Steven C. Shannon, DO, MPH

Much has been written about the implementation of a Single Accreditation System (SAS) for Graduate Medical Education (GME) specialty training in prior columns and articles within Inside OME and elsewhere. Osteopathic GME (OGME) is currently accredited by the American Osteopathic Association (AOA) and other GME is accredited by the Accreditation Council on Graduate Medical Education (ACGME). Graduates of osteopathic medical schools currently pursue both pathways for specialty training, with about 60 percent receiving some or all training in ACGME-accredited programs. All that will change by 2020, when all accreditation will fall under ACGME. The AOA, AACOM, and ACGME agreed to this plan a little over a year ago; over the next few months implementation will begin.

One important element of the agreement was the establishment of a mechanism for ACGME-accredited specialty programs to seek Osteopathic Recognition (OR). Programs seeking this designation would be accredited normally by the ACGME Review Committee overseeing that specialty, but would also provide a curriculum that included and incorporated newly-adopted ACGME standards for OR. For example,  ACGME-accredited programs in family medicine, internal medicine, pediatrics, or any other specialties could choose to seek OR. The standards for OR would be established and adherence reviewed by a new committee—the ACGME Osteopathic Principles Committee (OPC)—that has been up-and-running since last fall, preparing for implementation.

Medical education for DOs in both medical school and in AOA-accredited residency and fellowship programs is based upon foundational osteopathic principles and practices. These same principles guided the ACGME’s OPC in the development of its standards for OR, and will enable the continuity of osteopathic medical education to take place within the SAS. In addition, under the SAS, these specialty programs will be available to MDs as well as DOs. This will enable a broadening of the training opportunities for all physicians—MDs and DOs—in residency and fellowship training.

One key question being raised in planning the implementation of the SAS is: “Should our program seek to become an ACGME osteopathically-recognized program in the Single Accreditation System?” This is an issue for both programs as well as the institutions in which they are housed. It is a concern of programs that are currently dually accredited by both AOA and ACGME (of which there are several hundred); those programs only accredited by AOA; and those programs only accredited by ACGME. While there are a lot of specific “in the weeds”—type of issues surrounding any decisions along these lines, I want to provide some of my thoughts on this issue.

First, I think DO graduates will prioritize ACGME specialty programs that have osteopathic recognition. There are around 24,500 osteopathic medical students in the nation’s growing DO schools today, of which over 5,000 will graduate in 2015 and 7,000 or more are expected to graduate in 2020. These students chose to pursue an osteopathic medical education pathway to become a physician, and I believe most would like to continue to do so during their GME training. What evidence, you might ask, gives me the justification to say that? In a survey of all senior osteopathic medical students (with an 80 percent response rate) a little over a decade ago, 72 percent of graduating seniors responded yes to the statement, “Are dually-accredited (AOA/ACGME) residency programs in your field more appealing than are residency programs accredited by ACGME only?” I don’t believe there is any evidence to suggest that this sentiment has changed. AACOM conducted a survey in late March of current third-year osteopathic medical students which confirmed that a majority (70.55 percent) would prefer an ACGME-accredited program with osteopathic recognition over one without osteopathic recognition; see full survey results.

I believe that the appropriate conclusion to draw is that if institutions want to be the most competitive for the best, brightest, and most appropriate DO graduates for their residency programs, then they should obtain osteopathic recognition of their ACGME program as they transition into the Single Accreditation System. While the standards for osteopathic recognition have been adopted by ACGME, and the logistics of this process involve several steps, I think that those ACGME programs already dually accredited by AOA should have a clear pathway to maintain that alignment. Likewise, those AOA programs that will be transitioning through ACGME accreditation should have few problems maintaining an osteopathic focus in their programs, since they are already doing so. I encourage all programs and the institutions in which they operate to consider this important issue as they plan their transition in the Single Accreditation System.

Of course there are a number of other reasons why it makes sense to pursue OR as well, and here are a few:

• In a time in which renewed focus is rightly placed on the need to have a health care system that is high quality, patient-centered, and focused on health as well as disease prevention and cost-effectiveness, the primary-care focused osteopathic approach is on target. As Robert Cain, DO, Chair, ACGME Osteopathic Principles Committee, articulated during the 25th Annual Osteopathic Medical Education Leadership Conference in Los Angeles, “Patient care delivered within the context of the four tenets of osteopathic medicine, is aligned to patient-centered, high-value care and the needs of our nation’s health care system.”  Maintaining OGME within the SAS is a means to that end. 
• Distinctive branding--programs that are AOA-accredited have already invested resources in the osteopathic approach and can capitalize on that investment by maintaining that focus. Being an osteopathically-recognized ACGME program under the single accreditation system will help programs solidify their brand and will provide a tangible credential that will have significant meaning and function as an organizational asset.
• While standards and definitions have long existed governing the principles and practice of osteopathic medicine, the changing framework with the SAS offers a great opportunity. As we move through the transition period and begin to integrate and operationalize osteopathic principles and practices into the ACGME system of accreditation, we can use this as an opportunity to further evaluate, research, define, and codify the unique contributions of the osteopathic medical approach to serving the health care needs of our country.

In a recent column, AOA President Robert S. Juhasz, DO, provided a number of thoughts on this very topic. I thought the following particularly noteworthy:

“Market forces in this country are aligning in ways that are driving the value of osteopathic medicine. The significant shortage of primary care physicians; patients seeking our high-touch, high-empathy brand of care; our distinctive training and practice of medicine, which aligns neatly with the national demand to deliver high-quality care in a cost-effective way—all of these factors underscore the need for more DO training.”

Clearly, we are living through interesting times. Our profession and its education model are undergoing change. We are provided with the opportunity to engage on a larger stage to deliver the best we have to offer for the health of our country’s residents.