The Problem

We are facing a shortage of approximately 55,100 Physicians

Why is this agreement bad for the physician pipeline?

In April 2014, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) agreed to unify their resident physician training programs into a single accreditation system that would follow the academic medical center model used by the ACGME. The agreement threatens that the progress that has been made with the use of community-based residency training programs that has facilitated greater access to healthcare for people living in rural and underserved communities and has made medical school more affordable for its students.

There are four major flaws with unifying the Community-Based Residency training model with the Academic teaching hospital residency training model.

  • First, unifying the models will lead to the elimination of the communityresidency training model. The communitybased residency training model, which relies on physicians who remain in full-time patient care to training the residents that they supervise, helps smaller residency training programs to provide healthcare services to rural and underserved areas. In contrast, the academic teaching hospital training model requires a physician to be involved in resident training fulltime, thereby removing that physician from direct patient care and greatly adding to a program’s operating expenses

  • Second, it will increase expenses associated with training residents and the overall cost of the GME program.   The communitybased residency model utilizes practicing osteopathic physicians, who volunteer their time often without compensation to train new physicians. This has kept the cost associated with operating a communitybased residency program down, allowed osteopathic medical schools to keep medical school tuition affordable, and in turn, leads to lower student loan debt.  By phasing these lower costs programs out and transitioning to the academic medical center model which requires that a physician’s income to be replaced in exchange for their training time, the overall cost of administering these GME programs under the agreement increases dramatically both at the institutions and ultimately as a result of requests for larger reimbursements payments from in the Medicare GME program. Additionally the elimination of programs in rural and underserved areas who cannot meet the size and scope of the standards under the academic teaching hospital residency model could lead to millions in federal dollars being spent on a program that could undermine federal efforts to address physician shortages in the U.S.

  • Third, it diminishes the ability of osteopathic medical graduates to be placed in residency training slots.  Currently the AOA accredits more than 1,000 residency programs that trains approximately 7,800 osteopathic medical graduates.  Approximately 1,200 osteopathic residents are being trained in ACGME-sponsored residency programs across the country.  Under the agreement, all residency training slots will be controlled by an ACGME-dominated board.  Eliminating the communitybased osteopathic residency training sites, potentially jeopardizes the ability of the 7,800 osteopathic medical graduates to secure a placement in an accredited residency training program.

  • Finally, the single accreditation system creates a monopoly in GME medical accreditation which has not been subject to any public or government examination.  Under the agreement and with the withdrawal of AOA as an accreditor, the ACGME will have sole authority to accredit all residency programs in the United States.  No other accrediting agency will be eligible to receive Medicare funds to maintain its residency programs.  Ultimately, this means that one accrediting body would have control of the anticipated $15 billion in GME funding.  The elimination of competition is contrary to the position taken by Members of Congress and the Executive Branch to promote competition and reduce medical costs across the health sector. 

The ACGME and AOA agreement for a single accreditation system fails to ensure accountability, transparency, and fairness in the GME program.  It also jeopardizes the gains that have been made in addressing the physician shortage and increasing access to healthcare services in rural and underserved communities.  To address this issue, Representatives Mike Kelly (R-PA) and Vern Buchanan (R-FL) have introduced H.R. 2373 which requires two or more accrediting bodies for the GME program.  The legislation also would grant the U.S. Department of Health and Human Services the authority to ensure that alternate accreditors are in place and continue to utilize GME as a tool to ensuring healthcare in rural and underserved areas.  This legislation will break up the monopoly proposed under the agreement and ensure the fair and equitable distribution of GME residency training placement slots for graduates of both osteopathic and allopathic medical programs.     

So why will this negatively impact osteopaths and the pipeline of primary care physicians?

Physician IncreaseThe Health Resources and Services Administration (HRSA) projects that the total supply of physicians, including residents, engaged in primary and non-primary care will increase 13 percent from 713,800 to 866,400 physicians between 2005 and 2020, while the requirement of physicians engaged in patient care will increase 22 percent from 713,800 to 921,500 physicians.

Ask your Member of Congress or Senator to support HR 2373 today.

There is a
Solution

Congress needs to identify and give authority to an alternative accrediting body to prevent the elimination of the community residency training program which has been successfully administered by the AOA for the past 30 years. By talking to your Congressman or Dean you can help!
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