1. 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. jon.rohrer@hc.msu.edu Associate Director

2. 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?

3. 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.

5. Total Enrollment in COMs 1968-2010 Data drawn from the AACOM Annual Osteopathic Medical School Questionnaire 196819731978198319881993199820032004200520062007200820092010 0 2 4 6 8 10 12 14 16 18 20 22 Thousands Total Enrollment 1.8792.7804.2216.2126.6147.8229.88211.85712.52513.40614.40915.63416.89318.14319.427

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

9. DOs in Residency Training, 1995-2009 Totals in AOA and ACGME Programs* *DOs in AOA/ACGME Accredited Programs are Counted Twice YearAOAACGMETotal Percent in AOA 199526063333593943.9 199621413288542939.4 199726323367599943.8 199829983639663745.1 199929283869679743.1 200027814175695639.9 200124994658715734.9 200225325327785932.2 200325235838836130.2 200424225675809729.9 200525356474900928.1 200629896629961831.1 2007328967841007332.7 2008479472371203139.8 2009524776281287540.8

10. Trends in Osteopathic Matching 1988-2011 *Data drawn from AOA Office of Education and the AACOM Annual Report 1988199019921994199619982000200220042006200820102011 0 500 1000 1500 2000 2500 3000 Funded SlotsNumber Matched No. of Non-Participants Unfilled Slots Funded Slots 1515170117991676187718781814198921472206231224432553 Number Matched 1369125711451385125513531314129112051196135314731640 No. of Non-Participants 661663994121213631356174819922114 Unfilled Slots 146 502654 2916225255006989421010959970913

11. AOA Deficit in Residency Positions 2005 to 2012. 20052006200720082009201020112012 0.4 1.6 2.8 4 Thousand s Eligible DO Participants2.9082.8863.1733.6003.8994.1064.5815.014 Option 1 & 2 Slots9281.0301.1541.5581.7541.8011.9181.995 Residency Deficit1.9801.8562.0192.0422.1452.3052.6633.019

12. Positions Left Over in the AOA Match Program 2006-2012 Year Traditional Internships Family Practice Internal Medicine Other Specialties # of Unmatched Students Unfilled Positions 2006615170931321231010 200753418088120182922 2008397310152100273959 20094223061731013611002 201037933917478423970 201139033314446572913 201235130214293606888

13. Number of DOs in ACGME Residencies, 1992-2009 The Annual Number of DO Graduates, 1992-2009 92949698OOO2O4O6O8O9 1200 2000 2800 3600 4400 5200 6000 6800 7600 DOs in ACGME Progs.No. of DO Grads. DOs in ACGME Progs.3137326432883639417653275675662972377628 No. of DO Grads.1532173219322096227925362769281434623724

14. NRMP PGY-1 Slots 1975-2011 Number of USMD and DO Graduates YearPGY-1 Slots USMD Grads DO Grads 19751569112714809 198018055151351151 198518535164001560 199020101161791534 199520751158921932 200020598157142510 200521454157612707 201022809164273845 201123421168934228

15. IMGs in ACGME Programs 1995-2010 1995199619971998199920002001200220032004200520062007200820092010 24 25 26 27 28 29 30 31 32 Thousands Number 24,98224,70325,53125,41525.88024,70725,40325,78326,57726.72027,63628,17628,82429,48830,06830,441

16. DOs In The NRMP 1996-2011 YearNo. of Applic.Active Applic.Matched PGY-1 Unmatched PGY-1 19961176799552247 19971185790509281 19981343890614276 19991451984671313 200016651150823327 200117931241876365 200218591316933383 200319371408995413 2004203415591099461 2005204315241045479 2006222215091024485 2007239816521136516 2008271118701339531 2009287520151408607 201020451444601 201121781561617

17. Number of DOs Scrambling* 2006-2012 *Includes Current and Past Graduates Year Match Participants AOA Match Results NRMP Match Results No. in Scramble 2006288611961024666 2007317312671136770 2008360013531339908 20093899143314081058 20104106147314441189 2011 2012 4581 5014 1640 1767 1561 1311 1380

18. Results of the 2010 Medical School Enrollment Survey June 2011- AAMC

20. 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 2015.  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.

21. 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

22. Educational Directions MSUCOM Graduates 201020112012 MSUCOM Grads 192 187 197 SCS Hospitals 137 138 138 Other AOA Programs 17 16 14 Military 10 7 7 Total AOA Programs 164 161 159 ACGME Programs 27 26 24* Not Matched in AOA Match 13 *Not participating in AOA Match

23. 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

24. SCS Composition by COM Years 2000-2011 COM 200020012002200320042005200620072008200920102011 MWU/AZCOM1927334041443834374654 MWU/CCOM52515846 54445674716166 NSUCOM525758464953525667635759 DMU/COM1591411341108890117120130120124113 KCUMB/COM8195989392113108119128132134132 ATSU/KCOM136 12711610211310194 9391108 LECOM41924233561737911311210596 UNECOM181913999 2017181714 MSUCOM323367364333365377366401384425457493 UMDNJSOM466511764656 NYCOM813171319182520151314 OUCOM1422 2117 18 17242022 OSUCOM17118568141320221913 PCOM202823 212622 20172022 PCSOM6810128172537394643 UNTHSCTCO M 201516151422252327282219 TUCOM/CA813193034424148414837 WVCOM1217191718 172429222024 WU/COMP5655464236 4244364246 VCOM411162429 LECOM-FL17303141 TUNCOM/NV12254045 PCOM/GA081321 TUCOM/NY0004 RVUCOM0000 LMUCOM00018 ATSU/SOMA0008 PNWUCOM0000 TOTALS9761085108197910001099114712231336140414601547

25. SCS Intern and Resident/Fellows Numbers 2000 to 2011 Includes MD Participants in SCS Educational Programs. Track and Emphasis Interns are Counted as Residents 200020012002200320042005200620072008200920102011 0 200 400 600 800 1000 1200 1400 1600 1800 Rotating Interns Residents/Fellows Totals in OGME Rotating Interns143139154129 157 15513716395 94 67 Residents/Fellows867812 883891979105111151291136614631549 Totals in OGME1010951966101210481134118812781386146015301616

26. 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. 200020012002200320042005200620072008200920102011 0 200 400 600 800 1000 1200 Primary Care 367.5318.5281.5289.5261.5276298316353368416.5463.5 Non-Primary Care499.5493.5530.5593.5629.57037538049519981046.51085.5

27. 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.

28. 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

29. 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.

30. 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 2002.  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.

31. 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

32. scs.msu.edu Jon Rohrer, Ph.D., D.Min. jon.rohrer@hc.msu.edu