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Letters to the Editor  |   September 2012
Response
Article Information
Medical Education / Professional Issues / Graduate Medical Education
Letters to the Editor   |   September 2012
Response
The Journal of the American Osteopathic Association, September 2012, Vol. 112, 587-588. doi:10.7556/jaoa.2012.112.9.587
The Journal of the American Osteopathic Association, September 2012, Vol. 112, 587-588. doi:10.7556/jaoa.2012.112.9.587
We agree with Dr Zeichner and urge individuals to contact the Accreditation Council for Graduate Medical Education (ACGME). We would also like to provide clarifying comments to Dr Zeichner's points. The American Osteopathic Association (AOA) continues to work aggressively to address the proposed ACGME rules. A Joint AOA-ACGME Task Force is searching for ways to resolve this situation. The Task Force has met 3 times in the past 4 months, and a fourth meeting is scheduled. 
The issue of allowing MDs into DO training programs is complex, and it has been studied by a special AOA task force. Their report has been discussed and debated by both the AOA Board of Trustees and the AOA House of Delegates. Before admitting allopathic graduates into osteopathic programs, several important hurdles must be addressed, including prerequisite training, certification, and AOA membership. First, AOA residencies incorporate an additional core competency, “Osteopathic philosophy, principles and manipulative treatment,” beyond the other 6 competencies shared by the AOA and the ACGME. The required elements of this competency are fully integrated within the teaching and evaluation of the remaining competencies in each specialty's respective training standards. Accordingly, allopathic graduates would need some form of prerequisite training to enter an osteopathic training program. There is currently no approved curriculum available to teach allopathic graduates what osteopathic students learn about osteopathic principles and practices (including osteopathic manipulative treatment) in their 4 years of osteopathic medical school. 
Second, there is no board certification process for the allopathic graduates who would complete an osteopathic training program through either the AOA or the American Board of Medical Specialties (ABMS). We believe it would be unethical to train someone who would not be eligible for board certification. The ABMS does not recognize osteopathic postdoctoral training and, therefore, would not certify allopathic physicians (ie, MDs) who complete osteopathic residencies. (As a slight digression, the ABMS does not certify osteopathic physicians [ie, DOs] who complete allopathic fellowships after completing osteopathic residencies. The AOA has created certifications for those DOs who have followed this training path.) 
Third, osteopathic board certification requires regular membership in the AOA to monitor the ethics, licensure status, and CME (and soon osteopathic continuous certification) of certified members. Allopathic physicians are not eligible for regular membership in the AOA, so this would need to be addressed as well. 
It should be noted that many residency programs currently are accredited by both AOA and ACGME. Allopathic graduates of these programs are eligible for board certification by the ABMS. Although these dually approved programs have traditionally been created in existing primary care ACGME residencies, there is no prohibition for AOA-accredited residency programs to seek additional accreditation through the ACGME. This step would allow traditionally osteopathic programs to accept allopathic graduates who would be eligible for board certification upon successful completion. 
At its July 2012 meeting, the AOA Board of Trustees and House of Delegates heard an update on the AOA-ACGME discussions. We also reported on this issue to the AOA Bureau of Osteopathic Specialty Societies and the Council of Interns and Residents during their July meetings. The leadership of the AOA continues to hold a preference for this issue to be resolved in an amicable, collaborative way. We believe that writing letters to encourage the ACGME to reconsider their proposed rule is the right approach at this time.