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Letters to the Editor  |   September 2012
Need to Oppose Proposed ACGME Common Program Requirements
Author Affiliations
  • Simon B. Zeichner, DO
    Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   September 2012
Need to Oppose Proposed ACGME Common Program Requirements
The Journal of the American Osteopathic Association, September 2012, Vol. 112, 586-587. doi:10.7556/jaoa.2012.112.9.586
The Journal of the American Osteopathic Association, September 2012, Vol. 112, 586-587. doi:10.7556/jaoa.2012.112.9.586
To the Editor: 
Over the past several months, feelings of uneasiness have sprung up among many of us in osteopathic residency programs. On November 11, 2011, we were informed that the Accreditation Council for Graduate Medical Education (ACGME) had proposed 2 new policies that would limit future graduates of osteopathic medical schools from entering ACGME-accredited residency programs.1 The 2 new proposals of the ACGME Common Program Requirements were as follows2:
 

III.A.2. Prerequisite clinical education for entry into ACGME-accredited residency programs must be accomplished in ACGME-accredited residency programs or Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited residency programs located in Canada.

 

III.A.3. Prerequisite clinical education for entry into ACGME-accredited fellowship programs must meet the following qualifications: (a) for fellowship programs that require completion of a residency program, the completion of an ACGME-accredited residency program or an RCPSC-accredited residency program located in Canada; (b) for fellowship programs that require completion of some clinical education, clinical education that is accomplished in ACGME-accredited residency programs or RCPSC-accredited residency programs located in Canada.

 
The American Osteopathic Association (AOA) responded swiftly to this announcement by opposing the new proposals.1 The AOA leadership met with ACGME officials at AOA headquarters in March 2012 to advocate for the withdrawal or amendment of the ACGME proposals.1 After the meeting, residents were informed that the ACGME Board of Directors would review previous committee recommendations in June and provide a definitive decision regarding the proposals. 
In June, the American Medical Association's (AMA) House of Delegates approved a resolution related to the Common Program Requirements.3 The resolution called on the AMA to partner with stakeholder organizations, including the ACGME and the AOA, to revise residency and fellowship accreditation standards to recognize the alignment of the educational experiences of allopathic and osteopathic residents. The AOA announced that this resolution was “a positive action in support of our efforts to resolve the ACGME crisis and preserve access to ACGME programs for DO graduates.”3 At the time of the writing of the present letter, AMA committees were still discussing this matter, and a final decision had not yet been made. 
In my opinion, the proposed ACGME Common Program Requirements2 are a huge blow to the osteopathic medical profession. Not only are thousands of osteopathic medical students and residents impacted by the proposals, but so are entire osteopathic residency programs. Osteopathic medical students wanting to do an ACGME-accredited fellowship and an AOA-approved residency will be forced to reconsider the osteopathic residency. Osteopathic residency programs will no longer be able to attract top candidates. 
It is hard to wrap my head around these ACGME proposals.2 The osteopathic and allopathic medical professions have built a strong partnership during the past 20 to 30 years. The ACGME might oppose the AOA policy that graduates of allopathic medical schools are not allowed to enter into osteopathic residencies or fellowships. I agree with the ACGME on this point. I believe that allopathic medical school graduates should be allowed to enter into osteopathic residencies, as it is only fair. However, I also believe that the ACGME proposals underscore the fact that there are far fewer osteopathic fellowships than allopathic fellowships, and the few that are in place have not existed long enough to establish the reputation or build the research environment that is required to attract top talent. It is not reasonable for the ACGME to close the door on the opportunities of students and residents of a smaller, less established, more fragile graduate medical education system. 
I urge readers of JAOA—The Journal of the American Osteopathic Association to contact the ACGME to have your voice heard. Even if the ACGME proposals2 do not affect you, it is important that we unite and hold a firm stance on this issue. 
References
Timeline: AOA response to ACGME changes; updated June 25 , 2012. American Osteopathic Association Web site. http://www.osteopathic.org/inside-aoa/Pages/acgme-policy-timeline.aspx. Accessed June 26, 2012.
Common Program Requirements; effective July 1 , 2011. Accreditation Council for Graduate Medical Education Web site. http://www.acgme.org/acWebsite/reviewComment/CommonPRs_R&C.pdf. Accessed June 26, 2012.
Crosby JB. AOA Daily Report Blog: AMA passes resolution on ACGME crisis. June 20 , 2012. American Osteopathic Association Web site. http://www.osteopathic.org/inside-aoa/news-and-publications/blogs/daily-report-blog/default.aspx. Accessed June 26, 2012.