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A reader defends the American Osteopathic Association's decision to pursue a single GME accreditation program.
I am responding to the recent article, “Allopathic, Osteopathic Graduate Training Programs to Unify Accreditation Process,”(eConsult, July 28, 2014.) As a delegate at the 2014 American Osteopathic Association (AOA) House of Delegates, I disagree with some of the opinions expressed by Craig Wax, DO, about the osteopathic medical profession’s decision to pursue a single Graduate Medical Education (GME) accreditation system.
Dr. Wax is correct that the AOA and American Association of Colleges of Osteopathic Medicine pursued this course, in part, to ensure that there are enough training slots for osteopathic medical school graduates. The AOA and Colleges of Osteopathic Medicine are working hard to increase the number of osteopathic GME positions available to graduates, but it has been difficult keeping pace with 20 years of explosive growth.
In 2013, there were 5,153 DO graduates for fewer than 3,000 funded first year osteopathic GME positions. The new GME system will ensure that DO graduates continue to have access to residencies and fellowships offered through programs approved by the Accreditation Council for Graduate Medical Education (ACGME).
Dr. Wax suggests the alternative to GME accreditation reform is obtaining additional funding for residencies. No one disagrees that additional funding would alleviate the problem, but it should not be the only strategy: reform and funding are both needed.
The recent Institute of Medicine report on GME made recommendations about the need to modernize and realign the system to ensure the best use of federal funds. Any investor with this knowledge would be justifiably reluctant to invest in GME unless changes are made.
Dr. Wax described the AOA House of Delegate’s decision to pursue a single GME accreditation system as being “desperate.” It was not a desperate decision, but a thoughtful one, which will enable DOs and MDs to step up to meet the growing demand for more physicians. Desperation is refusing to acknowledge the reality that multiple, sometimes duplicative and competing, accreditation processes are barriers to osteopathic medical students. Acknowledging these deficiencies and fixing them will provide greater accountability and assurance to decision-makers that investing in GME is a smart move.
The AOA House of Delegates consideration of the single GME system was not a heavy-handed process as described by Dr. Wax. The dialog between state associations, specialty colleges, affiliates, students, and residents has been extensive and well documented. All possible outcomes of this new system have been considered and reported. Ultimately the House of Delegates voted overwhelmingly in support of the single GME system.
There is much work for our profession to do being “at the table” with ACGME, a position we have not had in the past while over 60% of our graduates train in ACGME programs. The outcome of this process will be much more successful if osteopathic physicians are engaged and supportive of our leaders to make the best choices to achieve the goals that we all share.
Shannon Scott, DO, FACOFP