At its meeting on November 11, the Ohio Academy of Family Physicians Board of Directors held a mega issue discussion on the merger of the DO and MD accreditation process and that merger’s potential impact on primary care physician workforce nationally and in the state of Ohio.
OAFP board member Julie Marcinek, DO, led the discussion as this was Dr. Marcinek’s research topic during her fellowship at the Robert Graham Center in Washington, DC.
In 2014, the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) announced that their separate accreditation systems would merge into a single accreditation system. All AOA programs must meet ACGME accreditation by Wednesday, July 1, 2020. to remain accredited; all AOA programs were required to be in “pre-accreditation” by January 1, 2018, to remain eligible for the single accreditation system.
Prior to the single accreditation system announcement, there were 263 AOA-accredited family medicine residencies; 98 of those are dually accredited and 165 had AOA accreditation only. Prior to the single accreditation system, 41 of the AOA-accredited family medicine residencies were rural; seven of those were dually-accredited, and 34 had AOA accreditation only.
As of August 9, 91 of the AOA-accredited family medicine residencies have become dually-accredited; 38 were pre-accredited; and 41 were not applying. As of August 9, 18 of the rural family medicine residencies were dually accredited, 8 were pre-accredited, and seven were not applying.
Prior to the single accreditation system, there were 40 family medicine residencies in Ohio: 19 accredited by ACGME only, four dually accredited; and 17 accredited by AOA only. All but three are accredited or pre-accredited as of November 3, 2018. Of Ohio’s seven rural programs, one was ACGME accredited only and six were AOA accredited only. All but one is accredited or pre-accredited as of November 3, 2018. Osteopathic programs not applying for accreditation are St. Joseph Warren Hospital in Warren, OH; UH Elyria Medical Center in Elyria, OH, and Southern Ohio Medical Center in Portsmouth, OH.
The top five barriers to ACGME accreditation for AOA residencies are OB faculty, pediatrics in-patient faculty, scholarly activity, adult in-patient faculty, and hospital support. Suggested interventions include professional organization support, extension of deadline, collaborative models, and funding for more residents.
- Positive aspects of the transition – have looked critically at programs and have improved areas of weakness. Collaboration, curricular innovation, working with consultants, and building infrastructure have been beneficial.
- Frustration with ACGME requirements around obstetric and pediatric inpatient training/faculty.
- Lack of organizational support, guidance, and direct intervention. Need for increased regulatory reform and more collaborative and equitable merging of the two accreditation systems.
- Administrative and financial burden – few programs perceived a benefit in quality with the increased regulatory burden of ACGME accreditation. A majority of closing programs cited financial burden as their reason for closing.
- Osteopathic identity and rural medicine – feared loss of osteopathic culture and tradition and concern for small, rural, and community-based programs.
DOs are more likely to go into family medicine and are more likely to practice in a rural area. It is important that the single accreditation system increases rural and community-based opportunities for all residents.
- Reach out to the Ohio Osteopathic Association (OOA) to offer support and to invite their leaders to attend a future OAFP board meeting to discuss; need coordinated action to ensure no net loss of primary care GME when/if residency programs close.
- Help facilitate partnerships between existing ACGME residencies and non-accredited AOA programs; encourage rural training or community medicine tracks.
- Explore and support changes in ACGME faculty requirements for family medicine residencies. Use non-family physicians for OB, pediatric, and adult in-patient faculty. This is a possible subject for a resolution for consideration at the American Academy of Family Physicians Congress of Delegates.
- Brian Bachelder, MD, and Mary Krebs, MD, both serve on the AAFP Working Group on Rural Health and will discuss the merger, its potential impact, and possible solutions with that group.
- Dr. Marcinek will write an article on this subject for a future issue of The Ohio Family Physician.
- Suggest to the Family Medicine Celebration CME Workgroup that a panel of OOA and OAFP members present on this topic at the 2019 annual meeting.