The Changing Face of Osteopathic Medical Education

in the United States

By Stephen C. Shannon, DO, MPH

Abstract and Background

Within the last 20 years, the number of U.S. osteo-pathic medical colleges/

branch campuses has nearly dou-bled, growing from 15 to 28. Nine of those campuses were added within the last eight years, and several more are planning to open within the next two to five years. At the same time, class sizes of existing schools have expanded. The growth in existing schools has frequently been initiat-ed in response to state policy maker requests to address current and pro-jected workforce shortages in target-ed areas. New schools and branch campuses generally have been located in states or regions where there previously were no osteo- pathic medical schools.

In 2008 more than 3,100 DOs (doc-tors of osteopathic medicine) grad-uated from U.S. schools. By 2016 that number is expected to exceed 5,000. Currently, nearly one in five students attending a U.S. medical school is attending an osteopathic medical school.

This period of growth in undergrad-uate osteopathic medical educa-tion (OME) is both a cause and an effect of the growing integration of osteopathic medicine into the U.S. medical care system. However, this growth also has raised concerns about clinical and faculty capacity, the adequacy of graduate medical education training systems and the congruence of OME’s traditional pri-mary care mission with the chang-ing choices made by osteopathic medical graduates. This poster pres-ents data on the growth of under-graduate OME and the trends in graduate medical education and specialty selection of osteopathic medical school graduates, and high-lights current concerns raised by the growth of OME.

U.S. Colleges of Osteopathic Medicine

Big Picture Questions

Why are fewer osteopathic graduates pursuing primary care specialties?

Why are more osteopathic graduates opting for ACGME graduate pro-grams as opposed to the traditional path into AOA programs?

What is the future of osteopathic (AOA) GME?

Will the primary care focus of osteopathic medicine survive?

What curriculum is needed to train physicians for the future?

Will the distinctiveness of U.S. osteopathic medical education and medi-cine survive these trends?

Conclusion

Osteopathic medical education is in a period of self-assessment. A significant research initiative is underway to evaluate the bio-medical basis and clinical effectiveness of one of osteopathic

medicine’s distinguishing characteristics—the utilization of manipula-tive medicine (in addition to other tools of modern scientific medicine) in the diagnosis and treatment of patients. The profession’s leadership, along with academic leadership, has convened a series of summits to evaluate its undergraduate and graduate medical education system, with a strong focus on assessment, accreditation, innovation and col-laboration with allopathic medical education. Ultimately, the future of osteopathic medical education will be an outcome of social and eco-nomic trends and forces, and the response of its leaders and institu-tions to the challenges they confront.

Growth-Related Issues for OME

What is the need and capacity for osteopathic physicians?

Will clinical systems accommo-date the development of clini-cal training opportunities for the growing cadre of students?

Will there be sufficient graduate medical education opportunities to meet the needs of graduates?

Will the growth of U.S. allopathic medical schools, along with the increasing number of interna-tional medical graduates seeking GME in the United States, create a shortage of clinical training opportunities?

Are there enough academically experienced faculty and adminis-trators to meet the needs that future growth demands?

Mission Statement

The American Association of Colleges of Osteopathic Medicine promotes excellence in osteopathic medical education, in research and in service, and fosters innovation and quality among osteopathic colleges to improve the health of the American public.

Contact:

Stephen C. Shannon, DO, MPHPresident, American Association of Colleges of Osteopathic Medicinesshannon@aacom.org

AACOM5550 Friendship Blvd., Suite 310Chevy Chase, MD 20815(301) 968-4100www.aacom.org

Traditionally, most DO graduates trained and practiced in a system

separated from U.S. MDs. There were separate colleges, hospitals, residencies and licensure and specialty boards accredited by the American Osteopathic Association (AOA).

Recent changes/trends:

No longer separate osteo- pathic hospital system (now mixed MD/DO staffs predominate).

Increasing number of DO graduates pursuing graduate medical educa-tion (GME) in ACGME (MD) accredited programs

(more than 60 percent of DOs in GME training are in ACGME programs).

Growing number of dually (AOA and ACGME) accredited primary care residency programs (nearly 100 of the 653 DO residency programs are dually certified by AOA and ACGME).

Increasing number of DO graduates pursuing non-primary care specialties (down from two-thirds to less than 50 percent).

The Special Challenge of Osteopathic Graduate Medical Education (OGME)

Copyright © 2008, AACOM. All rights reserved.

5,227

17,361 17,759

19,747

4,055 4,408

0

5,000

10,000

15,000

20,000

25,000

2006 2007 Projected 2012

# of

stu

dent

s

15%

16%

17%

18%

19%

20%

21%

22%

23%

24%

25%

% O

steo

path

ic

Osteopathic Allopathic Percent Osteopathic

U.S. Medical School 1st Year Enrollment

Sources: American Association of Colleges of Osteopathic Medicineand American Association of Medical Colleges

Copyright © 2008, AACOM. All rights reserved.

Growth of osteopathic medical colleges/enrollment (1968 – 2008)

Total Enrollment and Number of Colleges

1879 2780 4221 6212 6614 7822 9882 11857 12525 13406 14409 15586

5

7

1415 15

16

1920 20 20 20

23

25

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

1968 1973 1978 1983 1988 1993 1998 2003 2004 2005 2006 2007 2008

Tota

l enr

ollm

ent

0

5

10

15

20

25

30

Num

ber o

f col

lege

s

Total enrollmentNumber of colleges

Five-year intervals

Source: American Association of Colleges of Osteopathic MedicineOffice of Research Copyright © 2008, AACOM. All rights reserved.

0

5000

10000

15000

20000

25000

1992-93

1996-97

2000-01

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

2013-14

2014-15

2015-16

Ost

eopa

thic

med

ical

stu

dent

s

0%

5%

10%

15%

20%

25%

% o

f all

med

ical

stu

dent

s

Osteopathic medical students

Percentage of all medical students

Osteopathic Students as a Percent of All U.S. Medical Students

Sources: American Association of Colleges of Osteopathic Medicineand American Association of Medical Colleges

Copyright © 2008, AACOM. All rights reserved.

DOs in Primary Care Residency Position(Family, Internal and Pediatric Medicine)

Sources: American Association of Colleges of Osteopathic Medicineand American Osteopathic Association

DOs in Primary Care Residency Position(Family, Internal and Pediatric Medicine)

Source: American Osteopathic Association

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06

DOs in Training - AOA and ACGME Comparison

DOs in ACGME

COM Grads

DOs in AOA I/R

DOs in AOA Internship

DOs in AOA Residency

Copyright © 2008, AACOM. All rights reserved.

3 0 4 3

( 2 0 0 2 -0 3 )

5 , 2 2 7

( 2 0 1 2 -1 3 )

0

1 , 0 0 0

2 , 0 0 0

3 , 0 0 0

4 , 0 0 0

5 , 0 0 0

6 , 0 0 0

1 9 9 3 1 9 9 6 1 9 9 9 2 0 0 2 2 0 0 5 2 0 0 9 2 0 1 2

Actual

Projected

2,035 (1993-94)

First-Year Enrollment Growth Projections in Osteopathic Medical Colleges to 2012

Source: 2007 AACOM Enrollment Survey: Preliminary Findings,American Association of Colleges of Osteopathic Medicine Office of Research