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

[Dr Dazzle]

1) Prestige (the dirtiest word in medicine)
2) Ability to parlay that into a job in one of the super cush, super high paying community hospitals (there is an entire tier of these no one seems to know about) which are staffed mostly by almost-retired physicians from major centers
3) You believe (perhaps correctly) that your research will change the world. Which could lead to changing the world for the better, or just lots of money.
4) Being around the best might motivate you to be the best.
5) maybe the money is more than enough no matter what, so the lower pay is not going to deter you.

Aren't all these very long term pay offs? Whereas in medicine you have invested so much time in education, private practice will probably lead to higher salary quickly. Maybe academic centers provide more satisfaction and a less tense working environment? Maybe less pressure to push patients through to meet financial goals?

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[DocEspana]

Aren't all these very long term pay offs? Whereas in medicine you have invested so much time in education, private practice will probably lead to higher salary quickly. Maybe academic centers provide more satisfaction and a less tense working environment? Maybe less pressure to push patients through to meet financial goals?

AFAIK they would be *more* tense with a higher pressure to meet financial goals. The exception being you can extend stays if it fits a study parameter.

Its something people choose to do for the 5 reasons I listed, cause its what they (always?) wanted to do regardless of the cons of it. Prestige matters in peoples minds.

 

[JoocyBis]

ITT: premeds and med students talk about what it's like to be a physician

 

[IslandStyle808]

If you end up at an ACGME residency, wouldn't you have to take all the steps of both tests in order o get licensed and boar certified?

I did not think so...but I guess I had better check. Anyone know?
My first choice takes DOs regularly but is not dually accredited. There were no plans to pursue AOA as the merger was anticipated, but I will ask if that has changed.

You will need to take the COMLEX step I , II, and III definitely but you don't need to take all the USMLEs.

 

[SpecterGT260]

AFAIK they would be *more* tense with a higher pressure to meet financial goals. The exception being you can extend stays if it fits a study parameter.

Its something people choose to do for the 5 reasons I listed, cause its what they (always?) wanted to do regardless of the cons of it. Prestige matters in peoples minds.

I like your avatar

 

[DocEspana]

You will need to take the COMLEX step I , II, and III definitely but you don't need to take all the USMLEs.

AFAIK, If you're in an acgme residency you can stop at comlex 2 pe/ce and do all of the usmle if you so choose. But that is something most people will not choose because usmle 2cs feels arduous as a second practical and the comlex 3 is a lot easier than the usmle 3.

 

[DocEspana]

I like your avatar

Just protecting Gaia.

 

[NurWollen]

AFAIK, If you're in an acgme residency you can stop at comlex 2 pe/ce and do all of the usmle if you so choose. But that is something most people will not choose because usmle 2cs feels arduous as a second practical and the comlex 3 is a lot easier than the usmle 3.

Thanks for the info. Now, if you're in an ACGME residency and complete only the COMLEX series, you would still be able to sit for the ABMS boards and get your board certification through them? Because that is residency dependent and completely separate from licensure, am I right?

 

[DocEspana]

Thanks for the info. Now, if you're in an ACGME residency and complete only the COMLEX series, you would still be able to sit for the ABMS boards and get your board certification through them? Because that is residency dependent and completely separate from licensure, am I right?

I believe you are correct. I am like 80% confident. BUT, fellowships are a field I'm not well versed in, so maybe some residents/fellows/attendings can comment on that.

 

[DrMom]

COMLEX and USMLE are licensing exams (states use them...along with other things...to determine if you're eligible to be a licensed physician in a state) and are not related to which board certification exams you take. Your board certification exams are based on your residency (AOA vs ACGME).

 

[bpatient]

In for future reference. Great thread btw

 

[mbe36]

So why would anyone want to work at academic centers? I realize specialties like transplant surgery pretty much require it, but why would anyone take a lower pay? I guess maybe if you wanted to do clinical research?

1. To spend your career as a leader, not a follower.

2. To, perhaps, make a historical contribution to medicine- NBD.

3. The opportunity to educate medical students and guide young, eager minds- many academic guys feel this is the fountain of youth haha.

4. Access to cutting-edge resources.

 

[NurWollen]

Anyone have any updates on the rumored merger postponement?

 

[Spikebd]

Anyone have any updates on the rumored merger postponement?

+1. I'm a little disappointed by this but was always a little unsure of the whole merger. One match day would have been great for me as a member of the class of 2017. At least I think it should have been.

 

[SLC]

Anyone have any updates on the rumored merger postponement?

It sounds like there is some pushback from the Michigan Osteo. Assn. and maybe the ACOFP. Maybe not so much pushback as much as "concerns" about moving cautiously forward. They are talking about the risk of Osteopathic Medicine losing it's identity and seem to want some guarantees before throwing their full support behind the initiative (at least that's my interpretation of what I know).

This is based on an email from the JAOA that came in yesterday. There were statements of concern from a few folks; but that was followed by a response from the AOA pres. That I thought was very level-headed. It seems clear that he's very much in favor of the merger.

 

[canadaDO]

It sounds like there is some pushback from the Michigan Osteo. Assn. and maybe the ACOFP. Maybe not so much pushback as much as "concerns" about moving cautiously forward. They are talking about the risk of Osteopathic Medicine losing it's identity and seem to want some guarantees before throwing their full support behind the initiative (at least that's my interpretation of what I know).

This is based on an email from the JAOA that came in yesterday. There were statements of concern from a few folks; but that was followed by a response from the AOA pres. That I thought was very level-headed. It seems clear that he's very much in favor of the merger.

Was it some kind of a press release email? If so i would like to read it

 

[sylvanthus]

Hmm I said before that I thought this merger would be the beginning of the end for the DO profession and the AOA. Looks like a few DO groups are realizing this and opposing it. And here premeds thought the merger could only be a good thing? Will be an interesting next few years.

 

[oms2]

letters and the aoa response are in the current jaoa issue: http://www.jaoa.org/content/113/3/200.2.full.pdf

 

[sylvanthus]

A brief cut and past from the AOA response.

"If and when the proposed unified system goes into effect,..."

Nothing is certain, hell this may not even happen in 2018.

 

[Dr Dazzle]

+1. I'm a little disappointed by this but was always a little unsure of the whole merger. One match day would have been great for me as a member of the class of 2017. At least I think it should have been.

So 2017 not happening at all? That's a bummer. Well I guess it could be a good thing. Who knows.

 

[NurWollen]

I read the JAOA letters and the AOA response. I'm trying to understand the perspective of those weary of the merger, but I just don't get it. One letter writer worries that we would lose AOA spots because many hospitals can't afford to run programs meeting ACGME standards... it's like saying your own standards are inferior but then opposing the steps the AOA is taking to change that. Kudos to the AOA leadership for supporting the merger!

 

[NeuroLAX]

I read the JAOA letters and the AOA response. I'm trying to understand the perspective of those weary of the merger, but I just don't get it. One letter writer worries that we would lose AOA spots because many hospitals can't afford to run programs meeting ACGME standards... it's like saying your own standards are inferior but then opposing the steps the AOA is taking to change that. Kudos to the AOA leadership for supporting the merger!

Don't forget the "if you [the AOA] merge with the ACGME, the MDs will take our spots away from DOs".

 

[goofball]

Don't forget the "if you [the AOA] merge with the ACGME, the MDs will take our spots away from DOs".

I'm waiting for someone to post the South Park video right now.

 

[docmayer]

I read the JAOA letters and the AOA response. I'm trying to understand the perspective of those weary of the merger, but I just don't get it. One letter writer worries that we would lose AOA spots because many hospitals can't afford to run programs meeting ACGME standards... it's like saying your own standards are inferior but then opposing the steps the AOA is taking to change that. Kudos to the AOA leadership for supporting the merger!

I didn't get this either... he is straight up saying AOA residencies won't meet ACGME standards and is trying to keep it this way, as if inferior training is worth it as long as DO's can keep their distinction.... mind = blown

 

[Dmr6186]

I didn't get this either... he is straight up saying AOA residencies won't meet ACGME standards and is trying to keep it this way, as if inferior training is worth it as long as DO's can keep their distinction.... mind = blown

Could probably be the source of why MDs think the way they do about DOs when comparing each other?

 

[docmayer]

ignore

 

[IslandStyle808]

AFAIK, If you're in an acgme residency you can stop at comlex 2 pe/ce and do all of the usmle if you so choose. But that is something most people will not choose because usmle 2cs feels arduous as a second practical and the comlex 3 is a lot easier than the usmle 3.

Sorry for the late reply. I remember reading that if DO students choose to do all the USMLEs instead of the COMLEX that certain states would not recognize their certification. Is this true? (I was basing my comment off of this piece of knowledge)

 

[Drrrrrr. Celty]

Sorry for the late reply. I remember reading that if DO students choose to do all the USMLEs instead of the COMLEX that certain states would not recognize their certification. Is this true? (I was basing my comment off of this piece of knowledge)

They wouldn't graduate......

 

[IslandStyle808]

They wouldn't graduate......

Isn't that just COMLEX step I and II? I mean if they just stop there and only took all three USMLE steps to gain ACGME licensure. This license would not be recognized in some states because they are DO doctors (meaning those states only recognize AOA licensure).

 

[K31]

Sorry for the late reply. I remember reading that if DO students choose to do all the USMLEs instead of the COMLEX that certain states would not recognize their certification. Is this true? (I was basing my comment off of this piece of knowledge)

Probably, in the states that have separate MD and DO licensing bodies.

 

[Didierdrogba]

Isn't that just COMLEX step I and II? I mean if they just stop there and only took all three USMLE steps to gain ACGME licensure. This license would not be recognized in some states because they are DO doctors (meaning those states only recognize AOA licensure).

you can't. to get fully licensed as a DO you need all 3 steps of COMLEX

 

[Drrrrrr. Celty]

you can't. to get fully licensed as a DO you need all 3 steps of COMLEX

1 &2. You don't need step 3 to have the DO degree. Though I am curious, do DOs in ACGME programs need to take both step 3s?

 

[DrBumblebee]

you can't. to get fully licensed as a DO you need all 3 steps of COMLEX

How to take both COMLEX and USMLE exams in parallel and achieve good scores? Are they exclusively separate exams in that they both require separate test taking skills and info base?

 

[Didierdrogba]

1 &2. You don't need step 3 to have the DO degree. Though I am curious, do DOs in ACGME programs need to take both step 3s?

I know that we only need 1&2 to graduate, but i thought we are required to take step 3, otherwise something bad will happen, but I don't know what exactly. (residents please answer this)

How to take both COMLEX and USMLE exams in parallel and achieve good scores? Are they exclusively separate exams in that they both require separate test taking skills and info base?

they are pretty much the same test. COMLEX is basically USMLE with OMT component.

 

[NeuroLAX]

Found this, it might clarify a few things: http://forums.studentdoctor.net/showthread.php?t=914847

Also, if anyone is interested: http://www.fsmb.org/usmle_eliinitial.html

 

[Drrrrrr. Celty]

I know that we only need 1&2 to graduate, but i thought we are required to take step 3, otherwise something bad will happen, but I don't know what exactly. (residents please answer this)



they are pretty much the same test. COMLEX is basically USMLE with OMT component.

You probably can't practice your specialty without step 3 done. But you're a DO after your 4th year and step 2 and can go work in NIH or as w.e that doesn't require residency.

 

[DrBTS]

The last paragraph by Dr. Terry resonates with me. I fail to understand the thought-process of liquidating entire AOA residencies at the hands of some melting-pot ACGME-only conglomeration, a red flag raised towards the OMS distinction in the first place. This does not stabilize or give support for those osteopaths who initially focus on osteopathic philosophy (in an environment thats more than precarious for PCPs and DOs alike, but thats another story) and seek to proliferate this decision in PG training or even beyond. Adding insult to injury, how on earth does allowing competitive AOA residencies to recruit allopaths help increase match probabilities when it's evident that you are being screened, on the merit of your DO degree, in the first place from 'true' ACGME spots? It's like putting a dirty band-aid on the simple fact that OGME spots need to be more wide-spread and increased in number. And this, when allopathic medical schools are sprouting up and decreasing selectivity drastically. It's important for DOs to stand by the degree and have that alternative of supplementing OMM/philosophy as a career in every specialty, including the more competitive ones. The crux of it is: The AOA should maintain and increase competitive OGME specialties with the rising tide (even if that means more dually accredited programs) and not unify until osteopathy is prevalent.
edit: I like the way things are. But maybe I'm just a conservationist.

 

[DocEspana]

I don't think conservationist means what you think it does. Haha. But you might be a little conservative.

 

[r1d1]

letters and the aoa response are in the current jaoa issue: http://www.jaoa.org/content/113/3/200.2.full.pdf

The letters are basically saying: We're inferior, and we shall stay that way. We don't welcome outside evaluation and competition, because we'll fail.

I don't know how that attitude is going to benefit the osteopathic profession. I hope AOA won't act like a 20-yr old run-away bride, or the osteopathic students and residents are the ones to suffer.

 

[NurWollen]

The last paragraph by Dr. Terry resonates with me. I fail to understand the thought-process of liquidating entire AOA residencies at the hands of some melting-pot ACGME-only conglomeration, a red flag raised towards the OMS distinction in the first place. This does not stabilize or give support for those osteopaths who initially focus on osteopathic philosophy (in an environment thats more than precarious for PCPs and DOs alike, but thats another story) and seek to proliferate this decision in PG training or even beyond. Adding insult to injury, how on earth does allowing competitive AOA residencies to recruit allopaths help increase match probabilities when it's evident that you are being screened, on the merit of your DO degree, in the first place from 'true' ACGME spots? It's like putting a dirty band-aid on the simple fact that OGME spots need to be more wide-spread and increased in number. And this, when allopathic medical schools are sprouting up and decreasing selectivity drastically. It's important for DOs to stand by the degree and have that alternative of supplementing OMM/philosophy as a career in every specialty, including the more competitive ones. The crux of it is: The AOA should maintain and increase competitive OGME specialties with the rising tide (even if that means more dually accredited programs) and not unify until osteopathy is prevalent.
edit: I like the way things are. But maybe I'm just a conservationist.

I understand your perspective but I have two particular reservations.

First, you talk about how it is important for DO to "have that alternative of supplementing OMM/philosophy as a career in every specialty, including the more competitive ones." The merger won't keep DO's from doing so. There will still be Osteopathic residencies, they will just be accredited by the ACGME. They will still teach OMM.

You also mention how there should instead be an increase in AOA residencies until the 'osteopathy is more prevalent.' Osteopathic GME expansion is restricted by the same thing that restricts allopathic GME expansion: limited funding from congress.

I really think the merger will be a good thing. I am proud to be starting at a DO school the fall, but my goal is to to become a physician first and an osteopath second. The merger will preserve the osteopathic identity while keeping as many GME and sub specialty options open to me as possible.

 

[SpecterGT260]

I think a common issue is how one defines "osteopathy" and the myths and blatant falsehoods that get propagated in the interest of highlighting some phantom difference.

 

[IslandStyle808]

You will need to take the COMLEX step I , II, and III definitely but you don't need to take all the USMLEs.

AFAIK, If you're in an acgme residency you can stop at comlex 2 pe/ce and do all of the usmle if you so choose. But that is something most people will not choose because usmle 2cs feels arduous as a second practical and the comlex 3 is a lot easier than the usmle 3.

Sorry for the late reply. I remember reading that if DO students choose to do all the USMLEs instead of the COMLEX that certain states would not recognize their certification. Is this true? (I was basing my comment off of this piece of knowledge)

They wouldn't graduate......

Isn't that just COMLEX step I and II? I mean if they just stop there and only took all three USMLE steps to gain ACGME licensure. This license would not be recognized in some states because they are DO doctors (meaning those states only recognize AOA licensure).

Probably, in the states that have separate MD and DO licensing bodies.

Found this, it might clarify a few things: http://forums.studentdoctor.net/showthread.php?t=914847

Also, if anyone is interested: http://www.fsmb.org/usmle_eliinitial.html

That sums it up NeuroLAX, Thanks.

 

[HalfListic]

So, still no word yet on if the "merger" will be 2018 vs 2015?

 

[DrBumblebee]

So, still no word yet on if the "merger" will be 2018 vs 2015?

I think it's going on smoothly as planned before.

 

[Oo Cipher oO]

The American Osteopathic Association (AOA) is dedicated to advancing osteopathic medicine and promoting the distinctiveness of osteopathic physicians (ie, DOs). Discussions with the Accreditation Council on Graduate Medical Education (ACGME) are limited to a unified graduate medical education system, including maintaining core competencies for DOs in osteopathic manipulative medicine and osteopathic principles and practice. Losing the distinctiveness of the DO degree through a unified system is contrary to the AOA's mission, vision, and purpose.

The number of DO graduates has ex- ceeded the number of available osteopath- ic graduate medical education (OGME) positions for many years.1-3 Today there are more DOs training in ACGME residencies than in AOA programs.4 The proposed unified accreditation system will preserve access to ACGME residency and fellowship training programs for DOs. It will not necessarily guarantee us more spots, but it will ensure that our DOs will continue to have the opportunity to train in allopathic programs, particularly in those specialty areas in which there are few OGME programs. With the continued growth in numbers of both DO and MD graduates, neither the AOA nor the ACGME entered into these discussions to lose training programs. Our goal is to continue to work with the Bureau of OGME Development and the ACGME to increase the number of osteopathic-focused training programs and to ensure that current OGME programs meet ACGME standards.

If and when the proposed unified system goes into effect, there will be a transition phase. It is envisioned that OGME programs would undergo inspection within 3 years. Both AOA and ACGME leadership believe that the vast majority of programs will meet the requirements on the first attempt, and those that do not would have an opportunity to achieve compliance. Indeed, 30% of osteopathic internal medicine programs and half of osteopathic family medicine programs are already dually accredited.

We anticipate the specialty colleges will play an important role in the ongoing evolution of educational standards and milestones for osteopathic-focused resi- dency programs. Furthermore, osteopathic specialty colleges will always provide valuable services, including continuing medical education, communications, professional networking, and advocacy.

Most importantly, the AOA has always believed that osteopathic board certifica- tion measures the competence of our DO graduates, particularly with respect to the application of osteopathic principles and practice within each specialty. That is why ACGME discussions are limited to gradu- ate medical education and do not include AOA board certification. The ACGME is aware of the AOA's position on this matter and knows that the AOA will continue to encourage all DO graduates to take AOA board certification examinations, both now and in the future.

For the most recent updates on the pro- posed accreditation system, please visit http://www.osteopathic.org/ACGME.
Ray E. Stowers, DO
AOA President
Boyd R. Buser, DO
AOA Board of Trustees; AOA-ACGME- AACOM (American Association of Colleges of Osteopathic Medicine) Joint Task Force

This response by the AOA is right on the money. The writing is on the wall. The merger of residencies has to happen. The majority of DO grads do ACGME residencies. Yeah you are going to have some of the old guard put up a fit, but doing this right will preserve the profession access to quality residencies and fellowships for the future.

 

[Drrrrrr. Celty]

This response by the AOA is right on the money. The writing is on the wall. The merger of residencies has to happen. The majority of DO grads do ACGME residencies. Yeah you are going to have some of the old guard put up a fit, but doing this right will preserve the profession access to quality residencies and fellowships for the future.

I'm sorry, but this is more than a fit. It's a disgusting display of old men unwilling to give up power and change for the better.

 

[Oo Cipher oO]

I'm sorry, but this is more than a fit. It's a disgusting display of old men unwilling to give up power and change for the better.

Honestly, I can understand their responses. I don't agree with it, but I understand it. As they see it they, the osteopathy-focused DOs, are the vanguards of the osteopathic vision first established by A.T. Still. They will try to protect this with an almost religious zeal. But the important thing is that most of the people on top in charge of making these decisions are in favor of a merger of residencies. For those of you who are hoping for a more complete merger of the professions I think you can see that there will be significant resistance to that in the near future. Don't hold your breath.

 

[Drrrrrr. Celty]

Honestly, I can understand their responses. I don't agree with it, but I understand it. As they see it they, the osteopathy-focused DOs, are the vanguards of the osteopathic vision first established by A.T. Still. They will try to protect this with an almost religious zeal. But the important thing is that most of the people on top in charge of making these decisions are in favor of a merger of residencies. For those of you who are hoping for a more complete merger of the professions I think you can see that there will be significant resistance to that in the near future. Don't hold your breath.

Pretty much the same thing I said. Just a bunch of old diluted idiots who have a vision of osteopathic medicine out of this world and contradictory to most practitioners born after the 70s.

 

[DrBumblebee]

Pretty much the same thing I said. Just a bunch of old diluted idiots who have a vision of osteopathic medicine out of this world and contradictory to most practitioners born after the 70s.

Although, I fully support the unified match as well as the unified degree name for all US physicians (MD, Dr. etc.), I think these are some harsh statements against those who originally found the base for the osteopathic medicine in the US, long before even we were born. Please, keep your comments professional.

 

[Drrrrrr. Celty]

Although, I fully support the unified match as well as the unified degree name for all US physicians (MD, Dr. etc.), I think these are some harsh statements against those who originally found the base for the osteopathic medicine in the US, long before even we were born. Please, keep your comments professional.

Not really, they maintained the base for osteopathic medicine made by their fathers who went about getting accreditation by accepting allopathic medicine as a model, rejecting in majority osteopathic manipulation as an end all method, and then basically winning national respect by being equivalent to MDs. Today the AOA is an administration held by bloodlines of osteopathic founders and dinosaurs clinging to whatever they can to prevent their extinction. And to be completely frank their methods are unsavory, i.e making every DO aim for AOA board certification? Another way of saying I want DOs to pay us money so they can practice.

Sorry, but I have a very negative view of the AOA when ever it attempts to hold off on accepting the growing sentiments that there should be one system and one degree.