Healthcare reform proposals introduced in the House and Senate, put forward by foundations, professional associations and study groups, all call for medical schools to train more generalists. As these agents make recommendations for change, they are studying the osteopathic medical education model with fresh interest because of its success in maintaining more than 60% of its graduates in primary care practice. Most students of reform place the blame for producing too many specialists and subspecialists squarely on the academic health centers. The authors trace the development of academic health centers and compare and contrast the models developed in the osteopathic and allopathic medical settings. They enumerate the strengths in the osteopathic education model which have contributed to our favorable balance of generalists to specialists. However, they argue that specific changes in the osteopathic academic health center are essential if we are to retain leadership in generalist education under healthcare reform.