Every year, over 40,000 thousand medical students spend thousands of dollars applying and interviewing for residency positions. In addition to the substantial financial costs, every student agonizes over their application and anxiously waits for interview invitations. Couples have an even more difficult time through the process! However, this year is even tougher for applicants to Emergency Medicine Osteopathic Residencies. How can it get any worse, you ask? Well on September 22, one reddit user posted a screenshot of an email sent to all the 3-year Emergency Medicine residency programs that were previously accredited by the AOA (American Osteopathic Association). In the email, the AOA informs programs that only graduates of 4-year EM osteopathic residencies will be eligible for board certification. Instead of alerting applicants directly, the AOA has put that onus on residency programs. WHAT DOES THIS MEAN FOR APPLICANTS? Only the 3-year Emergency Medicine programs participating in the Osteopathic residency match are affected. Luckily, most applicants apply to both the Osteopathic NMS match and the “regular” NRMP match, and most will be unaffected. Hopefully these applicants have applied to enough programs that the few disqualified residencies should not impact their chances of matching. However, some applicants are undoubtedly being forced to submit last minute applications after the opening date. Late applications are usually thought to result in a lower likelihood of being accepted, putting these students at a disadvantage. Plus, with fewer programs, even more students will be forced to decide on whether or not to even participate in the Osteopathic residency match. Finally, these last-minute changes also bring a financial cost with them as well. Most applicants will not receive a refund from the NRMP for disqualified programs. Although the cost may seem small (usually under $26 per program) when compared to medical school tuition, the burden of fees is often higher during the fourth year. Every dollar helps when you have to schedule last minute flights, hotel rooms, and other travel expenses. WHY WOULD THE AOA DO THIS? Thankfully, by 2020 the AOA’s impact on residency applications will come to an end. With the single accreditation system, all residency programs will have to adhere to ACGME standards. The ACGME has no problem with 3-year emergency medicine residencies, and the 4-year Osteopathic requirement will be gone. But as the AOA’s influence starts to diminish, we can expect that there will be a higher rate of these kinds of events. The truth is that the AOA is quickly losing relevance. We’ve already written about the struggles of Osteopathic surgical residencies to meet the ACGME requirements. Many will not survive the process, and those that do will be under the authority of the ACGME. The Osteopathic leadership needs to continue to make these decrees in order to maintain some power during this transition. Unfortunately, they harm Osteopathic students in the process. However, I think that the saber rattling being done by the AOA actually hastens their power loss. Students already have to decide on whether or not to participate in the Osteopathic residency match at all. Because the NMS match happens over a month before the regular match, applicants often have to weigh the risk of not ranking Osteopathic residency programs in hopes of obtaining an ACGME residency. By making even more programs off limits, even more students are going to opt out of the Osteopathic match. CAN I GET A REFUND? Several people at my school have reached out directly to ERAS and the newly disqualified programs. I wish that I could tell you that they received an immediate full refund or automatic application to the allopathic equivalent. Unfortunately that is not the case. According to people who called and got through, ERAS is telling applicants to ask programs for the refund and the programs are telling applicants to look to ERAS. After dealing with my school’s administration, I’m not at all surprised by this answer. The AOA has handed down a ruling, and no one is willing to take responsibility for the outcome. IS THERE ANY GOOD NEWS? I guess the good news is that only applicants in 2017 will be affected by this decision. After this year, the 3-year EM programs should be taken off of the Osteopathic match, leaving only the 4-year programs. In fact, I checked today and there were only one or two three year programs still being listed under the D.O. section of ERAS. The real question will be: what’s next? The AOA only has a few more years to throw their weight around, and I’m sure that we will see more of these changes. Will all Osteopathic residencies require a Traditional Rotating Internship? Or will the AOA add some restrictions to Osteopathic students taking the USMLE?