In 2014, the two governing bodies of allopathic and osteopathic graduate medical education the ACGME (Accredidation Council for Graduate Medical Education) and the AOA (American Osteopathic Association) agreed to move toward one single accreditation system (SAS) for all residencies. Though many advances have been made since then, the results have only begun trickling down to medical students and residents.

It stands to reason that, since ACGME-accredited residencies already trained about 50% of osteopathic graduates, combining all GME accreditation under one organization would benefit both. One really good thing to come out of the merger is a greater recognition of osteopathic applicants at traditionally MD-oriented programs, a trend that will continue as the SAS fully manifests itstelf. With this in mind, I’ll lay out some of the changes happening right now under the SAS, and what they mean for you.

Current status of the SAS

The idea behind the SAS is that all AOA accredited programs will eventually be accredited by the ACGME, while the ACGME will have osteopathic representatives in its governance. Beginning in July 2015, AOA programs were able to start applying for ACGME accreditation.

An AOA program can become pre-accredited, which means it has initiated the process of ACGME accreditation. It can then become initially accredited after a site visit to confirm compliance with ACGME standards. Two years after initial accreditation, another site visit will take place to determine if the program is granted continued accreditation. AOA programs pursuing ACGME accreditation must achieve initial accreditation by June 2020.

To preserve osteopathic principles and practices being taught in residency, a program may also apply for osteopathic recognition. Once a program is recognized and accredited by the ACGME, both osteopathic and allopathic graduates may apply to these specially recognized programs.

Implications for The Match

For now  and until most programs are accredited by the ACGME  there are still two matches, one on the AOA side and one on the ACGME side. There will most likely be a single match by 2019. For now, it’s up to the applicant to research which programs are dually accredited or in the process of being accredited, which match the program is participating in and how many of their positions will be available in either match.

Implications for the COMLEX

The COMLEX isn’t going away. Osteopathic students are trained with an osteopathic curriculum and therefore will most likely always be assessed with an osteopathic exam. However, with the SAS more programs are going to recognize the COMLEX as legitimate and be able to interpret the scores more effectively. As of now, 77% of allopathic residencies accept the COMLEX  a figure that varies by specialty, region and program. Again, the applicants themselves must research which programs take only the COMLEX.

Implications for AOA programs

Most AOA programs won’t have trouble obtaining ACGME accreditation. That being said, problems are arising in smaller AOA subspecialty programs that don’t have the volume or staffing to comply with the somewhat more stringent ACGME standards. As a result, some of these programs are being forced to cease accepting new residents in anticipation of not attaining accreditation.

Implications for Fellowships and Board Certification

In general, with the SAS more fellowships are becoming available to AOA residency graduates, but this isn’t true across the board. Applicants should look into the ACGME eligibly requirements to determine which fellowships they are eligible for.

With all AOA residencies becoming ACGME-certified, most osteopathic residents will have a choice as to which specialty boards they’d like to take. This may lead to a competition between allopathic and osteopathic specialty boards as more residents take their particular exams.

Implications for medical students

All osteopathic students applying this year to current AOA accredited programs need to ask these programs a few questions:

1. Does your program intend to apply for ACGME accreditation and, if so, how far along in the accreditation process are you?
2. Does your program plan to apply for osteopathic recognition?
3. Which match(es) do you plan on participating in?
4. What are my board certification options graduating from your program (allopathic vs. osteopathic boards)?
5. What are my fellowship options graduating from your program?

Final thoughts

One last implication of the SAS is a change in the landscape of residency spot competition. Traditionally, AOA residencies were only available to osteopathic graduates. Thanks to the SAS, these spots will be available to US allopathic graduates and foreign medical graduates alike, opening up the market and decreasing the protection that these spots once had. Of all the complex elements of the merger, this is  one thing all eyes will be on as the SAS continues onward.