In an article published in 1995, Baker¹ explained that osteopathic medical schools were “five years and five percentage points behind” allopathic medical schools in terms of female enrollment. In the 1993-1994 academic year, female enrollment was 40.2% in allopathic medical schools and 34.7% in osteopathic medical schools, which was the approximate percentage of female enrollment in allopathic medical schools 5 years earlier (35.1% in the 1988-1989 academic year).¹ 

In the current report, we examined the more recent status of women in osteopathic medical education. We anticipated that for the 2016-2017 academic year, the percentage of female matriculants in osteopathic medical schools would be proportional to the percentage of female applicants. We also looked at applicants and matriculants for allopathic medical schools and whether differences between the percentage of female matriculants in osteopathic and allopathic medical schools existed. Furthermore, to assess whether increased enrollment of women in medical school has been accompanied by an increased representation of women in medical education leadership positions, we looked at the number of women who served as chief academic officers in osteopathic and allopathic medical schools. 

Historically, the term gender has been used to categorize students within the binary of male and female without consideration of the distinction between biological sex and gender identity and without acknowledging individuals who consider themselves both male and female, neither male nor female, or somewhere in between.^2,3 For the sake of comparison, we followed suit in this article and use the term gender, despite the uncertainty of whether past and current numbers represent sex or gender. 

To gather information regarding medical school applicants, matriculants, and first-year enrollees, we used self-reported gender summarized by the American Association of Colleges of Osteopathic Medicine (AACOM)^4-6 and the Association of American Medical Colleges (AAMC).^7,8 Statistical analysis of the data was conducted using SAS version 9 (SAS Institute, Inc). χ²analysis was used to investigate relationships between institution type (ie, osteopathic or allopathic medical school) and applicant gender; institution type and matriculant gender; applicant gender and whether the applicant matriculated at an osteopathic or allopathic medical school; and institution type and gender of chief academic officer (including and excluding interim positions). All tests were 2-tailed, with P<.05 considered statistically significant. 

Female applicant and matriculant data for both osteopathic and allopathic medical schools are shown in the Table and in Figure 1. In the 2016-2017 academic year, 10,031 of 20,671 applicants (48.5%) (95% CI, 47.9%-49.2%) and 3201 of 6778 matriculants (45.9%) (95% CI, 44.7%-47.1%) in osteopathic medical schools were women.^5,6 Female applicants were significantly less likely to become matriculants than male applicants (30.9% vs 34.4%, respectively; P<.001) in osteopathic medical schools that same year. For allopathic medical schools in the 2016-2017 academic year, 25,779 of 53,042 applicants (48.6%) (95% CI, 48.2%-49.0%) and 10,474 of 21,030 matriculants (49.8%) (95% CI, 49.1%-50.5%) were women.⁷ Female applicants in allopathic medical schools were significantly more likely to become matriculants than were male applicants (40.6% vs 38.7%, respectively; P<.001). When comparing the percentage of female matriculants at osteopathic medical schools with the percentage of female matriculants at allopathic medical schools, the difference was significant (45.9% vs 49.8%, respectively; P<.001). But, the difference between the percentage of female applicants to osteopathic medical schools did not significantly differ from the percentage of female applicants to allopathic medical schools (48.5% vs 48.6%; P=.834). 

Data on first-year enrollment (the total number of first-year students, including repeating students) were available for all years since Baker's 1995 report.¹ Information regarding first-year female students is shown in the Table and in Figure 1. First-year female enrollment in osteopathic medical schools more than quadrupled from the 1994-1995 academic year to the 2016-2017 academic year (805 to 3490).⁵ Of note, the number of accredited osteopathic medical schools, branch campuses, and additional locations expanded during this period, and existing schools increased their class sizes. Thus, the total number of first-year students increased from 2217 in the 1994-1995 academic year to 7575 in the 2016-2017 academic year.⁵ In the 2004-2005 academic year, 50.1% of first-year students enrolled in osteopathic medical schools were women; however, by the 2013-2014 academic year, this percentage had fallen to 44.2%.⁵ Since then, some gains have been made, and by the 2016-2017 academic year, 45.9% of first-year students enrolled in an osteopathic medical school were women.⁵ 

Information regarding female chief academic officers of medical schools was found by searching the AACOM⁹ and AAMC¹⁰ websites for lists of accredited medical schools in the United States. For osteopathic medical schools, the AACOM list⁹ identified the current chief academic officer of each school and included branches of schools that undergo their own accreditation process as a separate entity, for a total of 33 accredited osteopathic medical schools and 5 accredited branch sites. Although the chief academic officer identified was most frequently the dean, 2 individuals were executive deans and 1 was an associate dean. We confirmed that the names on the AACOM list corresponded to the names on the schools’ websites, and we verified the gender of each person through photographic identification. 

A similar list of chief academic officers at allopathic medical schools was not available, and, therefore, we created our own list for the 147 accredited allopathic medical schools in the United States. This list was created by searching the school websites to identify the chief academic officer, and, when necessary, the name was verified by calling the school and asking a representative. The chief academic officers’ gender was determined by their name and photographic identification. We specified interim and permanent chief academic officers in our list. Our research regarding chief academic officers took place from January 2017 through April 2017. 

As of March 2017, 11 of the 38 chief academic officers, including interim chief academic officers (28.9%) at osteopathic medical schools were women. If interim chief academic officers were not included in the analysis, 11 of 36 (30.6%) were women. Our research found that in spring 2017, 22 of 147 (15.0%) chief academic officers, including interim chief academic officers, at allopathic medical schools were women, and if interim chief academic officers were not included, 20 of 132 chief academic officers (15.2%) were women. Osteopathic medical schools have a significantly higher percentage of female chief academic officers than do allopathic medical schools when including (P=.045) and excluding (P=.035) interim chief academic officers. 

In fall 2003, when 50.2% of first-year students enrolled in an osteopathic medical school were women, it may have seemed that educational parity for women had been achieved.⁵ However, in fall 2016, that percentage dropped to 45.9%. This finding cannot be explained entirely by a lower percentage of female applicants; rather, female applicants were significantly less likely than male applicants to be matriculated. Further research using more sophisticated methods is needed to explain differences in interest and rates of matriculation of women in osteopathic medical school. These studies might include surveys of admissions officers and admissions committees at osteopathic medical schools regarding their perceptions of the reason that women are less likely than men to be matriculants. 

Furthermore, in spring 2017, 28.9% of chief academic officers (including interim positions) at osteopathic medical schools were women. It is possible that the low percentage of female chief academic officers may reflect the percentage of women with DO degrees in the age group from which chief academic officers are traditionally selected. Research of allopathic medical schools suggests that the current percentage of women in departmental leadership roles can potentially be affected by the percentage of women who entered residencies in those departments in the 1990s.¹¹ Although 28.9% is not yet parity with male chief academic officers, progress has been made over the past 2 decades: in 1995, 11.1% of chief academic officers were women.¹² Additionally, osteopathic medical schools have a significantly higher percentage of female chief academic officers than do allopathic medical schools (P<.05).¹³ A 2016 study reported that women are overrepresented in residency program director roles in multiple specialties within allopathic programs.¹¹ This overrepresentation in clinical educator roles has been suggested to limit women's advancement to major leadership positions at allopathic medical schools compared with research-based faculty tracks.¹¹ However, dedication to education may serve as an asset in osteopathic medical schools and may contribute to greater progress of women into leadership roles compared with that of allopathic medical schools. 

The current number of female chief academic officers at osteopathic and allopathic medical schools includes chief academic officers who have held the position for many years. Given the ongoing expansion of the number of medical schools in the United States (the number of osteopathic medical schools has nearly doubled since 1996), further research that identifies the percentage of women newly appointed to chief academic officer positions would provide more insight into the progress of women in medical school leadership. Five of 11 female chief academic officers at osteopathic medical schools were working at schools with female presidents. Evaluating the effect of a female president on the representation of women in other academic leadership roles would be an interesting avenue of future research. Additionally, articles have suggested that female physicians delivered better quality of care.^14-17 In future studies of quality of care and patient outcomes, the osteopathic medical profession may be at a disadvantage if it has fewer female graduates. 

The current study had several limitations. The analysis was based on data reported by AACOM and AAMC and relied on the accuracy of those reports, which were limited by missing data and inconsistent use of gender and sex. Another limitation is that our analysis of chief academic officers at allopathic medical schools relied on data obtained from school websites in a specified period. This information may not have been up to date. 

First-year female enrollment in osteopathic medical schools in the 2016-2017 academic year decreased since the 2004-2005 academic year. Furthermore, the percentage of female chief academic officers of both osteopathic and allopathic medical schools remains well below parity with male chief academic officers. Recruiters and admissions committees should reflect on the success of the osteopathic medical profession in meeting the goal of providing women with the same opportunities as men, with awareness that the percentage of women enrolled in osteopathic medical schools has declined.