What was the motive for ACGME to merge with the AOA?

[basikfx]

Probably so they can oversee all residency programs in the United States...

but what prompted them to carry on the action now? What's their vested interest? Just curious.

---

Members don't see this ad.

 

[Foot Fetish]

To make DO's feel more equal I guess.

 

[basikfx]

That doesn't seem like it's in the best interest of ACGME, though.

 

[Setto]

Opens more residency opportunities for MDs which could reduce pressure to open additional MD residency positions.

 

[basikfx]

But wouldn't it be easier to just increase more slots to existing programs rather than going through with the merger?

 

[Goro]

To squeeze out the IMGs

 

[DrBowtie]

But wouldn't it be easier to just increase more slots to existing programs rather than going through with the merger?

Who is going to pay for those?

Also the proposed barring of AOA trained residents from entering ACGME fellowships was also a contributing factor

 

[basikfx]

Who is going to pay for those?

Also the proposed barring of AOA trained residents from entering ACGME fellowships was also a contributing factor

I thought residencies are funded by the government anyways.

That was a leverage ACGME used to get the merger through but I still don't see how that would benefit them.

 

[basikfx]

To squeeze out the IMGs

OK this makes most sense but AOA already didn't accept IMGs and ACGME could've done that with a simple policy change..

 

[Stagg737]

Who is going to pay for those?

Also the proposed barring of AOA trained residents from entering ACGME fellowships was also a contributing factor

I think that was more incentive for the AOA to merge than for the ACGME to absorb. Since the merge gives them total control over all residencies they can shut down ones that they feel don't meet their standards and can indirectly have some control in new med schools opening. There are a lot of new med schools opening, and if they can't provide adequate training to get students into residency, it's a way to potentially control the number of medical graduates coming out of school with sub-par education. If those schools produce solid students, it's more reason to push out IMGs.

Disclaimer: I have no idea if that was part of the ACGME's reasoning, or if that will even happen. Just pointing out that it's a possible course they could take.

 

[FCMike11]

Just from reading a history through the book by Norman Gevitz it makes you wonder if it is a continued effort to absorb the profession to some degree. Obviously with the expansion of osteopathic schools, this wouldnt be completely viable. But, it could be viewed as a way for them to provide a standardization of training.

?

Sent from my Nexus 6P using SDN mobile

 

[NontradCA]

They're trying to learn OMM secrets.

 

[Dr. Death]

To make DO's feel more equal I guess.

I hope this is sarcasm because it's idiotic

Opens more residency opportunities for MDs which could reduce pressure to open additional MD residency positions.

Why would MDs want more residencies? Yes maybe they want access the handful (literally) of subspecialty programs but why would they take on all the other residencies when they already have a huge surplus of spots?

OK this makes most sense but AOA already didn't accept IMGs and ACGME could've done that with a simple policy change..

This doesn't make the most sense because there's no evidence that this is the case. While the total number of residencies in the U.S. will decrease, those residencies that are closing weren't open to IMG anyway and many of them were going unfilled year after year.



The answer to this question is $. Follow the $

 

[Setto]

Why would MDs want more residencies? Yes maybe they want access the handful (literally) of subspecialty programs but why would they take on all the other residencies when they already have a huge surplus of spots?

The answer to this question is $. Follow the $

I was under the impression there was a shortage which, if correct, would be following the $.

 

[pkwraith]

ACGME has vested interest because it opens up competitive specialty DO spots for MDs with out giving up anything (DOs can already apply to MD spots). It's win-win.

AOA has no choice but to agree, because ACGME threatened to close off their residency spots which will screw DO graduates. Lose less - lose more.

 

[basikfx]

ACGME has vested interest because it opens up competitive specialty DO spots for MDs with out giving up anything (DOs can already apply to MD spots). It's win-win.

AOA has no choice but to agree, because ACGME threatened to close off their fellowship spots which will screw DO graduates. Lose less - lose more.

lol taking on a daunting process of merger just to grab a few competitive DO spots? that seems unlikely..

also the bold for correction

 

[Moose A Moose]

You're all fooling yourselves if you think it's about anything other than money in the end. They're a business that allowed the AOA to keep their precious COMLEX cash cow... For now.

 

[AnatomyGrey12]

I was under the impression there was a shortage which, if correct, would be following the $.

Seeing as ~6000 IMG/FMGs match every year it definitely isn't because of a shortage

 

[NotYou20]

Just from reading a history through the book by Norman Gevitz it makes you wonder if it is a continued effort to absorb the profession to some degree. Obviously with the expansion of osteopathic schools, this wouldnt be completely viable. But, it could be viewed as a way for them to provide a standardization of training.

?

Sent from my Nexus 6P using SDN mobile

It gives them the machinery to make whatever changes to do education they want. No idea what will happen, but if a large part of the leverage used was threatening to close off fellowships from aoa residents then it's not all that hard to imagine the acgme doing the same thing one level down in the future.

 

[username456789]

I was under the impression there was a shortage.

Nope.

 

[the argus]

I'm sure there won't be an answer because there never has been, but I'll ask anyway for completion's sake.

To squeeze out the IMGs

Please explain how the merger is going to squeeze out the IMGs. You never have before, but since you continue to post this nonsense maybe you will now. I doubt it, but I'd love for you to prove me wrong.

OK this makes most sense but AOA already didn't accept IMGs and ACGME could've done that with a simple policy change..

What about this makes sense to you?

 

[AnatomyGrey12]

Honestly I think on the ACGME side it was just to standardize residency training. They really don't get anything except for a potential very small number of competative specialty spots at programs that may or may not still focus on DOs. I don't even know what financial benefit they get.

 

[mehc012]

You're all fooling yourselves if you think it's about anything other than money in the end. They're a business that allowed the AOA to keep their precious COMLEX cash cow... For now.

I think what people are asking IS...where's the money in this?

 

[hallowmann]

The benefit is clear and simple: it gives the ACGME complete control over all accredited GME in the country. By holding a monopoly, they have a stronger position to make changes or demand funding increases. They will have control over expansion, accreditation and negotiations with the fed related to GME. It solidifies their power and existence.

The whole process furthers the agenda of the ACGME as a body renowned and responsible for US GME.

I thought residencies are funded by the government anyways.

That was a leverage ACGME used to get the merger through but I still don't see how that would benefit them.

Laws cap the funding for the number of positions per hospital. By taking over OGME, they actually get access to already formed GME at generally non-maxed out institutions. It would also be hard given ACGME requirements to just expand/establish a bunch of programs compared to just absorbing them.

OK this makes most sense but AOA already didn't accept IMGs and ACGME could've done that with a simple policy change..

The ACGME can't bar IMGs from training unilaterally. It's actually illegal, and it would be against its best interests to bar any sizeable population from residencies, because it also serves the programs, which want to fill and as of now can only do so with IMGs.

It has nothing to do with DOs and everything to do with leverage.

 

[Moose A Moose]

I think what people are asking IS...where's the money in this?

If you need it spoon fed to you, refer to Hallowmann's post below yours.

 

[mehc012]

If you need it spoon fed to you, refer to Hallowmann's post below yours.

You're right, Hallowman's is an example of an actually useful response, rather than simple condescension. Good catch!

 

[TedStark]

 

[jw3600]

They're trying to learn OMM secrets.

Hey! That's sarcasm. I'm learning.

 

[deleted547631]

To squeeze out the IMGs

@Goro, woudn't IMGs and FMGs have greater access to more residency positions with the merger since AOA programs would now be open to MDs?

 

[Goro]

Nope. The goal was to remove the bypass that IMGs (qualified FMGs are different) that the Carib students use to avoid the stricter processes the mainland schools use.

Don't think that DO PDs are going to suddenly take MD grads, especially from Carib schools.

@Goro, woudn't IMGs and FMGs have greater access to more residency positions with the merger since AOA programs would now be open to MDs?

 

[235009]

Nope. The goal was to remove the bypass that IMGs (qualified FMGs are different) that the Carib students use to avoid the stricter processes the mainland schools use.

Don't think that DO PDs are going to suddenly take MD grads, especially from Carib schools.

They absolutely will. Mark my words. The primary goal of those PDs is to fill their programs. As DOs start having an opportunity to rank former AOA programs alongside ACGME programs some of these former AOA programs will basically be forced to interview and rank IMGs because some of the DOs that they depended on to fill thier spots will start diffusing into ACGME programs.

Logic. You should give it a try.


Sent from my iPhone using SDN mobile app

 

[Goro]

There's this thing called "brand loyalty", and as such, the DOs do stick together on this, I've noticed.

Still never got over that DO beating you up, taking your lunch money, and stealing you GF?

They absolutely will. Mark my words. The primary goal of those PDs is to fill their programs. As DOs start having an opportunity to rank former AOA programs alongside ACGME programs some of these former AOA programs will basically be forced to interview and rank IMGs because some of the DOs that they depended on to fill thier spots will start diffusing into ACGME programs.

Logic. You should give it a try.


Sent from my iPhone using SDN mobile app

 

[the argus]

There's this thing called "brand loyalty", and as such, the DOs do stick together on this, I've noticed.

Still never got over that DO beating you up, taking your lunch money, and stealing you GF?

How could this possibly be noticed? AOA residencies don't take IMGs, so at what point was there even an option to display "brand loyalty"?

I mean everyone knows non-physician PhDs who teach basic science at osteopathic schools are experts on residency placement and the inner workings of residency programs.

 

[235009]

There's this thing called "brand loyalty", and as such, the DOs do stick together on this, I've noticed.

A PD who claims "brand loyalty" as the reason he/she didn't fill their residency spots despite having 100s of applications from IMGs won't be a PD for much longer.

 

[darklabel]

lol taking on a daunting process of merger just to grab a few competitive DO spots? that seems unlikely..

also the bold for correction

Actually doesn't the AOA have a decent number of Ortho spots? Get ready for those to get hit with a high number of applicants with 240+ and good research.

I always thought this would be a negative for DOs in competitive specialties since they will now compete with a lot of highly qualified people. Though maybe this will be a positive for less competitive specialties? Idk honestly.

 

[Stagg737]

A PD who claims "brand loyalty" as the reason he/she didn't fill their residency spots despite having 100s of applications from IMGs won't be a PD for much longer.

This depends on the program though. If a program regularly isn't competitive and has open spots, of course they'll fill it. If it's a program in a major city that people are lining up to get into, they don't need to take any MDs if they don't want. Anecdote: I've talked to 2 higher ups in AOA programs in one of the most competitive specialties (one's a PD, one an attending) who said they will continue to highly favor DOs after the merger. Their argument was that they weren't about to make that specialty inaccessible to DO's (since it basically is on the ACGME side already).

 

[YoungDoc25]

How will this change osteopathic schools? Will we see a shift to more research since many of these competitive specialties will soon be open to MDs from schools that push research? I would think this would be the next step for any DO program that wants to realistically keep those residency spots for DO graduates. Also, this would be a great recruiting tool for DO schools, paired up with the merger allowing their graduates to be in a residency next to their MD counterparts.

Personally, I feel like the merger is an opportunity for the DOs that have been wanting to be seen as an equal to MDs the opportunity to finally have that. Programs have been debated on here on how they rank to MD schools, and I really hope to see them step up to the plate and deliver. In the long term, I only feel like the merger hurts the under-qualified MD/DO and the poor DO residencies. If you're a good student and bust your butt, I don't see this merger hurting you whether you're a DO or MD, foreign or American. Everyone is on the same playing field now for residencies and fellowships, as it should be.


As a side note, could ACGME be trying to cut the growth of DO schools by now controlling their residencies? COCA and the AOA now can't keep opening schools while 1) not expanding residency spots and/or 2) opening up poor residency spots that graduates gain nothing from. Seems like a strategic move to control the devaluing of the medical profession as a whole. COCA could continue opening up schools, but ACGME most likely won't do anything to help residency wise and/or will not approve or allow crappy residency programs to support unnecessary medical school growth.

 

[IslandStyle808]

I think that was more incentive for the AOA to merge than for the ACGME to absorb. Since the merge gives them total control over all residencies they can shut down ones that they feel don't meet their standards and can indirectly have some control in new med schools opening. There are a lot of new med schools opening, and if they can't provide adequate training to get students into residency, it's a way to potentially control the number of medical graduates coming out of school with sub-par education. If those schools produce solid students, it's more reason to push out IMGs.

Disclaimer: I have no idea if that was part of the ACGME's reasoning, or if that will even happen. Just pointing out that it's a possible course they could take.

How would the AOA have more control once absorbed into the ACGME than they do now over former AOA residencies? The reason why some programs are shutting down are because of current ACGME standards that these program cannot meet. They should have had enough power to shut these residencies before, why would it increase now. It is more to say I want to understand how this indirect control will work under the ACGME?

What you are saying about new schools is definitely true. However, don't forget that older schools are also at fault for having high numbers of students as well. There will be that small percentage who get shafted at these older school simple because the quality control is extremely hard to do. Overhaul of all DO schools need to be done now rather than wait for an LCME take over.

 

[cbrons]

Not sure the exact reason but 100% sure it involves $$$$$$$.

Sent from my SM-N910P using SDN mobile

 

[235009]

How will this change osteopathic schools? Will we see a shift to more research since many of these competitive specialties will soon be open to MDs from schools that push research? I would think this would be the next step for any DO program that wants to realistically keep those residency spots for DO graduates. Also, this would be a great recruiting tool for DO schools, paired up with the merger allowing their graduates to be in a residency next to their MD counterparts.

Bolstering research at DO schools would be nice but that doesn't fix the fundamental problem that deters many PDs from considering DOs which is inconsistent and poor clinical rotations. As I've said in the IM forum: having research is a nice cherry on top but no one is going care about the decoration if the cake isn't up to par. I suspect that some DO schools will look to improve research before they tackle clinical rotations because it's easier to do.... all you need to do is throw money at it by building lab space and offering grant funded professors competitive salaries to join your faculty. You can't improve clinical rotations by just throwing money at them.

 

[FiveOClock]

The point was to fill my primary care spots. DOs will effectively be non-competitive for medium and high competitive specialties. This will occur via a two-fold mechanism: 1) some DO programs will be shut down 2) the average MD applicant is more competitive than the avg DO. Some DO programs with DO residency directors will continue to take DOs but I presume this will be the minority. The net effect will be that DOs will be more likely to apply for primary care positions, and we will more effectively address the shortage.

 

[AnatomyGrey12]

The point was to fill my primary care spots. DOs will effectively be non-competitive for medium and high competitive specialties.

Your wrong here. DOs have consistently matched medium competative specialties and a decent number actually break into highly competative ones. The merger won't really change this. I think you are underestimating how competative some of the top 10-20% of DO students are these days. Outside of surgical-subs, Derm, and Rad Onc DOs match fairly consistently. The average DO has a number of specialty options available and is definitely not pigeonholed into general IM, FM, or Peds

DOs already filled primary care spots in large numbers and if that was the "goal" of the merger then it was pointless because that was already the case. It really is most likely a combo of $$$ and having a solitary accreditation body and standardized graduate training.

 

[YoungDoc25]

Bolstering research at DO schools would be nice but that doesn't fix the fundamental problem that deters many PDs from considering DOs which is inconsistent and poor clinical rotations. As I've said in the IM forum: having research is a nice cherry on top but no one is going care about the decoration if the cake isn't up to par. I suspect that some DO schools will look to improve research before they tackle clinical rotations because it's easier to do.... all you need to do is throw money at it by building lab space and offering grant funded professors competitive salaries to join your faculty. You can't improve clinical rotations by just throwing money at them.

I hadn't thought about it that way, but that definitely makes sense.

 

[Ho0v-man]

They're after grandpa Still's ancient falafel recipe!


Sent from my iPhone using SDN mobile

 

[PL198]

Your wrong here. DOs have consistently matched medium competative specialties and a decent number actually break into highly competative ones. The merger won't really change this. I think you are underestimating how competative some of the top 10-20% of DO students are these days. Outside of surgical-subs, Derm, and Rad Onc DOs match fairly consistently. The average DO has a number of specialty options available and is definitely not pigeonholed into general IM, FM, or Peds

DOs already filled primary care spots in large numbers and if that was the "goal" of the merger then it was pointless because that was already the case. It really is most likely a combo of $$$ and having a solitary accreditation body and standardized graduate training.

because they had their own protected spots to match into which MDs cannot. what do you think is going to happen when the MDs can match into those spots? Obviously some MDs will match into previously DO only spots. The question is at what frequency.

DOs matching into DO derm or DO ortho programs doesn't make your argument, it undermines it. Show me DOs matching into MD derm or MD ortho, that is where you make a point if there is one.

 

[deleted547631]

Question: roughly how many former AOA residency positions are anticipated being added to the NRMP?

 

[Donald Juan]

There's this thing called "brand loyalty", and as such, the DOs do stick together on this, I've noticed.

Still never got over that DO beating you up, taking your lunch money, and stealing you GF?

You're right that many PDs of historically DO residencies (HDORs, pronounced Hodors) will have some brand recognition. But the fact remains that DOs have been able to apply to MD residencies all along, so nothing will change with MD residencies. The only change is that MDs will be able to apply to HDORs, and will add competition to DO students who traditionally went to HDORs.

Let's just say, for argument sake, that 90% of HDORs PDs agree to throw out all MD applications on principle. Even so, it will still make matching more competitive for DOs as 10% of programs would be looking at other applications.

MDs also stick to brand loyalty, I don't think that US MD programs will suddenly stop that now. The rapid expansion of USDO schools will actually only hurt the DOs from longstanding, well respected schools.

 

[IslandStyle808]

because they had their own protected spots to match into which MDs cannot. what do you think is going to happen when the MDs can match into those spots? Obviously some MDs will match into previously DO only spots. The question is at what frequency.

DOs matching into DO derm or DO ortho programs doesn't make your argument, it undermines it. Show me DOs matching into MD derm or MD ortho, that is where you make a point if there is one.

That's not the point he is make, he agrees with the difficulty of matching into ultra competitive specialties. He is arguing against medium level specialities and programs. DOs have matched into such program like surgery or EM and even mid-tier program in Anesthesia. This will most likely not change.

I'm not getting the last point of your statement. We all know that is insanely difficult to get into MD derm or MD ortho (and yes DOs have matched into these fields, just look at the NRMP reports). The one thing you are not acknowledging is that now osteopathic student can put all former AOA residencies and ACGME into their rank list without being removed from the ACGME match. Put this factor in and it becomes far less predictable as to how osteopathic students do. For example, look at optho, there is fair amount of DOs who do match into this field. I don't believe for a second the DO bias is the weakest amongst the ultra competitive specialties, in fact I think it is about as strong as Rad Onc. The big difference is that the SF match happens before the AOA, thus you have more DOs matching into ACGME spots.

Again, we understand that it will still be insanely competitive to match into these fields and that MDs will match into former AOA specialties. However, this is not to say all of osteopathic matching will be nothing but negatives. The combined match is still a positive.

 

[Donald Juan]

Question: roughly how many former AOA residency positions are anticipated being added to the NRMP?

All of them.

 

[IslandStyle808]

Question: roughly how many former AOA residency positions are anticipated being added to the NRMP?

Somebody gave a break down of this. All of them have to apply for ACGME accreditation. However, not all of them make the cut. Ex. a lot of derm residency will not continue due to their poor quality residencies.