Finally read the Gevitz paper, its actually not completely unreasonable, but it does have major issues with some of the numbers that in my opinion skew them to make his point.
1) He assumes that the rate for DOs to attain positions in the SOAP will remain at the current rate. Here's the thing though, if we assume a bunch of the AOA programs that go unmatched (~700 spots) will now be added to the SOAP, it makes sense for the percentage of DOs that SOAP to go up. In addition, most DOs simply don't participate in the SOAP, because they know if they wait a few more days, they'll miss out on programs in the AOA scramble. No one knows how DO performance will be with a combined match. Him assuming the low projections he does is short-sighted. Personally I believe DOs will do better in both the NRMP match and SOAP with a combined match, but only time will tell.
2) There are a lot of problems with the numbers he quotes for AOA programs. The truth is many of the programs he's counting as "available" or in the match or need to make the transition, etc. are programs that have either closed in the last few years or haven't taken residents in the last few years. I first noticed this when I looked at the Osteopathic distinctiveness section. He said there were 41 NMM or NMM-combined programs. There are nowhere near that many. I looked into a lot of them, and many haven't taken residents for years because they don't have the PD or faculty for it. They still show up on AOA opportunities, but there's nowhere near 41 of them that are actually "active". So then I looked at his surgery program numbers more closely. He counted 182 surgical programs (that fits with AOA opportunities, which at times is outdated and inaccurate). I counted 139 that participated in last year's match. My guess is that a lot of the rest of the programs fill outside of the match (pre-match), and a handful are already closed or haven't taken residents in years.
3) He left out Urology from the surgery/surgical specialties calculation for some reason, which is odd. Almost all AOA Urology programs (10/11 - by the way 1 program was new for the 2016 year) have applied for ACGME accreditation and the majority have already received it. The fact that he left those out is suspicious, because they actually change the result by a significant degree.
4) He completely ignored the fact that a handful of the programs he counted as surgical programs that failed to apply were already dual-accredited programs that don't need to apply through the same pre-accreditation process.
5) He chose a time (July 30th) that actually had far fewer surgical programs that applied and were evaluated as compared to even a few days later. I'm not sure if this was intentional or simply because that's when he wrote this article. The problem is that at that point the sample size is so small, he couldn't possibly extrapolate the handful of programs in each specialty that were reviewed to all of the AOA positions.
6) In addition, in terms of actual spots, the numbers we're talking about are nowhere near 40% failing even if we scrap surgery as a complete loss. If we eliminate all of the AOA surgical positions (doesn't make sense since as of right now 1/3 of those reviewed already received accreditation), they only amount to <15% of all AOA seats. So unless we are also losing a ton of FM, IM and EM on top of the majority of surgery seats, we aren't getting anywhere close to the 40% number he's talking about.
7) As I've mentioned in another thread, he's ignoring the fact that for (1) programs have no risk in applying, because they can resubmit their app repeatedly during the transition at no extra fee and (2) the AOA incentivized them to apply ASAP in order to continue taking residents. You can't say that based on their first early attempt they won't make it. They can reapply and then get accredited. If anything, it might be beneficial to apply first without making significant changes, and then only changing the aspects that the RRC wants them to change. That way they save money only implementing the changes they need. Plus they have 4 more years to get it right. There's a transition period for a reason.
8) There are almost double the number of programs that applied for Osteopathic focus now than there are in his article. 24 additional programs have applied in 1.5 mos. It lends credence to what Promethean has heard, and honestly I've heard the same thing. Programs are waiting to first get ACGME initial accreditation before they apply for osteopathic focus.
9) He makes this claim that no AOA programs will open during the transition. It'll definitely slow, but a handful of programs already opened between 2015 and 2016, so obviously there still is growth. I also personally know of multiple AOA programs that opened up this year. The merger doesn't prevent the AOA from accrediting programs now, it prevents them from accrediting after 2020. So yeah, growth will slow, because they'll just open up as ACGME programs, but if anything, that means a greater increase of ACGME positions because all that OGME growth is going straight to the ACGME. That's another thing he didn't account for.
10) In his article he writes that some programs are choosing to close rather than apply (yes its a handful, but from 2015 to 2016 programs in the NMS still increased implying that the number is small or is off-set by OGME growth). Most of those programs were probably already considering closing, and this just seemed like a good time to do it, and honestly maybe its for the best. He even says that they "will voluntarily shut down because their sponsoring institutions have determined they do not have the fiscal or personnel resources or the patient load necessary to convert their programs into ACGME accredited programs", basically admitting that those that do close are deficient in terms of finances, personnel or patient load.
11) He also says that even though OGME may close "in many instances the positions will likely be harvested by other hospitals within a given health system or in a geographically adjacent area." This is yet another thing he doesn't account for as an increase in the rate of ACGME growth during the transition. If a lot of new ACGME spots will open up as a result of AOA spots closing, that effectively is equivalent to those spots not closing, but rather being converted to ACGME spots, just like all OGME during the transition. That's not really a loss.
12) His whole argument hinges around this idea that DOs will lose a safety net, so the majority of them won't match. The problem with that is that a lot of DOs apply with that idea in mind. They know there's a safety net, so they don't apply to as many programs. They know its tough on the ACGME surgical side, so they only focus on AOA apps and auditions. They know they can only rank a few MD programs and not participate in the SOAP, because they can always scramble to a TRI. Only time will tell how DOs will actually be affected by a combined match, but I highly doubt it'll be as bad as he implies.
Anyway, those are some issues I have with his article. I'm going to read the response now and see if they hit some of those issues.
Also, primary care is not a punishment or a destination for those who can't hack specialties. I came to a DO school because of the primary care focus. My stats were more than adequate for an MD school, but I wanted FM and this school had a program targeted for primary care that would let me shave off a year of time and tuition cost if I made that commitment up front. So, there is some self-fulfilling prophecy, as osteopathic medicine has a reputation of being very primary care relevant and people who are primary care bound by desire are likely to choose it.
People with board failures and red flags are not "stuck in PC." They are exceptionally fortunate to have the opportunity to pursue a career in an interesting and varied specialty, despite their personal shortcomings.
Don't forget one of the lowest tuition of DO schools (and private med schools in general) to begin with. You're probably spending for you're whole degree about as much as you would at another average private DO school for only 2 years. Basically, you're doing it right.
Tons of people in FM have good stats. It just happens that there is a population with major redflags that were lucky to get an FM spot, because there are so many of them to go around. There are FM programs everywhere. With something like 500 programs (>3000 spots) in the US, it constitutes the second largest field (second to IM), and its still one of the top 4 residencies in which US MDs and DOs match into.
I've also heard the same from NMM and other AOA PDs. They're waiting to apply until they have to and they're waiting for Osteopathic focus until after they get ACGME accreditation.
EDIT: Just read the response. It actually addresses some of the problems I noticed with his numbers. I also think it was a very good response. Short, to the point, and with clear explanations and points of why things actually are going well and why the merger was done in the first place.
I've said from the beginning that the creation of Osteopathic and NMM RRCs on the ACGME is a way to perpetuate OMM by literally putting it in the hands of potentially all US physicians. I was reaffirmed in that belief by hearing multiple MD students and residents explicitly mention (unprompted) that they wanted to learn OMT/NMM in residency.
Your post was good except for this.... When will people realize there are a ton of specialties that are very open to even the most average to below average DOs? Yeah the people with board failures and other red flags might get stuck in PC, but other than that there really isn't anyone who should feel forced into PC. The world isn't divided into family medicine doctors and neurosurgeons.
