The Graduate Medical Educational Merger: Dispelling the Myths

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This is a confusing time in the world of graduate medical education. The recent Memorandum of Understanding that will merge the American Osteopathic Association (AOA) and the Accreditation Council of Graduate Medical Education (ACGME) to one single accreditation system (SAS) has created a lot of turmoil in the minds of many residents seeking to become experts in emergency medicine. As the elected voice of emergency medicine residents, we felt it important to join together with a unified voice to provide some insight into what we know in an attempt to dispel some of the most prominent rumors about the merger.

MYTH 1.
My entire program leadership, including the program director (PD), will change when the AOA and ACGME merge.
The ACGME Review Committee for Emergency Medicine (RC-EM) has announced they will equally consider AOA certification as one of the criteria to meet the qualifications for an EM program director.

MYTH 2.
My program will close when we undergo the ACGME accreditation process, and I won’t be able to take the boards when I graduate.
Current AOA accredited programs will not automatically close during the ACGME accreditation process. These programs will maintain their AOA accreditation status until either ACGME
accreditation is achieved or until June 30, 2020.

The SAS will not affect board eligibility. Osteopathic certification exams will be recognized by the ACGME as valid and appropriate credentials for service as faculty members in ACGME training programs. No MD or DO will be required to take either certification exam; both certifications will be available to DOs who graduate from an ACGME accredited program. All DO residents will be encouraged to take osteopathic certification exams to demonstrate their competency in osteopathic principles and practices within the specialty.

Under the current American Board of Emergency Medicine (ABEM) rules, a physician must have completed an ACGME accredited residency to be eligible for ABEM board certification. When an AOA program applies for ACGME accreditation it is given a “preaccreditation” status, which signifies that an AOA accredited program is in the process of pursuing initial accreditation with the ACGME while still operating under its AOA accreditation. Our understanding is that a program’s preaccreditation status – which in many cases will qualify DO residents in that program for advanced ACGME residencies and fellowships — will not change a DO physician’s eligibility for AOBEM board certification. ABEM certification will be available to program graduates once the ACGME confers initial accreditation upon the AOA program, even if it is conferred on the last day of residency. Initial accreditation is the status that is achieved once an AOA program is ACGME accredited.

MYTH 3.
My AOA EM program will have to close with the ACGME merger.
All osteopathic EM programs must seek ACGME accreditation before June 30, 2020 (after this date the AOA will no longer accredit GME programs) or face closure. Each program will have to meet the standards as determined by the RC-EM. Though there are some differences in the current ACGME EM standards and AOBEM standards, osteopathic EM programs are held to high standards that are similar to those of ACGME. We are hopeful that all osteopathic programs will be able to obtain ACGME accreditation if pursued.

To answer the direct question of whether a specific program will close, this will depend on the sponsoring institution’s desire to continue educating EM residents. We encourage our members to direct this question directly to their sponsoring institution’s graduate medical education department chairs.

MYTH 4.
As an osteopathic medical student interested in EM, I will still have to apply to two distinct matches even after the merger.
The ACGME does not administer the allopathic MD match; rather, that is administered by the National Residency Match Program (NRMP) and the osteopathic match by the National Matching Services (NMS). Consequently, this is an issue that can be resolved only when the NRMP and NMS join in the merger discussions.

However, if all programs are considered ACGME-accredited after the transition to a single GME system is complete, it is likely there ultimately will be one match. During the transition, as AOA programs get approved by the ACGME, there will likely be conversations with the NRMP and the NMS to determine the best way to administer the match during the transition process. Unfortunately, this issue cannot yet be easily clarified, so there is no way to fully address this myth at this time.

 
MYTH 5.
As an allopathic medical student I will have more competition for the allopathic spots, but I still will not be able to apply to the osteopathic programs even after the merger.
Once the transition to a single GME accreditation system is complete, all DOs and MDs will have access to ACGMEaccredited training programs, including those with an osteopathic principles dimension. However, there is no specific date when osteopathic-focused programs must begin accepting MD candidates. Prerequisite competencies and a recommended program of training are expected to be required for MDs to enter osteopathic-focused programs, though this has not been confirmed. The newly formed Osteopathic Principles Committee of the ACGME will develop the prerequisites and prior training requirements. MDs will not be able to enter osteopathic-focused training programs until standards for these programs have been developed and that individual program has become ACGME-accredited.

MYTH 6.
If I graduate from an AOA residency program then I will not be eligible for an ABEM-sponsored subspecialty fellowship.
Nothing stops an AOA graduate from matriculating into an ABEM  sponsored fellowship if the program leadership deems him/her a desirable candidate. However, at this time you will not be able to sit for the ABEM subspecialty fellowship boards if you are not ABEM certified.

The current policy of the American Board of Medical Specialties (ABMS) is such that an AOA residency graduate who is not certified by one of the member specialties (e.g., ABEM) cannot become certified in an ABMS subspecialty even with completion of an eligible fellowship. Unfortunately, at this time graduating from an AOA accredited fellowship program will not result in ABEM subspecialty certification.

In order to sit for an ABEM subspecialty examination for certification, an AOA graduate would have to complete a residency program that has been given ACGME initial certification, become board certified by ABEM, complete an ABEM-sponsored fellowship program, and successfully pass that examination. The designation of “pre-accreditation status” is an ACGME designation that the ABMS does not recognize in this context. Graduates from osteopathic programs who are AOBEM certified and complete an ABEM fellowship may apply for a certificate of added qualification (CAQ) through AOBEM (visit aobem.org for more information).

The merger process will be ongoing until July 1, 2020, and as new information becomes available, the facts will be distributed. If at any time you have questions or concerns, please feel free to
contact your representatives from EMRA and the ACOEP-RC by tweeting your questions to @emresidents or @ACOEPRC. You can also email the EMRA RRC-EM Representative at rcemrep@emra.org.

Special thanks to Jan Wachtler, CSA, ACOEP Executive Director; Ashley Guthrie, DO, EM resident St. Joseph’s Regional Medical Center, EMRA Memberat- Large; Drew Kalnow, DO, EM resident Doctors Hospital, ACOEP Treasurer.

Leonard Stallings, MD

Leonard Stallings, MD

EMRA RRC-EM Representative, East Carolina University, EM/IM/CC Residency, Greenville, NC
Andrew Little, DO

Andrew Little, DO

Andrew G. Little, DO, of Ohio University Heritage College of Osteopathic Medicine, is the ACOEP Resident Chapter President.
Andrew Little, DO

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