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Single GME Accreditation System

What It Means to Be "Keepers of the Flame"

by Laura E. Griffin, DO, FAAO

A Message from the [AAO] President

AT Still quote-200pxWe as the osteopathic profession stand on the brink of the greatest opportunity we have ever seen to bring true osteopathic care to the forefront of medicine in America. The choices we have are: 1. Say no, it’s too much work, we shouldn’t have to change; 2. Hope that someone else will do it; or 3. Take the plunge and do the work that needs to be done to bring our residencies along with all of our other specialties into the single accreditation system of the Accreditation Council for Graduate Medical Education (ACGME).

Unfortunately, there continues to be an ongoing lack of understanding about what this transition means to our specialties. I hope to bring clarity. 

AOA Residencies

Within the American Osteopathic Association (AOA), there are currently four pathways to obtaining board certification. These are the pathways, along with how many of each program type there are and how many residents they are currently training:
  1. Neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM) residency. This is a two-year program completed after a traditional rotating internship or other approved first year. There are currently eight programs training 18 residents with seven more interns tracking to enter next year as NMM/OMM residents.
  2. Integrated family medicine/neuromusculoskeletal medicine (FM/NMM) residency. This is a four-year program leading to eligibility for certification by both the American Osteopathic Board of Neuromusculoskeletal Medicine (AOBNMM) and the American Osteopathic Board of Family Physicians. There are nine programs currently training 59 residents.
  3. Integrated internal medicine/neuromusculoskeletal medicine (IM/NMM) residency. This is a four-year program leading to eligibility for certification by both the AOBNMM and the American Osteopathic Board of Internal Medicine. There is currently one program training two residents.
  4. Neuromusculoskeletal medicine plus-one residency. This is a one-year program completed after another primary residency that also leads to eligibility for certification by the AOBNMM. There are currently 30 programs training 31 residents.

Over the last three years, an average of 45 residents completed their programs annually and were eligible to sit for boards with 54 more anticipated to do the same in 2017. If all AOA postgraduate training in the specialty of NMM/OMM ended today, there would be 117 fewer physicians graduating that can not only care for patients at that level but that are qualified to meet the current Commission on Osteopathic College Accreditation’s (COCA) requirement that the chairs of the Departments of Osteopathic Principles and Practices (or their equivalent) at our schools and colleges of osteopathic medicine be board-certified in NMM or hold the certification of special proficiency in osteopathic manipulative medicine (C-SPOMM). As we continue to open new institutions despite an apparent shortage of available faculty—as evidenced by the number of schools with open positions in those departments—this becomes more crucial than ever.

ACGME Residencies

In the new system under ACGME, there is a single specialty, osteopathic neuromusculoskeletal medicine (ONMM), which leads to eligibility for certification by the AOBNMM.

On the surface, it appears that the only type of program left to us is what has been referred to as the “traditional” two-year program. Digging deeper, we find that this program offers the opportunity to enter that pathway in the ONMM2 level which is 12 months in length, after completing a residency elsewhere, effectively completing an NMM/OMM plus-one residency.

While the requirements are different from the AOA’s plus-one program and while it will require some flexibility and creativity on the part of program directors, the option still exists to train physicians in that model as well as in the traditional two-year model and thereby maintain the majority of our existing programs.

However, the biggest misconception in my opinion, is that the “integrated programs are going away.” If you want to speak in strictly technical terms, then you could say that is true, but it is misleading and harmful to imply that this model can’t be effectively created within the parameters available to us.

As the FM/NMM and IM/NMM programs exist currently, a single program has been developed that meets requirements to sit for both certifying boards. However, in order to continue that model in the ACGME, the sponsoring institution would apply for accreditation in both the specialties. Once that is achieved, the institution would develop a curriculum that meets those requirements to take advantage of duplicated rotations, etc., and the program directors would submit those curricula to the respective boards for approval. Upon that approval, the ACGME will issue that institution a program number so that they can recruit and match directly into the program. While the program itself is technically unaccredited, it is based on two programs that are. After the initial hoops to jump through, it will essentially become business as usual.

As one of the earliest graduates of an official integrated FP/NMM program, I confess that I am more than a little biased in favor of this model, and over the years, I have seen many fine physicians and leaders produced by it. That said, if an institution has reservations about graduating residents from an “unaccredited program,” the institution may opt instead to have, as an example, a family medicine program with osteopathic recognition and an ONMM program, accepting residents into the second year of the ONMM program after the FM program. This model will functionally create the same physician graduates. This is exactly what these programs are already doing, and our existing integrated programs are perfectly poised to lead the way in this effort. It is not keeping the title of an integrated program that matters. It is continuing to produce physicians who are uniquely qualified not only to care for patients at the highest level of primary care and neuromusculoskeletal medicine on a specialty level, but also ensure the growth and prosperity of our profession by education of the physicians of the future.

Looking Forward

As of this writing, there are four ONMM programs in initial accreditation and one in pre-accreditation. Per the chair of the ACGME ONMM Review Committee, Lisa A. DeStefano, DO, these accredited programs will be available to offer a traditional two-year, integrated and plus-one AOA NMM/OMM equivalents, via the mechanisms similar to what I have described above. The chair of the AOBNMM, Michael S. Carnes, DO, FAAO, informs me that there is already one program that has submitted its curricula to the AOBNMM and AOBFP for review as an “integrated” program so that its residents can be eligible to sit for both boards.

While the transition might be happening at a slower pace than some might want, this is not the sign of a need to “reverse course” as suggested by some esteemed colleagues in our profession. It is a sign that we as the NMM specialists need to get motivated to get our existing programs accredited in ACGME and to start new ONMM programs wherever we can.

I challenge every school to start or support an ONMM program to help train our future teachers. Physicians with C-SPOMM or NMM certification have been involved in educating nearly all of the osteopathic physicians in practice, and if the current COCA requirements for OPP department chairs at colleges of osteopathic medicine remain in effect, as it must, we will be key participants in the education of 100 percent of all osteopathic physicians of the future.

If that doesn’t make us the “keepers of the flame” of keeping osteopathic medicine alive and flourishing, I have no idea what does.

The AOA is committed to helping our programs through this process. They offer free guidance and assistance in whatever way is needed, just shy of completing your application for you. Please see http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/accreditation-processes.aspx for further information.

If we at the AAO can be of assistance, let us know how. As I said, we stand on the brink of the future with our three options before us. To say no and let your programs close or to just hope someone else does the work for you is to say that our profession doesn’t mean enough to do all we can to ensure its survival. To take the responsibility of continuing old programs and the initiative of opening new ones is not only to ensure survival but to seize the opportunity to bring A.T. Still’s vision to fruition and to bring what has long been the bright future of medicine into reality, providing all patients with the opportunity to receive the benefits that only osteopathic care can give.

Laura E. Griffin, DO, FAAO
2016-17 AAO President

View the original AAO announcement