Something else for DOs to know

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gatorfann14

gatorfann14

Full Member
10+ Year Member
As an osteopathic medical student, you may be aware that ACGME recently proposed two new policies that would limit future DOs from being able to train in ACGME programs. They include:
Requiring an ACGME-accredited residency program as a prerequisite for clinical education for entry into an ACGME-accredited residency program or a Royal College of Physicians and Surgeons of Canada (RSPSC)-accredited residency program located in Canada. (This would limit a DO who completed an AOA-accredited internship from proceeding to an ACGME program unless they repeated their internship year in an ACGME-accredited residency program.)

Requiring an ACGME-accredited residency program or RCPSC-accredited residency program in Canada as a prerequisite for clinical education for entry into an ACGME-accredited fellowship program.
The AOA knows how important it is for you to have choices when it comes to selecting a residency program whether its due to geographic location or breadth of a program. That's why the AOA is actively working to have these proposed policies rescinded so that osteopathic physicians will continue to benefit from additional career opportunities.
This is the AOA working for you - our members and the future of our profession. We will keep you updated on any progress in this regard.

Sincerely,

Martin S. Levine, DO
President
American Osteopathic Association
Mansoor Ali Jatoi, OMS IV
AOA Board of Trustees Student Representative
Chair, AOA Council of Student Affairs



This was sent out by the AOA today
 
is this for all rez programs? or specialties?

i thought people were concerned about a doc shortage...and IMG taking over all the spots?

this makes no sense
 
Means if you want to do a ACGME fellowship you must complete a ACGME residency.

I should add, if you want to go into a specialty that requires a preliminary internship year then it must be ACGME in order for you to continue onto an ACGME residency program.

Ex: Radiology requires a one year preliminary year before going into radiology residency. If you want to do a ACGME radiology program, then you must complete a ACGME preliminary year vs AOA preliminary year.
 
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sylvanthus said:
I love how the end of the email says "This is the AOA working for you!" If they were somewhat competent, we wouldn't be in this situation in the first place.
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Yeah, because obviously it's THEIR problem! Of COURSE they weren't forced into this by a perceived drop in standards of osteopathic GME! Rabble rabble!
 
"The AOA knows how important it is for you to have choices when it comes to selecting a residency program whether its due to geographic location or breadth of a program. That's why the AOA is actively working to have these proposed policies rescinded so that osteopathic physicians will continue to benefit from additional career opportunities."

Is the irony completely lost on the author?
 
This might be a stupid attempt at a summation... but does this basically mean if you want to specialize, you have to go to an allo residency? Don't a lot of people do that anyway? I'm still a bit confused. 😕
 
Iliketoytles said:
This might be a stupid attempt at a summation... but does this basically mean if you want to specialize, you have to go to an allo residency? Don't a lot of people do that anyway? I'm still a bit confused. 😕
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no, it means that if you want to go into an ACGME residency that requires a preliminary intern year (e.g. Anesthesia, Radiology, etc.), you will be required to do an ACGME intern year. before, you could match into an AOA prelim year and then do your PGY2-4 years at an ACGME program. this sucks for people who live in 4 particular states (PA, FL, OK, MI) because those states require all DOs who want to be licensed there to do an AOA internship. however, if you still wanted to do an ACGME residency, you still can do it - but you'll have to repeat your prelim intern year through the ACGME.

the other part to this is that if you want to do an ACGME fellowship, you have to have done an ACGME residency first. you will not be able to do an AOA residency and then do an ACGME fellowship.

this has nothing to do with whether or not you want to "specialize." you can still "specialize" in anything you want, but some people's strategies will have to change based on this new proposal.
 
Iliketoytles said:
This might be a stupid attempt at a summation... but does this basically mean if you want to specialize, you have to go to an allo residency? Don't a lot of people do that anyway? I'm still a bit confused. 😕
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No, this means if you want to do an ACGME ("MD" from here on out, for simplicty) speciality residency or fellowship, you need to have done your prelim year at an MD residency. For example, if you want to do an MD radiology (as mentioned above) residency, you cannot do an AOA (DO) prelim year (or intern year) and then do an MD for your yrs PGY 2-4. You must do an MD prelim yr.

2nd ex: You cannot do an DO residency and then do an MD fellowship. Does this make sense?

You can still specialize either MD or DO.

EDIT: (Person above explained it nicely)
 
There's been a discussion going on about this for quite a bit now in the osteo forums:

http://forums.studentdoctor.net/showthread.php?t=862903

My concern about this resolution is if this is a prelude of what's to come- that is, eventually closing off ACGME residencies to D.O. grads. Today they are saying the internship/residency isn't up to par. Maybe they eventually say that the clerkships for core rotations aren't up to par either and they shut the door closed.

That's pretty extreme and would effectively shut out IMGs as well, so I doubt this will happen. Who knows though?
 
Dharma said:
There's been a discussion going on about this for quite a bit now in the osteo forums:

http://forums.studentdoctor.net/showthread.php?t=862903

My concern about this resolution is if this is a prelude of what's to come- that is, eventually closing off ACGME residencies to D.O. grads. Today they are saying the internship/residency isn't up to par. Maybe they eventually say that the clerkships for core rotations aren't up to par either and they shut the door closed.

That's pretty extreme and would effectively shut out IMGs as well, so I doubt this will happen. Who knows though?
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There's no way they'd do that. It'd kill the osteopathic profession nearly instantly. IIRC there is only 1 AOA residency per 3 DO students so if ACGME became MD only then 2/3rds of all DO students would be jobless.
 
Spatula said:
There's no way they'd do that. It'd kill the osteopathic profession nearly instantly. IIRC there is only 1 AOA residency per 3 DO students so if ACGME became MD only then 2/3rds of all DO students would be jobless.
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Why is there no way "they'd" (Who do you think they is?) do that?

The AOA has no seat at the ACGME table. Here's the member societies of ACGME:
American Board of Medical Specialties
American Hospital Association
American Medical Association
Association of American Medical Colleges
Council of Medical Specialty Societies

Realize the bolded represents the LCME accredited MD schools. IF push comes to shove with increased enrollments and decreased or stagnant residency positions due to cuts in GME funding, its not outside of the realm of possibility.

The AOA needs to step up and focus on its GME.
 
Spatula said:
There's no way they'd do that. It'd kill the osteopathic profession nearly instantly. IIRC there is only 1 AOA residency per 3 DO students so if ACGME became MD only then 2/3rds of all DO students would be jobless.
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Maybe they should stop making new schools then
 
DrBowtie said:

The AOA needs to step up and focus on its GME.
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+1,000,000

I shouldn't have to stress about being locked out of a given field due to a lack of AOA GME.

If they want the world to believe DO==MD, then prove it and allow a DO to specialize to the same level of an MD without relying on the ACGME to do it for them.
 
Dharma said:
My concern about this resolution is if this is a prelude of what's to come- that is, eventually closing off ACGME residencies to D.O. grads. Today they are saying the internship/residency isn't up to par. Maybe they eventually say that the clerkships for core rotations aren't up to par either and they shut the door closed.

That's pretty extreme and would effectively shut out IMGs as well, so I doubt this will happen. Who knows though?
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Short of massive budget cuts (knock on wood given our current situation), this is not going to happen. There are way too many ACGME spots for only US MDs, even including expanded MD enrollment. Without an excess of spots, US MDs would be up in arms claiming they're forced into a crappy specialty, so there will always be plenty of spots compared to US MD applicants.

My fear is DOs and IMGs will get the scraps in the future instead of being able to compete on somewhat equal footing like they do now.
 
DrBowtie said:
You'd have to do an ACGME residency to do an ACGME fellowship.
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I want to do my residency in Denver. At this time there aren't any DO residencies of any kind in Denver, so I don't think that's an issue, as I'd have to do an ACGME residency anyway. I don't intend to specialize, but... one never knows...
 
I'm still a little confused about all this. I thought that the intern year isn't as common anymore. I googled it, and it says that it's normally incorporated as the first year of residency. Can someone clarify this?



If someone wanted to go into specialities that required a fellowship... let's say pediatric surgery (just using this as an example)... what would the sequence look like broken down? 4 years of medschool... then what? Intern year... residency... then fellowship?

I guess my main question is... how difficult is it for a DO to get into an ACGME intern year? Because it seems to me like the main point among all this is that in order for a DO who wants to match into an ACGME general surgery residency... he has to do a ACGME intern year. So the most simplistic route for a DO beyond the initial 4 years of medschool is just to do everything via the ACGME path.

I hope I'm not taking this too lightly. Please correct me if I'm missing something.

And... can we just say "MD" instead of ACGME? Or is that incorrect?
 
Iliketoytles said:
I'm still a little confused about all this. I thought that the intern year isn't as common anymore. I googled it, and it says that it's normally incorporated as the first year of residency. Can someone clarify this?



If someone wanted to go into specialities that required a fellowship... let's say pediatric surgery (just using this as an example)... what would the sequence look like broken down? 4 years of medschool... then what? Intern year... residency... then fellowship?

I guess my main question is... how difficult is it for a DO to get into an ACGME intern year? Because it seems to me like the main point among all this is that in order for a DO who wants to match into an ACGME general surgery residency... he has to do a ACGME intern year. So the most simplistic route for a DO beyond the initial 4 years of medschool is just to do everything via the ACGME path.

I hope I'm not taking this too lightly. Please correct me if I'm missing something.

And... can we just say "MD" instead of ACGME? Or is that incorrect?
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The intern year is normally incorporated as the first year of your residency. The vast majority of people don't have to do a separate intern year for their specialty, but some such as Rads require a preliminary year before starting the rads residency. Those are the people effected when it comes to residency.

For your example of pediatric surgery you would do 4 years med school + 5 years of general surgery + the fellowship in Peds. So for these people if they want to get the Peds fellowship they will have to do an ACGME(MD) residency. If you are like me and just want to do ortho it probably will not effect me. I have no plans for a fellowship and in the unlikely event I try for an MD residency i don't have to do a transitional year so there would be no effect.

Also transitional years don't appear to be difficult to attain. They seem to be reserved for the rads and other residencies of that type and for the people that don't match in their desired field. There are many that go unfilled every year.
 
Iliketoytles said:
I'm still a little confused about all this. I thought that the intern year isn't as common anymore. I googled it, and it says that it's normally incorporated as the first year of residency. Can someone clarify this?



If someone wanted to go into specialities that required a fellowship... let's say pediatric surgery (just using this as an example)... what would the sequence look like broken down? 4 years of medschool... then what? Intern year... residency... then fellowship?

I guess my main question is... how difficult is it for a DO to get into an ACGME intern year? Because it seems to me like the main point among all this is that in order for a DO who wants to match into an ACGME general surgery residency... he has to do a ACGME intern year. So the most simplistic route for a DO beyond the initial 4 years of medschool is just to do everything via the ACGME path.

I hope I'm not taking this too lightly. Please correct me if I'm missing something.

And... can we just say "MD" instead of ACGME? Or is that incorrect?
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Check out a lot of DO match lists and you'll see a lot of people doing intern/transitional years and then matching into a program as a PGY-2 afterward. I don't particularly know why people do these either, but I'd assume it's a combination of not matching the first time or other factors.

But yes, this pretty much means that it is easier to just do an ACGME residency. Oh well, I get the feeling the AMA might just be doing a power ploy and going to simply force the AOA to cede it's authority over DO's. Which in all honesty might be the best thing that's happened to DO's since they were allowed to practice all forms of medicine in the 70s.
 
gatorfann14 said:
The intern year is normally incorporated as the first year of your residency. The vast majority of people don't have to do a separate intern year for their specialty, but some such as Rads require a preliminary year before starting the rads residency. Those are the people effected when it comes to residency.

For your example of pediatric surgery you would do 4 years med school + 5 years of general surgery + the fellowship in Peds. So for these people if they want to get the Peds fellowship they will have to do an ACGME(MD) residency. If you are like me and just want to do ortho it probably will not effect me. I have no plans for a fellowship and in the unlikely event I try for an MD residency i don't have to do a transitional year so there would be no effect.

Also transitional years don't appear to be difficult to attain. They seem to be reserved for the rads and other residencies of that type and for the people that don't match in their desired field. There are many that go unfilled every year.
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serenade said:
Check out a lot of DO match lists and you'll see a lot of people doing intern/transitional years and then matching into a program as a PGY-2 afterward. I don't particularly know why people do these either, but I'd assume it's a combination of not matching the first time or other factors.

But yes, this pretty much means that it is easier to just do an ACGME residency. Oh well, I get the feeling the AMA might just be doing a power ploy and going to simply force the AOA to cede it's authority over DO's. Which in all honesty might be the best thing that's happened to DO's since they were allowed to practice all forms of medicine in the 70s.
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Ah this helps clarify things a lot. Thanks so much you guys!

One more question (might be a bit off topic)... why would a DO not want to get into an MD residency anyway? I'm not trying to start a MD vs DO debate, just curious. I think I read that DO residency matches begin before MD residency matches... so do most DOs attempt a DO residency match, and if they don't succeed, attempt an MD match?

I'm just trying to figure out the mentality behind all of it. Thanks in advance! 🙂
 
AOA (DO) residencies are more geographically limited and are not as abundant in most fields (as President Levine so ironically admitted, way to stand up for your own residency programs...). In addition, DO match occurs before an ACGME (MD) match - if you successfully match into an AOA residency program, you are automatically withdrawn from the ACGME match since you are only allowed to enter into a single residency contract per Match rules.

DOs who only want to consider ACGME residencies often will not apply to AOA residencies at all, to avoid risk of matching into an AOA program they intended as a backup.
 
Iliketoytles said:
Ah this helps clarify things a lot. Thanks so much you guys!

One more question (might be a bit off topic)... why would a DO not want to get into an MD residency anyway? I'm not trying to start a MD vs DO debate, just curious. I think I read that DO residency matches begin before MD residency matches... so do most DOs attempt a DO residency match, and if they don't succeed, attempt an MD match?

I'm just trying to figure out the mentality behind all of it. Thanks in advance! 🙂
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I believe most DO's go to ACGME residency programs simply by the fact that they are more plentiful and in better places ( Climatically) than Michigan. However the DO's who are shooting for the high end residenices, Ortho, Neurosurgery, Derm, etc, will need to solely rely on DO residencies as their chances in the MD match are pretty much lim inf -> 0.
 
jinobi said:
AOA (DO) residencies are more geographically limited and are not as abundant in most fields (as President Levine so ironically admitted, way to stand up for your own residency programs...). In addition, DO match occurs before an ACGME (MD) match - if you successfully match into an AOA residency program, you are automatically withdrawn from the ACGME match since you are only allowed to enter into a single residency contract per Match rules.

DOs who only want to consider ACGME residencies often will not apply to AOA residencies at all, to avoid risk of matching into an AOA program they intended as a backup.
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serenade said:
I believe most DO's go to ACGME residency programs simply by the fact that they are more plentiful and in better places ( Climatically) than Michigan. However the DO's who are shooting for the high end residenices, Ortho, Neurosurgery, Derm, etc, will need to solely rely on DO residencies as their chances in the MD match are pretty much lim inf -> 0.
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This makes sense. I'm glad I finally got everything cleared up, haha.

Thanks a lot guys!
 
serenade said:
So... what's next for the DO profession?
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This is what I want to know. Of course no one has an answer. But the current climate does raise some concerns. For years now, the common response is "oh, don't worry, D.O.s can match into M.D. residencies and gain some top notch training..." And they will for the next few years. But who knows what the circumstances will be 5 years from now when a lot of people here will be starting their residencies.

As someone said above, maybe this will be the catalyst to boost the quality of current AOA residencies, and start putting the lockdown on opening new schools and campuses in the name of PCP shortages.

And it is sort of lame that the AOA leans so heavily on the ACGME. What does the AOA have to say about this? It sounds as if they want to preach this pro-D.O. stance and hold firm to it yet a substantial contributor to the success of many osteopathic medical school graduates, and somewhat to the success of the profession itself, are allopathic institutions. Confusing? Conflicting? This is a funny game.
 
Dharma said:
This is what I want to know. Of course no one has an answer. But the current climate does raise some concerns. For years now, the common response is "oh, don't worry, D.O.s can match into M.D. residencies and gain some top notch training..." And they will for the next few years. But who knows what the circumstances will be 5 years from now when a lot of people here will be starting their residencies.

As someone said above, maybe this will be the catalyst to boost the quality of current AOA residencies, and start putting the lockdown on opening new schools and campuses in the name of PCP shortages.

And it is sort of lame that the AOA leans so heavily on the ACGME. What does the AOA have to say about this? It sounds as if they want to preach this pro-D.O. stance and hold firm to it yet a substantial contributor to the success of many osteopathic medical school graduates, and somewhat to the success of the profession itself, are allopathic institutions. Confusing? Conflicting? This is a funny game.
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True dat homez.

Btw, your avatar freaks me out. :scared: lol
 
Dharma said:
As someone said above, maybe this will be the catalyst to boost the quality of current AOA residencies, and start putting the lockdown on opening new schools and campuses in the name of PCP shortages.

.
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Reading this thread has put a wrinkle in my forehead. I seriously hope that this turns out to be a good thing and our profession is stronger in the end for it
 
Dharma said:
This is what I want to know. Of course no one has an answer. But the current climate does raise some concerns. For years now, the common response is "oh, don't worry, D.O.s can match into M.D. residencies and gain some top notch training..." And they will for the next few years. But who knows what the circumstances will be 5 years from now when a lot of people here will be starting their residencies.
Who knows, I think the DO profession won't fall quickly, but slowly it might end up being reduced in many regards. This will be especially true if the AOA does not try to fix why the ACGME is closing the door to begin with, the lower quality of rotations and residencies. However I don't think quality was ever a concern....
But regardless, I theorize that either the AMA will simply strip the AOA of all power and make DO schools, MD schools if they suffice LCME's critieria.
Or
We can soon see the DO profession pretty much becoming the new Caribbean, as the actual Caribbean will be completely dismantled.

 As someone said above, maybe this will be the catalyst to boost the quality of current AOA residencies, and start putting the lockdown on opening new schools and campuses in the name of PCP shortages.
I doubt it, the AOA has never thought about the interests of DO's or DO students. It's all about keeping the power as long as possible and as I theorized before, it will be a siege upon the DO profession until the AMA simply either voids licenses or etc.

And it is sort of lame that the AOA leans so heavily on the ACGME. What does the AOA have to say about this? It sounds as if they want to preach this pro-D.O. stance and hold firm to it yet a substantial contributor to the success of many osteopathic medical school graduates, and somewhat to the success of the profession itself, are allopathic institutions. Confusing? Conflicting? This is a funny game.
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The AOA is probably as poor as its treatment of DO's. Anyways they realize that right now they have literally been put in check. The DO's who score very low and go to transitional years will find themselves struggling to find residencies which = failure to get licensure.

But anyways, this is all strictly theoretical...
 
serenade said:
The AOA is probably as poor as its treatment of DO's. Anyways they realize that right now they have literally been put in check. The DO's who score very low and go to transitional years will find themselves struggling to find residencies which = failure to get licensure.

But anyways, this is all strictly theoretical...
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That's theoretical like a street bum's theory of the end of the world.
 
serenade said:
The AOA is probably as poor as its treatment of DO's. Anyways they realize that right now they have literally been put in check. The DO's who score very low and go to transitional years will find themselves struggling to find residencies which = failure to get licensure.

But anyways, this is all strictly theoretical...
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Geez, I seriously doubt that's going to happen. The DO profession has survived much worse and usually in the end has come out stronger. The new Carribean? Highly unlikely imo
 
serenade said:
I believe most DO's go to ACGME residency programs simply by the fact that they are more plentiful and in better places ( Climatically) than Michigan. However the DO's who are shooting for the high end residenices, Ortho, Neurosurgery, Derm, etc, will need to solely rely on DO residencies as their chances in the MD match are pretty much lim inf -> 0.
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That one
 
rafman said:
Geez, I seriously doubt that's going to happen. The DO profession has survived much worse and usually in the end has come out stronger. The new Carribean? Highly unlikely imo
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It's a bit far fetched, but the reality does hold that if this continues some DO's will graduate and likely not be able to make it into a residency. Further down the road? Who knows...
 
Worst-case scenario: I can't speculate about the private DO schools, but I suspect that if a significant number of similarly qualified graduates from the big state DO schools can't find employment just because of their degree in the face of a primary-care physician shortage, there will be a serious debate in many legislatures, perhaps resulting in state-funded in-state residencies so their degrees won't go to waste, considering that these DO schools are creatures of the state with the express purpose to produce physicians on a parallel path. The inequity is absurd and won't go unnoticed.
 
DrCalculi said:
Worst-case scenario: I can't speculate about the private DO schools, but I suspect that if a significant number of similarly qualified graduates from the big state DO schools can't find employment just because of their degree in the face of a primary-care physician shortage, there will be a serious debate in many legislatures, perhaps resulting in state-funded in-state residencies so their degrees won't go to waste, considering that these DO schools are creatures of the state with the express purpose to produce physicians on a parallel path. The inequity is absurd and won't go unnoticed.
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Those schools in the worst case scenario could just become another branch of their state's already established MD schools. Big State DO schools have all the material to be LCME accredited, so they are pretty safe if the entire DO system falls apart.
 
Spatula said:
That's theoretical like a street bum's theory of the end of the world.
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How so? It may be a bit far-fetched, but with pending cuts in GME funding along with an increase in medical school graduates (both M.D. and D.O.), there is a possibility that some will be left stranded. No guarantees, either way.
 
Dharma said:
How so? It may be a bit far-fetched, but with pending cuts in GME funding along with an increase in medical school graduates (both M.D. and D.O.), there is a possibility that some will be left stranded. No guarantees, either way.
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I was referring more to his in-line quoting where he uses phrases like "voiding of licences"
 
Spatula said:
I was referring more to his in-line quoting where he uses phrases like "voiding of licences"
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If the AMA deems DO residencies unfit, which it already has for a few specialties, then why is it so insane to believe that they might void the medical licenses of those who received training which could potentially be harmful to patients? And I'm not saying DO residencies are substandard, but rather that the AMA might deem them substandard and as such make the training seem insufficient and as such dangerous to patients.
 
serenade said:
If the AMA deems DO residencies unfit, which it already has for a few specialties, then why is it so insane to believe that they might void the medical licenses of those who received training which could potentially be harmful to patients? And I'm not saying DO residencies are substandard, but rather that the AMA might deem them substandard and as such make the training seem insufficient and as such dangerous to patients.
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Has there been anything actually ever said by anyone that matters to the AOA that there may be a small possibility that there is any sort of danger of anyone losing licences?

Sometimes the AOA acts strangely. The AOA might be run by aliens and as soon as you attend your first day of osteopathic school you get transported to the mothership where you turned into a body-mask for an alien infiltrator who's mission is to implant soul batteries into all of it's patients for the rest of it's career.

The parallel here is that we're both taking a point (That the AMA might not like some DO residences and that the AOA is weird) and extrapolating that wildly.
 
Don't confuse the AMA (American Medical Association) with some other entity.

I think you mean to speak of the Accreditation Council for Graduate Medical Education (ACGME)
 
PCOMSurgery said:
Don't confuse the AMA (American Medical Association) with some other entity.

I think you mean to speak of the Accreditation Council for Graduate Medical Education (ACGME)
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Well the AMA is about a 40% stakeholder in the ACGME. I also would agree not to mix them up though. Just because they have a significant say doesnt mean the policies of the ACGME reflect the AMA. There are many other players involved here.
 
There really isn't much need to panic just yet. It is always very important to be aware, so i'm not saying to remain uninformed, but these have been in the proposal stage their start. It doesn't seem like they have been that successful in the past two decades, and it will be hit with a lot of criticism and resistance from the Osteopathic community. If you are an Osteopathic medical student, definitely voice your opinion if your school offers a meeting for current students to express concern. If you are an applicant, this may be a good question to pose to interviewers to get their thoughts on the matter.

Hopefully the voices of reason within the Allopathic community, along with our figure heads in the Osteopathic community will find the proposals to be demeaning to the Osteopathic profession.

A statement issued by AACOM and AOA:
"We are not aware that there is evidence of inadequate training within osteopathic medical education post-graduate programs. Thus, a sudden change such as the one proposed, which will affect hundreds of current students and residents, seems to be a solution to a problem that doesn't exist."

We should remain hopeful that this will be squashed. The AOA has had to fight in the past to protect our opportunities and will do so again.
 
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