The ACGME agreement and you
The AOA’s mission is to “advance the distinctive philosophy and practice of osteopathic medicine,” while our vision is to be the professional home for all osteopathic physicians. These two guiding principles were called into question in 2012 by a yearlong series of negotiations over the future of graduate medical education (GME) for U.S.-trained physicians.
The initial stage of those negotiations concluded on Oct. 24, when the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) announced our intent to work together to develop a single, unified accreditation system for all GME programs that would become effective July 1, 2015. (Watch my last video column to learn more.) While I think this a significant step forward for the profession and patients, I would be remiss not to acknowledge that the osteopathic family also has many concerns.
Support and concerns
For over 100 years relations between DOs and MDs have occasionally been marked by consternation, if not outright hostility. As one DO wrote to us recently, these personal and institutional power struggles might at last be put to rest by the agreement, the positive effect of which on specialty training he predicted would be “historic and profound.”
We’ve been trying to get the word out to AOA family members to hear their feedback. The initial news release was sent to all DOs and osteopathic medical students for whom we have email addresses, whether they were members or not. We hosted conference calls with state osteopathic medical associations, osteopathic specialty colleges, students and OPTI directors. So far, we’ve received a great deal of support from individual students and DOs, and from affiliate organizations as well.
But among the positive feedback, voices of concern point out many questions yet to be answered. How will we preserve the distinctiveness of osteopathic medicine in a single system? How will we protect our affiliates? Is this the first step toward a merger of our professions?
Maintaining OMM and OPP in GME
The first thing I want you to know is, at this point, we have agreed only to enter into discussions to develop a unified system. Negotiations with the ACGME over the next three years will answer many of your questions, such as the future role of osteopathic specialties and certifying boards.
Rest assured, if osteopathic medicine is threatened—espcially if we cannot reach an agreement that preserves osteopathic principles and practice, including osteopathic manipulative medicine, within future residencies—we will halt negotiations and keep our existing system. On the other hand, if discussions are successful, AOA GME programs will be accredited by the ACGME. We will continue to stress AOA board certification for all DOs as a demonstration of continued competence in osteopathic medicine.
The quality of AOA training programs is not in question. The ACGME shares our belief that our programs will meet its standards. The timeline for our transition to a unified accreditation system provides time for AOA programs to familiarize themselves with ACGME’s standards before inspection site visits.
DO access and representation
The unified accreditation system’s main goal, as far as the AOA is concerned, is to preserve access to all training programs for DOs. Currently, there are 11,025 AOA training positions and more than 4,000 DO graduates each year. As our school and enrollment levels continue to grow, osteopathic GME programs alone cannot support the demand for training slots and help alleviate the upcoming physician shortage. More than 60% of DOs currently train in ACGME programs!
The proposed system will preserve access for DOs to ACGME residency and fellowship programs and eliminate issues with their eligibility. Those DOs who want to be faculty for ACGME programs can do so with AOA certification beginning in 2015. For physicians who completed AOA-approved GME in the past, the ACGME’s agreement to deem their training as ACGME-accredited represents a historic acceptance of AOA graduate medical education.
While we expect this transition to be seamless, that does not mean it will be perfect. If you are applying for an ACGME fellowship and receive communication that your AOA training makes you ineligible, please forward this information on to the AOA. We will be keeping a list of residents who are denied access so that we can take their cases directly to ACGME leadership.
Strengthening the profession
The AOA and AACOM have also successfully advocated for DO representation on the ACGME’s governing bodies. We will each have one of seven seats on the ACGME Board, giving us veto power (the ACGME requires an 80% voting majority) over issues as the system evolves. DOs will be nominated to serve on each Residency Review Committee (RRC), and new RRCs will likely be formed for specialties unique to DOs, such as neuromuskuloskeletal medicine.
Overall, I believe that the single, unified accreditation system will strengthen—not threaten—the osteopathic medical profession. The next step in our discussions will be developing the first of what could be several memorandums of understanding with the ACGME spelling out each side’s “nonnegotiables” and setting a timeframe for developing the new system. This will require the active participation of osteopathic specialty college evaluating committees, meeting with their RRC counterparts, to develop common standards for training—including OPP. AOA education committees will play a critical oversight role throughout this process and beyond.
Later this month, AOA and ACGME representatives will be testifying before the Institute of Medicine’s Committee on GME to detail our plan and why we believe it will strengthen the medical professions. In response to efforts to cut GME funding, the unified accreditation process is a clear reflection of the collaborative work being done by the AOA and ACGME to improve GME with a focus on achieving demonstrated quality improvement.
Building an enduring great association
In Great by Choice, management consultant Jim Collins addresses the core questions of what it takes to build an enduring great association. Although any organization can control only a “tiny sliver” of what happens to it, we are “free to choose, free to become great by choice.” By choosing to enter into this agreement with the ACGME, the AOA lives up to its mission and vision for all DOs.
We understand that the osteopathic community will have many more questions on this issue as it evolves over the next three years. Osteopathic.org has a wealth of information, including frequently asked questions and a timeline of events. Above all, preserving OGME and protecting the future of the osteopathic medical profession remain our top goals. We can DO it!