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:
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!