The gorilla in the room and what are we going to do about it!?!

Last night I presented a consultant training webinar for the AOA’s Bureau of OGME Development.   Check out the link if you are interested.  One of the astute questions (and I’m paraphrasing) was: 

What is the AOA going to do about GME when the American Association of Medical Colleges (AAMC, organization of MD schools, organization of schools that are accredited by the Liaison Committee on Medical Education (LCME) – the accrediting body for MD schools) just announced that their numbers of graduates will be up 27.6% by 2015?  (Adding the DO graduate increase will bring that total to 35%)

This is the gorilla in the room!!

The short, analytical answer is:  barring significant paradigm shifts, the numbers do not and will not compute.  One can sugar coat this problem as much as they like, but without significant change, 1 + 1 will not equal 10.

This is why I think that change will happen…shortly.  This is also why I think that it is critically important that we stop living in the OGME past.  There are many calls for reform out there (COGME, Macy, ACP).  We pride ourselves on being nimble and efficient.  Do we have the vision (and the drive) to heed these calls and change?

Some of the most obvious change targets which I will discuss over the next several weeks are:

·         Providing training where patients receive their care.

·         Encouraging team-based training in our residency programs.

·         Changing the national financing structure of OGME.

·         Looking to alternative institution sponsorship of programs (not to be confused with academic sponsorship).

Who will we lead this change? 

There will be a new generation of leaders in OGME (and I am in no way suggesting that I am one of them).  There are currently around 78,000 DOs in the United States.  There are over 18,000 students enrolled in our schools.  One doesn’t need Excel to do the math.  The tipping point is near.  This is not a doomsday prediction and don’t even believe that this is hyperbole.

I would suggest that our biggest problem right now is that an OGME educator farm system does not exist.  Even worse (yes another sporting world analogy) we do not have any bench strength.  This is what keeps me up at night!

Almost all know the oft quoted warning from George Santayana’s The Life of Reason:  “Those who cannot remember the past are condemned to repeat it.”  This is sometimes used to suggest that absolute change is good and the past was bad.  The overlooked preceding lines state:  “Progress, far from consisting in change, depends on retentiveness. When change is absolute there remains no being to improve and no direction is set for possible improvement: and when experience is not retained, as among savages, infancy is perpetual.”

The leaders of the future remain to be seen.  Our institutional memory will be important to osteopathic medicine’s future.  It behooves those of us that were or are currently in leadership positions to CONSTRUCTIVELY (my purposeful emphasis) recruit and mentor these new leaders, help them with the history and not handicap them with the current “toolbox.”  One important role for the AODME moving forward is nurturing future OGME leaders.