76 New Challenges and Opportunities family medicine. There were simply not enough American MD graduates choosing to enter those understaffed residency positions. Graduates of osteopathic colleges, on the other hand, were filling those open positions and applying to those family medicine residences in greater numbers every year, at some point making an alliance with AOA a growing necessity. Another issue for ACGME arose in 2011, when it began instituting a major change in its accreditation framework known as the Next Accreditation System (NAS). In short, the NAS would continue to allow graduates of nonLiaison Committee on Medical Education (LCME) member schools to enter ACGME-accredited programs for residency training, but the NAS requirements also explicitly barred those same graduates from entering fellowship training in the ACGME-accredited subspecialties. This was a challenge that would not only negatively impact a significant number of AOA-accredited residency graduates, but it would also affect many international medical graduates who had trained in ACGME residencies and were not graduates of LCME-accredited schools. Osteopathic graduates from both AOAaccredited residencies who wished to enter subspecialty training within ACGME could potentially be impacted by that specific NAS requirement. There also was no apparent recourse for these graduates, including providing an alternate pathway for those ACGMEaccredited DO graduates to enter subspecialty training in the same system that accredited their residency training. The residency graduates’ inability to enter subspecialty fellowship training would be the breaking point that sparked an immediate request from the AOA Board of Trustees to ACGME leadership for an emergency meeting to resolve this problem as quickly as possible. From that meeting, ACGME, AOA, and AACOM would agree to immediately form a task force composed of members from all three organizations to come up with a mutually agreeable solution. ACGME would be the organization that proposed the final workable resolution to solve this problem. It would be an innovative and truly historic Memorandum of Understanding (MOU) outlining a plan suggesting that the organizations agree to combine the residency accreditation activities of ACGME and AOA into a Single GME Accreditation System (SAS). ACGME paused NAS implementation to allow a mutually agreed upon transition process to roll out over a five-year period starting July 2015. At the same time, osteopathic GME accreditation activities of AOA would cease by June 30, 2020. ACGME would then manage all the accreditation activities from that time forward for all MD and DO medical school graduates entering GME residency programs in the United States. It is important to note at this point that the Single Accreditation System only combined the administrative structure, curriculum delivery, and adequacy of clinical training and did not combine board certification, which remains a separate process within the respective AOA and ABMS specialty and subspecialty boards for certification, and licensure, which remains a function of the state licensure boards. In return for AOA and AACOM agreeing to join a SAS under ACGME, the two osteopathic organizations would gain the following: • AOA and AACOM would become member organizations of ACGME, and each one would occupy four seats on ACGME’s Board of Directors. AOA would serve as a nominating organization to the Review Committees (RC) of the ACGME.
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