Cummings Mark
M. Cummings is associate dean (emeritus), Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, and consultant, Germane Solutions, Dayton, Ohio.
Acad Med. 2016 Jan;91(1):36-41. doi: 10.1097/ACM.0000000000000892.
Osteopathic medicine is closely identified with primary care. The mission statements of a majority of colleges of osteopathic medicine (COMs) mention the goal of producing primary care physicians. By far, there are more family medicine and internal medicine residency programs in the American Osteopathic Association graduate medical education (GME) system than programs for any other specialty. In addition, the osteopathic profession is embarking on a new direction to ensure COM graduates are trained as practice-ready primary care physicians. In counterpoint to the osteopathic profession's emphasis on primary care, the majority of entering and graduating osteopathic medical students express preferences for residencies in non-primary care specialties. When graduating students confront their GME options, however, they discover their choices for non-primary care specialties are limited. Currently, approximately two-thirds of COM graduates end up in a primary care residency. The creation of a unified GME accreditation system under the Accreditation Council for Graduate Medical Education (ACGME) may further consolidate the osteopathic identity with primary care: Osteopathic training institutions may reduce the number of non-primary care programs they offer, which would allow them to increase enrollment in primary care programs to meet ACGME standards and remain below their Medicare caps. Additionally, in the National Resident Matching Program Match, selection patterns by program directors for competitive non-primary care residencies currently favor U.S. MDs. Therefore, while osteopathic students enter COMs aspiring to careers in non-primary care specialties, they are encountering a GME environment that offers them a shrinking number of alternatives.
整骨医学与初级保健紧密相连。大多数整骨医学院（COM）的使命声明都提到了培养初级保健医生的目标。到目前为止，在美国整骨疗法协会研究生医学教育（GME）系统中，家庭医学和内科住院医师培训项目比其他任何专科的项目都多。此外，整骨疗法专业正在朝着一个新的方向发展，以确保整骨医学院的毕业生能够被培养成随时可以执业的初级保健医生。与整骨疗法专业对初级保健的重视形成对比的是，大多数入学和即将毕业的整骨医学学生都表示更倾向于选择非初级保健专科的住院医师培训。然而，当即将毕业的学生面临他们的GME选择时，他们发现自己选择非初级保健专科的机会有限。目前，大约三分之二的整骨医学院毕业生最终进入了初级保健住院医师培训项目。在毕业后医学教育认证委员会（ACGME）的统一GME认证系统下，整骨疗法与初级保健的联系可能会进一步加强：整骨疗法培训机构可能会减少他们提供的非初级保健项目数量，这将使他们能够增加初级保健项目的招生人数，以符合ACGME标准，并保持在医疗保险上限以下。此外，在全国住院医师匹配项目中，目前竞争激烈的非初级保健住院医师培训项目主任的选拔模式更青睐美国的医学博士。因此，虽然整骨医学学生进入整骨医学院时渴望从事非初级保健专科的职业，但他们正面临着一个GME环境，这个环境为他们提供的选择越来越少。
