Ophthalmology Surgery Residents

  A big change is coming to the way medical students are paired (matched) with post-graduate training positions (residencies). Historically, there have been two “matches”: the smaller Osteopathic only match, and the larger ACGME match that allows both traditional Allopathic (MD) and Osteopathic (DO) graduates to participate. The two different match programs also have two separate governing bodies, each having their own requirements for training.  While this has worked out okay in the past, it presents several challenges for both medical school graduates and the governing of the residency programs themselves.

                For medical students, the primary frustration is that the Osteopathic only match occurs one month prior to the general ACGME match. This may seem trivial at first, but it often forces Osteopathic medical students to either settle for their second (or third, or fourth…) choice in residency training or to only participate in the ACGME match and possibly risk not matching. For example, say my number one choice is ACGME, but my second favorite program is Osteopathic (a fairly frequent occurrence). I now have to choose to either give up a chance at my favorite program, or skip the Osteopathic match completely and risk not matching at either (and ending up farther down my list). Additionally, Osteopathic residency do not allow MD students to apply. Although unfair, this has been less of an issue as the number of Osteopathic residencies make up less than 15% of all training positions, and are usually thought of as being less prestigious.

                Residency programs, on the other hand, had a very different problem, although many of the AOA regulators will deny it. The ACGME accrediting body updated its residency requirements in 2015 and there was a possibility that graduates of an Osteopathic residency would not be able to apply or complete an ACGME fellowship. Regardless of the reasons, the AOA and ACGME have worked together to outline a process by which the two programs will merge together to provide a single match system for both Osteopathic an Allopathic graduates.


Who wants the merger?

                Overall, the Osteopathic support for the merger has been almost completely divided by age. Older physicians (especially those whose jobs are dependent on keeping the Osteopathic match separate) seem to be overwhelmingly opposed to this process. Norman Gevitz, one of the most outspoken opponents to the merger, continuously spells out doom and gloom for the Osteopathic profession regarding the merger. He actually predicts that Osteopathic medicine will ultimately cease to exist as a direct result of combining the accrediting bodies. Ironically, in his position speech he compares Osteopathic medicine to homeopathy and herbal medicine, and states that the collapse of Osteopathy will mirror the decline of those professions. Maybe he does have a reason to be concerned if he feels that DOs are comparable to homeopathic practitioners. (Just to be clear, I do not feel that way at all. But I do find it hilarious that he used that analogy to justify his position)

                Students, on the other hand, are in almost complete support of the merger. A survey of 5,307 Osteopathic students (roughly 25% of all those currently enrolled) found that over 82.5% supported the merger, and only 5.6% were opposed. Seeing these results, it seems funny to me that there is a debate at all. The only reasons that I can think of that the previous generation of physicians are so against this process is that a) They will lose money in some way and b) they are so rooted in tradition that they cannot see past their own experiences. When I speak to the faculty/advisors at my (Osteopathic) school, the dialogue almost always degenerates into them telling us that students can’t understand why it’s so terrible, but we will. Essentially: you’ll understand when you’re older. In the end, the merger is happening, and it will come with growing pains.


Will residencies survive the merger?

                With the January 1st deadline  for surgical specialties to apply for ACGME accreditation, one question is on the front of every fourth-year medical student’s mind: Are Osteopathic surgical hopefuls doomed? The answer is that you’re not doomed, but it’s complicated. On September 16th of this year, the AOA released a response to highly negative position held by Norman Gevitz (discussed above). In the release, they outline a rosy picture and state that they are “on-track” in regards to programs applying for accreditation. As of September, over half of the Osteopathic programs had applied for accreditation, and programs that are 3-years or less in length have more than a year to still apply.

                Despite the initial good news, there has been some concern over the surgical specialties. In the September update, the AOA reported that 58% of general surgery, 64% of orthopedics, 52% of ENT, and 44% of OBGYN programs had submitted applications for pre-accreditation. The major outlier was ophthalmology, where only 2 of the 14 programs had applied. Other than ophthalmology, these numbers are encouraging. However, it is important to note that when this was published there was only approximately 3 months left for these programs to apply. If the program directors are anything like me, these applications will come in at 11:59PM on December 31st, but it still concerns me a little.


So, have these numbers improved?

                As my rank list is coming due, I wanted to see how the Osteopathic surgical specialties are faring. I interviewed at both AOA and ACGME programs, but am greatly concerned about the future of some of the AOA programs. Here is an update as to how many programs have applied per specialty:

surgical-specialties

 

             Overall, the Osteopathic surgical specialties look to be surviving the merger, with the notable exception of Ophthalmology (which is getting destroyed). The drop in OBGYN is also alarming, as these programs fit into the primary care category that DOs are strongly supportive of. It does, however, seem that Osteopathic applicants this year have a reduced likelihood of matching into the “cutting” specialties, especially if you want to be an eye dentist To be fair, this chart was created based on information from the ACGME website as of December 7th. It is entirely possible that more programs will be added right before the deadline, making these changes less extreme.


Why are surgical programs on the chopping block?

             This is going to be purely anecdotal, but I asked this question (tastefully) to any program director I could, and got answers from 3-4 of them. The overall consensus was that there is a significant cost associated with meeting the pre-accreditation guidelines, the man hours in paperwork, forging new agreements between departments etc. One program director that I spoke with estimated the cost to be somewhere between $60,000-$120,000 per resident when all was said and done. Surgical residents are at the higher end of that range, while non-procedural specialties are on the lower end. All of the program directors agreed that hospitals are prioritizing the specialties they require to keep the hospital running: Internal Medicine, Pediatrics, Family Medicine, General Surgery etc. This which explains why the surgical sub-specialties may lag behind, but does not explain who OBGYN is so far behind, or why all of the ENT programs are surviving. One thing is certain – the future is a little bit murky for students currently applying for the Osteopathic surgical programs this year.  

 Do you think the merger spells doom for the Osteopathic profession? What about the surgical specialties? Let us know in the comments!

5 thoughts on “Is This the End of Osteopathic Surgery?

  1. Great article, thank you for sharing. I am one of those 4th years that just went through the “audition season” and interview season for ENT. One of the most concerning things in my mind is what happens when 2020 comes along and the program you match into does not get accreditation. There are various rumors that “AOA/ACGME” wont allow that to happen and you would be offered a lateral transfer (but surely it isn’t feasiable to transfer several resident if few programs survive) or allowed to finish out the program (PGY3-5). Personally, I think there are things that been announced that go against these claims. Another interesting point is while 100% of ENT programs have applied for the merger there are no programs that have received accreditation (several programs have applied multiple times).

    Now that the Rank order is officially opened, do you have suggestions for how you would rank? The consensus seems to be “guess” where you think has the best chance and hope to go there (which may not be the program you really want).

    Looking forward to your thoughts.

    1. First off, I think you are asking the right questions. This is a very valid concern for many of the surgical specialties. I also recently finished with my “auditions” and directly asked two PDs of Osteopathic residencies if they were confident that their program would reach full accreditation. Both of them spoke honestly and admitted that they were banking on the ACGME lowering their standards to allow the DO programs to meet the standards, but felt that it would happen. As an applicant, this is very concerning for the reasons you’ve mentioned.

      Residents have been left high and dry in past. In 2013, St. Barnabas in New York ended their Radiology residency and refused to allow the residents to keep their funding. I believe most of these residents were able to find placement, but Radiology has become much less competitive than the surgical specialties continue to be. If you were left without placement as an ENT resident, I imagine it to be unlikely that other institutions will pick you up.

      In terms of ranking programs, I tried to focus on places that I liked but also had secure sources of funding. For example, one program relied on private funding from several hospitals for part of their resident salary. I feel that this is at a higher risk of default than programs that are funded primarily by Medicare + the core hospital. Luckily for me, the more established residencies (which tended to be the ones I liked) were the ones with better funding sources and will be higher on my rank list.

      It seems that there is a slight gamble inherent to this match season as an Ostopathic surgical candidate. As the match opened today, I hope you have a few choices that you’re happy with. How have you been trying to narrow down your list? Best of luck, and thanks for reading!

  2. Thanks for your response, I agree on all accounts. I too, spoke with the PD and you typically get the same generic response “we will get it through”, however, no one can say that with certainty. It’s been a struggle making my rank list (not submitted). Funding at the institutions I am considering seem to be solid but a few of the PD I think are being a-little to “lax” with the scrutiny the ABOto is showing. Some I believe are under the false impression that “once a few go through, more will”. I think this is a very naive statement given the scarce number of programs (surgical) that have gone through thus far.

    Over the course of rotations, one PD seems to think only 4-5 ENT programs will make the cut. Another concern is typically contracts are granted on a year by year basis. It seems logical, if there were a time to drop residents I think it would be after our intern year before we are in “to deep”.

    In terms of my rank list, I am basing my decision off the programs that “I think” have the best shot…… a gamble as well and still a struggle. I have been thinking of reaching out to a few residents and diving a bit deeper into strengths and weaknesses of the programs and changes that are being discussed since our time together.

    1. It is frustrating to hear PDs sound overconfident or downplay the difficulty of meeting the ACGME standards. Like many of the things we hear on interview day, there’s not a much we can do but take it at face value. I’m definitely not in a position to question programs on their funding (although I do it). I wish these questions were more transparent, and most of all I wish this wasn’t happening at time that it can affect my training.

      The one year contract is another way to tilt the residency process in favor of the hospital. If they drop out and leave their trainees hanging, there’s nothing legally holding them accountable to fulfill their promises made on match day? I mean I cannot drop out of the contract without significant consequences, yet I have to take their word on faith.

      With close to a month left until the DO Match, I hope you’re getting through this with only a little anxiety.

  3. As a student who has just finished boards and is now looking to go into ENT, I would love to know if there have been any new developments in the last 7 months. Do PGs still seem to think that few programs will make it through the merger? The only information I can find just shows most program’s status as “continued pre-accreditation”. I’m curious to know.

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