M.D.s and D.O.s Moving toward a Single, Unified Accreditation System for GME

[HockeyDr09]

Then continue to chug the koolaid, broski
If you are unable to see that you are electively backing the most positive outcome in the spectrum of things, and quoting the 1 individual who is under the most pressure to spin it in the most positive light possible then.... I just hope they chose a flavor you like (grape is nasty by the way)

You are assuming that the bylaws will all be changed magically to favor everything you are saying.

As it stands now, the AOA is not a voting member (see disclaimer in the next statement). The other 5 members with their 27-33 votes (whatever it was) will have to vote sequentially to pass things. The AOA may be given a provisional seat and votes in the meantime (unless that already happened... it would make sense if it did, as the AOA needs to be a voice in these matters as well, and it is the only way they will have this "veto power" in the adoption of the new bylaws).

In addition, over use of said "veto power" will result in a non-resolution. The provisional accredidation of AOA programs is contingent upon a resolution being met. If they abuse this ability to veto changes to the bylaws (and in reality, the changes all favor them anyways, so the only realistic reason to veto is if they feel they arent getting "enough", so veto the plan until articles are in place which, for example, put a majority vote on matters of accreditation and RRC formation - which I REALLY don't see the ACGME agreeing to, maybe for AOA programs.... but certainly not on the whole) and a non-resolution occurs, things go back to where they were at the offset of these threads - AOA programs lose access to ACGME fellowships and PGY2 programs. The AOA, while touting this as a victory (which is INCREDIBLY common in things like this.... you have apparently never worked for a company that has been acquired or "merged") will still tread lightly because the penalty for being stubborn is pretty severe.

So for now, I would say it is much more reasonable to keep fingers crossed that there arent AOA haters in significant quantities within the ACGME because one can only expect the bylaws to be changed FAIRLY, and "fair" does not mean changed such that a new "member" is untouchable and autonomous within the group. And that seems to be what you are proposing. This will become less and less of an issue as the AOA abandons its "different but equivalent" nonsense and starts moving towards true sameness. But holding to such clearly demarcating things is not going to persuade the rest of the ACGME to adopt policy that makes the AOA a more powerful member than any other individual member. As it stands now, each member only has "veto power" over the things I already mentioned, so touting it as a huge victory for the AOA is pretty disingenuous.

If I'm overly optimistic, you're overly pessimistic (from the AOA perspective). You're just as "guilty" as I am.

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[HockeyDr09]

Whose analogy is this? This sounds like what DocHoc is saying... but that isnt the case. It isnt becoming "equal share" in the oversight as in "50/50" where the AOA is getting 50/50 access to more spots and the ACGME is getting access to fewer.

It is as if you pool your 300k with 5 other people who have 300k and have to agree on how to spend the money. You want to invest in a burgeoning massage therapy business and the rest of your investees are more interested in funding research into a new cancer drug. Guess where your money is going

(That example may have been a little below the belt, but it was intended to be in good fun )

I never said it was 50/50, I actually explicitly stated otherwise. But nice try.

 

[SpecterGT260]

"nice try"

You are approaching this as some competition or something.... I am not in any way trying to misconstrue your points, so if you want to approach arguments with hostility you are going do nothing other than weaken your own argument. I didn't say you were claiming a 50/50 split, but many of your points, in reality, would ONLY work under such a system which is why I debate the irrational optimism you use in your arguments. You aren't thinking in real practical terms in how these things take place.

Also, PR's example there indicated a 50/50 split of the "resources" (votes, in this case), so unpucker your pooper and start addressing points rather than highlighting individual technicalities as if doing such has any impact on the rest of your post simply annihilating everything you (and the AOA char, assuming you are representing him accurately) have said

 

[HockeyDr09]

"nice try"

You are approaching this as some competition or something.... I am not in any way trying to misconstrue your points, so if you want to approach arguments with hostility you are going do nothing other than weaken your own argument. I didn't say you were claiming a 50/50 split, but many of your points, in reality, would ONLY work under such a system which is why I debate the irrational optimism you use in your arguments. You aren't thinking in real practical terms in how these things take place.

Also, PR's example there indicated a 50/50 split of the "resources" (votes, in this case), so unpucker your pooper and start addressing points rather than highlighting individual technicalities as if doing such has any impact on the rest of your post simply annihilating everything you (and the AOA char, assuming you are representing him accurately) have said

Don't be so upset. I've already countered your points. The truth is at this point, only time will tell how things will pan out. You have a very difficult time leaving it at that.

 

[SpecterGT260]

If I'm overly optimistic, you're overly pessimistic (from the AOA perspective). You're just as "guilty" as I am.

I disagree. I have mentioned negative possibilities in order to show you wide spectrum of possibilities within what is currently on paper.

I said explicitly that I don't think the ACGME is going to be vindictive or malicious in their policy and that, IMO the biggest hindrance will be if the AOA is overly stubborn in relinquishing autonomy - as would be indicated if they are anything like you have been suggesting. But I think you are actually mistaken on the whole and the AOA is simply flavoring things positively and in the end will agree to a resolution that makes them an equal member of the ACGME according to the current bylaws concerning accreditation with (most likely) the provision that prior AOA programs will still include OMM, but that will probably go away after 10 years as well and become entirely optional (just my guess, but I suspect there will always be those who adhere to it so it will never entirely go away).

That is where I see things going. True equal involvement with the protection of a few core DO principles. In this case "equal involvement" means minority in every sense of the word (and this is true of the AMA, and other members as well) and if they are not going to be a team player they stand to be bullied and strongarmed into policy very harshly according to the bylaws quoted above.

This has been my stance the entire time - that the potential for passing of negative policy will ensure they are not too stubborn moving forward in the resolution. It isnt a giant win for the AOA in terms scope of power and oversight. They give up more than they gain here in terms of accredidation oversight. What they gain for themselves is concrete access for their students in the ACGME - still a very good thing.

 

[SpecterGT260]

Don't be so upset. I've already countered your points. The truth is at this point, only time will tell how things will pan out. You have a very difficult time leaving it at that.

no you havent

You can't defend an extreme positive result and then counter a point made every bit within the same reality you are using by saying "well we dont know". That argument alone undermines your own position.

My points were not that "this will happen", it was "this is why you can't say what you are saying". Countering by saying "well we don't know" is 100% paraphrasing my entire position. You are unwittingly my biggest advocate right now

 

[HockeyDr09]

I disagree. I have mentioned negative possibilities in order to show you wide spectrum of possibilities within what is currently on paper.

I said explicitly that I don't think the ACGME is going to be vindictive or malicious in their policy and that, IMO the biggest hindrance will be if the AOA is overly stubborn in relinquishing autonomy - as would be indicated if they are anything like you have been suggesting. But I think you are actually mistaken on the whole and the AOA is simply flavoring things positively and in the end will agree to a resolution that makes them an equal member of the ACGME according to the current bylaws concerning accreditation with (most likely) the provision that prior AOA programs will still include OMM, but that will probably go away after 10 years as well and become entirely optional (just my guess, but I suspect there will always be those who adhere to it so it will never entirely go away).

That is where I see things going. True equal involvement with the protection of a few core DO principles. In this case "equal involvement" means minority in every sense of the word (and this is true of the AMA, and other members as well) and if they are not going to be a team player they stand to be bullied and strongarmed into policy very harshly according to the bylaws quoted above.

This has been my stance the entire time - that the potential for passing of negative policy will ensure they are not too stubborn moving forward in the resolution. It isnt a giant win for the AOA in terms scope of power and oversight. They give up more than they gain here in terms of accredidation oversight. What they gain for themselves is concrete access for their students in the ACGME - still a very good thing.

We agree here. I guess you're one of my advocates here...

 

[HalfListic]

Wait...what's the problem?

 

[SpecterGT260]

Classy.....




For the second time, it's the executive director of the AOA, and it's published through the AOA. If you don't want to believe his statements that your prerogative. I already said it was a good move to read the gritty details of the ACGME bylaws. My point was that you're reading bylaws that are accurate now, but will be changing as this has been the biggest change in the history of the ACGME. We differ in how we think everything is going to pan out. You think that the AOA relinquished all of their control, and have gained very little. Personally, I'm excited about the merger, and I'm happy with what the AOA has accomplished. Apparently we have two different opinions that are not going to change. Only time will tell.

Fine you assume that the changes will be sweeping and will entirely re-structure the AOA and that the current members who have structured it as such for years are going to be totally down with this

I assume that the bylaws will change only such that the AOA is included in the same capacity as current members, who, via 80% vote have constructed the current set of bylaws as they saw fit for a very long time. and I also assume (I am using the word assume in this particular case very lightly... I expect) That the more drastic the changes, the harder it will be to get 80% of the body to vote in favor of it, given that post-AOA inclusion 80% of the board will be prior members who voted in favor (often unanimously) of the bylaws as they see fit.

So the question is which do we all find more logical: AOA inclusion suddenly enlightening everyone else and the laws they all agreed to earlier no longer seeming appropriate, or AOA inclusion with people voting the way they have for years and minimal changes to bylaws that are not concerned with defining membership?

 

[SpecterGT260]

We agree here. I guess you're one of my advocates here...

I tend to advocate objectivity and rationality.

I will support and advocate anything you say to that end. I don't find much of what you are saying other than "we dont know" to be logically sound, and counter the points by showing perfectly valid outcomes within what we do actually know. For every over optimistic point given, an overly pessimistic (albeit still valid) point means that maybe we should settle somewhere in the middle

 

[SLC]

HockeyDr,

Don't waste anymore time with Spectre, he/she spends more time searching out threads about DO's and their post-graduate prospects than anyone else on here. Think about it, a student in an allopathic school, that spends his/her time on pre-DO trying to put people in their place. The moment someone posts in a thread with a message that's anything but doom and gloom for DO's, spectre is there to "squash" it. It's kind of pathetic actually, and I'm starting to pity him/her.

I think there's some sort of insecurity there or something. Needs the "MD" to be significantly more prestigious than the "DO" (whatever that means) perhaps. Now that this merger will unify the GME for both Osteopathic and Allopathic students, that's one less thing Spectre can feel superior over, and that's probably quite threatening for him/her.

As for MedPR, he's just becoming a troll. We all know how to deal with trolls don't we?

 

[DocEspana]

when I said a casual polling, I was speaking of aoa program directors. Primarily I have talked to urology directors surgery directors and rotating internship directors.for different reasons every director I have talked to has been very optimistic about this. Some for the future gain in status of their programs training by being held to equal standards as acgme. Some just because they know they don't fill all their spots and having more applicants who actually match would strengthen their program. And others just because a program that has no MD residencies doesn't pull in many or any MD's from big name institutions because no 1 has heard of them since they don't train MDs. Even if they never took any, being on the application map makes them more visible .

 

[HockeyDr09]

I tend to advocate objectivity and rationality.

I will support and advocate anything you say to that end. I don't find much of what you are saying other than "we dont know" to be logically sound, and counter the points by showing perfectly valid outcomes within what we do actually know. For every over optimistic point given, an overly pessimistic (albeit still valid) point means that maybe we should settle somewhere in the middle

You know exactly what I've said in the past, and why I think this merger is a good thing for everyone. We were currently focusing on veto power because of the article I posted. I've stated quite a few reasons in the past on why this is beneficial for both MD's and DO's, and I won't rehash them again, because they're well known at this point. The truth is that I'm already in the middle, as I've already stated there is a bias against DO's (which sucks), but it absolutely exists. The only point I was trying to make is that the AOA is going to be just fine, and that I look forward to see what the future holds.

 

[HockeyDr09]

HockeyDr,

Don't waste anymore time with Spectre, he/she spends more time searching out threads about DO's and their post-graduate prospects than anyone else on here. Think about it, a student in an allopathic school, that spends his/her time on pre-DO trying to put people in their place. The moment someone posts in a thread with a message that's anything but doom and gloom for DO's, spectre is there to "squash" it. It's kind of pathetic actually, and I'm starting to pity him/her.

I think there's some sort of insecurity there or something. Needs the "MD" to be significantly more prestigious than the "DO" (whatever that means) perhaps. Now that this merger will unify the GME for both Osteopathic and Allopathic students, that's one less thing Spectre can feel superior over, and that's probably quite threatening for him/her.

As for MedPR, he's just becoming a troll. We all know how to deal with trolls don't we?

I just didn't want everyone to believe the doom and gloom. Two sides to every story I guess (or was it three sides?)

 

[MedPR]

As for MedPR, he's just becoming a troll. We all know how to deal with trolls don't we?

If you read my posts on this thread and other merger threads/discussions you would know that I'm about 10 steps behind the rest of you on this topic.

I'm not trolling in this thread. I'm severely misinformed and even when I do Google stuff I don't find much clarity. Perhaps I'm too dumb to comprehend what's really happening with the merger. Certainly not trolling though.


Sent from my SGH-T999 using SDN Mobile

 

[SpecterGT260]

HockeyDr,

Don't waste anymore time with Spectre, he/she spends more time searching out threads about DO's and their post-graduate prospects than anyone else on here. Think about it, a student in an allopathic school, that spends his/her time on pre-DO trying to put people in their place. The moment someone posts in a thread with a message that's anything but doom and gloom for DO's, spectre is there to "squash" it. It's kind of pathetic actually, and I'm starting to pity him/her.

I think there's some sort of insecurity there or something. Needs the "MD" to be significantly more prestigious than the "DO" (whatever that means) perhaps. Now that this merger will unify the GME for both Osteopathic and Allopathic students, that's one less thing Spectre can feel superior over, and that's probably quite threatening for him/her.

As for MedPR, he's just becoming a troll. We all know how to deal with trolls don't we?

Let's review, for your benefit.

1) My time spent in pre-osteo makes my statements invalid and by extension the ACGME who I directly quoted for their most recently approved set of bylaws - yes yes, it is obviously my need to feel superior that is at work here and nothing else Seriously, this is... you should just stop. I'm embarrassed for you. And if "searching out" means simply viewing the first page of pre-osteo and seeing the ~3 MD vs DO threads that are always active, well...... guilty as charged

2) you automatically assume it is my need to feel superior that has me discussing PGE prospects with pre-meds in both forums accurately and providing tangible evidence to support my points. You are totally right, it is absolutely my insecurity and not yours that determines this . In the residency match threads, it is usually pre-DOs who argue with me and most DO students agree and second the things I say. Again, obviously not your insecurity that makes you feel like I am "putting people in their place" Not like realistically understanding the system is going to be of benefit to anyone or anything.
To put it bluntly, any feeling of superiority I have has nothing to do with the letters you have or will have attached to your name. It has everything to do with the very transparent self-affirming arguments that many in those threads make and the poor reasoning or stark avoidance of reasoning used to defend such statements. If you bothered to read my input in those threads you would notice that I am every bit as quick to call out an MD student or pre-MD who is simply flaming DOs for being DOs.

3)As it already stood, ~50% of DOs were already ACGME trained so... you had to inaccurately portray GME in order to even make your points - was it ignorance or just the desire to pick a fight to defend an ego that wasn't even being attacked in reality in the first place? By all accounts, it looked like DocHoc and I were about to land on some common ground until you opted to stir the pot.

I would say combat the points rather than the person. As often as people like to incorrectly cite "ad hominem" around here (not that you did, just that it often happens) I find it pretty entertaining that your rebuttal to my posts has nothing to do with the factual merit of them and everything to do with the discussions I am involved in. Way to royally screw the pooch on this one duder

 

[SpecterGT260]

You know exactly what I've said in the past, and why I think this merger is a good thing for everyone. We were currently focusing on veto power because of the article I posted. I've stated quite a few reasons in the past on why this is beneficial for both MD's and DO's, and I won't rehash them again, because they're well known at this point. The truth is that I'm already in the middle, as I've already stated there is a bias against DO's (which sucks), but it absolutely exists. The only point I was trying to make is that the AOA is going to be just fine, and that I look forward to see what the future holds.

ok This thread is giant as hell and it is hard to keep track of everything. There may have been some mutual miscommunication. I can't recall you saying much that hasnt included gains of power that have seemed drastically overstated which is the only reason I have been trying to give the flipside of that coin. Much of it has had to do with the idea that ACGME programs are suddenly going to swing open their doors to DO applicants which is an entirely separate and unrelated issue. I have agreed with you at every turn that preservation of access is a good thing. I have disagreed that this means expanded access.

My money says that in 5 years the AOA will be functionally indistinct within the ACGME from the AMA, ABMS, AHA, whatever and the sole differences will be what these groups do within their own business. MD/DO bias in the match will remain a subjective and personal issue around individual programs as it is today. AOA PDs in some programs will get irritated at having to meet and document a new set of requirements with very few of them closing due to non adherence. And at least for awhile the AOA will retain protection over OMM in its programs, but it will eventually become optional or relegated to OMM specific or friendly specialties.

 

[DocEspana]

I have not read the last 50 posts. I honestly do not want to read the last 50 posts. But if you kids cannot play nice and moderate the optimism and the pessimism to a nice frothy reality based analysis rather than fear mongering and discrediting based on post history, I'm going to be forced to comment on everyone else's post. And I'll drop some knowledge on y'all.

1 day very soon I will not be as well connected as I am now, but that day hasn't come yet. I can actually ask the Board of Trustees acgme questions.

 

[BlackSwan]

TL;DR

1. This will not greatly affect MD students and current ACGME residencies.
2. This may help or hurt DO students and current AOA residencies. Any conclusions at this point are just speculation. We'll see what really happens come 2015. Initially, any improvement or degradation in DO matching will probably be minimal.
3. If this hurts DO students, too bad too sad. If this helps DO students, yay for osteopathy.

 

[HalfListic]

when I said a casual polling, I was speaking of aoa program directors. Primarily I have talked to urology directors surgery directors and rotating internship directors.for different reasons every director I have talked to has been very optimistic about this. Some for the future gain in status of their programs training by being held to equal standards as acgme. Some just because they know they don't fill all their spots and having more applicants who actually match would strengthen their program. And others just because a program that has no MD residencies doesn't pull in many or any MD's from big name institutions because no 1 has heard of them since they don't train MDs. Even if they never took any, being on the application map makes them more visible .

Ok thanks

 

[SpecterGT260]

I have not read the last 50 posts. I honestly do not want to read the last 50 posts. But if you kids cannot play nice and moderate the optimism and the pessimism to a nice frothy reality based analysis rather than fear mongering and discrediting based on post history, I'm going to be forced to comment on everyone else's post. And I'll drop some knowledge on y'all.

1 day very soon I will not be as well connected as I am now, but that day hasn't come yet. I can actually ask the Board of Trustees acgme questions.

I say go for it.

 

[MotorTrain]

HockeyDr,

Don't waste anymore time with Spectre, he/she spends more time searching out threads about DO's and their post-graduate prospects than anyone else on here. Think about it, a student in an allopathic school, that spends his/her time on pre-DO trying to put people in their place. The moment someone posts in a thread with a message that's anything but doom and gloom for DO's, spectre is there to "squash" it. It's kind of pathetic actually, and I'm starting to pity him/her.

I think there's some sort of insecurity there or something. Needs the "MD" to be significantly more prestigious than the "DO" (whatever that means) perhaps. Now that this merger will unify the GME for both Osteopathic and Allopathic students, that's one less thing Spectre can feel superior over, and that's probably quite threatening for him/her.

As for MedPR, he's just becoming a troll. We all know how to deal with trolls don't we?

+100.

Both of these characters do need to get a life.

Jeebus Cripes. How many times can you go around saying MDs and MD schools are superior?

BORING.

 

[MedPR]

+100.

Both of these characters do need to get a life.

Jeebus Cripes. How many times can you go around saying MDs and MD schools are superior?

BORING.

Hey at least I don't have to make a new account everytime I want to call someone out.

 

[HockeyDr09]

I say go for it.

Seconded.

 

[DocEspana]

I'll have an update for you guys in a few days. Anything you would really want yk ask a acgme trustee candidly? Try to keep it somewhat simple, cause I'm not checking sdn when I hang out with her to read the questions.

 

[SpecterGT260]

I'll have an update for you guys in a few days. Anything you would really want yk ask a acgme trustee candidly? Try to keep it somewhat simple, cause I'm not checking sdn when I hang out with her to read the questions.

I guess the big one is going to be: "what measures are being discussed which will retain AOA autonomy/set the AOA as separate from other voting members like the AMA or AHA?"

That is what is at the heart of the matter. The connotations included in things like "veto power", "merger", and whatever have spurred a lot of talk that has resulted in a lot of speculation. So my biggest question is in what capacity will the AOA be unique from other members of the ACGME.

 

[DocEspana]

I guess the big one is going to be: "what measures are being discussed which will retain AOA autonomy/set the AOA as separate from other voting members like the AMA or AHA?"

That is what is at the heart of the matter. The connotations included in things like "veto power", "merger", and whatever have spurred a lot of talk that has resulted in a lot of speculation. So my biggest question is in what capacity will the AOA be unique from other members of the ACGME.

I can already answer that one for you. The AOA will be given about 1/7th of the total representative vote on the board. All of the talk of veto powers is more creative spin and terminology. The fact of the matter is that there will be enough DO votes to not pass anything grossly anti-DO, but the nature of these organizations is that if the board is paralyzed, the larger organization acts autonomously so "inaction" doesnt prevent anything... you can only prevent things by authorizing policy that accomplishes the opposite of what you want to avoid. Otherwise the organization has the leeway to potentially do whatever it so wishes without board approval (Though thats not commonly done either since the board will generally cut the deals necessary to have suggested policy in place).

And terminology is important. The AOA remains an independent organization. Its the osteopathic association. The ACGME doesn't care about that. They care about AOA residencies. In this situation its a subset deal. Like how marine medics are "marine medics" and they call themselves such and often train with marines... but they are 100% Navy medics by every official designation that matters except what troops they are deployed with. (IDK why that is the example i jumped to). The AOA residencies are being given some autonomy to run themselves and *potentially* collect dues as usual, but they will be under ACGME oversight. Oversight is a good word. The ACGME will "own" them so to speak, but will let the existing AOA infrastructure "run" them. If this arrangement will change in the future (2018?) is something that is actively being debated (very little of this is actually set in stone yet, but most details are agreed on and non-contentious. This is not one of those agreed upon details). I will probably ask my connection what the current status of that debate is. But given what I said about "merger" is not a good term either since its not a merger, its a change of ownership with a retained management.

As for the uniqueness of the AOA: I will ask for specific details. The next few things I say are from my source, but from a causal conversation so I would put a good amount of faith in it, but wouldnt place money on it being 100% correct and unchanged since my last conversation with them. Supposedly the AOA residencies will be fully under ACGME in every conceivable way except for still collecting AOA dues from their residents come 2015. All remnants of the AOA will be in who manages the day-to-day activities and micromanagement, and not in the larger "quality control" and "accredit vs probation" control. The integration of MDs into AOA residencies is greatly expected but not actually accepted yet as the ACGME has not pushed for this to absolutely happen by 2015 given the issues raised by the AOA over OMM/T proficiency. There is no plan currently for what proficiency testing would equate out to, and until there is a plan there is no agreement that the MD integration into the AOA will happen. Now we all know it *will* happen eventually, but there is a decent chance that it will be complex enough of an issue to address to prevent that from happening in 2015.

 

[SpecterGT260]

Cool. That is exactly what I was saying earlier, although I think it may have gotten lost in some of the back and forth as we went down the rabbit hole.

 

[Ost3oclast]

I can already answer that one for you. The AOA will be given about 1/7th of the total representative vote on the board. All of the talk of veto powers is more creative spin and terminology. The fact of the matter is that there will be enough DO votes to not pass anything grossly anti-DO, but the nature of these organizations is that if the board is paralyzed, the larger organization acts autonomously so "inaction" doesnt prevent anything... you can only prevent things by authorizing policy that accomplishes the opposite of what you want to avoid. Otherwise the organization has the leeway to potentially do whatever it so wishes without board approval (Though thats not commonly done either since the board will generally cut the deals necessary to have suggested policy in place).

And terminology is important. The AOA remains an independent organization. Its the osteopathic association. The ACGME doesn't care about that. They care about AOA residencies. In this situation its a subset deal. Like how marine medics are "marine medics" and they call themselves such and often train with marines... but they are 100% Navy medics by every official designation that matters except what troops they are deployed with. (IDK why that is the example i jumped to). The AOA residencies are being given some autonomy to run themselves and *potentially* collect dues as usual, but they will be under ACGME oversight. Oversight is a good word. The ACGME will "own" them so to speak, but will let the existing AOA infrastructure "run" them. If this arrangement will change in the future (2018?) is something that is actively being debated (very little of this is actually set in stone yet, but most details are agreed on and non-contentious. This is not one of those agreed upon details). I will probably ask my connection what the current status of that debate is. But given what I said about "merger" is not a good term either since its not a merger, its a change of ownership with a retained management.

As for the uniqueness of the AOA: I will ask for specific details. The next few things I say are from my source, but from a causal conversation so I would put a good amount of faith in it, but wouldnt place money on it being 100% correct and unchanged since my last conversation with them. Supposedly the AOA residencies will be fully under ACGME in every conceivable way except for still collecting AOA dues from their residents come 2015. All remnants of the AOA will be in who manages the day-to-day activities and micromanagement, and not in the larger "quality control" and "accredit vs probation" control. The integration of MDs into AOA residencies is greatly expected but not actually accepted yet as the ACGME has not pushed for this to absolutely happen by 2015 given the issues raised by the AOA over OMM/T proficiency. There is no plan currently for what proficiency testing would equate out to, and until there is a plan there is no agreement that the MD integration into the AOA will happen. Now we all know it *will* happen eventually, but there is a decent chance that it will be complex enough of an issue to address to prevent that from happening in 2015.

Good post. Needs to by a sticky

 

[DrBumblebee]

I can already answer that one for you. The AOA will be given about 1/7th of the total representative vote on the board. All of the talk of veto powers is more creative spin and terminology. The fact of the matter is that there will be enough DO votes to not pass anything grossly anti-DO, but the nature of these organizations is that if the board is paralyzed, the larger organization acts autonomously so "inaction" doesnt prevent anything... you can only prevent things by authorizing policy that accomplishes the opposite of what you want to avoid. Otherwise the organization has the leeway to potentially do whatever it so wishes without board approval (Though thats not commonly done either since the board will generally cut the deals necessary to have suggested policy in place).

And terminology is important. The AOA remains an independent organization. Its the osteopathic association. The ACGME doesn't care about that. They care about AOA residencies. In this situation its a subset deal. Like how marine medics are "marine medics" and they call themselves such and often train with marines... but they are 100% Navy medics by every official designation that matters except what troops they are deployed with. (IDK why that is the example i jumped to). The AOA residencies are being given some autonomy to run themselves and *potentially* collect dues as usual, but they will be under ACGME oversight. Oversight is a good word. The ACGME will "own" them so to speak, but will let the existing AOA infrastructure "run" them. If this arrangement will change in the future (2018?) is something that is actively being debated (very little of this is actually set in stone yet, but most details are agreed on and non-contentious. This is not one of those agreed upon details). I will probably ask my connection what the current status of that debate is. But given what I said about "merger" is not a good term either since its not a merger, its a change of ownership with a retained management.

As for the uniqueness of the AOA: I will ask for specific details. The next few things I say are from my source, but from a causal conversation so I would put a good amount of faith in it, but wouldnt place money on it being 100% correct and unchanged since my last conversation with them. Supposedly the AOA residencies will be fully under ACGME in every conceivable way except for still collecting AOA dues from their residents come 2015. All remnants of the AOA will be in who manages the day-to-day activities and micromanagement, and not in the larger "quality control" and "accredit vs probation" control. The integration of MDs into AOA residencies is greatly expected but not actually accepted yet as the ACGME has not pushed for this to absolutely happen by 2015 given the issues raised by the AOA over OMM/T proficiency. There is no plan currently for what proficiency testing would equate out to, and until there is a plan there is no agreement that the MD integration into the AOA will happen. Now we all know it *will* happen eventually, but there is a decent chance that it will be complex enough of an issue to address to prevent that from happening in 2015.

So, 6/7 of the board are from MDs. No doubt, in the future, the rules of the game could be changed to favor MDs such that the votes of, let say, 3/7 of the board would suffice to veto/accept anything.

During this unification process, its AOA's sole responsibility to etch it on the stone with strong guarantees from the current ACGME that DOs won't be forced to assume any inferior roles (like being forced to accept only the primary care roles, as some say here in SDN) by this unification come 2015.

IMHO, it'd be a much better way to unify the MD/DO title into something universal and understandable even to the layman (I admit that it could be "MD", since DOs are gonna be joining to MDs' world.) Otherwise, being represented as a marginal group or a small "minority" at a powerful organization is not gonna be a nice situation, and things would be much more painful than it's been to defend DOs' rights. Harsh posts coming from MDs and alike at SDN is a solid example.

On the other side, even the FMGs' titles (like MBBS, Dr., etc.) have been equated to US-MD before they apply to ACGME residencies. If DOs will be going to nowhere but ACGME residencies, they shouldn't be treated differently.

I'd like to learn what's AOA's stance and plans about this.

P.S.: Unified AOA into ACGME should also accept membership applications from MDs. Primary care MD physicians might be welcoming OMM as another tool if AOA would like to offer advanced certification courses to them under ACGME umbrella, as well.

 

[docmayer]

During this unification process, its AOA's sole responsibility to etch it on the stone with strong guarantees from the current ACGME that DOs won't be forced to assume any inferior roles (like being forced to accept only the primary care roles, as some say here in SDN) by this unification come 2015.

IMHO, it'd be a much better way to unify the MD/DO title into something universal and understandable even to the layman (I admit that it could be "MD", since DOs are gonna be joining to MDs' world.) Otherwise, being represented as a marginal group or a small "minority" at a powerful organization is not gonna be a nice situation, and things would be much more painful than it's been to defend DOs' rights. Harsh posts coming from MDs and alike at SDN is a solid example.

On the other side, even the FMGs' titles (like MBBS, Dr., etc.) have been equated to US-MD before they apply to ACGME residencies. If DOs will be going to nowhere but ACGME residencies, they shouldn't be treated differently.

I'd like to learn what's AOA's stance and plans about this.

P.S.: Unified AOA into ACGME should also accept membership applications from MDs. Primary care MD physicians might be welcoming OMM as another tool if AOA would like to offer advanced certification courses to them under ACGME umbrella, as well.

Well said, sir.

 

[MedPR]

.

 

[DocEspana]

Well Dr. BumbleBee, lets not forget, DOs have been on the board before. It's noy 6/7ths MDs. Its 6/7ths other groups. The AMA sends its representatives, the AAMC sends their representatives, the AHA sends theirs, the ABMS sends theirs, the AOA/AACOM sends theirs, the CMMS send theirs and the ACGME itself has its own 4 members.

DOs can be on any of these positions and have been in the past. Its simply who gets elected from each group to be the four representatives to the ACGME.

 

[DrBumblebee]

Well Dr. BumbleBee, lets not forget, DOs have been on the board before. It's noy 6/7ths MDs. Its 6/7ths other groups. The AMA sends its representatives, the AAMC sends their representatives, the AHA sends theirs, the ABMS sends theirs, the AOA/AACOM sends theirs, the CMMS send theirs and the ACGME itself has its own 4 members.

DOs can be on any of these positions and have been in the past. Its simply who gets elected from each group to be the four representatives to the ACGME.

Thanks for this nice side-note, DocEspana. I honestly haven't known of that before.

But, then why ACGME, with its 4 members, has been able to give only the "MD residencies" although there've been DOs in some of these groups on the board? How those DOs weren't able to prevent ACGME to inhibit DOs from getting ACGME fellowships? How are things gonna change to favor DOs this time around? (well, I know, it's been said that they'll be allowed to ACGME fellowships.)

Isn't it gonna be a much better alternative for everyone to unify MD/DO titles to reduce this complexity for everyone? (Even FMGs have been equalized to US-MD before they start to their ACGME residencies, so why not the DOs?)

 

[SpecterGT260]

Thanks for this nice side-note, DocEspana. I honestly haven't known of that before.

But, then why ACGME, with its 4 members, has been able to give only the "MD residencies" although there've been DOs in some of these groups on the board? How those DOs weren't able to prevent ACGME to inhibit DOs from getting ACGME fellowships? How are things gonna change to favor DOs this time around? (well, I know, it's been said that they'll be allowed to ACGME fellowships.)

Isn't it gonna be a much better alternative for everyone to unify MD/DO titles to reduce this complexity for everyone? (Even FMGs have been equalized to US-MD before they start to their ACGME residencies, so why not the DOs?)

They were already allowed into ACGME fellowships. That part isnt changing. The proposal came up to force a single track pathway for all people - i.e. if you want to end up ACGME you have to start ACGME. That was all that was proposed, but this would screw over a subset of current DO residents and would make AOA programs very unattractive in the future.

 

[DocEspana]

Something interesting brought up to me on an interview the other day. (yes residency interview of all places).

Though the AOA is an exception to this... the ACGME has made zero references to FMGs and USFMGs in their documentation. There is generally a conscious effort to identify when things can impact then and how it does, but in this case there has been zero references to any interests of americans training in the islands or foreign physicians with aspirations to come here. The zero mention of these groups could be coincidental but seems to imply more of an "outside looking in" future for them looming in the distance.

The exception i mentioned is that the AOA has talked a surprising amount in their town halls about what impact they think the FMGs and USFMGs will see from this.

 

[HalfListic]

I can already answer that one for you. The AOA will be given about 1/7th of the total representative vote on the board. All of the talk of veto powers is more creative spin and terminology. The fact of the matter is that there will be enough DO votes to not pass anything grossly anti-DO, but the nature of these organizations is that if the board is paralyzed, the larger organization acts autonomously so "inaction" doesnt prevent anything... you can only prevent things by authorizing policy that accomplishes the opposite of what you want to avoid. Otherwise the organization has the leeway to potentially do whatever it so wishes without board approval (Though thats not commonly done either since the board will generally cut the deals necessary to have suggested policy in place).

And terminology is important. The AOA remains an independent organization. Its the osteopathic association. The ACGME doesn't care about that. They care about AOA residencies. In this situation its a subset deal. Like how marine medics are "marine medics" and they call themselves such and often train with marines... but they are 100% Navy medics by every official designation that matters except what troops they are deployed with. (IDK why that is the example i jumped to). The AOA residencies are being given some autonomy to run themselves and *potentially* collect dues as usual, but they will be under ACGME oversight. Oversight is a good word. The ACGME will "own" them so to speak, but will let the existing AOA infrastructure "run" them. If this arrangement will change in the future (2018?) is something that is actively being debated (very little of this is actually set in stone yet, but most details are agreed on and non-contentious. This is not one of those agreed upon details). I will probably ask my connection what the current status of that debate is. But given what I said about "merger" is not a good term either since its not a merger, its a change of ownership with a retained management.

As for the uniqueness of the AOA: I will ask for specific details. The next few things I say are from my source, but from a causal conversation so I would put a good amount of faith in it, but wouldnt place money on it being 100% correct and unchanged since my last conversation with them. Supposedly the AOA residencies will be fully under ACGME in every conceivable way except for still collecting AOA dues from their residents come 2015. All remnants of the AOA will be in who manages the day-to-day activities and micromanagement, and not in the larger "quality control" and "accredit vs probation" control. The integration of MDs into AOA residencies is greatly expected but not actually accepted yet as the ACGME has not pushed for this to absolutely happen by 2015 given the issues raised by the AOA over OMM/T proficiency. There is no plan currently for what proficiency testing would equate out to, and until there is a plan there is no agreement that the MD integration into the AOA will happen. Now we all know it *will* happen eventually, but there is a decent chance that it will be complex enough of an issue to address to prevent that from happening in 2015.

Thank you for taking the time to explain all of this!

Please do come back and follow up on these few questions when you can.

 

[shimaMD]

I think it all depends. This AOA-ACGME benefits Canadian students who are currently in a US DO school. They no longer have to worry about applying to ACGME-only spots in order to have a chance of ever practicing in Canada.

bottom-line: DO's and MD's are all going to be in the same pool, competing for the same amount of spots. Just as some programs are anti-DO, many DO programs are anti-MD. So, this goes both ways: It provides advantages and disadvantages to both of us. However, I believe the changes will be minimal. And who knows, overtime, those 2 letters behind our name could all be the same and the descrimination will end.

But no matter what, everything we are all saying right now is nothing but speculations! We all just have to wait and see.

 

[Drrrrrr. Celty]

I think it all depends. This AOA-ACGME benefits Canadian students who are currently in a US DO school. They no longer have to worry about applying to ACGME-only spots in order to have a chance of ever practicing in Canada.

bottom-line: DO's and MD's are all going to be in the same pool, competing for the same amount of spots. Just as some programs are anti-DO, many DO programs are anti-MD. So, this goes both ways: It provides advantages and disadvantages to both of us. However, I believe the changes will be minimal. And who knows, overtime, those 2 letters behind our name could all be the same and the descrimination will end.

But no matter what, everything we are all saying right now is nothing but speculations! We all just have to wait and see.

This is very positive for Canadians, it's also very good for DOs who might want to go work in other areas of the world.

 

[advair250]

Shims, I believe you are misinformed. AOA residencies rarely sponsor the necessary visas, therefore Canadians. The chances of getting aoa residencies for Canadians doesn't change with the merger, nor would its being acgme approved change anything when coming back to Canada.

I would like clarification if I am wrong, but that is my understanding. Canadians would still have to go for a us acgme md residency or through CaRms.

Useful link: http://forums.studentdoctor.net/archive/index.php/t-857359.html

Additionally year differences in different residency programs.

There's lots of different variables for Canadians, so don't assume it's magically going to be easier because of the merger. I think it will end up being neutral for Canadians wanting to come back to Canada, with a chance of having less exams to write(usmle vs comlex vs mcee)

 

[Drrrrrr. Celty]

Shims, I believe you are misinformed. AOA residencies rarely sponsor the necessary visas, therefore Canadians. The chances of getting aoa residencies for Canadians doesn't change with the merger, nor would its being acgme approved change anything when coming back to Canada.

I would like clarification if I am wrong, but that is my understanding. Canadians would still have to go for a us acgme md residency or through CaRms.

Useful link: http://forums.studentdoctor.net/archive/index.php/t-857359.html

Additionally year differences in different residency programs.

There's lots of different variables for Canadians, so don't assume it's magically going to be easier because of the merger. I think it will end up being neutral for Canadians wanting to come back to Canada, with a chance of having less exams to write(usmle vs comlex vs mcee)

Before the Merger a Canadian could not get an AOA residency or else they would be unable to practice medicine in Canada. Even if one AOA program is open to Canadians it's a win for them.

 

[advair250]

Serenade, youre also mislead. Canadians have never been barred from aoa, just no point. as canada doesn't accept them. unless they planned on staying us. Practically, few places sponser as well, but some do.

Beat a dead horse, no confirmation that royal college will accept aoa after merger. Hope they do for the few canadians who do get an aoa residency and want to go back to canada.

 

[SpecterGT260]

Am I the only one who struggled making sense of that?

Sent from my DROID RAZR using SDN Mobile

 

[Textbookversion]

Serenade, youre also mislead. Canadians have never been barred from aoa, just no point. as canada doesn't accept them. unless they planned on staying us. Practically, few places sponser as well, but some do.

Beat a dead horse, no confirmation that royal college will accept aoa after merger. Hope they do for the few canadians who do get an aoa residency and want to go back to canada.

No, you don't get it.

There will be no distinction. All "aoa" programs will now be acgme accredited. This is a big change for Canadians and you are completely missing the point.

 

[SpecterGT260]

No, you don't get it.

There will be no distinction. All "aoa" programs will now be acgme accredited. This is a big change for Canadians and you are completely missing the point.

From what I understand, the AOA will retain a distinction for their programs. And it will depend how the laws or policies are written. If they say "must be ACGME accredited " then yes, things will change.

Sent from my DROID RAZR using SDN Mobile

 

[advair250]

Yes, it really depends on how the canadian regulators view things. Ill try and look up the documentation.

 

[lalongo]

Yes, it really depends on how the canadian regulators view things. Ill try and look up the documentation.

I did some asking around after our last conversation.

- A current student who is applying for residency soon said he talked to several AOA programs and they were okay with J1, not H1b though.
- Another person whom I asked said he knows of a few Canadian DOs currently doing AOA surgical residencies in the midwest (meaning they must have gotten at the very least, a J1 visa sponsorship)

I cannot remember if it was you who told me that AOA did not sponsor any kind of visa at all so we Canadians are completely barred from AOA residencies. If it wasn't you, I apologize. Regardless, I think based on the information listed above, we can conclude that there are in fact a few AOA residency which are willing sponsor a J1 visa for Canadians. While it may not be very many, some is better than none.

Now, if the AOA/ACGME does follow through with their merge into one combined residency in 2015, and assuming that Royal College will then accept the residencies that were previously AOA (I think they will have to, I mean, if its good enough for ACGME standards from 2015 and forward, I don't know why it wouldn't be good enough for Canada). Then, this is all in all, great news for Canadian DOs.

In the past, if we Canadian DOs performed poorly and do not have the board scores to match an ACGME residency, we are left with AOA and thus effectively lose any hopes of going back for practice. Now with the rule change, it provides a glimmer of hope for these Canadians, even if they can only match with AOA residencies, they still have hopes of being able to one day return to their home country.

Can't complain about having more options.

For the record, I'd be completely open to practicing in either country, and I plan on rocking all my board exams. But, like I said, its nice to be able to keep all your options open even if the board exams don't end up going your way.

 

[JGimpel]

For other DOs now in their training:
I can't wait until the Anti Osteopathic Association and National Board of Obstructive Medical Examiners are gone and this takeover will hopefully see an end to them both.

Please, please promise that you'll report back your opinion of Osteopathic GME vs. ACGME programs once you've had a taste of both types and let us know what you think. There is definitely a "distinct" difference between them in quality and support of it's staff and trainees.

For our friends to the North:
The Canadian students should definitely have no problem getting an F1 to start medical school; you'll definitely be full-time students. If you're starting in the next year or so, I think they'll keep the ACGME linkage for an F1 to convert to an H1b visa once you can show proof of being accepted into an ACGME residency.

Whether a program actually wants to go through the trouble of getting you set up as a resident in their program and issuing the renewal after 3 years as an H1b visa holder is a whole other subject. I would say that MD programs in underserved areas would still be the most likely to do this for you. Since DO GME programs have little or no experience with this sort of thing, I doubt they would be able to do this for you, even when accepted under the ACGME umbrella. I can't comment on how the laws will work for you on what will be needed for you to return back to Canada to practice, but I can't imagine them giving you a hard time coming from an ACGME program, no matter what its prior roots were.

I toast my Sam Adams to your Labatt and wish you good luck on your studies in the U.S!

 

[Textbookversion]

Just marry a classmate problem solved.

 

[pre med 2014]

..