The AOA Match and the Future of Osteopathic Residency Positions: The Good News and the Bad News MAME- March 7, 2012 Jon Rohrer, Ph.D., D.Min. Associate Director

Perceptions  What is your perception about the future of osteopathic residency education?  What is the evidential foundation of your perception about the future of osteopathic residency education?  What impact does this have on your sphere of influence and practice?

Presentation  Overview of trends for colleges of osteopathic medicine.  Summary of recent match results and positions  Review of LCME accredited schools and ACGME residency positions and the impact on the future of GME for osteopathic students  Observations and summary conclusions- good news bad news with not recommendations for response and application.

Total Enrollment in COMs Data drawn from the AACOM Annual Osteopathic Medical School Questionnaire Thousands Total Enrollment

Trends in COMs  Significant Increase in Colleges of Osteopathic Medicine  Exponential Growth in Enrollment of Osteopathic Students  Disconnect with Osteopathic GME

DOs in Residency Training, Totals in AOA and ACGME Programs* *DOs in AOA/ACGME Accredited Programs are Counted Twice YearAOAACGMETotal Percent in AOA

Trends in Osteopathic Matching *Data drawn from AOA Office of Education and the AACOM Annual Report Funded SlotsNumber Matched No. of Non-Participants Unfilled Slots Funded Slots Number Matched No. of Non-Participants Unfilled Slots

AOA Deficit in Residency Positions 2005 to Thousand s Eligible DO Participants Option 1 & 2 Slots Residency Deficit

Positions Left Over in the AOA Match Program Year Traditional Internships Family Practice Internal Medicine Other Specialties # of Unmatched Students Unfilled Positions

Number of DOs in ACGME Residencies, The Annual Number of DO Graduates, OOO2O4O6O8O DOs in ACGME Progs.No. of DO Grads. DOs in ACGME Progs No. of DO Grads

NRMP PGY-1 Slots Number of USMD and DO Graduates YearPGY-1 Slots USMD Grads DO Grads

IMGs in ACGME Programs Thousands Number 24,98224,70325,53125, ,70725,40325,78326, ,63628,17628,82429,48830,06830,441

DOs In The NRMP YearNo. of Applic.Active Applic.Matched PGY-1 Unmatched PGY

Number of DOs Scrambling* *Includes Current and Past Graduates Year Match Participants AOA Match Results NRMP Match Results No. in Scramble

Results of the 2010 Medical School Enrollment Survey June AAMC

Future Growth Trends: AAMC and AACOM  Using a baseline of first year students enrolled in 2002, US MD schools will increase by 22% from 16,488 to 20,181 by  Using a baseline of first year students enrolled in medical schools in 2002 US DO schools will increase enrollment by 102% from 3,079 to 6,222  By 2015, MD and DO schools will have a combined increase of 35%, producing almost 7,000 more new doctors every year compared to 2002.

2012 Match Projections for Osteopathic Students  The final picture will only be known after the NRMP.  2,352 Students did not participate in the AOA Match.  70% of osteopathic students applying to the NRMP match with a residency program  30% will not match (705)  705 unmatched NRMP +606 unmatched AOA match candidates= 1311 students that will seek to fill 888 slots that were unfilled in the AOA Match  Some may find positions in the NRMP SOAP Program

Educational Directions MSUCOM Graduates MSUCOM Grads SCS Hospitals Other AOA Programs Military Total AOA Programs ACGME Programs * Not Matched in AOA Match 13 *Not participating in AOA Match

MSUCOM: Top 10 Specialty Choices AOA and ACGME Programs for 2010 and 2011 *Many Interns Matched to ACGME Advanced Residencies at the PGY-2 Level 2010 List of Top 10Number2011 List of Top 10Number Internal Medicine42Family Medicine43 Family Medicine41Internal Medicine43 Trad. Internship*29Emer. Medicine17 Emer. Medicine22OB/GYN17 Anesthesiology12Trad. Internship*12 Pediatrics12Pediatrics12 PM&R9Neurology9 General Surg.8Psychiatry7 Orthopedic Surg.8Orthopedic. Surg.7 OB/GYN5General Surg.4

SCS Composition by COM Years COM MWU/AZCOM MWU/CCOM NSUCOM DMU/COM KCUMB/COM ATSU/KCOM LECOM UNECOM MSUCOM UMDNJSOM NYCOM OUCOM OSUCOM PCOM PCSOM UNTHSCTCO M TUCOM/CA WVCOM WU/COMP VCOM LECOM-FL TUNCOM/NV PCOM/GA TUCOM/NY0004 RVUCOM0000 LMUCOM00018 ATSU/SOMA0008 PNWUCOM0000 TOTALS

SCS Intern and Resident/Fellows Numbers 2000 to 2011 Includes MD Participants in SCS Educational Programs. Track and Emphasis Interns are Counted as Residents Rotating Interns Residents/Fellows Totals in OGME Rotating Interns Residents/Fellows Totals in OGME

SCS Primary Care vs. Non-Primary Care 2000 to 2011 Minus the Intern Count *Combined Primary Care/Specialty Residents, e.g. FM/ER, are Counted as a.5 FTE, all FM & IM Emphasis and Track Interns are Included in these Numbers as well as MDs who participate in SCS programs. Traditional interns are not included Primary Care Non-Primary Care

SCS Hospital Match Summary  SCS hospitals offered 436 slots for the AOA match (16% of the 2,655 positions offered nationally.)  347 slots have filled, leaving 89 vacant positions  Majority of the unfilled slots are traditional internships (33), family medicine (26), and internal medicine (14).  Given the number of students that did not match nationally in the AOA match (606) and the projected number that will not match in the NRMP, it is assumed that all open SCS slots will be filled.

Good News Bad News Good News  Osteopathic Colleges will continue to grow.  Hospitals with osteopathic slots will fill their positions \  Michigan will be a destination for osteopathic students seeking osteopathic residencies, particularly in the surgical specialties Bad News  GME will not grow to meet the demands of the growth in osteopathic graduates.  The number of osteopathic students will increase  The increase in MSUCOM graduates will narrow the availability of residency slots in Michigan

Good News Bad News Good News  The COCA Study Group on Osteopathic Graduate Medical Education has published a report on recommended requirements for osteopathic GME  The AOA has formulated a Blue Ribbon Panel to propose solutions to the AOA BOE and BOT Bad News  Measures recommended are too little too late  At this point, no one knows what the recommendations will entail.

Conclusion: Multiple Factors in Play With No Immediate Solutions  Combined first year MD and DO enrollment in 2015 is projected to be 26,403, 35% above  Increase in GME slots shows no significant projected increase to correspond to the increase of students as the disparity between student and GME slots worsens.  Osteopathic dependence on ACGME programs will increase at a time when MD students and IMGs grow in number.  Osteopathic medicine will remain rooted in primary care.  ACGME guidelines will restrict access of residents trained osteopathically.  All this against the projected shortage of physicians by 2020.

Good News Bad News  Osteopathic dependence on ACGME programs will increase  Osteopathic medicine will remain rooted in primary care  The disparity between students and GME slots will worsen

scs.msu.edu Jon Rohrer, Ph.D., D.Min.