that I decide to do an AOA approved traditional internship and then proceed to an ACGME residency. Do I apply for the residency in the fourth year of med school or during internship? Do you apply as PGY1 or PGYII?

totally confused

 

[rtk]

Okay, this is a step in the right direction for the AOA, however it appears that it's simply a token resolution... Let me explain my concerns:

1) This resolution offers an alternative for students who want to train at locations where there are no AOA internship sites (and there are many). Realistically, this policy change places the onus on the DO trainee when it is, in fact, the AOA that has created a problem by graduating more DO's than they have post-graduate positions. The responsible policy change that the AOA could make to the internship requirement would be to: (a)create more intership positions so all graduates could get 'good' training through the AOA -or- (b)ammend their intership requirement guidelines -or- (c)decrease the number of medical students admitted to DO schools each year to match the number of available AOA intership positions. This resolution is simply the easiest way out for the AOA.

2) This policy change doesn't address the concerns that many new grads have regarding funding for residency. Whether a DO grad does an extra year through an AOA internship or an ACGME trasitional year, funding through Medicare is still regulated to the number of years required to become board eligible for the particular specialty the medical grad is ultimately enrolled. Sure, there are occasionally PGY-2 positions available in a specialty of interest but with many fewer options than there are for PGY-1 spots. This is yet another way DO's are disadvantaged to MD's in competition for the best residency spots.

3) On paper, the policy offers options for DO's that weren't available before but in practice it places huge demands on already 'maxed-out' time schedules. In my personal experience with first year of residency, I would have had no time (or energy) to meet the extra requirements for CME and presentations (as well as all the extra paper work and travel expenses). Sure I had two weeks of vacation, but after 90 hour weeks and 2-3 call shifts per week, those 14 days off were sacred.

In my opinion (remember this is an opinion) the AOA's requirement for an AOA internship after graduation has outlived its usefullness. The original policy was created in a time when undergraduate osteopathic medical training lacked adequate clinical experiences. Sure, it is a good policy in theory, allowing addition training in all specialties (kinda like repeating 4th year of medical school) making for a more 'well rounded physician'. However, currently with rising medical student debt, changes in GME funding policies, advancement of osteopathic medical training to be on par with allopathic training, and the general lack of OMT training in any GME site (be it AOA or ACGME) the AOA should ammend the requirement for Internship training and lobby states that require an AOA internship for DO liscensure to drop the requirement.

As the AOA pushes for 'Osteopathic Unity', it should also ammend the policy that splits the DO community at the beginning of their training.

 

[ms]

This only means that you can to a rotating internship (traditional program) at a acgme accredited program. Which means you now have more options to go for a rotating internship. This does not allow you to do a surgery internship at ACGME program and have it count toward the AOA rotating internship requirement.

Few if any traditonal programs(rotating internship)fill by MDs because the traditonal program does not lead to anything. A few MD take this program as a prelim year, instead of one year of either surgery or medicine.
Certain specialities require one prelim year prior to going into their field(example optho and derm)

Accordingly, there should not be any major competition for the ACGME approved traditional program(rotating internship)

If you wanted to to a IM residency after an ACGME approved rotating internship, only time spend in IM and maybe ER during an acgme approved rotating internship would count toward the IM residency. Thats maybe 3 months and this reduction has to be approved by the program director of the IM residency and by the American board of Internal Medicine.

 

[PCSOM2002]

I hope I hit all issues put forth above. First, after discussions today with a certain administrator at our school it appears that this option will be open only to those people who want to do a residency and practice in a state that has either none or only a few osteopathic programs in that state. Therefore, states like Ohio, Michigan, Pennsylvania, etc. would not be options for this program. Secondly, you can complete your first year residency in anything as long as you can meet the requirements listed in the resolution. Surgery would be an option, but you would have to get the program to allow you to complete the required rotations in FM, IM, Peds, Surgery, and OB/GYN. If you are going into a FM or IM program this should not be too big of a problem. The preliminary positions issue was included in a separate resolution by the AOA. This resolution states that the AOA in conjunction with the ACGME preliminary programs will look into the feasibility of making some of those positions AOA approved. This would give the AOA more positions and fill those slots for the training hospitals. These are just my opinion on the resolutions after having discussed them with others.
I believe that if you did an AOA internship and wanted to transfer to an ACGME residency you would have to go through the same process as always. The ACGME program might give you some or total credit for your internship. It total, then you are a PGY2 if partial credit, then you will be a few months behind your counterparts in finishing your residency. Once again, my opinions.

 

[UHS2002]

Did the AOA make a "terminology mistake" when it specifically stated "transitional year" in its resolution?!

Transitional year, as it was already pointed out, is the ACGME equivalent of an AOA rotating internship, and not a PGY1 position at whatever residency program you chose to attend. Which would mean, IMHO, that, unless you were going for an ACGME program that only accepted students at the PGY2 level to begin with, isn't going to make a huge difference in changing the problems already discussed on this board in regards to ACGME programs, AOA rotating internship and funding.

An AOA official has already graciously participated in other discussion on this board. I would be interested in hearing whether from the AOA if the resolution really means "transitional year" or any PGY1 ACGME residency position.

I would also like to know, from those of you who are currently in a residency program, if it is at all feasible to fit the completion of the "extra requirements" in your program. For instance, if you are in an IM program, would you really have time to fulfill the OB/GYN and Surg requirements???

 

[ms]

If you do a ACGME prelim year the only program that would be like a transitional program would be a family practice residency program.

You would not be able to do surgery, peds, and OB/gyn at an ACGME approved IM program. The requirements are strict and do not allow for time to rotate through these specialities.

This is true of other ACGME programs like surgery and ob/gyn you will not be able to rotate through other specialties in order to complete the AOA requirments of a rotating internship,

 

[yogi]

If I want to do an ACGME IM residency and still get AOA internship approval, what's the best way? If I go to an ACGME transitional year, the funding still won't be there?!?! Will I be stuck after that year? OR will they be happy to take me into the IM program, with a certain amount of credit toward the completion of the residency?
Given my above goal, where should I do my elective "audition" rotations? I had originally assumed that I would have to repeat a year, so I was going to rotate at a few places where I'd want to do an AOA internship, and a few ACGME places I'd like to go after the internship. Now, should I go to all ACGME places?

These are BIG, TOUGH decisions!