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AOA Communication  |   March 2010
Osteopathic Graduate Medical Education 2010
Author Notes
  • From the Department of Education at the American Osteopathic Association (AOA) in Chicago, Illinois. 
  • Address correspondence to Elizabeth Freeman, MS, EdS, Assistant Director, AOA Division of Postdoctoral Training, Department of Education, 142 E Ontario St, Chicago, IL 60611-2864.E-mail: bfreeman@osteopathic.org 
Article Information
AOA Communication   |   March 2010
Osteopathic Graduate Medical Education 2010
The Journal of the American Osteopathic Association, March 2010, Vol. 110, 150-159. doi:10.7556/jaoa.2010.110.3.150
The Journal of the American Osteopathic Association, March 2010, Vol. 110, 150-159. doi:10.7556/jaoa.2010.110.3.150
Abstract

Osteopathic graduate medical education (OGME) continues to evolve. With the restructuring of the traditional osteopathic internship, which became effective July 1, 2008, for most specialties, the number of trainees in osteopathic residency programs has substantially grown. The authors detail the effects of the restructuring on OGME and provide an update on the current availability of OGME training opportunities. The present article does not, however, report data from the American Osteopathic Association Intern/Resident Registration Program (ie, the AOA “Match”).

The annual 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. However, this year's article will focus on the impact of the major reorganization of the first OGME year (OGME-1) by analyzing information from TIVRA. Data reflect substantial increases in numbers of trainees in osteopathic residency programs, suggesting that OGME-1 trainees made the transition from osteopathic internships to osteopathic residencies. We also review the current availability of OGME training opportunities and trainee approval pathways. Program data reported in the present article are current as of May 31, 2009. 
Reorganization of the OGME-1 Training Year
Changes to the traditional internship structure became effective July 1, 2008, under an initiative called “restructuring.”1,2 The majority of specialty colleges restructured their OGME-1 year into the residency (Figure 1). Current OGME-1 years are now structured as follows: 
  • OGME-1R, Residency (Option 1)—Students match directly into the residency for the OGME-1R year. Requirements are reflected in the specialty standards.
  • OGME-1P, Preliminary Internship (Option 2)—Programs require completion of a designated preliminary year of training (ie, an internship) as a prerequisite for the first year of residency (ie, the OGME-2 year). Matching successfully assures entry into both the preliminary year as well as the OGME-2 year in residency training. Requirements are reflected in the specialty standards.
  • OGME-1T, Traditional Internship (Option 3)—The traditional rotating internship year is not linked to a specialty residency. Specialties selecting this option prefer a traditional rotating internship as the OGME-1 year. This option is also available to students who are undecided on specialization or who plan on entering residencies accredited by the Accreditation Council on Graduate Medical Education (ACGME). Movement into Option 1 or Option 2 specialty programs depends on availability of open positions for the next training year and may be limited for in-demand specialties. Requirements are listed in the AOA Basic Document for Osteopathic Postdoctoral Training Programs.1
Figure 1.
Training pathways as determined by medical specialty as of July 1, 2009. Abbreviation: OGME-1, first year of osteopathic graduate medical education.
Figure 1.
Training pathways as determined by medical specialty as of July 1, 2009. Abbreviation: OGME-1, first year of osteopathic graduate medical education.
The AOA Basic Document for Postdoctoral Training Programs and the specialty standards are available on DO-Online (http://www.do-online.org) by clicking on the “Education” tab and then selecting “Postdoctoral Training.” 
Impact of Restructuring on Programs and Training Positions
The number of osteopathic medical graduates totaled 3462 in 2008 and reached 3724 in 2009, surpassing 3500 for the first time (D.N. Burkhart, PhD, unpublished data, 2009). There were substantial changes in the number of programs and positions available primarily as a result of restructuring the OGME-1 year as a residency year for the majority of specialties. While the number of internship programs and positions decreased, increases in residency programs and positions offset those numbers. For purpose of discussion here, “internship” refers only to the OGME-1 year specifically designated as an internship (ie, OGME-1P and OGME-1T). “Residency” refers to training in a resident or fellowship program and includes the OGME-1R year. 
Changes in the allotment of approved OGME positions show an expected and clear movement of positions and trainees from internship to residency programs. Initial data on re-designation of OGME-1 positions by specialty college were previously reported.3 Applications for restructuring were closed as of September 1, 2008, except for two specialties (neurology and psychiatry), for which the OGME-1R option became effective July 1, 2009. Further changes in allotment of OGME positions were not tracked as part of the restructuring initiative effort beyond that initial report. 
For the 2007-2008 academic year, there were 223 approved internship programs with 2762 positions, of which 1645 were filled.3 In the 2008-2009 academic year—the year in which the restructured OGME-1R, OGME-1P, and OGME-1T became effective—there were 154 internship programs approved for a total of 1391 positions, of which 605 were filled (Table 1). This comparison reveals decreases of 69 internship programs (-31%) and 1371 internship positions (-50%) from the previous year. Of these positions, 24 internships closed in the 2007-2008 academic year compared to 45 closures reported for the 2008-2009 academic year. While internship programs tended to decrease their positions by the number of positions re-designated as residency positions, they did not close at the expected levels. Future closures will be tracked during the next 2 years to determine whether higher-than-average closure rates continue. 
Table 1
No. of AOA-Approved Internship and Residency Programs and Trainees Filling Available Positions by State, 2007-2008 Academic Year *


Internship Programs

Residency Programs

Total
State
Programs
Positions
Trainees
Programs
Positions
Trainees
Programs
Positions
Trainees
Alaska000198198
Arizona 0 0 0 7 82 44 7 82 44
Arkansas00011231123
California 6 75 24 25 301 170 31 376 194
Colorado143000143
Connecticut 1 12 6 1 11 5 2 23 11
Delaware11510124923919
Florida 10 136 56 44 499 265 54 635 321
Georgia141329943310
Illinois 6 41 19 39 417 271 45 458 290
Indiana31244301474218
Iowa 0 0 0 3 38 29 3 38 29
Kansas0001121111211
Kentucky 3 18 4 6 44 19 9 62 23
Maine18510100491110854
Massachusetts 2 10 8 2 12 6 4 22 14
Michigan21206921811848122520220541317
Minnesota 0 0 0 2 14 4 2 14 4
Mississippi00011831183
Missouri 3 15 6 22 161 113 25 176 119
Nevada1151668553710069
New Jersey 6 77 28 49 529 312 55 606 340
New Mexico000165165
New York 19 210 80 57 765 444 76 975 524
North Carolina121218932010
Ohio 13 112 48 103 928 553 116 1040 601
Oklahoma21662527119227287198
Oregon 1 6 0 7 51 0 8 57 0
Pennsylvania362811379911236831351404820
Rhode Island 0 0 0 2 36 13 2 36 13
South Carolina0001121111211
Tennessee 2 14 9 2 24 0 4 38 9
Texas43223201658524197108
Virginia 3 33 12 12 151 52 15 184 64
Washington000164164
West Virginia 7 37 7 18 208 95 25 245 102
Wisconsin0002432024320
Wyoming 0
0
0
1
12
6
1
12
6
Total 154 1391 605 762 8094 4794 916 9485 5399
 Source: Training Programs by State: Year-End Reports, Division of Postdoctoral Training, American Osteopathic Association, Chicago, Ill.
 *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, 2009. Osteopathic medical internship and residency positions are not currently approved in the District of Columbia or in the following 12 states: Alabama, Hawaii, Idaho, Louisiana, Maryland, Montana, Nebraska, New Hampshire, North Dakota, South Dakota, Utah, and Vermont.
Table 1
No. of AOA-Approved Internship and Residency Programs and Trainees Filling Available Positions by State, 2007-2008 Academic Year *


Internship Programs

Residency Programs

Total
State
Programs
Positions
Trainees
Programs
Positions
Trainees
Programs
Positions
Trainees
Alaska000198198
Arizona 0 0 0 7 82 44 7 82 44
Arkansas00011231123
California 6 75 24 25 301 170 31 376 194
Colorado143000143
Connecticut 1 12 6 1 11 5 2 23 11
Delaware11510124923919
Florida 10 136 56 44 499 265 54 635 321
Georgia141329943310
Illinois 6 41 19 39 417 271 45 458 290
Indiana31244301474218
Iowa 0 0 0 3 38 29 3 38 29
Kansas0001121111211
Kentucky 3 18 4 6 44 19 9 62 23
Maine18510100491110854
Massachusetts 2 10 8 2 12 6 4 22 14
Michigan21206921811848122520220541317
Minnesota 0 0 0 2 14 4 2 14 4
Mississippi00011831183
Missouri 3 15 6 22 161 113 25 176 119
Nevada1151668553710069
New Jersey 6 77 28 49 529 312 55 606 340
New Mexico000165165
New York 19 210 80 57 765 444 76 975 524
North Carolina121218932010
Ohio 13 112 48 103 928 553 116 1040 601
Oklahoma21662527119227287198
Oregon 1 6 0 7 51 0 8 57 0
Pennsylvania362811379911236831351404820
Rhode Island 0 0 0 2 36 13 2 36 13
South Carolina0001121111211
Tennessee 2 14 9 2 24 0 4 38 9
Texas43223201658524197108
Virginia 3 33 12 12 151 52 15 184 64
Washington000164164
West Virginia 7 37 7 18 208 95 25 245 102
Wisconsin0002432024320
Wyoming 0
0
0
1
12
6
1
12
6
Total 154 1391 605 762 8094 4794 916 9485 5399
 Source: Training Programs by State: Year-End Reports, Division of Postdoctoral Training, American Osteopathic Association, Chicago, Ill.
 *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, 2009. Osteopathic medical internship and residency positions are not currently approved in the District of Columbia or in the following 12 states: Alabama, Hawaii, Idaho, Louisiana, Maryland, Montana, Nebraska, New Hampshire, North Dakota, South Dakota, Utah, and Vermont.
×
For the same period, there were equivalent or better increases in the number of residency programs and positions. Data for the 2007-2008 academic year showed 718 programs approved for 6564 positions, of which 3289 positions were filled.3 In the 2008-2009 academic year, there were 762 residency programs, an increase of 44 programs (+6%) with a total of 8094 residency positions, an increase of 1530 positions (+23%), with 4794 filled (Table 2). For 2008-2009, there were a total of 916 internship and residency programs with 9485 total positions, of which 4924 were filled—an increase of 465 filled positions from the previous year. Totals for programs and positions (internship and residency) for 2008-2009 show a total decrease of 25 programs but a total increase of 159 positions. These changes reflect a net gain for the first year of the restructured OGME-1 year (Table 1). 
Table 2
No. of AOA-Approved Residency Programs and Residents Filling Available Positions as Reported by Academic Year and Specialty, 2006-2009 *


2006-2007

2007-2008

2008-2009
Specialty
Programs
Positions
Residents
Programs
Positions
Residents
Programs
Positions
Residents
Anesthesiology1173641286691210792
□ Anesthesiology and Pain Management 2 3 0 2 3 0 2 3 1
□ Pediatric AnesthesiologyNANANANANANA130
Dermatology 19 108 83 19 111 89 20 123 93
□ Mohs Micrographic SurgeryNANANA110111
Diagnostic Radiology 14 130 105 14 132 112 14 133 120
□ Radiation Oncology000000000
□ Radiology (Vascular Interventional) 1 1 0 1 1 0 1 1 0
Emergency Medicine407254714378551343979780
□ Emergency Medical Service 2 3 1 2 3 1 2 3 0
□ Emergency Medicine and Internal Medicine121137312115781213092
Family Practice 162 1704 609 173 1823 652 184 2341 1056
□ Family Practice and Emergency Medicine548215482255932
□ Integrated Family Practice and NMM 6 39 20 7 48 17 7 49 21
Geriatrics835473139382
Internal Medicine 79 973 286 83 1082 360 88 1320 672
□ Cardiac Electrophysiology130131130
□ Cardiology 18 113 69 21 132 78 23 148 84
□ Cardiology (Interventional)6154821810259
□ Critical Care Medicine§ 5 13 5 5 13 5 5 13 4
□ Endocrinology243363364
□ Gastroenterology 8 28 17 9 40 22 12 51 24
□ Hematology and Oncology25141134115
□ Infectious Diseases 2 8 2 2 8 3 2 8 2
□ Nephrology618861887208
□ Oncology 2 6 0 3 9 1 3 9 1
□ Pulmonary (Critical Care)51787261172211
□ Pulmonary Medicine 3 7 0 3 7 1 4 11 2
□ Rheumatology385388387
Neurology 6 39 20 6 39 21 7 61 31
NMM and OMM631137331483817
□ NMM Plus 1 14 41 10 18 56 13 19 62 14
Obstetrics and gynecology323391503335715231370247
□ Gynecological Oncology 3 9 3 3 9 6 3 9 7
□ Maternal and Fetal Medicine391394276
□ Reproductive Endocrinology 1 3 0 1 3 1 1 3 2
Ophthalmology125738125741125744
Orthopedic Surgery 30 350 291 29 348 313 31 465 393
□ Hand Surgery130130130
□ Orthopedic Spine Surgery 2 3 0 2 3 1 2 3 0
Otolaryngology and Facial Plastic Surgery189977191147919132103
□ Otolaryngic Allergy 1 3 0 1 3 0 2 6 1
Pathology000000000
□ Forensic Pathology 1 1 0 1 1 0 1 1 0
Pediatrics1415465171678217225130
□ Pediatric Allergy and Immunology NA NA NA 1 2 0 1 2 2
□ Pediatric and Emergency Medicine000000000
□ Pediatric and Internal Medicine 1 6 6 2 14 6 2 18 10
□ Pediatric Radiology130130130
Physical Medicine and Rehabilitation Medicine 3 28 16 3 28 22 3 28 23
Preventive medicine and Public Health131131130
□ Preventive Medicine (Occupational and environmental) 0 0 0 1 3 0 1 3 0
Proctology121122252
Psychiatry 5 48 36 7 72 30 9 95 32
□ Child Psychiatry121284284
□ Geriatric Psychiatry 1 3 0 1 3 0 1 3 0
Sports Medicine134213144214164712
Surgery (General) 39 387 287 39 424 306 41 536 435
□ Cardiothoracic Surgery21112110190
□ General Vascular Surgery 9 20 4 9 20 5 9 20 4
□ Neurological Surgery128649118152119781
□ Plastic and Reconstructive Surgery 5 18 13 6 21 15 6 21 16
□ Urological Surgery74534752371112355
Other (Conjoint)
□ Palliative MedicineNANANANANANA240
□ Sleep Medicine NA
NA
NA
1
2
0
1
2
0
Total 669 6045 2989 718 6564 3289 762 8094 4794
 Abbreviations: AOA, American Osteopathic Association; NA, not applicable; NMM, neuromusculoskeletal medicine; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.3
 *Because data for the 2008-2009 academic year may change, they are to be considered incomplete and will be finalized in the JAOA's 2011 osteopathic medical education issue.
 Family practice refers to family practice and osteopathic manipulative treatment.
 Geriatrics includes geriatrics and family practice and geriatrics and internal medicine.
 §Critical care medicine includes critical care (surgery).
 Palliative medicine and sleep medicine are fellowships governed by Conjoint Standards by two or more specialties.
Table 2
No. of AOA-Approved Residency Programs and Residents Filling Available Positions as Reported by Academic Year and Specialty, 2006-2009 *


2006-2007

2007-2008

2008-2009
Specialty
Programs
Positions
Residents
Programs
Positions
Residents
Programs
Positions
Residents
Anesthesiology1173641286691210792
□ Anesthesiology and Pain Management 2 3 0 2 3 0 2 3 1
□ Pediatric AnesthesiologyNANANANANANA130
Dermatology 19 108 83 19 111 89 20 123 93
□ Mohs Micrographic SurgeryNANANA110111
Diagnostic Radiology 14 130 105 14 132 112 14 133 120
□ Radiation Oncology000000000
□ Radiology (Vascular Interventional) 1 1 0 1 1 0 1 1 0
Emergency Medicine407254714378551343979780
□ Emergency Medical Service 2 3 1 2 3 1 2 3 0
□ Emergency Medicine and Internal Medicine121137312115781213092
Family Practice 162 1704 609 173 1823 652 184 2341 1056
□ Family Practice and Emergency Medicine548215482255932
□ Integrated Family Practice and NMM 6 39 20 7 48 17 7 49 21
Geriatrics835473139382
Internal Medicine 79 973 286 83 1082 360 88 1320 672
□ Cardiac Electrophysiology130131130
□ Cardiology 18 113 69 21 132 78 23 148 84
□ Cardiology (Interventional)6154821810259
□ Critical Care Medicine§ 5 13 5 5 13 5 5 13 4
□ Endocrinology243363364
□ Gastroenterology 8 28 17 9 40 22 12 51 24
□ Hematology and Oncology25141134115
□ Infectious Diseases 2 8 2 2 8 3 2 8 2
□ Nephrology618861887208
□ Oncology 2 6 0 3 9 1 3 9 1
□ Pulmonary (Critical Care)51787261172211
□ Pulmonary Medicine 3 7 0 3 7 1 4 11 2
□ Rheumatology385388387
Neurology 6 39 20 6 39 21 7 61 31
NMM and OMM631137331483817
□ NMM Plus 1 14 41 10 18 56 13 19 62 14
Obstetrics and gynecology323391503335715231370247
□ Gynecological Oncology 3 9 3 3 9 6 3 9 7
□ Maternal and Fetal Medicine391394276
□ Reproductive Endocrinology 1 3 0 1 3 1 1 3 2
Ophthalmology125738125741125744
Orthopedic Surgery 30 350 291 29 348 313 31 465 393
□ Hand Surgery130130130
□ Orthopedic Spine Surgery 2 3 0 2 3 1 2 3 0
Otolaryngology and Facial Plastic Surgery189977191147919132103
□ Otolaryngic Allergy 1 3 0 1 3 0 2 6 1
Pathology000000000
□ Forensic Pathology 1 1 0 1 1 0 1 1 0
Pediatrics1415465171678217225130
□ Pediatric Allergy and Immunology NA NA NA 1 2 0 1 2 2
□ Pediatric and Emergency Medicine000000000
□ Pediatric and Internal Medicine 1 6 6 2 14 6 2 18 10
□ Pediatric Radiology130130130
Physical Medicine and Rehabilitation Medicine 3 28 16 3 28 22 3 28 23
Preventive medicine and Public Health131131130
□ Preventive Medicine (Occupational and environmental) 0 0 0 1 3 0 1 3 0
Proctology121122252
Psychiatry 5 48 36 7 72 30 9 95 32
□ Child Psychiatry121284284
□ Geriatric Psychiatry 1 3 0 1 3 0 1 3 0
Sports Medicine134213144214164712
Surgery (General) 39 387 287 39 424 306 41 536 435
□ Cardiothoracic Surgery21112110190
□ General Vascular Surgery 9 20 4 9 20 5 9 20 4
□ Neurological Surgery128649118152119781
□ Plastic and Reconstructive Surgery 5 18 13 6 21 15 6 21 16
□ Urological Surgery74534752371112355
Other (Conjoint)
□ Palliative MedicineNANANANANANA240
□ Sleep Medicine NA
NA
NA
1
2
0
1
2
0
Total 669 6045 2989 718 6564 3289 762 8094 4794
 Abbreviations: AOA, American Osteopathic Association; NA, not applicable; NMM, neuromusculoskeletal medicine; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.3
 *Because data for the 2008-2009 academic year may change, they are to be considered incomplete and will be finalized in the JAOA's 2011 osteopathic medical education issue.
 Family practice refers to family practice and osteopathic manipulative treatment.
 Geriatrics includes geriatrics and family practice and geriatrics and internal medicine.
 §Critical care medicine includes critical care (surgery).
 Palliative medicine and sleep medicine are fellowships governed by Conjoint Standards by two or more specialties.
×
Further, Table 3 compares numbers of trainees in specialty residency programs for 2006-2007 and 2007-2008, the academic years just before the restructuring, with the number of trainees in these programs in 2008-2009, the first year the restructuring was in effect. Data were reviewed only for residencies (including the OGME-1R year); internships and fellowships (training following completion of a base specialty) are not reviewed here. Percentages for some specialties are based on fairly small numbers of trainees and are not meaningful in isolation. However, the data indicate gains across all Option 1 (OGME-1R) specialties substantial enough to reflect most or all OGME-1 positions previously designated as internships for these specialties. If, as a rough measure, it is assumed that increases would reflect a percentage equivalent to a 1-year portion of the full training requirement (ie, 33% as 1 year of a 3-year program), the increase clearly exceeds that measure for internal medicine and pediatrics programs. These data need to be followed for at least 1 additional academic year and will be reviewed again in 2011. 
Table 3
No. of Trainees in Base Residencies and Percent Increases by OGME-1 Year, 2006-2009 Academic Years


Academic Year

Increase in Trainees, %
Specialty
2006-2007
2007-2008
2008-2009
2006-2007 to 2007-2008
2007-2008 to 2008-2009
Option 1—Residency
□ Anesthesiology 64 69 92 7% 25%
□ Emergency Medicine4715137808%34%
□ Emergency Medicine and Internal Medicine 73 78 92 6% 15%
□ Family Practice and Emergency Medicine6096521,0566%38%
□ Family Practice 21 22 32 4% 31%
□ Integrated Family Practice/NMM201721-23%19%
□ Internal Medicine 286 360 672 20% 46%
□ Obstetrics and Gynecology1501522471%38%
□ Orthopedic Surgery 291 313 393 7% 20%
□ Otolaryngology and Facial Plastic Surgery77791032%23%
□ Pediatrics 65 82 130 21% 37%
□ Pediatric and Emergency Medicine000NANA
□ Pediatric and Internal Medicine 6 6 10 0% 40%
□ Surgery (General)2873064356%29%
□ Neurological Surgery 49 52 81 6% 36%
□ Urological Surgery3437558%33%
Option 2—Preliminary Internship
□ Diagnostic Radiology1051121206%7%
□ Neurology* 20 21 31 5% 32%
□ NMM and OMM1314177%18%
□ Ophthalmology 38 41 44 7% 7%
□ Pathology000NANA
□ Psychiatry* 36 30 32 -20% 6%
Option 3—Traditional Internship
□ Dermatology 83 89 93 7% 4%
□ Physical Medicine and Rehabilitation Medicine16222327%4%
□ Preventive Medicine and Public Health 1 1 0 NA NA
□ Preventive Medicine (Occupational and Environmental)000NANA
□ Proctology 1 2 2 NA NA
 Abbreviations: NMM, neuromusculoskeletal medicine; OGME-1, first year of osteopathic graduate medical education; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.5
 *Changed to Option 1 effective July 1, 2009. All other specialty options became effective July 1, 2008.
Table 3
No. of Trainees in Base Residencies and Percent Increases by OGME-1 Year, 2006-2009 Academic Years


Academic Year

Increase in Trainees, %
Specialty
2006-2007
2007-2008
2008-2009
2006-2007 to 2007-2008
2007-2008 to 2008-2009
Option 1—Residency
□ Anesthesiology 64 69 92 7% 25%
□ Emergency Medicine4715137808%34%
□ Emergency Medicine and Internal Medicine 73 78 92 6% 15%
□ Family Practice and Emergency Medicine6096521,0566%38%
□ Family Practice 21 22 32 4% 31%
□ Integrated Family Practice/NMM201721-23%19%
□ Internal Medicine 286 360 672 20% 46%
□ Obstetrics and Gynecology1501522471%38%
□ Orthopedic Surgery 291 313 393 7% 20%
□ Otolaryngology and Facial Plastic Surgery77791032%23%
□ Pediatrics 65 82 130 21% 37%
□ Pediatric and Emergency Medicine000NANA
□ Pediatric and Internal Medicine 6 6 10 0% 40%
□ Surgery (General)2873064356%29%
□ Neurological Surgery 49 52 81 6% 36%
□ Urological Surgery3437558%33%
Option 2—Preliminary Internship
□ Diagnostic Radiology1051121206%7%
□ Neurology* 20 21 31 5% 32%
□ NMM and OMM1314177%18%
□ Ophthalmology 38 41 44 7% 7%
□ Pathology000NANA
□ Psychiatry* 36 30 32 -20% 6%
Option 3—Traditional Internship
□ Dermatology 83 89 93 7% 4%
□ Physical Medicine and Rehabilitation Medicine16222327%4%
□ Preventive Medicine and Public Health 1 1 0 NA NA
□ Preventive Medicine (Occupational and Environmental)000NANA
□ Proctology 1 2 2 NA NA
 Abbreviations: NMM, neuromusculoskeletal medicine; OGME-1, first year of osteopathic graduate medical education; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.5
 *Changed to Option 1 effective July 1, 2009. All other specialty options became effective July 1, 2008.
×
Other Trends in Postdoctoral Training Programs
As of May 31, 2009, there were 160 residency training programs with 1901 approved positions that were dually accredited by the AOA and the ACGME. These data reflect an increase of 10 residency training programs more than the number of dually accredited programs (approved for 934 positions) in May 2008.4 Trainees who complete dual programs have the option to become board certified by the AOA, the American Board of Medical Specialties, or both. In 2009, there were also 4 programs with 30 approved positions that were AOA approved but not dually accredited. These programs, known as parallel programs, occur side-by-side with ACGME training programs in the same institution, but trainees can only be AOA board certified. There has been no growth in parallel programs in recent years.4 
In the 2008-2009 academic year, 12,636 osteopathic physicians (DOs) were in postdoctoral training programs (Figure 2). A total of 5399 trainees (43%) were in AOA-approved programs and 7237 (57%) were in ACGME programs.4 This number represents a slightly higher percentage of DOs attending osteopathic programs during the 2007-2008 academic year, when 42% of osteopathic trainees were in AOA programs and 58% were in ACGME programs.5,6 
The percentage of filled positions in osteopathic training programs continues to increase. In the 2008-2009 academic year, there were 762 AOA-approved residency programs comprising 8094 approved positions with 4894 positions filled, for a fill rate of 59%. During this period, there was a 9% increase in the number of trainees in osteopathic programs (Figure 2). In 2006-2007 and 2007-2008, residency programs overall filled at 49% and 50%, respectively. If data are reviewed for combined fill rates in internship and residency positions for 2008-2009, the fill rate is 56%, with 5399 of 9485 positions filled. 
Figure 2.
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. ‡Restructuring of the AOA internship, effective July 1, 2008. 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 2008-2009. Data for academic years 1999-2000 through 2007-2008 were previously published in the JAOA.5
Figure 2.
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. ‡Restructuring of the AOA internship, effective July 1, 2008. 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 2008-2009. Data for academic years 1999-2000 through 2007-2008 were previously published in the JAOA.5
There were 56 new program approvals in 2009 for a total of 380 new positions in 26 specialty areas, including internships. Of these, 54 are residency programs with a total of 356 positions. There were 21 new fellowship programs with a total of 60 fellowships positions. The largest increases in positions were in family practice and subspecialties (153) and internal medicine and subspecialties (87). The largest increases in programs by specialty were in internal medicine (16) and family practice (15) (Table 4). 
Table 4
No. of New Approved AOA Programs and Positions in 2009 *

Specialty

Programs

Positions
Internships224
Residencies
□ Family Practice14150
□ Geriatric Medicine-FP 1 3
□ Internal Medicine554
□ Cardiac Electrophysiology 1 2
□ Cardiology16
□ Interventional Cardiology 1 2
□ Gastroenterology26
□ Geriatrics-Internal Medicine 3 8
□ Hematology and Oncology13
□ Nephrology 1 2
□ Pulmonary Diseases14
□ Dermatology 3 12
□ Diagnostic Radiology116
□ Maternal and Fetal Medicine 1 3
□ Reproductive Endocrinology13
□ Orthopedic Surgery 1 5
□ Otolaryngic Allergy13
□ Palliative Medicine 2 5
□ Pediatric/Emergency Medicine16
□ Proctology 1 3
□ Psychiatry18
□ Sports Medicine 5 13
□ Surgery-General220
□ Surgery-Urological 2 16
□ Surgery-General Vascular 1
3
Total
56
380
 *Data are current as of November 19, 2009.
 Fellowship after completion of base residency.
Table 4
No. of New Approved AOA Programs and Positions in 2009 *

Specialty

Programs

Positions
Internships224
Residencies
□ Family Practice14150
□ Geriatric Medicine-FP 1 3
□ Internal Medicine554
□ Cardiac Electrophysiology 1 2
□ Cardiology16
□ Interventional Cardiology 1 2
□ Gastroenterology26
□ Geriatrics-Internal Medicine 3 8
□ Hematology and Oncology13
□ Nephrology 1 2
□ Pulmonary Diseases14
□ Dermatology 3 12
□ Diagnostic Radiology116
□ Maternal and Fetal Medicine 1 3
□ Reproductive Endocrinology13
□ Orthopedic Surgery 1 5
□ Otolaryngic Allergy13
□ Palliative Medicine 2 5
□ Pediatric/Emergency Medicine16
□ Proctology 1 3
□ Psychiatry18
□ Sports Medicine 5 13
□ Surgery-General220
□ Surgery-Urological 2 16
□ Surgery-General Vascular 1
3
Total
56
380
 *Data are current as of November 19, 2009.
 Fellowship after completion of base residency.
×
Figure 3 is a map of concentration of available osteopathic postdoctoral training positions. There was no major shift in distribution of positions by state during the 2008-2009 academic year as compared to 2007-2008.3 A detailed list of programs and positions by state and by internship and residency is provided in Table 1. 
Review of Trainee Data and Training Approval Processes
A number of changes have occurred in the past 2 years to streamline processes for training approvals while maintaining accountability. The following sections summarize the PGY-1 internship approval process, military internship approvals, and the revised ACGME approval process that was implemented July 2009. Data in corresponding tables are complete as of January 1, 2010. 
Approval of PGY-1 Year as an AOA-Internship (Resolution 42)
Currently, 4 states (Florida, Michigan, Oklahoma, and Pennsylvania) require an AOA internship for osteopathic medical licensure. An AOA internship is also required of DOs seeking osteopathic board certification. Resolution 42 (A/2000—Approval of ACGME Training as an AOA-Approved Internship) provides a pathway for DOs who trained in ACGME postdoctoral programs for their postgraduate year 1 (PGY-1) to have it approved as an AOA internship.7 Whether they are currently in or have completed an ACGME PGY-1 training year, DOs are eligible for approval. 
To obtain approval, the DO must meet the following four requirements: (1) be an AOA member in good standing; (2) apply for approval; (3) have completed a PGY-1 rotation comparable to either an AOA traditional rotating internship or OGME-1 specialty year; and (4) provide evidence of completing at least one approved osteopathic educational activity.7 As of February 2009, the requirement for exceptional circumstances for approval was discontinued. Verification that the PGY-1 training year is complete is required for approval. 
Of 2394 applications, 1818 (76%) were approved through Resolution 42 (Table 5). Seventy-nine applications are approved pending verification of an educational activity, 232 applications (10%) are incomplete, and 242 applicants (10%) are pending in, and 79 (3%) are pending out. Pending status refers to applicants with missing documentation. When an applicant is pending in, the applicant is currently in a residency training program. Conversely, a pending out applicant is out of residency training. Only 12 applications (1%) have been denied. 
Table 5
Application Status of Osteopathic Physicians Who Have Applied for Approval of ACGME Training as an AOA-Approved Internship* (N=2394)

Application Status

No. (%)
Approved1818 (76)
Deferment 1 (<1)
Denied12 (1)
Incomplete 232 (10)
Pending In242 (10)
Pending Out 79 (3)
Withdrawn
10 (<1)
 *Osteopathic physicians who are currently in or have completed an postgraduate year 1 program accredited by the Accrediation Council on Graduate Medical Education (ACGME) are eligible to apply for American Osteopathic Association (AOA) approval of that internship, as stated in Resolution 42 (A/2000—Approval of ACGME Training as an AOA-Approved Internship).
 Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
Table 5
Application Status of Osteopathic Physicians Who Have Applied for Approval of ACGME Training as an AOA-Approved Internship* (N=2394)

Application Status

No. (%)
Approved1818 (76)
Deferment 1 (<1)
Denied12 (1)
Incomplete 232 (10)
Pending In242 (10)
Pending Out 79 (3)
Withdrawn
10 (<1)
 *Osteopathic physicians who are currently in or have completed an postgraduate year 1 program accredited by the Accrediation Council on Graduate Medical Education (ACGME) are eligible to apply for American Osteopathic Association (AOA) approval of that internship, as stated in Resolution 42 (A/2000—Approval of ACGME Training as an AOA-Approved Internship).
 Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
×
Figure 3.
Total approved internship and residency positions by state.
Figure 3.
Total approved internship and residency positions by state.
Approval of Federal or Military Training as an AOA Internship
Osteopathic physicians who have received federal or military internship training may apply to have their internship training approved. It is the responsibility of the trainee to meet the rotational requirements of an AOA rotating internship. The approval process requires the following: (1) AOA membership in good standing; (2) application; (3) a copy of the DO's military orders; and (4) a copy of the DO's rotations. 
A total of 1637 DOs have applied for approval of their Federal or Military internship training with 1300 applications (79%) approved, 6 applications (<1%) denied, and 2 applications (<1%) incomplete (Table 6). 
Table 6
Application Status of Osteopathic Physicians Who Have Applied for American Osteopathic Association Approval of Federal or Military Internship (N=1637)

Application Status

No. (%)*
Approved1300 (79)
Denied 6 (<1)
Incomplete2 (<1)
Pending In 172 (11)
Pending Out
157 (10)
 *Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
Table 6
Application Status of Osteopathic Physicians Who Have Applied for American Osteopathic Association Approval of Federal or Military Internship (N=1637)

Application Status

No. (%)*
Approved1300 (79)
Denied 6 (<1)
Incomplete2 (<1)
Pending In 172 (11)
Pending Out
157 (10)
 *Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
×
AOA Approval of PGY-2 Years and Beyond
The AOA developed a new approval process in July 2009 for ACGME training.10 Beginning September 2009, to obtain approval of allopathic training in PGY-2 years and beyond, DOs must submit documentation directly to the AOA for approval of their training. Applicants must meet the following three requirements: (1) Resolution 42 approval of ACGME internship or AOA internship; (2) AOA membership in good standing; and (3) verification that the applicant has successfully completed training from an ACGME-accredited residency program. Since September 2009, 121 applications have been approved in 9 specialties (Table 7). 
Table 7
AOA Approval of ACGME Training Since September 2009 by Specialty (N=121)

Specialty

No. (%)*
Anesthesiology11 (9)
Family Practice 30 (25)
Internal Medicine39 (32)
Neurology and Psychiatry 7 (6)
Obstetrics and Gynecology4 (3)
Pediatrics 11 (9)
Radiology5 (4)
Surgery 10 (8)
Physical Medicine & Rehabilitation4 (3)
 Abbreviations: ACGME, Accreditation Council on Graduate Medical Education; AOA, American Osteopathic Association.
 *Percentages do not total 100 because of rounding.
Table 7
AOA Approval of ACGME Training Since September 2009 by Specialty (N=121)

Specialty

No. (%)*
Anesthesiology11 (9)
Family Practice 30 (25)
Internal Medicine39 (32)
Neurology and Psychiatry 7 (6)
Obstetrics and Gynecology4 (3)
Pediatrics 11 (9)
Radiology5 (4)
Surgery 10 (8)
Physical Medicine & Rehabilitation4 (3)
 Abbreviations: ACGME, Accreditation Council on Graduate Medical Education; AOA, American Osteopathic Association.
 *Percentages do not total 100 because of rounding.
×
Conclusion
After the 2008-2009 academic year, data will indicate how postdoctoral training is adapting to the restructuring of the OGME-1 year. Data so far suggest that the reorganization of the initial training year has not decreased positions available to trainees, and a modest but steady increase in programs, positions, and trainees continues to grow. Pathways established to approve training of DOs in allopathic programs, and thus increase the availability of certification, continue to show positive trends. Recent streamlining of those pathways has been beneficial to DOs who have pursued alternative modes of training. 
American Osteopathic Association. Accreditation Document for Osteopathic Postdoctoral Training Institutions and the Basic Document for Postdoctoral Training Programs. Chicago, IL: American Osteopathic Association; 2009. https://www.do-online.org/pdf/sir_postdoctrainproced.pdf. Accessed March 12, 2010.
Obradovic JL, Winslow-Falbo P. Osteopathic graduate medical education. J Am Osteopath Assoc. 2007;107(2):57-66. http://www.jaoa.org/cgi/content/full/107/2/57. Accessed March 12, 2010.
Freeman, E, Lischka, TA. Osteopathic graduate medical education. J Am Osteopath Assoc. 2009;109(3):135-145. http://www.jaoa.org/cgi/content/full/109/3/135. Accessed March 12, 2010.
Burkhart, DN, Lischka, TA. Dual and parallel postdoctoral training programs: implications for the osteopathic medical profession. J Am Osteopath Assoc. 2009;109(3):146-153. http://www.jaoa.org/cgi/content/full/109/3/146. Accessed March 12, 2010.
Brotherton SE, Etzel SI. Graduate medical education, 2008-2009 [appendix]. JAMA. 2009;302(12):1357-1372.
Brotherton SE, Etzel SI. II. Graduate medical education, 2007-2008 [appendix]. JAMA. 2008;300(10):1228-1243.
For training prior to July 1, 2008: Resolution 42. American Osteopathic Association Web site. http://www.do-online.org/index.cfm?PageID=sir_postdocres42. Accessed March 13, 2010.
Figure 1.
Training pathways as determined by medical specialty as of July 1, 2009. Abbreviation: OGME-1, first year of osteopathic graduate medical education.
Figure 1.
Training pathways as determined by medical specialty as of July 1, 2009. Abbreviation: OGME-1, first year of osteopathic graduate medical education.
Figure 2.
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. ‡Restructuring of the AOA internship, effective July 1, 2008. 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 2008-2009. Data for academic years 1999-2000 through 2007-2008 were previously published in the JAOA.5
Figure 2.
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. ‡Restructuring of the AOA internship, effective July 1, 2008. 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 2008-2009. Data for academic years 1999-2000 through 2007-2008 were previously published in the JAOA.5
Figure 3.
Total approved internship and residency positions by state.
Figure 3.
Total approved internship and residency positions by state.
Table 1
No. of AOA-Approved Internship and Residency Programs and Trainees Filling Available Positions by State, 2007-2008 Academic Year *


Internship Programs

Residency Programs

Total
State
Programs
Positions
Trainees
Programs
Positions
Trainees
Programs
Positions
Trainees
Alaska000198198
Arizona 0 0 0 7 82 44 7 82 44
Arkansas00011231123
California 6 75 24 25 301 170 31 376 194
Colorado143000143
Connecticut 1 12 6 1 11 5 2 23 11
Delaware11510124923919
Florida 10 136 56 44 499 265 54 635 321
Georgia141329943310
Illinois 6 41 19 39 417 271 45 458 290
Indiana31244301474218
Iowa 0 0 0 3 38 29 3 38 29
Kansas0001121111211
Kentucky 3 18 4 6 44 19 9 62 23
Maine18510100491110854
Massachusetts 2 10 8 2 12 6 4 22 14
Michigan21206921811848122520220541317
Minnesota 0 0 0 2 14 4 2 14 4
Mississippi00011831183
Missouri 3 15 6 22 161 113 25 176 119
Nevada1151668553710069
New Jersey 6 77 28 49 529 312 55 606 340
New Mexico000165165
New York 19 210 80 57 765 444 76 975 524
North Carolina121218932010
Ohio 13 112 48 103 928 553 116 1040 601
Oklahoma21662527119227287198
Oregon 1 6 0 7 51 0 8 57 0
Pennsylvania362811379911236831351404820
Rhode Island 0 0 0 2 36 13 2 36 13
South Carolina0001121111211
Tennessee 2 14 9 2 24 0 4 38 9
Texas43223201658524197108
Virginia 3 33 12 12 151 52 15 184 64
Washington000164164
West Virginia 7 37 7 18 208 95 25 245 102
Wisconsin0002432024320
Wyoming 0
0
0
1
12
6
1
12
6
Total 154 1391 605 762 8094 4794 916 9485 5399
 Source: Training Programs by State: Year-End Reports, Division of Postdoctoral Training, American Osteopathic Association, Chicago, Ill.
 *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, 2009. Osteopathic medical internship and residency positions are not currently approved in the District of Columbia or in the following 12 states: Alabama, Hawaii, Idaho, Louisiana, Maryland, Montana, Nebraska, New Hampshire, North Dakota, South Dakota, Utah, and Vermont.
Table 1
No. of AOA-Approved Internship and Residency Programs and Trainees Filling Available Positions by State, 2007-2008 Academic Year *


Internship Programs

Residency Programs

Total
State
Programs
Positions
Trainees
Programs
Positions
Trainees
Programs
Positions
Trainees
Alaska000198198
Arizona 0 0 0 7 82 44 7 82 44
Arkansas00011231123
California 6 75 24 25 301 170 31 376 194
Colorado143000143
Connecticut 1 12 6 1 11 5 2 23 11
Delaware11510124923919
Florida 10 136 56 44 499 265 54 635 321
Georgia141329943310
Illinois 6 41 19 39 417 271 45 458 290
Indiana31244301474218
Iowa 0 0 0 3 38 29 3 38 29
Kansas0001121111211
Kentucky 3 18 4 6 44 19 9 62 23
Maine18510100491110854
Massachusetts 2 10 8 2 12 6 4 22 14
Michigan21206921811848122520220541317
Minnesota 0 0 0 2 14 4 2 14 4
Mississippi00011831183
Missouri 3 15 6 22 161 113 25 176 119
Nevada1151668553710069
New Jersey 6 77 28 49 529 312 55 606 340
New Mexico000165165
New York 19 210 80 57 765 444 76 975 524
North Carolina121218932010
Ohio 13 112 48 103 928 553 116 1040 601
Oklahoma21662527119227287198
Oregon 1 6 0 7 51 0 8 57 0
Pennsylvania362811379911236831351404820
Rhode Island 0 0 0 2 36 13 2 36 13
South Carolina0001121111211
Tennessee 2 14 9 2 24 0 4 38 9
Texas43223201658524197108
Virginia 3 33 12 12 151 52 15 184 64
Washington000164164
West Virginia 7 37 7 18 208 95 25 245 102
Wisconsin0002432024320
Wyoming 0
0
0
1
12
6
1
12
6
Total 154 1391 605 762 8094 4794 916 9485 5399
 Source: Training Programs by State: Year-End Reports, Division of Postdoctoral Training, American Osteopathic Association, Chicago, Ill.
 *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, 2009. Osteopathic medical internship and residency positions are not currently approved in the District of Columbia or in the following 12 states: Alabama, Hawaii, Idaho, Louisiana, Maryland, Montana, Nebraska, New Hampshire, North Dakota, South Dakota, Utah, and Vermont.
×
Table 2
No. of AOA-Approved Residency Programs and Residents Filling Available Positions as Reported by Academic Year and Specialty, 2006-2009 *


2006-2007

2007-2008

2008-2009
Specialty
Programs
Positions
Residents
Programs
Positions
Residents
Programs
Positions
Residents
Anesthesiology1173641286691210792
□ Anesthesiology and Pain Management 2 3 0 2 3 0 2 3 1
□ Pediatric AnesthesiologyNANANANANANA130
Dermatology 19 108 83 19 111 89 20 123 93
□ Mohs Micrographic SurgeryNANANA110111
Diagnostic Radiology 14 130 105 14 132 112 14 133 120
□ Radiation Oncology000000000
□ Radiology (Vascular Interventional) 1 1 0 1 1 0 1 1 0
Emergency Medicine407254714378551343979780
□ Emergency Medical Service 2 3 1 2 3 1 2 3 0
□ Emergency Medicine and Internal Medicine121137312115781213092
Family Practice 162 1704 609 173 1823 652 184 2341 1056
□ Family Practice and Emergency Medicine548215482255932
□ Integrated Family Practice and NMM 6 39 20 7 48 17 7 49 21
Geriatrics835473139382
Internal Medicine 79 973 286 83 1082 360 88 1320 672
□ Cardiac Electrophysiology130131130
□ Cardiology 18 113 69 21 132 78 23 148 84
□ Cardiology (Interventional)6154821810259
□ Critical Care Medicine§ 5 13 5 5 13 5 5 13 4
□ Endocrinology243363364
□ Gastroenterology 8 28 17 9 40 22 12 51 24
□ Hematology and Oncology25141134115
□ Infectious Diseases 2 8 2 2 8 3 2 8 2
□ Nephrology618861887208
□ Oncology 2 6 0 3 9 1 3 9 1
□ Pulmonary (Critical Care)51787261172211
□ Pulmonary Medicine 3 7 0 3 7 1 4 11 2
□ Rheumatology385388387
Neurology 6 39 20 6 39 21 7 61 31
NMM and OMM631137331483817
□ NMM Plus 1 14 41 10 18 56 13 19 62 14
Obstetrics and gynecology323391503335715231370247
□ Gynecological Oncology 3 9 3 3 9 6 3 9 7
□ Maternal and Fetal Medicine391394276
□ Reproductive Endocrinology 1 3 0 1 3 1 1 3 2
Ophthalmology125738125741125744
Orthopedic Surgery 30 350 291 29 348 313 31 465 393
□ Hand Surgery130130130
□ Orthopedic Spine Surgery 2 3 0 2 3 1 2 3 0
Otolaryngology and Facial Plastic Surgery189977191147919132103
□ Otolaryngic Allergy 1 3 0 1 3 0 2 6 1
Pathology000000000
□ Forensic Pathology 1 1 0 1 1 0 1 1 0
Pediatrics1415465171678217225130
□ Pediatric Allergy and Immunology NA NA NA 1 2 0 1 2 2
□ Pediatric and Emergency Medicine000000000
□ Pediatric and Internal Medicine 1 6 6 2 14 6 2 18 10
□ Pediatric Radiology130130130
Physical Medicine and Rehabilitation Medicine 3 28 16 3 28 22 3 28 23
Preventive medicine and Public Health131131130
□ Preventive Medicine (Occupational and environmental) 0 0 0 1 3 0 1 3 0
Proctology121122252
Psychiatry 5 48 36 7 72 30 9 95 32
□ Child Psychiatry121284284
□ Geriatric Psychiatry 1 3 0 1 3 0 1 3 0
Sports Medicine134213144214164712
Surgery (General) 39 387 287 39 424 306 41 536 435
□ Cardiothoracic Surgery21112110190
□ General Vascular Surgery 9 20 4 9 20 5 9 20 4
□ Neurological Surgery128649118152119781
□ Plastic and Reconstructive Surgery 5 18 13 6 21 15 6 21 16
□ Urological Surgery74534752371112355
Other (Conjoint)
□ Palliative MedicineNANANANANANA240
□ Sleep Medicine NA
NA
NA
1
2
0
1
2
0
Total 669 6045 2989 718 6564 3289 762 8094 4794
 Abbreviations: AOA, American Osteopathic Association; NA, not applicable; NMM, neuromusculoskeletal medicine; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.3
 *Because data for the 2008-2009 academic year may change, they are to be considered incomplete and will be finalized in the JAOA's 2011 osteopathic medical education issue.
 Family practice refers to family practice and osteopathic manipulative treatment.
 Geriatrics includes geriatrics and family practice and geriatrics and internal medicine.
 §Critical care medicine includes critical care (surgery).
 Palliative medicine and sleep medicine are fellowships governed by Conjoint Standards by two or more specialties.
Table 2
No. of AOA-Approved Residency Programs and Residents Filling Available Positions as Reported by Academic Year and Specialty, 2006-2009 *


2006-2007

2007-2008

2008-2009
Specialty
Programs
Positions
Residents
Programs
Positions
Residents
Programs
Positions
Residents
Anesthesiology1173641286691210792
□ Anesthesiology and Pain Management 2 3 0 2 3 0 2 3 1
□ Pediatric AnesthesiologyNANANANANANA130
Dermatology 19 108 83 19 111 89 20 123 93
□ Mohs Micrographic SurgeryNANANA110111
Diagnostic Radiology 14 130 105 14 132 112 14 133 120
□ Radiation Oncology000000000
□ Radiology (Vascular Interventional) 1 1 0 1 1 0 1 1 0
Emergency Medicine407254714378551343979780
□ Emergency Medical Service 2 3 1 2 3 1 2 3 0
□ Emergency Medicine and Internal Medicine121137312115781213092
Family Practice 162 1704 609 173 1823 652 184 2341 1056
□ Family Practice and Emergency Medicine548215482255932
□ Integrated Family Practice and NMM 6 39 20 7 48 17 7 49 21
Geriatrics835473139382
Internal Medicine 79 973 286 83 1082 360 88 1320 672
□ Cardiac Electrophysiology130131130
□ Cardiology 18 113 69 21 132 78 23 148 84
□ Cardiology (Interventional)6154821810259
□ Critical Care Medicine§ 5 13 5 5 13 5 5 13 4
□ Endocrinology243363364
□ Gastroenterology 8 28 17 9 40 22 12 51 24
□ Hematology and Oncology25141134115
□ Infectious Diseases 2 8 2 2 8 3 2 8 2
□ Nephrology618861887208
□ Oncology 2 6 0 3 9 1 3 9 1
□ Pulmonary (Critical Care)51787261172211
□ Pulmonary Medicine 3 7 0 3 7 1 4 11 2
□ Rheumatology385388387
Neurology 6 39 20 6 39 21 7 61 31
NMM and OMM631137331483817
□ NMM Plus 1 14 41 10 18 56 13 19 62 14
Obstetrics and gynecology323391503335715231370247
□ Gynecological Oncology 3 9 3 3 9 6 3 9 7
□ Maternal and Fetal Medicine391394276
□ Reproductive Endocrinology 1 3 0 1 3 1 1 3 2
Ophthalmology125738125741125744
Orthopedic Surgery 30 350 291 29 348 313 31 465 393
□ Hand Surgery130130130
□ Orthopedic Spine Surgery 2 3 0 2 3 1 2 3 0
Otolaryngology and Facial Plastic Surgery189977191147919132103
□ Otolaryngic Allergy 1 3 0 1 3 0 2 6 1
Pathology000000000
□ Forensic Pathology 1 1 0 1 1 0 1 1 0
Pediatrics1415465171678217225130
□ Pediatric Allergy and Immunology NA NA NA 1 2 0 1 2 2
□ Pediatric and Emergency Medicine000000000
□ Pediatric and Internal Medicine 1 6 6 2 14 6 2 18 10
□ Pediatric Radiology130130130
Physical Medicine and Rehabilitation Medicine 3 28 16 3 28 22 3 28 23
Preventive medicine and Public Health131131130
□ Preventive Medicine (Occupational and environmental) 0 0 0 1 3 0 1 3 0
Proctology121122252
Psychiatry 5 48 36 7 72 30 9 95 32
□ Child Psychiatry121284284
□ Geriatric Psychiatry 1 3 0 1 3 0 1 3 0
Sports Medicine134213144214164712
Surgery (General) 39 387 287 39 424 306 41 536 435
□ Cardiothoracic Surgery21112110190
□ General Vascular Surgery 9 20 4 9 20 5 9 20 4
□ Neurological Surgery128649118152119781
□ Plastic and Reconstructive Surgery 5 18 13 6 21 15 6 21 16
□ Urological Surgery74534752371112355
Other (Conjoint)
□ Palliative MedicineNANANANANANA240
□ Sleep Medicine NA
NA
NA
1
2
0
1
2
0
Total 669 6045 2989 718 6564 3289 762 8094 4794
 Abbreviations: AOA, American Osteopathic Association; NA, not applicable; NMM, neuromusculoskeletal medicine; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.3
 *Because data for the 2008-2009 academic year may change, they are to be considered incomplete and will be finalized in the JAOA's 2011 osteopathic medical education issue.
 Family practice refers to family practice and osteopathic manipulative treatment.
 Geriatrics includes geriatrics and family practice and geriatrics and internal medicine.
 §Critical care medicine includes critical care (surgery).
 Palliative medicine and sleep medicine are fellowships governed by Conjoint Standards by two or more specialties.
×
Table 3
No. of Trainees in Base Residencies and Percent Increases by OGME-1 Year, 2006-2009 Academic Years


Academic Year

Increase in Trainees, %
Specialty
2006-2007
2007-2008
2008-2009
2006-2007 to 2007-2008
2007-2008 to 2008-2009
Option 1—Residency
□ Anesthesiology 64 69 92 7% 25%
□ Emergency Medicine4715137808%34%
□ Emergency Medicine and Internal Medicine 73 78 92 6% 15%
□ Family Practice and Emergency Medicine6096521,0566%38%
□ Family Practice 21 22 32 4% 31%
□ Integrated Family Practice/NMM201721-23%19%
□ Internal Medicine 286 360 672 20% 46%
□ Obstetrics and Gynecology1501522471%38%
□ Orthopedic Surgery 291 313 393 7% 20%
□ Otolaryngology and Facial Plastic Surgery77791032%23%
□ Pediatrics 65 82 130 21% 37%
□ Pediatric and Emergency Medicine000NANA
□ Pediatric and Internal Medicine 6 6 10 0% 40%
□ Surgery (General)2873064356%29%
□ Neurological Surgery 49 52 81 6% 36%
□ Urological Surgery3437558%33%
Option 2—Preliminary Internship
□ Diagnostic Radiology1051121206%7%
□ Neurology* 20 21 31 5% 32%
□ NMM and OMM1314177%18%
□ Ophthalmology 38 41 44 7% 7%
□ Pathology000NANA
□ Psychiatry* 36 30 32 -20% 6%
Option 3—Traditional Internship
□ Dermatology 83 89 93 7% 4%
□ Physical Medicine and Rehabilitation Medicine16222327%4%
□ Preventive Medicine and Public Health 1 1 0 NA NA
□ Preventive Medicine (Occupational and Environmental)000NANA
□ Proctology 1 2 2 NA NA
 Abbreviations: NMM, neuromusculoskeletal medicine; OGME-1, first year of osteopathic graduate medical education; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.5
 *Changed to Option 1 effective July 1, 2009. All other specialty options became effective July 1, 2008.
Table 3
No. of Trainees in Base Residencies and Percent Increases by OGME-1 Year, 2006-2009 Academic Years


Academic Year

Increase in Trainees, %
Specialty
2006-2007
2007-2008
2008-2009
2006-2007 to 2007-2008
2007-2008 to 2008-2009
Option 1—Residency
□ Anesthesiology 64 69 92 7% 25%
□ Emergency Medicine4715137808%34%
□ Emergency Medicine and Internal Medicine 73 78 92 6% 15%
□ Family Practice and Emergency Medicine6096521,0566%38%
□ Family Practice 21 22 32 4% 31%
□ Integrated Family Practice/NMM201721-23%19%
□ Internal Medicine 286 360 672 20% 46%
□ Obstetrics and Gynecology1501522471%38%
□ Orthopedic Surgery 291 313 393 7% 20%
□ Otolaryngology and Facial Plastic Surgery77791032%23%
□ Pediatrics 65 82 130 21% 37%
□ Pediatric and Emergency Medicine000NANA
□ Pediatric and Internal Medicine 6 6 10 0% 40%
□ Surgery (General)2873064356%29%
□ Neurological Surgery 49 52 81 6% 36%
□ Urological Surgery3437558%33%
Option 2—Preliminary Internship
□ Diagnostic Radiology1051121206%7%
□ Neurology* 20 21 31 5% 32%
□ NMM and OMM1314177%18%
□ Ophthalmology 38 41 44 7% 7%
□ Pathology000NANA
□ Psychiatry* 36 30 32 -20% 6%
Option 3—Traditional Internship
□ Dermatology 83 89 93 7% 4%
□ Physical Medicine and Rehabilitation Medicine16222327%4%
□ Preventive Medicine and Public Health 1 1 0 NA NA
□ Preventive Medicine (Occupational and Environmental)000NANA
□ Proctology 1 2 2 NA NA
 Abbreviations: NMM, neuromusculoskeletal medicine; OGME-1, first year of osteopathic graduate medical education; OMM, osteopathic manipulative medicine.Sources: AOA Intern/Resident Contracts received by the division of postdoctoral training for the academic years shown (taken annually on May 31); and AOA's Trainee Information, Verification and Registration Audit system, (TIVRA) academic years 2008-2009. Data for the 2006-2007 and 2007-2008 academic years have been reported previously in JAOA—The Journal of the American Osteopathic Association.5
 *Changed to Option 1 effective July 1, 2009. All other specialty options became effective July 1, 2008.
×
Table 4
No. of New Approved AOA Programs and Positions in 2009 *

Specialty

Programs

Positions
Internships224
Residencies
□ Family Practice14150
□ Geriatric Medicine-FP 1 3
□ Internal Medicine554
□ Cardiac Electrophysiology 1 2
□ Cardiology16
□ Interventional Cardiology 1 2
□ Gastroenterology26
□ Geriatrics-Internal Medicine 3 8
□ Hematology and Oncology13
□ Nephrology 1 2
□ Pulmonary Diseases14
□ Dermatology 3 12
□ Diagnostic Radiology116
□ Maternal and Fetal Medicine 1 3
□ Reproductive Endocrinology13
□ Orthopedic Surgery 1 5
□ Otolaryngic Allergy13
□ Palliative Medicine 2 5
□ Pediatric/Emergency Medicine16
□ Proctology 1 3
□ Psychiatry18
□ Sports Medicine 5 13
□ Surgery-General220
□ Surgery-Urological 2 16
□ Surgery-General Vascular 1
3
Total
56
380
 *Data are current as of November 19, 2009.
 Fellowship after completion of base residency.
Table 4
No. of New Approved AOA Programs and Positions in 2009 *

Specialty

Programs

Positions
Internships224
Residencies
□ Family Practice14150
□ Geriatric Medicine-FP 1 3
□ Internal Medicine554
□ Cardiac Electrophysiology 1 2
□ Cardiology16
□ Interventional Cardiology 1 2
□ Gastroenterology26
□ Geriatrics-Internal Medicine 3 8
□ Hematology and Oncology13
□ Nephrology 1 2
□ Pulmonary Diseases14
□ Dermatology 3 12
□ Diagnostic Radiology116
□ Maternal and Fetal Medicine 1 3
□ Reproductive Endocrinology13
□ Orthopedic Surgery 1 5
□ Otolaryngic Allergy13
□ Palliative Medicine 2 5
□ Pediatric/Emergency Medicine16
□ Proctology 1 3
□ Psychiatry18
□ Sports Medicine 5 13
□ Surgery-General220
□ Surgery-Urological 2 16
□ Surgery-General Vascular 1
3
Total
56
380
 *Data are current as of November 19, 2009.
 Fellowship after completion of base residency.
×
Table 5
Application Status of Osteopathic Physicians Who Have Applied for Approval of ACGME Training as an AOA-Approved Internship* (N=2394)

Application Status

No. (%)
Approved1818 (76)
Deferment 1 (<1)
Denied12 (1)
Incomplete 232 (10)
Pending In242 (10)
Pending Out 79 (3)
Withdrawn
10 (<1)
 *Osteopathic physicians who are currently in or have completed an postgraduate year 1 program accredited by the Accrediation Council on Graduate Medical Education (ACGME) are eligible to apply for American Osteopathic Association (AOA) approval of that internship, as stated in Resolution 42 (A/2000—Approval of ACGME Training as an AOA-Approved Internship).
 Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
Table 5
Application Status of Osteopathic Physicians Who Have Applied for Approval of ACGME Training as an AOA-Approved Internship* (N=2394)

Application Status

No. (%)
Approved1818 (76)
Deferment 1 (<1)
Denied12 (1)
Incomplete 232 (10)
Pending In242 (10)
Pending Out 79 (3)
Withdrawn
10 (<1)
 *Osteopathic physicians who are currently in or have completed an postgraduate year 1 program accredited by the Accrediation Council on Graduate Medical Education (ACGME) are eligible to apply for American Osteopathic Association (AOA) approval of that internship, as stated in Resolution 42 (A/2000—Approval of ACGME Training as an AOA-Approved Internship).
 Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
×
Table 6
Application Status of Osteopathic Physicians Who Have Applied for American Osteopathic Association Approval of Federal or Military Internship (N=1637)

Application Status

No. (%)*
Approved1300 (79)
Denied 6 (<1)
Incomplete2 (<1)
Pending In 172 (11)
Pending Out
157 (10)
 *Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
Table 6
Application Status of Osteopathic Physicians Who Have Applied for American Osteopathic Association Approval of Federal or Military Internship (N=1637)

Application Status

No. (%)*
Approved1300 (79)
Denied 6 (<1)
Incomplete2 (<1)
Pending In 172 (11)
Pending Out
157 (10)
 *Percentages do not total 100 because of rounding.
 Pending in refers to applicants currently in a residency training program, while pending out refers to applicants out of the residency training program.
×
Table 7
AOA Approval of ACGME Training Since September 2009 by Specialty (N=121)

Specialty

No. (%)*
Anesthesiology11 (9)
Family Practice 30 (25)
Internal Medicine39 (32)
Neurology and Psychiatry 7 (6)
Obstetrics and Gynecology4 (3)
Pediatrics 11 (9)
Radiology5 (4)
Surgery 10 (8)
Physical Medicine & Rehabilitation4 (3)
 Abbreviations: ACGME, Accreditation Council on Graduate Medical Education; AOA, American Osteopathic Association.
 *Percentages do not total 100 because of rounding.
Table 7
AOA Approval of ACGME Training Since September 2009 by Specialty (N=121)

Specialty

No. (%)*
Anesthesiology11 (9)
Family Practice 30 (25)
Internal Medicine39 (32)
Neurology and Psychiatry 7 (6)
Obstetrics and Gynecology4 (3)
Pediatrics 11 (9)
Radiology5 (4)
Surgery 10 (8)
Physical Medicine & Rehabilitation4 (3)
 Abbreviations: ACGME, Accreditation Council on Graduate Medical Education; AOA, American Osteopathic Association.
 *Percentages do not total 100 because of rounding.
×