Determinants of Neurosurgery Match Success Among Osteopathic Graduates: A Retrospective Analysis of 111 Applicants

Neurosurgery is one of the most competitive residencies with only a small number of Doctor of Osteopathy (DO) graduates matching each year. This study aims to identify applicant characteristics associated with successful neurosurgery match among DOs.

We conducted a retrospective analysis of DO graduates who matched into neurosurgery from 2007-2017. Data on demographics, research productivity, gap years, program accreditation, fellowship training, and current practice setting were obtained from the American Association of Neurological Surgeons and public sources. Multivariate logistic regression identified independent predictors of matching into Accreditation Council for Graduate Medical Education (ACGME)-accredited programs.

Of 1883 US neurosurgery matriculants, 111 (6%) were DO graduates. Of these, only 18 (16%) entered ACGME programs. Compared to their peers in American Osteopathic Association programs, ACGME-matched DOs had a significantly higher number of preresidency publications (median 4 vs. 1, P < 0.001) and H-indices (median 2 vs. 0, P < 0.001). They were also more likely to have completed a research gap year and pursue fellowship training and academic practice (P < 0.05). Independent predictors of ACGME match included gap year completion (odds ratio [OR]: 5.96; 95% confidence interval [CI]: 1.40-25.3), number of publications (OR: 1.86; 95% CI: 1.17-2.94), and older age (OR: 1.22; 95% CI: 1.01-1.47). The osteopathic institutions with the highest number of neurosurgery matches were geographically clustered near metropolitan research hubs.

For DO applicants, taking a research-focused gap year and demonstrating strong scholarly output significantly increase the likelihood of ACGME match. Implementing targeted mentorship and research programs at osteopathic medical schools may help bridge the gap in research productivity and enhance DO match success in neurosurgery.