Should we have a joint match? (new info)

[TCOM-2006]

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Combining the matches is actively being investigated by the AOA. *crosses fingers* The absolute earliest class that has any chance of this is 2007.

on this subject (posted on another thread) - i just wanted to make sure that ya'll are aware that resolutions calling for a combined match were submited at the AMA meeting last june and the AOA meeting last july. in both cases - the resolutions were referred to committees for further study and report back at a later meeting. i am going to paste the info i have about both the AMA and the AOA resolution in a subsequent post. i also have DO student friend who is pro-joint-match, and has some statistics / info this is useful (he is currently in the process of getting that info to me).

whether you support or oppose a joint match (or if you just want to learn more so you can form an opinion) - the time to act is now!! how do we act?

--via the AOA: talk to your student govt president - who is part of COSGP and is usually the one voting in the AOA house of delegates. talk to your SOMA leadership. talk with your state osteopathic organization. get the facts together, present your case, and ask for support.

--via the AMA: talk to your school's AMA chapter (if your school has a chapter). by the way - this is an example of a good reason to form an AMA chapter at your school if you don't have one (involvement = influence). talk with the leadership of the AMA-MSS osteopathic caucus (i can provide contact info if you PM me and tell me who you are). talk to me - i know influential people and i know how things work in the AMA.

--i know the joint-match issue has probably been discussed before, but it's at a critical time now, so that's why i started a new thread. hopefully it will generate some good discussion.

bl

 

[TCOM-2006]

**AOA:

1> the original resolution...

RES. NO. 293
A/04

SUBJECT: JOINT MATCH

SUBMITTED BY: Maine Osteopathic Association

REFERRED TO: Committee on Professional Affairs

WHEREAS, the graduates of the colleges of Osteopathic Medicine are in need of postgraduate training placements; and

WHEREAS, some OPTI's have partnered with Osteopathic and dually approved postgraduate training sites where programs have both AOA and ACGME approval to provide such training; and

WHEREAS, some graduates of colleges of Osteopathic Medicine are choosing military and allopathic training programs; and

WHEREAS, conducting these separate matches can cause conflict between trainees and programs, the appearance of unethical behavior and considerable administrative burden and costs; and

WHEREAS, the AODME has often discussed a joint match that would protect the rights of students and programs to achieve an equitable match; and

WHEREAS, such a process would allow obligations to the military and the osteopathic profession to be met through a computer match cascade designed to assure that, for DO graduates, the military match takes precedence over the civilian match and the osteopathic graduate match with osteopathic programs takes precedence over an allopathic match; and

WHEREAS, the AOA is desirous of building harmonious relations with its graduates and fostering increased participation in the match; now, therefore, be it

RESOLVED, that the AOA endorses the concept of a joint match for the military, osteopathic and allopathic medical professionals; and, be it further

RESOLVED, that the AOA will assist the COPT in effecting the implementation of a joint match for the class of 2006.

2>email from the NRMP that was sent to COSGP leadership...

At the request of medical student groups, the National Resident Matching
Program (NRMP) is investigating the feasibility and desirability of conducting
a two-phased Main Residency Match. This is the second time the NRMP has
considered a second match. The first deliberations occurred in 1997-1999
and were centered on relieving the pressure on unmatched applicants to
make uninformed decisions in a very short period of time during the post-match Scramble.

To place this issue in context, in the 2004 Main Match, 13,572 (92.9%)
of the U.S. medical school seniors and 5,820 (58.7%) of the independent
applicants who submitted rank order lists were matched to PGY-1 positions.
Thus, 1,037 (7.1%) U.S. medical school seniors and 4,818 (41.3%) independent applicants were unmatched and participated in the Scramble.

A proposal describing how the NRMP could conduct a second match has been
posted to our public web site at http://www.nrmp.org. This model is being
disseminated widely to residency program directors, Match applicants, and
medical school student affairs deans. We urge you to spend a few minutes
carefully reviewing it before you register for the 2005 Main Match. All
Match registrants will be asked to complete a brief survey, and the results
will be considered by the NRMP's Board of Directors at its May 2005 meeting,
when a decision will be made whether to implement a two-phased Match.

As always, we will be happy to answer any questions. Please email us at
[email protected] or call 202-828-0676 and speak with one of the Help Desk
Specialists.

We look forward to another successful matching season! Remember applicant
registration begins in just a few weeks on August 15th!

 

[TCOM-2006]

**AMA:

1> original resolution (the part that concerns joint match is #9 under resolved #2):

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution: 309
(A-04)

Introduced by: California Delegation

Subject: National Residency Match Program Reform

Referred to: Reference Committee C
(Thomas V. Whalen, MD, Chair)



Whereas, An antitrust lawsuit against the National Residency Match Program (NRMP) has been filed in US District Court for the District of Columbia alleging that the NRMP, its sponsoring organizations, and 29 teaching hospitals have violated the Sherman Act by the fact that they and others ?...have illegally contracted, combined, and conspired among themselves to displace competition in the recruitment, hiring, employment, and compensation of resident physicians....?; and

Whereas, The lawsuit and surveys of California resident physicians have uncovered a level of dissatisfaction with ?the Match? process; and

Whereas, The California Medical Association (CMA), in January, convened a special Match Technical Advisory Committee consisting of medical students, residents, residency program directors, and young physicians, and in its report to the CMA Board of Trustees, included here by reference, was able to identify and reach consensus on several potential reforms to the Match program based on certain core principles; and

Whereas, Our AMA should decide whether certain other, more controversial reforms for which the CMA TAC could not reach consensus should be recommended to the NRMP; and

Whereas, Reform of the National Residency Match Program is necessary and may render the issues of the current lawsuit moot; therefore be it

RESOLVED, That our American Medical Association work with the National Residency Match Program to seek reforms to the NRMP to include the following basic principles:
1. Rank ordering must continue to prefer student, not program choices.
2. Programs and students must continue to be able to get second, third and lower choices.
3. Couples must continue to be able to apply dually.
4. Antitrust laws must be followed.
5. Transaction costs must be kept to reasonable levels.
6. Residents must continue to be recognized as ?labor.?
7. Training and education must be dominant vs. ?scut work? in any realignment of work hours.
8. Programs must be able to continue their ?safety net? function.
9. All solicitations must avoid ?exaggeration of interest? (Directive to Take Action); and be it further

RESOLVED, That our AMA work with the National Residency Match Program to seek reforms to the NRMP to include the following requirements:
1. The Match should be continued, not abolished.
2. The Match should continue to be held in March.
3. Programs should not be permitted to remove positions from the Match once they have committed these positions to it. Students should not be permitted to withdraw from the Match after the deadline for submission of the ?rank order? to the Match.
4. Students should be allowed to ?opt out? of the NRMP Match without penalty when there are extenuating circumstances.
5. Programs should pay all the costs of the Match, i.e., no cost to students.
6. Solicitation of students by programs should not begin before October 1.

7. Programs should provide a ?draft? contract to students on request, anytime after October 1, and it should be negotiable up until the student submits their rank-order for program preference.
8. Programs must make all information they share with other programs available to students, i.e., ?transparent.?
9. The Osteopathic Match should be incorporated into a single all-students Match (Directive to Take Action); and be it further

RESOLVED, That our AMA support working with the National Residency Match Program to seek reforms to the NRMP that should include the following requirements:
1. Non-US medical school graduates should not be treated the same as US graduates by the Match.
2. Programs should be allowed to provide ?commentary? about their programs referable to other programs, e.g., regional averages for salary.
3. The US Military Residency Selection process should not be incorporated into the Match; (Directive to Take Action); and be it further

RESOLVED, That our AMA address the following issues, for which there has not been consensus, in any modification of the NRMP:
1. The Match should not allow short (less than 7 days) deadlines for responses to position offerings.
2. If any revised Match allows a student the option to refuse the program with which the student matches, then all programs the student applied to must give the student a sufficient amount of time (not less than 7 days, not more than 30 days) to respond to the offers tendered.
3. Programs should be allowed to offer some positions outside of the Match.
4. Programs should be permitted to continue to set aside a specified portion of available positions (__ %) for students they recruit outside of the Match. Some or all of these positions can be re-entered into the Match, but no later than (___) weeks before the Match.
5. Students should be allowed to ?opt out? of their matched residency if they want to try for another position via a secondary Match.
6. Students should not be allowed to ?opt out? without penalty after the Match, i.e., seek other program opportunities than the ones with which they have matched.
7. Students should continue to have access, secured and confidential, to the FREIDA database, and programs should not be able to access the data of the other programs.
8. The Accreditation Council for Graduate Medical Education should continue to review only such program data as necessary to set standards that assure proper residency educational experience, workload and program viability.
9. There should be a body that oversees and recommends fair salaries for residents. (Directive to Take Action)


Fiscal Note: Estimated $2,500, including $2,000 in legal fees and $500 in staff cost to develop communication to appropriate groups.

Received: 5/3/04

RELEVANT AMA POLICY

D-310.997 Compliance with National Resident Matching Program Requirements by Residency Program Directors
(1) Our AMA will distribute to medical students (via the Medical Student Section) copies of the forthcoming National Resident Matching Program (NRMP) brochure summarizing NRMP policies and procedures. (2) Our AMA will distribute to medical students (via the Medical Student Section) information about the process for reporting violations of NRMP policies and procedures. (3) Our AMA will continue to monitor the issue and report back to the House of Delegates on progress in reducing the number of violations, either through the annual report on medical education or, if warranted, in a separate report. (4) Organizations of program directors be included in future discussions of violations of NRMP policies and procedures. (CME Rep. 4, I-99)

H-295.891 Governance of the National Resident Matching Program
Our AMA will encourage the National Resident Matching Program to structure its governance board so as to include designated seats for direct representation of residency directors and the medical school deans of students. (Res. 302, A-99)




2> REF COM REPORT AND HOD FINAL ACTION

(26) RESOLUTION 309 - NATIONAL RESIDENT MATCHING PROGRAM REFORM

RECOMMENDATION:

Madam Speaker, your Reference Committee recommends that Resolution 309 be referred to the Board of Trustees.

HOD ACTION: Resolution 309 referred to the Board of Trustees.

Resolution 309, National Resident Matching Program Reform, introduced by the California Delegation, asks our AMA to work with the NRMP to seek reforms to the NRMP to include certain principles and requirements. The resolution also asks our AMA to address a number of issues regarding modification of the NRMP.

Your Reference Committee heard extensive testimony suggesting referral of this complex resolution. It was noted that many of the specific statements in the Resolveds were not within the scope of the National Residency Matching Program and that some statements appeared to be contradictory. Additional testimony was heard on this issue the same resolution was being considered by the Resident and Fellow Section and the Medical Student Section and that data collection on this issue was underway. The Council on Medical Education should serve as the facilitator of this process, coordinating the efforts of the two sections and seeking input from other relevant parties and providing a comprehensive report of possible reform of the matching program.

 

[Sense]

I believe you got that quote from DrMom from my thread a month ago. One of the doctors talking to us at our orientation told us that by the time we went for the match, it would be a combined match. That would be the 2008 March match. It seems feasible and the doctor looked like he knew what he was talking about.

I think it's a great idea and can only help DO grads in getting good residencies.

 

[Malph]

Hi all,

I guess it's time I weigh in on this topic. I have been a delagate to the AMA for the last three years and as a DO student have had a chance to see this issue develop into where you see it today. I am a member of the Governing Counsel of CMA (California Medicle Association) and thus intimately involved in the creation of the AMA resolution you see here. I have also been active in my school's SGA, and as such know the responses of SOMA and COSGP.

Let me first say that there are some concerns about the AOA resolution that may have not been intended, but may have, I do not truely know at this stage. It is my understanding that the goal is to allow D.O.s to be able to rank programs without regard to affiliation. I have recently sent out a message that has prompted discussion within the Osteopathic Caucus. I will include that message at the end of this posting.

At the AMA, the students are more concerned about other issues in the match than just this one point. Frankly they do not view D.O. students as different than themselves, but as equals, and as such it seemed only natural that the D.O. and the AMA (ACGME) matches be combined. The AMA MSS (Medical students section) has a long traditon of working closely with the D.O. Student Delagates that are there. Many D.O. students hold high positions in the AMA not only in the MSS, but in the RPS (Resident Physician Section), and many other places.

It is due to this close association of sutdents that the combination of the matches be included in the AMA resolution. Seeing that a parallel resolution has been submitted to the AOA--which frankly I was planning to do at the next session--this matter must truely be on the minds of D.O. sutdents.

I think I will stop here and allow you to read the email I sent out on our list serve and await your repsonses to this post before I chime on any further:

--------email below------------

Well let me start by saying this, the military matches and the non-military matches are computed in two completely different ways, so combining them is almost impossible. So what are the main issues that drive us (me) to want a combined MATCH? I have so many examples of how we as DOs stand to gain. And not in the training realm, but in the logistics of the process:

Let's say I am a couple who is applying to the MATCH. Regardless of which field me and my partner desire, we apply to the DO MATCH. Then we get rejected. The scramble for the DO MATCH takes place immediately after the results are posted. This is a month before the ACGME one. This puts us in the horrible position of having to decide to scramble for positions that may not be in the same state, much less the same city, or we can wait it out and hope that we match into the ACGME. To take the first choice places a strain on the relationship, to take the second relies on the hope that you MATCH as a couple int the ACGME. I should note that the most recent post match study shows that one of the top reasons people choose a residency is LOCATION. Say we took the chance but do not Couples MATCH in the ACGME either. So now we have missed the scramble for the DO and are forced to scramble in the ACGME. There might still be some obscure positions that have not been filled still in the DO programs, but if not we hope to find one in the ACGME. This puts us back to the point where we hope to be as close as possible with no guarantees. Now since we are hard core DOs at heart and only applied to the ACGME because the LOCATION was the most important thing and we had to wait it out for the results of the ACGME to be disappointed, we have lost the chance to get into our back up plan--which was that if we could not be together we would get the best DO spots we could to make the best of the situation. But look, now the best spots are gone because we did not decide to do the DO scramble because we still wanted to be together and now we can't be together and we have been forced into less desirable programs.
So how would the combined MATCH prevent such a tragedy. Well there are no guarantees in life and many can argue that if they are so hard core why not take the DO scramble and miss the ACGME? Hmm, well as I stated that LOCATION--be it single or couple--was one of the top reasons for picking a program, and in this case being together meant more than the quality of the program. The combined MATCH would allow this couple and even an individual to be able to see the results of both MATCHs at the same time hence the scramble at the same time and a better chance at a program with higher standards, location and could be more in line with personal goals than the two divided.

With the current system the spacing is more like a month and both matches are a contract, which is why once you match in the D.O. Match you are dropped from the M.D. one--not a choice to wait and see. So, you actually would not have the opportunity to take a spot in the M.D. Match "a few weeks later."

I undertand that there are far less couples in the MATCH then individuals and only used the above as an illustration. Here is a private email that was sent to me recently to illustrate the point. This is NOT an example this is what happened:

This year I applied for Pediatrics... I was not extremely concerned about the internship year even though I am from PA because I have heard from several of people that it is easy to be excused based on Resolution 42. I applied both Osteopathic and Allopathic. The reason I did this was because there are A LOT of Allopathic pediatrics programs in the Philadelphia area that I was interested in, but at the same time I did not feel completely comfortable not applying to ANY osteopathic programs... Anyway, interview season came along and I got interviews at all of the programs I applied to. However, at the end of December I got phone calls from two osteopathic programs offering me spots in the DO match; however, none of the allopathic programs could tell me anything even though I explained my situation and told them about my two offers. The only thing that they said was that I was a "competitive applicant" and my application was highly favorable (whatever that means). Needless to say, I didn't feel comfortable declining an osteopathic spot at a good program and going through the rigmarole of the allopathic match with the chance of not matching at any of my allopathic programs and then having to scramble. If the two matches were combined then I could have ranked my osteopathic programs and also my allopathic programs and gotten the best of both worlds because I would have increased my chances of obtaining a position from either an allopathic or osteopathic program.

Combining the Match will actually take nothing away from how D.O. programs are run. As a point of fact, the AOA is actively working towards a duel accreditation system that will give us both Osteopathic and Allopathic credit. The one thing it will do is allow a person or a couple to have a fair chance at matching to any program they desire without having to sweat being dropped by one system or the other--or as stated above be unduly pressured to go any one direction.
The system has not always been this way. The policies came about because many people where matching in both and after looking at the options reneged on either their Osteopathic or Allopathic match and so the other program they matched to was rightly infuriated. What did this accomplish? In 2000, when the process happened we had grown from 78.4% of positions filled in 1997 to 80% in 2000. Post 2000, after the implementation the numbers dropped to 59.8% in 2003 for filled funded potions--based on the NMS (National Match Services) data as of February 2003. Why such a drastic drop in numbers? I suggest that it is because many people fearing lack of a true opportunity to choose have opted to just not go into the Osteopathic match as you suggested.

The post match survey of AOA programs listing reasons for not participating in the AOA match showed 14.36% stating that geographic location was a factor. This was the second highest reason listed. The first highest was "perceived quality of problems in osteopathic internship programs" which we at this meeting cannot address.

I know this has gone on fairly long, but I have more stories and statistics that show that for our part supporting the direction of a combined match will not only alleviate many undue pressures, but may actually give the osteopathic programs a greater chance of being filled in the end.

Please, I invite feedback on this topic. As I understand it, the students and residents at the AOA were the ones most against the combined match, NOT the doctors in practice who have been through the process and have seen the end results. This is a good point to consider

Thanks for you time and efforts.

 

[fuegorama]

I believe you got that quote from DrMom from my thread a month ago. One of the doctors talking to us at our orientation told us that by the time we went for the match, it would be a combined match. That would be the 2008 March match. It seems feasible and the doctor looked like he knew what he was talking about.

I think it's a great idea and can only help DO grads in getting good residencies.

Sounds great, but do not rely on the word of this doc. This will not happen without LOUD student involvement. This is really what's holding the move back. (see next post) As a 2007er, I am gunning for an earlier combination.

 

[fuegorama]

My understanding of why this issue is now in committee is a little cloudy. I was told last month by an AOA delegate that the combined match motion was canned by the student gov't presidents and the interns/residents organizations.

WHY??? 😡

The move to committee was a last gasp effort to salvage any chance of passage.
If any rep/prezs/cheerleader/lackey for these groups could explain the benefits of the present system over the combination proposal, I would appreciate the effort.

In the meantime, I encourage my fellow SDNers to aggressively bug your SGA, attendings, AOA reps about the necessity of a combined match. This is THE doorway to more combined post-grad training, increased opportunity on match day, a way to insure the continuation of osteopathic residencies.

Combine Match for 2007!!!

 

[Idiopathic]

I still argue that the only one to hold this up would be the AOA. They currently have all the advantages of 'fear' to entice osteopaths to participate in their match. Combining them would help every group but the osteopathic governing body. No matter what they say, I would be surprised if they a) allowed it happen, or b) didnt put serious restrictions on it.

 

[NotShorty]

Yes.

Wait, what was the question? There was lots of text...I didn't read it.

Look at my avatar.

-NS

 

[fuegorama]

1st bump in SDN career.

This topic is of immediate importance. The threads with multiple pages currently in rotation include topics on-DOs on TV, Should we Join the AMA?, Why are DOs in allopathic residencies, etc. Fun, frivolous discussion with no tangible results.
This current thread about a combined match could be pertinent to the most positive effect this profession has enjoyed in years.

If you are an osteopathic MSI or MSII, this is your immediate future.

A few months back there was a thread/sticky about wanting a revolution for DO education.

Well kids-this is how it's done.

 

[Paul1441]

My understanding of why this issue is now in committee is a little cloudy. I was told last month by an AOA delegate that the combined match motion was canned by the student gov't presidents and the interns/residents organizations.

WHY??? 😡

The move to committee was a last gasp effort to salvage any chance of passage.
If any rep/prezs/cheerleader/lackey for these groups could explain the benefits of the present system over the combination proposal, I would appreciate the effort.

In the meantime, I encourage my fellow SDNers to aggressively bug your SGA, attendings, AOA reps about the necessity of a combined match. This is THE doorway to more combined post-grad training, increased opportunity on match day, a way to insure the continuation of osteopathic residencies.

Combine Match for 2007!!!

How long ago was the motion for match merger "canned" by the nationa DO SGA?

 

[Paul1441]

How long ago was the motion for match merger "canned" by the nationa DO SGA?

To answer my own question... my own SGA president tells me the reversal of the SG presidents and intern/resident orgs. opinion on a combined match toward disapproval happend in July

 

[EMTLizzy]

Could someone please explain this resolution in clearer terms to me? I read every post on this thread (including the text of the resulutions) and I'm somewhat confused.

I think I'm just not fully understanding how the match works right now. I'm not in med school yet ( still in the process of applying), but I see this as relevant since 10 of the 13 schools I applied to are osteopathic schools. This is obviously something important to me.

As I understand it... (and this is purely for example and entertainment) Dr. Thyroid, D.O. wants to be an endocrinologist. He applies for the Osteopathic match. If somebody wants him then he has a place and he has to take it. But he lives in New York City, has 12 children with his wife and she's expecting another one. The only match he got was with a hospital in Alaska which would be very difficult on his family. He wants a residency near his home. My question....He can't later decide to go into the NRMP and apply for allopathic residencies because he already matched osteopathic? His only other option is to skip applying osteopathic at all knowing that he has a better chance of matching close to home if he goes with NRMP? If he withdraws from the osteopathic match he may not get an allopathic residency either and then be unemployed, have student loans, and 13 kids to feed?


By "combined match", does this mean that everyone (DO and MD) applies to one match and just choose their preference of schools? Everyone crosses their fingers on the same day? Together? In perfect harmony? Having a Coke and a smile?

My other confusion is with one of the resolutions that American medical graduates will get preference over IMG's. Isn't this already true? Does this mean that if it was a combined match that graduates of american medical schools get all the first spots and IMG's get what's left over? If a certain percentage of medical students don't match, wouldn't that mean that with this resolution IMG's would almost never match and the % of american medical students not matching would be lower?

I guess this isn't something I can do much about since I'm not an MSI (yet), but I would like to get involved if I am accepted (I mean *when*. Must think positive.)

 

[Idiopathic]

If somebody wants him then he has a place and he has to take it. But he lives in New York City, has 12 children with his wife and she's expecting another one. The only match he got was with a hospital in Alaska which would be very difficult on his family. He wants a residency near his home. My question....He can't later decide to go into the NRMP and apply for allopathic residencies because he already matched osteopathic? His only other option is to skip applying osteopathic at all knowing that he has a better chance of matching close to home if he goes with NRMP? If he withdraws from the osteopathic match he may not get an allopathic residency either and then be unemployed, have student loans, and 13 kids to feed?

Well, in all likelihood, this individual would have done everything he/she could to stay close to home, including NOT applying to and residency in Alaska 😉

The hypothetical Dr. may choose to not match DO rather than match far away, and even though he will apply to the match, he will only rank programs that are close to home. If he then does not match DO, he may have to expand his scope to match allo. Also, once you match, you are pretty much committed to that location, so one should really settle all these internal conflicts before ever ranking.

 

[Idiopathic]

My other confusion is with one of the resolutions that American medical graduates will get preference over IMG's. Isn't this already true? Does this mean that if it was a combined match that graduates of american medical schools get all the first spots and IMG's get what's left over? If a certain percentage of medical students don't match, wouldn't that mean that with this resolution IMG's would almost never match and the % of american medical students not matching would be lower?

I dont know about this. There is no doctrine in place that says that an American MD/DO student should get preference over an IMG. In fact, there appear to be several cases where foreign-trained American MD's (i.e. SGU, Ross) are given preference over American-trained DO's.

 

[EMTLizzy]

In fact, there appear to be several cases where foreign-trained American MD's (i.e. SGU, Ross) are given preference over American-trained DO's.

Bummer!

I suppose this is why one of the resolutions was to change this? Or is something else meant by "not treated the same"? Are they to become the red-headed stepchildren of medicine? Beaten, flogged publically, and forced to wear a red "I" on their chest? Or simply held to a different standard?

RESOLVED, That our AMA support working with the National Residency Match Program to seek reforms to the NRMP that should include the following requirements:
1. Non-US medical school graduates should not be treated the same as US graduates by the Match.

 

[Idiopathic]

I would agree. American training will always be superior to IMG training, in my opinion, just because of resources and proximity. To say that an MD may be preferred over a DO is biased, but at least semi-understandable, if that is all you know...but to say that a foreign-trained MD is superior to a DO is simply bigotry.

 

[eadysx]

I would agree. American training will always be superior to IMG training, in my opinion, just because of resources and proximity. To say that an MD may be preferred over a DO is biased, but at least semi-understandable, if that is all you know...but to say that a foreign-trained MD is superior to a DO is simply bigotry.

I would just like to take a second to say I think this discussion is going in a good direction. And I respect that Idiopathic is expressing his opinion the quality of US based training vs IMG based training. That being said, I would hate to see this turn into a debate about which is better. 🙄

E-

 

[TCOM-2006]

hi everyone--

--just for the sake of making sure everyone (including myself) has a chance to get informed on this issue - here's an outline of the basic structure along with links for more info:

*********************************

--"AOA" "DO" or "Osteopathic" GME (graduate medical education) programs (internships/residencies/fellowships) recieve accreditation from the "COPT = Council on Osteopathic Postdoctoral Training" which is part of the "Bureau of Osteopathic Education" of the AOA. See:
http://do-online.osteotech.org/index.cfm?PageID=sir_postdoc
and
http://do-online.osteotech.org/index.cfm?PageID=acc_postdoc
and
http://do-online.osteotech.org/index.cfm?PageID=ps_yearbook
<scroll to the bottom and look under "postdoctral education">

--the AOA keeps a list of all these programs at:
http://do-online.osteotech.org/index.cfm?PageID=sir_oppmain

--*all* of these programs participate in the osteopathic match:
http://do-online.osteotech.org/index.cfm?PageID=sir_matchprotocol
and this match is administered by:
http://www.natmatch.com/aoairp/

--the match is a seperate process from the application (i could not find a link for this one)

******************************************

--"AMA" or "MD" or "allopathic" - but more properly called "ACGME" GME programs (internships, residencies, fellowships) recieve accreditation from the ACGME (accreditation council for graduate medical education):
http://www.acgme.org/
basically, the ACGME is composed of members nominated from the ABMS (american board of medical specialties), AMA (american medical association), AHA (american hospital assn), AAMC (association of american medical colleges), CMSS (council of medical specialty scoeities)

--the AMA keeps a searchable list of ACGME programs at:
http://www.ama-assn.org/ama/pub/category/2997.html

--unlike that AOA programs - the ACGME programs do *not* all participate in a single match. most participate in the national residency matching program (NRMP):
http://www.nrmp.org/
which is sponsored by the same 5 organizations that nominate to the ACGME. It is also supported by NMS.

--some ACGME programs do not take part in the NRMP match. a couple of examples are:
the "san francisco match"
http://www.sfmatch.org/
the "urology match"
http://www.auanet.org/residents/resmatch.cfm

--again, the application process forACGME programs is seperate from the match. for more on application to ACGME programs, see:
http://www.aamc.org/audienceeras.htm

***********************************

--i hope this sheds some light on this complex process and all of the different organizations involved (i'm still trying to learn how all this works myself). if you noticed that i said something incorrect, or have some more info to add, please reply.

bl

 

[TCOM-2006]

now that ya'll have had a chance to review some of the information, i want to suggest that this issue revolves around 2 key questions:

1> what is in the best interests of the individual DO student?

2> what is in the best interests of the osteopathic profession?

i think it's pretty clear that having a true joint match would be in the best interests of the individual student (more GME opportunities). i could eloborate more on this point, but i'll save it for now since i'm running low on time.

regarding question #2, i think it could be argued that a true joint match would be beneficial to the DO profession because
1> it would definitely lead to more applicants to osteopathic residencies
2> it would probably lead to a greater fill-rate in osteopathic residencies:see Malf's post about the fill rate droping from 80% in 2000 to 60% in 2003 (this change occurs along with the post-2000 rule that automatically drops you from the NRMP match once you match AOA).
3> it gives AOA programs more of incentive to compete, and hopefully improve.
i could go on, but let me make just one final point.

i say "true" joint match because it appears that the AOA resolution could be supporting a system whereby you could rank both AOA and ACGME programs together, but you would automatically be matched with your highest osteopathic program, regardless if one of the ACGME programs that you ranked higher accepts you (see the 6th whereas clause). this "AOA trump" system would totally defeat the purpose of having a true joint match, and would lead many DO students to not rank any AOA programs. i'm trying to get in touch with AOA student leadership to clarify this, and i'll post when i find out for sure.

thoughts?

bl

 

[TCOM-2006]

To answer my own question... my own SGA president tells me the reversal of the SG presidents and intern/resident orgs. opinion on a combined match toward disapproval happend in July

yes - this resolution was presented in chicago at the AOA house of delegates annual meeting last july. my understanding is that the committee that it was referred to will write a report and the issue will come up for a vote at the next HOD meeting in july 2005.

i have a project for everyone who attends an osteopathic school: email your student body president - ask them what position they took on this issue last july - and share their feedback (or ask them to reply) to this thread, so we can be sure that we're seeing this issue from all angles.

bl

 

[Paul1441]

now that ya'll have had a chance to review some of the information, i want to suggest that this issue revolves around 2 key questions:

1> what is in the best interests of the individual DO student?

2> what is in the best interests of the osteopathic profession?

i think it's pretty clear that having a true joint match would be in the best interests of the individual student (more GME opportunities). i could eloborate more on this point, but i'll save it for now since i'm running low on time.

regarding question #2, i think it could be argued that a true joint match would be beneficial to the DO profession because
1> it would definitely lead to more applicants to osteopathic residencies
2> it would probably lead to a greater fill-rate in osteopathic residencies:see Malf's post about the fill rate droping from 80% in 2000 to 60% in 2003 (this change occurs along with the post-2000 rule that automatically drops you from the NRMP match once you match AOA).
3> it gives AOA programs more of incentive to compete, and hopefully improve.
i could go on, but let me make just one final point.

i say "true" joint match because it appears that the AOA resolution could be supporting a system whereby you could rank both AOA and ACGME programs together, but you would automatically be matched with your highest osteopathic program, regardless if one of the ACGME programs that you ranked higher accepts you (see the 6th whereas clause). this "AOA trump" system would totally defeat the purpose of having a true joint match, and would lead many DO students to not rank any AOA programs. i'm trying to get in touch with AOA student leadership to clarify this, and i'll post when i find out for sure.

thoughts?

bl

What do you think about MD grads not being able to apply to the osteopathic residencies. I can see why the AOA would want to keep these spots reserved for DO grads since they would benifit from continued OMM training, but wouldn't it be realistic to assume there would be very little MD grads applying for those spots?

 

[fuegorama]

What do you think about MD grads not being able to apply to the osteopathic residencies. I can see why the AOA would want to keep these spots reserved for DO grads since they would benifit from continued OMM training, but wouldn't it be realistic to assume there would be very little MD grads applying for those spots?

MDs should be able to apply for these slots.

If the difference is OMM training, then formulating a post-grad fellowship in manipulation could be a possible solution. An example would be the current +1 board certs available through the AOA.

 

[Robz]

I say open it up. Bring it on.

Make one match and simplify things.

I think it will not only make more competition for the programs but in the long run make lesser programs keep up with their quality. I don't care if your a DO or MD I think all spots should be open to apply to. The only ideal I can even think of that might be tricky is a pure OMT practice which I am not sure there are even residencies for.

edit: (extra thought)

I feel that if we are to be the best we must compete with the best. Sometimes I feel like there is a conginency of people boasting yet hiding away from the rest of the profession. I feel to be the best you must attract the best....this means NOT EXCLUDING based on philosophy differences.

 

[DocAmazingDO]

this "AOA trump" system would totally defeat the purpose of having a true joint match, and would lead many DO students to not rank any AOA programs.
bl

I wrote about this earlier in another thread: my main deciding factor is location. If an osteopathic residency is the third closest residency to my wife, then it will be third on my list. I strongly prefer to get an osteopathic residency, but if the "trump" system is intact, then I likely will not apply for an osteopathic residency. This "trump" is not beneficial at all and makes the AOA look desperate.

 

[Robz]

I wrote about this earlier in another thread: my main deciding factor is location. If an osteopathic residency is the third closest residency to my wife, then it will be third on my list. I strongly prefer to get an osteopathic residency, but if the "trump" system is intact, then I likely will not apply for an osteopathic residency. This "trump" is not beneficial at all and makes the AOA look desperate.

That is a main reason I may not apply to an osteopathic residency at all. I want to make sure I get the best quality education and if after my decisions I decide that my top 4 may be allopathic residencies and my 5th is an osteopathic one, I know that I will have a good chance to get in but may be trumped by my fifth place choice. Hense, I may not even apply to it. Whereas, if there was a dual EVEN match process I would have.

In this instance I feel that the osteopathic residency would be shorted out of having a higher quality resident than if it was fully open.

 

[Robz]

Oh and as another sidenote, not only do I think the match should be merged but I also feel that IMG/FMG's should be allowed to apply to the osteopathic residencies as well as allopathic ones.

I think it is a great way to share the ideals of the profession.

 

[PACtoDOC]

This is why there should be a joint match. Most top DO applicants do not tend to even consider DO programs because they would have to commit to the DO match and give up their dream of a top allo program. My scenario has me wanting to do OBGYN, and there is only one DO residency that I am interested in. I would probably put it at number 4 on my wish list behind allopathic programs near me, and then I probably have another 4-5 allopathic programs I would like to attend after that DO program. If the match was combined, I could easily end up in a DO program because it is in the middle of my wish list. But I am not about to pass up my top 3 programs in order to get an interview and get shut out from them. SO as it currently is set up, I could not possibly match AOA. If there was a combined match, the AOA could theoretically match many more DO's who never even gave DO programs a look anyway. Insecurity keeps the match the way it is, and it is the AOA doing it.

 

[Idiopathic]

This is why there should be a joint match. Most top DO applicants do not tend to even consider DO programs because they would have to commit to the DO match and give up their dream of a top allo program. My scenario has me wanting to do OBGYN, and there is only one DO residency that I am interested in. I would probably put it at number 4 on my wish list behind allopathic programs near me, and then I probably have another 4-5 allopathic programs I would like to attend after that DO program. If the match was combined, I could easily end up in a DO program because it is in the middle of my wish list. But I am not about to pass up my top 3 programs in order to get an interview and get shut out from them. SO as it currently is set up, I could not possibly match AOA. If there was a combined match, the AOA could theoretically match many more DO's who never even gave DO programs a look anyway. Insecurity keeps the match the way it is, and it is the AOA doing it.

This is also why I believe the AOA will fight a joint match tooth and nail. Right now they have some semblance of power over students who are afraid not to match and will commit to the AOA match rather than risk not matching. If combined, they may potentially fill all spots, but the caliber of candidate will decrease, for sure, and they will lose out on most of the top osteopaths, who will almost certainly list top allo programs, just on a whim, and several might actually match there, especially in FP, IM, etc.

 

[Paul1441]

So why didn't the SGA presidents represent the best intrest of the students and push for a joint match back in July?

 

[Malph]

Oh and as another sidenote, not only do I think the match should be merged but I also feel that IMG/FMG's should be allowed to apply to the osteopathic residencies as well as allopathic ones.

I think it is a great way to share the ideals of the profession.

Acutally the reason IMG/FMG are left out in the AMA resoltuion is because of their timeline. The way they graduate and get everthing together makes them not able to meet the current system. This was not meant to be a discrimintation, but like the military system the IMG/FMG system are not really compatable with the current timelines.

 

[jhug]

they will lose out on most of the top osteopaths, who will almost certainly list top allo programs, just on a whim, and several might actually match there, especially in FP, IM, etc.

that's just it...i think the aoa IS missing out on some of the best graduates...simply because they'll take the shot at landing that great/#1 allo residecy...even if it means skipping the osteo match. I'm swinging for the fence when i match and if that means skipping on osteo res in the hope of getting a better allo residency...so be it, the aoa made that decision for me.

also, if OMM is (and i really believe it is) such a wonderful addition to medicine, why not share/teach it with everyone??? i've always wondered why some in the aoa/do's are so protective of such beneficial treatments...like they want it to be/remain a secret...

 

[TCOM-2006]

--thanks for the good discussion. just wanted to re-state some key points (and changes that would need to occur on the AOA resolution). i'll try to reply to some of the other comments sometime soon...

--it would seem that the AOA resolution would need to make more clear in the 1st resolved statement whether it supports a "AOA trump" system or a "true match". current language:

RESOLVED, that the AOA endorses the concept of a joint match for the military, osteopathic and allopathic medical professionals; and, be it further

RESOLVED, that the AOA will assist the COPT in effecting the implementation of a joint match for the class of 2006.

--as i have stated, an "AOA trump" system would be essentially no different that what we have now, and will lead many DO students *not* to apply to any AOA programs that would have otherwise.

--it should also probably make clear that it supports a joint match between NRMP instead of the "allopathic" match, since some ACGME programs don't participate in NRMP (eg - sanfrancisco match and urology match). i'm not sure how the military match fits into this picture... i'll try to find out.

--hopefully the AOA council that is studying this will see this and make these suggested changes in their report. this is, of course, assuming that they will support something in the first place - which is questionable. if it does not occur with the committee - it needs to occur in the form of an ammendment at the AOA-HOD.

--the fear that a "true match" will lead to a decrease in filled AOA residency slots is understandable - but i don't think it should be assumed that this will occur. i think looking at data which my friend Malph has posted is helpful:

"...many people where matching in both and after looking at the options reneged on either their Osteopathic or Allopathic match and so the other program they matched to was rightly infuriated. What did this accomplish? In 2000, when the process happened we had grown from 78.4% of positions filled in 1997 to 80% in 2000. Post 2000, after the implementation the numbers dropped to 59.8% in 2003 for filled funded potions--based on the NMS (National Match Services) data as of February 2003. Why such a drastic drop in numbers? I suggest that it is because many people fearing lack of a true opportunity to choose have opted to just not go into the Osteopathic match as you suggested."

--also, if there are any residents out there - you need to get in touch with your BIR leaders and express your opinion (whatever it is) to them:
http://do-online.osteotech.org/index.cfm?PageID=sir_birroster

bl

 

[Malph]

If OMM is (and i really believe it is) such a wonderful addition to medicine, why not share/teach it with everyone??? i've always wondered why some in the aoa/do's are so protective of such beneficial treatments...like they want it to be/remain a secret...

You know, I have for the longest time believed the very same thing. At my school we had MDs teaching OMM/OMT along side our DO instructors. Why is the AOA so afraid to share something that is at the heart of what we feel is "in the patient's best interest" with all physicains really preplexes me? Just something to think about when you are proud of being a DO (as am I). I can't tell you how many times in my rotations that I have seen something that is resistant to Allopathic treatment, yet responsive to OMM/OMT.

As I posted before, I couldn't even get the AOA to tell me how many of our own programs include OMM/OMT in their training. I know I have also stated that the MATCH does not control the quality or scope of training, but if anyone is using those as a foundation to be against the combined MATCH, maybe they need to consider the patient's best interest in the end?

That said, the AOA is currently actively seeking dual accreditations for many ACGME programs and the question outside of the MATCH issue is are they also pushing these programs to include OMM/OMT and if not then why on earth would anyone at the AOA use OMM/OMT as a basis for being against the distribution of students that a combined MATCH will provide?

 

[jhug]

tcom....buddy, we are on the same page!!!!
i read that clause and thought...what's the point??? if i rank ANY do program i'll have to go do, regardless of the MD programs ranked above it...the only things i see this creating are A: a lot of upset DO students who got mislead by this whole thing, B: a lot of DO students still not ranking do programs and C: a huge mess on match day!!!
there should be no clause...simply, you rank, you go! You rank program A #1...they rank you...that is where you are going...end of story. If this is going to happen, i want to see it done right. It will be much tougher to fix later on down the road.

 

[Malph]

tcom....buddy, we are on the same page!!!!
i read that clause and thought...what's the point??? if i rank ANY do program i'll have to go do, regardless of the MD programs ranked above it...the only things i see this creating are A: a lot of upset DO students who got mislead by this whole thing, B: a lot of DO students still not ranking do programs and C: a huge mess on match day!!!
there should be no clause...simply, you rank, you go! You rank program A #1...they rank you...that is where you are going...end of story. If this is going to happen, i want to see it done right. It will be much tougher to fix later on down the road.

The KEY now is to get all of your SGA and SOMA presidents to vote this way. Unltimately, they hold the power to change the system. And since they are supposed to represent the views of their classes, I suggest that EVERYONE of you have school polls to show them where the student body truely lies on this issue. I also suggest that you link this sight to everyone one in ALL your classes so they might get a better picture of what is at stake.

 

[TCOM-2006]

i just wanted to keep this issue on the front page, because it's important - and will be important that we continue to discuss it over the next several months. let me give you a timeline of recent and upcoming events:

--recently (early nov., 2004): COSGP (council of osteopathic student government presidents) and the BIR (bureau of interns and residents) met and discussed the issue at the AOA conference in sanfrancisco. no formal action was taken, from what i understand. the AOA resolution that calls for a joint match is being studied and will be re-considere for a vote at the july AOA house of delegates meeting.

--dec 2-4, 2004: the AMA-MSS meets in Atlanta, and will consider the joint match issue. when AMA-MSS resolutions and reports become available - i'll post the link. this is an important step if the joint match is going to happen (the AMA is one of 5 organizations that sponsor/govern NRMP). the AMA-HOD *may* consider this issue this december (we'll have to wait and see).

--june 2005: AMA meeting in chicago. the AMA-HOD will most likely vote on this issue if it has not already (i believe this is when the report is due from the council on medical education - which was started from a resolution introduced in june 2004 meeting)

--july 2005: AOA meeting in chicago. the report will become available, and the AOA-HOD will have a chance to vote on the issue.

please let me know if you have any corrections to this. i think it's well worth everyone's time to learn more about this issue, as me any questions, and voice your opinion to your student government and SOMA leadership, as well as your chapter AMA student leadership.

bl

 

[Idiopathic]

that's just it...i think the aoa IS missing out on some of the best graduates...simply because they'll take the shot at landing that great/#1 allo residecy...even if it means skipping the osteo match. I'm swinging for the fence when i match and if that means skipping on osteo res in the hope of getting a better allo residency...so be it, the aoa made that decision for me.

Well, at least now you are risking something by going that route. If the matches were truly combined there would be no risk.