Ensuring a Successful Transition From AOA to ACGME Accreditation

June 2020 may seem like it’s a long time from now. But for leaders of osteopathic graduate medical education (GME) programs, that date is already significant.

By June 2020, osteopathic GME programs – those currently accredited by the American Osteopathic Association (AOA) – must secure accreditation through the Accreditation Council for Graduate Medical Education (ACGME) under the Single Accreditation System (SAS). Obtaining ACGME accreditation is a multistep, often multiyear, process for new residency programs. But to meet AOA-imposed deadlines, training programs four years and longer must condense this timeline and submit their applications by January 1, 2017, giving them just a couple of months to complete this process.¹

This tight timeline is creating a sense of urgency among osteopathic GME administrators, who are rushing to develop transition strategies. Sponsoring institutions need to focus on developing a clear understanding of the ACGME requirements, then translating that into a structured approach that considers the major differences between running an osteopathic GME program and operating a GME program under SAS. The process should reflect operational, financial, and strategic implications associated with the transition. In particular, hospitals will likely need to complete a rapid gap analysis and remediation plan, develop application materials, and prepare physicians for a different type of site visit.

Impact on Program and Hospital Operations

Osteopathic program leaders need to consider the differences between typical osteopathic and allopathic residency programs as they prepare for ACGME accreditation. For example:

• Smaller osteopathic programs may have to increase program size to fulfill ACGME requirements
• Without restructuring or redesigning their curricula, osteopathic programs may be challenged to fulfill stricter minimum clinical volume and experience requirements stipulated by the ACGME
• Osteopathic programs have long been characterized by one-on-one teaching, which will likely need to change to a more resident-team-based approach as part of SAS
• Programs may be required to more clearly define and document faculty performance expecta-tions, and this may necessitate renegotiation of physician contracts and/or changes to faculty arrangements

Impact on GME Finance

Organizations will also need to understand and plan for the financial impact of adjusting to the operating model. The magnitude of the financial impact will likely vary according to a number of factors, including:

• Number and size of programs making the transition
• Program-specific requirements related to program director, coordinator, and faculty protected time
• Historical reliance on faculty volunteerism
• Current fixed and variable cost structure
• Current level of investment into the existing GME programs (e.g., facilities, technology)
• Opportunities for cost savings through collaboration and partnerships (e.g., with existing Osteopathic Postgraduate Training Institutions [OPTIs], allopathic or osteopathic medical schools)

Strategic Considerations

As with any major transition, many organizations are using this opportunity to reevaluate the size, mix, and distribution of residents to ensure alignment with delivery system strategies. As GME leaders have conversations with health system, hospital, and physician leaders regarding the changes that are taking place with the transition, it is important to be able to clearly articulate the ways in which the existing GME programs support the organization’s strategic imperatives now and into the future.

Questions warranting consideration include:

• How do the current programs support the organization’s overall strategy?
• Are there service lines or signature programs that the residency programs support?
• Do the programs support partner or community strategies?
• How would the absence of the programs affect day-to-day operations, community stand-ing/reputation, patient access, physician workforce development, and so forth?

The transition to SAS calls for a thorough evaluation of existing and potentially available resources, a critical assessment of gaps, and the development of a detailed implementation and communication plan to ensure that the organization can continue to provide high-quality educational experiences for the physicians of the future. Success will not be measured by the completion of an application packet alone, but rather by the long-term impact that the GME programs have on the hospitals and communities in which they operate and on the physicians that they train.

Published November 9, 2016