Letters to the Editor  |   August 2008
Author Affiliations
  • Peter B. Ajluni, DO
    Clinton Township, Mich
    Orthopedic Surgical Physicians Pc
Article Information
Medical Education
Letters to the Editor   |   August 2008
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 460-461. doi:
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 460-461. doi:
I am disappointed with the most recent letter from George Mychaskiw II, DO. He has mischaracterized my earlier letter to the editor,1 in which I cautioned against a priori condemnation of an institution simply because of its for-profit or nonprofit tax status. 
Tax status determines a number of financial considerations for an institution, including the allowable methods of raising funds, the tax treatment of received revenues, and the distribution of those revenues. The main point noted in my previous letter1 was that the leadership of any organization is a larger determinate of that organization's character than is its tax status. Despite Dr Mychaskiw's lengthy correspondence, I still hold this conviction. 
Dr Mychaskiw naively heralds the blanket superiority of nonprofit institutions of higher learning by claiming that all excess revenue at such institutions is used to improve facilities, expand programs, and engage in research. However, Dr Mychaskiw fails to mention that the nonprofit approach can be wasteful—in a number of ways that have previously been documented. For example, universities across the United States have been known to use excess revenues to fund large salary and staffing increases and to build luxurious facilities.2 Many universities have purchased impressive athletic facilities and opulent student unions that are far more ostentatious than functional—such as the 53-person Jacuzzi at one large state university.3 
These kinds of wasteful decisions on deployment of resources can be made in nonprofit and for-profit organizations. It is leadership—not the tax code—that will be the key determinant of an organization's character and spending habits. 
I must say that, after receiving and responding to several communications from Dr Mychaskiw,4,5 I am struck by his lack of understanding of the factors that drive commercial free-market businesses. Profits are generated by a company because satisfied consumers value the company's products or services; find those products or services to be available at prices that are acceptable; and are willing to purchase products or services from the company. When these factors are no longer met, consumers seek other sources to fulfill their needs. 
This system of checks and balances is not perfect, as recent scandals in the financial markets demonstrate. Nevertheless, any institution of higher education that no longer meets the needs of its potential students will survive only with great difficulty and at great cost—regardless of its tax status. 
In his current letter to the editor, Dr Mychaskiw intimates (I believe) that research is important at colleges of osteopathic medicine (COMs). I certainly agree with this point. However, COMs need to devote appropriate amounts of their limited resources to research. As with any other activity, research is not immune to the law of diminishing returns. Throwing money at research, or any other activity, can be wasteful. Likewise, using tuition at a nonprofit COM to finance a pharmacy or veterinary school is not necessarily the best use of that COM's funds. We must all rely on our leaders to make prudent spending decisions. 
Because markets are imperfect, we put safeguards in place to help them function appropriately. The accreditation standards developed by the Commission on Osteopathic College Accreditation (COCA)6 require COMs to “make contributions to the advancement of knowledge and the development of osteopathic medicine through scientific research.” Thus, it is the responsibility of COCA (leadership again) to ensure that all COMs and branch campuses uphold these standards in a financially appropriate manner—regardless of their tax status. 
As leaders of the osteopathic medical profession, we must accept that there are times when people reach a point at which they agree to disagree and move on. This is such a time. 
 Editor's Note: Dr Ajluni served as the 2007-2008 President of the American Osteopathic Association.
Ajluni PB. Nonprofit and for-profit COMs: investing in the future of osteopathic medicine [letter]. J Am Osteopath Assoc. 2007;107:425-426. Available at: Accessed July 31, 2008.
Vedder R. Going Broke by Degree: Why College Costs Too Much. Washington, DC: AEI Press; 2004.
Winter G. Jacuzzi U? A battle of perks to lure students. New York Times. October 5, 2003. Available at: Accessed July 31, 2008.
Mychaskiw G II. COM accreditation: the Flexner report revisited [letter]. J Am Osteopath Assoc. 2007;107:246-277. Available at: Accessed July 31, 2008.
American Osteopathic Association daily reports blog. Various comments by George Mychaskiw II, DO. Available at: Accessed July 31, 2008.
Commission on Osteopathic College Accreditation. Accreditation of Colleges of Osteopathic Medicine: COM Accreditation Standards and Procedures. Chicago, Ill: American Osteopathic Association. Available at: Accessed July 31, 2008.