Combined Residency Programs

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Combined Residency Programs

• Meeting Accreditation Standards of Both the ACGME
  and AOA

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This presentation can be downloaded in its
entirety athttp//www.com.msu.edu/scs/info/down
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Presentation Goals

• Depict trends for osteopathic graduates.
• Explain reasons for combined programs.
• Describe various types of relationships.
• Explain benefits/costs of such programs.
• Describe our combined residency.
• Forecast the future of such programs.

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Sweet S JAOA 2000671-680.

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Sweet SJAOA 2000671-680.
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Swallow CSJAOA 2000681-690.
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Swallow CSJAOA 2000681-690. Botherton
SE JAMA 2001 1056-1060.
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Source Unpublished data from AOA..
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DOs in ACGME Programs

• Insufficient number of positions
• Policies American Osteopathic Association
• College-based internship programs at JCAH
  Institutions
• Approval of ACGME internship training
• Approval of ACGME residency training
• Shrinking of Osteopathic Hospitals

Meyer CT Acad Med 1992810-816.
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DOs in ACGME Programs

• Perceived higher quality training programs
• Better resources and facilities
• Reputation of the program
• Greater career enhancement opportunities
• Financial reasons
• Research opportunities
• Preferred geographic location

Pecora AA JAOA 1990527-533.
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ACGME Programs Wanting DOs

• Declining interest of US graduates in primary
  care residencies
• Decreasing fill rate of residency programs
• Balanced Budget Act of 1997 (PL 105-33)
• Increasing dependence on IMGs
• Attract DOs through the NMRP or in a relationship
  with an AOA program

Cummings M Acad Med 1999949-50.
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DOs in ACGME Programs

• 4,175 DOs in ACGME residencies (4)
• Anesthesiology 167
• Emergency Medicine 254
• Family Practice 1,057
• Internal Medicine 916
• Obstetrics/Gynecology 210
• Pediatrics 334
• PM/Rehabilitation 134
• Psychiatry 197

Brotherton SEJAMA 20011057-1060.
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Combined Allopathic and Osteopathic GME Programs

• College-sponsored internships (1995)
• Curricular requirements of AOA internship grafted
  onto family practice residency
• An integrated ACGME/AOA Emergency Medicine
  Residency Program (1986)
• Slow but steady growth of residency programs
  during the past 15 years

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Educational Relationships 1st Generation Programs

• Osteopathic Internship with an existing ACGME
  residency program (FP or IM)
• Meet standards of two accrediting agencies
• Slightly different rotational experiences
• Minimal participation of DO faculty
• Trainee moves directly into PGY 2 year of AGCME
  program
• Osteopathic component small in comparison with
  over-all size of ACGME program

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Educational Relationships 2nd Generation Programs

• Partially Integrated Model- Separately meets
  AOA/ACGME residency requirements
• Dedicated positions for MDs and DOs
• Rotational experiences may be similar
• More participation of DO faculty
• Trainee completes AOA/ACGME requirements
• Dual reporting and accounting mechanisms
• Dual contracting for osteopathic residents

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Educational Relationships 3rd Generation Programs

• Integrated (parity) Model Single residency
  meeting ACGME/AOA requirements
• Positions for either MDs and DOs (best
  candidate approach)
• Rotational experiences virtually identical
• Complement of both DO/MD faculty
• Program insures AOA/ACGME requirements
• Single reporting and accounting mechanism

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Advantages of a Combined Program

• Develop a larger applicant pool
• Garner additional resources
• Improve environment for our residents
• Expand the number of residency positions
• Strengthen and expand our faculty
• Improve our residencys position in the hospital

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Costs of a Combined Residency Program

• Additional Inspection
• Additional Fees
• Additional Paperwork
• Training of Osteopathic Principles
• OPTI Involvement
• Additional faculty

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Accreditation Parallel

• Five Organizations
• ACGME
• RRC
• Site Survey

• AOA
• COPT
• Specialty College
• Inspector

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Lessons Learned from our Combined Program

• Understanding the residency requirements
• Knowledge of the ACGME and AOA
• Disclosure-hospital and accreditation bodies
• Flexible administrative structure
• Incorporation of osteopathic principles
• Driving out advantages of dual accreditation

Hayes OW JAOA 1998647-653.
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Forces Affecting Combined Programs

• Neither the ACGME nor AOA identifies or track
  such combined programs
• Action by ACGME or RRC could encourage or blunt
  development
• Additional expenses accreditation, marketing,
  managing paperwork, leadership and faculty costs,
  and osteopathic principles

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Perspectives for the Future

• From the osteopathic viewpoint
• Shrinkage of osteopathic hospital system
• Formation of OPTIs centralized approach
• BBA limiting growth of residency programs
• No formal policy yet on combined programs
• Outlook is favorable
• Development requires policy changes

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Perspectives for the Future

• From allopathic perspective
• Directly related to manpower needs
• Why incur costs if already attracting DOs?
• Upper threshold limit assumption
• Opportunities still exist for affiliation
• Overall favorable especially for programs with
  large numbers of IMGs.

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Summary

• Our experience with combined program has been
  very favorable.
• One of the only growth areas left for osteopathic
  GME.
• Some advantages for ACGME programs for this
  educational relationship.

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