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The AOA Match and the Future of Osteopathic Residency Positions: The Good News and the Bad News

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. Perceptions. What is your perception about the future of osteopathic residency education?

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The AOA Match and the Future of Osteopathic Residency Positions: The Good News and the Bad News

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  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.

  4. Total Enrollment in COMs 1968-2010 Total Enrollment Thousands 22 20 18 16 14 12 10 8 6 4 2 0 1968 1973 1978 1983 1988 1993 1998 2003 2004 2005 2006 2007 2008 2009 2010 1.879 2.780 4.221 6.212 6.614 7.822 9.882 11.857 12.525 13.406 14.409 15.634 16.893 18.143 19.427 Total Enrollment Data drawn from the AACOM Annual Osteopathic Medical School Questionnaire

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

  6. DOs in Residency Training, 1995-2009 Totals in AOA and ACGME Programs* Percent in AOA Year AOA ACGME Total 1995 2606 3333 5939 43.9 1996 2141 3288 5429 39.4 1997 2632 3367 5999 43.8 1998 2998 3639 6637 45.1 1999 2928 3869 6797 43.1 2000 2781 4175 6956 39.9 2001 2499 4658 7157 34.9 2002 2532 5327 7859 32.2 2003 2523 5838 8361 30.2 2004 2422 5675 8097 29.9 2005 2535 6474 9009 28.1 2006 2989 6629 9618 31.1 2007 3289 6784 10073 32.7 2008 4794 7237 12031 39.8 2009 5247 7628 12875 40.8 *DOs in AOA/ACGME Accredited Programs are Counted Twice

  7. Trends in Osteopathic Matching 1988-2011 3000 2500 2000 1500 1000 500 0 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2011 Funded Slots 1515 1701 1799 1676 1877 1878 1814 1989 2147 2206 2312 2443 2553 Number Matched 1369 1257 1145 1385 1255 1353 1314 1291 1205 1196 1353 1473 1640 No. of Non-Participants 661 663 994 1212 1363 1356 1748 1992 2114 502 654 Unfilled Slots 146 291 622 525 500 698 942 1010 959 970 913 Funded Slots Number Matched No. of Non-Participants Unfilled Slots *Data drawn from AOA Office of Education and the AACOM Annual Report

  8. AOA Deficit in Residency Positions 2005 to 2012 Thousands 4 2.8 1.6 0.4 2005 2006 2007 2008 2009 2010 2011 2012 Eligible DO Participants 2.908 2.886 3.173 3.600 3.899 4.106 4.581 5.014 Option 1 & 2 Slots 928 1.030 1.154 1.558 1.754 1.801 1.918 1.995 Residency Deficit 1.980 1.856 2.019 2.042 2.145 2.305 2.663 3.019 .

  9. Positions Left Over in the AOA Match Program 2006-2012 Traditional Internships Internal Medicine Other Specialties # of Unmatched Students Unfilled Positions Year Family Practice 2006 615 170 93 132 123 1010 2007 534 180 88 120 182 922 2008 397 310 152 100 273 959 2009 422 306 173 101 361 1002 2010 379 339 174 78 423 970 2011 390 333 144 46 572 913 2012 351 302 142 93 606 888

  10. Number of DOs in ACGME Residencies, 1992-2009 The Annual Number of DO Graduates, 1992-2009 7600 6800 6000 5200 4400 3600 2800 2000 1200 92 94 96 98 OO O2 O4 O6 O8 O9 DOs in ACGME Progs. 3137 3264 3288 3639 4176 5327 5675 6629 7237 7628 No. of DO Grads. 1532 1732 1932 2096 2279 2536 2769 2814 3462 3724 DOs in ACGME Progs. No. of DO Grads.

  11. NRMP PGY-1 Slots 1975-2011 Number of USMD and DO Graduates Year PGY-1 Slots USMD Grads DO Grads 1975 15691 12714 809 1980 18055 15135 1151 1985 18535 16400 1560 1990 20101 16179 1534 1995 20751 15892 1932 2000 20598 15714 2510 2005 21454 15761 2707 2010 22809 16427 3845 2011 23421 16893 4228

  12. IMGs in ACGME Programs 1995-2010 Thousands 32 31 30 29 28 27 26 25 24 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 24,982 24,703 25,531 25,415 25.880 24,707 25,403 25,783 26,577 26.720 27,636 28,176 28,824 29,488 30,068 30,441 Number

  13. DOs In The NRMP 1996-2011 Unmatched PGY-1 Year No. of Applic. Active Applic. Matched PGY-1 1996 1176 799 552 247 1997 1185 790 509 281 1998 1343 890 614 276 1999 1451 984 671 313 2000 1665 1150 823 327 2001 1793 1241 876 365 2002 1859 1316 933 383 2003 1937 1408 995 413 2004 2034 1559 1099 461 2005 2043 1524 1045 479 2006 2222 1509 1024 485 2007 2398 1652 1136 516 2008 2711 1870 1339 531 2009 2875 2015 1408 607 2010 2045 1444 601 2011 2178 1561 617

  14. Number of DOs Scrambling* 2006-2012 Match Participants AOA Match Results NRMP Match Results No. in Scramble Year 2006 2886 1196 1024 666 2007 3173 1267 1136 770 2008 3600 1353 1339 908 2009 3899 1433 1408 1058 2010 4106 1473 1444 1189 2011 4581 1640 1561 1380 2012 5014 1767 1311 *Includes Current and Past Graduates

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

  16. 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.

  17. 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

  18. Educational Directions MSUCOM Graduates *Not participating in AOA Match

  19. MSUCOM: Top 10 Specialty Choices AOA and ACGME Programs for 2010 and 2011 2010 List of Top 10 Number 2011 List of Top 10 Number Internal Medicine 42 Family Medicine 43 Family Medicine 41 Internal Medicine 43 Trad. Internship* 29 Emer. Medicine 17 Emer. Medicine 22 OB/GYN 17 Anesthesiology 12 Trad. Internship* 12 Pediatrics 12 Pediatrics 12 PM&R 9 Neurology 9 General Surg. 8 Psychiatry 7 Orthopedic Surg. 8 Orthopedic. Surg. 7 OB/GYN 5 General Surg. 4 *Many Interns Matched to ACGME Advanced Residencies at the PGY-2 Level

  20. SCS Composition by COM Years 2000-2011 COM 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 MWU/AZCOM 19 27 33 40 41 44 38 34 37 46 54 MWU/CCOM 52 51 58 46 46 54 44 56 74 71 61 66 NSUCOM 52 57 58 46 49 53 52 56 67 63 57 59 DMU/COM 159 141 134 110 88 90 117 120 130 120 124 113 KCUMB/COM 81 95 98 93 92 113 108 119 128 132 134 132 ATSU/KCOM 136 136 127 116 102 113 101 94 94 93 91 108 LECOM 4 19 24 23 35 61 73 79 113 112 105 96 UNECOM 18 19 13 9 9 9 13 20 17 18 17 14 MSUCOM 323 367 364 333 365 377 366 401 384 425 457 493 UMDNJSOM 4 6 6 5 1 1 7 6 4 6 5 6 NYCOM 8 13 17 13 19 18 25 20 15 13 14 14 OUCOM 14 22 22 21 17 17 18 18 17 24 20 22 OSUCOM 17 11 8 5 6 8 14 13 20 22 19 13 PCOM 20 28 23 23 21 26 22 22 20 17 20 22 PCSOM 6 8 10 12 8 17 25 37 39 46 43 UNTHSCTCOM 20 15 16 15 14 22 25 23 27 28 22 19 TUCOM/CA 8 13 19 30 34 42 41 48 41 48 37 WVCOM 12 17 19 17 18 18 17 24 29 22 20 24 WU/COMP 56 55 46 42 36 36 42 44 36 42 46 46 VCOM 4 11 16 24 29 LECOM-FL 17 30 31 41 TUNCOM/NV 12 25 40 45 PCOM/GA 0 8 13 21 TUCOM/NY 0 0 0 4 RVUCOM 0 0 0 0 LMUCOM 0 0 0 18 ATSU/SOMA 0 0 0 8 PNWUCOM 0 0 0 0 TOTALS 976 1085 1081 979 1000 1099 1147 1223 1336 1404 1460 1547

  21. SCS Intern and Resident/Fellows Numbers 2000 to 2011 1800 1600 1400 1200 Rotating Interns 1000 Residents/Fellows 800 Totals in OGME 600 400 200 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Rotating Interns 143 139 154 129 155 137 163 95 67 67 157 94 Residents/Fellows 867 812 812 883 891 979 1051 1115 1291 1366 1463 1549 Totals in OGME 1010 951 966 1012 1048 1134 1188 1278 1386 1460 1530 1616 Includes MD Participants in SCS Educational Programs. Track and Emphasis Interns are Counted as Residents

  22. SCS Primary Care vs. Non-Primary Care 2000 to 2011 Minus the Intern Count 1200 1000 800 600 400 200 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Primary Care 367.5 318.5 281.5 289.5 261.5 276 298 316 353 368 416.5 463.5 Non-Primary Care 499.5 493.5 530.5 593.5 629.5 703 753 804 951 998 1046.5 1085.5 *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.

  23. 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.

  24. 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

  25. 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.

  26. 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.

  27. 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

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

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