Letter to AOA on ACGME merger: Problem & new solution

Dear AOA Pres. Dr. Vinn, et al.

This letter is in regard to, “Single accreditation for MDs and DOs by 2020,” in family practice news this month. We have been told by former AOA President Dr Ray Stowers that in recent years Osteopathic schools proliferated too quickly and created the need for more residencies than AOA could supply and government could fund. We were then told last year that the only solution would be to combine our Osteopathic GME with allopathic MD ACGME. In the article Dr. Vinn states, “… But Osteopathic training programs will still retain their unique focus.” He goes on to say, “this is an opportunity to both reinforce and proliferate or principles.” The question I raise is how is it possible to train, reinforce our principal teachings, philosophy and skills while not experiencing the potential disaster of the California experience of 1960?

As a product of, and believer in Osteopathic principles, schools, internships, residency training, postgraduate fellowships and CME, I believe our programs offer unique and distinct advantages over the other possibilities that exist. This unique Osteopathic approach to training, education and practice must be maintained for the betterment of human health. Under the plan to merge osteopathic graduate medical education with ACGME we would be absorbed, overrun and thereby changed to accommodate only the allopathic practice model.

Osteopathic graduate medical education has always strived for independence and excellence. This merger of programs would be a catastrophic mistake in the history of osteopathic medicine. Our DO distinctiveness would disappear from the practice of medicine of the merger goes to completion. The logical sequellae of the merger would be the loss of Osteopathic Medical philosophy in practice, as well as, all of our DO program directors will lose their jobs by the merger completion date of 2020.

I offer the DOs COMITT alternate plan to save Osteopathic training programs: The first step would be control of and smart steady growth of osteopathic schools, not uncontrolled proliferation. Osteopathic training programs produce diverse physicians with a large number of primary care specialty physicians including family medicine, pediatrics, gynecology, etc. The second step is the AOA to bring the data of our current primary care programs’ output to the government authorities and Congress that authorizes money for training programs. If we can mount a organized and cogent movement to convince the Congress and government leaders to champion the cause of primary care specialty training, they will support it for the good of the country’s health and their own political goals. Please consider this approach previous to your acceptance of the ACGME merger program which would destroy our osteopathic integrity.


Best wishes for good health,
Craig M. Wax, DO
Family physician, Editorial Board of Medical Economics
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax
Independent Physicians For Patient independence @IP4PI

3 thoughts on “Letter to AOA on ACGME merger: Problem & new solution

  1. Hello, Craig,

    I appreciate your thoughtful and passionate letter. As a physician “in the trenches”, I am not privy to the reasons behind the decision to allow the rapid growth of osteopathic training facilities that you mentioned. But it would take only a short moment to realize that the result of this would be that there are now many osteopathic medical school graduates who will not be able to be trained in purely osteopathic residencies. Indeed, this has been a true statement for several decades.

    But I am not as pessimistic as you seem to be about the implication that the “merger of programs would be a catastrophic mistake in the history of osteopathic medicine.” I was once the original osteopathic family medicine residency director at a combined allopathic/osteopathic program. I have been interested to see how that has fared over the last 10 years. What has, in fact, happened is that those osteopathic students who were interested in OMM have maintained and strengthened their interest by reaching out to mentors in their communities. As part of that process. there has indeed been a greater exposure of our principles to both allopathic residents and faculty. With this has come a better understanding and consequent acceptance of our training as having value and effectiveness.

    Medicine, in my experience, generally gradually embraces effective principles especially when the main driving reason for their existence is to improve patient outcomes. I have spoken with many of the osteopathic leaders who have been part of the discussions that have led to this ACGME merger. Time will tell whether your prediction of catastrophe proves to be right or not. But I submit that the osteopathic principles which have guided my professional career are deep, strong, and are being enthusiastically endorsed by or osteopathic students and patients alike. As such I am not worried about the future of our profession.

    The love of students for translating scientific principles into patient-specific treatments for the relief of their suffering is an inestimable power. It is the purity of that commitment, as it is taught in our schools, nourished by mentors, and instilled as a guiding principle in the mature physician that separates the osteopathic profession from all others and makes it unique. It is the individual D.O., therefore, that is the steward of our osteopathic legacy. It is the individual physician who is the purist manifestation of the ideal of our profession – an ideal that states that the honor of truly caring for another human being is more than enough compensation for the sacrifices necessary to fulfill that role. Despite the government and insurance regulations, long hours, and opportunity cost for pursuing and perfecting our craft, there is simply the opportunity to benefit of our fellow human beings and to simultaneously develop and use all of our talents in that quest. For us, this is enough. This is what matters.
    The magic that is our profession takes place when a knowledgeable, caring osteopathic physician meets a patient in need. Unlike politics or sports, these encounters will usually take place behind closed doors. Technology will help physicians have the right information at the right time to do their job better. But the real, unsurpassed in all the world, wonder of our profession occurs when a physician looks into the eyes of his or her patient and simply knows enough about that patient without consulting an electronic record, to shut everything else out, look into the patient’s eyes, and ask, “What happened?”
    These are the traits for which the osteopathic profession has come to be known. This is not by accident. This is the standard that has been created by the physicians who founded our profession, and continues to be passed down to our students and actively practicing physicians. This is the standard that will be passed on to future physicians. This standard is what motivates me, and I know it is what motivates many of my colleagues. Programs will come and go. Fear not. The roots of our profession are far too deep to allow the whirlwinds of initiatives to shake us.
    This is a time of great change in the healthcare arena. Our current, and upcoming physicians, stand ready to make the adaptations necessary to continue our osteopathic heritage, strengthen it, adapt our methods, incorporate new tools, and explore new ways to help relieve and/or eliminate human suffering. What will not change is our commitment to use the best of our ability to take care of our patients. This is our overriding goal. Programs, methods, and technology will all change. Our ability to adapt our knowledge the good of the patients we serve will not change. Because of this, our profession is in good hands. It always has been. It always will be.


    Theodore W. Shively, DO
    PrimeCare of Novi
    Novi, MI

  2. Dr. Shively,

    Thanks for your reflections, understanding and thoughts on the future of Osteopathic Medicine. As a solo Osteopathic Family Physician in private practice, I see the “Stakeholders,” government, insurance companies, hospital corporations, big pharma, big data/EHR industry and others strangling our “finding health approach” to death by countless rules, regulations, laws and denial of payment schemes. Unfortunately, when the patient consumer is uncoupled from payment, their interest, understanding, motivation and compliance changes drastically. When patients are responsible for the care they receive, they are invested and have personal interest in the goal of successful health. I see the patient as the only relevant “Stakeholder.”

    I also believe that the truth of the Osteopathic medicine will rise up, however, it cannot support the weight of the false, “Stakeholders.” Atlas must shrug.

    Best health,
    Craig M. Wax, DO

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