# Osteopathic Acceptance in General Surgery Residency: A Five-Year Review of Resident Outcomes

## TL;DR

This study examines the representation of osteopathic medical graduates in general surgery residency programs and finds that most programs have below-average DO representation.

## Contribution

The study provides a nationwide analysis of osteopathic representation in general surgery residencies using recent data and highlights disparities.

## Key findings

- 64.7% of programs have below-average DO representation compared to the national average of 14.3%.
- Only 35.3% of programs show equal or greater-than-expected DO representation.
- Historically osteopathic programs show above-average DO representation, with 88.9% exceeding NRMP benchmarks.

## Abstract

Introduction: A well-trained and equitably distributed general surgery workforce is an essential component to meeting national healthcare needs. The composition of surgical residency programs is under continuous evaluation as it can shape the future of surgically trained doctors. While prior studies have highlighted trends such as increasing presence of international medical graduates in general surgery, there is still limited data on the osteopathic representation and how its trends may relate to resident demographics. The key interests include integration of osteopathic graduates, where disparities persist despite ongoing shifts. Systemic changes, such as the recent transition to a single accreditation system, may have the potential to influence match rates in other surgical specialties. This study offers a contemporary, nationwide analysis of 2024-2025 general surgery residency data, which highlights growing and changing trends of surgical resident demographics and program characteristics to better understand trends in matching into general surgery.

Methods: This study encapsulates publicly available data primarily extrapolated from the National Residency Match Program (NRMP) Main Residency Match data and using the Fellowship and Residency Electronic Interactive Database Access (FREIDA), maintained by the American Medical Association (AMA). FREIDA was used to locate residency program websites, serving as the primary source for detailed resident and faculty information and where more extensive data collection was conducted. Programs were excluded if essential residency data were not publicly available. Other exclusion criteria include preliminary positions and the absence of critical data relevant to categories of interest. Data collection was obtained and organized into different domains that included categorical data among resident and program data (e.g., Medical Doctor (MD) vs Doctor of Osteopathic Medicine (DO), American Osteopathic Association (AOA) affiliation, Program Setting, Gender, and Postgraduate Year). Descriptive statistics were used to summarize program size, resident demographics, and degree. Chi-square tests were applied to evaluate proportional differences across programs.

Results: Of the 364 Accreditation Council for Graduate Medical Education (ACGME) accredited general surgery residency programs identified, 292 met inclusion for this analysis. In total, 7,846 residents across these programs were evaluated. Among the 292 programs, 103 (35.3%) demonstrated equal to or greater-than-expected representation of DO residents compared to the national average of 14.3% calculated from NRMP data. In contrast, 189 programs (64.7%) have below-average DO representation. Forty programs (13.7%) were classified as DO dominant, while 246 programs (84.2%) had more MDs than DOs. Of the historically osteopathic (AOA affiliated) programs, 32 (88.9%) demonstrated above-average DO representation relative to NRMP benchmarks. DOs represented 13.8% (n=1082) of the total 7,846 residents analyzed.

Conclusion: Osteopathic medical students continue to face challenges despite progress in DO representation in general surgery. This study aims to highlight the current landscape of osteopathic inclusion, underscore the potential to further grow DO interest in general surgery, and emphasize the ongoing efforts needed to promote equitable representation across training programs for integration of osteopathic physicians into the surgical workforce.