Osteopathic Graduate Medical Education

The present report on osteopathic graduate medical education (OGME) is based primarily on annual data 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.

In the present report, statistics on the Match are provided primarily for the 2007-2008 academic year. However, data may change and should not be considered final until publication of the JAOA's 2010 Osteopathic Medical Education theme issue. These data are discussed in light of various OGME development activities and the restructuring of the traditional osteopathic internship.

AOA-Approved First Year of Postdoctoral Training

As previously reported,¹ the AOA Board of Trustees and House of Delegates approved changes to the traditional internship structure in 2006 (Resolution 19 [A/2006]—Restructuring of the Osteopathic Internship). The majority of specialty colleges selected their OGME-1 options before the restructuring went into effect on July 1, 2008. A few approved changes to become effective July 1, 2009. Current OGME-1 training options are as follows:

• Option 1: OGME-1R, Residency—Students match directly into the residency, and the first postdoctoral year will be considered the first year of residency training.

• Option 2: OGME-1P, 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 as the second postdoctoral year of training. Students who match successfully are assured entry into the preliminary year and the subsequent second year in residency training.

• Option 3: OGME-1T, Traditional (Internship)—This option represents a traditional rotating internship, and programs are not linked to a specialty residency. Specialties selecting this option prefer that graduates complete a traditional rotating internship as the first year of training. This option is also available to students who are undecided on specialization or who plan to enter residencies accredited by the American Council on Graduate Medical Education (ACGME). Movement into Option 1 or Option 2 specialty programs will depend on availability.

The majority of specialty colleges selected their OGME-1 options in 2007 (Figure 1).

The requirements for OGME-1R and OGME-1P are reflected in each specialty college's basic standards, which are available at https://www.do-online.org/index.cfm?PageID=acc_postdocstdspeclistnew. Requirements for OGME-1T are listed in the Accreditation Document for Osteopathic Postdoctoral Training Institutions and the Basic Document for Osteopathic Postdoctoral Training Programs.²

Figure 1.

Training pathways as determined by medical specialty. *Specialty was previously designated as Option 2 but will become Option 1 effective July 1, 2009. Applicants for the 2009-2010 academic year will match directly into the first year of the residency. Abbreviation: OGME-1, first year of osteopathic graduate medical education.

The restructuring effort created a major shift in the designation of OGME-1 positions. The final reorganization of “internship” positions to “residency” positions under restructuring was effective July 1, 2008, after the Match. As of September 3, 2008, 267 programs in 15 specialties restructured a total of 1034 OGME-1 positions that were previously designated as internship positions into OGME-1R positions (Table 1). As of December 1, 2008, the restructuring initiative has resulted in 45 internship program closures.

Specialties whose restructuring is to become effective July 1, 2009, are in the process of re-designating OGME-1 positions.

OGME Development

An OGME Development Initiative was established nearly a decade ago to enhance OGME.³ An expanded initiative was launched in 2007 after AOA leaders were appointed to an advisory committee in October 2006.⁴ The initiative received additional support from the current AOA President, Carlo J. DiMarco, DO, who designated OGME as a key focus of his presidential year.⁵

The purpose of the expanded initiative is to assist nonteaching hospitals in the development of OGME training programs by providing written materials and a corps of consultants trained in areas such as program development and accreditation, OPTI partnerships, and matters related to the osteopathic medical profession and OGME.^5,6 So far, the initiative has trained more than 40 consultants⁶ to assist interested stakeholders in understanding financial and academic requirements needed to start new programs. These advisors have been breaking ground with hospitals that are eligible for funding from the Centers for Medicare and Medicaid Services, particularly in states that have had historically few OGME training opportunities.⁷

In April 2007, the AOA Council on Postdoctoral Training formally approved “The OR²CA Project,” which was sponsored by OPTI-West to develop OGME programs in Oregon and California. The project also served as a demonstration model in program development, particularly in a geographic area with few OGME opportunities. The project was endorsed by senior AOA leadership, including then–AOA President John A. Strosnider, DO (written communication, September 2006). To date, the project has resulted in 84 new training positions in California and 47 new positions in Oregon for the 2008-2009 academic year. West Virginia was also among the top five states in position development with 66 new positions, followed by Michigan (89 new positions) and New York (49 new positions). Total approved positions by state are reflected in Figure 2. The total number of AOA-approved internship and residency programs and positions, as well as trainees filling available positions, are provided in Table 2 and are described later in greater detail.

Figure 2.

Total approved internship and residency positions by state.

The Match: Training Years 2007-2008 and 2008-2009

In 2008, two COMS—Lake Erie College of Osteopathic Medicine-Bradenton in Bradenton, Fla, and Touro University Nevada College of Osteopathic Medicine in Henderson—matriculated their first classes of osteopathic medical students. As a result, 3462 COM students graduated in 2008, which represents a 12% increase over the 2007 record-breaking total of 3103 graduates (Table 3).¹ This increase also represents a 23% growth since 2006.

Compared to 2007, the number of students participating in the 2008 AOA Match increased 11%.¹ A total of 1267 (41%) graduates from the class of 2007 and previous graduates matched into internships through the AOA Match, with 1097 graduates (87%) matching to their first choice. According to final data, as of May 31, 2008, an additional 378 graduates (12%) successfully matched to AOA positions in the post-Match scramble, raising the total number of trainees in osteopathic positions to 1645 (53%).¹

For the 2008-2009 training year, 1353 (38%) graduates (1316 current graduates and 37 previous graduates) matched into internships and first year residency slots through the AOA Match, with 1078 current graduates (82%) matching into their first choice. An estimated additional 475 graduates (13%) matched to AOA positions during the post-Match scramble, bringing the total estimated number of trainees in first-year osteopathic positions to 1828 (51%).

Although traditional rotating internships continue to have the highest Match numbers among osteopathic medical graduates (Table 4), this number has dropped substantially from previous years as a result of the OGME-1 restructuring. In 2006 and 2007, the number of graduates matched to the traditional rotating internship was 746 and 734, respectively.¹ For class of 2008 graduates, the number was 350. Likewise, many specialties that chose OGME-1R—particularly emergency medicine and family practice—saw jumps in matches compared with previous years.¹

Because this is the first year data are available for positions affected by the restructuring of the traditional osteopathic internship, data for programs beginning for the 2008-2009 training year, which will be reported in the JAOA's 2010 Medical Education issue, are expected to change substantially.

The Electronic Residency Application Service (ERAS) is a centralized service that transmits applications, letters of recommendation, medical student performance evaluations, medical school transcripts, COMLEX transcripts, and other supporting credentials for students and deans' offices to program directors using the Internet. According to this service, which analyzed programs with OGME-1 positions only, the number of applications per applicant submitted to osteopathic training programs through the ERAS increased from 8.7 in 2007 to 10.4 in 2008. In addition, the number of ERAS applicants increased from 2268 in 2007 to 2626 in 2008, a 16% increase. It is reasonable to assume that at least some of this change is a result of a positive response from fourth-year osteopathic medical students to the restructuring.

Military and ACGME Training Approvals

The number of osteopathic medical students electing to train in the military has increased in the past several years. In 2006, 211 graduates (7.3%) matched into military training positions.¹ That number rose to 226 (6.3%) in 2008. 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 2008, 247 DOs have applied for approval of their military training for AOA certification.

The AOA has long-established mechanisms by which DOs may obtain approval for training provided through the ACGME (Resolution 42 [A/2000]—Approval of ACGME Training as an AOA-Approved Internship). This approval helps DOs seeking medical licensure in states requiring an osteopathic internship as well as those physicians desiring osteopathic board certification. Between July 2001 and December 2008, a total of 2056 DOs petitioned the AOA for approval of their first year of ACGME postgraduate training. A total of 1818 DOs have completed the application process, of which 1520 (84%) have been approved. An additional 270 requests (15%) have been given approval, “pending completion of the requirements.” In addition, 18 applicants (1%) have been denied, and 10 (<1%) withdrew their requests.

Osteopathic Graduate Medical Education Programs

As of May 31, 2008, 11,718 DOs were in either osteopathic (ie, AOA-approved) or allopathic (ie, ACGME-accredited) postdoctoral training programs in the 2007-2008 academic year. A total of 4934 trainees (42%) were in AOA-approved programs and 6784 (58%) were in ACGME programs (Figure 3).⁸ This number represents a higher percentage of osteopathic trainees attending AOA-approved programs compared with the 2006-2007 academic year, when 4511 (40%) osteopathic trainees were in AOA programs and 6629 (60%) were in ACGME programs.^1,8

Figure 3.

Trends of osteopathic physician (DO) enrollment in both osteopathic and allopathic postdoctoral training programs. Data may change and should be considered incomplete until finalized in the 2009 Medical Education issue of JAOA—The Journal of the American Osteopathic Association. *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 1998-1999 through 2006-2007 were previously published in the JAOA¹and JAMA.⁷

In addition, 150 residency training programs in 2008 were dually accredited by the AOA and the ACGME and 5 parallel training programs were AOA approved but occurred side-by-side with ACGME training programs in the same institution. These types of training programs are described in greater detail elsewhere, beginning on page 146.⁹

AOA-approved internship positions decreased slightly from 2839 in the 2006-2007 academic year to 2762 in the 2007-2008 academic year (Table 2). The Program and Trainee Review Council approved 656 new positions between June 2007 and May 2008, exclusive of position changes as a result of the restructuring initiative. Loss of positions as a result of program closures is not calculated here (Table 2) but is reflected in overall position numbers.

Funded positions available in the AOA Match provide another perspective because not all approved positions are funded. In 2007, 2189 funded positions were offered in the AOA Match compared to 2312 funded positions in 2008. As of January 15, 2009, 662 programs were registered to participate in the AOA Match with a total number of 2492 positions available for the 2417 COM graduates who registered for the Match.

In the 2007-2008 academic year, there were 718 AOA-approved residency programs (Table 5) compared with 669 residency programs in the 2006-2007 academic year and 648 approved programs in the 2005-2006 academic year.¹⁰ Of the 6564 positions approved in the 2007-2008 academic year, half (3289) were filled. These data represent an increased fill rate compared with the 2005-2006 academic year, in which only 2535 (44%) of 5766 positions were filled. With the restructuring of the OGME-1 year into residency positions, data for the 2008-2009 academic year will be presented in the 2010 JAOA Medical Education theme issue in a different format.

Conclusion

Osteopathic postdoctoral training continues to demonstrate growth in approved positions available, geographic availability of programs, and initiatives to support program development. It is expected that the increasing number of COMs in an expanding geographic area will provide the stimulus to continue that trend. 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.