Recent and future trends in osteopathic orthopedic surgery residency match rates following the transition to a single accreditation system.

Context: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field.

Objectives: The main objective of this study aimed to investigate recent match rate trends in orthopedic surgery within the past 5 years and to forecast match trends for both allopathic and osteopathic students to further analyze the future projection of the orthopedic surgery match.

Methods: This study utilized publicly available data from the National Residency Match Program (NRMP) Main Residency Match data. Data were collected retrospectively from 2020 to 2024 regarding students applying for orthopedic surgery residency. The number of matched Doctor of Osteopathic Medicine (DO) applicants, Doctor of Medicine (MD) applicants, overall applicants, and the proportion of matched applicants being DOs were forecasted over the next 10 years utilizing an Autoregressive Integrated Moving Average (ARIMA) model in SPSS 29.0. This model harvests data from previous instances (number of matched applicants from 2008 to 2024) to develop a close-fit model to predict future values and their respective confidence intervals (CIs). This study incorporated all applicants applying to orthopedic surgery, including international medical graduates (IMGs).

Results: There was an increase in the total applicants applying to orthopedic surgery residency positions for both allopathic and osteopathic students. The largest increase in applicants occurred between the 2021 and 2022 application cycles. There was a statistically significant difference in the total number of applicants overall over the 2020-2024 match cycle. The percentage of DOs to match into an orthopedic surgery residency position decreased from 63.28 % in 2020 to 45.70 % in 2024, and there was a statistically significant decline in the match percentage of DOs in orthopedic surgery residency over the 2020-2024 match cycle. Based on the ARIMA model projection utilizing data from 2008 to 2024, there is expected to be an average increase of 14.1 % in the total number of positions offered by 2034, to 1,045 positions total. There is expected to be a moderate increase in the number of matched DO applicants, from 128 in 2024 to 161 in 2034. Utilizing data from 2016 to 2024, there is expected to be an average increase of 10.7 % in the total number of positions offered by 2034, leading to a decreased proportion of positions filled by DO applicants by 2034, from 14.0 % in 2024 to 12.2 % by 2034.

Conclusions: Osteopathic students continue to face challenges despite progress in DO representation within orthopedic surgery. We hope to provide insight into the growing competitiveness of orthopedic surgery programs and to describe future trends in DO match rates to aid students pursuing this field.