The Single Graduate Medical Education (GME) Accreditation System Will Change the Future of the Family Medicine Workforce

Discussion

Our findings suggest that the increasing numbers of physicians educated in osteopathic medical schools entering training in ACGME-accredited family medicine residency training programs has had a substantial impact on the composition of trainees preparing for careers in family medicine as well as electing for certification by the ABFM. As noted in Table 1 and Figure 1, both the number and proportion of IMG-MDs are decreasing while the number and proportion of USMG-DOs are increasing. The increase in the number of DOs should not be surprising as the number of first-year enrollees in osteopathic medical schools has more than doubled since 2001.² Furthermore, in 2013 the National Residency Matching Program (NRMP) instituted their “All-In” policy, which that stipulates residencies participating in the Match cannot sign applicants outside of the Match³, potentially eliminating the ability of IMGs to sign outside of the match and increasing their direct competition with USMG-DOs for Match spots.⁴

The work of Biggs et al⁴ and Kozakowski et al⁵ provides a framework for understanding trends in the volume and training of medical graduates entering family medicine residency. Their analyses of the NRMP are strikingly similar to our findings, confirming the increase in osteopaths entering family medicine training. Like our data, however, these analyses were limited in that they considered only ACGME-accredited programs.

Interestingly, Kozakowski et al⁵ note that the number of US citizen IMGs entering residency is increasing while the number of non-US citizen IMGs is declining.

When osteopathic physicians graduate from an ACGME-accredited or dually-accredited ACGME/AOA residency program, they are eligible to certify with 1 of the 24 member boards of the American Board of Medical Specialties (ABMS), 1 of the 18 specialty boards of the AOA, or both. Recent estimates indicate that 75% of licensed physicians in the United States hold a certification from an ABMS board⁵, whereas only 38% of osteopathic physicians held an ABMS board certification. Similarly, only 40% of licensed osteopathic physicians were found to have a certification by an AOA board.⁶ Given that ABMS and AOA boards typically do not share information about their diplomates with each other, the number of osteopathic physicians who hold certifications from both ABMS and AOA member boards is not known. One survey of osteopathic program directors of dually accredited family medicine residency programs reported 66% of program directors indicated that less than half of their program’s osteopathic graduates elected to certify with both the ABFM and the American Osteopathic Board of Family Practice.⁷ Another study⁸ found that approximately 86% of residents in dually accredited programs were opting for ABFM certification.

Significant changes in ACGME family medicine program requirements most likely affected the rate at which osteopathic residents elected to take the ABFM certification examination. In 2013, the ACGME approved new program requirements for family medicine residency training that went into effect on July 1, 2014, requiring that 95% of a program’s graduates would have taken the ABFM certification on a 5-year rolling average (V.C.4) in addition to the requirement that 90% of the graduates pass the ABFM examination (V.C.5).⁹ In an effort to assist program directors with meeting the ACGME’s new Take-Rate requirement⁹, in 2012 the ABFM changed the timing of the certification examination from July to April.¹⁰ Moving the examination date before completion of residency allowed program directors to encourage the examination-taking behavior of their residents to meet the new Take-Rate requirement. This likely had a direct impact on the increased Take Rate noted for osteopathic residents who had trained in dually accredited programs.