AOA vs. ACGME IM residency, hospital privileges and job opportunities

[yanon]

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I am in the process of deciding between accepting an AOA IM residency spot (in a nice location) versus scrambling for an ACGME IM residency spot (I had very few ACGME residency interviews).

Currently, my main career goal is to become a competent hospitalist and I have no plan of pursuing a fellowship. Thus, my main worry is that completing an AOA IM residency will limit of my chance of obtaining hospital privileges at certain hospitals. Is my worry warranted? Please give me some advice.


Some background information about me.
Passed both Comlex Step 1 (average score) and Step 2 (borderline score) on first attempt. Took Comlex PE (equivalent to USMLE CS) but will not get score back until April, 2010.

 

[Hernandez]

Currently, my main career goal is to become a competent hospitalist and I have no plan of pursuing a fellowship. Thus, my main worry is that completing an AOA IM residency will limit of my chance of obtaining hospital privileges at certain hospitals. Is my worry warranted? Please give me some advice.

Depends on what you mean by "certain hospitals." all I can tell you that a soon to be grad from a AOA IM residency, I'm still getting contacted all the time for hospitalist positions all over the country.

 

[FutureDocDO]

How are you deciding to accept an AOA IM program as the match is over? If you matched you are bind to that program for at least 1 year. 😕

 

[yanon]

Some people (MD attendings, residents, and even some medical students) are telling me that I might have trouble obtaining hospital privileges from academic centers or hospitals in areas with very few DOs if I choose to complete an AOA residency. I have been searching hospital staff directory. I don't see many DO hospitalists working for Kaiser Permanente (a big HMO group in West Coast) and those DOs who are working for Kaiser Permanente usually have ABIM board certification (which means they completed an ACGME residency).

 

[yanon]

How are you deciding to accept an AOA IM program as the match is over? If you matched you are bind to that program for at least 1 year. 😕

Is the match result binding if I haven't sign the employment contract yet? I just don't want all those years of studying and training go to waste. If completing AOA residency does limit my chance of obtaining hospital privileges, then I will have to re-enter the NRMP match next year.

 

[Hernandez]

Is the match result binding if I haven't sign the employment contract yet? I just don't want all those years of studying and training go to waste. If completing AOA residency does limit my chance of obtaining hospital privileges, then I will have to re-enter the NRMP match next year.

Read the fine print. The match is binding......

What happens if I match to a program and decide not to accept the position?

The Match Participation Agreement to which you affixed your password when you registered for the Match states that a match between an applicant and a program creates a binding commitment to accept a position if a match results and to begin training on the date specified in the appointment contract. A decision not to honor that commitment is a breach of the Agreement and will be investigated by the NRMP in accordance with the Policies and Procedures for the Reporting, Investigation, and Disposition of Violations of NRMP Agreements. Penalties may be levied if a violation is confirmed.

Under certain limited circumstances, the NRMP may grant to an applicant or program a waiver of the match commitment if honoring the Match outcome would result in serious and extreme hardship. Waivers must be requested from, and can be granted only by, the NRMP. Click here for additional information on the waiver review process.​

If you wanted to end up in an academic center to practice in, you should have done more research up front. And as far as Kaiser P, I know several AOA board-cert'd DOs who work for Kaiser.

 

[Hernandez]

The consequences of a confirmed violation of this Agreement are set forth in the Violations Policy. They include the following:

7.2.1 Applicants

If the NRMP's investigation of an alleged violation results in a finding that an applicant has committed a violation of this Agreement, the processing of the applicant's rank order list may be interrupted. The NRMP at its discretion may withdraw the applicant from the Matching Program.

If a matched applicant is the subject of a violation investigation, the program to which the applicant matched may not fill the position until the Final Report has been issued and/or a waiver has been granted by the NRMP.

The NRMP's Final Report on the confirmed violation will be delivered to the applicant with copies to: (omitted for brevity)

In addition, the applicant may be barred from subsequent NRMP matches and/or identified as a match violator to participating programs for one to three years or permanently, as determined by the NRMP. The applicant also may be barred from accepting or starting a position in an NRMP match-participating program that would commence training within one year from the date of issuance of the Final Report. Further, any matched applicant who does not accept his/her matched position and has been denied a waiver of his/her match commitment may be barred from accepting or starting a position in an NRMP match-participating program that would commence training within one year from the date of the NRMP's final decision on the waiver.

The decision conveyed in the Final Report will be reflected in the Match Site Applicant Match History for one to three years or permanently, as determined by the NRMP. Term limits of any sanction(s) imposed for the violation will be included to identify the length of time the action is in effect.​

Since you didn't read the agreement the first time, here are the pertinent parts.......

 

[yanon]

Hernandez,

Thanks for the info. I know there are quite a few primary care IM DOs who work in the Kaiser outpatient offices. Any AOBIM-certified DO hospitalist working for Kaiser?

 

[Hernandez]

Hernandez,

Thanks for the info. I know there are quite a few primary care IM DOs who work in the Kaiser outpatient offices. Any AOBIM-certified DO hospitalist working for Kaiser?

Dunno, there aren't any Kaiser hospitals around here, but why would they higher AOBIM primary care and subspecialists, but not hospitalists?

 

[ShyRem]

Why didn't you try for a dually accredited program? There are plenty around... and you could have gone through the AOA match to get into one. Then you would be able to take the ABIM boards and the AOBIM if you wanted.

 

[yanon]

Why didn't you try for a dually accredited program? There are plenty around... and you could have gone through the AOA match to get into one. Then you would be able to take the ABIM boards and the AOBIM if you wanted.

I never thought that having AOBIM certification would limit where I can work. Thus, I didn't take board certification into account when making up my ranklist. I was happy to tell all of my previous preceptors about matching into my number one choice. Then my MD rotation preceptors warned me about some AOA board certified physicians have problems in obtaining hospital privileges from certain hospitals. 🙄

 

[ShyRem]

I've never heard of which boards you take being a limiting factor for employment. it was just a suggestion for doing a dually accredited program.

 

[w a n g]

There was another thread about this issue but it was mostly relevant to surgical fields in certain areas.

As far as I have heard, I dont think being AOBIM certified will make a difference.

Dont risk the scramble.

 

[DrWBD]

I've never heard of which boards you take being a limiting factor for employment.

Shyrem, you actually POSTED in the thread where I brought this issue up (and provided a link to a court decision upholding the right of a hospital to deny AOA-certified physicians hospital privileges).

The thread:
http://forums.studentdoctor.net/showthread.php?t=695677

The court decision (See page 3):
http://courts.michigan.gov/supremecourt/Press/May2005.pdf

 

[ShyRem]

I get the feeling from reading that decision there was something else going on. The hospital routinely grants other osteopathic physicians privileges... and the appeals court upheld the decision based on a different reason. It does not state which board certification the surgeon held, and it is assumed here it is an AOA board certification. The physician also had to give documentation of his equivalency of training, which the hospital asserts he was unable to do. We are not given information regarding his documentation of training. The quoted bit of statute in question is clear. So it seems there is critical information here we are not given.

Bottom line: I'm not buying 100% into the argument based on the brief summary of the case cited. But I'm not a lawyer and I haven't read the decision and brief(s) in their entirety. I'm betting this was a far more complicated situation than the simple question brought earlier in this thread.

Also of note: this case was in 2005. And the plaintiff is listed as appealing. It may very well still be in litigation.

 

[Arch Guillotti]

Interesting link to the pdf file. I am surprised that privileges were restrcited in Michigan of all places where I presume DO's are running around all over the place.

I am not surprised at the general gist of the ruling though. DO's can and do have their practice rights occasionally restricted based on AOA versus ACGME training. I suspect this is more of an issue with surgical and subspecialized fields that with primary care type fields.

 

[DrWBD]

I get the feeling from reading that decision there was something else going on.

This isn't CSI or Law and Order. Are you such an apologist for the AOA that you are just incapable of calling a spade a spade??

The hospital routinely grants other osteopathic physicians privileges...

Yes, because they are ACGME trained, obviously.

It does not state which board certification the surgeon held, and it is assumed here it is an AOA board certification.

There are only two organizations that can accredit MDs and DOs - the ACGME and the AOA. It explicitly states "To be eligible as a staff physician in that department, a candidate must have successfully completed a residency training program approved by the Accreditation Council for Graduate Medical
Education (ACGME)". Again, obviously, if he is a practicing osteopathic surgeon not trained in an ACGME program, he must be AOA trained. Process of elimination. It's not that hard.

The physician also had to give documentation of his equivalency of training, which the hospital asserts he was unable to do.

That is legalese for "We do not recognize AOA training as equivalent to ACGME training". Again, you're going out on a limb to avoid the glaringly obvious truth here.

The bottom line is that yes, there is discrimination based on board certification out there in the real world. Does it happen often? Probably not, especially for primary care. But it is important to be aware that it can happen and that we shouldn't pretend otherwise.

 

[Arch Guillotti]

Agree w/all of the above post (unfortunately).

 

[thesauce]

Is the match result binding if I haven't sign the employment contract yet? I just don't want all those years of studying and training go to waste. If completing AOA residency does limit my chance of obtaining hospital privileges, then I will have to re-enter the NRMP match next year.

Of course the match is binding. If it was just a suggestion, it wouldn't be much use.