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DO-MD Merger: What the Single Accreditation System Means for Students

6 min read / Medical School

Significant changes to medical education always take time to roll out. The gap between an official announcement and the date when a new process or system actually begins is often so long that it can easily sneak up on you. Look no further than the DO-MD merger, which combines the allopathic and osteopathic graduate medical education accreditation systems, for proof.

The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) announced an agreement to move toward a single system for accrediting residency programs back in 2014. But the change officially takes place July 1, 2020. Residencies will no longer be MD versus DO—they’ll all be grouped together.

Now that the transition to the single system is right around the corner, current and soon-to-be medical students have started to take notice. What does the DO-MD merger mean for your future? Will you face new obstacles or advantages?

The good news is that moving to one system is a lot less scary than it sounds. Here’s a breakdown of what every medical student should know about the future of residency training.

Why are the accreditation systems merging?

Many medical students wonder why changing to a single system is necessary. If having separate accreditation standards for DO and MD residencies has worked fine thus far, why rock the boat?

While combining the two accreditation systems has taken a considerable amount of effort, it’s for good reason. The ACGME highlights numerous benefits of consolidating into a single system, including:

  • Lower costs and improved efficiency from eliminating duplicate accreditation
  • Consistency in how residents and fellows are evaluated
  • Uniformity in the pathway to residency for all medical students
  • Greater opportunities for osteopathic graduate medical education

You can see that the intention is to create a simpler, more equitable system that still respects both allopathic and osteopathic medical education. Programs can even, if they wish, obtain Osteopathic Recognition to demonstrate a commitment to teaching and assessing DO principles.

What do residency programs have to do?

Before digging into the differences between DO and MD residency programs already meeting their respective standards, it’s useful to understand the typical ACGME accreditation process. Any new program seeking this credential needs to do a fair amount of legwork. A physician involved in launching a categorical pediatric program wrote a journal article highlighting the need to first build a solid foundation by establishing an institutional affiliation and training site, securing funding, and laying out a reasonable timeline.

New programs then need to complete an application and ensure they meet established standards to participate in the Match. A site visit is also a part of the accreditation process. These are conducted to ensure programs are compliant with all requirements, which fall under three categories: Institutional Requirements, Common Program Requirements, and Program Requirements—specific standards established for different specialties.

For programs that are already accredited by the ACGME, they simply need to maintain the same standards they always have. That’s true for programs that have dual-accreditation, too. But achieving this benchmark is not a onetime effort. Programs are expected to submit data annually. If the numbers suggest a problem, the program may be subject to another site visit. And every program will undergo a site visit once every 10 years.

AOA-approved programs will need to transition to ACGME accreditation, and they can do so via three pathways. Once an AOA-approved program has completed the initial ACGME application, it will be given a pre-accreditation status. After a site visit, the program will either move to initial accreditation or remain in pre-accreditation status if the program fails to meet any requirements. That program can continue to seek accreditation, but AOA-approved programs must receive an initial accreditation status by June 30, 2020, in order to continue training residents.

How does the merger affect students?

The merger should really be an exciting announcement for medical students. They’ll have equal access to a vast array of residency programs. MD students, in particular, are now eligible to apply for many residency positions that once weren’t available to them. If all the programs participating in the AOA Match transition to the new system, that would increase the available first-year residencies by more than 1,200 positions.

It’s also important to point out that allopathic graduates can complete their residency training at a program that’s achieved Osteopathic Recognition. The ACGME notes these programs will expect MD graduates to demonstrate knowledge of osteopathic teaching and training, but they can do so in a variety of ways. Graduates may need to have gained experience by completing osteopathic elective rotations, for example. They may even need to complete a structured onboarding program.

While some have expressed concern that DO students will be at a disadvantage without a pool of residencies reserved solely for them, they actually stand to reap certain benefits. For starters, they no longer have to go through two separate application processes to access all the first-year residencies.

Furthermore, students attending osteopathic medical schools don’t have to take multiple sets of licensing exams to apply to every program. Previously, DO students needed to complete the United States Medical Licensing Examination (USMLE) series in addition to the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) sequence if they were interested in applying to both DO and MD residency programs. Now, both licensing exams will be equally recognized.

The advice for all medical students wanting to secure their choice residency program is the same both pre- and post-merger: work hard in school and score as high as you possibly can on your licensing exams.

Are current DO residents going to face additional hurdles?

One thing you may have noticed earlier is that it’s possible some osteopathic residency programs will cease to exist after the DO-MD merger is complete. But the doom-and-gloom messages you may have heard are likely overstated. Many programs have successfully made the transition, and there will be more to come.

What about residents currently in DO programs that don’t make the June deadline? It isn’t a dire situation. There’s a plan in place for these individuals. The ACGME, AOA, and AACOM reached an agreement to allow these residents to complete their training and advance to AOA board eligibility. In some cases, they may be able to transfer to an ACGME-accredited program as well.

Get yourself ready for residency

While the DO-MD merger for graduate medical training shouldn’t really change how you approach applying to residency programs, you still need to put your best foot forward. That means securing the best licensing exam scores you can, acquiring excellent letters of recommendation, and being thoughtful and honest during interviews.

It’s never too early to start thinking about how you can prepare for residency interviews, either. Practicing is actually one of the best ways to ensure you’ll represent yourself well. Learn more about how you can get ready for these all-important conversations by reading our article “Experts Share Residency Interview Preparation Tips for Medical Students.”


November 6, 2019