Neurological Surgery Podium Presentation: Geographic Disparities in County-Level Prevalence of Allopathic, Osteopathic, Non-Surgical, and Surgical Residency Programs in the United States

Introduction/Purpose: Physician shortage is a well-documented contributor to inequitable medical care access in rural and underserved communities. Residency prevalence may contribute to this shortage. Therefore, we aimed to characterize the distribution and socioeconomic profiles of U.S counties with residency programs by residency type.

Methods or Case Description: Medical residencies (n=4,882) were compiled from the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association residency databases. Programs were categorized by type (allopathic, osteopathic, non-surgical, surgical). County frequencies were merged with 19 county-level variables from the U.S. Census Bureau American Community Survey 5-Year Estimates (2013-2018). The Rural-Urban Continuum Code (RUCC) was used as a measure of rurality.

Outcomes: Allopathic and osteopathic programs differed significantly in frequency and geographic distribution yet were independently consistent with most census variable mean values of the general U.S. population. Comparisons between counties with exclusively allopathic and osteopathic programs revealed osteopathic residencies served less populous and educated counties with [mean(SD)]: lower incomes [$52,152($12,022)], older age [39.8(4.8)], higher percentage of disabled persons [15.8%(4.1%)], and higher percentage of veterans [9.3%(2.5%)]. Logistic regression revealed that for every 1-unit RUCC increases, there was a 50% decreased odds of finding a residency program, 40% decreased odds of finding an allopathic program, and 25% decreased odds of finding an osteopathic program. Post-accreditation unification reduced the prevalence of surgical and non-surgical residencies in 36 counties. Fifty percent of osteopathic neurosurgical residencies were eliminated despite having an average existence of 26.9(18.5) years, thereby impacting four counties.

Conclusion: Osteopathic residencies are distributed in more rural and underserved counties. Post-accreditation unification may reduce access to surgical and non-surgical care. ACGME accreditation efforts toward improving access to care through residency distribution should incorporate osteopathic strategies.