CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.
The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.
The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.
As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”
Approximately half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.
In reference committee, AOA board member and trustee Karen J. Nichols, D.O., dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.
“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.
She reinforced her presentation with the results of two student surveys conducted this year: An AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs.
In the larger survey, 70% of students said they were in favor of a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.
Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs.”
Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA president Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.”
SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told FAMILY PRACTICE NEWS that the major determinants of students' residency choices are location and quality.
If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.
Other Issues at the House of Delegates
▸ End-of-life care. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.