Letters to the Editor  |   December 2013
Osteopathic Graduate Medical Education: A Way Forward
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   December 2013
Osteopathic Graduate Medical Education: A Way Forward
The Journal of the American Osteopathic Association, December 2013, Vol. 113, 878-879. doi:
The Journal of the American Osteopathic Association, December 2013, Vol. 113, 878-879. doi:
To the Editor: 
The July 2013 refusal of the Board of Trustees of the American Osteopathic Association (AOA) to accept unification under the proposed memorandum of understanding from the Accreditation Council for Graduate Medical Education (ACGME) is the best outcome the osteopathic medical profession could have hoped for. As I described in a March 2013 letter to the editor,1 the underlying premise of relinquishing our accreditation process to the ACGME was flawed from the beginning. This line of inconsistent thinking is outlined by Thomas J. Nasca, MD, in his July 2013 letter in response to the AOA's refusal to ratify the ACGME's proposed memorandum of understanding.2 His implication is that quality in graduate medical education (GME) is somehow bestowed by the accrediting body; it is not. If this were indeed true, then our current US hospital accreditation process, in which hospitals independently choose their accrediting body, should be questioned as well.3 If the ACGME and Dr Nasca were fully committed to fostering an environment that is diverse, welcoming, and inclusive of the osteopathic medical profession, then they would not hold the continued participation of osteopathic residents in ACGME fellowship positions in contention. 
Improving quality and safety in the arduous task of training physicians knows no arbitrary time limit nor requires 1 single accrediting board. There is no reason both the AOA and the ACGME cannot coexist as separate accrediting bodies while collaborating on innovations such as the ACGME's new accreditation system and other outcome measures that improve training. 
Unified accreditation with the ACGME is not the answer. The osteopathic medical profession has a long history of resiliency, and with our new adversities we will continue to persevere. We must define our own destiny, beginning with a cogent strategy on how to avert the impending crisis in osteopathic GME. Although there are no simple solutions to the challenges we face, the following suggestions are a start:
    Colleges of osteopathic medicine (COMs) must work together in an environment of collaboration to create more osteopathic GME opportunities. This collaboration can be accomplished by working hand in hand with nonteaching hospitals and alternative sites such as teaching health centers and large medical groups. Our COMs need to be aggressive and held accountable in developing new opportunities for our graduates. According to my estimates (based on the number of graduates and the percentage typically enrolling in the ACGME match), we need at least a 20% increase in first-year positions annually (580 new positions per year) from our current number of 2900 over the next 5 years.
    Each COM must have its own osteopathic postdoctoral training institution (OPTI). With 29 COMs operating in 37 sites4 but only 21 OPTIs,5 we must be smarter about how we allocate resources and define who we are. The comparatively small number of OPTIs has enabled multiple COMs to claim the same GME spots as their own. In some cases, according to my observations, this set-up has led programs to double and even triple dip into another OPTI's spots. Each COM's OPTI must be responsible for its own COM's graduates and should not be allowed to join a different OPTI.
    The AOA must aggressively pursue osteopathic accreditation of ACGME fellowships that have historically accepted COM graduates. A facilitated accreditation process must be developed toward “osteopathic friendly” allopathic fellowships without additional costs to the program. These programs want our graduates because of their high quality. This relationship will mitigate the loss of any fellowship opportunities as a result of the ACGME's discriminatory proposal not to accept graduates from osteopathic residency programs to their fellowships.
    In addition, the osteopathic medical profession must support legal action against the ACGME in any and all instances of discrimination against residents trained in AOA-accredited programs who are denied acceptance into ACGME residencies or fellowship training programs.
    As a profession, we must promote our strengths to the government. Osteopathic physicians already play a significant role in providing primary care in the United States, and with our continued growth, our position will only increase. The Affordable Care Act, with its emphasis on cost savings and preventive medicine, is a gift to the osteopathic medical profession. More than 60% of osteopathic physicians are in primary care,6 a percentage that is no doubt higher than that of allopathic physicians. This status provides osteopathic physicians leverage with Congress. I believe that osteopathic medicine is in line with the health care needs of this country,7 whereas our allopathic counterparts continue to produce an excess of specialist physicians that drives health care costs higher and does nothing to alleviate the access to care issue.
Osteopathic GME is at a critical juncture. Unless there is a concerted effort to substantially grow osteopathic GME and strategic planning to further expand, our profession will soon face the grim reality of not having enough opportunities for our graduates and the possible extinction of the osteopathic medical profession as we know it. 
I give special thanks to John M. Ferretti, DO, and Dennis Tchir, MS, MBA, for providing editorial assistance. 
   Editor's Note: For more information regarding this topic, visit
Terry R. A single, unified graduate medical education accreditation system [letter]. J Am Osteopath Assoc. 2013;113(3):199. [PubMed]
Nasca TB. Letter to: Program directors, designated institutional officials, faculty members, residents and fellows, program coordinators, and other members of the graduate medical education (GME) community. Accreditation Council for Graduate Medical Education website. Accessed October 30, 2013.
Meldi D, Rhoades F, Gippe A. The big three: a side by side matrix comparing hospital accrediting agencies. SYNERGY. January/February 2009:12-14.
Colleges of Osteopathic Medicine. American Osteopathic Association website. Updated September 27, 2013. Accessed October 30, 2013.
Biszewski M. Osteopathic postdoctoral training institutions and academic sponsorship. J Am Osteopath Assoc. 2013;113(4):311-319. [PubMed]
2012 Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 2013. Accessed November 4, 2013.
Fordyce MA, Doescher MP, Chen FM, Hart LG. Osteopathic physicians and international medical graduates in the rural primary care physician workforce. Fam Med. 2012;44(6):396-403. Accessed October 30, 2013.