Would it be feasible or legal to limit DO's from all ACGME residencies?

[Oo Cipher oO]

I know I'm adding to the neurotic threads that have been very common on this forum recently but a point was brought up in another thread that I feel warrants its own discussion. To be clear there are no current policies or plans to limit DOs from apply to ACGME residencies any more then is currently the case. This is not the same as the failed residency merger or the limitations to AOA trained DOs to enter ACGME PGY-2 positions or ACGME fellowships.

I want to discuss if it would be feasible or even legal to limit DO participation in ACGME residencies of any sort. The point that was raised was that as residencies become less available then they may be a push to allow MD students to match first and then allow DO students to pick up the rest.

Could this ever happen? I don't know. Legally, I can see problems with tax-subsidized residencies discriminating solely based on degree designation. Obviously PD have to use discretion in the form of board scores, grades, LOR, etc, but if the candidate is otherwise qualified for the position I don't think it would be legal to deny them a residency spot because they are a DO student. DO students meet the curriculum requirements of MD schools.

Some people may point out that DO's discriminate completely in their AOA residencies and that is true; MD graduates can not apply. But I believe the AOA would say that MD student do not qualify because of a lack of education in OMT treatments. In this way MD students do not meet the curriculum requirements of DO schools. Both ACGME and AOA residencies are supported by federal and state money so this becomes a tricky issue. Perhaps if an MD applicant also had certified OMT training there would be no legal basis for the AOA to discriminate against them as well.

I think a unified policy of all ACGME residencies to limit DO applicants would probably never happen. We already know that there currently are certain residencies with PDs that don't look at DOs at all but this is still program and specialty dependent. DOs have been matching into ACGME residencies for decades. I seriously doubt a large shift in this policy.

Short summary: Is there a legal or feasible basis for an ACGME policy that would limit DOs completely or partially for applying to ACGME residency positions?

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[NurWollen]

I know I'm adding to the neurotic threads that have been very common on this forum recently but a point was brought up in another thread that I feel warrants its own discussion. To be clear there are no current policies or plans to limit DOs from apply to ACGME residencies any more then is currently the case. This is not the same as the failed residency merger or the limitations to AOA trained DOs to enter ACGME PGY-2 positions or ACGME fellowships.

I want to discuss if it would be feasible or even legal to limit DO participation in ACGME residencies of any sort. The point that was raised was that as residencies become less available then they may be a push to allow MD students to match first and then allow DO students to pick up the rest.

Could this ever happen? I don't know. Legally, I can see problems with tax-subsidized residencies discriminating solely based on degree designation. Obviously PD have to use discretion in the form of board scores, grades, LOR, etc, but if the candidate is otherwise qualified for the position I don't think it would be legal to deny them a residency spot because they are a DO student. DO students meet the curriculum requirements of MD schools.

Some people may point out that DO's discriminate completely in their AOA residencies and that is true; MD graduates can not apply. But I believe the AOA would say that MD student do not qualify because of a lack of education in OMT treatments. In this way MD students do not meet the curriculum requirements of DO schools. Both ACGME and AOA residencies are supported by federal and state money so this becomes a tricky issue. Perhaps if an MD applicant also had certified OMT training there would be no legal basis for the AOA to discriminate against them as well.

I think a unified policy of all ACGME residencies to limit DO applicants would probably never happen. We already know that there currently are certain residencies with PDs that don't look at DOs at all but this is still program and specialty dependent. DOs have been matching into ACGME residencies for decades. I seriously doubt a large shift in this policy.

Short summary: Is there a legal or feasible basis for an ACGME policy that would limit DOs completely or partially for applying to ACGME residency positions?

The problem is that having a DO degree (or any other degree for that matter) doesn't make you part of a federally protected class the way your race, age, or sex would. So I don't think there would be much ground for a legal challenge if the ACGME decided I restrict DOs from entering ACGME residencies.

 

[Oo Cipher oO]

The problem is that having a DO degree (or any other degree for that matter) doesn't make you part of a federally protected class the way your race, age, or sex would. So I don't think there would be much ground for a legal challenge if the ACGME decided I restrict DOs from entering ACGME residencies.

Right but MD students or schools do not exclusively own ACGME. The member organizations are the American Board of Medical Specialties, American Hospital Association, American Medical Association, Association of American Medical Colleges, and Council of Medical Specialty Societies. Of those only the AAMC is an exclusive MD organization. Limiting federally funded residencies to allopathic students when osteopathic students meet the same requirements seems dubious.

I understand DOs are not a "federally protected class" but if there is no rational basis for prohibiting DOs that would otherwise qualify then I do see it open to a legal challenge. I need a lawyer. Where is Law2Doc? Do you think writing his name will summon him?

 

[MRSAful Fate]

MD applicants are barred from DO residencies, I don't see why they would have any legal problem reciprocating the limitations placed on them by the DO establishment.

 

[DrNightMoves]

Although it would be legal, and really easy to do, it wouldnt ever happen. Since pretty much all GME is funded by medicare, it would make a lot more sense and cause less backlash if IMGs were to get the ax long before DOs do. I could never see US tax money being allocated away from DOs before IMGs.

 

[user3]

Couldnt the ACGME have ensured a merger by threatening to bar DO grads from md residencies if the AOA did not comply?

 

[TriagePreMed]

Couldnt the ACGME have ensured a merger by threatening to bar DO grads from md residencies if the AOA did not comply?

Realistically, it would be a bluff they couldn't call. You realize how many people have invested in making new osteopathic schools and the money that the AOA gets plus what they contribute to congress? If ACGME effectively shut the door completely to DO students it would be such a legal nightmare and congress would step in. It's NOT in the interest of the ACGME to put themselves through this. If in 20-30 years they start seeing MD grads hurting, then they will see closing the door to DO students as necessary and feasible.

 

[Hemorrage]

I'm very concerned about this myself as i'm applying to both MD/DO. Realistically since most residency positions are funded by medicare, the ACGME wouldn't have the authority to "shut out" DO's if there would be unfilled training positions left over. This would be a big issue considering both the ACGME and AOA are working to fix the physician shortage problem. If allopathic school expansion continues as it is now then there will be a point where the number of MD graduates per year will roughly match the amount of training positions there are. In this situation i think they would be able to get away with barring DO's.

 

[DocEspana]

to be fair, a few state legislatures are considering legislation that would do a very similar thing... but it would be American vs international medical students and it would be for 3rd year clerkship spots. Basically a very compelling argument was made by a few members of a pretty well known organization that due to restrictions in what american students can and cannot due to acquire rotation spots, it is a matter of securing a fair deal for those who are having their historic spots taken by those with more resources to expend. Basically that a hospital can't accept offshore students until all the local medical schools have their students accounted for.

In no way saying the equivalent residency action could be taken... only that a very amusing parallel can be drawn. Where similar logic has been deemed legal, or at the least, not grossly illegal (at least initially. None have been voted on yet)

 

[JGimpel]

As others have mentioned before, since DO programs actually have it in writing that MD students could not apply to them, for whatever reason, it would follow that MD residencies could fully shut out the DOs from their programs. Why wouldn't they? Too many people rooting for the underdog and the organizations previously mentioned could cry foul and cause the MD programs a great deal of time and cost that they would rather spend on more fruitful endeavors.

Can MD programs fed up with the way the AOA has acted so rudely against them decide as a group to hire less and less of DO students as residents, even though nothing is specifically written down that states this? They sure can and now have another reason to do so besides the many reasons they've come up with to do so for decades.

 

[DrNightMoves]

As others have mentioned before, since DO programs actually have it in writing that MD students could not apply to them, for whatever reason, it would follow that MD residencies could fully shut out the DOs from their programs. Why wouldn't they? Too many people rooting for the underdog and the organizations previously mentioned could cry foul and cause the MD programs a great deal of time and cost that they would rather spend on more fruitful endeavors.

Can MD programs fed up with the way the AOA has acted so rudely against them decide as a group to hire less and less of DO students as residents, even though nothing is specifically written down that states this? They sure can and now have another reason to do so besides the many reasons they've come up with to do so for decades.

For the most part, MD program directors don't care in the slightest bit about the AOA or what they do.

 

[JGimpel]

For the most part, MD program directors don't care in the slightest bit about the AOA or what they do.

Thanks medical student for speaking on behalf of all MD program directors in the United States.

 

[GlowInTheDark]

No. Who would fill all the FM/IM slots? NPs?

I'm surprised they haven't already, since DO residencies are too cool for MDs I'm surprised they haven't taken their ball and gone home.

 

[DrNightMoves]

Thanks medical student for speaking on behalf of all MD program directors in the United States.

It was a generalization. That's what "for the most part" means.

However,

I would love to hear ONE reason that any MD programs have been affected by the recent AOA decisions. Literally nothing has changed, nor would it have changed for them if the 'merger' were to go through.

 

[NontradCA]

Overreacting. SDN seems confused, the ACGME represents just that- gme. They have issue with aoa gme and want to control aoa residencies. They're not representatives of MD students like the AOA is for DO students. They're not going to suddenly make a requirement not allowing to DO students to enter ACGME programs. It's not an MD v DO debate for them like it is for all you drama queens.

*waits for mouth breather to come bitch about DOs*.

 

[JGimpel]

Seriously? Let's say that a program was on the fence about allowing DOs in. There are many MD programs like this and you will hear more about it when you get to your clinicals. Do you think they're going to want to have anything to do with the AOA after this? Look at the threads for "DO Friendly" and give some thought to why these exist in the first place for a few minutes.

The AOA attitude reflects poorly on physicians as a whole and their students/residents as well. No, this would not affect the MD PDs day to day operations, but whom they allow to participate in them? Probably.

For the most part, MD program directors don't care in the slightest bit about the AOA or what they do.

The ones that do have kept up with the latest pissing match between the AMA and AOA camps have seen the arrogance and the AOA getting drenched for all of it. Who would want to be under their purview by having one of their students when they don't have to? If they don't have any idea of whom the AOA or what a DO is, do you think that they'd be so eager to gamble a spot on such an unknown entity?

Try to remain objective. You're receiving advice from people that have gone through everything that you will go through and know their way around the political landscape well. You could always look at the other threads about the failed merger if you don't want to take my word for it.

 

[DrNightMoves]

Seriously? Let's say that a program was on the fence about allowing DOs in. There are many MD programs like this and you will hear more about it when you get to your clinicals. Do you think they're going to want to have anything to do with the AOA after this?

The AOA attitude reflects poorly on physicians as a whole and their students/residents as well. No, this would not affect the MD PDs day to day operations, but whom they allow to participate in them? Probably.



The ones that do have kept up with the latest pissing match between the AMA and AOA camps have seen the arrogance and the AOA getting drenched for all of it. Who would want to be under their purview by having one of their students when they don't have to? If they don't have any idea of whom the AOA or what a DO is, do you think that they'd be so eager to gamble a spot on such an unknown entity?

This makes zero sense at all.

MD programs that are on the fence, do not have anything to to with the AOA, and wouldn't have anything to to with the AOA even by accepting DO students.

MD programs are not, and never will be a part of the AOA.

If the decisions do not affect the PDs at all, then why would they "probably affect who they allow in"?

 

[JGimpel]

This makes zero sense at all.

MD programs that are on the fence, do not have anything to to with the AOA, and wouldn't have anything to to with the AOA even by accepting DO students.

MD programs are not, and never will be a part of the AOA.

If the decisions do not affect the PDs at all, then why would they "probably affect who they allow in"?

Once you have a DO in your residency program, you must follow their ridiculous demands as well as your own. That's how the AOA works. Check the other threads in the Osteopathic forum.

The decision making of the MD PDs could definitely be affected by how the AOA carries itself. Check the other threads in the Osteopathic forum.

I went to a DO school, rotated and interviewed with programs on both sides of the medical profession, have a medical and C2 eligible DEA license through my state DO governing body, and am in an AOA residency that rotates it's doctors through DO and MD programs. I've tried to be polite, but it's time to do some research on your own whether you take the easy route and check some other threads on SDN or call around to get the information first-hand. Your lack of experience in this area is very obvious and you're well out of your depth in this. Focus on your Harrison's and First Aid; that would be a much better us of your time.

 

[NurWollen]

Once you have a DO in your residency program, you must follow their ridiculous demands as well as your own. That's how the AOA works. Check the other threads in the Osteopathic forum.

The decision making of the MD PDs could definitely be affected by how the AOA carries itself. Check the other threads in the Osteopathic forum.

I went to a DO school, rotated and interviewed with programs on both sides of the medical profession, have a medical and C2 eligible DEA license through my state DO governing body, and am in an AOA residency that rotates it's doctors through DO and MD programs. I've tried to be polite, but it's time to do some research on your own whether you take the easy route and check some other threads on SDN or call around to get the information first-hand. Your lack of experience in this area is very obvious and you're well out of your depth in this. Focus on your Harrison's and First Aid; that would be a much better us of your time.

The bolded part is interesting... care to elaborate?

 

[JGimpel]

The bolded part is interesting... care to elaborate?

This has a pretty good comparison for you. Read closely and you'll see the AOA has ridiculous requirements that the MD programs that have a DO are sometimes pressured into following.

http://www.google.com/url?sa=t&rct=...rTH_pcS7-KttKQpZU6k6VDQ&bvm=bv.51495398,d.aWM

Anyways, I'm in a DO program, so it may be better to get feedback from a DO in an MD program.

 

[DrNightMoves]

The fact that you linked about resolution 42 pretty much proves that you dont know what you are talking about. That is more or less instructions on how the RESIDENT needs to apply to the AOA for ACGME PGY-1 approval............and its relevant to 4 states in the country. ....... and resolution 42 has been around for a decade now. So again, the recent AOA decisions affect MD program directors how?

 

[hallowmann]

Relax people. The truth is neither of you know for sure whether ACGME PDs will react negatively to this news or not, unless one of you is an ACGME PD, in which case, you should totally accept DOs because they have magic coming out of their fingers (or at least the pads of their fingers).

I wouldn't be surprised if some PDs on the fence tipped towards not accepting DOs because of what happened and I wouldn't be surprised if some didn't even really know or care what was happening with the merger.

Overall though, I'd say what happened with the AOA doesn't really do DOs any favors when it comes to people on the outside.

 

[JGimpel]

The fact that you linked about resolution 42 pretty much proves that you dont know what you are talking about. That is more or less instructions on how the RESIDENT needs to apply to the AOA for ACGME PGY-1 approval............and its relevant to 4 states in the country. ....... and resolution 42 has been around for a decade now. So again, the recent AOA decisions affect MD program directors how?

I apologize, I meant to include this link:

http://scs.msu.edu/media/GME/2011-06/Comparison of AOA and ACGME Educational Requirements.pdf

You can make whatever decision you want to make about the general GME atmosphere and how the recent stupidity by the AOA will affect the MD PDs, but you've gotta admit that they won't need too much more information to make it easier on themselves by not getting involved with the AOA or it's members.

To make an analogy, if there was a choice in hanging out with one person that is good to his pets and one that kicks his dog around, this may not directly affect me if I don't have any pets to protect, but I'll still probably go with the person that's good to his pets simply to avoid all of the trouble and bad association that society puts on one that kicks them. The AOA basically kicks dogs, cats and anything else it can and now who can blame anyone for being associated with it.

 

[preDoGuy24]

I apologize, I meant to include this link:

http://scs.msu.edu/media/GME/2011-06/Comparison of AOA and ACGME Educational Requirements.pdf

You can make whatever decision you want to make about the general GME atmosphere and how the recent stupidity by the AOA will affect the MD PDs, but you've gotta admit that they won't need too much more information to make it easier on themselves by not getting involved with the AOA or it's members.

To make an analogy, if there was a choice in hanging out with one person that is good to his pets and one that kicks his dog around, this may not directly affect me if I don't have any pets to protect, but I'll still probably go with the person that's good to his pets simply to avoid all of the trouble and bad association that society puts on one that kicks them. The AOA basically kicks dogs, cats and anything else it can and now who can blame anyone for being associated with it.

Why would an acgme program give a sh"t about what the AOA says or "demands"? The DO in there program is not going to be taking the AOA specialty boards, the DO will take comlex level 3, but that can and will essentially be the end of there affiliation with the AOA. I honestly didn't read your metaphor (they are over used and silly) but I see no reason for your assertion of MD PDs avoiding DOs because of the AOA - I would argue that MD program directors have been poaching the cream of our crops for years and will continue (rightfully so) to keep doing just that.

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[cliquesh]

I think you're giving MD PDs too much credit. Most of them know nothing about DOs let alone the AOA. My program director the other day asked me if their is a DO version of step 3 or if I just take the usmle step 3. He's a real smart guy who has written a few important books for my field.

 

[JGimpel]

I think you're giving MD PDs too much credit. Most of them know nothing about DOs let alone the AOA. My program director the other day asked me if their is a DO version of step 3 or if I just take the usmle step 3. He's a real smart guy who has written a few important books for my field.

Agreed.

Let people have their own reality check when it comes their time; that's probably the only way to make it clear for them. For me, any time I spend a quarter-million and more on anything, I'd avail myself of all of the information possible. The DO bubble that some students have put themselves into has all but burst for most of them in the last few months.

For most of us in DO programs, we'll chime along with the AOA until we finish residency, have our employer write that yearly check to them for membership and get Boarded on the MD side and be done with the AOA for good. We never were planning on becoming DO Program Directors and our fellowship options were always limited as DOs anyways. Any other AOA residents care to post their experience?

AOA Resident