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Thursday Mar 20, 2014

Accreditation Merger Creates Unified Standard, Preserves D.O.s' Identity

As a fourth year osteopathic medical student, I was torn between my options. Matching at an osteopathic residency would eliminate my ability to apply for the allopathic match, but there were several allopathic programs that appealed to me.

Would I have to sacrifice my osteopathic training to satisfy other opportunities I felt were crucial for my career? Fortunately, I found an allopathic residency with a strong tradition of accepting osteopathic residents and a supportive curriculum that included weekly osteopathic clinics.

Here I am with my grandmother, Eileen Krempetz, at my medical school graduation. Creating a single accreditation system for graduate medical education will simplify residency choices for medical students in the future.

A decision recently was made that will minimize similar struggles for future medical students. The American Osteopathic Association (AOA), the Accreditation Council for Graduate Medical Education (ACGME) and the American Association of Colleges of Osteopathic Medicine (AACOM) announced their decision to create one combined accreditation system to oversee resident education. The possibility of a combined national Match is under discussion.

While respecting the differences between osteopathic and allopathic training, this merger will ensure that all residency programs throughout the United States adhere to the same accreditation standards, thereby promoting increased consistency in the basic training of all physicians. The hope is that this will benefit patients by maintaining a high standard for training in the United States.

This unifying move is consistent with what already exists beyond residency. M.D.s and D.O.s work side by side throughout the country in a variety of settings. It makes sense that the training environment should mirror this collaboration. Already, there are seminars and brief courses for allopathic physicians interested in learning various osteopathic skills. Many of my M.D. co-residents expressed an interest in manipulative medicine; the new accreditation process will
allow allopathic students to learn osteopathic manipulation during their residencies. The new system, for the first time, also will allow allopathic physicians to enter osteopathic fellowships upon completion of their residencies.

For anyone concerned about the ability to preserve the unique training, skills and principles of osteopathic medicine, the AOA and the AACOM will become member organizations of the ACGME and have representative seats on the ACGME board of directors. And, of course, these changes will not happen overnight. The plan is to transition to this system during the next six years, which should give programs and students sufficient time to adjust.

We desperately need more well-qualified primary care physicians, and D.O.s often choose primary care fields. In fact, family medicine ranked the highest in this year's osteopathic match. The number of osteopathic medical schools continues to grow, and it is estimated that there will be more than 100,000 practicing osteopaths by 2020.

This merger is a step in the right direction because it acknowledges the commitment of osteopathic medicine to primary care; preserves osteopaths' identity; and creates a single, high standard for training to provide the primary care workforce our nation needs.

Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services, including osteopathic manipulation, at a community health center in the Bronx, N.Y. She is actively involved in teaching residents and medical students to deliver evidenced-based care to underserved communities.


I agree that a single accreditation system will open more training slots for new osteopathic graduates. My concern is the loss of osteopathic identity. At the recent ACOFP meeting in Philadelphia, the MOU was presented. It is true that AACOM and the AOA will have board seats on the combined ACGME, but will represent a small minority. I have yet to see the MOU to read for myself. It appears that many traditional small osteopathic residencies would close as they would be unable to meet ACGME requirements, thereby reducing the number of primary care training slots available. I am also concerned that any osteopathic program directors and directors of medical education become superfluous under the proposal. There is also the question of what will be done with all the doctors in leadership positions who are boarded through the AOA. Currently, they would be ineligible for leadership positions or faculty positions as they wouldn't have ABMS boards. A lot of questions need to be answered before I can consider this proposed merger a good thing for osteopathy.

Posted by Glenn V Dregansky, DO, FAAFP on March 24, 2014 at 02:55 PM CDT #

Thank you, Dr. Dregansky, for your comment! I appreciate your concerns surrounding the need to protect the osteopathic identity, as well as its unique history and dedication to primary care. I had similar concerns when I initially heard about the merger. While it is true that all programs will have to comply with the ACGME requirements in order to continue, the programs will have six years to adjust to these requirements. My hope is that, in an effort to train as many primary care physicians as possible to keep up with the demands of our healthcare system, there will be sufficient support in place to enable these programs to make the changes that will ultimately strengthen the training they offer. As for current osteopathic program directors and directors of medical education, the requirement is for AMBS certification “or” specialty qualification; osteopaths, therefore, can become faculty and program directors in the new system. However, in the long-term, once this adjustment period has passed, all residency graduates will be eligible for ABMS certification. Already, most osteopathic family physicians are trained in dually accredited programs and, thus, are trained in an ABMS system. All change comes with “growing pains” that can be difficult to maneuver at times. But I think there are enough vocal osteopaths who are actively involved in ensuring that our unique identity and the skills we have to offer aren’t lost in this merger. After all, it is our osteopathy that keeps many of our patients coming back year after year! If you want more information, Dr. Boyd Buser just wrote a great article in this month’s Journal of the American Osteopathic Association, “A Single Graduate Medical education Accreditation System: Ensuring Quality Training for Physicians and IMproved Health Care for the Public.”

Posted by Margaux Lazarin, DO, MPH on April 07, 2014 at 12:31 PM CDT #

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