New Challenges and Opportunities ACOFP: OUR CONTINUING HISTORY 75 The growth of osteopathic colleges had previously been controlled by the number of osteopathic hospitals that offered graduate medical education training opportunities. As previously mentioned, the slow progressive loss of osteopathic hospitals began in 1969, when hospital corporations began to take control, either closing them or converting them to allopathic hospitals and dropping osteopathic hospital accreditation. This trend continued up to 2012, when the last osteopathic medical center was purchased in Pontiac, Michigan. Little did anyone realize or strongly articulate at the time that the loss of osteopathic hospitals would stifle the autonomy of osteopathic education to control its own destiny to expand or even control the direction of undergraduate and postgraduate training for its students. Clinical education of osteopathic students and residents had been forced to adapt by slowly moving training opportunities to community hospitals and large, private, nonacademic hospital networks. These were often located in areas of socioeconomic need where many osteopathic colleges were located and osteopathic hospitals had thrived in years past. Sadly, these hospitals did not always share the same mission of the schools to support osteopathic postgraduate training programs. The second issue was the long-standing invitation from the American Medical Association (AMA) dating back to 1969, that welcomed all osteopathic physicians to receive full unrestricted membership into its organization. This also included an open invitation to all graduating seniors to enter allopathic residency training programs and even certify with the American Board of Medical Specialists (ABMS). A similar measure to have medical students transfer medical schools before graduation was proposed but did not catch on. These practices would continue after the AMA-sponsored residency accreditation process was transferred to the ACGME. Though strongly opposed by AOA membership, even to the point of ostracizing those who did so, invitations to train in allopathic-accredited residency programs were accepted by a growing number of osteopathic medical graduates each year. Many simply desired a greater variety of residency choices, which only existed with ABMS, an affiliate of AMA. A majority of these residencies also led to subspecialty fellowships that were not available through AOA, so graduates often had little choice but to train outside the osteopathic profession if they wanted to train in one of the newer subspecialties. By 2014, more than half of osteopathic graduates each year were training in ACGME programs. A large number of those osteopathic graduates went on to certify with the member boards of ABMS, such as the American Board of Family Medicine, rather than AOBFP. Unfortunately, many of these graduates did not rejoin AOA or any osteopathic specialty organizations after receiving ABMS certification. This resulted in an alarming loss of young physicians to populate osteopathic national or state organizations and teaching institutions. AOA, having earlier lost all its osteopathic hospitals and the ability to accredit more hospitals to train the growing number of graduates, was now powerless to take steps to reverse this trend. Also, in 2014, ACGME was confronted with a conundrum of a different nature but just as pressing, which would make it more open to outside collaboration with AOA and its affiliate specialty organizations. Foremost was a surplus of unfilled ACGME residency positions, especially in critically needed specialties like
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