In the 2004–2005 academic year, COMs confronted a number of challenges also facing the wider medical community in the United States. Some of these challenges were noted by Jordan J. Cohen, MD, former president of the Association of American Medical Colleges (AAMC), in his presidential address of November 2005.¹ The AAMC president called for allopathic medical schools in the United States to increase their student capacity by 30% over the next decade. Dr Cohen issued this call in response to a possible physician shortage that some studies have predicted.^2–4 

Dr Cohen also used his address to identify the following five challenges facing allopathic medical schools in the United States: (1) increasing the racial and ethnic diversity of the medical profession; (2) leading the transformation of the healthcare system; (3) strengthening the continuum of medical education; (4) upholding the integrity of research and ensuring the safety of human research subjects; and (5) enlarging the capacity of medical schools accredited by the Liaison Committee on Medical Education. 

Colleges of osteopathic medicine and the osteopathic medical profession are facing challenges similar to those outlined in Dr Cohen's speech. As is addressed in the present article, osteopathic medical schools are successfully meeting some of these challenges by substantially increasing the student enrollment of women and members of ethnic minorities. Another success for osteopathic medical schools has been maintaining the stability of entrance credentials during a time of modest increases in class sizes. Although beyond the scope of this article, the osteopathic medical profession has, for several years, been examining methods to strengthen the educational continuum, from the undergraduate phase to graduate medical education and continuing medical education.^5,6 

This article also addresses how requests for increasing class sizes and the development of new COMs are affecting school applications, enrollment, and entrance credentials. Finally, tuition, revenues, and expenditures at COMs are summarized. 

In anticipation of the possible looming physician shortage,^2–4 many COMs have made requests to the American Osteopathic Association's Commission on Osteopathic College Accreditation (COCA) for increases in class sizes. Since 1999, COCA has fielded nearly 25 requests for class-size increases submitted by 85% of the COMs. These requests have resulted in approximately 700 additional students being admitted into COMs. 

Since 2004, COCA has received several applications to establish new COMs. The Commission works diligently to review such applications and other required support materials. 

It is likely that the establishment of new COMs is related to the perceived growing need for physicians in the United States, as well as to an increased number of highly qualified applicants and the success that COMs have had in developing community-based primary care clinical education opportunities. 

With the many requests for increases in class size being made by existing COMs and the increasing number of new COMs, an important question is raised: What effects are these changes having on the applicant pool? 

All 20 COMs experienced an increase in the number of applications for the 2004–2005 academic year, representing an overall increase in applications of 19.8% from the 2003–2004 academic year (Table 1). The five colleges with the most applications received, in consecutive order, were the Philadelphia College of Osteopathic Medicine (PCOM); New York College of Osteopathic Medicine of New York Institute of Technology (NYCOM/NYIT); Midwestern University/Chicago College of Osteopathic Medicine (MWU/CCOM); Lake Erie College of Osteopathic Medicine (Pennsylvania [LECOM] and Florida [LECOM-Bradenton] campuses combined); and Kirksville College of Osteopathic Medicine of A.T. Still University of Health Sciences (KCOM/ATSU). The overall 19.8% growth in applications between the 2003–2004 academic year and the 2004–2005 academic year compares with the 5.8% growth documented between the 2002–2003 and 2003–2004 academic years.⁷ 

Among those school applications that were processed by the American Association of Osteopathic Medicine Applications Service (AACOMAS), there was a 14% increase between 2004 (n=7240) and 2005 (n=8255). (Table 2). (The AACOMAS-processed applications do not include those individuals who applied directly to the schools.) The total number of AACOMAS-processed applications from members of underrepresented minority groups (blacks, Hispanics, Native Americans) has been on the rise since 2002—in an increase that mirrors that of white, non-Hispanic applicants and Asian/Pacific Islander applicants (Figure 1). In addition, the percentage of women applying to COMs has steadily increased since 2000 (Table 2). 

It is clear that the representation of minority and women applicants to COMs is on the rise, proving that such groups are available to meet the challenge of increasing racial and ethnic diversity in medicine. Furthermore, the enrollment data reveals that these minority and women applicants are being selected to attend COMs. 

First-year student enrollment at COMs continues to increase. The first-year student enrollment in the 2004–2005 academic year was 3646, an increase of 338 students over the previous academic year (Figure 2). The growing number of students enrolled during the past decade is consistent with the requests of COMs for class-size increases and the approvals of such requests by COCA. 

Like the number of applications by ethnic minority students to COMs, the percentage of ethnic minority students enrolled in COMs also increased in the 2004–2005 academic year. Asian/Pacific Islander, black, Hispanic, and Native American students represented 23.9% of the total enrollment at COMs during the 2004–2005 academic year (Table 3). This ethnic minority enrollment represents a slight increase from the previous academic year (23.2%).⁷ 

The number and percentage of women enrolled at COMs continues to increase. In the 2004–2005 academic year, 48.8% of all students were women, and the total number of women enrolled was 6115 (Table 4). 

The steady increase of women and members of ethnic minority groups applying to and enrolling in COMs may be attributable to recruitment programs that have placed high value on greater diversity among students. Another possible explanation for this increase is that many women and members of minority groups may be receiving the familial and financial support necessary to pursue an osteopathic medical degree. 

First-year osteopathic medical students entering the 2004–2005 academic year had a mean grade point average (GPA) of 3.43. Mean scores of Medical College Admission Tests (MCAT) for these first-year students were as follows: biological sciences, 8.53; physical sciences, 7.89; and verbal reasoning, 8.24 (Figure 3). The mean MCAT scores of osteopathic medical students entering the 2004–2005 academic year were greater than the MCAT means of the previous academic year in the verbal reasoning, physical sciences, and biological sciences sections of the test (Figure 3). The mean GPA for 2004–2005 (3.43) was equivalent to that reported in the 2001–2002 and 2002–2003 academic years.⁷ 

For the 2004–2005 academic year, tuition averaged $16,445 for in-state residents in public osteopathic medical schools and $28,078 in private osteopathic medical schools. For out-of-state residents, tuition averaged $32,753 in public schools and $30,606 in private schools (Table 5). 

Many students benefit from government funding, which continues to play an important role in the fiscal health of osteopathic medical education. The US Armed Forces, through the Armed Forces Health Professions Scholarship Program, also continues to be an important source of funds for osteopathic medical students and schools. Accessibility to such scholarship programs and financial aid allows osteopathic medical education to be within reach for many students who would otherwise not be able to attend school. 

For FY 2004, the 20 COMs reported revenues totaling approximately $852 million, which constitutes a 5.1% increase from 2003 ($810 million).^7,8 As in the past, tuition contributes substantially more to total revenues in the private schools than it does in the public schools, which draw more heavily from state subsidies. 

Total expenditures reported by COMs for FY 2004 were approximately $759 million, an increase of 2% from FY 2003 ($744 million).^7,8 Instruction continues to account for the largest portion of these expenditures.^7,8 

There are likely many reasons for the recent growth in applications to COMs, including the increase in women and minority applicants. Considering the fact that women now represent half of all applicants to osteopathic medical schools, much of the growth may be representative of women viewing an osteopathic medical degree as a viable option. The rise in enrollment, which is also evident among members of ethnic minority groups, may be attributable to the high value that COM recruitment programs have placed on minority recruitment. 

In the future, the continued growth of student applications may have a major influence on the requests of COMs for class size increases and in plans to establish new COMs. All COMs will need to exercise greater diligence in their recruiting efforts if they are to maintain their high admission standards in a more “open” environment. The Commission will need to use extra care in the scrutiny of new COM applications, as well as in COM recruitment plans and clerkship training opportunities, to ensure the success of future COM graduates. Finally, COCA will need to review all substantive changes in class sizes at COMs to make sure that the quality of undergraduate osteopathic medical education is not compromised.