By Saroj Misra, DO, FACOFP
Program Director & Department Chair—Family Medicine, Ascension Macomb-Oakland Hospital
Governor, American College of Osteopathic Family Physicians

As most residents are aware, the single-accreditation initiative has rapidly transformed the landscape of residency training over the last five years. With the Accreditation Council for Graduate Medical Education (ACGME) now overseeing all programs and residents in terms of the training experience, it becomes critical to understand how these historic changes affect current and future residents, both during and after residency. This blog post seeks to help clarify what has, at times, been confusing and frustrating for any resident who wants to know what options are available for him or her in terms of assessment and certification.

Historical Background

To understand the current situation, a small amount of historical background information is needed. Prior to 2015, accreditation of residency programs was either by the American Osteopathic Association (AOA) or ACGME. (These programs were often referred to as “osteopathic” or “allopathic” programs, respectively—even though the makeup of these programs might contain both MD and DO residents.)

In the field of family medicine, the formative assessment testing (held every year for each resident) was produced and administered by the American Board of Family Medicine (ABFM) or the American College of Osteopathic Family Physicians (ACOFP). This testing was a prerequisite to sitting for a certification exam at the end of residency, which was either administered by ABFM or the American Board of Osteopathic Family Physicians (AOBFP).

If your residency was ACGME-accredited, you would take the ABFM In-Training Exam (ITE) for three years and be eligible for the ABFM Certification Exam. If your program was AOA-accredited, you would take the ACOFP In-Service Training Exam for three years and be eligible for the AOBFP Certification Exam. If your program was dually-accredited (yes, that was possible), you could sit for both certification exams—but had to take both formative exams to do so (ITE and ISTE). Basically, your program’s accreditation determined which path you were on for training and your career (as you would need to recertify periodically throughout it).

In addition, both pathways have historically had a “continuous certification component” that requires completion of modules that the physician must pay for every cycle. These are known as Maintenance of Certification (MCC) for the ABFM pathway and Osteopathic Continuous Certification (OCC) for the AOBFP pathway.

A New Scenario

Single accreditation gave programs and residents a new scenario—that there could be a choice for residents about which certification exam they wished to sit for. This choice has led to many residents being confused about what to do: Should they sit for one or the other—or possibly both? It also has led to implications for programs because they must agree to use the formative exam that allows for a resident to certify in their chosen path. If your program opts not to provide one formative exam or the other, you are effectively cut off from that path of certification.

In the last few years, AOBFP has worked in conjunction with ACOFP to make the osteopathic certification pathway more viable for residents. They have adjusted costs, removed the mandatory OMT practical exam component and created an Early Entry Initial Certification (EEIC) pathway, which effectively reduces the length of the Initial Certification Exam by 50%, lowers the other costs associated with the Initial Certification Exam and lowers the cost of the OCC.

To be eligible for this exciting new option, however, you must complete two osteopathic in-service exams. The options you have to choose from are the AOBFP In-Service Exam (ISE), produced an administered by ACOFP; and the AOBFP  In-Service Exam Plus (ISE+) , produced and administered by ACOFP. Registration for both of these exams is currently open and will close on August 30.

What’s a Resident to Do?

So what should a resident do with all these choices (even though some, like the choice of formative exam, may not fully be within their control)? Well, here are some points to consider:

  • Program choice. Your programs, in part, have the power to determine your pathway. If only the ABFM ITE is offered, a resident could still choose to take the AOBFP certifying exam, but they would not be able to take advantage of the EEIC pathway offered by AOBFP (and thus have to pay more for this pathway).
  • Cost. This is always a consideration for financially overburdened residents. When looking at cost, the ACOFP/AOBFP pathway becomes a slightly cheaper option if using the EEIC pathway. Adding the OMT element raises the cost, but it ensures that your certification specifically includes osteopathic manipulation as a component.
    Protip: Through a generous grant from the ACOFP Education & Research Foundation, residents who sit for both the AOBFP cognitive and practical exams, are eligible for reimbursement of exam fees and travel (up to $500). This option is incredibly valuable and makes the AOBFP certifying exam very competitive on the point that, arguably, is most important to graduating residents: the cost of certification.
  • Travel. Both written exams can be administered at multiple testing sites around the country, but opting for the OMT element means traveling to a convention (either AOA-OMED or the ACOFP Annual Convention) to take the practical exam.
  • Practice rights. There is no difference in your ability to practice based on which pathway you choose. In the future, it is possible that not having certification in osteopathic manipulation could be used to restrict reimbursement to only those with the certification, but no such restrictions are present now nor for the foreseeable future.
  • Longevity of certification. There are no plans for either certification path to go away. Both certifying boards have reiterated their intention to continue their certification pathway indefinitely.
  • Support of your profession. Depending on your desire, participation in the AOBFP pathway advocates for both the certification and osteopathy in general. Without this pathway, osteopathy runs the risk of losing many elements of what allows for distinctiveness in the larger professional world. This is often a point not recognized by residents as they mull this decision over. It is one, as I have noticed through discussion, that does seem to matter over time to osteopathic physicians.

In the end, the pathway we choose and the certification we obtain means different things to different people. For those of us who wish to find the best cost option, maintain support and advocacy for the osteopathic profession (by supporting its approach to formative exam and certification) and demonstrate certification proof that they are qualified to practice OMT, the ACOFP/AOBFP certification pathway may offer greatest satisfaction. For those who choose the ABFM pathway, nothing will prevent you from being a great osteopath (something, it is assumed, you consciously chose to be when you came to the osteopathic profession)— but it may cost you more to get there.

If you need more specific data and detail, ACOFP has developed a one-page TL;DR (Too Long; Didn’t Read) sheet with additional information and relevant links.

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