It’s the year 2019 and the last American Osteopathic Association (AOA) Residency Match was completed on February 4th. This coming spring, there will be a single match for US programs that will all be accredited by the Accreditation Council for Graduate Medical Education (ACGME).
The transition from independently accredited AOA and ACGME residencies into a Single Accreditation System (SAS) officially started on July 1, 2015. The process was based on some big expectations outlined in the SAS agreement between ACGME, AACOM, and the AOA back in 2013. In the first part of the agreement (there are actually four parts), they outline a facilitated accreditation process for the AOA to stop accrediting GME programs and transition the previously AOA accredited residencies into ACGME accredited programs. This process ends in June 2020.
There’s been a lot of info out there on the general SAS process but it can be a little harder to find information on orthopedic surgery programs specifically. Our last blog post on Breaking Down the Lingo was way back in 2016 and it’s time for an update!
How is this supposed to go again?
All AOA programs who wish to continue training residents after 2020 must apply for ACGME accreditation. After submission, they are granted “Pre-accreditation” status. Once the program passes the site visit and the review by the Orthopedic Review Committee, they are granted “Initial Accreditation”. At this stage, a program can start to accept residents through the ACGME match.
From there, the program will have another site visit within 2 years. At that point, the program will be granted one of four possible statuses.
1. Withdrawal of Accreditation – the program will be closing.
2. Initial Accreditation with Warning – there are some issues that need to be addressed before another site visit in a year.
3. Continued Accreditation without Outcome – the program is doing well but there isn’t enough data to be granted Continued Accreditation just yet. For the AOA ortho programs, this is a common result because two years of graduates does not provide enough data for them to accurately assess board pass rates. Another site visit review will need to be done within 6 years (length of training program + 1 year)
4. Continued Accreditation – You’re in! Basically, the program then follows the regular oversight protocol. They have to submit yearly data and also have a site visit every 10 years.
How are things going?
That depends on who you ask. According to American Osteopathic Association, “89% of AOA-accredited programs that applied to the ACGME through the transition are now accredited” and “nearly 40% of all ACGME programs now have at least one DO in training”.
But if you look at the orthopedic surgery programs, things aren’t quite as rosy. Here are some of the numbers since April 4, 2019.
41 programs have applied for ACGME accreditation
24 programs have achieved at least Initial Accreditation and will be participating in the 2020 match
- 2 of these programs have Initial Accreditation with Warning
- 3 of these programs have Continued Accreditation without Outcomes
It has certainly been a challenging process. Perhaps some of the biggest issues come from the community based model of most osteopathic ortho programs. ACGME requires an institution to have in-house general surgery and pediatric residencies. They also do not like the consortium model of training (out rotations for specialty training) because of the lack of centralized oversight. For many osteopathic programs, this was a way for residencies that are primarily community based to also train residents at Level I trauma centers and pediatric hospitals. There are also research and academic activity requirements for faculty that community/private practice based attendings may struggle with because it is not a part of their reimbursement structure. There has also been a tremendous administrative burden in applying for review and figuring out how to address citations with adequate and appropriate data.
The American Osteopathic Academy of Orthopedics (AOAO) executive director, Dr. Lee Vander Lugt, has been active in the transition since the beginning and wrote about where we’re at for the Orthopod. We also recorded a podcast together on the topic that will be released soon. Ultimately, he remains hopeful that the vast majority of the AOA orthopedic programs will be accredited by the deadline.
To do so via the single accreditation system pathway, there are three more opportunities to be evaluated by the ACGME orthopedic review committee. They are: September 14, 2019, January 17-18, 2020, and April 17-18, 2020.
When planning away rotations for this year, this timeline is really important. Match Day will be March 20, 2020 but rank lists open on January 15th and will need to be certified by February 26th. If a program is not granted initial accreditation until January, there is very little administrative time for a program to receive, review, and interview students between their accreditation date and the rank list due date. Unfortunately, there is no public reporting of who has submitted an application for review for the September 14, 2019 date so questions will need to be directed at the programs individually.
To get up-to-date public information on the accreditation status of the programs going through the transition, go to the ACGME SAS site, select “orthopaedic surgery” in the drop down menu, and run the report.
What about the programs that do not get ACGME accredited?
The original agreement has been amended to allow the AOA to continue accrediting the current residents until they graduate. According to the AOA site, “the agreement will give the AOA restricted authority to extend the AOA accreditation date to allow any remaining resident in such programs to complete training in an accredited program.” I’m not sure exactly what that will look like but this is something that will need to be addressed soon.
Needless to say, this is going to be a very interesting application year in the osteopathic orthopedic world. Sign up for the mailing list to stay on top of updates.