Geographical distribution and match trends of osteopathic residents in otolaryngology residency programs: a cross-sectional analysis.

Context: Following the implementation of the Single Accreditation System (SAS) in 2020, the integration of osteopathic and allopathic residency programs has reshaped access to surgical specialties. Despite these efforts, osteopathic medical graduates remain underrepresented in otolaryngology residencies, with historical concentration in a few Midwestern states and limited access to home residency programs.

Objectives: The objective of this study was to assess the geographical distribution, training site characteristics, and match patterns of osteopathic otolaryngology residents from 2020 to 2024, including relationships with medical school location and program history (historically AOA-accredited vs. historically allopathic-only).

Methods: A retrospective cross-sectional analysis was conducted utilizing data on 109 osteopathic otolaryngology residents matched from 2020 to 2024. Data were gathered from National Resident Matching Program (NRMP) results, residency websites, and public sources. Variables included residency location, hospital size, urban/rural status, and medical school affiliation. Statistical methods included descriptive statistics, chi-square tests for trend, Pearson correlation, regression analysis, and a two-sample t test for geographic mobility.

Results: Michigan, Pennsylvania, and Ohio accounted for 74.3 % of residents. Geographic distribution trends over the 5-year period (2020-2024) showed no significant year-to-year change (p=0.54). A positive correlation (p=0.014) existed between osteopathic school locations and resident distribution. All residents trained in urban programs; 80.7 % trained in large hospitals (≥400 beds). A two-sample t test showed that residents who relocated for residency moved significantly farther than those who remained in-state (p=0.014). More osteopathic residents matched into historically AOA-accredited programs than into formerly allopathic-only programs.

Conclusions: Five years after the SAS merger, osteopathic otolaryngology residents continue to cluster geographically near osteopathic medical schools and train predominantly in large, urban hospitals. Historically AOA-accredited programs remain a primary entry point for osteopathic graduates. Further efforts are needed to expand access and representation across the broader otolaryngology training landscape.