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Editorial  |   March 2010
Osteopathic Medical Education in 2010: Another Decade of Growth
Author Notes
  • Dr Shannon is a member of the Editorial Advisory Board for JAOA—The Journal of the American Osteopathic Association. He has served as the guest editor for the JAOA's annual theme issue on osteopathic medical education since 2006. 
  • Address correspondence to Stephen C. Shannon, DO, MPH, President, American Association of Colleges of Osteopathic Medicine, 5550 Friendship Blvd, Chevy Chase, MD 20815-7231.E-mail: sshannon@aacom.org 
Article Information
Medical Education
Editorial   |   March 2010
Osteopathic Medical Education in 2010: Another Decade of Growth
The Journal of the American Osteopathic Association, March 2010, Vol. 110, 108-109. doi:10.7556/jaoa.2010.110.3.108
The Journal of the American Osteopathic Association, March 2010, Vol. 110, 108-109. doi:10.7556/jaoa.2010.110.3.108
It is well known that osteopathic physicians (DOs) are the minority in the US physician workforce. In 2008, DOs made up 51,715 (6.7%) of 773,809 active physicians.1 The majority of physicians (67.9%) hail from US allopathic medical schools, with the remaining physicians (24.2%) from international medical schools.1 In other words, practicing DOs are outnumbered approximately 15 to one by their allopathic colleagues (ie, MDs). In the area where most DOs practice—primary care—the story is not much different, with DOs outnumbered 10 to one by their allopathic colleagues, making up around 9% of the nation's primary care physicians.1 
Although these data may all be true, they do not convey the full picture of the medical professions for several reasons: 
  • The number of DOs has been growing proportionally faster than MDs.
  • The DO presence in many states is much greater than national averages convey.
  • In the primary care specialties—where the majority of DOs practice—the presence of DOs in some states is substantial.
In considering the data, although 6.7% of physicians were DOs in 2008, in 2000 the nation's 42,212 DOs made up 5.2% of US physicians.2 The proportion of DOs in the physician workforce grew by 29% in those 8 years. Looking back nearly 30 years to 1980, when 17,620 DOs comprised 3.8% of US physicians, the growth is even more remarkable.2 Between 1980 and 2008, the proportion of DOs in the physician workforce grew by 76%.2 
This growth is likely to continue during the next decade. For example, based on calculations using data from the 2009 AOA Physician Masterfile and the 2008 AMA Physician Masterfile, the average age of DOs is about 5 years younger than that of MDs (46 years vs 51.5 years, respectively). If retirement rates are similar for the two groups, MDs will be retiring at a higher rate than DOs in coming years. Although this difference seems small, when it is coupled with increasing numbers of DO graduates, “there will be almost five times as many new [US-trained MDs] as DOs [between 2006 and 2025]...so many more [US-trained MDs] will be leaving active practice that the net growth will be greater for DOs.”3 
In addition, as highlighted throughout the profession, the number of colleges of osteopathic medicine (COMs), students, and graduates is growing dramatically. In the past 10 years, the number of colleges, branch campuses, and additional locations have increased from 20 to 32, and the number of students has grown from 10,800 to more than 18,300 (69%).4 With some COMs planning expansions and several additional COMs in development, the growth will likely continue.4 
Latest projections by Tom Levitan, MEd, indicate DO matriculant totals will grow from 5100 in the 2009-2010 academic year to around 6300 by the 2015-1016 academic year.5 And over the next decade, the number of COM graduates is expected to grow by 70% (from around 3730 in 2010 to around 6200 in 2020).6 During the same period, US-trained MD graduates are projected to increase from 16,600 to 20,200—a 24% increase. Because the proportion of COMs is growing faster than allopathic medical colleges, the proportion of U.S. medical school graduates that are DOs is expected to increase from 18% in 2010 to 24% in 2020.6 In fact, if you look at this trend over 2 decades, DO graduates (2279 in 2000) will have grown by 170% between 2000 and 2020, while US-trained MD graduates (15,674 in 2000) will have grown by 29%.6 With over 100,000 active DOs expected by 2020,7 DOs will likely exceed 10% of the national physician population by the end of the current decade.3,6-8 
However, national proportions do not convey the reality existing within individual states. The presence of DOs in the physician workforce varies greatly from state to state. For example, DOs already make up more than 10% of US-trained physicians in 10 states and more than 20% of primary care physicians in 5 states (Table).1,9 
Table
Proportion of Osteopathic Physicians (DOs) in the United States by State

Top 10 States

%
Proportion of Total DOs*
□ Pennsylvania 10.0
□ Michigan9.1
□ Florida 7.2
□ California6.7
□ Ohio 6.7
□ New York6.4
□ Texas 6.0
□ New Jersey5.2
□ Illinois 3.9
□ Missouri3.3
Proportion of DO Physicians
□ Oklahoma21.1
□ Michigan 18.7
□ Iowa17.0
□ Maine 14.2
□ West Virginia14.1
□ Pennsylvania 13.7
□ Missouri12.7
□ Ohio 11.9
□ Arizona11.3
□ Delaware 10.9
Proportion of DO Primary Care Physicians
□ Oklahoma 26.0
□ Iowa25.5
□ West Virginia 21.2
□ Maine20.4
□ Michigan 20.3
□ Pennsylvania19.3
□ Missouri 17.8
□ Arizona14.7
□ Delaware 14.3
□ Kansas13.8
 Sources: Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 20099; Center for Workforce Studies. 2009 State Physician Workforce Data Book. Washington, DC: Association of American Medical Colleges; November 2009.1
 *Nearly two-thirds of all DOs, including those not in practice, live in 10 states, as listed.
 Percentages calculated by comparing the number of active DOs vs the number of active US-trained and foreign-trained allopathic physicians (MDs).
Table
Proportion of Osteopathic Physicians (DOs) in the United States by State

Top 10 States

%
Proportion of Total DOs*
□ Pennsylvania 10.0
□ Michigan9.1
□ Florida 7.2
□ California6.7
□ Ohio 6.7
□ New York6.4
□ Texas 6.0
□ New Jersey5.2
□ Illinois 3.9
□ Missouri3.3
Proportion of DO Physicians
□ Oklahoma21.1
□ Michigan 18.7
□ Iowa17.0
□ Maine 14.2
□ West Virginia14.1
□ Pennsylvania 13.7
□ Missouri12.7
□ Ohio 11.9
□ Arizona11.3
□ Delaware 10.9
Proportion of DO Primary Care Physicians
□ Oklahoma 26.0
□ Iowa25.5
□ West Virginia 21.2
□ Maine20.4
□ Michigan 20.3
□ Pennsylvania19.3
□ Missouri 17.8
□ Arizona14.7
□ Delaware 14.3
□ Kansas13.8
 Sources: Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 20099; Center for Workforce Studies. 2009 State Physician Workforce Data Book. Washington, DC: Association of American Medical Colleges; November 2009.1
 *Nearly two-thirds of all DOs, including those not in practice, live in 10 states, as listed.
 Percentages calculated by comparing the number of active DOs vs the number of active US-trained and foreign-trained allopathic physicians (MDs).
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Osteopathic physicians are concentrated in certain parts of the country—in areas where the profession has its historical roots. Also, physician workforce trends have shown that physicians tend to settle in (or close to) the communities where they are educated.10 It is no accident that nearly two-thirds of DOs live in 10 states,9 all of which have at least one COM and five of which have two. In the 2008-2009 academic year, those 10 states contained 763 (83%) of the 916 osteopathic graduated medical education internship and residency programs.11 
Although DOs have historically concentrated in areas where they trained and could practice in communities with osteopathic hospitals and other DOs, the defeat of discriminatory regulations and practices, loss of osteopathic hospitals, integration of DOs into larger health delivery practices and systems, and acceptance—and recruitment—of osteopathic medical graduates into ACGME residency programs have changed those historic influences. In all likelihood, the dispersal of COMs—always the entry point into the profession—is and will continue to play a significant role in the location of DOs in the United States. 
Rebecca Pratt, PhD, assistant professor of anatomy at West Virginia School of Osteopathic Medicine, instructs second-year osteopathic medical students. (Photograph by Pat Bauserman, WVSOM)
Rebecca Pratt, PhD, assistant professor of anatomy at West Virginia School of Osteopathic Medicine, instructs second-year osteopathic medical students. (Photograph by Pat Bauserman, WVSOM)
Osteopathic medical education, especially the location of COMs, is therefore driving the future face of the profession in the United State. This profession is going through a period of transition that is resulting from external circumstances, such as the loss of osteopathic hospitals, as well as “internal” decisions, such as opening new COMs or changing osteopathic graduate medical education program requirements. This issue of the JAOA—an annual dedication to the continuum of osteopathic medical education—continues to provide a resource to track these changes and outcomes and present information about innovations within the osteopathic medical education environment. 
Center for Workforce Studies. 2009 State Physician Workforce Data Book. Washington, DC: Association of Medical Colleges; November 2009. http://www.aamc.org/workforce/statedatabook/statedata2009.pdf. Accessed March 22, 2010.
Salsberg ES, Forte GJ. Trends in Physician Workforce, 1980-2000. Health Aff (Millwood). 2002; 21(5):165-173. http://content.healthaffairs.org/cgi/content/full/21/5/165. Accessed March 22, 2010.
Dill MJ, Salsberg ES; Center for Workforce Studies. The Complexities of Physician Supply and Demand: Projections Through 2025. Washington, DC: American Association of Medical Colleges; November 2008. http://services.aamc.org/publications/showfile.cfm?file=version122.pdf&prd_id=244&prv_id=299&pdf_id=122. Accessed March 22, 2010.
Enrollment growth in the nation's COMs. American Association of Colleges of Osteopathic Medicine Web site. http://www.aacom.org/about/fastfacts/Documents/FastFacts/FF-Enrollment-NationCOMs.pdf. Accessed March 22, 2010.
Levitan T. A Report on a Survey of Osteopathic Medical School Growth: Analysis of the Fall 2009 Survey. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine; January 2010. http://www.aacom.org/resources/bookstore/Documents/GrowthRpt2009.pdf. Accessed March 22, 2010.
Shannon SC. Osteopathic physician supply and distribution. Presented at: Osteopathic Health Policy Fellows Seminar; February 12 , 2010; Phoenix, AZ.
Swartwout J. Compendium of Osteopathic Workforce Studies. Chicago, IL: American Osteopathic Association; June 2005. http://www.do-online.org/pdf/lcl_optirepworkstudycompenium.pdf.
Council on Graduate Medical Education. Physician Workforce Policy Guidelines for the United States, 2000-2020. 16th report. Washington, DC: US Department of Health and Human Services; January 2005. http://www.cogme.gov/16.pdf. Accessed March 22, 2010.
DO population within all 50 states. Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; May 31 , 2009.
Seifer SD, Vranizan K, Grumbach K. Graduate medical education and physician practice location: implications for physician workforce policy. JAMA. 1995;274(9):685-691.
Freeman E, Duffy T, Lischka TA. Osteopathic medical education 2010. J Am Osteopath Assoc. 2010;110(3):150-159.
Rebecca Pratt, PhD, assistant professor of anatomy at West Virginia School of Osteopathic Medicine, instructs second-year osteopathic medical students. (Photograph by Pat Bauserman, WVSOM)
Rebecca Pratt, PhD, assistant professor of anatomy at West Virginia School of Osteopathic Medicine, instructs second-year osteopathic medical students. (Photograph by Pat Bauserman, WVSOM)
Table
Proportion of Osteopathic Physicians (DOs) in the United States by State

Top 10 States

%
Proportion of Total DOs*
□ Pennsylvania 10.0
□ Michigan9.1
□ Florida 7.2
□ California6.7
□ Ohio 6.7
□ New York6.4
□ Texas 6.0
□ New Jersey5.2
□ Illinois 3.9
□ Missouri3.3
Proportion of DO Physicians
□ Oklahoma21.1
□ Michigan 18.7
□ Iowa17.0
□ Maine 14.2
□ West Virginia14.1
□ Pennsylvania 13.7
□ Missouri12.7
□ Ohio 11.9
□ Arizona11.3
□ Delaware 10.9
Proportion of DO Primary Care Physicians
□ Oklahoma 26.0
□ Iowa25.5
□ West Virginia 21.2
□ Maine20.4
□ Michigan 20.3
□ Pennsylvania19.3
□ Missouri 17.8
□ Arizona14.7
□ Delaware 14.3
□ Kansas13.8
 Sources: Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 20099; Center for Workforce Studies. 2009 State Physician Workforce Data Book. Washington, DC: Association of American Medical Colleges; November 2009.1
 *Nearly two-thirds of all DOs, including those not in practice, live in 10 states, as listed.
 Percentages calculated by comparing the number of active DOs vs the number of active US-trained and foreign-trained allopathic physicians (MDs).
Table
Proportion of Osteopathic Physicians (DOs) in the United States by State

Top 10 States

%
Proportion of Total DOs*
□ Pennsylvania 10.0
□ Michigan9.1
□ Florida 7.2
□ California6.7
□ Ohio 6.7
□ New York6.4
□ Texas 6.0
□ New Jersey5.2
□ Illinois 3.9
□ Missouri3.3
Proportion of DO Physicians
□ Oklahoma21.1
□ Michigan 18.7
□ Iowa17.0
□ Maine 14.2
□ West Virginia14.1
□ Pennsylvania 13.7
□ Missouri12.7
□ Ohio 11.9
□ Arizona11.3
□ Delaware 10.9
Proportion of DO Primary Care Physicians
□ Oklahoma 26.0
□ Iowa25.5
□ West Virginia 21.2
□ Maine20.4
□ Michigan 20.3
□ Pennsylvania19.3
□ Missouri 17.8
□ Arizona14.7
□ Delaware 14.3
□ Kansas13.8
 Sources: Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 20099; Center for Workforce Studies. 2009 State Physician Workforce Data Book. Washington, DC: Association of American Medical Colleges; November 2009.1
 *Nearly two-thirds of all DOs, including those not in practice, live in 10 states, as listed.
 Percentages calculated by comparing the number of active DOs vs the number of active US-trained and foreign-trained allopathic physicians (MDs).
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