Title: Accreditation of Fellowship Programs Gets a Deferment
Abstract: The idea of accrediting ophthalmology training programs has been placed on hold following a vote at the February 2002 meeting of the Association of University Professors of Ophthalmology (AUPO). The AUPO supports the principle of assuring the quality of fellowship training by developing a process of accreditation with accountability, but does not support the current proposal before the American Medical Association's Accreditation Council of Graduate Medical Education (ACGME). The AUPO will coordinate a task force to design an accreditation process, which will consider standard of education, protection of institutional training, public protection, and enforcement. FIGUREFigure: Robert L. Lesser, MD (Waterbury, CT), Grace W. Kao, MD (Orange, CA), and Robert M. MacFadzean, MD (Glasgow, Scotland) in front of Dr. Kao's poster.FIGUREFigure: Grant T. Liu, MD (Philadelphia, PA) points to something important to Eric R. Eggenberger, DO (East Lansing, MI).The history of this issue goes something like this: In the early 1990s, several retina societies and NANOS unsuccessfully petitioned the American Board of Ophthalmology (ABO) to issue ophthalmology subspecialty certifications. (Specialty boards certify physicians as competent; the ACGME accredits training programs as meeting minimum quality standards.) The American Academy of Ophthalmology's (AAO) Board of Councilors then considered the issue of seeking subspecialty accreditation and first voted against it in 1995 and 1996, and then in favor of it in 1997. As a result, the AAO directed the ABO to establish a Fellowship Accreditation Committee to direct ophthalmology subspecialty societies to draft fellowship accreditation requirements. NANOS members approved the accreditation guidelines for neuro-ophthalmology in 1999. FIGUREFigure: Preston C. Calvert, MD (Alexandria, VA), Larry Frohman, MD (Newark, NJ), center, and Mark Kupersmith (New York, NY) confer at the poster session.FIGUREFigure: Cheryl L. Zaret, MD (Chicago, IL), Jon Currie, MD (Westmead, Australia), Richard L. Sogg, MD (Los Gatos, CA), and Michael C. Brodsky, MD (Little Rock, AK) (his back, but who else?) cluster around the posters.Fellowship program accreditation by the ACGME has the attraction of assuring minimum quality uniform standards. This advantage is counterbalanced by the fact that fellows in accredited programs would have to be paid as house officers rather than as faculty members. Most hospitals would require that fellows be paid based on their years of medical training, namely at the postgraduate year (PGY) 5 or 6 level. In the meantime, the Health Care Financing Administration 1996 capped expenditures for graduate medical education (that means house officers), so that there would be no extra money to cover ophthalmology fellows in accredited programs. To add to the misery: if fellows were to be transformed from faculty members to house officers, they would no longer be able to bill for services, supervise house officers, or take faculty call. At the February 2002 AUPO meeting, ophthalmology program directors got a taste of the potential problems of fellowship accreditation from Steven Nestler, PhD, Executive Director of the ACGME's Residency Review Committee for Ophthalmology and Orthopedic Surgery, who reported the experience of orthopedic surgery, which achieved permission to accredit eight subspecialty programs in 1985. Only one program, hand surgery, has a certification process. Of 375 programs, 175 programs are accredited, most in academic institutions. The major points from Dr. Nestler's presentation were: 1) accreditation is a long process and that many orthopedic programs have not chosen to become accredited for a variety of reasons, and 2) the ACGME would not support accreditation for ophthalmology unless the majority of the subspecialty supports the process. FIGUREFigure: Mentor/mentee pair (originally University of Iowa) James J. Corbett, MD (Jackson, MS), right, and Daniel M. Jacobson, MD (Marshfield, WI).FIGUREFigure: Mentor/mentee pair (originally Michigan State University) David Kaufman, DO (East Lansing, MI), right, and Michael S. Vaphiades, DO (Little Rock, AK).FIGUREFigure: Suzanne C. Berry, NANOS Administrative Director, left, with Thomas J. Carlow, MD (Alburquerque, NM) at the poster session.FIGUREFigure: William F. Hoyt, MD (San Francisco, CA) points out an interesting item on the poster of Grace W. Kao, MD, MPH (Orange, CA).The NANOS Accreditation Committee (John L. Keltner, MD, Mark L. Moster, MD, Steve A. Newman, MD, and Ralph A. Sawyer, MD) rethought the pros and cons of neuro-ophthalmology fellowship accreditation, having polled NANOS fellowship directors and discovered that a majority could not afford accredited fellows. At the February 2002 AUPO meeting, most of the program directors in other ophthalmic subspecialties had come to the same conclusion and voted to find another way to accredit fellows that they could afford. The NANOS Accreditation Committee is looking into the feasibility of accrediting programs based on a NANOS (rather than ACGME) monitoring system that would be based on NANOS-approved standards. The committee will be anxious to see what the AUPO develops. A report is expected at the next NANOS meeting at Snowbird, Utah, in February 2003. Stay tuned.