In the 2011-2012 academic year, modest growth in the number of available osteopathic graduate medical education (OGME) positions and the number of trainees in slots approved by the American Osteopathic Association (AOA) was observed. The rate of growth, however, has not kept up with the increasing number of graduating osteopathic physicians (ie, DOs) each year,¹ and AOA leadership have expressed concern regarding this imbalance and the need for additional DO residency slots. The imbalance was an agenda item at the Bureau of Osteopathic Education retreat in August 2012. The present article reports the number of training slots that are available to DOs through the AOA Match and expresses the concern that there will be insufficient slots for first-year DO trainees should the current availability of training slots available to DOs become limited in the future. In the current report, this issue will be examined from the vantage of specialty and geographic location. 

The AOA Department of Education's Division of Educational Resource Services maintains historical annual data on approved, funded, and filled AOA first-year positions, as reported by the National Matching Service (an AOA vendor) and the Trainee Information, Verification and Registration Audit (TIVRA) survey tool. The division has reported this information to education bureaus and councils to ensure that AOA leadership is aware of the alarming growth in the rate of filled, funded first-year positions, which topped at 91% in 2012 after the postmatch scramble was reported in TIVRA. In addition, AOA staff have monitored National Resident Matching Plan outcomes for DOs. Although 2012 showed the highest rate of successful matches, with a fill rate of 95.3%,¹ there remains concern that the number of unmatched graduating DOs may increase. 

The AOA Program and Trainee Review Council reviews and approves all OGME programs and positions. For the 2011-2012 academic year, 9741 positions were approved in 883 residency programs (Table 1). A comparison of this number of AOA-approved positions and programs to the 2010-2011 academic year shows an increase, whereas before there were 9110 positions in 827 approved residency programs.² The number of AOA-approved internship programs and positions has continued to decline because of the internship restructuring program that was implemented in 2008. Beginning July 1, 2008, the first year of training in an osteopathic residency was accepted in lieu of the internship year and, for most specialties, the internship year was no longer needed for completion of a residency (AOA House of Delegates Resolution H-207).^2-5 

Internship positions for the 2011-2012 academic year totaled 1279 in 132 programs compared with 1284 positions in 134 programs for the 2010-2011 academic year. Internship and residency positions have increased by 626, or 6%, since the 2010-2011 academic year. It is clear that—despite the values that the osteopathic profession placed on internships, which were required for most specialties until 2008—students have opted to bypass the internship, unless it is required by a specialty or by 1 of the 4 states that mandates a first year of AOA training for licensure (ie, Florida, Michigan, Oklahoma, and Pennsylvania). 

The number of trainees in OGME programs continues to grow (Figure 1). In the 2011-2012 academic year, 6895 DOs trained in AOA-approved programs (Table 1), an increase of 573 trainees (9.1%) since the previous academic year.² 

Table 2 identifies the number of AOA residency programs, approved positions, and trainees by specialty for the past 3 academic years. On the basis of feedback we have received from hospital and program directors, primary care specialties directly support the needs of the hospitals and therefore have the greatest number of slots. Specifically, family medicine and internal medicine continue to show strong growth in terms of the number of new programs, positions, and trainees. Family medicine showed the most growth this past year with an additional 8 programs, 146 positions, and 180 trainees. Internal medicine grew by 3 programs, 103 positions, and 168 trainees. There are indications that primary care residencies will continue to grow as governmental decisions and actions such as the Affordable Care Act propose to fund an increase in the number of primary care specialists.^6,8 

The percentage of filled positions in funded osteopathic residency program positions continues to increase. In the 2011-2012 academic year, there were 883 AOA-approved residency programs with 9741 approved funded positions, of which 6290 were filled, for a fill rate of 65%—an increase over the 63% fill rate for 2010-2011 and 62% fill rate for 2009-2010.^2,5 

Table 3 notes AOA-approved residency programs and approved and filled positions. From 2010-2011 to 2011-2012, there was a net growth of 56 programs, 631 positions, and 559 trainees, compared with a net growth of 35 programs, 609 positions, and 484 trainees from 2009-2010 to 2010-2011.² 

Figure 2 depicts the geographic concentration of approved OGME positions. Programs approved by the AOA are located in 40 of the 50 states. Approximately 54% of all AOA-approved training positions are located in the following 4 states: Florida, New York, Michigan, and Pennsylvania. Florida had the most growth in 2011-2012, with an increase of 25 programs and 242 approved positions. Also of note are increases in New Jersey, with an additional 97 positions; Oklahoma, with an additional 66 positions; and New York, with an additional 56 positions. Internship and residency data by state for the 2011-2012 academic year are also provided in Table 1. 

Data reports continue to show modest growth in the number of available OGME positions and trainees in AOA-approved slots. This increase, however, has not kept up with the increasing number of graduating DOs each year. Strategies to increase the number of training positions for graduating DOs continue to be a priority for the osteopathic medical profession. The AOA Bureau of Osteopathic Graduate Medical Education Development is available to provide support for new residency training program development. Efforts to increase primary care positions remain a priority of the US government.^6,7 

The AOA has invested time and effort to investigate whether it has become appropriate to permit allopathic physicians (ie, MDs) into osteopathic residency training slots. Because of the high number of filled, funded slots, the AOA Board of Trustees, after convening a task force to study the issue, has asked the Council on Osteopathic Postdoctoral Training to monitor this factor and make a recommendation to the Board of Trustees by 2015. From the outset, many members of the task force expressed doubts AOA programs had room for MDs, particularly because the MD community has agreed to a 30% increase in the number of MD graduates by 2020 to meet the physician shortage predicted in the next decade.⁹ 

Although the number of osteopathic postdoctoral training positions has increased over the years, the number of students graduating from DO schools has increased at a substantial rate. Strategies to increase the number of residency slots for graduating DOs will continue to be a priority for the osteopathic medical community.