Stephen C. Shannon, DO, MPH
“So… how do you explain the growth in osteopathic medical schools?”
That is a question I receive frequently, whether during the Q and A period following a formal presentation, from journalists in interviews, from professional peers and colleagues, and sometimes even from friends and family in casual conversation. While this question relates to the growth in the number of osteopathic medical schools, it is usually coupled with inquiries relating to the number of students and applicants.
Given the recently released AACOM preliminary enrollment report showing over 11 percent first year matriculant growth since last year, it seems like as good a time as any to discuss with readers my take on some of the reasoning behind this exciting growth in osteopathic medical education. Of course, this topic is worthy of a more data-driven, in-depth analysis than I offer here, so consider this the beginning of an ongoing conversation on the topic of growth in OME. I would also like to invite readers to submit their own observations and responses to InsideOME@aacom.org.
First, what exactly has grown? Actually, there are several different areas of growth involved:
- The number of colleges has grown
- Some colleges have started additional teaching locations
- Some colleges have expanded their class size
- The overall number of students has increased as a result of all the above
- The number of applicants to osteopathic medical schools has increased
There are currently 30 osteopathic medical schools in the United States, with 40 teaching locations and over 23,000 medical students (over 20 percent of the medical students enrolled in U.S. medical schools this year)[i].Between the 2000-01 academic year and today, the number of osteopathic medical colleges has increased from 19 to 30 (58 percent), the number of teaching locations from 19 to 40 (111 percent), the total number of medical students from 10,817 to 23,144 (114 percent), the number of first year matriculants from 2,927 to 6,449 (120 percent), and the number of applicants from 7,708 to 16,705 (117 percent)[ii] [iii].
- How do I explain the growth in the number of schools/teaching locations/students/applicants? It is my belief that these areas of growth are related to and, in no particular order, are associated with the following:
- Projected physician shortages in the United States., particularly in primary care, made growth a priority as a policy issue: Since 1970’s there has been relatively little overall growth in U.S. MD school graduates. While there was some growth in DO schools during these decades[iv], it became clear over time that U.S. domestic physician production would not be sufficient to offset an aging baby boom population entering into the phase of their lives in which they would have their greatest health care needs; coupled with an epidemic of chronic disease and population growth, it was evident that increasing the U.S. domestic supply of physicians needed to become a national priority.[v]
- Demonstrated success of a DO education: DO graduates have had success in pursuing and succeeding in graduate medical education in a wide variety of specialties, institutions, and settings. As more experience with DO graduates occurred, they were increasingly and aggressively recruited into residency programs. As they completed training, DOs frequently continued into practice in which they delivered clinical care and/or became clinical faculty in medical education programs with their MD colleagues. As a result, graduates have pursed training and careers throughout the United States and DO presence exists in areas in which it was rare in the past.
- DOs in public roles: DO graduates are well represented in a variety of public roles. Their numbers are very prominent amongst military physicians and National Health Service Corps scholars, and they hold leadership positions in hospital and health system administration, public health, and research enterprises.
- Osteopathic medical schools offer an efficient model of education: Osteopathic medical schools have demonstrated success at producing quality physicians outside traditional academic health centers. While there are many different models of DO undergraduate medical education institutions, many have been able to start and thrive in rural and/or underserved areas, and in regions in which medical education at either the undergraduate or graduate level was lacking.
- There were (and are) many states without DO schools: The value of having a DO school in ones’ state has been increasingly recognized for the convenience of state residents wishing to pursue a medical education and for the comprehensiveness of a state’s health care and educational system. Since 2000, the number states with osteopathic college campuses has grown from 15 to 28.
- Policy makers or educational institutions see a good fit: For states, regions, hospital systems, and educational entities considering starting a medical school, it would be difficult not to consider pursuing the establishment of an osteopathic medical school. DO graduates have a high placement rate in local primary care residency training and practice, especially family medicine—which is attractive to policy makers in states experiencing or projecting primary care physician shortages.
- A good fit for changing health care system: As the health care system continues to evolve and hospitals and delivery systems consider the importance of medical education to their future, these institutions have played an increasingly important role in the development of osteopathic medical campuses through relationships that go beyond simple affiliations for the purposes of clinical training to participating in the expansion or founding of osteopathic medical schools.
- Growing numbers of applicants: There has been growing interest in osteopathic medical education as a pathway to become a physician, clearly demonstrated by a decade of continuous increases in the number of applicants to DO schools. Osteopathic medical education is no longer the “best kept secret” that it was before the broader distribution of DOs in practice and information technology-driven sources of information became available. Today it would be hard for a student interested in becoming a physician to not hear about the osteopathic medical education pathway opportunity. So the number of academically qualified applicants has more than kept up with the growth in the number of positions available.
- Osteopathic medicine’s approach to health care: Osteopathic principles and practice, with the emphasis on patient-centered, community-based, preventive-focused and hands-on care is a model of health care well-recognized as fitting the health care needs of our population and the evolving health care delivery system.
There are many other factors as well, of course, that arise in relationship to growth—factors that are positive and supportive of growth, such as the related economic development that occurs in communities in which osteopathic medical college teaching locations are established. Alternately, there are factors that are of concern as well: Are there adequate numbers of experienced osteopathic medical educators and administrator? Will clinical education resources continue to shrink due to changes in the health care delivery system? And of course, will there be adequate graduate medical education opportunities for DO graduates in the future? The answers to these and the multitude of other questions associated with this trend of growth in OME are yet to be seen. However, the future of the physician workforce, as well as the broader health care workforce as a whole, in our evolving health care system deserves to be a prominent part of the overall issue of health care in this nation. It is the responsibility of individuals across the osteopathic medical education continuum, as well as policy makers, to contribute to this discussion with the goal of ensuring the success of osteopathic medical students and graduates as well as the health and wellness of our nation.
[i] Based upon accreditation criteria, the Commission on Osteopathic College Accreditation (COCA) classifies teaching locations based upon administrative and curriculum organizational factors. A location is therefore classified as a college, a branch campus of a college or an additional location of a college. Hence there are 30 colleges, but 40 teaching locations: click here.
[ii] Not all colleges currently have students enrolled because of the lag time between accreditation decisions enabling enrollment and instruction, and the matriculation of a class. Currently, there are 29 colleges at 37 locations with enrolled osteopathic medical students click here.
[iii] Data on enrollment numbers and other information about osteopathic medical education is available here.
[iv] DO schools were started between 1980 and 2000 include the Lake Erie College of Osteopathic Medicine and the Nova Southeastern University College of Osteopathic Medicine.
[v] See the Association of American Medical Colleges’ (AAMC) report, “The Complexities of Physician Supply and Demand,” click here.