Osteopathic Otolaryngology Residency Match Trends: Impact of the ACGME Single Accreditation System (2010-2024)

The 2020 merger creating the Single Accreditation System (SAS) unified the graduate medical education accreditation process under the Accreditation Council for Graduate Medical Education (ACGME). Prior to this merger, osteopathic (DO) and allopathic (MD) residency pathways were separate, particularly limiting osteopathic representation in competitive specialties such as otolaryngology. The impact of the SAS merger on osteopathic applicants matching into otolaryngology residencies has not been quantitatively evaluated. The objective was to evaluate osteopathic applicant trends in otolaryngology residency matches across three distinct periods: pre-merger (2010-2014), transition (2015-2019), and post-merger (2020-2024), surrounding the implementation of the ACGME Single Accreditation System.

A cross-sectional analysis was conducted utilizing publicly available residency match data from the National Resident Matching Program (NRMP), National Matching Services (NMS), Accreditation Council for Graduate Medical Education (ACGME), and Fellowship and Residency Electronic Interactive Database (FREIDA). Annual match outcomes were analyzed across three distinct periods: pre-merger (2010-2014), transition (2015-2019), and post-merger (2020-2024). Descriptive statistics and Spearman rank correlation (α = 0.05) were used to evaluate match trends, including the association between calendar year and the number of osteopathic senior matches into ACGME otolaryngology residency programs.

Prior to the merger, during the 2010-2014 period, osteopathic seniors rarely matched into ACGME otolaryngology residencies (average <1 per year), predominantly utilizing the AOA-specific match system (NMS) averaging 22 matches annually. During the transition period, (2015-2019), osteopathic matches slightly increased to an average of four per year. During and following the full implementation of the SAS (2020-2024), osteopathic matches significantly increased from 17 in 2020 to 26 in 2024 (53% increase, p=0.013). Spearman's rank correlation indicated a strong positive association between year and number of osteopathic matches (ρ=0.915, p<0.001). Allopathic match numbers remained stable (p=0.215), indicating no negative impact on MD candidates.

The ACGME Single Accreditation System merger was associated with a substantial increase in osteopathic match outcomes in otolaryngology residency programs without an observable decline in allopathic match outcomes. These findings suggest the unified accreditation system expanded access and opportunities for osteopathic medical graduates. These findings have important implications for osteopathic applicant access, match equity, and ongoing GME policy discussions. Future research should investigate specific applicant characteristics influencing match success and program directors' selection criteria post-merger.