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

[Dr Dazzle]

Why does this new ruling matter when the MD and DO program directors will maintain the biases they have in place currently?

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[Dissected]

Why does this new ruling matter when the MD and DO program directors will maintain the biases they have in place currently?

It will blur over time

 

[HalfListic]

It will blur over time

+1

Exactly...this is one of those slower developing changes

 

[Ost3oclast]

+1

Exactly...this is one of those slower developing changes

I agree. I doubt that we will see that "blur" when we apply to residency programs though...

 

[HockeyDr09]

I posted this in the Osteo forum, but I figured it would be good for the pre-meds to be aware of as well.

A lot has been said about this merger being a bad move for DO's because they would be effectively relinquishing their power. I have been trying to explain why this wasn't the case, as there would be DO's sitting on the ACGME board, and have been met with venomous remarks. It appears that DO's will be fine.

"The AOA and AACOM have also successfully advocated for DO representation on the ACGME’s governing bodies. We will each have one of seven seats on the ACGME Board, giving us veto power (the ACGME requires an 80% voting majority) over issues as the system evolves. DOs will be nominated to serve on each Residency Review Committee (RRC), and new RRCs will likely be formed for specialties unique to DOs, such as neuromuskuloskeletal medicine."

http://www.do-online.org/TheDO/?p=120691

Does this mean that DO's will be able to push through whatever they want, of course not. Despite this, they will have veto power, which is far more than other posters on here wanted you to believe. Although I'm sure that this is somehow a "bad" thing for DO's and somehow they're still giving up power somewhere else, and this is the end of the AOA, and DO's will be regulated to primary care.....

 

[DocEspana]

A casual polling of program directors shows that they are hugely in support of this on the DO end. Calm down fearmobgers.

 

[HalfListic]

A casual polling of program directors shows that they are hugely in support of this on the DO end. Calm down fearmobgers.

Cool cool

Meaning, AOA PDs were polled and are supportive, or ACGME PDs were polled and are supportive of DOs combining?

 

[MedPR]

Cool cool

Meaning, AOA PDs were polled and are supportive, or ACGME PDs were polled and are supportive of DOs combining?

Pretty sure AOA PDs were polled.

I doubt the ACGME guys even care. What do they stand to gain by merging?

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[Ost3oclast]

Pretty sure AOA PDs were polled.

I doubt the ACGME guys even care. What do they stand to gain by merging?

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Yeah I agree with this. ACGME boys could probably care less what happened.

 

[HalfListic]

Pretty sure AOA PDs were polled.

I doubt the ACGME guys even care. What do they stand to gain by merging?

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Is this a guess, or did you read something?


I guess a simple answer, rather than a few possible longer ones, is if the ACGME has nothing to gain, they wouldn't have merged. Do you think the AOA strong armed the deal? haha



I any case, I'm just wondering about the specifics of who was polled, if anyone knows. Just curious really...

 

[MedPR]

Is this a guess, or did you read something?


I guess a simple answer, rather than a few possible longer ones, is if the ACGME has nothing to gain, they wouldn't have merged. Do you think the AOA strong armed the deal? haha



I any case, I'm just wondering about the specifics of who was polled, if anyone knows. Just curious really...

Do the ACGME PDs have a say? Isn't it just some board of a handful of people voting on this sort of stuff?

The USA has nothing to gain by helping impoverished countries. We do it anyway.
No, I'm not comparing the AOA to an impoverished country.
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[SLC]

The USA has nothing to gain by helping impoverished countries. We do it anyway.

Wow, you really missed the boat with this comment!

 

[MedPR]

Wow, you really missed the boat with this comment!

Yes taken out of context it's quite poor. Point is that people help other people even when they stand nothing to gain. It was a counter argument to "if the ACGME has nothing to gain they wouldn't have merged"

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[docmayer]

Yes taken out of context it's quite poor. Point is that people help other people even when they stand nothing to gain. It was a counter argument to "if the ACGME has nothing to gain they wouldn't have merged"

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He's right.... if they had nothing to gain in the long run, they would not have merged.... no one has time to waste, especially the ACGME...or they would have just said "sorry DO's, but you can't apply to our fellowships anymore, see ya!".. just my 0.02

 

[MedPR]

He's right.... if they had nothing to gain in the long run, they would not have merged.... no one has time to waste, especially the ACGME... just my 0.02

It's great that we all have an opinion but what does the ACGME stand to gain? The top DO students were already applying ACGME if they wanted to. The only thing that might have held them back was the dual match.

I'm guessing the merger was done in the interest of stepping up AOA quality and working towards training better physicians. That isn't to the benefit of the ACGME so much as it is to society and the profession though.


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[HalfListic]

Do the ACGME PDs have a say? Isn't it just some board of a handful of people voting on this sort of stuff?

The USA has nothing to gain by helping impoverished countries. We do it anyway.
No, I'm not comparing the AOA to an impoverished country.
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You have good advice at times(and I mean that sincerely), med, but I don't think you have a handle on this merger.


I don't think your example is great, but, actually, the US govt doesn't do anything that it doesn't benefit from. But that's beside the point.

As you recognized, this merger is nothing like a US helping another country, lol. A better comparison is when Apple computers was re-building its company under a returned Steve Jobs. Long story short, there was time that Jobs struck a deal with Microsoft and Bill Gates, who invested millions into Apple. Many think this was a main turning point for Apple...and it actually benefitted both companies. And now, Apple is what it is( the most valuable company and brand ever) and Microsoft is what it is...prolific and ubiquitous.

Not saying this is how it will play out in the future, but this is how they are coming into it...like two companies who stand more to benefit from compromise than from bickering.

 

[SpecterGT260]

I do think the ACGME stood to gain here, and I do think the AOA is still giving up its control. Veto power in inconsequential... They had sole control over their programs and as of 2015 that is no longer the case. If they attempt to.... lets call it "GOP" the ACGME policy votes another round of drastic changes will follow. It would make literally no sense for the ACGME to bring in a group of people of very definable common interest, give them a voting number equal to that of veto power, and then just hope that it is smooth sailing from then on. There will be escape clauses if the AOA members are not playing nice (not sying they arent going to, just saying IF).

Also, I need to do a little more reading on the ACGME bylaws. A quick look made it appear that organizations do not simply send representatives to the board, but each get to nominate an equal number. If that is the case it would imply that voting on board members also occurs and it is possible for 1 group to not have all of their nominations accepted. In other systems like this usually everyone gets who they want because they have equal votes and equal nominations and everyone just votes for their home group. I gotta look into that more, though, as that was browsing via my phone and I just sat down now to the computer to get a better look at it.

Anyone have the primary text of the resolution and not an AOA interpretation?

 

[docmayer]

It's great that we all have an opinion but what does the ACGME stand to gain? The top DO students were already applying ACGME if they wanted to. The only thing that might have held them back was the dual match.

I'm guessing the merger was done in the interest of stepping up AOA quality and working towards training better physicians. That isn't to the benefit of the ACGME so much as it is to society and the profession though.


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Yeah well either way increasing the quality of programs is good. I'm thinking ACGME did this for the most obvious reason, ie power.

 

[MedPR]

I do think the ACGME stood to gain here, and I do think the AOA is still giving up its control. Veto power in inconsequential... They had sole control over their programs and as of 2015 that is no longer the case. If they attempt to.... lets call it "GOP" the ACGME policy votes another round of drastic changes will follow. It would make literally no sense for the ACGME to bring in a group of people of very definable common interest, give them a voting number equal to that of veto power, and then just hope that it is smooth sailing from then on. There will be escape clauses if the AOA members are not playing nice (not sying they arent going to, just saying IF).

Also, I need to do a little more reading on the ACGME bylaws. A quick look made it appear that organizations do not simply send representatives to the board, but each get to nominate an equal number. If that is the case it would imply that voting on board members also occurs and it is possible for 1 group to not have all of their nominations accepted. In other systems like this usually everyone gets who they want because they have equal votes and equal nominations and everyone just votes for their home group. I gotta look into that more, though, as that was browsing via my phone and I just sat down now to the computer to get a better look at it.

Anyone have the primary text of the resolution and not an AOA interpretation?

When posts like this pop up I wonder if the majority of med students are this involved/informed/interested or if it's mainly isolated to SDN.

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[SpecterGT260]

It's great that we all have an opinion but what does the ACGME stand to gain? The top DO students were already applying ACGME if they wanted to. The only thing that might have held them back was the dual match.

I'm guessing the merger was done in the interest of stepping up AOA quality and working towards training better physicians. That isn't to the benefit of the ACGME so much as it is to society and the profession though.


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That is probably part of it. All in all it is usually a better idea to incorporate a competitor into your ranks rather than expend resources fighting against each other. Until I get a look at the original documents I still say the only big win for DOs as a whole is preservation of access. There will be programs spending much needed resources on complying with new standards (note, I didnt say "higher", just new, a.k.a. "different", so no butthurted freakouts please )

 

[HalfListic]

When posts like this pop up I wonder if the majority of med students are this involved/informed/interested or if it's mainly isolated to SDN.

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...you realize you are one who is misinformed on this matter, right? I don't want to bicker but your comments and example show you don't quite understand what's happening

 

[MedPR]

...you realize you are one who is misinformed on this matter, right? I don't want to bicker but your comments and example show you don't quite understand what's happening

What does this have to do with me being curious about how informed most med students are?

I've never denied that my knowledge of the merger is limited.

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[HalfListic]

That is probably part of it. All in all it is usually a better idea to incorporate a competitor into your ranks rather than expend resources fighting against each other. Until I get a look at the original documents I still say the only big win for DOs as a whole is preservation of access. There will be programs spending much needed resources on complying with new standards (note, I didnt say "higher", just new, a.k.a. "different", so no butthurted freakouts please )

This is a bit better...as I said, these are more like two companies merging. They stand more to benefit from cooperating than bickering


-this is why I like you, specter. We usually come at a situation from different angles, but I think your are sincere in your analyses

 

[MedPR]

This is a bit better...as I said, these are more like two companies merging. They stand more to benefit from cooperating than bickering

Again the speculation that both stand to gain something but no mention of what the ACGME gets out of the deal... [

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[HalfListic]

Again the speculation that both stand to gain something but no mention of what the ACGME gets out of the deal... [

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Did you want me to google it for you? I can't hold your hand med...go read

** also, we've had this conversation before...

 

[MedPR]

Did you want me to google it for you? I can't hold your hand med...go read

** also, we've had this conversation before...

Like I said before. It seems like the merger simplifies the match process and increases quality expectations of AOA programs. Great for the profession, but no direct gain by the ACGME itself.

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[HockeyDr09]

Like I said before. It seems like the merger simplifies the match process and increases quality expectations of AOA programs. Great for the profession, but no direct gain by the ACGME itself.

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The ACGME gains access to over 3,000 additional residency slots. It's that simple.

 

[HalfListic]

The ACGME gains access to over 3,000 additional residency slots. It's that simple.

Among many other things that you have already listed in conversation we were all in. At this point...med needs to take his oft given advice and use the search function.

 

[MedPR]

The ACGME gains access to over 3,000 additional residency slots. It's that simple.

How does that work? The AOA gains easier access to the ACGME spots that were formerly "protected" by having a separate match.

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[HalfListic]

How does that work? The AOA gains easier access to the ACGME spots that were formerly "protected" by having a separate match.

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Re read...you have it reversed. He said, the ACGME gains 3000 spots (currently AOA only spots...)


What's silly is that you used to argue that the AOA and DOs have nothing to gain. Now, the ACGME is greeting the shaft?

Just remember, merger=both benefit

 

[MedPR]

Re read...you have it reversed. He said, the ACGME gains 3000 spots (currently AOA only spots...)

I read it correctly. ACGME gains shared access to those spots, but the AOA gains easier shared access to all the ACGME spots. Reread what I wrote. I think it was clear.

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[HalfListic]

How does that work? The AOA gains easier access to the ACGME spots that were formerly "protected" by having a separate match.

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So...then you don't get it...because this is your reply. See how you talk about what the AOA has to gain, and you should have been talking about the ACGME?

You're a slippery fish!!!

 

[MedPR]

Re read...you have it reversed. He said, the ACGME gains 3000 spots (currently AOA only spots...)


What's silly is that you used to argue that the AOA and DOs have nothing to gain. Now, the ACGME is greeting the shaft?

Just remember, merger=both benefit

I never argued the AOA had nothing to gain. I argued that DOs wouldn't have an easier time matching because PD bias wouldn't go away.

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[MedPR]

So...then you don't get it...because this is your reply.

Then I dont get it. Searching has led me to this.

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[HalfListic]

Then I dont get it. Searching has led me to this.

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Lol

I admire your resilience

 

[HockeyDr09]

I do think the ACGME stood to gain here, and I do think the AOA is still giving up its control. Veto power in inconsequential... They had sole control over their programs and as of 2015 that is no longer the case. If they attempt to.... lets call it "GOP" the ACGME policy votes another round of drastic changes will follow. It would make literally no sense for the ACGME to bring in a group of people of very definable common interest, give them a voting number equal to that of veto power, and then just hope that it is smooth sailing from then on. There will be escape clauses if the AOA members are not playing nice (not sying they arent going to, just saying IF).

Also, I need to do a little more reading on the ACGME bylaws. A quick look made it appear that organizations do not simply send representatives to the board, but each get to nominate an equal number. If that is the case it would imply that voting on board members also occurs and it is possible for 1 group to not have all of their nominations accepted. In other systems like this usually everyone gets who they want because they have equal votes and equal nominations and everyone just votes for their home group. I gotta look into that more, though, as that was browsing via my phone and I just sat down now to the computer to get a better look at it.

Anyone have the primary text of the resolution and not an AOA interpretation?

Although I'll agree that the AOA is losing some power over it's own residencies, it's gaining power over 18,000 ACGME residencies. How could you possibly think that having a veto power is inconsequential? You previously stated that the AOA could be pushed around because they won't have enough votes. Now it's been proven that they'll have veto power, it's still not good enough, and it's inconsequential? Are the 2/7 votes going to be enough to pass through major changes to ACGME programs, obviously not, but it is enough to prevent any major negative changes to DO's. That's irrefutable. That being said, I wouldn't mind seeing a text of the resolution. Can't you just concede that the AOA didn't fair nearly as bad as most posters on here initially thought?

 

[MedPR]

Lol

I admire your resilience

I admire your ability to continue to dodge the question about what the ACGME actually gains.

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[SpecterGT260]

I posted this in the Osteo forum, but I figured it would be good for the pre-meds to be aware of as well.

A lot has been said about this merger being a bad move for DO's because they would be effectively relinquishing their power. I have been trying to explain why this wasn't the case, as there would be DO's sitting on the ACGME board, and have been met with venomous remarks. It appears that DO's will be fine.



http://www.do-online.org/TheDO/?p=120691

Does this mean that DO's will be able to push through whatever they want, of course not. Despite this, they will have veto power, which is far more than other posters on here wanted you to believe. Although I'm sure that this is somehow a "bad" thing for DO's and somehow they're still giving up power somewhere else, and this is the end of the AOA, and DO's will be regulated to primary care.....

This is the verbatim response I gave in the other thread, but I felt the pre-meds may want to be aware of this as well. It isnt about picking at you personally or anything

The point is, "DO-online.org" is not the AOA nor are they the ACGME. They are reporting facts as they interpret them, and that isnt necessarily the best source.

Here are the current ACGME bylaws concerning these things:

From other thread:

I have been trying to stress that DO's will be given a seat at the table and have been mostly met with the belief that their impact will be negligible. Looks like you guys may be off by a little.



http://www.do-online.org/TheDO/?p=120691

Although I'm sure that this is somehow a "bad" thing for DO's and somehow they're still giving up power.

Here is the thing - the AOA sources you are quoting are being overly simplistic. If you look at the actual ACGME bylaws, an 80% vote is not the norm.
https://www.acgme.org/acgmeweb/Portals/0/ab_ACGMEbylaws.pdf

Section 12. Matters Requiring Seven-eights Vote of the Directors: The following
matters shall require a seven-eights vote of the directors present and
voting at any regular meeting of the Board of Directors at which a quorum
is present:
a) A change in the term or terms of any director; and
7
b) Any amendment to this provision of the bylaws.

Section 13. Matters Requiring Votes of Directors and Members:
Notwithstanding any other provisions of these bylaws,
a) The following matters shall require first, a seven-eights vote of the
directors present and voting at any regular meeting of the Board of
Directors at which a quorum is present, and thereafter, if the
Board of Directors passes the matter, a four-fifths vote of the
members:
i) Dissolution;
ii) Sale or transfer of all assets;
iii) Merger;
iv) Addition of a member;
v) Removal of a member;
vi) Amendment of Article IV, Section 2, Article V, Sections 2,
3, or 13 of the bylaws; and This ammendment is the one that is concerned with allowing the AOA to be a "member"
b) The following matters shall require first, a three-quarters vote of
the directors present and voting at any meeting of the Board of
Directors at which a quorum is present, and thereafter, if the
Board of Directors passes the matter, a four-fifths vote of the
members:
i) Amendment of Article II, Section 1 of the bylaws;
ii) Any single capital expense that exceeds 20% of the
reserve fund, as defined in the annual auditors' report;
iii) Aggregate capital expenses that would exceed 30% of the
reserve fund in a given fiscal year; and
iv) Any actions that would cause the debt to equity ratio to
exceed 1.0.

on number of votes

Section 2. Number and Residency Directors: The number of directors shall be a
minimum of twenty seven and a maximum of thirty. Without the
amendment of the bylaws, the Board of Directors may change the
number of directors, within the minimum and maximum, for terms
beginning upon adjournment of the annual meeting of the Board of
Directors. Directors need not be residents of the State of Illinois.

This number will be increased by 7 to accommodate the AOA. They have a 20% max vote if the minimum number of directors within this scheme is chosen. If, however, 30 prior ACGME seats are used there is no longer an AOA majority vote. There are also additional board members outside of this scheme which may throw a wrench in whoever published the veto vote thing in the first place:

Additional Directors: One to four at large directors, three public
directors, one ACGME Council of Review Committees director, and two
resident physician directors shall serve on the Board of Directors. The at
large directors and the public directors shall be appointed by the Board of
Directors. The Chair of the ACGME Council of Review Committees shall
be the Chair of the ACGME Council of Review Committees director. One
resident physician director shall be the Chair of the Council of Review
Committee Residents. One resident physician director shall be appointed
by the Resident and Fellow Section of the American Medical Association.
In selecting the resident physician for appointment to the Board of
Directors, the Resident and Fellow Section shall seek the advice of
national organizations representing resident physicians who are currently
participating in graduate medical education.

Again, because it is all speculation and nothing has been signed on either side (with the exception of an agreement to work towards an agreement), I will wait for the actual resolution before feeling comfortable agreeing with the very sunny interpretations that some people are giving.

In terms of non-monetary policy and things that do not affect the bylaws a simple majority suffices:

Manner of Acting: The act of a majority of the directors present and
voting at a meeting at which a quorum is present shall be the act of the
Board of Directors, unless the act of a greater number is required by the
statute, these bylaws, or the Articles of Incorporation. If a quorum is not
present at any meeting of the Board of Directors, a majority of the
directors present may adjourn the meeting to another time, with at least
thirty days' written or electronic notice of the time and location of the
adjourned meeting. At any adjourned meting at which a quorum is
present, any business may be transacted which might have been
transacted at the original meeting. Withdrawal of directors at any meeting
shall not cause failure of a duly constituted quorum at that meeting.

This part directly precedes the "matters which require 7/8s vote" section I quoted earlier. Things in that section all deal with changing terms of directors, editing bylaws, and capital expenses, nothing about governing or accrediting programs. Matters involved in setting up RCCs are by simple majority alone. There are also detailed matters of quorum stating that at least 2 directors from each of the 5 (soon to be 6) members (AOA, AMA, ect...) must be present. If they sent all 7 directors, and each of the other 5 each send their 2 for a minimum quorum, there is still not enough for a veto vote on matters that affect residencies.

Again, the details of the resolution have yet to be established. The AOA may demand a narrower variance in board members to ensure their veto power over things which include their involvement - however all of these things require editing of the bylaws which requires an 80% vote to do, and unless I am mistaken, the current "agreement to work towards agreement" was subject to a simple majority, the actual numbers not withstanding - 80-85% of the current members (i.e. not AOA) will need to vote in favor including AOA board membership before any of that can happen in the first place. Until then the AOA programs have provisional accreditation that, technically, could be stripped at any time (again, unless there is something concrete that points to me being mistaken, but from what I have read the AOA is not a member until 2015, and nobody said that this motion will absolutely definitely go through. This is a major ACGME bargaining chip if I am correct)

Here is the part that we have been talking about that is a simple majority vote in which the AOA has lost power:

ARTICLE XI - MODUS OPERANDI
Section 1. Establishing Institutional Requirements and Program Requirements for
Institutional and Program Evaluations:
a) Institutional Requirements: The Board of Directors shall adopt Institutional
Requirements for all institutions that sponsor ACGME accredited graduate
medical education programs. The Institutional Requirements may be
approved by a majority vote of the directors present and voting at any regular
meeting of the Board of Directors at which a quorum is present, provided that
the proposed change has been previously submitted in writing to the
directors for review and comment.
b) Program Requirements: Each Review Committee shall prepare Program
Requirements for the specialty programs over which it has cognizance. The
Program Requirements shall be approved by the respective Review
Committees, after review and comment by their Review Committee
appointing organizations, and then submitted for approval by the Board of
Directors. Program Requirements may be approved by a majority vote of the
directors present and voting at any regular meeting of the Board of Directors
at which a quorum is present.
Section 2. Accreditation:
a) Except as provided under Article XI, Subsection 2(c) of these Bylaws, the
Residency Review Committees shall evaluate and make recommendations
regarding the accreditation of programs in graduate medical education in
accordance with the Institutional and applicable Program Requirements,
notify program directors of their recommendations, and submit their
recommendations to the Board of Directors.
b) The Board of Directors shall accredit programs in accordance with
the Institutional and applicable Program Requirements, following receipt of
the recommendation from the appropriate RRC, and shall promptly notify the
program directors of its determination. The Board of Directors may establish
procedures to delegate its accreditation authority to an appeals panel which
includes the Executive Committee for appeals from expedited accreditation
actions.
c) Upon application of a Review Committee, including RRCs, the IRC, and the
TYRC, and following a review of its performance, the Board of Directors may
Relevant Excerpt from ACGME Bylaws, Policies and Procedures (approved 2/08)
Council of Review Committee Chairs
Page 3
delegate accreditation authority to the Review Committee. Such delegation
shall be for a period to be determined by the Board of Directors. The Board
of Directors shall conduct periodic reviews of the accreditation process of the
Review Committee and of its authority to accredit.
d) The Board of Directors shall have published annually the Institutional and
Program Requirements for accreditation of institutions and programs in
graduate medical

So, basically, each body gets to send "directors" who get to vote. The only thing the AOA can THEORETICALLY veto is removal of the AOA, or spending money (which is a non issue because I doubt they have too differing of fiscal interests). The RRCs are nominated, and voted upon, a simple majority vote system in which even though the AOA can nominate, it does not mean that they will be seated (although there was talk of the AOA requiring inclusion on RRCs for prior AOA programs, so that may be in the final product) at which point the RRC gives a recommendation and it is voted upon via simple majority by the board. There are at least 3 areas in which AOA interests can be subverted if the rest of the ACGME found it in their best interest.

 

[HockeyDr09]

This is the verbatim response I gave in the other thread, but I felt the pre-meds may want to be aware of this as well. It isnt about picking at you personally or anything

The point is, "DO-online.org" is not the AOA nor are they the ACGME. They are reporting facts as they interpret them, and that isnt necessarily the best source.

Here are the current ACGME bylaws concerning these things:

The author of the article I posted was the executive director of the AOA. I'm sure he has NO idea what he is talking about...

Also, you just went from claiming that a veto vote is inconsequential, to the executive director of the AOA is just wrong and it doesn't matter anyway.

Although I admire your ability to find the specific bylaws (which I did read through), It honestly means nothing. We do not know what the new bylaws are going to be, and I apologize if I take the word of the executive director of the AOA over your interpretation of bylaws that will be changing.

 

[HalfListic]

Although I'll agree that the AOA is losing some power over it's own residencies, it's gaining power over 18,000 ACGME residencies. How could you possibly think that having a veto power is inconsequential? You previously stated that the AOA could be pushed around because they won't have enough votes. Now it's been proven that they'll have veto power, it's still not good enough, and it's inconsequential? Are the 2/7 votes going to be enough to pass through major changes to ACGME programs, obviously not, but it is enough to prevent any major negative changes to DO's. That's irrefutable. That being said, I wouldn't mind seeing a text of the resolution. Can't you just concede that the AOA didn't fair nearly as bad as most posters on here initially thought?

To add to this...this is compared to 0 votes they currently have. And further, it's not fully clear how much influence the ACGME will have with current AOA programs after the merger.

It's not all sunshine for either side, but there aren't any big losers here either.

 

[MedPR]

Perhaps this is due to my obvious misunderstanding, but to say the ACGME gains access to 3000 spots = what the ACGME gains by the merger is like saying that you gain access to your house guest's luggage and belongings by letting them stay in your house. They get way more compared to what you get and what you do get you barely needed in the first place.

The ACGME has to be getting more out of this.

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[HalfListic]

Perhaps this is due to my obvious misunderstanding, but to say the ACGME gains access to 3000 spots = what the ACGME gains by the merger is like saying that you gain access to your house guest's luggage and belongings by letting them stay in your house. They get way more compared to what you get and what you do get you barely needed in the first place.

The ACGME has to be getting more out of this.

Sent from my SGH-T999 using SDN Mobile

You could benefit from reading up on the relationship of the ACGME and AOA over the years.

Also, really, if you want a good comparison, look at apple and Microsoft during the time Microsoft backed apple. It's very similar and parallels are easy to draw.

You are right to think that the ACGME is gaining more than a access to GME spots, but you have to understand that significance too...which it seems like you don't

 

[HockeyDr09]

Perhaps this is due to my obvious misunderstanding, but to say the ACGME gains access to 3000 spots = what the ACGME gains by the merger is like saying that you gain access to your house guest's luggage and belongings by letting them stay in your house. They get way more compared to what you get and what you do get you barely needed in the first place.

The ACGME has to be getting more out of this.

Sent from my SGH-T999 using SDN Mobile

Enough with these awful analogies. 3,000 spots, and the power to oversee these 3,000 spots is nothing to scoff at. Both sides have made gains.

 

[MedPR]

Enough with these awful analogies. 3,000 spots, and the power to oversee these 3,000 spots is nothing to scoff at. Both sides have made gains.

Isn't the AOA gaining some power over ACGME spots (more than 3000) that they previously had no say over?

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[HockeyDr09]

Isn't the AOA gaining some power over ACGME spots (more than 3000) that they previously had no say over?

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Both sides have made gains.

 

[MedPR]

Both sides have made gains.

Oh, well when you put it that way it all makes sense...

Edit: This is my understanding.

Pre-merger:

ACGME controls all its spots. AOA controls all its spots.


Post-merger.

ACGME gains majority control over AOA spots. AOA gains some control over ACGME spots.

So I have a million dollars, you have $300k. We merge our bank accounts. I get access to your money, but you also get access to mine and I had more money to begin with. I gain very little while giving you access to much more.

 

[SpecterGT260]

The author of the article I posted was the executive director of the AOA. I'm sure he has NO idea what he is talking about...

Also, you just went from claiming that a veto vote is inconsequential, to the executive director of the AOA it just wrong and it doesn't matter anyway.

oh come on, I had just refreshed the page to thank you for being insistent because it made me read more into the ACGME bylaws, and remark that where the facts lay now vs where they will in 2015 has yet to be decided... but instead I find you being stubborn (decidedly different than insistent).

If you want to throw your chips in like that fine. No, the AOA exec director is a complete mo-**** if he actually believes everything as you have put it forth. I have maintained that the AOA is flavoring things very positively.

If you took a minute (probably more like 10) to read my last post carefully you will see where and how you are wrong in this matter. The veto vote is inconsequential because 1) the variable number of directors according to the current bylaws is ONLY subject to a 7 vote veto at its smallest number and 2) the 80% requirement is only required for capital expenses and restructuring of the bylaws. It is NOT required for issues of accreditation to any program currently accredited by the body. Accreditation is done, as I mentioned, by recommendation by nominated individuals and voted upon by simple majority by the board, a situation in which even if every AOA rep attends and the minimum of the rest attend they still do not have "veto power". Hopefully, the AOA plays ball and is willing to compromise on a good many things. I don't really see the ACGME using this as an opportunity to squash the AOA, but realistically unless the bylaws regarding accredidation are changed (which, again, will require an 80% vote before the AOA even has a vote, or if it is done after they are seated you will need to convince another 60% of the rest of the board to vote in favor....) it is theoretically possible for the ACGME to close any AOA program they wish simply by calling it to vote. I really don't think they will because I dont see the acquisition as malicious, but you are overstating the importance of this "veto power".

I am not quoting a blog... these are the most recent published bylaws

 

[SpecterGT260]

Although I admire your ability to find the specific bylaws (which I did read through), It honestly means nothing. We do not know what the new bylaws are going to be, and I apologize if I take the word of the executive director of the AOA over your interpretation of bylaws that will be changing.

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.

 

[SpecterGT260]

Oh, well when you put it that way it all makes sense...

Edit: This is my understanding.

Pre-merger:

ACGME controls all its spots. AOA controls all its spots.


Post-merger.

ACGME gains majority control over AOA spots. AOA gains some control over ACGME spots.

So I have a million dollars, you have $300k. We merge our bank accounts. I get access to your money, but you also get access to mine and I had more money to begin with. I gain very little while giving you access to much more.

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 )

 

[HockeyDr09]

If you want to throw your chips in like that fine. No, the AOA exec director is a complete mo-**** if he actually believes everything as you have put it forth. I have maintained that the AOA is flavoring things very positively.

Classy.....

If you took a minute (probably more like 10) to read my last post carefully you will see where and how you are wrong in this matter. The veto vote is inconsequential because 1) the variable number of directors according to the current bylaws is ONLY subject to a 7 vote veto at its smallest number and 2) the 80% requirement is only required for capital expenses and restructuring of the bylaws. It is NOT required for issues of accreditation to any program currently accredited by the body. Accreditation is done, as I mentioned, by recommendation by nominated individuals and voted upon by simple majority by the board, a situation in which even if every AOA rep attends and the minimum of the rest attend they still do not have "veto power". Hopefully, the AOA plays ball and is willing to compromise on a good many things. I don't really see the ACGME using this as an opportunity to squash the AOA, but realistically unless the bylaws regarding accredidation are changed (which, again, will require an 80% vote before the AOA even has a vote, or if it is done after they are seated you will need to convince another 60% of the rest of the board to vote in favor....) it is theoretically possible for the ACGME to close any AOA program they wish simply by calling it to vote. I really don't think they will because I dont see the acquisition as malicious, but you are overstating the importance of this "veto power".

I am not quoting a blog... these are the most recent published bylaws

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.