Osteopathic Graduate Medical Education Elizabeth Freeman, MS, EdS Terri A. Lischka, BS The information provided in 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 reporting system. In 2007, the number of osteopathic medical graduates totaled 3103, surpassing 3000 for the first time. In 2008, the total reached 3462 graduates. Statistics on the Match in this article are reported for both 2007 and 2008. A total of 1267 (41%) and 1316 (38%) graduates and previous graduates participated and matched in 2007 and 2008, respectively. With post-match scramble data, the number of graduates and previous graduates in AOAapproved internships and first-year residency positions rose to 1645 (53%) for the 2007-2008 academic year and is estimated to be 1828 (51%) for the 2008-2009 academic year. The response of students through the Match and the increased attention to innovative OGME development activities particularly the internship restructuring and OGME Development Initiative are evidence of a positive momentum in OGME in recent years. J Am Osteopath Assoc. 2009;109:135-145 From the Department of Education at the American Osteopathic Association (AOA) in Chicago, Ill. Address correspondence to Elizabeth Freeman, MS, EdS, Assistant Director, Division of Postdoctoral Training, AOA Department of Education, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: bfreeman@osteopathic.org Submitted January 21, 2009; final revision received February 18, 2009; accepted February 20, 2009. 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 JAOA Vol 109 No 3 March 2009 135
Option 1: OGME-1R, Residency Anesthesiology Emergency medicine Emergency medicine and internal medicine Family practice Family practice and emergency medicine Integrated family practice/neuromusculoskeletal medicine Internal medicine Internal medicine/pediatrics Neurological surgery Neurology* Obstetrics and gynecology Orthopedic surgery Otolaryngology and facial plastic surgery Pediatrics Psychiatry* Surgery (general) Urological surgery Option 2: OGME-1P, Preliminary (Internship) Diagnostic radiology Neuromusculoskeletal medicine and osteopathic manipulative medicine Ophthalmology Pathology Radiation oncology Option 3: OGME-1T, Traditional (Internship) Dermatology Physical medicine and rehabilitation Preventive medicine and public health Proctologic surgery 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 consultants 6 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 OR 2 CA 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 Table 1 No. of Programs and Positions Re-designated as OGME-1 Residency Programs and Positions as a Result of Restructuring, by Specialty Specialty Programs Positions Anesthesiology 8 20 Emergency Medicine 30 152 Emergency Medicine and Internal Medicine 6 15 Family Practice 83 392 Family Practice and Emergency Medicine 2 6 Integrated Family Practice/NMM 3 6 Internal Medicine 35 144 Internal Medicine/Pediatrics 1 4 Neurological Surgery 6 10 Obstetrics and Gynecology 12 36 Orthopedic Surgery 26 79 Otolaryngology and Facial Plastic Surgery 11 16 Pediatrics 7 51 Surgery (General) 32 78 Urological Surgery 5 25 Total 267 1034 * Data are current as of September 3, 2008. Abbreviations: AOA, American Osteopathic Association; NMM, neuromusculoskeletal medicine; OGME-1, first year of osteopathic graduate medical education. 136 JAOA Vol 109 No 3 March 2009
Table 2 No. of AOA-Approved Internship and Residency Programs and Trainees Filling Available Positions by State, 2007-2008 Academic Year* Internship Residency Total State Programs Positions Trainees Programs Positions Trainees Programs Positions Trainees Alaska 1 3 3 0 0 0 1 3 3 Arizona 3 20 15 7 71 30 10 91 45 Arkansas 1 4 0 1 8 3 2 12 3 California 6 112 64 23 216 112 29 328 176 Colorado 1 4 0 0 0 0 1 4 0 Connecticut 1 13 10 1 9 3 2 22 13 Delaware 1 15 12 1 16 6 2 31 18 Florida 13 173 111 38 419 182 51 592 293 Georgia 3 14 5 3 23 3 6 37 8 Illinois 15 133 77 36 322 184 51 455 261 Indiana 3 15 8 3 24 12 6 39 20 Iowa 2 10 8 3 28 21 5 38 29 Kansas 1 12 3 1 8 3 2 20 6 Kentucky 6 44 16 7 72 15 13 116 31 Maine 4 30 14 9 75 42 13 105 56 Massachusetts 3 12 11 2 10 3 5 22 14 Michigan 24 522 338 174 1570 858 198 2092 1196 Minnesota 1 4 0 1 8 0 2 12 0 Mississippi 0 0 0 1 18 0 1 18 0 Missouri 5 40 24 21 124 90 26 164 114 Nevada 1 32 25 4 60 23 5 92 48 New Hampshire 1 4 4 0 0 0 1 4 4 New Jersey 9 165 83 48 472 236 57 637 319 New Mexico 1 4 1 1 4 4 2 8 5 New York 21 343 191 52 624 298 73 967 489 North Carolina 2 9 7 2 12 7 4 21 14 North Dakota 1 5 0 0 0 0 1 5 0 Ohio 17 263 168 97 765 397 114 1028 565 Oklahoma 4 64 54 25 221 135 29 285 189 Oregon 1 6 0 6 41 0 7 47 0 Pennsylvania 43 454 282 97 890 455 140 1344 737 Rhode Island 0 0 0 2 36 0 2 36 0 South Carolina 1 4 5 1 8 3 2 12 8 Tennessee 2 14 2 0 0 0 2 14 2 Texas 9 70 39 20 128 62 29 198 101 Virginia 5 33 16 9 89 30 14 122 46 Washington 0 0 0 1 6 0 1 6 0 West Virginia 8 80 43 18 156 53 26 236 96 Wisconsin 2 28 5 2 23 16 4 51 21 Wyoming 1 4 1 1 8 3 2 12 4 Total 223 2762 1645 718 6564 3289 941 9326 4934 * Data shown represent the number of positions approved by the executive committee of the American Osteopathic Association (AOA) Council on Postdoctoral Training and the Program and Trainee Review Committee for the academic year indicated. Data are current as of May 31, 2008. Osteopathic medical internship and residency positions are not currently approved in the District of Columbia or in the following 10 states: Alabama, Hawaii, Idaho, Louisiana, Maryland, Montana, Nebraska, South Dakota, Utah, and Vermont. Source: Training Programs by State: Year-End Reports, Division of Postdoctoral Training, American Osteopathic Association, Chicago, Ill. JAOA Vol 109 No 3 March 2009 137
WA MT ND ME OR ID WY SD MN WI MI NY VT NH MA CT RI CA NV UT CO NE KS IA MO IL IN KY OH WV PA VA MD NJ DE AZ NM OK AR TN SC NC Total Approved Positions TX LA MS AL GA 967 to 2,092 (4) 451 to 966 (3) FL 91 to 450 (10) 30 to 90 (7) 1 to 29 (15) Figure 2. Total approved internship and residency positions by state. 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. 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 tra- 138 JAOA Vol 109 No 3 March 2009
Table 3 AOA Registration Program: Intern/Resident Match Participants Matched to First Choice OGME-1 Internship or Residency by COM* 2007 AOA Match 2008 AOA Match Class of 2007 Matched, Matched With Class of 2008 Matched, Matched With COM Graduates, No. No. (%) First Choice, No. (%) Graduates, No. No. (%) First Choice, No. (%) DMU-COM 189 51 (27) 43 (84) 211 66 (31) 56 (85) KCOM 156 50 (32) 47 (94) 172 59 (34) 54 (92) KCUMB-COM 226 75 (33) 63 (84) 232 62 (27) 51 (87) LECOM 230 126 (55) 102 (81) 222 125 (56) 100 (80) LECOM-Bradenton NA NA NA 143 56 (39) 45 (80) MSUCOM 136 113 (83) 107 (95) 147 101 (69) 90 (89) MWU/AZCOM 132 26 (20) 23 (88) 134 26 (19) 22 (85) MWU/CCOM 181 55 (30) 49 (89) 166 56 (34) 49 (88) NSU-COM 189 80 (42) 65 (81) 212 80 (38) 60 (75) NYCOM 307 111 (36) 97 (87) 297 119 (40) 94 (79) OSU-COM 83 41 (49) 36 (88) 84 35 (42) 30 (86) OU-COM 102 46 (45) 42 (91) 111 54 (49) 48 (89) PCOM 239 150 (63) 122 (81) 260 131 (50) 97 (74) PCSOM 71 36 (51) 35 (97) 73 31 (42) 28 (90) TUCOM-CA 136 43 (32) 38 (88) 141 35 (25) 29 (83) TUNCOM NA NA NA 77 21 (27) 12 (57) UMDNJ-SOM 91 49 (54) 43 (88) 90 53 (59) 45 (85) UNECOM 111 33 (30) 27 (82) 122 30 (25) 27 (90) UNTHSC/TCOM 126 22 (17) 22 (100) 128 18 (14) 15 (83) VCOM 144 52 (36) 48 (92) 151 55 (36) 44 (80) WesternU/Comp 155 41 (26) 32 (78) 188 46 (24) 39 (85) WVSOM 99 50 (51) 42 (84) 101 57 (56) 40 (70) Total 3103 1250 (40) 1083 (87) 3462 1316 (38) 1078 (82) * Some percentages do not total 100 because of rounding. Data for class of 2007 do not include 70 graduates from previous years or military match participants. Class of 2008 data do not include 138 graduates from previous years or military match participants. Total number of students matched and matched to first choice do not match data reported previously for the class of 2007. 1 Data for these columns are slightly lower because they do not include previous graduates. Abbreviations: COM, college of osteopathic medicine; NA, not applicable; OGME-1, first year of osteopathic graduate medical education. The full names of the COMs and branch campuses appear with their abbreviations, locations, and years established on pages 196-198 of this issue of JAOA The Journal of the American Osteopathic Association. Source: American Osteopathic Association Intern/Resident Registration Program (ie, the AOA Match). Data for the class of 2007 were reported previously in the JAOA. 1 ditional 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 rec- ommendation, 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. JAOA Vol 109 No 3 March 2009 139
Table 4 AOA Intern/Resident Registration Program: OGME-1 Internship and Residency Match Summary for the Class of 2008 by COM and Program Type COM, No. (%)* DMU- KCUMB- LECOM- MWU/ MWU/ NSU- OSU- Program Type COM KCOM COM LECOM Bradenton MSUCOM AZCOM CCOM COM NYCOM COM Anesthesiology 2 (3) 3 (5) 0 2 (2) 2 (4) 4 (4) 0 1 (2) 0 0 1 (3) Diagnostic Radiology 1 (2) 1 (2) 1 (2) 1 (1) 0 2 (2) 1 (4) 3 (5) 1 (1) 4 (3) 1 (3) Emergency Medicine 9 (14) 8 (14) 8 (13) 10 (8) 10 (18) 16 (16) 5 (19) 9 (16) 7 (9) 18 (15) 8 (23) Emergency Medicine and Internal Medicine 0 0 0 1 (1) 0 0 1 (4) 0 0 2 (2) 0 Family Practice 9 (14) 15 (25) 8 (13) 22 (18) 5 (9) 13 (13) 6 (23) 12 (21) 15 (19) 21 (18) 6 (17) Family Practice and Emergency Medicine 0 0 0 2 (2) 0 1 (1) 0 0 1 (1) 2 (2) 0 Integrated Family Practice/NMM 0 0 0 0 1 (2) 1 (1) 0 0 0 0 1 (3) Internal Medicine 10 (15) 6 (10) 8 (13) 16 (13) 8 (14) 11 (11) 4 (15) 6 (11) 16 (20) 2 (2) 4 (11) Internal Medicine/ Pediatrics 0 0 0 0 0 0 0 0 0 0 0 Neurological Surgery 0 1 (2) 1 (2) 1 (1) 1 (2) 3 (3) 0 2 (4) 0 2 (2) 0 Neurology 0 0 1 (2) 2 (2) 0 6 (6) 0 0 0 0 0 NMM and OMM 0 0 0 0 0 0 1 (4) 0 0 0 0 Obstetrics and Gynecology 5 (8) 4 (7) 4 (6) 3 (2) 3 (5) 7 (7) 0 2 (4) 5 (6) 2 (2) 5 (14) Ophthalmology 0 0 0 0 1 (2) 1 (1) 0 1 (2) 1 (1) 1 (1) 1 (3) Orthopedic Surgery 7 (11) 3 (5) 6 (10) 9 (7) 3 (5) 6 (6) 3 (12) 2 (4) 1 (1) 7 (6) 1 (3) Otolaryngology and Facial Plastic Surgery 1 (2) 3 (5) 3 (5) 0 1 (2) 2 (2) 0 2 (4) 0 0 1 (3) Pediatrics 2 (3) 3 (5) 2 (3) 4 (3) 0 4 (4) 0 1 (2) 6 (8) 4 (3) 1 (3) Psychiatry 0 0 0 2 (2) 0 1 (1) 0 0 0 0 0 Traditional Rotating Internship 14 (21) 8 (14) 11 (18) 42 (34) 16 (29) 18 (18) 4 (15) 9 (16) 23 (29) 47 (39) 4 (11) Surgery (General) 5 (8) 4 (7) 9 (15) 8 (6) 5 (9) 5 (5) 0 5 (9) 4 (5) 7 (6) 1 (3) Urological Surgery 1 (2) 0 0 0 0 0 1 (4) 1 (2) 0 0 0 Matched, No. 66 59 62 125 56 101 26 56 80 119 35 - (continued) * Some percentages do not total 100 because of rounding. Emergency medicine and internal medicine, family practice/emergency medicine, integrated family practice/neuromusculoskeletal medicine (NMM), neurology, neurological surgery, NMM and osteopathic manipulative medicine (OMM), ophthalmology, and orthopedic surgery were not previously available to first-year trainees. These programs are now available as a result of the restructuring of the first year of osteopathic graduate medical education (OGME-1). A total of 1316 graduates in 2008 participated and matched to an internship or residency position through the American Osteopathic Association Intern/Resident Registration Program (ie, the AOA Match ). This total does not include previous graduates, military match participants, or data from the post-match scramble. Abbreviations: AOA, American Osteopathic Association; COM, college of osteopathic medicine. The full names of the COMs appear in the appendix with their abbreviations, locations, and dates established in Appendix 1 on pages 196-198 of this issue of JAOA The Journal of the American Osteopathic Association. 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 140 JAOA Vol 109 No 3 March 2009
Table 4 (continued) AOA Intern/Resident Registration Program: OGME-1 Internship and Residency Match Summary for the Class of 2008 by COM and Program Type COM, No. (%)* OU- PC TUCOM- TUN UMDNJ- UNE UNTHSC/ Western WV Program Type COM PCOM SOM CA COM SOM COM TCOM VCOM U/COMP SOM Total Anesthesiology 1 (2) 0 0 0 1 (5) 0 0 0 2 (4) 1 (2) 1 (2) 21 Diagnostic Radiology 1 (2) 0 0 0 2 (10) 0 0 0 1 (2) 1 (2) 0 21 Emergency Medicine 9 (17) 13 (10) 4 (13) 6 (17) 3 (14) 5 (9) 6 (20) 1 (6) 6 (11) 7 (15) 7 (12) 175 Emergency Medicine and Internal Medicine 1 (2) 2 (2) 1 (3) 0 0 2 (4) 0 0 0 0 0 10 Family Practice 17 (31) 23 (18) 5 (16) 5 (14) 2 (10) 7 (13) 9 (30) 4 (22) 11 (20 8 (17) 10 (18) 233 Family Practice/ Emergency Medicine 0 0 0 0 0 1 (2) 0 0 0 0 0 7 Integrated Family Practice/NMM 0 0 1 (3) 0 0 0 0 0 0 0 0 4 Internal Medicine 4 (7) 17 (13) 8 (26) 5 (14) 3 (14) 8 (15) 6 (20) 2 (11) 5 (9) 8 (17) 11 (19) 168 Internal Medicine/ Pediatrics 0 1 (1) 0 0 0 0 0 0 0 0 0 1 Neurological Surgery 0 0 1 (3) 0 0 1 (2) 0 0 1 (2) 2 (4) 0 16 Neurology 1 (2) 0 0 0 0 0 0 0 0 0 0 10 NMM and OMM 0 0 0 0 0 0 0 0 0 0 0 1 Obstetrics and Gynecology 3 (6) 1 (1) 4 (13) 1 (3) 0 1 (2) 0 1 (6) 1 (2) 5 (11) 2 (4) 59 Ophthalmology 1 (2) 0 0 1 (3) 0 0 1 (3) 0 3 (5) 0 0 12 Orthopedic surgery 5 (9) 6 (5) 0 3 (9) 3 (14) 1 (2) 1 (3) 1 (6) 1 (2) 1 (2) 2 (4) 72 Otolaryngology and Facial Plastic Surgery 1 (2) 1 (1) 0 1 (3) 0 1 (2) 1 (3) 1 (6) 0 0 0 19 Pediatrics 1 (2) 3 (2) 0 1 (3) 1 (5) 3 (6) 0 1 (6) 3 (5) 0 0 40 Psychiatry 1 (2) 0 0 0 0 0 0 0 0 0 0 4 Traditional Rotating 6 (11) 54 (41) 3 (10) 7 (20) 5 (24) 22 (42) 6 (20) 3 (17) 17 (31) 10 (22) 21 (37) 350 Surgery (General) 2 (4) 10 (8) 4 (13) 5 (14) 1 (5) 1 (2) 0 2 (11) 4 (7) 3 (7) 2 (4) 87 Urological Surgery 0 0 0 0 0 0 0 2 (11) 0 0 1 (1) 6 Matched, No. 54 131 31 35 21 53 30 18 55 46 57 1316 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 comple- - * Some percentages do not total 100 because of rounding. Emergency medicine and internal medicine, family practice/emergency medicine, integrated family practice/neuromusculoskeletal medicine (NMM), neurology, neurological surgery, NMM and osteopathic manipulative medicine (OMM), ophthalmology, and orthopedic surgery were not previously available to first-year trainees. These programs are now available as a result of the restructuring of first year of osteopathic graduate medical education (OGME-1). A total of 1316 graduates in 2008 participated and matched to an internship or residency position through the American Osteopathic Association Intern/Resident Registration Program (ie, the AOA Match ). This total does not include previous graduates, military match participants, or data from the post-match scramble. Abbreviations: AOA, American Osteopathic Association; COM, college of osteopathic medicine. The full names of the COMs appear in the appendix with their abbreviations, locations, and dates established in Appendix 1 on pages 196-198 of this issue of JAOA The Journal of the American Osteopathic Association. tion 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 JAOA Vol 109 No 3 March 2009 141
7000 6000 DOs in ACGME Postdoctoral Training Programs Total DOs in AOA Internship and Residency Programs COM Graduates* DOs in AOA Residency Programs DOs in AOA Internships 5000 Total, No. 4000 3000 2000 1000 1998-1999 1999-2000 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 Academic Year 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 JAOA 1 and JAMA. 7 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 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 sideby-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 AOAapproved 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. 142 JAOA Vol 109 No 3 March 2009
Table 5 No. of AOA Approved Residency Programs and Residents Filling Available Positions as Reported by Academic Year and Specialty, 2005-2008* 2005-2006 2006 2007 2007-2008 Specialty Programs Positions Residents Programs Positions Residents Programs Positions Residents Anesthesiology 12 73 57 11 73 64 12 86 69 Anesthesiology 2 3 1 2 3 0 2 3 0 and pain management Dermatology 19 106 66 19 108 83 19 111 89 Mohs micrographic surgery NA NA NA NA NA NA 1 1 0 Diagnostic Radiology 14 129 100 14 130 105 14 132 112 Radiation oncology 0 0 0 0 0 0 0 0 0 Radiology (vascular 1 1 0 1 1 0 1 1 0 interventional) Emergency Medicine 37 689 401 40 725 471 43 785 513 Emergency medical services 2 3 0 2 3 1 2 3 1 Emergency medicine 12 113 73 12 113 73 12 115 78 and internal medicine Family Practice 157 1691 500 162 1704 609 173 1823 652 Family practice 5 36 14 5 48 21 5 48 22 and emergency medicine Integrated family practice 7 35 7 6 39 20 7 48 17 and NMM Geriatrics // 8 35 4 8 35 4 7 31 3 Internal Medicine 74 853 237 79 973 286 83 1082 360 Cardiac electrophysiology # NA NA NA 1 3 0 1 3 1 Cardiology 18 108 47 18 113 69 21 132 78 Cardiology (Interventional) 5 12 0 6 15 4 8 21 8 Critical care medicine** 4 10 3 5 13 5 5 13 5 Endocrinology 2 4 1 2 4 3 3 6 3 Gastroenterology 7 24 15 8 28 17 9 40 22 Hematology and oncology 2 5 1 2 5 1 4 11 3 Infectious diseases 2 8 2 2 8 2 2 8 3 Nephrology 6 18 7 6 18 8 6 18 8 Oncology 1 3 0 2 6 0 3 9 1 Pulmonary (critical care) 5 17 6 5 17 8 7 26 11 Pulmonary medicine 2 5 0 3 7 0 3 7 1 Rheumatology 3 6 2 3 8 5 3 8 8 Sleep medicine NA NA NA NA NA NA 1 2 0 Neurology 6 39 20 6 39 20 6 39 21 NMM and Osteopathic 7 39 11 6 31 13 7 33 14 Manipulative Medicine NMM 1 14 46 5 14 41 10 18 56 13 (continued) * Data shown for residency programs, positions, and residents is reported by the residency programs to the AOA s Division of Postdoctoral Training through the AOA s Trainee Information, Verification, and Registration Audit system. Because current data for the 2007-2008 academic year may change, they are to be considered incomplete and will be finalized in the JAOA s 2010 Medical Education issue. Changes made to the data reported for the 2006-2007 academic year are underlined. Residency programs were approved by the AOA for Mohs micrographic surgery, sleep medicine, and pediatric allergy and immunology in the 2007-2008 academic year. Reports published in previous editions of THE JOURNAL s Osteopathic Medical Education issue 1 combined emergency medical services, integrated family practice and neuromusculoskeletal medicine (NMM), NMM+1, gynecologic oncology and reproductive endocrinology, otolaryngologic allergy, and geriatric psychiatry under the single headings of emergency medicine, family medicine, NMM and osteopathic manipulative medicine, obstetrics and gynecology, otolaryngology and facial plastic surgery, and psychiatry, respectively. They have been separated here for all years reported. Family practice refers to family practice and osteopathic manipulative treatment. // Geriatrics includes geriatrics and family practice as well as geriatrics and internal medicine. Data is also available for interns and residents in their first year on the following specialty tracks: internal medicine (2005-2006, 106; 2006-2007, 166; and 2007-2008, 214), obstetrics and gynecology (2005-2006, 42; 2006-2007, 46; and 2007-2008, 72), otolaryngology and facial plastic surgery (2005-2006, 19; 2006-2007, 16; and 2007-2008, 21), and pediatrics (2005-2006, 35; 2006-2007, 46; and 2007-2008, 39). These numbers are exclusive of residency number. The total number of tracked internships for each academic year noted is as follows: 2005-2006, 202; 2006-2007, 274; and 2007-2008, 346. # Residency programs were approved by the AOA for cardiac electrophysiology, reproductive endocrinology, and geriatric psychiatry in the 2006-2007 academic year. ** Critical care medicine includes critical care (surgery). Abbreviations: AOA, American Osteopathic Association; NA, not applicable; NMM, neuromusculoskeletal medicine. Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown; and AOA s Trainee Information, Verification, and Registration Audit system, academic year 2007-2008. Data for the 2005-2006 and 2006-2007 academic years have been reported previously in JAOA The Journal of the American Osteopathic Association. 1,4 As noted in the first footnote, current data for the 2007-2008 academic year are to be considered incomplete. JAOA Vol 109 No 3 March 2009 143
Table 5 (continued) No. of AOA Approved Residency Programs and Residents Filling Available Positions as Reported by Academic Year and Specialty, 2005-2008* 2005-2006 2006 2007 2007-2008 Specialty Programs Positions Residents Programs Positions Residents Programs Positions Residents Obstetrics 33 331 159 32 339 150 33 357 152 and Gynecology Gynecologic oncology # 2 5 2 3 9 3 3 9 6 Maternal and fetal medicine 2 6 1 3 9 1 3 9 4 Reproductive endocrinology # NA NA NA 1 3 0 1 3 1 Ophthalmology 11 48 36 12 57 38 12 57 41 Orthopedic Surgery 29 341 252 30 350 291 29 348 313 Hand surgery 1 3 0 1 3 0 1 3 0 Orthopedic spine surgery 1 2 0 2 3 0 2 3 1 Otolaryngology and 18 94 72 18 99 77 19 114 79 Facial Plastic Surgery Otolaryngologic allergy 1 3 0 1 3 0 1 3 0 Pathology 0 0 0 0 0 0 0 0 0 Forensic pathology 1 1 0 1 1 0 1 1 0 Pediatrics 14 154 63 14 154 65 17 167 82 Pediatric allergy NA NA NA NA NA NA 1 2 0 and immunology Pediatric emergency medicine 0 0 0 0 0 0 0 0 0 Pediatric radiology 1 3 0 1 3 0 1 3 0 Pediatrics (Internal medicine) 1 6 6 1 6 6 2 14 6 Physical Medicine and 3 28 14 3 28 16 3 28 22 Rehabilitation Medicine Preventive Medicine 1 3 0 1 3 1 1 3 1 and Public Health Preventive medicine 1 3 0 0 0 0 1 3 0 (occupational and environmental) Proctology 1 2 1 1 2 1 1 2 2 Psychiatry 5 48 24 5 48 36 7 72 30 Child psychiatry 1 2 0 1 2 1 2 8 4 Geriatric psychiatry # NA NA NA 1 3 0 1 3 0 Sports Medicine 14 48 10 13 42 13 14 42 14 Surgery (General) 40 368 234 39 387 287 39 424 306 Cardiothoracic surgery 2 11 0 2 11 1 2 11 0 General vascular surgery 9 21 5 9 20 4 9 20 5 Neurological surgery 11 66 39 12 86 49 11 81 52 Plastic and reconstructive surgery 4 14 9 5 18 13 6 21 15 Urological surgery 7 44 28 7 45 34 7 52 37 Total 648 5766 2535 669 6045 2989 718 6564 3289 * Data shown for residency programs, positions, and residents is reported by the residency programs to the AOA s Division of Postdoctoral Training through the AOA s Trainee Information, Verification, and Registration Audit system. Because current data for the 2007-2008 academic year may change, they are to be considered incomplete and will be finalized in the JAOA s 2010 Medical Education issue. Changes made to the data reported for the 2006-2007 academic year are underlined. Residency programs were approved by the AOA for Mohs micrographic surgery, sleep medicine, and pediatric allergy and immunology in the 2007-2008 academic year. Reports published in previous editions of THE JOURNAL s Osteopathic Medical Education issue 1 combined emergency medical services, integrated family practice and neuromusculoskeletal medicine (NMM), NMM+1, gynecologic oncology and reproductive endocrinology, otolaryngologic allergy, and geriatric psychiatry under the single headings of emergency medicine, family medicine, NMM and osteopathic manipulative medicine, obstetrics and gynecology, otolaryngology and facial plastic surgery, and psychiatry, respectively. They have been separated here for all years reported. Family practice refers to family practice and osteopathic manipulative treatment. // Geriatrics includes geriatrics and family practice as well as geriatrics and internal medicine. Data is also available for interns and residents in their first year on the following specialty tracks: internal medicine (2005-2006, 106; 2006-2007, 166; and 2007-2008, 214), obstetrics and gynecology (2005-2006, 42; 2006-2007, 46; and 2007-2008, 72), otolaryngology and facial plastic surgery (2005-2006, 19; 2006-2007, 16; and 2007-2008, 21), and pediatrics (2005-2006, 35; 2006-2007, 46; and 2007-2008, 39). These numbers are exclusive of residency number. The total number of tracked internships for each academic year noted is as follows: 2005-2006, 202; 2006-2007, 274; and 2007-2008, 346. # Residency programs were approved by the AOA for cardiac electrophysiology, reproductive endocrinology, and geriatric psychiatry in the 2006-2007 academic year. ** Critical care medicine includes critical care (surgery). Abbreviations: AOA, American Osteopathic Association; NA, not applicable; NMM, neuromusculoskeletal medicine. Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown; and AOA s Trainee Information, Verification, and Registration Audit system, academic year 2007-2008. Data for the 2005-2006 and 2006-2007 academic years have been reported previously in JAOA The Journal of the American Osteopathic Association. 1,4 As noted in the first footnote, current data for the 2007-2008 academic year are to be considered incomplete. 144 JAOA Vol 109 No 3 March 2009
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. References 1. Burkhart DN, Lischka TA. Osteopathic graduate medical education. JAm Osteopath Assoc. 2008;108:127-137. Available at: http://www.jaoa.org/cgi /content/full/108/3/127. Accessed February 26, 2009. 2. American Osteopathic Association. Accreditation Document for Osteopathic Postdoctoral Training Institutions and the Basic Document for Postdoctoral Training Programs. Chicago, Ill: American Osteopathic Association; 2008. Available at: https://www.do-online.org/pdf/sir_postdoctrainproced.pdf. Accessed February 26, 2009. 3. Kasovac M. The osteopathic graduate medical education development initiative. J Am Osteopath Assoc. 2001;201:677-678. Available at: http: //www.jaoa.org/cgi/reprint/101/11/677. Accessed February 27, 2009. 4. Crosby JB. Advisory committee to expand OGME. AOA Daily Report (serial online). October 5, 2006. Available at: http://blogs.do-online.org/dailyreport.php?itemid=284. Accessed March 13, 2009. 5. Johnson B. Vision for greatness: AOA President Carlo J. DiMarco, DO, sets sights on OGME reform. The DO. September 2008;49(9):22-28. 6. Crosby JB. OGME Development Initiative training session. AOA Daily Report (serial online). January 12, 2009. Available at: http://blogs.do-online.org/daily report.php?itemid=19201. Accessed February 27, 2009. 7. DiMarco CJ. Taking action to expand OGME. The DO. February 2009;50(2): 5-6. 8. Brotherton SE, Etzel SI. Graduate Medical Education, 2007-2008 [appendix II]. JAMA. 2008;300:1228-1243. 9. Burkhart DN, Lischka TA. Dual and parallel postdoctoral training programs: implications for the osteopathic medical profession. J Am Osteopath Assoc. 2009;109:146-153. 10. Obradovic JL, Winslow-Falbo P. Osteopathic graduate medical education. J Am Osteopath Assoc. 2007;107:57-66. Available at: http://www.jaoa.org/cgi/content/full/107/2/57. Accessed February 27, 2009.