Email the acgme regarding new changes!

[MaximusD]

You can sue for anything, but that doesn't mean you'll win. What we have here on one hand is that no MD has ever completed an AOA residency, however many, MANY DO's having completed their AOA internship or residency have gone on to successfully complete ACGME residencies and fellowships.

Frankly, I think that all of this ugliness is unnecessary and counterproductive. This all seems very archaic and backward to me -- as it should to all objective observers outside of the medical field.

And i agree re: AOA internships and residencies... should be open. I also think that there should be no COMLEX as it exists today (only the USMLE plus a small supplemental OMT-rich exam containing discrete OMT questions AND OMT-integrated medical questions) so that everyone is on even footing and DO students don't have to pay for and study for extra exams when they seek competitive specialties... Would certainly prove that we're all receiving the same caliber of education, wouldn't it, if every DO student passed the USMLE... would also have a role for the AOA and NBOME to continue to play...

But I do recognize, as the ACGME has, that by keeping your residencies completely open you limit your own graduates' opportunities. USMD student and FMGs will absolutely reduce the overall AOA number of spots... it will begin as filling unfilled spots but will eventually, especially with the increase in DO matriculants, reduce opportunity for DOs. This is a major concern.

That is why I am avoiding that argument above -- it is hard to deny that there is a precedent for DOs succeeding in ACGME programs after completing AOA training. That is why the ACGME will have to justify this change because they are denying a career pathway and opportunity based on...what exactly? And that's precisely the question they would have to answer if this was escalated. In what measurable way is AOA training inferior -- yes we know that by-and-large the training is at smaller institutions with less focus on research, but does this translate into a less qualified or poorly trained physician? Are clinical outcomes worse in these individuals to justify the additional expense of having AOA internship trainees repeat their internship (paid for by tax dollars)....

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[scotchtapetest]

You can sue for anything, but that doesn't mean you'll win. What we have here on one hand is that no MD has ever completed an AOA residency, however many, MANY DO's having completed their AOA internship or residency have gone on to successfully complete ACGME residencies and fellowships.

Frankly, I think that all of this ugliness is unnecessary and counterproductive. This all seems very archaic and backward to me -- as it should to all objective observers outside of the medical field.

And i agree re: AOA internships and residencies... should be open. I also think that there should be no COMLEX as it exists today (only the USMLE plus a small supplemental OMT-rich exam containing discrete OMT questions AND OMT-integrated medical questions) so that everyone is on even footing and DO students don't have to pay for and study for extra exams when they seek competitive specialties... Would certainly prove that we're all receiving the same caliber of education, wouldn't it, if every DO student passed the USMLE... would also have a role for the AOA and NBOME to continue to play...

But I do recognize, as the ACGME has, that by keeping your residencies completely open you limit your own graduates' opportunities. USMD student and FMGs will absolutely reduce the overall AOA number of spots... it will begin as filling unfilled spots but will eventually, especially with the increase in DO matriculants, reduce opportunity for DOs. This is a major concern.

That is why I am avoiding that argument above -- it is hard to deny that there is a precedent for DOs succeeding in ACGME programs after completing AOA training. That is why the ACGME will have to justify this change because they are denying a career pathway and opportunity based on...what exactly? And that's precisely the question they would have to answer if this was escalated. In what measurable way is AOA training inferior -- yes we know that by-and-large the training is at smaller institutions with less focus on research, but does this translate into a less qualified or poorly trained physician? Are clinical outcomes worse in these individuals to justify the additional expense of having AOA internship trainees repeat their internship (paid for by tax dollars)....

Let's say we go ahead and abolish COMLEX, then what are you going to suggest when 5-years down the road, NBME says we are not going to let DOs sit for USMLE anymore? Are you just going to get on SDN and tell people to go sue NBME while our graduates won't be able to get licensed?

Also, all of the Caribbean grads pass the USMLE; I don't think anyone argues that their education is equivalent to USMD just because they've passed the USMLE...

 

[DocEspana]

Actually the nbme is unable to restrict who takes the test. So that is not a concern. They have no vested interest except confirming the identity of the test taker and earning money.

 

[scotchtapetest]

Actually the nbme is unable to restrict who takes the test. So that is not a concern. They have no vested interest except confirming the identity of the test taker and earning money.

What are you talking about? So, can anyone with proof of identity take the USMLE? Or do they have to meet some criteria (e.g. being a medical student/grad)? Whoever defined US medical student as LCME & AOA students can redefine it as LCME only students!

 

[DocEspana]

Anyone with proper ID cab take it. That is correct. Absolutely no requirement to be a medical student. You would apply directly as an independet student (generally this is reserved for people with chips on their shoulders and physicians who chose to take a job outside of residency and 5 years later have to retake their first two exams to qualify to reenter the resident match. But totally open to non students through this method)

 

[scotchtapetest]

Anyone with proper ID cab take it. That is correct. Absolutely no requirement to be a medical student.

Wow! What year are you? Because you obviously have no clue what you are talking about and have never registered for any board exams!

www.usmle.org/bulletin/eligibility/

 

[DocEspana]

Wow! What year are you? Because you obviously have no clue what you are talking about and have never registered for any board exams!

www.usmle.org/bulletin/eligibility/

Third year. and its already been done where NPs have sat for the usmle step 1 to make thia point. They had to apply directly. They were allowed. Did you ever notice that you had to apply through a seperate organization? Not the nbme legal entity? Cause I did both times I registered for steps 1 and 2. You can also apply directly. Been done many times for people who dot fit the specific requirements laid forward in your link.

 

[scotchtapetest]

Anyone with proper ID cab take it. That is correct. Absolutely no requirement to be a medical student. You would apply directly as an independet student (generally this is reserved for people with chips on their shoulders and physicians who chose to take a job outside of residency and 5 years later have to retake their first two exams to qualify to reenter the resident match. But totally open to non students through this method)

See now you went back and changed your original post!

1) They went to medical school! You can't just show up, pay the fee and take the exam; you have to meet SOME defined criteria (whatever that may be) and they are subject to change!

2) My argument was that there are rules for taking the USMLE and those rules can be changed as evident by recent ACGME move. Therefore, getting rid of COMLEX is a BAD idea!

 

[Dharma]

Third year. and its already been done where NPs have sat for the usmle step 1 to make thia point. They had to apply directly. They were allowed. Did you ever notice that you had to apply through a seperate organization? Not the nbme legal entity? Cause I did both times I registered for steps 1 and 2. You can also apply directly. Been done many times for people who dot fit the specific requirements laid forward in your link.

I love your posts man... but you have to change that new avatar. Although those who frequent the East Village will love it.

Keep up the awesome posts bro. Glad to see you're reppin' da BK now.

 

[DocEspana]

Playing a game of thrones themes thing in another part of SDN. I like to get in the spirit of it all. Expect some play on my usual Spain and bulls theme soon.

 

[Dharma]

Playing a game of thrones themes thing in another part of SDN. I like to get in the spirit of it all. Expect some play on my usual Spain and bulls theme soon.

I don't have HBO (not even Netflix) anymore, so I'm out of the loop. I hear the books are good.

sorry for the slight thread jacking. recommence with the usual...

 

[MaximusD]

Let's say we go ahead and abolish COMLEX, then what are you going to suggest when 5-years down the road, NBME says we are not going to let DOs sit for USMLE anymore? Are you just going to get on SDN and tell people to go sue NBME while our graduates won't be able to get licensed?

Also, all of the Caribbean grads pass the USMLE; I don't think anyone argues that their education is equivalent to USMD just because they've passed the USMLE

1. The MDs wouldn't prevent us from sitting for the USMLE. They haven't prevented the FMGs from doing so -- why would they prevent us? You can point to what's currently happening and claim that it is MDs trying to box DOs out, but the reality is that they're trying to say DO GME is inferior and not to the same standards. It is an entirely different argument altogether -- one that I feel, by the way, is not supported by any real clinical endpoints (which is the crux of my argument above).

2. If an FMG took a FMG-specific equivalency exam, would you be more inclined or less inclined to think they were well qualified than if they had taken and passed the USMLE steps? Our goal isn't to make the DO and MD degrees seem equivalent. They are inherently slightly different. What we should want is professional equivalence both practical and perceived. Taking the exact same licensure exam would create that in general perception and practically with program directors of residency programs. I challenge you to refute this basic assumption.

Your post is a huge embarassing failure. Try again.

 

[scotchtapetest]

1. The MDs wouldn't prevent us from sitting for the USMLE. They haven't prevented the FMGs from doing so -- why would they prevent us? You can point to what's currently happening and claim that it is MDs trying to box DOs out, but the reality is that they're trying to say DO GME is inferior and not to the same standards. It is an entirely different argument altogether -- one that I feel, by the way, is not supported by any real clinical endpoints (which is the crux of my argument above).

2. If an FMG took a FMG-specific equivalency exam, would you be more inclined or less inclined to think they were well qualified than if they had taken and passed the USMLE steps? Our goal isn't to make the DO and MD degrees seem equivalent. They are inherently slightly different. What we should want is professional equivalence both practical and perceived. Taking the exact same licensure exam would create that in general perception and practically with program directors of residency programs. I challenge you to refute this basic assumption.

Your post is a huge embarassing failure. Try again.

Your last line was a nice touch. I'm glad we can have a civilized discussion!

AMA et. al would love nothing more than to get rid of DOs as evident by 100+ years of history of osteopathic medicine in the US. Not because of any principles but because they would love to have a monopoly (even more than what they currently have). FMGs who match are MDs and therefore, under their umbrella and it doesn't affect their control/monopoly.

Right now, preventing us from taking the USMLE only equals to loss of revenue because we don't need USMLE to get licensed. However, if we didn't have our own licensing exam, by preventing us from taking the USMLE, their goal to get rid of DOs can easily become realized. All I'm saying is that under no circumstance should we lose our autonomy in any situation (board exams/OGME/Licensing/etc.).

Also as I mentioned ACGME move wasn't about DOs and OGME but it was a move to prevent FMGs who use exemptions (based on length of practice) from obtaining advance ACGME residencies and unfortunately their actions also affected DOs. At least that's what they claim! And BTW I agree with your arguments about OGME. My only disagreement is with your statement regarding COMLEX.

Your second argument fails because as I said before having FMGs take the same licensing exam (i.e. USMLE) has not helped them with their perceived educational quality so you can't make the argument that by passing USMLE somehow people are perceived differently. AMGs with 85/85 USMLE scores are almost always preferred over FMGs with 99/99 on the USMLE by the PDs. Furthermore, a Harvard grad with a 85/85 is perceived better than some random state university grad with a 85/85. Do I agree with that? No; Is it a fact? Yes!

 

[MaximusD]

Your last line was a nice touch. I'm glad we can have a civilized discussion!

AMA et. al would love nothing more than to get rid of DOs as evident by 100+ years of history of osteopathic medicine in the US. Not because of any principles but because they would love to have a monopoly (even more than what they currently have). FMGs who match are MDs and therefore, under their umbrella and it doesn't affect their control/monopoly.

Right now, preventing us from taking the USMLE only equals to loss of revenue because we don't need USMLE to get licensed. However, if we didn't have our own licensing exam, by preventing us from taking the USMLE, their goal to get rid of DOs can easily become realized. All I'm saying is that under no circumstance should we lose our autonomy in any situation (board exams/OGME/Licensing/etc.).

Also as I mentioned ACGME move wasn't about DOs and OGME but it was a move to prevent FMGs who use exemptions (based on length of practice) from obtaining advance ACGME residencies and unfortunately their actions also affected DOs. At least that's what they claim! And BTW I agree with your arguments about OGME. My only disagreement is with your statement regarding COMLEX.

Your second argument fails because as I said before having FMGs take the same licensing exam (i.e. USMLE) has not helped them with their perceived educational quality so you can't make the argument that by passing USMLE somehow people are perceived differently. AMGs with 85/85 USMLE scores are almost always preferred over FMGs with 99/99 on the USMLE by the PDs. Furthermore, a Harvard grad with a 85/85 is perceived better than some random state university grad with a 85/85. Do I agree with that? No; Is it a fact? Yes!

I posed a basic question to you, and you dodged it and then repeated the same point you already made. If FMGs took a ECFMG licensure exam instead of the USMLE, do you think their acceptance level into residency would be helped or hindered?

 

[scotchtapetest]

I posed a basic question to you, and you dodged it and then repeated the same point you already made. If FMGs took a ECFMG licensure exam instead of the USMLE, do you think their acceptance level into residency would be helped or hindered?

I don't think it would be affected at all! Regardless of what exam they take, AMGs are preferred over FMGs. end of story! Again is it right? Probably not. Factual? Yes!

Some programs take a certain number of FMGs and they will continue to take them regardless of what exam they take to fill their spots.

 

[MaximusD]

AMA et. al would love nothing more than to get rid of DOs as evident by 100+ years of history of osteopathic medicine in the US. Not because of any principles but because they would love to have a monopoly (even more than what they currently have). FMGs who match are MDs and therefore, under their umbrella and it doesn't affect their control/monopoly.

Right now, preventing us from taking the USMLE only equals to loss of revenue because we don't need USMLE to get licensed. However, if we didn't have our own licensing exam, by preventing us from taking the USMLE, their goal to get rid of DOs can easily become realized. All I'm saying is that under no circumstance should we lose our autonomy in any situation (board exams/OGME/Licensing/etc.).

This is your perception but you can only really back it up by pointing to the CA debacle in the 70's and that was at one isolated instutition. The rest of it is based on fear of the unknown. MAYBE the AMA is out to get the DOs or maybe they are just ambivalent to our success. The two can be mutually exclusive.

Also as I mentioned ACGME move wasn't about DOs and OGME but it was a move to prevent FMGs who use exemptions (based on length of practice) from obtaining advance ACGME residencies and unfortunately their actions also affected DOs. At least that's what they claim! And BTW I agree with your arguments about OGME. My only disagreement is with your statement regarding COMLEX.

Your second argument fails because as I said before having FMGs take the same licensing exam (i.e. USMLE) has not helped them with their perceived educational quality so you can't make the argument that by passing USMLE somehow people are perceived differently. AMGs with 85/85 USMLE scores are almost always preferred over FMGs with 99/99 on the USMLE by the PDs. Furthermore, a Harvard grad with a 85/85 is perceived better than some random state university grad with a 85/85. Do I agree with that? No; Is it a fact? Yes!

And to address your final point, I care less about the osteopathic profession than I do about individuals receiving the osteopathic degree. Perhaps this is where we diverge. I don't care about the perception of DOs, because that is something that cannot be directly addressed. People will always have prejudices and reasons to look down on others -- many DO colleagues of mine look down at FMGs. FMGs that come to the US probably look down at their colleagues who didn't (ETC ad nauseum).

My focus is that individuals who receive the DO degree should be afforded the ability to compete to any level with those receiving MD degrees. On an individual basis, there is no question -- DOs who have taken the USMLE have a greater degree of acceptance into ACGME programs. Can you challenge this? These individuals are forced to pay for two full series of exams. This is a travesty, and it favors the preservation of a profession over the interests of individuals, which is just not something I can get on-board with. I love being a DO, but I don't think that the preservation of the profession is more important that our graduates. I think the PRESERVE THE PROFESSION mentality coupled with its rapid irresponsible expansion will be the undoing of the osteopathic profession -- which will be a sad day for me. I think we can best preserve the integrity of our profession by doing the best for its members. This is a shift in focus that I wish many of my colleagues would accept.

 

[MaximusD]

I don't think it would be affected at all! Regardless of what exam they take, AMGs are preferred over FMGs. end of story! Again is it right? Probably not. Factual? Yes!

Some programs take a certain number of FMGs and they will continue to take them regardless of what exam they take to fill their spots.

lol you're being ridiculous. If FMGs didn't take the USMLE, they wouldn't get into residency programs at all. Forgive me but I am laughing at this argument as it's absurd. No matter how small a positive number is, it's still greater than zero.

 

[scotchtapetest]

This is your perception but you can only really back it up by pointing to the CA debacle in the 70's and that was at one isolated instutition. The rest of it is based on fear of the unknown. MAYBE the AMA is out to get the DOs or maybe they are just ambivalent to our success. The two can be mutually exclusive.



And to address your final point, I care less about the osteopathic profession than I do about individuals receiving the osteopathic degree. Perhaps this is where we diverge. I don't care about the perception of DOs, because that is something that cannot be directly addressed. People will always have prejudices and reasons to look down on others -- many DO colleagues of mine look down at FMGs. FMGs that come to the US probably look down at their colleagues who didn't (ETC ad nauseum).

My focus is that individuals who receive the DO degree should be afforded the ability to compete to any level with those receiving MD degrees. On an individual basis, there is no question -- DOs who have taken the USMLE have a greater degree of acceptance into ACGME programs. Can you challenge this? These individuals are forced to pay for two full series of exams. This is a travesty, and it favors the preservation of a profession over the interests of individuals, which is just not something I can get on-board with. I love being a DO, but I don't think that the preservation of the profession is more important that our graduates. I think the PRESERVE THE PROFESSION mentality coupled with its rapid irresponsible expansion will be the undoing of the osteopathic profession -- which will be a sad day for me. I think we can best preserve the integrity of our profession by doing the best for its members. This is a shift in focus that I wish many of my colleagues would accept.

There are multiple instances where AMA tried to fight DOs. Almost in every state where we tried to obtain full licensure, AMA was there to fight us. For a long period of time they barred MDs from teaching at osteopathic schools, they barred DOs from practicing in allopathic hospitals (hence the creation of osteopathic hospitals) and most famously the California incident which was actually in the 60s.

In any event, whatever their current view/mission may be, we should NOT lose our autonomy because that would give them an opportunity to prevent us from getting licensed. A $500-$1000 extra cost for taking an extra board exam is not worth risking licensure eligibility in the future.

Also, preserving the profession = preserving our graduates' rights to practice the full scope of medicine. IMHO!

And I absolutely agree with you regarding expansion!

lol you're being ridiculous. If FMGs didn't take the USMLE, they wouldn't get into residency programs at all. Forgive me but I am laughing at this argument as it's absurd. No matter how small a positive number is, it's still greater than zero.

Your question was that if they took a different exam! assuming that the other exam was acceptable for licensure, IMO would make absolutely no difference in their match rate. Programs would still take AMGs over FMGs and they would take as many FMGs that they currently do to fill their spots.

But, I guess we can agree to disagree!

 

[DocEspana]

Is this conversation above me for real?

The AMA has pretty rapidly turned itself around and become a very DO friendly organization. DO's make up about 20% of their membership and their entire reason for being is hinging upon being the organization that represents all physicians. As someone who HAS been there in the rooms where this stuff was discussed and HAS gone and talked to two of the authors (I do not know how many people created this, but its likely <10) I can tell you that they want to aid DOs wherever possible and fair. Pretty much the only group they *dont* represent is FMGs, as they are not represented by the AMA until they are licensed (aka by the time they finish, or nearly finish, residency)

 

[scotchtapetest]

Is this conversation above me for real?

The AMA has pretty rapidly turned itself around and become a very DO friendly organization. DO's make up about 20% of their membership and their entire reason for being is hinging upon being the organization that represents all physicians. As someone who HAS been there in the rooms where this stuff was discussed and HAS gone and talked to two of the authors (I do not know how many people created this, but its likely <10) I can tell you that they want to aid DOs wherever possible and fair. Pretty much the only group they *dont* represent is FMGs, as they are not represented by the AMA until they are licensed (aka by the time they finish, or nearly finish, residency)

Of course they do now, because we have obtained full practice rights in all 50 states. The only thing they can do is to include us for revenue purposes.

As I said, even if they have changed their views/mission and currently love DOs, 5-10-15-20 years down the road they may change their mind again as they have regarding DOs over the years. We should continue to preserve our full autonomy to prevent any issues in the future.

BTW, trust me, in this discussion, you are not the only one who "has been there."

 

[DocEspana]

On an unrelated note, i feel like our icons are having a stare down.

 

[scotchtapetest]

On an unrelated note, i feel like our icons are having a stare down.

 

[TeamZissou]

Is this conversation above me for real?

The AMA has pretty rapidly turned itself around and become a very DO friendly organization. DO's make up about 20% of their membership and their entire reason for being is hinging upon being the organization that represents all physicians. As someone who HAS been there in the rooms where this stuff was discussed and HAS gone and talked to two of the authors (I do not know how many people created this, but its likely <10) I can tell you that they want to aid DOs wherever possible and fair. Pretty much the only group they *dont* represent is FMGs, as they are not represented by the AMA until they are licensed (aka by the time they finish, or nearly finish, residency)

Something to think about.

http://m.yahoo.com/w/news_america/w..._host_hdr=news.yahoo.com&.intl=us&.lang=en-us

 

[DocEspana]

Something to think about.

http://m.yahoo.com/w/news_america/w..._host_hdr=news.yahoo.com&.intl=us&.lang=en-us

The official party line, which I assume is factually correct, is that a coding system needs to exist and the AMA actually won a bidding war to acquire the rights back then. They offered to do it for the cheapest. Even to this day the generap argument against switching away from CPT to less complicated (diagnosis based) systems is that no other system has cheaper overhead and rights due than the CPT coding for Medicare.

Does it play into the ama accepting dofferent care models? No clue. I always assumed it was obama going to the Chicago HQ and pleading his case the day before the AMA decided to back the reform. And even to this day, the ama supports a version, and only that version, which was not passed in congress and their money is all going towaes ammending PPACA. Personally i think that specific method is a waste of resources.

Edit: its still a good read because the timeline and events are important to know. The AMA definitely has diverse funds, but (hopefully) only one interest. The article, the ama would argue, paints the ability to function as a business within the healthcare sphere as a reason to leave the advocacy for physicians behind. I disagree, bit I do it on subjective interpretation.

 

[MaximusD]

Any news on this mess?

 

[Dharma]

Any news on this mess?

Bump (but no grind)

 

[DocEspana]

Any news on this mess?

Update: The changes got voted down. While i think there feeling amongst most people is this change will happen again in a few years, it got voted down right now!!

so be happy people!

 

[donkeykong1]

Update: The changes got voted down. While i think there feeling amongst most people is this change will happen again in a few years, it got voted down right now!!

so be happy people!

 

[painmd87]

Update: The changes got voted down. While i think there feeling amongst most people is this change will happen again in a few years, it got voted down right now!!

so be happy people!

A whole lot of clamoring, wringing of hands, and gnashing of teeth, and ultimately nothing gets done?? Whoda thunk it!

 

[p1acebo]

Update: The changes got voted down. While i think there feeling amongst most people is this change will happen again in a few years, it got voted down right now!!

so be happy people!

Thank god.

 

[newbie04]

Update: The changes got voted down. While i think there feeling amongst most people is this change will happen again in a few years, it got voted down right now!!

so be happy people!

link?

 

[DocEspana]

link?

no official word yet, nor will there ever likely be except on internal document at the acgme. the head of my surgery department who, is involved with acgme as a representative at some level, turns to me this morning and says "you must be very excited about the news as a do student ..." and then informs me how it was just voted down yesterday or the day before

he's a reliable source. he does a lot of ama nonsense with me indirectly because he's well connected enough to be my insider source for many things (though he himself is only involved in minor ways, his network is huge)

 

[DocEspana]

actually now that I think about it, I'm sure the aoa will have a response claiming 100 percent responsibility on this in 3....2...1....

 

[sylvanthus]

This is awesome and im very glad it got voted down. Also sorta relieved it hasnt been officially released as I just submitted an article discussing the change. Would suck to have to retract it this fast.

 

[NewBlood]

I think it is rather interesting if you read this: http://www.osteopathic.org/inside-a...ily-report-blog/Lists/Posts/Post.aspx?ID=2094

I found the last line interesting, that the ACGME and AOA discussed "possible collaboration to develop a new outcomes-based GME accreditation system." I'm pretty sure that the ACGME has shifted their accreditation mechanism to judge the "outcomes" of how programs HAVE trained residents, rather than the "plans" for how programs WILL train residents. This likely equates to accreditation reviewers scrutinizing programs to a much greater depth.

To me, it seems that the ACGME used these proposed changes to their GME regulations as a means to pressure the AOA to strengthen its residency programs (or at least to strengthen its accreditation processes). I suspect that the meeting wasn't as much of a discussion of "possible collaboration" between the ACGME and AOA as it was the ACGME telling the AOA that if they want their programs to hold parity, then they better get their AOA standards up to snuff with the ACGME's standards. But then again, that's just my hunch.

However, it would be VERY interesting if a single GME accreditation group/process came out of this. Who knows what will happen, especially with all the looming healthcare changes.

 

[SoulinNeed]

As a pre-med student who wants to go DO & is thinking about doing PM&R (I want to be in Chicago, so it's going to hopefully be an MD one), has it been confirmed that this has been shot down? Would make it a lot harder to do PM&R if I had to go through an allopathic Internship year, otherwise.

 

[THH]

As a pre-med student who wants to go DO & is thinking about doing PM&R (I want to be in Chicago, so it's going to hopefully be an MD one), has it been confirmed that this has been shot down? Would make it a lot harder to do PM&R if I had to go through an allopathic Internship year, otherwise.

Someone can correct me if I'm wrong, but I thought there were not any osteopathic PM&R residencies anyway. So you would be doing a MD residency and this wouldn't affect you either way.

 

[Wolverines83]

Someone can correct me if I'm wrong, but I thought there were not any osteopathic PM&R residencies anyway. So you would be doing a MD residency and this wouldn't affect you either way.

I thought the same thing until 30 seconds ago but here's a link showing 5 AOA PM&R residencies. 3 show a start date of 1july2011 and one shows 1july2012. The other has apparently been around since 1900 (I'm going to assume a typo there, lol).

I can't believe a profession that teaches OMM would take this long to get into PM&R.

http://www.opportunities.osteopathic.org/search/search_details.cfm?program_id=163794&hosp_id=119006&returnPage=1

 

[SoulinNeed]

Someone can correct me if I'm wrong, but I thought there were not any osteopathic PM&R residencies anyway. So you would be doing a MD residency and this wouldn't affect you either way.

I'll admit I'm a bit ignorant to the whole process, but I thought most MD PM&R residencies were PGY-2 starting, and required you to do an internship your first year. I thought the whole point of this was that you could previously do an AOA internship year to satisfy that requirement, but these new rules would change that. Am I wrong here?

 

[Wolverines83]

I'll admit I'm a bit ignorant to the whole process, but I thought most MD PM&R residencies were PGY-2 starting, and required you to do an internship your first year. I thought the whole point of this was that you could previously do an AOA internship year to satisfy that requirement, but these new rules would change that. Am I wrong here?

Not sure about what your exact question is. Basically the rule changes (the ones that were voted down and are a moot point) would have required an MD (ACGME) internship in order to apply to any MD residency/fellowship. So, it wouldn't have been possible to do PM&R (or any MD residency requiring an intern year) w/out an MD internship. But those changes are no longer an issue so AOA internship = MD internship for resume/check the box purposes.

 

[SoulinNeed]

Not sure about what your exact question is. Basically the rule changes (the ones that were voted down and are a moot point) would have required an MD (ACGME) internship in order to apply to any MD residency/fellowship. So, it wouldn't have been possible to do PM&R (or any MD residency requiring an intern year) w/out an MD internship. But those changes are no longer an issue so AOA internship = MD internship for resume/check the box purposes.

Yeah, that's my point. I was worried that I would have to do an MD internship in order to do MD PM&R, which would have made things a good deal harder.

 

[Dharma]

no official word yet, nor will there ever likely be except on internal document at the acgme. the head of my surgery department who, is involved with acgme as a representative at some level, turns to me this morning and says "you must be very excited about the news as a do student ..." and then informs me how it was just voted down yesterday or the day before

he's a reliable source. he does a lot of ama nonsense with me indirectly because he's well connected enough to be my insider source for many things (though he himself is only involved in minor ways, his network is huge)

One would assume that some type of announcement would be made (after the $hit-storm they whirled up with this hoopla). And has the resolution DEFINITELY been shot down? I'm still skeptical about it, especially since the AOA has yet to utter an official word. It's nice that you have this inside connection, but it's also tough to rely on one comment by one person on an anonymous internet forum, regardless of the fact that most of your posts are pretty much spot-on, minus the fun-trolling you like to engage in (which are usually hilarious).

 

[ajndersn]

Looks like we won't really know much until the next meeting in June. You can find out all of the updates at http://www.osteopathic.org/inside-aoa/Pages/acgme-policy-timeline.aspx

 

[Dharma]

Looks like we won't really know much until the next meeting in June. You can find out all of the updates at http://www.osteopathic.org/inside-aoa/Pages/acgme-policy-timeline.aspx

Thanks for the link.

 

[ooitsrich]

I'm actually really confused with all the terminology between categorical/internship/preliminary.. Can anyone enlighten me? Also is it really that much harder for a DO graduate to match into an MD internship? Thanks for your help!

Yeah, that's my point. I was worried that I would have to do an MD internship in order to do MD PM&R, which would have made things a good deal harder.

 

[the alchemist]

I'm actually really confused with all the terminology between categorical/internship/preliminary.. Can anyone enlighten me? Also is it really that much harder for a DO graduate to match into an MD internship? Thanks for your help!

categorical means that you do your intern year and residency at the same program and match all the years in one fell swoop. i think that all specialties except pathology that i can think of have an intern year before starting the specialty residency years.

prelim year is a separate intern year all by itself not attached to anything else. in the DO world, we call it the traditional rotating internship (TRI). in the MD world, they call it a prelim or transitional year (TY). same thing. ppl do these if they don't know what they want to do after internship, they are matching into an advanced residency where they do the residency years after internship at another institution, or they didn't match (either for a categorical or advanced residency) and will be reapplying and just want to get their intern year done during the reapplication year.

fields like anesthesiology have both categorical (all 4 years incl intern year at the same program) and advanced (1 yr internship somewhere and then 3 years anes at another place). u can rank both categorical and advanced programs but it gets tricky b/c then you might also need to rank TRI/TY programs in case you don't match into an advanced program. some places have both options available at the same institution. cooper univ hospital for instance has 1 categorical spot and the rest are advanced spots (so those ppl have to find an internship somewhere else). pm&r, radiology, derm also can have separate intern + residency years (ie - advanced programs). other specialties like internal med, family med, em, surgery generally have categorical programs where you do all the years at the same institution.

 

[the alchemist]

AMA et. al would love nothing more than to get rid of DOs as evident by 100+ years of history of osteopathic medicine in the US. Not because of any principles but because they would love to have a monopoly (even more than what they currently have). FMGs who match are MDs and therefore, under their umbrella and it doesn't affect their control/monopoly.

actually i don't think that this true. yes, in the past, the AMA did take this stance and there was the CA merger debacle...but as the old guard changes, i find that not all younger physicians (the future AMA leaders) think this way and don't consider there to be a big difference b/t the 2 professions. yes, there will always be monopolistic territorialism but i think the perception of how MDs view DOs has changed a lot since the 1970s. also even though FMGs are considered MD for all extensive purposes, many of them get an equivalent degree but its not called MD in their country (i'm thinking of india and i think also china where the degree is actually MBBS). they're considered MD b/c obviously if u had to choose b/t our American MD and DO, MD is easier to give them as an equivalent title

Right now, preventing us from taking the USMLE only equals to loss of revenue because we don't need USMLE to get licensed. However, if we didn't have our own licensing exam, by preventing us from taking the USMLE, their goal to get rid of DOs can easily become realized. All I'm saying is that under no circumstance should we lose our autonomy in any situation (board exams/OGME/Licensing/etc.).

Also as I mentioned ACGME move wasn't about DOs and OGME but it was a move to prevent FMGs who use exemptions (based on length of practice) from obtaining advance ACGME residencies and unfortunately their actions also affected DOs. At least that's what they claim! And BTW I agree with your arguments about OGME. My only disagreement is with your statement regarding COMLEX.

this is the official line from the acgme though i was surprised that they couldn't see the implications of their policy proposal on DOs and remain skeptical.

Your second argument fails because as I said before having FMGs take the same licensing exam (i.e. USMLE) has not helped them with their perceived educational quality so you can't make the argument that by passing USMLE somehow people are perceived differently. AMGs with 85/85 USMLE scores are almost always preferred over FMGs with 99/99 on the USMLE by the PDs. Furthermore, a Harvard grad with a 85/85 is perceived better than some random state university grad with a 85/85. Do I agree with that? No; Is it a fact? Yes!

i think that you make some assumptions here w/o evidence. having just gone through the interview process as a DO awaiting the MD match, i don't agree with your statement entirely. yes, AMGs are preferred over FMGs and this is becoming even more so with more AMGs graduating and not having a proportional increase in ACGME spots available so the FMGs will feel the crunch first then DOs/carib AMGs. but in some places that i rotated at, if the institution/dept had a lot of FMG/caribbean attendings, i saw more of them getting accepted than DOs (at this place, it was 40% MD, 40% caribbean AMG or FMG, 20% DO and many of my schoolmates rotate at this MD institution that is close to our school)

there are some programs that just want the best candidates regardless of MD/DO/FMG and think of them all as equivalent and don't have different board score requirements for each group (washu comes to mind b/c this is what most of their attendings said to me on interview day). and there are some acgme programs that don't really accept DOs or require 2-3 USMLES to apply (only a handful out of the ones i applied to but i did get rejected from not having the prereq usmle scores in by then and was told this was the reason and this from lower tier schools when i got interviews at top/high tier programs). but you are right that for the majority of programs, FMGs need higher board scores than they allow for AMG candidates.

and non-physicians can take USMLE. i know my professor at a DO school who is a PHD took it. not for anything related to her career but i think she said she was taking it to give feedback on the test. i can't remember if she said that she would give feedback to nbme or to some other organization but she did get permission from nbme to take it for that reason. so there is probably a small group of non-physicians who take usmle for various reasons. not sure about the NP thing that docespana talked about but i wouldn't be surprised.

 

[the alchemist]

Not sure about what your exact question is. Basically the rule changes (the ones that were voted down and are a moot point) would have required an MD (ACGME) internship in order to apply to any MD residency/fellowship. So, it wouldn't have been possible to do PM&R (or any MD residency requiring an intern year) w/out an MD internship. But those changes are no longer an issue so AOA internship = MD internship for resume/check the box purposes.

actually what soulinneed said is true. all the pm&r residencies i know of start w/ pgy-2 but i admit that i could be wrong since this is not the specialty i'm going into so i haven't researched this but def the majority are. so u do have to do an intern yr. currently, 4 MD specialties that start pgy-2 accept a DO intern year: anes, pm&r, radiology, and family/derm (yes, there are these hybrid fm programs w/ a concentration in derm). anything else you would have to repeat the intern year. for instance, if u did a DO intern year and want to go neuro, you would have to repeat an MD intern year b4 doing the 3 years of MD neuro. but most, if not, all MD neuro programs are categorical anyways but i do know of someone in this predicament - lost MD neuro spot and scrambled into a DO intern year. this person will have to do MD internship if the neuro program accepts this person back (was verbally promised they would once internship was completed somewhere else since intern year was under the IM dept and that dept let this person go). so rarely, things like this happen.

not sure if the acgme proposal was voted down...heard different rumors about this and it seems we won't have a def answer til june or so.

 

[DocEspana]

Slight update. Some friends more directly in the know than I am said the acgmes working proposal has do exemptions in it. Now those exemptions have one review tyis month that may or may bot have happened yet but is unlikely the change anything. on the other hand on june anything can happen in more open debate. I will say 3 out of 4 times not a thing happens and the working proposal (with exemptions) passes. But the debates do happen at which point really randok stuff can occur.

Tldr: so far so good. Much more clear picture in June.

 

[valkener]

i think that you make some assumptions here w/o evidence. having just gone through the interview process as a DO awaiting the MD match, i don't agree with your statement entirely. yes, AMGs are preferred over FMGs and this is becoming even more so with more AMGs graduating and not having a proportional increase in ACGME spots available so the FMGs will feel the crunch first then DOs/carib AMGs. but in some places that i rotated at, if the institution/dept had a lot of FMG/caribbean attendings, i saw more of them getting accepted than DOs (at this place, it was 40% MD, 40% caribbean AMG or FMG, 20% DO and many of my schoolmates rotate at this MD institution that is close to our school)

there are some programs that just want the best candidates regardless of MD/DO/FMG and think of them all as equivalent and don't have different board score requirements for each group (washu comes to mind b/c this is what most of their attendings said to me on interview day). and there are some acgme programs that don't really accept DOs or require 2-3 USMLES to apply (only a handful out of the ones i applied to but i did get rejected from not having the prereq usmle scores in by then and was told this was the reason and this from lower tier schools when i got interviews at top/high tier programs). but you are right that for the majority of programs, FMGs need higher board scores than they allow for AMG candidates.

and non-physicians can take USMLE. i know my professor at a DO school who is a PHD took it. not for anything related to her career but i think she said she was taking it to give feedback on the test. i can't remember if she said that she would give feedback to nbme or to some other organization but she did get permission from nbme to take it for that reason. so there is probably a small group of non-physicians who take usmle for various reasons. not sure about the NP thing that docespana talked about but i wouldn't be surprised.

Your statement is just as much "without evidence". A while ago there were statistics that showed match rates between DOs and Carribeans and the DOs won by far. Source: NRMP.org.