Pros and Cons of Dual Accreditation John B. Bulger, DO, FACOI, FACP Director, Osteopathic Medical Education Geisinger Health System AACOM Annual Meeting.

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