Addressing Osteopathic Medicine’s Vulnerabilities: The View through an External Lens

This is a version of a talk I gave in November 2021 to a group of osteopathic medical school deans, who invited me to share my opinions on the vulnerabilities of osteopathic medicine and osteopathic medical education as a prelude to their own strategic planning.
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SECTIONS:

I. TUITION (6:35)
COMs are more dependent on tuition revenue than allopathic medical schools… which means they’re uniquely sensitive to anything that disrupts the flow of tuition dollars. But what if lenders began to use some underwriting standards?

II. STUDENT LOAN DEBT (16:30)
Osteopathic students take on more debt than their MD colleagues, then enter careers with less earnings potential. We may be in an “education bubble market” - could the bubble burst?

III. MATCH OUTCOMES (24:16)
MD students enjoy greater success in the Match than DOs, and the more competitive the specialty, the greater the disparity. But it’s hard to sell a more expensive product that leads to fewer job opportunities.

IV. EXPANSION (37:59)
The number of accredited COMs has increased exponentially over the past 20 years. But there is real danger to osteopathic medicine and the DO degree if expansion comes at the expense of educational quality.

V. DISTINCTIVENESS (53:36)
Many things about osteopathic medicine are distinctive. But which are the essential features that should be defended? And which are just different for different’s sake?

VI: FINAL THOUGHTS (1:00:11)
We used to have two professional basketball leagues in the U.S: the NBA and the ABA. In 1976, they merged. So who “won” the NBA-ABA merger?

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NOTES:

1. This version is slightly longer than the one I actually delivered, which had to fit within an hour time slot - so some of the discussion at the end is a bit more fleshed out here.

2. The lecture received a mixed response. Some deans, I think, appreciated hearing the opinions of an outsider. But certain others were put off both by some of the things I mentioned and the way that I mentioned them. In particular, my opinions about the National Board of Osteopathic Medical Examiners (NBOME) were not favorably received. Certainly, others are entitled to their opinions… but I stand by mine.

If you’re interested, I’ve written before about how the NBOME seems like an organization that’s outlived its usefulness on the Sheriff of Sodium site:

https://thesheriffofsodium.com/2020/1...

I’ve also debated the merits of a “separate but equal” examination system in an article and series of correspondence in Academic Medicine (including some from the CEO of the NBOME himself).

Here are those articles, in sequence:

a. Original article:

https://journals.lww.com/academicmedi...

b. First letter to editor:

https://journals.lww.com/academicmedi...

c. Our reply to the first LTE:

https://journals.lww.com/academicmedi...

d. NBOME CEO’s reply to our reply:

https://journals.lww.com/academicmedi...

e. Our reply to the NBOME CEO:

https://journals.lww.com/academicmedi...

3. In my Q&A, I invited anyone who had concerns to please reach out to me, because although we may disagree about the inference, the data I present should be good. If you find something that seems incorrect, please let me know - I want to get it right.

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ADDENDUM (12/4/2021):
There are incorrect figures presented on two slides in the talk. These figures relate to the number of osteopathic medical school applicants and matriculants from Idaho and Montana, and appear at 38:47 and 40:27, respectively.

I mistakenly used 2021 data from AACOM - but these figures are preliminary. I should have used their figures from 2020, which would have shown that there were 143 osteopathic medical school applicants and 64 matriculants from Idaho, and 48 applicants and 18 matriculants from Montana.

Full AACOM data are here:

https://www.aacom.org/docs/default-so...

Upon careful consideration, I’ve chosen not to take down the video, because these data are not central to the point I was making in that section. Whether there’s 1 or 64 medical students from Idaho is honestly irrelevant to my central point, which is that if you expand medical school enrollment faster than you expand your supply of highly-qualified applicants, you put the quality of your degree at risk.

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MUSIC
“Clutch,” by Nicolas Major.