Osteopathic Graduate Medical Education

Annual data on osteopathic graduate medical education (OGME) is provided through the American Osteopathic Association (AOA) Intern/Resident Registration Program (ie, the AOA “Match”) and the AOA Trainee Information, Verification, and Registration Audit (TIVRA) reporting system. Statistics on the Match in this article are reported for both the 2005-2006 and 2006-2007 academic years. Although Match data does not change, data on programs, number of trainees, and approved positions may change throughout the year as a result of decisions and actions of the AOA Council on Osteopathic Postdoctoral Training (COPT) and the Program and Trainee Review Council, which meet three times per year to approve residency programs and positions. After the Match takes place, minor changes can occur by individual trainees and programs. Those data are reported on TIVRA, which is completed each fall. The current article discusses these data and highlights the many areas of growth related to OGME.

AOA-Approved First Year of Postdoctoral Training

As previously described,¹ the AOA Board of Trustees and House of Delegates passed a resolution in 2006 for the restructuring of the traditional osteopathic internship (Resolution 19 [A/2006]—Restructuring of the Osteopathic Internship). As a result of the resolution, which goes into effect July 1, 2008, specialty colleges were required to select one of the following three AOA-approved training options:^1-3

• Option 1: AOA OGME-1 Resident (Residency)—Students will “match” directly into the residency, and the first postdoctoral year will be considered the first year of residency training. Specialties were required to develop curriculum for the first year of training. Specialties that chose this option include anesthesiology; emergency medicine and emergency medicine and internal medicine; family practice, family practice and emergency medicine, and integrated family practice and neuromusculoskeletal medicine; internal medicine; obstetrics and gynecology; orthopedic surgery; otolaryngology and otolaryngology and facial plastic surgery; pediatrics and pediatrics internal medicine; and general surgery, neurological surgery, and urological surgery.

• Option 2: AOA OGME-1 Preliminary (Internship)—Programs require completion of a designated preliminary year of training (ie, an internship) as a prerequisite for entry into the first year of residency in the second postdoctoral year of training. Students who match successfully into such programs are ensured entry into both the preliminary year and the subsequent first year in residency training. In most cases, both training periods will be offered in the same institution or in an affiliate institution. Specialties that chose this option include diagnostic radiology and radiation oncology, neurology, neuromusculoskeletal medicine and osteopathic manipulative medicine, ophthalmology, pathology, and psychiatry.

• Option 3: AOA OGME-1 Traditional (Internship)—Specialties that have chosen this option require residents to complete a traditional, stand-alone rotating internship. This option is particularly suitable for students who are either undecided on their future plans or who plan on entering residencies accredited by the American Council on Graduate Medical Education (ACGME). Students completing a traditional rotating internship and then selecting option 1 or 2 specialties must contact that specialty college to determine whether advanced standing will be granted. This option will depend on available residency positions because most will have been filled with trainees who matched during the first year and are advancing to their second postgraduate year. Specialties that chose this option include dermatology, occupational and preventive medicine, physical medicine and rehabilitation, preventative medicine and public health, and proctology.

The requirements for traditional rotating internships remain unchanged.^1-3 Fourth year osteopathic medical students have responded positively to these changes, as evidenced by preliminary data that show a 13% increase in the number of students participating in the 2008 AOA Match. In addition, the number of applications submitted to osteopathic training programs through the Electronic Residency Application Service increased by 34% this year. Additional data on the impact of the restructuring, including the number of programs and trainees selecting each option, will be available in the The Journal`s 2009 Medical Education issue. Specific requirements of each specialty are available on DO-Online under Postdoctoral Training under the Education tab.

The Match: Academic Years 2005-2006 and 2006-2007

In 2007, for the first time in the history of osteopathic medicine, the number of COM graduates surpassed 3000 (Table 1). There were a total of 3103 COM graduates in 2007 compared with 2826 graduates in 2005 and 2814 in 2006. These data represent a 10% increase in the number of COM graduates compared with the previous year. This increase is partly attributable to 144 graduates of the Virginia College of Osteopathic Medicine in Blacksburg—the school's first graduating class.

A total of 1196 (41%) graduates from the class of 2006 and previous graduates matched into internships through the AOA Match, with 1045 graduates (87%) matching to their first choice (Table 1). An additional 329 graduates (11%) successfully matched to AOA positions in the post-Match scramble, raising the total number of trainees in osteopathic positions to 1525 (53%). In the 2006-2007 academic year, 1267 (40%) graduates and previous graduates matched into internships through the AOA Match, with 1097 graduates (87%) matching into their first choice. An additional 396 graduates (12%) matched to AOA positions during the post-Match scramble. Accordingly, the total number of trainees matched to osteopathic positions in 2007 increased to 1663 (52%). From the 2004-2005 to 2006-2007 academic years, the number of students entering osteopathic training programs increased over 10%, but because of the simultaneously increasing number of graduating students, the market share shows only a 1.5% increase.

As in previous years, traditional internship programs had the highest Match numbers among osteopathic medical graduates (Table 2 and Table 3).^1,4 However, the data for next year's programs are expected to change substantially as a result of the restructuring of the traditional osteopathic internship, as previously described.

There has been significant growth in the number of osteopathic students electing to train in the military in the past several years. In 2003, 48 graduates (1.8%) matched into military training positions. That number rose to 211 (7.3%) in 2006 and then to 226 (6.8%) in 2007. Osteopathic physicians trained in the military have the option to become board certified in their specialty by either the AOA or the American Board of Medical Specialties (ABMS). Between 2003 and 2007, 247 osteopathic physicians have applied for approval of their military training for AOA certification.

The AOA has established mechanisms by which osteopathic physicians may obtain approval for training provided through the ACGME (Resolution 42 [A/2000]—Approval of ACGME Training as an AOA-Approved Internship). This approval is key for those osteopathic physicians seeking medical licensure in states requiring an osteopathic internship and for those physicians desiring osteopathic board certification. Between July 2001 and December 2007, a total of 1603 osteopathic physicians have petitioned the AOA for approval of their first year of ACGME postgraduate training, of which 1217 (76%) have been approved. An additional 369 requests (23%) have been given approval, “pending completion of the requirements.” In addition, 10 applicants (<1%) have been denied, and 7 (<1%) withdrew their requests.

Osteopathic Graduate Medical Education Programs

As noted elsewhere, annual data on OGME is reported using information gathered from the AOA's Intern/Resident Registration Program and data reported by AOA-approved residency programs using the AOA's TIVRA reporting system. Although data from the Match does not change in a given year, program data does change because the AOA COPT and the Program and Trainee Review Council meet three times per year to approve residency programs and positions. Program data reported in the present article are current as of May 31, 2007, and will be finalized in THE JOURNAL`s 2009 Medical Education issue.

In the 2006-2007 academic year, 11,140 osteopathic physicians were in either osteopathic or allopathic (ie, ACGME-accredited) postdoctoral training programs (Figure 2).^1,4-14 A total of 4511 trainees (40%) were in AOA-approved programs and 6629 (60%) were in ACGME programs.¹⁰ This number represents a slightly higher number of osteopathic physicians attending osteopathic programs during the 2005-2006 academic year, when 4020 (38%) osteopathic trainees were in AOA programs and 6474 (62%) were in ACGME programs.¹¹

In addition, there were 90 residency training programs in 2006 that were dually accredited by the AOA and the ACGME as well as 19 parallel training programs that were AOA approved but occurred side-by-side with ACGME training programs in the same institution. Trainees who complete dual programs have the option to become board certified by either or both the AOA and the ABMS. Trainees who complete parallel programs are only eligible to become AOA–board certified.

As reported last year,¹ approximately 75% of all AOA-approved internship training positions are located in seven states: Florida, Illinois, Michigan, New Jersey, New York, Ohio, and Pennsylvania (Table 4). Although some states had fewer positions compared with 2005-2006 data, 10 states had an increase of approved positions (Figure 3). As a result, there was a total increase of 31 positions in the 2006-2007 academic year—a 1% increase from the previous year.

The number of AOA-approved first year positions decreased slightly from 2704 in the 2005-2006 academic year to 2688 in the 2006-2007 academic year. Although a number of training positions were lost as a result of program closures, the Program and Trainee Review Council approved 644 new positions between April 2007 and November 2007. Funded positions give a better perspective on change than approved positions, which may or may not be funded. In 2005, 2165 positions were funded, 2206 positions were funded in 2006, and 2189 positions were funded in 2007. The fill rates for these funded positions were 68%, 69%, and 76%, respectively. As of January 2, 2008, 633 programs were registered to participate in the AOA Match with a total number of 2456 positions available for the 2330 COM graduates who registered for the Match.

In the 2006-2007 academic year, there were 665 approved AOA residency programs (Table 5) compared with 648 AOA-approved residency programs in the 2005-2006 academic year and 569 approved programs in the 2004-2005 academic year. Although there were 6045 positions available in the 2006-2007 academic year, slightly fewer than half of the positions (2989 [49%]) were filled. However, this data represents an improvement from the previous year, in which only 2535 (44%) of 5766 positions were filled.

Conclusion

Postdoctoral residency training continues to demonstrate positive growth. It is expected that the growing number of COMS, located in geographic regions where osteopathic opportunities have been limited, will positively impact growth. In addition, several initiatives are underway to support growth in postdoctoral training.^15-18 The AOA OGME Development Initiative has been breaking ground with hospitals that are eligible for funding from the Centers for Medicare and Medicaid Services, particularly hospitals in states that currently have few OGME positions available.¹⁵ Advisors are available to assist interested stakeholders to understand financial and academic requirements needed to start new programs through this initiative. Both new and existing COMs that are located in underserved geographic regions have developed programs and initiatives to provide additional training programs for their graduates and others who hope to relocate to these areas.¹⁶ The Medical Education Summit II, held in November 2007 in Lombard, Ill, focused the 3-day agenda entirely on OGME.^17,18 Together, leaders in the osteopathic medical profession and particularly osteopathic medical education continue to develop recommendations and prioritize actions that will enhance OGME and ultimately move the profession forward.

Figure 1.

Trends of osteopathic physician (DO) enrollment in both osteopathic and allopathic postdoctoral training programs. Although Match data does not change in a given year, program data does change because the American Osteopathic Association (AOA) Council on Osteopathic Postdoctoral Training and the Program and Trainee Review Council, which have the authority to approve osteopathic medical residency programs and positions, meet three times per year, and newly approved residency programs and positions are added to the AOA database at that time. Therefore, current data for the 2006-2007 academic year are to be considered incomplete and will be finalized in the JAOA`s 2009 Medical Education issue. *Total college of osteopathic medicine (COM) graduates do not include previous years' graduates. †Total DOs in AOA internships include trainees who matched to osteopathic internship positions during both the Match and post-Match scramble.Sources:AOA Intern/Resident Contracts received by the AOA Division of Postdoctoral Training for the academic years shown; and AOA's Trainee Information, Verification, and Registration Audit system, academic year 2006-2007. Data for academic years 1997-1998 through 2005-2006 were previously published in the JAOA—The Journal of the American Osteopathic Association^1,4-9and JAMA.^10-14

Figure 2.

American Osteopathic Association's Intern/Resident Registration Program. When compared with data reported for the 2005-2006 academic year, the number of approved osteopathic medical internships in the 2006-2007 academic year increased in 10 states but decreased in 7 states, for an overall net gain of 31 AOA-approved internship positions.