AOA, AACOM, and the ACGME agree to unified accreditation system

[chasm-e-baddoor]

lol @ people saying that OMT is all hogwash

things like precision counterstrain or muscle energy techniques are extremely effective

just because youre some DO student who half asses everything in OMM lab just to pass the practical, doesnt mean that it doesnt work. there are 3 MDs in my immediate family, and they all go to the same DO for certain problems that MDs didnt know how to do anything about (musculoskeletal issues)

saying OMT is bogus is almost like saying physiotherapy and occupational therapy are bogus. yet, i'm sure many of you are going to refer to phsyysio/occupational therapy when you practice

that said, for OMT to work, you really gotta do it properly or it will suck.

---

Members don't see this ad.

 

[GUH]

Yeah I would like to know what they said at that conference thing. It was 6 AM in my time zone so I missed it.

Third year. Don't get too carried.

Potato potato. Percentiles are percentiles all my grades in ug were on a normal curve or normalized sorry if yours were a result of arbitrary grade inflation

Your numbers still don't make sense. If you think the 65th percentile is a D then you're implying that the average score "should" be 50 percent, which is an F. That's ridiculous.

 

[user3]

no one has discussed this yet- why the failed negotiations after the confidential MOU-- THEN this about-face?

 

[SLC]

no one has discussed this yet- why the failed negotiations after the confidential MOU-- THEN this about-face?

I'm guessing the backlash against the AOA from within their own student body and a strong percentage of the younger DO physicians out there (the up and coming's) was too much.

Sad that it may have come to this, but what do you expect from the AOA?

 

[bajastapler]

rage all you want this is the best thing to happen since sliced bread.

 

[ostrich love]

rage all you want this is the best thing to happen to since sliced bread.

Sliced Bread, D.O

 

[BurghStudent]

Speaking of OMT, are there any published surveys about how many DOs eventually keep practicing OMT after their residency? It would be interesting to compare ACGME and AOA trained DOs.

 

[Kevin Baker]

no one has discussed this yet- why the failed negotiations after the confidential MOU-- THEN this about-face?

Have you ever wanted to seriously date someone, they turn you down, you start seeing someone else, and your ex gets all jealous and comes back... yeah

 

[Oo Cipher oO]

I'm guessing the backlash against the AOA from within their own student body and a strong percentage of the younger DO physicians out there (the up and coming's) was too much.

Sad that it may have come to this, but what do you expect from the AOA?

The director of our OPTI said a few times the big motivator in this merger was Medicare, the source of government funding for all US residencies. Whether this is so now the ACGME can better lobby Medicare for more funding or if this was pushed by Medicare regulators I do not know. I think we like to think that the students had a large role in this reversal (#unifiedGME) but I think at the end of the day it was these concerns that won over the board of directors.

 

[Dr. Zombie]

The director of our OPTI said a few times the big motivator in this merger was Medicare, the source of government funding for all US residencies. Whether this is so now the ACGME can better lobby Medicare for more funding or if this was pushed by Medicare regulators I do not know. I think we like to think that the students had a large role in this reversal (#unifiedGME) but I think at the end of the day it was these concerns that won over the board of directors.

All we are, are pawns and/or collateral damage in the bigger game of medical politics. The medical field is nothing but a busine$$ and the board members will make decisions based on the best way to make money move.

If it doesn't make cents, it doesn't make sense.

 

[magicdo]

This is a sad time for the osteopathic community. We are losing the osteopathic identity. We should all be proud to be DOs and for the osteopathic schools accepting us to allow us to become osteopathic physicians.

Now, DO residencies will be open to both MDs and DOs. No longer will DOs have their own ENT, ophthalmology, neurology, dermatology, ortho, urology ,etc residencies. These will all be allopathic and no DO will ever get in. I hope you all like primary care. Not that there is anything wrong with that but I think this effectively locks us out of specialties.

Trust me, there is nothing good about this decision.

 

[Law2Doc]

no one has discussed this yet- why the failed negotiations after the confidential MOU-- THEN this about-face?

There was no choice. The allo programs are on a growth pace to fill all allo residencies with their own grads in just a few years. It's either merge in or get boxed out. Everybody knew that when the osteo leadership bailed on negotiations they would have to come back soon. The sticking point had been opening up osteo residencies to allo, and they finally caved.

This will be great for osteo grads not going for competitive fields. A lot less DO stigma. Allo programs will feel like they can take DO grads without judgment from peer programs and perspective med students. But I think it will hurt the osteo grads who needed osteo only residencies to land a Derm, ortho, optho spot. The opportunity for research is simply better at a lot of the academic allo med schools, and as a result a lot if the applicants for the competitive fields have very lengthy CVs that many osteo grads couldn't compete with. It will be interesting to see how the playing field levels over time but I think the osteo only competitive spots were what got sacrificed for this deal to happen, which was much more of a Hostile takeover than a merger of equals.

 

[DrEnderW]

No longer will DOs have their own ENT, ophthalmology, neurology, dermatology, ortho, urology ,etc residencies. These will all be allopathic and no DO will ever get in. I hope you all like primary care. Not that there is anything wrong with that but I think this effectively locks us out of specialties.

There may be some truth to this, although I think its a huge exaggeration.

Why do you think the DO PDs for, lets say the 100ish DO ortho spots, will want to only take all MDs suddenly? This is as absurd as saying top MD programs will now be taking scores of DOs. Why would top MD students with research CVs want to train in a community hospital with no brand name and no research focus? Why would DO PDs at community surgery programs suddenly value this? Would audition rotations suddenly not be valued? Why would these DOs running the programs not take competitive DO applicants? Why would a DO (especially sub-specialty surgeons who have all previously been essentially barred from ACGME residencies and often times fellowships and battled DO bias with their profession) take an MD with a 220 USMLE that never rotated compared to a rockstar DO with a 245 USMLE that knows the program well?

Sure, some MD students may match in these programs. I don't see a huge problem with that. What I am excited to see is how many DOs match at ACGME programs they may have been competitive at but didn't apply to because it wasn't worth skipping the AOA route. Will this be at Columbia and MGH in the next few years? Absolutely not, but I do expect competitive DOs to land some spots they previously didn't take chances on. This is especially true if you have an equivalent CV. Personally, I think if you're a DO and don't have an equivalently high board score and the research skills and background to succeed in an academic residency you want to apply for, you have do business matching anyways.

 

[Dr. Zombie]

This is a sad time for the osteopathic community. We are losing the osteopathic identity. We should all be proud to be DOs and for the osteopathic schools accepting us to allow us to become osteopathic physicians.

Now, DO residencies will be open to both MDs and DOs. No longer will DOs have their own ENT, ophthalmology, neurology, dermatology, ortho, urology ,etc residencies. These will all be allopathic and no DO will ever get in. I hope you all like primary care. Not that there is anything wrong with that but I think this effectively locks us out of specialties.

Trust me, there is nothing good about this decision.

I would like for you to please explain how the osteopathic community is losing their identity starting with the merger? Last time I checked, 50% or greater amounts of DO graduates are going into ACGME programs and no one ever seemed to talk about a loss of "osteopathic identity" when this was occurring.

Second, if you feel a merger is a bad idea, then go ahead and tell AOA to double their residency spots and add fellowships to support ALLLLLLLLL osteopathic graduates so that no one has an excuse to go to the dreaded MD side.

------------

Folks, this is why the DO degree is the way that it is. People who share this mentality is too caught up on this special "distinction" and not wanting to make the hard, practical decisions to improve the DO caliber. DO residencies has less resources and inconsistent GME quality that hurts us. There is no reason why we should stick with the weaknesses out of the sake of "distinction". If ACGME is willing to help improve our medical education and training, there is NOTHING wrong with that.

If you so fear that MD's will take all former AOA-exclusive spots, then you clearly are saying DO graduates are super under-qualified to compete. If so, then don't complain when your peers see you as a second-class doctor---because you are contributing to this stigma. If you want to be seen like an equal, then make your application competitive and nothing should hold you back.

Lastly, former AOA spots will still look out for DO graduates if that makes you feel any better. MD students are still wanting to go to the higher-desirable locations which are less prevalent in the AOA world.

To be realistic, if more MD's participate in AOA spots, guess what happens? It increases the reputation of the programs and the more mixed residency positions become across the nation, the more blurry the MD vs DO line becomes in regards to discrimination.

 

[Dr. Zombie]

There may be some truth to this, although I think its a huge exaggeration.

Why do you think the DO PDs for, lets say the 100ish DO ortho spots, will want to only take all MDs suddenly? This is as absurd as saying top MD programs will now be taking scores of DOs. Why would top MD students with research CVs want to train in a community hospital with no brand name and no research focus? Why would DO PDs at community surgery programs suddenly value this? Would audition rotations suddenly not be valued? Why would these DOs running the programs not take competitive DO applicants? Why would a DO (especially sub-specialty surgeons who have all previously been essentially barred from ACGME residencies and often times fellowships and battled DO bias with their profession) take an MD with a 220 USMLE that never rotated compared to a rockstar DO with a 245 USMLE that knows the program well?

Sure, some MD students may match in these programs. I don't see a huge problem with that. What I am excited to see is how many DOs match at ACGME programs they may have been competitive at but didn't apply to because it wasn't worth skipping the AOA route. Will this be at Columbia and MGH in the next few years? Absolutely not, but I do expect competitive DOs to land some spots they previously didn't take chances on. This is especially true if you have an equivalent CV. Personally, I think if you're a DO and don't have an equivalently high board score and the research skills and background to succeed in an academic residency you want to apply for, you have do business matching anyways.

I like a classmate who can talk common sense.

 

[magicdo]

When you see fellow classmates who have very competitive CVs get passed over for a competitive residency slot, you will appreciate the fact that the osteopathic community had their own residencies and fellowships in some of the more competitive specialties.

 

[DrEnderW]

When you see fellow classmates who have very competitive CVs get passed over for a competitive residency slot, you will appreciate the fact that the osteopathic community had their own residencies and fellowships in some of the more competitive specialties.

I 100% agree that competitive DOs get passed on for often less competitive MDs at ACGME programs. There's data and a plethora of anecdotes on here to convince anyone of that. No argument there. I believe this will remain, for the most part, relatively unchanged in the short term. I expect it to happen to myself someday and am not viewing things with rose colored glasses.

I just don't think that the previously AOA programs with a DO history and DO PDs will start doing the same thing - taking less qualified MDs over qualified DOs.

 

[SnowDoggy44]

I wonder if the osteopathic "traditional rotating internships" (524 PGY-1 only positions this year) will become part of the ACGME "transitional internship" (937 PGY-1 only positions last year)? If so, that would be over a 55% increase from the ACGME perspective and seems like it might be over kill. If only they could turn some of those positions/programs into more categorical options.

In comparison, here is the relative growth of some of the other major categories from the ACGME perspective assuming they would all meet standards for accreditation:
Family Medicine - 29% growth
Emergency - 15.4%
Orthopedics - 15%
Gen Surg - 11.7%
Internal Medicine - 9.7%
Neurosurgery - 7.8%
Urology - 7.6%
ENT - 6.5%
OB/GYN - 6.2%
Psychiatry - 3.6%
Ophthalmology - 3.6%
Pediatrics - 2.6%
IM/EM combined - 59%

Anesthesiology - 2.8% (amongst PGY-1 grant programs), 1.8% overall
PM&R - 11.6% (amongst PGY-1 granting programs), 3% overall
Dermatology - 12.1% (amongst PGY-2 granting programs), 11% overall
Neurology - 5.8% (amongst PGY-1 granting programs), 3.0% overall
Diag Radiology - 20.7% (amongst PGY-1 granting programs), 2.9% overall
Pathology - 0%

 

[Dr. Zombie]

When you see fellow classmates who have very competitive CVs get passed over for a competitive residency slot, you will appreciate the fact that the osteopathic community had their own residencies and fellowships in some of the more competitive specialties.

I completely understand your concern. It's extremely valid, as my classmate has pointed out above me. But let's look at some things:

1. At least half of DO graduates decide to skip the AOA match and go into ACGME---successfully. That hasn't changed and will not change. In fact, DO students who planned to go ACGME regardless, will in fact, reap the benefits of MORE residency opportunities since more doors will be open to them, especially for fellowships.

2. Yes, this will mean that AOA ENT, Derm, etc. will be accessible to MD students. There is no question about it. But please understand that exclusive residencies will still favor DO students. It's not like AOA residencies will suddenly backstab us and decide to only add MD students. That's exaggeration.

3. Not every competitive MD student will want to go through the hoops of learning OMM for the sake of matching an obscure AOA Derm spot, when ACGME has a gazillion more desirable Derm spots that they are nicely competitive in.
I understand the fears, but it doesn't merit to blow this merge out of proportion. The best advice I can give you and everyone else who is scared, is to please work hard, prepare yourself well for the COMLEX and USMLE, apply broadly and do research. Whatever you can do to make you stand out, do it!!! Be proactive in your competitiveness.

If you only work for the minimum, you will get the minimum--if anything at all.

 

[GUH]

I 100% agree that competitive DOs get passed on for often less competitive MDs at ACGME programs. There's data and a plethora of anecdotes on here to convince anyone of that. No argument there. I believe this will remain, for the most part, relatively unchanged in the short term. I expect it to happen to myself someday and am not viewing things with rose colored glasses.

I just don't think that the previously AOA programs with a DO history and DO PDs will start doing the same thing - taking less qualified MDs over qualified DOs.

Even if current AOA programs in competitive fields accept MD's on an equal basis as DO's, and even assuming that the average DO student has the same access to resume-building research opportunities as the average MD student, current AOA programs may still be overwhelmingly MD by virtue of the fact that there are four times as many MD students as DO students, and MD students tend to gravitate towards specialties.

Also, there is no indication to my knowledge that AOA programs outside of OMM will require MD applicants to first receive OMM training.

 

[Dr. Zombie]

Also, there is no indication to my knowledge that AOA programs outside of OMM will require MD applicants to first receive OMM training.

Will MDs and IMGs be allowed to train in osteopathically-focused training programs?
DO and MD graduates would have access to ACGME accredited training programs including those with an osteopathic principles dimension. Prerequisite competencies (recommended by the new Osteopathic Principles Review Committee) and a recommended program of training for MD graduates may be required for entry into programs that have an osteopathic principles dimension. The same would apply for IMGs.

 

[hallowmann]

This is a sad time for the osteopathic community. We are losing the osteopathic identity. We should all be proud to be DOs and for the osteopathic schools accepting us to allow us to become osteopathic physicians.

Now, DO residencies will be open to both MDs and DOs. No longer will DOs have their own ENT, ophthalmology, neurology, dermatology, ortho, urology ,etc residencies. These will all be allopathic and no DO will ever get in. I hope you all like primary care. Not that there is anything wrong with that but I think this effectively locks us out of specialties.

Trust me, there is nothing good about this decision.

I find it hilarious that people see this as a loss of DO identity. By requiring MDs to not fulfill OMM requirements, but also have the ACGME accredit OMM/NMM programs, if anything it brings validity to an area that many people have questiones. Even more important than that, it spreads the teaching of osteopathic medicine not only to DO students, but MD students as well in order to benefit the patient. This is a success for osteopathic medicine, period.

On top of that, its ridiculous seeing all these posts scared acting like suddenly DOs will never be able to land competitive specialties, because now MDs can get in. What's with this inferiority complex? I don't know about you, but in my school there are tons of geniuses in the upper 10-15% of the class. I know this in comparison to people I know in a top 20 MD school. They are committed to working hard and their ability to absorb info is quite frankly amazing.

Now some people seemed to think that any DO could apply AOA ortho, derm, ophtho, etc. and be guaranteed a spot, but the truth is that some of those people are at the top, and they could quite frankly compete with MDs vying for the same spots. They for one won't be competing with the top MDs, who will be getting the same ACGME spots they would have gotten before (why would such people even apply AOA). They'll be competing with the MDs at the lower border of those residencies. On top of that, its ridiculous to think that more than a handful of those formerly AOA spots will be straight lost to MDs for at least a decade or so after the merger. It takes a hell of a long time for people to change their minds and change how they've done things. This is no different, there will be pro-DO bias.

It really makes me ashamed when I hear DOs crying, oh all the MDs are going to steal our spots now. Well work harder then, prove that you are just as capable and successful as MDs, something we've been claiming for years. Come on now. It really is ridiculous. Work hard, be at the top of your class, and prove that you can compete (and we can).

 

[Elevencents]

Will MDs and IMGs be allowed to train in osteopathically-focused training programs?
DO and MD graduates would have access to ACGME accredited training programs including those with an osteopathic principles dimension. Prerequisite competencies (recommended by the new Osteopathic Principles Review Committee) and a recommended program of training for MD graduates may be required for entry into programs that have an osteopathic principles dimension. The same would apply for IMGs.

Osteopathic principle dimension I.e. not very likely to be needed in surgery subspecialties and other competitive specialties.

It's not like we're gonna see a huge influx of MD's applying to FM AOA residencies.

 

[GUH]

Will MDs and IMGs be allowed to train in osteopathically-focused training programs?
DO and MD graduates would have access to ACGME accredited training programs including those with an osteopathic principles dimension. Prerequisite competencies (recommended by the new Osteopathic Principles Review Committee) and a recommended program of training for MD graduates may be required for entry into programs that have an osteopathic principles dimension. The same would apply for IMGs.

1) There is no definition of a program "with an osteopathic principles dimension" so this could exclude specialty residencies such as surgery
2) The word "may"
3) There is no indication as to the length and intensity of the training - a weekend seminar doesn't erect much of a barrier (or provide sufficient knowledge to use OMM appropriately)

 

[GUH]

I find it hilarious that people see this as a loss of DO identity. By requiring MDs to not fulfill OMM requirements, but also have the ACGME accredit OMM/NMM programs, if anything it brings validity to an area that many people have questiones. Even more important than that, it spreads the teaching of osteopathic medicine not only to DO students, but MD students as well in order to benefit the patient. This is a success for osteopathic medicine, period.

On top of that, its ridiculous seeing all these posts scared acting like suddenly DOs will never be able to land competitive specialties, because now MDs can get in. What's with this inferiority complex? I don't know about you, but in my school there are tons of geniuses in the upper 10-15% of the class. I know this in comparison to people I know in a top 20 MD school. They are committed to working hard and their ability to absorb info is quite frankly amazing.

Now some people seemed to think that any DO could apply AOA ortho, derm, ophtho, etc. and be guaranteed a spot, but the truth is that some of those people are at the top, and they could quite frankly compete with MDs vying for the same spots. They for one won't be competing with the top MDs, who will be getting the same ACGME spots they would have gotten before (why would such people even apply AOA). They'll be competing with the MDs at the lower border of those residencies. On top of that, its ridiculous to think that more than a handful of those formerly AOA spots will be straight lost to MDs for at least a decade or so after the merger. It takes a hell of a long time for people to change their minds and change how they've done things. This is no different, there will be pro-DO bias.

It really makes me ashamed when I hear DOs crying, oh all the MDs are going to steal our spots now. Well work harder then, prove that you are just as capable and successful as MDs, something we've been claiming for years. Come on now. It really is ridiculous. Work hard, be at the top of your class, and prove that you can compete (and we can).

Work as hard as you want - if you're a DO applying to a program that bans DO's, you're not getting in. This is not about whether we're equally capable-it's about at least some DO's having the opportunity to pursue any specialty.

 

[hallowmann]

Work as hard as you want - if you're a DO applying to a program that bans DO's, you're not getting in. This is not about whether we're equally capable-it's about at least some DO's having the opportunity to pursue any specialty.

Was I even talking about strictly ACGME programs that ban DOs? I believe I was talking about losing formerly AOA spots to MDs. Call me optimistic, but I doubt residencies that are filled with DO attendings and residents will suddenly bar DOs the second they get pre-accreditation status from the ACGME.

 

[Dr. Zombie]

Was I even talking about strictly ACGME programs that ban DOs? I believe I was talking about losing formerly AOA spots to MDs. Call me optimistic, but I doubt residencies that are filled with DO attendings and residents will suddenly bar DOs the second they get pre-accreditation status from the ACGME.

The negative nancy's don't realize that those DO students who make it into AOA Derm, ENT, etc. more than likely can be competitive in ACGME Derm and ENT and the only thing holding them back is the DO bias.

What? You all think that DO Derms applicants are just regular joe's?? Even if MD's attempt to apply to AOA Derm, the DO applicants will hold their own against MD applicants.

I don't see what makes DO applications instantly subpar when applying to ROAD AOA spots. Plenty of us have stellar connections and stellar numbers and stellar research. It's extremely ignorant to keep thinking that "Oh once this AOA spot gets ACGME accreditation, they will pass on DO applicants even if they are stronger than the MD applicant in the next folder." --- Get this chip off your shoulder and stop promoting this inferiority complex.

Like @hallowmann says, the DO attendings are not going to ban DO's. It's silly to think that suddenly only MD's will be sub-specializing or Derm-ing it up across the board.

 

[GUH]

Was I even talking about strictly ACGME programs that ban DOs? I believe I was talking about losing formerly AOA spots to MDs. Call me optimistic, but I doubt residencies that are filled with DO attendings and residents will suddenly bar DOs the second they get pre-accreditation status from the ACGME.

1) DO residency programs in competitive specialties will accept some MD students by mere virtue of the fact that many highly-qualified MD's will apply, and that there are four times as many MD's as DO's. This has nothing to do with the quality of DO applicants.
2) ACGME programs which ban DO's will continue to do so (there is no evidence to the contrary)
3) This will result in less spots in these specialties for DO's.

I'm not sure why this is so difficult to understand.

 

[Dr. Zombie]

1) DO residency programs in competitive specialties will accept some MD students by mere virtue of the fact that many highly-qualified MD's will apply, and that there are four times as many MD's as DO's. This has nothing to do with the quality of DO applicants.
2) ACGME programs which ban DO's will continue to do so (there is no evidence to the contrary)
3) This will result in less spots in these specialties for DO's.

I'm not sure why this is so difficult to understand.

Simply because there are 4 times as many MD's as DO's is not enough reason to assume that MD's will occupy virtually all spots in the competitive specialties in AOA programs. You are assuming that DO program directors will disregard osteopathic applicants for the simply reason that they are "overwhelmed" with 4 piles of MD applicants. If there is anti-DO bias on ACGME side, there is going to be pro-DO bias on the AOA side by DO attendings. (There is no evidence to support your glass half-empty opinion).

Did you know why DOs are usually discriminated against in some sub-specialties? Because an ACGME residency is preferred. An AOA residency would be seen as subpar training by those hard-to-please PD's.

Let's say in 2025, what do you think will happen to all top osteopathic residents who will be ACGME-accredited in general surgery apply to surgery sub-specialties? Will they get thrown to the shredder because the D.O. attending has 4 times more MD's to choose from?

- You do realize that these D.O. attendings are not oblivious to the discrimination that exists in the MD side? I'm sure more than half experienced discrimination at some point. Why would they turn their backs on their professional family simply because they just got extra applications.

Aside from the whole 4 : 1 ratio, do you have other factors that you'd like to add in support of your argument?

 

[GUH]

Simply because there are 4 times as many MD's as DO's is not enough reason to assume that MD's will occupy virtually all spots in the competitive specialties in AOA programs. You are assuming that DO program directors will disregard osteopathic applicants for the simply reason that they are "overwhelmed" with 4 piles of MD applicants. If there is anti-DO bias on ACGME side, there is going to be pro-DO bias on the AOA side by DO attendings. (There is no evidence to support your glass half-empty opinion).

I never said "virtually all" spots. But it would be unrealistic to assume that none of the spots would be taken by MD's, or that MD PD's who currently ban DO's will suddenly stop. The net effect will likely be less DO's in these programs.

Do you know why DOs applicants are usually discriminated against in these fancy specialties? Because most of them require a transitional/preliminary year which if you went through AOA, would be seen as subpar training by those PD's. Do you know why DOs are usually discriminated against in these fancy sub-specialties? Because an ACGME residency is preferred. An AOA residency would be seen as subpar training by those hard-to-please PD's...

That's a good point, and one that I haven't heard before. I guess time will tell whether this is the case.

Let's make a hypothetical: Assume that you have an AOA program that accepts 10 new residents per year.
Let's say that in 2013, you have twenty applicants with the following USMLE scores (or the COMLEX equivalent):
5 applicants with a 250+
5 applicants with a 240-249
5 applicants with a 220-240
5 applicants below 220

They will rank ten DO applicants.

Now after the merger, you have the same number of DO's applying, plus a proportional number of MD's with identical qualifications:
5 DO and 20 MD applicants with 250+
5 DO and 20 MD applicants with 240-249
5 DO and 20 MD applicants with a 220-240
5 DO and 20 MD applicants with below a 220

Now they will accept, at most, only 5 DO applicants if they treat all applicants equally. And even in this case, they are favoring the DO's since they are accepting all 5 with 250+ scores. This means that 5 DO students who would have otherwise matched into the program and are fully qualified to do so will not match into the program this year. Even if you take into account that most MD's will not apply to what are currently AOA programs by reducing the number of MD's by 3/4's in this scenario, you get the same results.

This is just an example but it illustrates what I'm trying to say.

 

[Dr. Zombie]

I never said "virtually all" spots. But it would be unrealistic to assume that none of the spots would be taken by MD's, or that MD PD's who currently ban DO's will suddenly stop. The net effect will likely be less DO's in these programs.

That's a good point, and one that I haven't heard before. I guess time will tell whether this is the case.

Let's make a hypothetical: Assume that you have an AOA program that accepts 10 new residents per year.
Let's say that in 2013, you have twenty applicants with the following USMLE scores (or the COMLEX equivalent):
5 applicants with a 250+
5 applicants with a 240-249
5 applicants with a 220-240
5 applicants below 220

They will rank ten DO applicants.

Now after the merger, you have the same number of DO's applying, plus a proportional number of MD's with identical qualifications:
5 DO and 20 MD applicants with 250+
5 DO and 20 MD applicants with 240-249
5 DO and 20 MD applicants with a 220-240
5 DO and 20 MD applicants with below a 220

Now they will accept, at most, only 5 DO applicants if they treat all applicants equally. And even in this case, they are favoring the DO's since they are accepting all 5 with 250+ scores. This means that 5 DO students who would have otherwise matched into the program and are fully qualified to do so will not match into the program this year. Even if you take into account that most MD's will not apply to what are currently AOA programs by reducing the number of MD's by 3/4's in this scenario, you get the same results.

This is just an example but it illustrates what I'm trying to say.

Yep. I've heard from a few PD's who have said they don't have issues with DOs, but rather with the inconsistent quality of the residencies from where they come from, that they feel more comfortable accepting an MD from an ACGME program that's more regulated and familiar with.

Now, I like your example. It's a good one, even though, this is only taking into consideration this particular AOA program. We must consider other possible factors for these DO students who scored 240-249 and went unmatched (because let's face it, a 240 is a freakin 240):

a. These students were able to apply and match into another AOA residency.

b. These students were able to apply and match into a fresh, new ACGME residency/fellowship that was recently closed off prior to the merger (because there's no denying that there WILL be programs willing to open up their doors to us in light of universal ACGME-accreditation).

c. These students go unmatched and end up in a Transitional/Preliminary ACGME-accredited internship, which gives them a nice shot at a PGY-2 spot provided they continue to excel in their internship.

*Your example is taking into consideration ONLY board score. There are multiple factors that can sway the ratio one way or the other:
- Quality of research, if any.
- Quality of residency, if applying to fellowship.
- Clinical rotation grades
- LORs
- Class rank, maybe
- AOA, SSP qualification
- The list goes on and on.

Thus, you can see why I'm not so worried about the merger. We all busted our a$$es to get into medical school. We need to bust our a$$ to get into a good residency. If we apply broadly enough with a good application, I don't think we will go unmatched.

 

[Dr. Zombie]

I also wanted to add that unfortunately, DO schools are very lenient with who they accept. It's the truth. But the world is not getting easier and accepting lower-qualified applicants is doing a disservice to the applicants themselves when it comes to Match Day. Do you know how many applicants have dared applied to competitive/semi-competitive specialties after putting the most minimal effort during medical school, or simply outright struggled?

MCAT is getting harder.
USMLE minimum passing score used to be 188 and they moved it up to 192 now.
Specialties like EM is getting more competitive too.

Everything is simply getting more competitive. We just need to study harder during pre-clinicals, work on that class rank, do research whenever possible, make connections with program directors, be proactive in clinical rotations, get strong letters of recommendations, and apply to residencies broadly. Then when your jaw drops in March when you actually matched, you can log on to SDN and prove to these people that 95% of SDNers were malignant and giving you insecurities instead of encouragement.

SDN people will make you insecure about the MCAT, when you see 90% of people with fake 35's and telling you that your 28 or 30 will need a retake. (We all can agree on this, yes?)

SDN people will make you insecure during admission cycles telling you that SchmoCOM is only taking 3.6+ with a 30+ this year and that if you are below these stats you probably will get rejected or waitlisted---and if you do get accepted they will counter-attack by telling you that you are either URM or simply a n=1 (we all remember that time huh)

SDN people will make you insecure about residency matching too by telling you this merger will bring about the apocalypse for DO applicants and how we will slowly be knocked out of AOA spots while ACGME will refuse to open more doors for us. (mmhmm....)

 

[Law2Doc]

Will MDs and IMGs be allowed to train in osteopathically-focused training programs?
DO and MD graduates would have access to ACGME accredited training programs including those with an osteopathic principles dimension. Prerequisite competencies (recommended by the new Osteopathic Principles Review Committee) and a recommended program of training for MD graduates may be required for entry into programs that have an osteopathic principles dimension. The same would apply for IMGs.

Translation -- if you want to do an osteo residency, you will take an OMM class the summer before residency the same way people take ACLS now.

 

[Law2Doc]

The negative nancy's don't realize that those DO students who make it into AOA Derm, ENT, etc. more than likely can be competitive in ACGME Derm and ENT and the only thing holding them back is the DO bias.

What? You all think that DO Derms applicants are just regular joe's?? Even if MD's attempt to apply to AOA Derm, the DO applicants will hold their own against MD applicants.

I don't see what makes DO applications instantly subpar when applying to ROAD AOA spots. Plenty of us have stellar connections and stellar numbers and stellar research. It's extremely ignorant to keep thinking that "Oh once this AOA spot gets ACGME accreditation, they will pass on DO applicants even if they are stronger than the MD applicant in the next folder." --- Get this chip off your shoulder and stop promoting this inferiority complex.

Like @hallowmann says, the DO attendings are not going to ban DO's. It's silly to think that suddenly only MD's will be sub-specializing or Derm-ing it up across the board.

I think you might be drastically underestimating what the typical allo derm, optho, ENT, ortho applicant CV looks like. very few osteo programs offer the opportunity to do research at the level many allo program do. Lots of applicants for these fields are coming out of med school with a half dozen specialty targeted peer reviewed first or second author publications to go with their stupidly high board scores and many have worked with the big names in the field (most are at allo academic programs). Without protected osteo only programs at least some competitive osteo derm- wannabes will drop off the list, not because they are worse students, but because they didn't have access to the same kinds of resources residencies covet. Objectively the borderline ivy derm applicant is going to often look better on paper (more research, LORs from bigger people) than the osteo grad who sneaked into the osteo only residency because they wouldn't have been considered by allo. I'm not saying those folks are "regular Joes" but I am saying you are underestimating the competition in these fields if you think the DO label was the only hurdle. I think this might be the big eye opener of this deal.

That being said, I think this merger us going to be a huge benefit to the majority of osteo grads who aren't pining for the competitive specialties, as the playing field will be much more level and biases largely will wane. Together the US med schools will box out the foreign grads in a Few short years, as US med schools fill US health care needs.

 

[NontradCA]

I think you might be drastically underestimating what the typical allo derm, optho, ENT, ortho applicant CV looks like. very few osteo programs offer the opportunity to do research at the level many allo program do. Lots of applicants for these fields are coming out of med school with a half dozen specialty targeted peer reviewed first or second author publications to go with their stupidly high board scores and many have worked with the big names in the field (most are at allo academic programs). Without protected osteo only programs at least some competitive osteo derm- wannabes will drop off the list, not because they are worse students, but because they didn't have access to the same kinds of resources residencies covet. Objectively the borderline ivy derm applicant is going to often look better on paper (more research, LORs from bigger people) than the osteo grad who sneaked into the osteo only residency because they wouldn't have been considered by allo. I'm not saying those folks are "regular Joes" but I am saying you are underestimating the competition in these fields if you think the DO label was the only hurdle. I think this might be the big eye opener of this deal.

That being said, I think this merger us going to be a huge benefit to the majority of osteo grads who aren't pining for the competitive specialties, as the playing field will be much more level and biases largely will wane. Together the US med schools will box out the foreign grads in a Few short years, as US med schools fill US health care needs.

But isn't research limited at AOA residency programs as well? This is notorious at the surgery programs. Do you think this will change with the merger? If not, why would PDs care about research?

 

[Law2Doc]

But isn't research limited at AOA residency programs as well? This is notorious at the surgery programs. Do you think this will change with the merger? If not, why would PDs care about research?

You miss my point. The AOA programs up to now only could choose from amongst osteo grads, so research wasn't focused on because so few had it. Once the doors open, that ceases to be true. Suddenly it becomes clear that for the competitive fields, there are actually a lot of allo grads with much lengthier CVs. Some on here are underestimating what is presently involved in the allo world to get some of these competitive paths. This should present a problem for those osteo grads who otherwise would have had the inside track for competitive osteo residencies. But the majority of osteo grads weren't going into these so the merger I probably. Benefit for the majority. Just don't kid yourself that there aren't going to be sacrifices on the osteo side, and I think the few people each year currently landing derm, ENT, ortho, optho in AOA residencies are the sacrificial lambs that allowed this deal to happen.

 

[NontradCA]

You miss my point. The AOA programs up to now only could choose from amongst osteo grads, so research wasn't focused on because so few had it. Once the doors open, that ceases to be true. Suddenly it becomes clear that for the competitive fields, there are actually a lot of allo grads with much lengthier CVs. Some on here are underestimating what is presently involved in the allo world to get some of these competitive paths. This should present a problem for those osteo grads who otherwise would have had the inside track for competitive osteo residencies. But the majority of osteo grads weren't going into these so the merger I probably. Benefit for the majority. Just don't kid yourself that there aren't going to be sacrifices on the osteo side, and I think the few people each year currently landing derm, ENT, ortho, optho in AOA residencies are the sacrificial lambs that allowed this deal to happen.

I think you missed my point. I'm not arguing just asking you a question. The residencies themselves don't do research, and I think that's why they put less emphasis on it. Do you think this will change? I wanna say that the average osteo grad who is applying to these programs have something like 3-4 pubs.

Also now that they can be ranked at both sets of residencies, won't that open up more options?

 

[Law2Doc]

I think you missed my point. I'm not arguing just asking you a question. The residencies themselves don't do research, and I think that's why they put less emphasis on it. Do you think this will change? ...

Also now that they can be ranked at both sets of residencies, won't that open up more options?

Yes, that will change. Nobody wants to be the bottom of the barrel, and so programs will change their approaches when they get put in the same barrel. And to some extent you emphasize that which you can get, so research becomes more important when a bigger chunk if your applicants have some.

Yes more access to residencies opens more options in theory, but if you needed the benefit of an osteo only residency to limit competition and get a slot, you are hosed. So I'd bet (and the allo leadership is betting on this too or they wouldn't have made it a sticking point in the deal)there will be a net loss of competitive slots to osteo grads. But probably more noncompetitive allo slots that otherwise might have gone to foreign grads. This was understandably a tough issue for osteo leadership to stomach, and part of the reason they had to initially leave the negotiating table and ultimately cave on this issue.

 

[Dharma]

This is a sad time for the osteopathic community. We are losing the osteopathic identity. We should all be proud to be DOs and for the osteopathic schools accepting us to allow us to become osteopathic physicians.

Now, DO residencies will be open to both MDs and DOs. No longer will DOs have their own ENT, ophthalmology, neurology, dermatology, ortho, urology ,etc residencies. These will all be allopathic and no DO will ever get in. I hope you all like primary care. Not that there is anything wrong with that but I think this effectively locks us out of specialties.

Trust me, there is nothing good about this decision.

I think this is a bit over the top. "No DO will ever get in."??? I see a good number of absolutes in your statement. Nevers and always rarely ring with truth.

Here's my take (although quite speculative and just a thought): 30 years from now, medical schools will all offer MD degrees and the DO will be available for those who wish to pursue as an add-on. All of this distinction and identity hogwash is superficial. Those are attributes that should come from an individual, not some title or other exogenous source that makes one somehow feel unique.

 

[DrEnderW]

I think you might be drastically underestimating what the typical allo derm, optho, ENT, ortho applicant CV looks like. very few osteo programs offer the opportunity to do research at the level many allo program do. Lots of applicants for these fields are coming out of med school with a half dozen specialty targeted peer reviewed first or second author publications to go with their stupidly high board scores and many have worked with the big names in the field (most are at allo academic programs). Without protected osteo only programs at least some competitive osteo derm- wannabes will drop off the list, not because they are worse students, but because they didn't have access to the same kinds of resources residencies covet. Objectively the borderline ivy derm applicant is going to often look better on paper (more research, LORs from bigger people) than the osteo grad who sneaked into the osteo only residency because they wouldn't have been considered by allo. I'm not saying those folks are "regular Joes" but I am saying you are underestimating the competition in these fields if you think the DO label was the only hurdle. I think this might be the big eye opener of this deal.

That being said, I think this merger us going to be a huge benefit to the majority of osteo grads who aren't pining for the competitive specialties, as the playing field will be much more level and biases largely will wane. Together the US med schools will box out the foreign grads in a Few short years, as US med schools fill US health care needs.

I understand your point about how there are many more MD grads with more complete CVs. I completely agree that the average DO student vastly underestimates what a top MD applicant looks like. I'm doing surg-subspecialty research at a top MD program for that specialty and have done research at other top institutions in other fields -- there is absolutely no doubt those med students, residents, and fellows have better school names and quality and quantity of pubs compared to the overwhelmingly vast majority of DO students. No underestimation here.

However, no one is speaking to my point as to why an academic CV will start to matter to DO PDs at previously AOA programs. There is no research infrastructure at these community hospitals, most of the faculty and attendings do not have extensive research experience, and they have been selecting applicants without heavily weighting research for years. It's exactly the same reason community peds programs don't highly weight research... there isn't a lot of research being done there. I completely understand if you're applying for a 7 year GS program or a NS program with built in research years -- you legitimately will benefit yourself and the program by having a research background and a proven record of publication quality work.

I respect your opinions and insight you share on here and am wondering why you think these programs will instantly shift their focus to weighing academic/research CVs more heavily when the faculty and hospital don't participate in significant research? I can understanding having USMLE scores that are on equal standings as to not be viewed as a weak program.

On a related note, I think it would be great if the DO profession augmented it's research standards. Maybe this will indirectly contribute to this - who knows.

 

[KGflyboy]

Reason 1 I do not think MDs will take many spots at AOA specialty programs as some suggest:

I think the research discussion is interesting. I am refraining from making a lot of assumptions about how the merger will go, but I am fairly confident current AOA residencies will NOT start doing more research after the merger like a lot of ACGME programs. Residency accreditation has nothing, repeat NOTHING to do with the missions and goals of community hospitals and private practices that oversee AOA residencies. Suburbian Community Hospital XYZ has very little interest in become an academic or research focused hospital no or ever.

There is no reason to think PDs at SCH will suddenly recruit or rank MD applicants with publications more favorably than DO applicants. AOA ortho, derm, etc. are often at private practices that have zero research ambition. I'm pretty sure PDs will continue to prefer DO applicants. The example for GUH above is ok, but the numbers are off. AOA derm, ortho, etc. do not take 10 students per year. They take 1 or 2 or maybe 5, depending on the specialty. If a program has 3 spots, I am confident it will take 3 DO applicants and call it a day most of the time. Thos 3 will be extraordinarily qualified as is the case now. Those PDs will not be in a position where they have to choose between a less qualified DO and MD applicants with 472 1st author publications. They will not run out of top quality DO candidates first. Research will continue to be a minor factor for those PDs.

Reason 2 I do not think MDs will take many spots at AOA specialty programs as some suggest:

Perhaps the most likely reason MDs will not make an impact on DO specialty residencies is that you can't even get interviews with most of these places without an audition rotation. I doubt many MD students attempt to rotate at SCH. An MD student interested in ortho is going to rotate at the "best" places possible in order to not lower his or her chances of matching at an MD ACGME program. Also, who says Private Practice Orthopedics at SCH will even take MD students for rotations. It will either officially deny MDs the opportunity to rotate or it will only take a limited amount, just as many academic centers currently deny DO students the opportunity to rotate or only offer DOs a few spots in many instances.

It's just a prediction, so I know things could change a lot over the next few years. I am humble enough to realize my opinion is no better or correct than anyone else's.

 

[nmakhija]

Obviously I know no one knows for sure but I was just wondering what your guys thoughts are on how this would effect the class of 2017.
Im an M1 now and I assume we will be done applying for residency by the end of 2016. The way I interpreted it, it seems unlikely that many of the AOA residencies will be accepting MDs if this is the first year they could possibly be accredited to participate in the ACGME match. I realize i might not fully understand the agreement and details so I was just wondering what opinions you had on this. Thanks, I appreciate your input!

 

[HarryPlopper]

You miss my point. The AOA programs up to now only could choose from amongst osteo grads, so research wasn't focused on because so few had it. Once the doors open, that ceases to be true. Suddenly it becomes clear that for the competitive fields, there are actually a lot of allo grads with much lengthier CVs. Some on here are underestimating what is presently involved in the allo world to get some of these competitive paths. This should present a problem for those osteo grads who otherwise would have had the inside track for competitive osteo residencies. But the majority of osteo grads weren't going into these so the merger I probably. Benefit for the majority. Just don't kid yourself that there aren't going to be sacrifices on the osteo side, and I think the few people each year currently landing derm, ENT, ortho, optho in AOA residencies are the sacrificial lambs that allowed this deal to happen.

Of course there will be some sacrifice on the DO side, but I do think the shift on the importance of research and other allopathic parameter sets to gauge students for a DO program is going to be slow or at least not instantaneous. It wouldn't make sense for a residency to suddenly switch from not weighing research heavily to weighing research very significantly. Now as time changes and the residency changes its infrastructure on focusing on research and becoming more like allopathic residencies, this parameter will definitely change.

Any residency that makes this sudden switch will be heavily criticized by the DO community. The osteopathic community's opinion may not weigh as much as the allopathic's but it is still present.

 

[Law2Doc]

Of course there will be some sacrifice on the DO side, but I do think the shift on the importance of research and other allopathic parameter sets to gauge students for a DO program is going to be slow or at least not instantaneous. It wouldn't make sense for a residency to suddenly switch from not weighing research heavily to weighing research very significantly. Now as time changes and the residency changes its infrastructure on focusing on research and becoming more like allopathic residencies, this parameter will definitely change.

Any residency that makes this sudden switch will be heavily criticized by the DO community. The osteopathic community's opinion may not weigh as much as the allopathic's but it is still present.

Switches won't be instantaneous, but if in the match a program used to DO applicants suddenly getS applications that are almost overwhelming with the number if publications, LORs from big name people, and absurdly high board scores, that are tHe norm in some specialties, it will be hard to just shrug and say -- we never cared about any of this before so why start now. Plus their peers will be grabbing up superstars to try and one up them, so they will need to too, or become the low end DO residency program.

Not to mention that the ACGME and AOA are both going to be a bit watchful for PDs who ignore all objectively better candidates in favor of the DO degree -- those guys whose biaseS show through will be out of a job before the deal gets blown up. The opening of DO residencies as a contingent wasn't just a throw in -- this was a material part of the deal and without this really happening, the deal will be undone. This was the big concession the AOA had to give up, so anyone who thinks they will have their cake and eat it too doesn't realize who really won this deal yet.

 

[HarryPlopper]

Switches won't be instantaneous, but if in the match a program used to DO applicants suddenly getS applications that are almost overwhelming with the number if publications, LORs from big name people, and absurdly high board scores, that are tHe norm in some specialties, it will be hard to just shrug and say -- we never cared about any of this before so why start now. Plus their peers will be grabbing up superstars to try and one up them, so they will need to too, or become the low end DO residency program.

Not to mention that the ACGME and AOA are both going to be a bit watchful for PDs who ignore all objectively better candidates in favor of the DO degree -- those guys whose biaseS show through will be out of a job before the deal gets blown up. The opening of DO residencies as a contingent wasn't just a throw in -- this was a material part of the deal and without this really happening, the deal will be undone. This was the big concession the AOA had to give up, so anyone who thinks they will have their cake and eat it too doesn't realize who really won this deal yet.

If the discrepancy is that huge then I agree that residencies will have to resort to such a move. I am still skeptical that this will be the case but I see your point.

PDs that have bias against MDs will be noted but the same can still be said for PDs that totally ignore the DO applicants. I do understand that those programs have made it a custom to ignore DOs and the world has come to accept it. However their excuse of "that DO didn't meet our requirements" doesn't hold as much water when other residencies have been accepting DOs of equivalent stats. What makes it different from before is that there are now expectations that ACGME programs drop some of their DO bias.

 

[Law2Doc]

If the discrepancy is that huge then I agree that residencies will have to resort to such a move. I am still skeptical that this will be the case but I see your point.

PDs that have bias against MDs will be noted but the same can still be said for PDs that totally ignore the DO applicants. I do understand that those programs have made it a custom to ignore DOs and the world has come to accept it. However their excuse of "that DO didn't meet our requirements" doesn't hold as much water when other residencies have been accepting DOs of equivalent stats. What makes it different from before is that there are now expectations that ACGME programs drop some of their DO bias.

It will be interesting to see how it pans out. My bet I that research on CVs becomes even more important for both allo and Osteo competitive programs -- for osteo because they now see credentials they weren't seeing before and want to play with the big dogs, and allo because unfortunately it's an easy non-discriminatory way to keep favoring the allo applicants who have better access to research. This may push osteo schools to get more involved in research over time because students will demand it.

But for the noncompetitive fields it should be beneficial for everyone -- more places to potentially match and fewer biases in training. And most osteo students weren't gunning for osteo competitive residencies anyhow, so if that couple of percent gets hosed on a deal that benefits the 90% of osteo grads not going into uber competitive fields, it's probably still a Good deal.

 

[Dharma]

he opening of DO residencies as a contingent wasn't just a throw in -- this was a material part of the deal and without this really happening, the deal will be undone. This was the big concession the AOA had to give up, so anyone who thinks they will have their cake and eat it too doesn't realize who really won this deal yet.

“Those skilled at making the enemy move do so by creating a situation to which he must conform; they entice him with something he is certain to take, and with lures of ostensible profit they await him in strength.”

“Anger may in time change to gladness; vexation may be succeeded by content.
But a kingdom that has once been destroyed can never come again into being; nor can the dead ever be brought back to life.”
-Sun Tzu, The Art of War

Not completely relevant, but I love quoting this dude! Carry on...

 

[Law2Doc]

“Those skilled at making the enemy move do so by creating a situation to which he must conform; they entice him with something he is certain to take, and with lures of ostensible profit they await him in strength.”

“Anger may in time change to gladness; vexation may be succeeded by content.
But a kingdom that has once been destroyed can never come again into being; nor can the dead ever be brought back to life.”
-Sun Tzu, The Art of War

Not completely relevant, but I love quoting this dude! Carry on...

I think there was a lot of this going on in this deal. Osteo really had no choice, and allo took full advantage. Losers of the deal are osteo leadership and those who would have coasted into osteo only residencies with less competition. Winners were everyone else. Mega losers -- anyone training outside of the US who hopes to land a residency here in a few years.

 

[KGflyboy]

Obviously I know no one knows for sure but I was just wondering what your guys thoughts are on how this would effect the class of 2017.
Im an M1 now and I assume we will be done applying for residency by the end of 2016. The way I interpreted it, it seems unlikely that many of the AOA residencies will be accepting MDs if this is the first year they could possibly be accredited to participate in the ACGME match. I realize i might not fully understand the agreement and details so I was just wondering what opinions you had on this. Thanks, I appreciate your input!

I think they MDs will be eligible for the old AOA residencies as soon as they are granted ACGME accreditation in 2015. Unless the plan gets delayed, your class will not be the first with MD applicants eligible for osteopathic residencies. However, like you said, we can only guess about how many programs take MDs from the start. I too am curious.

 

[wjs010]

I think they MDs will be eligible for the old AOA residencies as soon as they are granted ACGME accreditation in 2015. Unless the plan gets delayed, your class will not be the first with MD applicants eligible for osteopathic residencies. However, like you said, we can only guess about how many programs take MDs from the start. I too am curious.

I've also seen people say the exact opposite, like the majority of programs won't make it on time, and they will be slow to convert. I'm wondering if anyone actually knows lol.