Trends and Outcomes in Residency Matches – Assessing the Post-Merger Landscape for DO and MD Graduates Both MD and DO graduates apply for residency positions through the National Resident Matching Program, the NRMP. Prior to 2014, residency positions accredited by the American Osteopathic Association, the AOA, were exclusively available to osteopathic medical graduates, while residency positions accredited by the Accreditation Council for Graduate Medical Education, the ACGME, were accessible to both MD and DO graduates. In 2014, a merger was announced to unify the ACGME and AOA accreditation systems, and this process completed in 2020. This merger aimed to provide equal opportunities for MD and DO graduates, but the actual impact on DO match rates into competitive specialties remains a critical question. Our study aimed to analyze the proportion of MD and DO graduates in select competitive specialties from 2014 to 2024. It also sought to compare match rates before and after the ACGME merger. We defined the pre-merger period to be 2014 to 2019 and the post-merger period to be 2020 to 2024. Methods. We collected data from publicly accessible databases for the years 2014 through 2024 from the National Resident Matching Program, the National Matching Service, American Association of Colleges of Osteopathic Medicine, and the Association of American Medical Colleges. Data was analyzed using linear regression, Spearman's correlation, and Mann-Whitney U-Tests. Moving on to our results. Figure 1 shows an increasing proportion of DO graduates for the years 2014 to 2023. Figure 2, panels A and B, reflects our dermatology data. We found a weak negative correlation for DO graduates filling dermatology residencies post-merger. When the pre-merger data was compared to the post-merger data with a Mann-Whitney U-Test, we found a significant decrease in the percentage of DOs filling dermatology positions and a significant increase in MDs filling dermatology positions. Figure 2, panels C and D, reflects neurosurgery data. In neurosurgery, DO graduates exhibited a significant negative correlation in matching rates and a significant decrease in match rates post-merger. MD match rates were consistently high, showing little change before and after the merger. Figure 2, panels E and F, reflects orthopedic surgery. Interestingly, no significant correlation was found for either DO or MD graduates in this field. Figure 3 displays our radiology, anesthesiology, and obstetrics-gynecology data, respectively. All three fields showed a significant positive correlation for DO match rates post-merger. When assessing the pre-merger and post-merger data, radiology in panels A and B and obstetrics-gynecology in panels E and F saw a small but significant increase in DO matches. Meanwhile, anesthesiology in panels B and C showed a trend toward increased matches for DOs, though this was not statistically significant. Discussion. Our study found that the ACGME merger led to decreased match rates for DO graduates in competitive specialties, specifically in dermatology and neurosurgery. Possible reasons include increased competition for former AOA-accredited residency positions, fewer associated home residency programs for DO schools, and a disparity in research accomplishments. Additionally, the shift from a graded United States medical licensing examination Step 1 to a pass-fail system in 2022 may also have altered the landscape of residency applications, placing more emphasis on research and extracurricular activities. Furthermore, the loss of osteopathic-centric graduate medical education programs following the merger may have disproportionately impacted DO applicants. For DO students aiming for competitive specialties, early mentorship, research involvement, and strategic planning, including taking USMLE exams, are likely important steps to enhance match success. In conclusion, the ACGME merger appears to have had mixed effects on DO graduates' residency match outcomes. While the number of osteopathic graduates has increased, their representation in some of the most competitive residencies has declined post-merger. Despite these challenges, the study found that DO match rates improved in less competitive specialties like radiology, suggesting the impact of the merger varies across different specialties.

ACGME AOA merger

residency opportunities

DO graduates

match rates

USMLE Step 1