Implications for Educators and Students

How will this impact educators? A contentious issue exists for most DO-trained residency directors in that residency directors in the new combined system will have to be ACGME-trained or paired with an ACGME director for an undetermined time. Many DO directors see this as a slight to their training and acumen, but it is really just to ensure a smooth transition to a unified system. Norman Vinn, DO, president of the AOA, provided an excellent analogy: “If you were a manager at Microsoft and the director of Windows 7 and went to work for Apple, chances are that you would be paired up with someone who knew the Apple system for a while until you knew their system well. It isn’t about whether Windows 7 was inferior to Apple or whether your training at Microsoft was equivalent but rather about knowledge of how the system operates.” There will be many bumps in the road that will be worked out by a plethora of task forces or committees. In my tenure in the government, politics, and medicine (principal deputy assistant secretary for health affairs and deputy chief medical officer and chief of space medicine for NASA, etc.), I have yet to see a perfect policy from the get-go. They all get tweaked over time as you discover unintended consequences or challenges.

 After implementation, all training programs will be ACGME-accredited. Osteopathic principles will not be thrown out with the bathwater; in fact, just the opposite will happen. Osteopathic principles will be recognized and codified in the single accreditation system, and there will be training programs with an osteopathic dimension under ACGME accreditation. A Neuromusculoskeletal Review Committee and an Osteopathic Principles Review Committee will be developed. Osteopathic primary care programs have been routinely filled and serve the rural communities well, with osteopathic medical school graduating 50 percent or more of physicians headed to primary care. The ACGME will not want that to disappear; nobody wants that secret sauce of minting primary care physicians to disappear.

The questions I get from medical students usually center around the match and board examination. The match is administered by the National Residency Match Program (NRMP) and not the ACGME. Consequently, this is an issue that can be resolved only when NRMP claims a seat at the table. However, if all programs are considered ACGME-accredited, a system with one match seems inevitable. Regarding the examination process, I am sure students would prefer to have a single exam.