Equal but Separate: The Slow Assimilation of Osteopathic Surgery Residents Two Years After the Unified Match.

OBJECTIVES: The purpose of this study was to monitor the integration of general surgery residency programs before and after the 2020 unified match. We hypothesized that integration of osteopathic (DO) surgery residents would increase. DESIGN: We performed a retrospective cohort study of surgery residency programs between 2019 and 2021 utilizing data provided by the Association of American Medical Colleges. Program composition (2021) and changes in composition (2019-2021) were compared by program type. Multivariable logistic regression models assessed variables associated with DO presence (2021) and integration (2019-2021). SETTING: General surgery residency programs across the United States. PARTICIPANTS: Civilian surgery residencies that completed the 2019-2021 program survey. RESULTS: Out of 320 programs, DO residents were integrated at 69% (221/320), including 52% (63/122) university programs, 78% (101/129) university-affiliated programs and 83% (57/69) community programs (p < 0.01). Overall, 23 (8%) programs integrated DO residents from 2019 to 2021, and 9 (21%) ex-American Osteopathic Association programs integrated MD residents (both p < 0.01). The median number of DO residents was 1 (interquartile range, IQR 0-2) at university programs, 2 (IQR 1-7) at university-affiliated programs, and 5 (IQR 2-12) at community programs (p < 0.01). The median number of DO residents at all programs increased from 1 (IQR 0-5) to 2 (IQR 0-6) since 2019 (p < 0.01). Community (OR 2.6, p = 0.04), university-affiliated (OR 2.3, p = 0.02), and programs with DOs in 2019 (OR 19.0, p < 0.01) were associated with increased odds of DOs present in 2021, while DO faculty (OR 2.6, p = 0.02) was the only factor independently associated with integrating DOs after 2019. CONCLUSIONS: While some programs have integrated DO residents, progress is slow, median numbers of DO residents remain low, and familiarity with DOs is most associated with integration. We explore barriers to integration, and advance recommendations to eliminate potential disparities.

On the Eve of Integration: Community and Affiliated Residency Programs Pave the Way Towards the Assimilation of Osteopathic Surgery Residents.

OBJECTIVE: The 2020 match integrated former osteopathic and allopathic residency programs under single Graduate Medical Education accreditation. We describe the composition of general surgery residency programs prior to the 2020 integration and provide a baseline to monitor future progress. DESIGN: Retrospective, cross-sectional data provided by the Association of American Medical Colleges for the 2018 academic year were analyzed. Descriptive analyses were used to summarize the characteristics of residents by program type and program location. Logistic regression was used to estimate factors associated with the presence of osteopathic (DO) residents. An alpha of 0.05 defined statistical significance. SETTING: Data were collected and analyzed at a United States osteopathic medical school. PARTICIPANTS: All civilian surgery residencies that approved the 2018 Program Survey. RESULTS: Out of 285 programs, the percentages with at least one DO resident were significantly different among university (44.0%), university-affiliated (62.7%) and community (78.4%) programs (p < 0.001). DO residents made up 41.4% of community residents, 13.3% of university-affiliated residents, and 2.8% of university residents (p < 0.001). A significant regional difference was observed, as DO residents made up 16.9% of residents in the central region, compared to 10.4% in the northeast, 7.0% in the south and 8.9% in the west (p = 0.004). The logistic regression analysis found that the presence of DO residents at a program was significantly related to the type of program (Affiliated vs University OR = 3.1, 95% CI 1.5-6.5; Community vs University OR = 5.2, 95% CI 1.9-14.4) and the presence of DO faculty (OR = 2.7, 95% CI 1.6-4.8) (all p < 0.05). CONCLUSIONS: We observed significant differences in the presence of DO residents in different program types. As surgical education transitions to single accreditation, this study identifies opportunities for greater integration between osteopathic and allopathic surgery training programs.