Exploring the Cost and Access Gap Between Osteopathic and Allopathic Medical Students When Applying for General Surgery Fourth-Year Away Rotations

Abstract

Introduction: Away rotations have been widely accepted as a critical factor involved in the selection of future residents by general surgery residency programs nationwide. With the recent change to a single accreditation system merging the American Osteopathic Association (AOA) and Accreditation Council for Graduate Medical Education (ACGME), programs offering away rotation positions must contend with an increased applicant pool consisting of both allopathic (MD) and osteopathic (DO) medical students. The aim of the study was to determine if any ACGME general surgery residency institutions discriminated against either osteopathic or allopathic students applying for away rotations.

Methods: All active, non-military ACGME-accredited general surgery residency programs (N=336) were reviewed. Official residency program websites, affiliated medical school websites, and the visiting student application service portal were all reviewed during the 2023-2024 application cycle. Eligibility criteria, associated fees, and specific verbiage were recorded and scored on a scale of zero to two. Additionally, we assessed for the acceptance of either the United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX), as mandated by allopathic and osteopathic schools, respectively. A score of two was given for unequal rotation fees between applicant degree types or language inhibiting students with a specific degree type from applying. A score of one was given to programs that only accepted USMLE scores and would not accept COMLEX scores or programs that only allowed students to apply from a limited list of osteopathic schools. A score of zero was given to programs that had no restrictive language.

Results: Out of the 336 programs reviewed, 52 did not have information regarding away rotations available on their respective websites, leaving 284 programs available for review. Of those 284 programs, 82.7% (N=235) were awarded a score of 0; 17.3% (N=47) received a score of either one or two. Among the subset of 47 programs, 40.4% (N=18) had a lexicon restricting students from Commission on Osteopathic College Accreditation (COCA) schools from rotating within the institution. 2.3% (N=1) had unequal monetary expenses between MD and DO applicants, with the latter group being charged 2500% more than the former; 59.6% (N=28) had specific language requiring USMLE scores while simultaneously stating their disapproval of COMLEX scores being used in their place. No programs (N=0) had discriminatory criteria (expense, board score, degree) directed toward MD applicants, and any disparities were only associated with DO applicants.

Conclusion: This study aimed to assess the degree of discrimination between MD and DO candidates applying for general surgery away rotations following the adoption of the single accreditation system. We highlight a subset of barriers that persist in the 'away rotation' application process that impacts allopathic and osteopathic applicants. Further elucidation of similar variables may be an essential target to recognize the value and contributions of both DO and MD applicants to general surgery residency programs.

Keywords: away rotation; away rotations; general surgery; medical student; osteopathic medical student.

Figure 1. Total programs allocated to each region.

Figure 2. Percentage of general surgery residency programs by region which display any form of bias towards DO candidates when applying for fourth year away rotations.

DO: Osteopathic