On Feb. 24, 2013, the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) announced their agreement to a memorandum of understanding that outlined a single graduate medical education system for residency and fellowship programs in the United States. Together, the organizations embarked upon a journey creating the infrastructure for a smooth transition to merge into a single system, which will transpire over the next five years.
As our allopathic and osteopathic emergency medicine programs undergo this merger together, there are current differences between the two regulatory bodies that may be especially significant to a subset of AOA emergency medicine residency programs: the community hospital–based osteopathic programs. Nearly three-quarters of the AOA EM programs are community based and have trained highly skilled board-certified physicians for many years. However, differences in core faculty requirements, as well as sponsoring institutional support, may threaten their stability and financial viability.
The ACGME, unlike the AOA, requires protected time for core faculty. The current ACGME requirements state that core EM faculty cannot work in excess of 28 clinical hours per week on average. Further restrictions are placed on program directors (PDs), who are restricted to 20 clinical hours per week, and assistant or associate PDs, who are restricted to 24 clinical hours per week. The AOA requirements include protected time for their PDs but not for core faculty. Many of the community osteopathic programs pay their core faculty a small stipend, and many of those faculty members donate this stipend back to the school, serving as faculty for free. These osteopathic core faculty members earn their salary most often through their hourly paid clinical shift work. AOA community EM programs are understandably concerned about how to fund core faculty protected time, assuming incorporation of the limits on clinical hours with ACGME as the single accreditation body.