Cut-THROAT

CUT-THROAT October 25, 2012

CUT-THROAT A GUIDE TO EVERYTHING SURGERY

Presented by the Western University of Health Sciences COMP Student Osteopathic Surgery Club

General Surgery

Contents

Dr. Gregory Imler, MD

Overview General Surgery...1 Dr. Imler Interview...........2-3 The da Vinci Surgical System...2 GME Funding Showdown Looms in Washington ......4-5 Breaking the Myth: what program directors really look for ............................6-7 What Next? Scores..............8 Residency Programs.......9-11 Useful Resources.....12

Overview:

General Surgery is a broad spectrum field that deals with the majority of the body.

It incorporates diagnosis, preoperative, operative, and postoperative management of patients. *T h e AOA - a p p rove d residency programs are all at least five clinical years, which includes an OGME-1R. The OGME-1R is a first year residency that is required for all general surgery, neurological surgery and urological surgery residency programs in the AOA. T h e AC G M E r e s i d e n c y programs are also designed to

consist of at least five clinical years.

Both ACGME and AOA approved residency programs require residents to train in each of the following areas during their five clinical years: -alimentary tract (including

Bariatric Surgery) -abdomen and contents -breast skin and soft tissue -endocrine system -solid organ transplantation -pediatric surgery -surgical critical care -surgical oncology (including

head and neck surgery) -trauma, burns and

emergency surgery

-vascular surgery.

Many surgical specialties require completing general surgery training prior to the subspecialty.

The following specialities indicate the additional years in parenthesis: Thoracic Surgery (2), Colon and Rectal Surgery (1), Pediatric Surgery (2), Vascular Surgery (1-2).

These disciplines all have training programs related to, but separated from general surgery *since the recent unity between the AOA and ACGME graduate medical education this portion may change.

(More information can be found at So, You Want to be A Surgeon by Dr. Kaj Johansen http://www.facs.org/ residencysearch/contents.html)

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CUT-THROAT October 25, 2012

Dr. Imler Interview

General Surgeon, Sharp Rees-Stealey Group San Diego, CA

by Evan Robinson

How did you get to where you are today?

Well, I knew I wanted to be a doctor from a very early age. I remember even in elementary school I would have my parents drive me to the library so that I could check out anatomy books. I guess from there I did “You need to be able to make difficult decisions with incomplete information.

Surgeons often have to make the decision to operate before all the information they’d ideally want is available. Even more importantly, is someone that knows when NOT to operate...”

Dr. Imler in response to student personality type for General Surgery

well in school and went to college and eventually graduated from the University of Cincinnati College of Medicine and entered residency at UCSD. After my residency I joined a group of surgeons and have been with them for about 25 years now.

How conducive is your field to family life?

Now? Well, I’d say it’s pretty good for family life at this point in my career. I’m able to spend time with my wife and kids and only take call every couple weeks now. Of course, at the beginning it was more difficult, during residency I had much less free time, but I feel it was definitely worth it. I love my job. (continued on page 3)

The da Vinci Surgical System: Start playing video games The da Vinci Surgical System is designed to offer minimally invasive options for major surgeries. It combines computer and robotic technologies in laparoscopic, thoarcoscopic, and endoscopic surgeries. The da vinci consists of four arms which hold different surgical tools and an endoscopic camera. The physician controls the arms of the da Vinci at a console. The four arms are designed to exceed the natural range ROM of the human hand giving the physician optimal access to the problem. The da Vinci is also equipped with motion scaling and tremor reduction to further assist the physician. A magnified, 3-D image is produced for the physician to carry out his procedure.

"The advantages of the da Vinci are that one, it's minimally invasive, you only make small holes in the abdomen. Two you don't really lose very much blood. And three we're able to see much better so we're able to handle the tissues a lot more delicately," says Urologist Dr. Paul Bretton.

Intuitive Surgical, ranked sixth on Forbes’ list, created the da Vinci system which performed approximately 360,000 operations in 2011. The da Vinci has proven to cut down patient recovery time, having the potential to save the hospital $1000s. But so far only 1,840 machines have been installed in hospitals across the nation due to its high cost (a few million before maintenance and other service costs).

Check out these demonstrations: da Vinci Robot Origami demonstration: www.youtube.com/watch?v=pxInFn047js da Vinci Robot Peeling a Grape: www.youtube.com/watch?v=PvUIocA12pc&feature=related (Chakravorty, Robotic Surgery Company Behind da Vinci System October 17th, 2012 )

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CUT-THROAT October 25, 2012

Dr. Imler, MD INTERVIEW CONTINUED Do you have any advice for students who are looking to go into this field?

You need to work hard and be confident in your abilities. Shadow to find out if this is really the career for you.

What is the DO bias in this field?

Nowadays, I don’t think there’s much. I’ve hired D.O.’s in the past and I would again.

To me, it’s much more important where you did your residency training and what your program director says about your abilities.

It’s important to train in a center that has a high volume of patients and where you do a lot of different procedures.

What student-personality type have you found to be suited for this specialty?

You need to be able to make difficult decisions with incomplete information.

Surgeons often have to make the decision to operate before all the information they’d ideally want is available. Even more importantly, is someone that knows when NOT to operate. You need to be confidant and a hard worker. Anyone can operate; taking out a gallbladder is not complicated.

But, the remainder of a surgeon’s job is what makes someone a good surgeon, which is taking care of the patient before and after surgery. For a lot of your patients, when you operate on them, they will have never had surgery before and they’ll probably be scared. The art of developing trust with a patient and taking care of them can be more difficult than the operation itself.

What other rotations would help students prepare for this subspecialty?

Internal medicine and psychiatry.

Understanding your patients’ medical and mental health issues will pay off.

Did you do/ do you do research? Is that essential in getting into this field?

I did a little research in medical school, but I didn’t really like research. I don’t think it’s necessary to become a surgeon, but of course it won’t hurt. I think if you enjoy research, and if you want to go into academics then you should do research.

What is the hardest part of your job?

Telling someone that his or her family member has died, or telling a patient that you made a mistake.

What is the best part of your job?

I love my job, and not many people can say that. I enjoy operating, I enjoy the relationship with my patients, and it has allowed me to spend time with my family. I wouldn’t choose anything else.

Dr. Gregory Imler, MD Medical School: University of Cincinnati College of Medicine Internship: University of California, San Diego Residency: University of California, San Diego

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CUT-THROAT October 25, 2012

amednews.com American Medical News

GME Funding Showdown Looms in Washington

Many in organized medicine want more residency positions, but government officials have recommended reducing federal GME Spending BY: Carolyne Krupa, amednews staff. Posted Aug 27, 2012.

For years, medical educators and others in academic medicine have warned of the need to expand federal funding for graduate medical education to stave off impending physician shortages.

Nationwide, work force shortages are expected to reach 62,900 physicians by 2015 and 91,500 by 2020, according to the Assn. of American Medical Colleges. More doctors will be needed due to an aging population, rising chronic disease rates and an influx of an estimated 30 million newly insured individuals over the next decade under the Affordable Care Act. Despite those projections, there have been multiple proposals to slash GME funding as pressure mounts for Congress to reduce federal spending and prevent automatic, governmentwide cuts from taking effect starting in 2013. GME reductions as high as 50% have been recommended by the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform, as well as President Obama’s budget proposal.

However, some physicians and others are backing a proposal to expand GME funding. Introduced Aug. 2 in the House, with a companion bill in the Senate, HR 6352 calls for Medicare to add 15,000 more residency slots over five years.

“The U.S. is already facing the reality of having a significant shortfall in trained doctors and medical professionals, and this shortage will only continue to grow if we don’t begin to address the problem now,” said Rep. Aaron Schock (R, Ill.), the bill’s sponsor.

Medicare funding for GME has been capped since the Balanced Budget Act of 1997, raising concerns that there won’t be enough residency positions to train an expanding pool of U.S. medical school graduates.

4

Cutting those funds would be devastating, said Stephen Shannon, DO, MPH, president and CEO of the American Assn. of Colleges of Osteopathic Medicine.

“The shortage of physicians in our health care system, particularly in primary care, is nothing short of a national crisis,” he said.

The American Medical Association has supported lifting the 1997 funding cap. AMA policy says the Association will advocate to increase GME positions to address physician work force needs.

first-year residency positions for Match Day 2012, of which about 6,800 were non-U.S. citizens who graduated from international medical schools, according to the National

estimated in a 2011 report that a 50% reduction in Medicare GME funding would result in the closing of 2,551 residency and fellowship programs nationwide and the loss of 33,023 GME positions

During the last several years, medical schools have responded to physician shortage projections by expanding class sizes and opening new allopathic and osteopathic schools for the first time in decades. But that growth hasn’t been mirrored in GME. “There has been some growth, but it has been pretty marginal,” Dr. Shannon said. “There is increasing recognition that there is a squeeze coming. None of us wants to be graduating students who can’t go on to do their residency training to become physicians.”

Federal, state and private funds pay for GME. Medicare contributes the bulk, about $9.5 billion annually, while Medicaid pays about $2 billion, according to an Aug. 16 Health Affairs report. Of the Medicare portion, about $3 billion is for direct payments for the salaries of residents and supervising physicians, and $6.5 billion is for indirect payments to subsidize the costs of running a training program, such as longer hospital stays and more patient tests.

Resident Matching Program. More than 95% of U.S. medical school seniors were matched to first-year positions.

Any effort to expand GME funding faces numerous obstacles, particularly with the presidential election Nov. 6, said Glen Stream, MD, president of the American Academy of Family Physicians.

The high cost of expanding GME is a major barrier. The projected cost of funding 15,000 new GME slots a few years ago was $12 billion to $15 billion over 10 years, said Len Marquez, AAMC director of government relations. There is no current estimate of the cost.

“It’s expensive, and we’re in the middle of very challenging fiscal times,” he said.

Without more federal money, many residency programs cannot grow to meet increasing demands, said Lisa Bellini, MD, vice chair for education in the Dept. of Medicine at the University of Pennsylvania Perelman School of Medicine.

There are about 115,000 physicians in “There are only so many sources of residency programs nationwide, says revenue for hospitals,” she said. “It the Health Affairs report. About just gets more and more difficult to 23,000 physicians were assigned

FASHIONMONTHLY September 12, 2012

GME Funding Showdown Looms in Washington continued: expand or even maintain what you’ve got.”

“It needs to be a combination of both,” she said.

Some argue that the federal government shouldn’t be investing so

The American Medical Student Assn. would like to see more focus on ensuring that any expansion of funding is tied to meeting society’s health care needs, particularly through training more primary care physicians, said AMSA President Elizabeth Wiley, MD, MPH.

Medicare funding for GME has been capped since the balanced Budget Act of 1997 heavily in the training of physicians when it doesn’t make the same kind of contributions to train other health professionals, Dr. Shannon said. It’s a challenge to get Congress to consider the long-term picture.

“We’re always dealing with the shortterm issues and not the long-term,” he said. “The politics is pretty thick in this on a lot of levels, and it is a lot of money, but it is a major need.”

The Institute of Medicine also is examining issues surrounding GME. An 18-member committee has been appointed to look at the regulation, financing, governance and organization of GME. The group is charged with developing recommendations by the spring of 2014 on how to increase the physician work force to meet current and future needs.

More than adding residency slots HR 6352, also known as the Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, would do more than expand Medicare funding for an additional 15,000 GME slots. It also would require academic medical centers to meet new performance standards or risk payment reductions.

Dr. Bellini supports any proposal that helps to expand the pool of physicians. But the bill is unclear whether it would expand GME positions through new funding or a restructuring of the existing approach.

Representatives of the AMSA and the AAFP are concerned that the bill would allocate a portion of Medicare GME money to pay for residency positions that already are funded by other sources, such as hospitals.

“They would have the federal government pay for positions that already exist,” Dr. Wiley said.

The bill also emphasizes hospitalbased residency programs at a time when there needs to be more focus on training physicians in communitybased clinics and health centers, Dr. Stream said. “It doesn’t make sense that all of the funding has to flow through teaching hospitals,” he said.

Another bill, HR 3667, calls for a budget-neutral pilot program to test community-based residency training models. It emphasizes primary care training in rural and other medically underserved communities, and allows for more flexibility in training models while also requiring accountability, Dr. Stream said.

“There is a lot of concern about the nearly $10 billion that the federal government spends on GME every year, and what is it getting for that,” he said.

Meeting future health care needs While debate continues about how best to fund and structure GME, many agree that proposals to cut GME funding suddenly would be devastating to the system.

After surveying GME programs, the Accreditation Council for Graduate

Medical Education estimated in a 2011 report that a 50% reduction in Medicare GME funding would result in the closing of 2,551 residency and fellowship programs nationwide and the loss of 33,023 GME positions.

Such cuts would result in some U.S. medical school graduates losing their chance to complete training, said Dr. Wiley, of the AMSA. Cuts also would hit teaching hospitals, which rely on physicians-in-training to help care for patients at less cost than attending physicians.

“It’s a recipe for disaster,” she said.

At the same time, the AMSA doesn’t agree that there needs to be an expansion of GME funding — at least not yet. Under the current system, there are more residency positions than there are U.S. medical school graduates, and the country relies on international medical graduates to fill the remaining positions.

The AMSA supports federal funding to ensure only that there is a sufficient number of positions for U.S. medical school graduates, Dr. Wiley said.

“We don’t think it’s necessary to lift the cap yet,” she said. “We think it’s more important to focus on ensuring that medical schools are producing enough graduates to meet our needs.”

Dr. Stream said the focus needs to be on expanding the number of primary care physicians.

“Not a lot has been done to expand our training capacity for family medicine and primary care,” he said.

“Our concern is that any expansion of GME positions needs to take into consideration the physician work force needs of the country. We don’t just need to produce more people with MD after their name. We need to produce people who will meet the health care needs of America.”

(Krupa, C. (2012, August 27). Gme funding showdown looms in washington. .

Retrieved from http://www.ama-assn.org/ amednews/2012/08/27/prl20827.htm)

5

CUT-THROAT October 18, 2012

Breaking the Myth Many students enter medical school with a false sense of what is needed to match into surgery.

On a daily basis, I encounter false accusations of what residencies require of us to be competitive applicants: “To be a surgeon I need to be the class gunner” “To get into a surgical residency I need to be top 10%” “I have to be published multiple times or I wont be considered” Well I decided it was time to break that myth and shed some REAL light on this topic. These percentages came from the 2012ACGME National Resident Matching Program director survey. http://www.nrmp.org/data/programresultsbyspecialty2012.pdf

Figure GS-1

General Surgery Percentage of Programs Citing Each Factor in Selecting Applicants to Interview

84%

USMLE/COMLEX Step 1 score

89%

Letters of recommendation in the specialty

74%

Personal Statement

78%

Grades in required clerkships

73%

USMLE/COMLEX Step 2 score Wait what!? Grades are Grades in clerkship in desired specialty number 9??? so stop gunning so hard...cough Graduate of U.S. allopathic medical school cough

Medical Student Performance Evaluation (MSPE/Dean's Letter) Class ranking/quartile

75% 71% 63% 66% 69%

Gaps in medical education Personal prior knowledge of the applicant Perceived commitment to specialty

6

Honors in clinical clerkships

65% 56% 64%

Well we all knew that BUT notice that your letters of rec. are more important...

CUT-THROAT October 18, 2012

Medical Student Performance Evaluation (MSPE/Dean's Letter)

Figure GS-1

63%

Class ranking/quartile 66% General Surgery Percentage of Programs Citing Each Factor in Selecting Applicants to Interview (continued) Gaps in medical education 69%

65% 47% 56%

Personal prior knowledge of the applicant Evidence of professionalism and ethics Perceived commitment to specialty

51% 64%

Interpersonal skills Honors in clinical clerkships

Applicant was flagged with Matchinterest violation the Perceived in by program NRMP

49% 59% 54% 65%

Graduate of highly regarded U.S. experiences medical school Volunteer/extracurricular

whoa! according to ACGME Volunteer/ extracurricular OtherLeadership life experience 64% qualities 52% experience is only 1% lower than rank!!!

Honors in clerkship in desired specialty 69% aka: Alpha Omega Alpha (AOA) membership 60% LEAVE THE LIBRARY General Surgery Consistency of grades 64% Figure GS-1 Percentage of Programs Citing Each Factor in Selecting Applicants to Interview Demonstrated involvement and interest in research 56% (continued)

Audition elective/rotation within your department Feedback from current residents 0% Evidence of professionalism and ethics Visa status* Interpersonal skills Honors in basic sciences

NRMP Program Director Survey Results, 2012

Perceived interest in program Fluency in language spoken by your patient population

20%

40%

56% N=140

51% 49%

51

49%

26% 54% 43%

Graduate of highly regarded U.S. medical school Interest in academic career Leadership qualities Away rotation in your specialty at another institution Alpha Omega Alpha (AOA) membership USMLE/COMLEX Step 3 score* Demonstrated involvement and interest in research Other post-interview contact

Honors in clerkship (69%) and clerkship 59% grades in desired 54% specialty (75%) are 60% 80% 100% super important!

47%

52%

21% 60%

24% 56%

22%

Feedback from current residents 54% (statistics continued22% on page 52 of report) Gold Society membership

If you want to pad your resume go and do research but if you will do better in school and boards without doing research... you do the math

56%

Visa status*

...These numbers are to illustrate the point that you hear60% is true! There 0%not everything 20% 40% 80% are 100% many false accusations about what the ACGME is looking for, so instead of stressing about Honors in basic sciences 49% it go check out the numbers yourself. These were specifically collected from General N=140 Surgery residency program directors by the NRMP but the report has a breakdown of all Fluency in language spoken by your patient population 26% specialties so go check it out! * International Medical Graduates only Obviously, don’t take this advice as a reason to slack off during the first two years, but Interestthat in academic career 43% rather realize NRMP Program Director Survey Results, 2012 other things are 52just as or more important. http://www.nrmp.org/data/programresultsbyspecialty2012.pdf Away rotation in your specialty at another institution or 21% www.nrmp.org under DATA AND REPORTS USMLE/COMLEX Step 3 score*

24%

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CUT-THROAT October 25, 2012

What Next?

Table 11 Table 2

Getting the USMLE Score! Matching These scores reflect the 2011 match *It should be noted that we advice aiming for the USMLE score or better.

Osteopathic Graduates Matched to PGY-1 Positions by Specialty, 2008 - 2012 http://www.nrmp.org/data/ Matches by Specialty and Applicant Type, 2012 2012 2011index.html 2010 2009 2008

U.S. % Non-U.S. U.S. Number No.U.S.% No. % No. % No. 5th% No. Osteo Canadian Pathway IMG IMG Grad Senior Filled Anesthesiology 95 5.4 72 4.6 76 5.3 53 3.8 47 3.5 PGY- 1 Positions Child Neurology 4 0.2 0 0.0 0 0.0 0 0.0 0 0.0 Anesthesiology 919 897 725 8 95 1 0 37 31 Dermatology 0 0.0 0 0.0 2 0.1 0 0.0 2 0.1 Child Neurology 99 79 58 3 4 0 0 3 11 Emergency Medicine 23 177 163 11.6 1330 9.9 Dermatology 23 and171 229.7 0 11.3 0 159 11.00 0 1

by Preferred Specialty Applicant Type Emergency Med-Family Med 0 0.0 2 0.1 2 0.1 0 0.0 1 0.1 Emergency Medicine 1,668 1,668 1,335 68 171 0 0 69 25 Family Medicine 324 18.4 291 244 17.3 2642 19.7 Emergency Med-Family Med 4 4 2 0 18.6 0 270 18.70 0 0 Family Medicine Family Med-Preventive 2,740 2,591 1,322 79 0 0.0324 0 0.01 515 Med 1 0.1 0 30.0 0 0.0 347 Family Med-Preventive 6 4 1 0 19.8 1 292 20.20 0 2 InternalMed Medicine (Categorical) 355 20.1 309 306 21.7 2640 19.7 Internal MedicineMedicine-Dermatology (Categorical) 5,277 5,226 2,941 87 355 4 2 598 1,239 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Medicine-Dermatology 9 8 8 0 0 0 0 0 0 Medicine-Emergency Med 2 0.1 1 0.1 1 0.1 2 0.1 5 0.4 Medicine-Emergency Med 26 22 17 0 2 0 0 1 2 Medicine 0 20.0 1 00.1 01 0.0 Medicine-Family Medicine-Family Medicine 4 4 0 1 0.1 0 1 0.10 1 Medicine-Medical Genetics 0 0.0 0 0.0 0 0.0 0 0.0 00 0.0 Medicine-Medical Genetics 1 1 1 0 0 0 0 0 Medicine-Neurology 0 20.0 0 00.0 10 0.1 Medicine-Neurology 2 2 0 0 0.0 0 0 0.00 0 Medicine-Pediatrics 344 221 1.3 27 21 1.50 25 1.8 14 Medicine-Pediatrics 362 27 2761.5 27 01.9 24 Medicine-Preliminary (PGY-1 Only) 1,861 1,738 1,4274.0 2247 3.0 71 53 3.72 102 Medicine-Preliminary (PGY-1 Only) 71 59 04.2 47 3.5 114 Medicine-Preventive Med 5 4 2 0 2 0 0 0 Medicine-Preventive Med 2 0.1 0 0.0 0 0.0 0 0.0 10 0.1 Medicine-Primary 311 300 186 3 10 0 0 44 57 Medicine-Primary 10 0.6 8 0.5 13 0.9 10 0.7 11 0.8 Medicine-Psychiatry 20 18 12 0 0 0 0 2 4 Medicine-Psychiatry 0 00.0 2 00.1 10 0.1 Neurodevelopmental Disabilities 3 1 1 1 0.1 0 0 0.00 0 Medical Genetics 0 1700.0 0 00.0 05 0.0 Neurological Surgery 196 194 5 0 0.0 1 0 0.00 13 Neurology 292 289 6 0 0.0 22 0 0.00 21 67 Neurodevelopmental Disabilities 0 1730.0 0 00.0 0 0.0 General Surgery Obstetrics-Gynecology 1,223 24 0 0.0133 1 0.11 80 72 Neurological Surgery1,240 1 9130.1 1 00.1 0 0.0 Orthopedic Surgery 682 682 3029 1.9 2 20 1.40 6 Neurology 22 6411.2 10 00.7 113 0.8 Otolaryngology Obstetrics-Gynecology285 283 277 5 0 0 0 1 0 133 7.5 120 7.7 105 7.3 108 7.7 118 8.8 General Surgery Pathology 521 466 262 31 43 0 1 33 96 Ophthalmology 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Pediatrics (Categorical) 2,475 2,443 1,732 27 254 1 0 187 242 Orthopedic Surgery 2 70.1 5 00.4 20 0.1 Pediatrics-Anesthesiology 7 7 0 2 0.1 0 3 0.20 0 Otolaryngology 0 60.0 0 00.0 10 0.1 Pediatrics-Emergency Med 7 7 0 0 0.0 1 1 0.10 0 Pediatrics-Medical Genetics 7 6 034 2.2 0 31 2.10 2 Pathology 43 42.4 34 02.4 240 1.8 Pediatrics-P M &Pediatrics R 2 2 0 14.5 0 200 13.90 0 0 (Categorical) 2 254 14.4 226 190 13.5 2130 15.9 3 Pediatrics-Preliminary 55 48 0 0 0.0 1 0 0.00 Pediatrics-Anesthesiology 0 430.0 0 00.0 01 0.0 Pediatrics-Primary 67 64 27 0 2 0 0 14 21 Pediatrics-Dermatology 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Peds/Psych/Child Psych 18 17 13 0 3 0 0 1 0 Pediatrics-Emergency Med 1 0.1 0 0.0 0 0.0 1 0.1 1 0.1 Physical Medicine & Rehab 86 86 51 4 17 1 0 9 4 Pediatrics-Medical Genetics 0 870.0 0 00.0 01 0.0 Plastic Surgery (Integrated) 101 97 9 0 0.0 0 0 0.00 0 Pediatrics-P M & R 0 10.0 0 00.0 01 0.0 Preventive Medicine 4 2 0 0 0.0 0 0 0.00 0 Matches by Specialty and Type,33 2012 Psychiatry (Categorical) 1,118 1,080Applicant 168 Pediatrics-Preliminary 1 6160.1 0 0.0124 0 0.01 0 10.0 0 0.0 137 NRMP Data Warehouse by permissionU.S. of the ECFMG. Psychiatry-FamilyPediatrics-Primary Medicine 10 of 8 Sources:2U.S. 80.1 0 1and AAMC 0 Warehouse.

00.1 0 Non-U.S. U.S. Number Number 0.1 Data 1 0.10USMLE scores 15th 10 NBME 0.1 and Specialty Psychiatry-Neurology 1 0 4 0.3 0 0Canadian 0 Osteo IMG Pathway Grad Senior Filled Peds/Psych/ChildPositions Psych2 3 10.2 0.00 0 00.0 10 0.1 IMG Radiation Oncology 15 15 15 0 0 0 0 0 0 Physical Medicine & Rehab 17 1.0 19 1.2 13 0.9 15 1.1 14 1.0 PGY- 1 Positions Radiology-Diagnostic 135 124 90 4 14 0 0 5 11 AnesthesiologySource 919 897 8 0 0.0 95 0 0.01 37 31 Plastic Surgery 0 7250.0 1 00.1 0 0.0 Surgery (Categorical) 1,146 1,143 914 76 36 0 1 59 57 Child Neurology 99 79 58 3 4 0 0 3 11 0.0 Plastic Surgery (Integrated) 0 1 0.1 0 0.0 0 0.0 0 0.0 Surgery-Preliminary (PGY-1 Only) 1,221 737 478 18 20 0 0 78 143 Dermatology 23 23 220.0 0 0 0 1 0 19 0 000.0 000 0.0 Thoracic SurgeryPreventive Medicine 20 20 1 0 0.0 0 0 0.00 0 Emergency Medicine 1,668 1,668 1,335 68 171 0 0 69 25 36 7.5 51 Transitional (PGY-1 Only) (Categorical) 941 915 14 Psychiatry 124 7857.0 114 7.3 28 109 7.50 102 17.2 100 Emergency Med-Family Med 2 Vascular Surgery 414 414 3820.0 00 0 0.0 10 1 0.100 000.1 20 Psychiatry-Family Medicine 0to 1 2008 00 0.0 Osteopathic Graduates Matched PGY-1 Positions by Specialty, 2012 FamilyPGY-1 Medicine 2,740 2,591 1,322 79 324 1 3 515 347 24,034 22,934 15,712 560 1,764 12 9 2,102 2,775 Total Psychiatry-Neurology 0 0.0 1 0.1 0 0.0 1 0.1 0 0.0 Family Med-Preventive Med 6 4 1 02011 1 2010 0 0 0 2 2012 2009 2008 Radiation Oncology 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 PGY2 Positions Internal Medicine Specialty (Categorical) 5,277 5,226 2,941% 87 598 % 1,239 No. No. % 355 No. %4 No. 2% No. Radiology-Diagnostic 5579 14 39780.8 8 000.6 60 0.4 Anesthesiology 5408 30011 0.7 540 8 0.610 41 170 Medicine-Dermatology Anesthesiology 95 5.4 72 4.6 76 5.3 53 3.8 47 3.5 Surgery (Categorical) 36 2.0 28 1.8 20 1.4 31 2.2 31 Child Neurology 47 35 23 20 22 00 00 11 2.3 72 Medicine-Emergency Med 26 22 17 Child Neurology 0.2 0.0 30 190 1.3 0.0 0.0 0 0.6 0.0 Dermatology 3404 Only)3294 340180 1.2 00 11 Medicine-Family Medicine Sources: Surgery-Preliminary (PGY-1 20428821.1 160 001.1 831 Neurodevelopmental Disabilities 71 61 00 10 0.1 00 00 Dermatology 0.0 0.0 00 02 0.0 0.1 0.0 2 0.0 0.1 Medicine-Medical Genetics Thoracic Surgery 00 610.0 00 000.0 000 Neurology 346 3262 181 9.7 6177 24 1 011.6 410 9.9 730 Medicine-Neurology 022 11.3 Emergency(PGY-1 Medicine 171 163 133 Transitional Only)2 28 21.6 1.4 0 159 22 11.0 1.50 16 0 1.1 7 0.5 Nuclear Medicine Emergency Med-Family 4Med 3 0 0.0 02 2 0.1 27 0 00 000.0 1 0.1 14 2 Medicine-Pediatrics 362 344 276 25 0 2 0.1 0 Sources: Urology 0 0.0 0 0.0 0 0.0 0 0.0 01 0.0 Physical Medicine & Rehab 281 277 142 7 78 02 00 34 16 Medicine-Preliminary (PGY-1 Only) 1,861 1,738 1,427 22 71 102 114 Family Medicine 324 18.4 291 18.6 270 18.7 244 17.3 264 19.7 Surgery 1 190.1 0 00.0 01 0.0 Plastic Surgery Vascular 205 204 00 0 0.0 02 0 0.000 00 Medicine-Preventive Med 2 0 0 Family Med-Preventive Med 1 0100 0.1 1,561 0 100 0.0 01,4440 100 0.0 0 0100 0.0 1,33900 100 0.0 1,408 TOTAL PGY-1 1,764 Preventive Medicine 1 0 0 0 0 Medicine-Primary 311 300 186 3 10 0 0 44 57 Internal Medicine (Categorical) 355 20.1 309 19.8 292 20.2 306 21.7 264 19.7 Specialty

Specialty

Table 2

Table 11

8

Number of Positions

Number Unfilled 22 20 0 0 0 149 2 51 1 4 0 0 0 18 123 1 11 2 2 2 3 17 0 2 55 32 0 0 1 0 7 3 1 0 4 2 38 2 Number 1 Unfilled 0 11 22 3 20 484 0 0 0 26 00 149 1,100 2 51 171 124 110 10 200 1 18 4 123 01 1 11

CUT-THROAT October 25, 2012

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State

341509

Mountain Vista Medical Center Surgery-General Residency

Surgery-General

Mesa

AZ

152159

WesternU/COMP/Arrowhead Regional Medical Center Surgery-General Residency

Surgery-General

Colton

CA

182454

NSUCOM/Largo Medical Center Surgery-General Residency

Surgery-General

Largo

FL

339637

NSUCOM/Larkin Community Hospital - Surgery-General Residency

Surgery-General

South Miami

FL

148246

DMU/OMC/Mercy Hospital Medical Center - SurgeryGeneral Residency

Surgery-General

Des Moines

IA

126376

St James Hosp & Health Centers - Surgery-General Residency

Surgery-General

Olympia Fields

IL

195296

Henry Ford Macomb Hospitals MEP - Surgery-General Residency

Surgery-General

Clinton Township

MI

326172

DMC Osteo Division/Sinai Grace Hospital - Surgery-General Residency

Surgery-General

Detroit

MI

131417

Botsford General Hospital Surgery-General Residency

Surgery-General

Farmington Hills

MI

128416

Garden City Hospital - SurgeryGeneral Residency

Surgery-General

Garden City

MI

128283

Genesys Regional Med CtrHealth Park - Surgery-General Residency

Surgery-General

Grand Blanc

MI

341466

MSUCOM/Allegiance Health Surgery-General Residency

Surgery-General

Jackson

MI

126079

McLaren-Greater Lansing Surgery-General Residency

Surgery-General

Lansing

MI

130115

McLaren-Macomb - SurgeryGeneral Residency

Surgery-General

Mount Clemens

MI

130781

McLaren-Oakland - SurgeryGeneral Residency

Surgery-General

Pontiac

MI

328833

MSUCOM/Lakeland Regional Med Ctr - Surgery-General Residency

Surgery-General

St. Joseph

MI

9

CUT-THROAT October 25, 2012

10

AOA continued 195889

Oakwood Healthcare System Osteo Div - Surgery-General Residency

Surgery-General

Trenton

MI

182006

St John Providence Health System-Osteo Div - SurgeryGeneral Residency

Surgery-General

Warren

MI

169367

Henry Ford Wyandotte Hospital - Surgery-General Residency

Surgery-General

Wyandotte

MI

128524

Metro Health Hospital - SurgeryGeneral Residency

Surgery-General

Wyoming

MI

339641

KCUMB/St Mary's Hospital of Blue Springs - Surgery-General Residency

Surgery-General

Blue Springs

MO

132357

Northeast Regional Med Ctr Surgery-General Residency

Surgery-General

Kirksville

MO

130236

Des Peres Hospital - SurgeryGeneral Residency

Surgery-General

Saint Louis

MO

339160

Palisades Medical Center Surgery-General Residency

Surgery-General

North Bergen

NJ

189075

UNECOM/St Joseph's Hospital & Med Ctr - Surgery-General Residency

Surgery-General

Paterson

NJ

126309

UMDNJ/SOM/Kennedy University Hosp/Our Lady of Lourdes - Surgery-General Residency

Surgery-General

Stratford

NJ

339639

UMDNJ/SOM/South Jersey Healthcare - Surgery-General Residency

Surgery-General

Vineland

NJ

126101

St Barnabas Hospital - SurgeryGeneral Residency

Surgery-General

Bronx

NY

129229

NYCOM/Wyckoff Heights Medical Center - Surgery-General Residency

Surgery-General

Brooklyn

NY

148267

NYCOM/Lutheran Medical Center - Surgery-General Residency

Surgery-General

Brooklyn

NY

341465

LECOM/Arnot Ogden Medical Center - Surgery-General Residency

Surgery-General

Elmira

NY

132274

St. John's Episcopal Hospital Surgery-General Residency

Surgery-General

Far Rockaway

NY

336416

NYCOM/Flushing Hospital Medical Ctr - Surgery-General Residency

Surgery-General

New York

NY

CUT-THROAT October 25, 2012

AOA continued 328837

NYCOM/EastEnd Health Alliance - Surgery-General Residency

Surgery-General

Riverhead

NY

126136

OUCOM/Doctors Hospital Surgery-General Residency

Surgery-General

Columbus

OH

126187

Summa Western Reserve Hospital - Surgery-General Residency

Surgery-General

Cuyahoga Falls

OH

126164

OUCOM/Grandview Hosp & Med Ctr - Surgery-General Residency

Surgery-General

Dayton

OH

126171

OUCOM/Affinity Medical Center Surgery-General Residency

Surgery-General

Massillon

OH

164259

Mercy St Vincent MC - SurgeryGeneral Residency

Surgery-General

Toledo

OH

126196

South Pointe Hosp - SurgeryGeneral Residency

Surgery-General

Warrensville Heights

OH

130317

Oklahoma State University Medical Center - SurgeryGeneral Residency

Surgery-General

Tulsa

OK

194850

WesternU/COMP/Good Samaritan Reg Med Ctr Surgery-General Residency

Surgery-General

Corvallis

OR

130996

UPMC Horizon - SurgeryGeneral Residency

Surgery-General

Farrell

PA

127068

LECOM/Pinnacle Health Community General Osteopathic Hosp - Surgery-General Residency

Surgery-General

Harrisburg

PA

130922

Mercy Suburban Hospital Surgery-General Residency

Surgery-General

Norristown

PA

126229

Philadelphia College Osteopathic Med - Surgery-General Residency

Surgery-General

Philadelphia

PA

187725

PCOM/Geisinger Wyoming Valley - Surgery-General Residency

Surgery-General

Wilkes-Barre

PA

129830

Memorial Hospital - SurgeryGeneral Residency

Surgery-General

York

PA

142347

UNTHSC/TCOM/Plaza Medical Center - Surgery-General Residency

Surgery-General

Fort Worth

TX

Due to the shear volume of ACGME General Surgery programs they are not listed in this issue. This list can be accessed by following this link: https://www.acgme.org/ads/Public/Reports/Report/1 11

CUT-THROAT October 25, 2012

12

Useful Websites: ACGME Statistics with the Match: http://www.nrmp.org/ http://www.nrmp.org/data/resultsanddatasms2012.pdf The American Osteopathic Board of Surgery: http://www.aobs.org/ AOA Residency Training in Surgery and the Surgical Subspecialties: http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-trainingstandards/Documents/basic-standards-for-residency-training-in-surgery-and-surgical-specialties.pdf