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Letters to the Editor  |   December 2010
Is Something Wrong With Osteopathic Graduate Medical Education?
Author Affiliations
  • Kenneth J. Steier, DO, MPH, MHA, MGH
    Medical Director, Pre-Surgical Testing, Long Island Jewish Medical Center, North Shore-Long Island Jewish Health System, Lake Success, New York
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   December 2010
Is Something Wrong With Osteopathic Graduate Medical Education?
The Journal of the American Osteopathic Association, December 2010, Vol. 110, 740-741. doi:10.7556/jaoa.2010.110.12.740
The Journal of the American Osteopathic Association, December 2010, Vol. 110, 740-741. doi:10.7556/jaoa.2010.110.12.740
To the Editor:  
According to data released in February 2010, 1896 graduates of colleges of osteopathic medicine (COMs)—representing only 48% of eligible COM graduates—participated in this year's American Osteopathic Association (AOA) Intern/Resident Registration Program (ie, the AOA Match), the residencies of which started in July 2010.1 That participation rate compares with 51% of eligible COM graduates who participated in the 2009 AOA Match2 and 52% of eligible COM graduates who participated in the 2005 AOA Match.3 Clearly, this trend is heading in the wrong direction. 
The 2010 AOA Match results also document that although 2443 funded AOA-approved internship or residency positions were offered, only 1473 (60%) of these positions were filled, leaving 970 positions (40%) open.4 These unfilled positions are in the subspecialties as well as in primary care—and in all types and sizes of hospitals with AOA-approved training programs. At the same time, in the 2010 National Resident Matching Program (NRMP [ie, allopathic medicine]) Match, there were 2045 participants who were COM graduates, among whom 1444 (71%) were matched and 601 (29%) were not matched.5 
These data reveal that substantially more COM graduates participated in the NRMP Match (20454) than in the AOA Match (18961) this year—an alarming trend. While acknowledging that many COM graduates will participate in the post-Match scramble, I believe that these data lead to several important questions, including the following: 
  • Why are decreasing percentages of eligible COM graduates choosing to participate in the AOA Match?
  • Why are only 60% of AOA-approved training positions filled through the AOA Match,4 considering that there are enough COM graduates to fill all offered positions?
  • With the increased number of COMs and COM graduates, shouldn't the number of unfilled AOA-approved training positions be decreasing rather than increasing, as it has often done in recent years?2,3,6
  • Given 4 years of COM training and mentoring, why is it that 2045 COM graduates in the 2009-2010 academic year—more than half the total number of COM graduates that year5,7—applied directly to Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs through the NRMP Match?
  • What are the implications of this trend for the osteopathic medical profession and for the growth of osteopathic graduate medical education?
  • Can AOA-approved training programs be made more competitive to attract more COM graduates to fill their slots? Do AOA-approved training programs need to be made more competitive? If so, whose job is it?
As a graduate of a COM who completed strictly AOA-approved postgraduate training, I have predominantly worked at allopathic medical institutions. All these institutions have accepted my AOA-approved training and certification as equivalent to allopathic medical training. 
I currently work as a medical director for the third largest nonprofit health system in the United States—the North Shore-Long Island Jewish Health System in New York State. This system has a $4 billion annual budget and 38,000 employees. My job is located just a few city blocks from where I lived as a child, in Glen Oaks, Queens. I have never regretted pursuing AOA-approved residency training, nor have I ever felt “held back” because of my training. 
Furthermore, there are hundreds of other COM graduates who have been equally successful as I have been—or even more successful—after completing AOA-approved residency training. Clearly, completing osteopathic graduate medical education is an established pathway to career success. 
Considering this record of success, I can't help but wonder what is so wrong with osteopathic graduate medical education that decreasing percentages of COM graduates are participating in the AOA Match, while COM graduates are instead choosing, in increasing numbers, to participate in ACGME-accredited residency training programs. 
Crosby JB. Osteopathic Match results released. Daily Report Blog; February 9, 2010. DO-Online Web site. http://blogs.do-online.org/dailyreport.php?itemid=39321. Accessed November 13, 2010.
Crosby JB. Osteopathic Match results released. Daily Report Blog; February 10, 2009. DO-Online Web site. http://blogs.do-online.org/dailyreport.php?itemid=20731. Accessed November 13, 2010.
Crosby JB. AOA Match program results. Daily Report Blog; February 14, 2005. DO-Online Web site. http://blogs.do-online.org/dailyreport.php?itemid=1943. Accessed November 13, 2010.
2010 Match results. DO-Online Web site. http://www.do-online.org/index.cfm?au=D&PageId=aoa_profmain&SubPageId=sir_match10res. Accessed November 13, 2010.
National Resident Matching Program. Results and Data: 2010 Main Residency Match. Washington, DC: National Resident Matching Program; April 2010: 9. http://www.nrmp.org/data/resultsanddata2010.pdf. Accessed November 13, 2010.
Crosby JB. Osteopathic Match results released. Daily Report Blog; February 12, 2008. DO-Online Web site. http://blogs.do-online.org/dailyreport.php?itemid=3947. Accessed November 13, 2010.
Applications, first_year enrollment, total enrollment and graduates by osteopathic medical school. American Association of Colleges of Osteopathic Medicine Web site. http://www.aacom.org/data/Documents/Applicants/AppEnrollGradsbySchool-061710.pdf. Accessed November 13, 2010.