The Impact of the Osteopathic and Allopathic Merger on Foot and Ankle Case Log Volumes: A 2014-2023 ACGME Report Analysis

Abstract

Category: Other; Ankle Introduction/Purpose: The Accreditation Council for Graduate Medical Education (ACGME) Surgical Review Committee monitors the quantity of experiences through Current Procedural Terminology (CPT) codes logged by residents based on the procedures they perform. The ACGME currently requires a minimum of 20 specific foot and ankle procedures to be completed prior to graduation. These are defined as 15 'ankle fracture' cases and 5 'ankle, hindfoot, or midfoot arthroscopy' cases. The year 2020 marked a milestone change in residency training, as the Allopathic (MD) and Osteopathic (DO) residency accreditation merger resulted in unified graduate medical education training. The purpose of this study was to better understand the effect the merger had on the average number of cases, as well as the defined minimum cases for graduating orthopedic residents. Methods: A retrospective analysis of ACGME case logs examined the max and average number of adult orthopaedic cases related to both Leg/Ankle and Foot/Toes performed by graduating orthopaedic surgery residents from 2014 to 2023, spanning a 10-year period. Trends in case exposure were analyzed by assessing the average number of adult orthopaedic procedures during the study period. All data were sourced directly from the ACGME website.1 Descriptive statistics will be used along with unpaired t-tests to examine if there are statistical differences between pre and post merger averages (Microsoft Corporation, 2018. Microsoft Excel). Results: In 2014, 151 programs graduated 684 residents, compared to 197 programs in 2023 graduating 884 residents. The overall average of leg/ankle procedures prior to the merger was 176.74 (range 151.9-200.8, SD 18.9), which increased to 212.93 post-merger (range 206.5-219.9, SD 6.7; p = 0.006). Similarly, the total number of foot/toes procedures increased from a mean of 72.6 (range 62.5-83, SD 7.3) pre-merger to 82.9 post-merger (range 83.2-83.9, SD 1.1; p = 0.023). The average number of ankle fractures pre-merger was 58.3 (range 53-62.3, SD 3.7), which increased to 68.2 post-merger (range 66.6-69.7, SD 1.5; p < 0.01). Additionally, the average number of ankle arthroscopy procedures increased from 13.8 pre-merger (range 11.4-15.6, SD 1.7) to 15.3 post-merger (range 14.8-15.9, SD 0.5; p = 0.9). Conclusion: The merger between MD and DO residency programs in 2020 has led to a significant increase in the average number of orthopedic surgery procedures related to the foot and ankle performed by graduating residents. This indicates a positive impact on the training and exposure of orthopedic surgery residents in these areas. The findings suggest that the merger has helped to enhance the educational experience and preparedness of orthopedic surgery residents in foot and ankle procedures, meeting the ACGME requirements for graduation.