Residency Merger and Resolution 42

[Ceusina]

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Is anyone aware of any updates regarding resolution 42 and the residency merger? The last relevant post I could find was from 2012:

http://forums.studentdoctor.net/threads/new-merger-and-intern-year-res-42.959994/

Specifically, will the 5 states (4?) that "require" an osteopathic TRI for licensure (or completion of a waiver via resolution 42) abandon this in the near future? I plan on completing a residency and practicing in a state with the osteopathic TRI "requirement." I'm specifically interested in ACGME surgery, which does NOT have an equivalent osteopathic TRI intern year.

Thanks in advance for any help.

 

[costales]

It is still wait-and-see. This is the last I saw:

Training approval for licensure: DOs who complete an internship or first year of GME training in an ACGME-accredited training program should be aware that four states (Florida, Michigan, Oklahoma and Pennsylvania) require a first year of AOA residency training for licensure. The AOA uses a process called Resolution 42 to provide recognition of ACGME first-year training to meet state requirements. DOs training in ACGME-accredited programs when the single accreditation system goes into effect will continue to use Resolution 42 for licensure in those four states unless the states change their requirements once a single system is in place. At that time, the AOA will reevaluate the situation and determine if Resolution 42 will still be needed.​

 

[AnonymousD.O.]

I'm from PA. Nothing in Pennsylvania ever changes. You can't even purchase alcohol there in a grocery store.

But on a serious note, this is completely up to the state to change according to one of the podcast things the AOA promoted right after the merger. The state will have to form there own legislation for it to change. May be a while

 

[DocEspana]

yup. This stuff is state controlled. The states havent made the logical switch in decades and remained strong on the historic/dogmatic position. I dont think they will make any changes to it any time soon. But if anything would change their minds, it would be this. At the very least, the states would have to double down on their choice soon, since I doubt the wording they had before will apply in a little while when AOA residencies exist more as a technicality than an actual legal entity.

 

[NurWollen]

I'm assuming it's no accident that the four holdout states are among those with historically the strongest DO/AOA presence. The licensing requirements are probably the way they are because the AOA lobbied for it. If they've done such an about face, it's not hard to imagine them 'influencing' the states to do the same.

 

[DocEspana]

I'm assuming it's no accident that the four holdout states are among those with historically the strongest DO/AOA presence. The licensing requirements are probably the way they are because the AOA lobbied for it. If they've done such an about face, it's not hard to imagine them 'influencing' the states to do the same.

No. Its not the AOA lobbying for it. Its all the state level osteopathic societies. So the AOA switching does have an impact on the state societies, but its quite indirect as the state societies enjoy having this power to continue their traditions.

 

[hallowmann]

I'm assuming it's no accident that the four holdout states are among those with historically the strongest DO/AOA presence. The licensing requirements are probably the way they are because the AOA lobbied for it. If they've done such an about face, it's not hard to imagine them 'influencing' the states to do the same.

No. Its not the AOA lobbying for it. Its all the state level osteopathic societies. So the AOA switching does have an impact on the state societies, but its quite indirect as the state societies enjoy having this power to continue their traditions.

This is exactly what I was going to say. In the last 10-15 years the AOA seems to have significantly bent over to accommodate DOs from those states that go ACGME. It's actually an area where the AOA has realized it makes more sense to welcome ACGME trained DOs than shun then. It's the state DO organizations (like POMA in my state) that are holding out this requirement, and I don't see it disappearing.

Also, don't forget that these states have some of the largest DO populations and DO:MD ratios in the country, so their DO societies are even stronger and would rather not risk their existence (and are scared of change just like any other organization).

 

[Ceusina]

Thanks for the input everyone. I'm hoping to do my residency in PA. What a VERY frustrating state for DOs to train in (especially for anyone with an interest outside IM/FM). Fingers crossed there's some sort of meaningful change in the next year or so (doubtful)...

 

[hallowmann]

Thanks for the input everyone. I'm hoping to do my residency in PA. What a VERY frustrating state for DOs to train in (especially for anyone with an interest outside IM/FM). Fingers crossed there's some sort of meaningful change in the next year or so (doubtful)...

You can still train, as far as I know (i.e. double check this, don't take my word for it), in the state whether you do a TRI/Res42 or not. I believe you can still get the temporary training license regardless, you just can't get a full/permanent license in those states. I've been told that you could do residency, you just can't get licensed there afterwards.

So really, I guess you have like at least 4 years for them to fix the issue.

 

[ChrisGriffen]

Expect it not to change. Maybe we will get lucky, but definitely plan to have to jump through some hoops.

Some nit-picking here though.

"Resolution 42" is not a law or regulation or anything like that. People on SDN especially dont seem to know what it actually is.

Res 42 is actually the means by which you apply to have your acgme intern year "count" as an aoa intern year.

Its the name of the application process, not the name of a law

Contrary to SDN's definition of it, Resolution 42 is actually the thing that helps you work around the stupid laws

http://www.jaoa.osteopathic.org/content/111/4/244.full.pdf

 

[hallowmann]

..."Resolution 42" is not a law or regulation or anything like that. People on SDN especially dont seem to know what it actually is...

What gave you that impression? It seems like everyone here in this thread knows what it is. Most people I've talked to who've heard of it knows what it is. To be fair though, I am in one of the 4 states.

 

[ChrisGriffen]

What gave you that impression? It seems like everyone here in this thread knows what it is. Most people I've talked to who've heard of it knows what it is. To be fair though, I am in one of the 4 states.

Haha after re-reading its pretty clear to me that everyone in this thread already knew that. Im an idiot

 

[hallowmann]

Haha after re-reading its pretty clear to me that everyone in this thread already knew that. Im an idiot

Haha, don't worry about it. I'm sure I stumbled upon a thread before where that wasn't clear.

 

[AnonymousD.O.]

yup. This stuff is state controlled. The states havent made the logical switch in decades and remained strong on the historic/dogmatic position. I dont think they will make any changes to it any time soon. But if anything would change their minds, it would be this. At the very least, the states would have to double down on their choice soon, since I doubt the wording they had before will apply in a little while when AOA residencies exist more as a technicality than an actual legal entity.

We can only hope. The DO powers at be in PA have to be aware of how ridiculous this resolution is. Although I hear some are still old cronies that are passionate about it.

 

[ChrisGriffen]

Lol

 

[AnonymousD.O.]

What gave you that impression? It seems like everyone here in this thread knows what it is. Most people I've talked to who've heard of it knows what it is. To be fair though, I am in one of the 4 states.

I agree. I mean ya Res 42 is the resolution that allows you to go through the process of practicing in one of the 4 states (as said in a post above) and not the actual restriction itself. But I think most people just refer to this whole mess as res 42 and know what they are referring too.

 

[noshie]

I have a random question about resolution 42. I just found out that I am going to MI for residency, so I don't know much about the resolution and a search on it did not give me the answers I need...

I realize that it pertains to practicing in those states after you finish residency, which I am almost positive I will not be doing. My program also has a dual enrollment option so I can bypass resolution 42 and still get to practice anywhere. I don't want to do either option though. I would lose a valuable elective and 2 months of training in my specialty. I don't feel it is a valuable use of my time. My biggest question and concern is, if I don't do resolution 42 or the dual enrollment, would it hinder my ability to moonlight in MI during residency?

 

[group_theory]

I have a random question about resolution 42. I just found out that I am going to MI for residency, so I don't know much about the resolution and a search on it did not give me the answers I need...

I realize that it pertains to practicing in those states after you finish residency, which I am almost positive I will not be doing. My program also has a dual enrollment option so I can bypass resolution 42 and still get to practice anywhere. I don't want to do either option though. I would lose a valuable elective and 2 months of training in my specialty. I don't feel it is a valuable use of my time. My biggest question and concern is, if I don't do resolution 42 or the dual enrollment, would it hinder my ability to moonlight in MI during residency?

Most likely it will hinder your ability to do external moonlighting. If you moonlight outside your program/institution, you need an unrestricted license to practice medicine (or osteopathic medicine). You can't moonlight with a training license. You also need an unrestricted license as well to get a DEA license, which you will need if you want to moonlight outside your home institution. If your institutions allow internal moonlighting (with a training license), then not really an issue. (of course this is program/institution dependent)

Also while you have no plans on practicing in the 4 states in the future, you never will know what the future will hold. Your ideal job, or your spouse's ideal job, may be in one of these states. Those 4 states may change their laws in the future to reflect current practice realities. Or those states might just keep the law as is, and the AOA will continue to do Resolution 42 to allow DOs to practice in those states (esp since there will no longer be AOA internships/residencies)

 

[hallowmann]

I have a random question about resolution 42. I just found out that I am going to MI for residency, so I don't know much about the resolution and a search on it did not give me the answers I need...

I realize that it pertains to practicing in those states after you finish residency, which I am almost positive I will not be doing. My program also has a dual enrollment option so I can bypass resolution 42 and still get to practice anywhere. I don't want to do either option though. I would lose a valuable elective and 2 months of training in my specialty. I don't feel it is a valuable use of my time. My biggest question and concern is, if I don't do resolution 42 or the dual enrollment, would it hinder my ability to moonlight in MI during residency?

3 different (not extra just different) rotations seems like a small price to pay in the longrun to never have to worry about these licensing issues or Res 42. You will presumably have 3-4 years of rotations primarily in your specialty, losing 2 mos in first year doesn't seem like it'll really affect your training or skill. As for the elective, it honestly doesn't seem like a huge deal to me, but obviously only you can make that decision.

You never know what might happen in 4-5 yrs. You may decide you love MI, you may meet and marry someone in your program or just in the area, who wants to stay nearby. So many things could happen. It's really a small price to pay for that kind of freedom. It might all be meaningless after 2020, but there's no guarantees for that. If it were me is bite the bullet and just do the dual-path, but obviously you have to be content and love with whatever choice you make.

 

[noshie]

3 different (not extra just different) rotations seems like a small price to pay in the longrun to never have to worry about these licensing issues or Res 42. You will presumably have 3-4 years of rotations primarily in your specialty, losing 2 mos in first year doesn't seem like it'll really affect your training or skill. As for the elective, it honestly doesn't seem like a huge deal to me, but obviously only you can make that decision.

You never know what might happen in 4-5 yrs. You may decide you love MI, you may meet and marry someone in your program or just in the area, who wants to stay nearby. So many things could happen. It's really a small price to pay for that kind of freedom. It might all be meaningless after 2020, but there's no guarantees for that. If it were me is bite the bullet and just do the dual-path, but obviously you have to be content and love with whatever choice you make.

You're right, 3 months aren't that big of a deal for having that level of job security to practice anywhere... Except I plan on doing a toxicology fellowship afterwards. There won't be any toxicologists at my residency, so I feel like the elective time I get will be beneficial for rotating at my top tox fellowship program towards the end of residency. If I do the dual track to get the "AOA internship", I will only get 2 weeks of elective time during my entire residency program. The tox place I choose will be in another state. After the time I will need for travel, staying somewhere for barely 2 weeks won't be beneficial... I may as well not even do a rotation in that case.

 

[Mass Effect]

I read your post three times and I still don't understand why you wouldn't just apply for Resolution 42? You don't lose any months of training or electives.

 

[NurWollen]

I'm still interested to see how the 4 holdout states end up handling the merger. If there is no such thing as an AOA-accredited internship after 2020, then they will HAVE to change the law, at the very least. Then again, Old Guard state Osteopathic societies being what they are, I can see the laws being changed to simply requiring an "osteopathically focused" internship year.

 

[noshie]

I read your post three times and I still don't understand why you wouldn't just apply for Resolution 42? You don't lose any months of training or electives.

I can just apply for resolution 42, but being in an ACGME residency in Michigan and at a program that offers a dual AOA intern option, I'm afraid they won't approve it. So the dual option seems like the safer bet, but I'll lose electives. I see what you're saying though, I could just do the paperwork for resolution 42 and see if it passes.

 

[hallowmann]

I can just apply for resolution 42, but being in an ACGME residency in Michigan and at a program that offers a dual AOA intern option, I'm afraid they won't approve it. So the dual option seems like the safer bet, but I'll lose electives. I see what you're saying though, I could just do the paperwork for resolution 42 and see if it passes.

I don't know if this advice makes sense (and anyone with more experience can chime in), but have you talked to people in your program? Current residents, faculty, PD, etc. There might be ways to "adjust" your schedule such that you'll at least have a little more elective time, or maybe have a required rotation overlap with a different service. Usually if the PDs are understanding, they tend to be willing to adjust things for your benefit (within reason of course). This is at least what I've heard, and obviously the degree to which this is possible is really up to how strict your specialty committee is and how tight your residency program schedule is.

Don't expect to be able to do everything, but it might be worth testing the waters. I would talk to other residents you trust first though to make sure its a reasonable thing to bring up. Also, ask if they know anyone who did Res42 successfully. Maybe you're worried about all this for nothing.

 

[Makati2008]

I'm still interested to see how the 4 holdout states end up handling the merger. If there is no such thing as an AOA-accredited internship after 2020, then they will HAVE to change the law, at the very least. Then again, Old Guard state Osteopathic societies being what they are, I can see the laws being changed to simply requiring an "osteopathically focused" internship year.

From what I am gathering that will be what happens