Letters to the Editor  |   February 2005
Chairman of COPT Concludes Debate on “Hardship Exception”
Author Affiliations
  • Michael I. Opipari, DO
    Council on Postdoctoral Training American Osteopathic Association
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   February 2005
Chairman of COPT Concludes Debate on “Hardship Exception”
The Journal of the American Osteopathic Association, February 2005, Vol. 105, 53-54. doi:
The Journal of the American Osteopathic Association, February 2005, Vol. 105, 53-54. doi:
This is my final response to the ongoing debate initiated last year by my friend, Kenneth J. Steier, DO, (J Am Osteopath Assoc. 2004;104[8]:314–315) as a result of actions taken by the American Osteopathic Association's (AOA) Council on Postdoctoral Training (COPT) over the past four years. 
In particular, Dr. Steier has objected to COPT's approval of Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs for first-year residency training to meet the AOA requirements for internship completion. 
Dr. Steier writes again (J Am Osteopath Assoc. 2005;105[1]:4-5) in opposition to Council actions, this time attempting also to draw attention to what he appears to believe are negative impacts of Resolution 42 actions by COPT. For example, he indicates that only 9.3% of applicants who were granted AOA approval through Resolution 42 have thus far received AOA certification on the completion of their residencies. I would argue that, since Resolution 42 is applicable to internships and has seen only approximately 5 years of activity, most trainees for whom this resolution applies would just now be in the certification process. Therefore, analysis of current certification data (ie, after the completion of a 3–4 year residency since the resolution was enacted) is premature. 
In answer to Dr. Steier's rhetorical question, I respond, yes, absolutely, the survival of osteopathic graduate medical education is important. Although we have unfilled AOA-approved intern and residency positions, we do not have a sufficient number of funded positions for the current number of graduates—and certainly not for the increasing number of graduates that are expected in the coming years. In addition, many geographic areas of need are entirely devoid of approved and funded positions for our graduates. 
New colleges of osteopathic medicine are not establishing AOA-approved positions to equal the number of osteopathic medical graduates in their graduating classes. Further, the positions they are establishing are not in traditional osteopathic hospitals. These new positions are predominately located in established ACGME-accredited sites as “carve-outs” of ACGME-accredited programs and many of those programs maintain only the minimum requirements for staff positions filled by osteopathic medical faculty. 
We are indeed fortunate that the allopathic institutions and ACGME-accredited programs have accepted our quality osteopathic medical graduates when we could not accommodate them. If they had not, think of the potential consequences to our colleges of osteopathic medicine that have continued to open the pipeline wider. 
Dr. Steier further indicates that we are sending the wrong message to our osteopathic medical students by “automatically approving ACGME-accredited training programs as equivalent (or better) than AOA-approved training.” To this, I respond that Resolution 42 indicates that ACGME training must be accredited. This policy has never implied equivalency or better. In reality, “equivalency” cannot be determined on either side, only comparability. Accreditation signifies that the program has met basic standards; it is not a comparative measure of the program's quality, as was also previously implied in a letter by Kevin L. Hornbeck, RPH, DO (“DO notes difference between residency programs.” J Am Osteopath Assoc. 2004;104[9]:367). If a program meets accreditation standards, it is eligible for AOA approval. Approval means nothing more than that: approval. 
I believe it is time to end the Resolution 42 debate. I would hope that the AOA could accommodate every osteopathic medical graduate with reasonable numbers of available quality residency positions (we cannot) in all specialties (we cannot) and in all geographic regions of need in the United States (we cannot). Until the AOA can accommodate all osteopathic medical graduates to the desired levels, we must continue to allow our graduates—created by our colleges of osteopathic medicine—to be trained in accredited residency programs in an array of specialties and in geographic regions of need. 
As I have previously noted (J Am Osteopath Assoc. 2004;104[8]:315), those DOs not desirous of AOA approval have not applied for an exception under Resolution 42. 
While I respect Dr. Steier's strong commitment to the AOA's training system, the osteopathic graduate medical education system must remain a matter of choice for our students and not a tool of force wielded against them by the profession.