Free
Letters to the Editor  |   March 2008
Response
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   March 2008
Response
The Journal of the American Osteopathic Association, March 2008, Vol. 108, 105-106. doi:10.7556/jaoa.2008.108.3.105
The Journal of the American Osteopathic Association, March 2008, Vol. 108, 105-106. doi:10.7556/jaoa.2008.108.3.105
As director of the Department of Education at the American Osteopathic Association (AOA), I review and monitor the results of the AOA Intern/Resident Registration Program (ie, the AOA “Match”), as well as the results of the allopathic National Residency Match Program (NRMP) of the Accreditation Council for Graduate Medical Education (ACGME). Each year, published results from the AOA Match1 appear to indicate a decline in the number of graduates from colleges of osteopathic medicine (COMs) electing to train in AOA-approved programs. In truth, however, the total number of filled slots in AOA-approved training programs has remained relatively stable during the last decade, hovering between 51% and 56%.2 
Match data indicated that, in 2005, 1240 graduates of COMs successfully matched to AOA-approved training programs out of a combined pool of 2908 current graduates and previous graduates for a 43% fill rate.2 It is important to note that, as the number of COM graduates seeking training positions increases, AOA Match percentages will decrease unless numbers for matching graduates and for total graduates grow exponentially. The rapid increase in the number of new COM graduates could continue to make it difficult to maintain current AOA Match percentages over time. 
The AOA Match, however, does not represent the full picture when we assess the annual fill rate of our training programs. For example, a substantial number of COM graduates participate in the post-Match “scramble” for training positions. The number of additional filled slots is not known to the AOA until the fall, when all the training programs report the full complement of filled positions through the Trainee Information, Verification, and Registration Audit (TIVRA) system. Regrettably, these data are not available until after publication of the annual osteopathic medical education theme issue of JAOA—The Journal of the American Osteopathic Association.1 Post-Match data for 2005 brought an additional 241 graduates into AOA-approved programs, for a total fill rate of 51%.2 In 2007, an additional 396 graduates participating in AOA-approved programs were identified through TIVRA for a total fill rate of 52%.2 
The number of osteopathic physicians who participate in the NRMP match process but fail to match into ACGME-accredited programs is a contributing factor to these additional numbers. In 2005, 2006, and 2007, 31% of the osteopathic physicians participating in the NRMP match did not successfully match into ACGME-accredited programs.3 Many of these individuals then chose to scramble into AOA-approved programs. 
In 2006, 1341 osteopathic physicians were training in ACGME-accredited family medicine programs, compared with 507 DOs training in AOA-approved programs.4 These 507 DOs do not include first-year trainees who will enter family practice in their second year at an osteopathic program. However, clearly the number of COM graduates in allopathic programs is on the rise.4 
Osteopathic medical students are heavily recruited into ACGME-accredited family medicine programs because of declining interest in primary care from allopathic medical students. Directors of medical education, program directors, and hospital administrators involved with AOA-approved family practice programs are going to have to review their own recruitment practices and ensure competitive program quality if they want to attract graduates into their programs. 
The AOA does not have enough slots for all the current and previous COM graduates seeking training positions. In 2007, the AOA Match offered 2189 funded slots for the pool of 3173 trainees seeking positions.2 Graduates of COMs filled 1663 of the funded slots, for a total fill rate of 76%.2 The AOA and the American Association of Colleges of Osteopathic Medicine focused on this topic at the Osteopathic Medical Education Summit II, held in November 2007 in Lombard, Ill. More than 100 leaders of the osteopathic medical profession participated in this discussion. Recommendations derived from this summit are currently under review. 
Various initiatives to increase the number of COM graduates electing to fill slots in AOA-approved training programs have been drafted and implemented by the AOA and approved by the AOA's Board of Trustees. 
In fact, the AOA has restructured the requirements for training programs. Starting in July 2008, graduates specializing in family practice and most other osteopathic medical specialties can begin residency training in the first year after graduation. As a result of this restructuring, we expect to find fewer trainees transferring to ACGME-accredited programs in the second year—and to attract more first-year trainees into AOA-approved training positions. 
An initiative to develop new programs in specialties and hospitals that have never trained COM graduates before is also in progress. Hospitals that have no residency training programs are eligible for funding from the Centers for Medicare and Medicaid Services to cover the cost of training residents. 
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 14, 2008.
National Matching Services, Inc. Match data by specialty. (unpublished raw data, 1998-2007).
National Resident Matching Program. Advanced Data Tables for 2005 Main Residency Match. Washington, DC: National Resident Matching Program; 2007.
Department of Education. DOs in specialty training—osteopathic and allopathic comparisons [graph]. OPTI Clearinghouse Reports. Chicago, Ill: American Osteopathic Association; 2007. Available at: https://www.do-online.org/pdf/lcl_optirepresidentcomparison.pdf. Accessed February 15, 2008. ♦