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Pros and Cons of Dual Accreditation
John B. Bulger, DO, FACOI, FACPDirector, Osteopathic Medical Education
Geisinger Health SystemAACOM Annual Meeting
June 25, 2004
Overview
• Is there a crisis? What do the numbers show?
• What are the pragmatic challenges to getting from here to there?
• Why would a hospital do this?• Vision for the future – integrated
medical education system which maintains osteopathic distinctiveness
Is there a crisis?
That depends on your perspective…
1993
1994
1995
1996
1997
1998
1999
2000
2001
0
1000
2000
3000
4000
5000
Number of DOs in AOA & ACGME Residency Programs Trend for the Years 1993-2001
AOA
ACGME
AOA/ACGME Task Force
DO’s in ACGME programs
624
1312
0
200
400
600
800
1000
1200
1400
Total
'96-'97
'02-'03
2.9%
6.0%
JAMA. 2003;290:1197-1202.
DO’s in ACGME programs
233
405
188
413
54
111
0
50
100
150
200
250
300
350
400
450
FP IM Peds
'96-'97
'02-'037%
14%
2%
5%
2%
5%
JAMA. 2003;290:1197-1202.
DO’s in ACGME programs
17
69
11
69
17
54
9
18
0
10
20
30
40
50
60
70
ER Surg OB IM/Peds
'96-'97
'02-'03
JAMA. 2003;290:1197-1202.
Overview
• Is there a crisis? What do the numbers show?
• What are the practical challenges to getting from here to there?
• Why would a hospital do this?• Vision for the future – integrated
medical education system which maintains osteopathic distinctiveness
ACGME program fees
• 5 or fewer residents = $2000
• 6 or more residents = $2500
• this yearly fee includes institution, site reviews, etc.
• extra charges except for new application fees, appeal fees, etc.
AOA program fees
• $300 per program
• $120 per trainee
• PLUS…
OPTI fees
• $5000 membership fee plus
• $255 per intern
• $255 per resident
• PLUS…
Extras
• AOA Dues = $60 per trainee
• AOA Dues for DME = $655
• AODME Dues for DME = $300
• DME Travel to AODME
• COH Dues = $2500 (optional)
IM Program ACGME Cost AOA Cost
Program Fee $2,500 $300
AOA/resident $1,440
OPTI/resident $3,060
AOA Dues $720
Total $2,500 $5,520
Our Example
ItemNumber of Trainees/ Programs
Cost per Trainee/ Program
Cost per Item
AOA Program Fees 3 $300.00 $900.00
AOA Trainee Fees 43 $120.00 $5,160.00
AOA Dues for Trainees 43 $60.00 $2,580.00
OPTI Fee 1 $5,000.00 $5,000.00
OPTI Trainee Fees 43 $255.00 $10,965.00
DOME AOA Dues 1 $655.00 $655.00
DOME AODME Dues 1 $600.00 $600.00
DOME Travel $2,500.00
AOA COH Dues 1 $2,500.00 $2,500.00
TOTAL $30,860.00
PD requirements
• Internship program directors and residency program directors must be:– AOA board certified– AOA members– Osteopathic specialty college members
Board certification
• 80% rule
• If you have enough DO’s – this can be a challenge– Year 1 – 1:2, 50%– Year 2 – 1:1, 66%– Year 3 – 6:6, 89%, but if 5:6, 78%
Overview
• Is there a crisis? What do the numbers show?
• What are the practical challenges to getting from here to there?
• Why would a hospital do this?• Vision for the future – integrated
medical education system which maintains osteopathic distinctiveness
Recruitment
What are residency programs looking for?
• Competent communication skills
• Possibility for staff recruitment
• Proven commodity
Recruitment
• $15,000 - $25,000 for primary care
• Up to $50,000 for certain specialists
Responses
AOAInternshipResidency
ACGMEResidency
AOA/ACGMEDual Accredited
Internship/Residency Total
Students % 5% 10% 83% 98%
(Number) (38) (75) (601) 714
Interns/Residents % 10% 8% 81% 99%
(Number) (174) (155) (1488) 1817
AOA/ACGME Task Force
Recruitment
IMG’s in ACGME programs
5033
5623
47004800490050005100520053005400550056005700
Total
'96-'97
'02-'03
24%
26%
JAMA. 2003;290:1197-1202.
IMG’s in ACGME programs
316
897
2574 2593
633 540
0
500
1000
1500
2000
2500
3000
FP IM Peds
'96-'97
'02-'037%
14%
13%
46%
51%
10%
JAMA. 2003;290:1197-1202.
6%16%
Overview
• Is there a crisis? What do the numbers show?
• What are the practical challenges to getting from here to there?
• Why would a hospital do this?• Vision for the future – integrated
medical education system which maintains osteopathic distinctiveness