WILL YOUR NEXT FAMILY DOC BE AN OSTEOPATH?

“Traditional” allopathic medical schools are awarding MD (Medical Doctor) degrees at a faster rate than ever before. Yet, “The Association of American Medical Colleges reports there was a shortage of 45,000 primary care physicians in 2020.” They project that “in 2025 that number will increase to 65,000 and by 2030 to 104,900.” That tells me “MD-producing schools” are graduating medical doctors, but they aren’t going into primary care. Interest in primary care, absolutely the most important specialty, has dropped off over the past 10 years. 

What has happened? Allopathic medical schools, or traditional MD diploma institutions, have never been seriously committed to graduating primary care/family doctors. Instead, med school deans and faculty members, who are overwhelmingly specialty physicians, focus their teaching efforts on prospective practitioners in some specialty. They graduate specialists not generalists. Family medicine residency programs report that only 9% of allopathic medical graduates choose family medicine. That means residency slots either go unfilled or residents must come from somewhere else. Who, or what, will fill those open slots?

Osteopathic medical schools report that 23% of their students are interested in primary care. “Osteopathy is the treatment of disease based on the premise that the manipulation of muscles and bones promotes structural integrity and return to, or preservation of, health.” Consequently, most newly-educated primary care/family physicians are Doctors of Osteopathy (DO) and not Doctors of Medicine (MD). “Osteopathic medical schools design their curricula to emphasize family medicine…[with] courses and rotations that [provide] almost 50% of clinical experiences. On average, only 30% of the allopathic curriculum focuses on primary care, and students report a lack of encouragement for entering the family medicine specialty.” I don’t personally remember any professor, or resident, ever encouraging me to become a family physician. 

I think I’ve written about this before, but Indiana University School of Medicine is one of those allopathic medical schools that has a dismal record of producing family physicians. The school has had a Family Medicine residency for decades, but it is has never had the reputation or graduated as many primary care physicians as many other schools or community-based programs. To fill the void in Indiana, Marian University started its own medical school and has been very successful at graduating practitioners, but it is an osteopathic medical school. A high percentage of Marian graduates go on to pursue a career in family medicine. The family medicine residency at St. Francis Hospital filled all nine of its slots again this year, as it has for as long as it has been in existence. In years past, all of the residents were MD graduates mostly from IU. For the residency class of 2024, however, seven of the 9 residents were DO grads from Marian, and the other two were MD’s from IU. 

Nationally, in 2021, 47.1% of residency entrants were MD’s, 41.7% were DO’s, and 11.1% were foreign medical graduates. Osteopathic graduates choosing family medicine increased 5.31% per year from 2016 to 2021. According to my AAFP reference, graduate medical education applicants planning on a career in family medicine are increasingly choosing osteopathic schools over allopathic schools. This is especially true for women, rural students, and first-generation college graduates. This is good, but I admit to being biased in favor of allopathic medical education. I know the academic standards for admission to IU med school are more demanding, and competition for each of the 300 or so places in the class is very keen. That’s not to demean osteopathy, but the better undergrad students will apply to allopathic schools first, and if they are rejected, still have applying for an osteopathic education as an option.

I am happy that Marian University has done what it set out to do; that’s increase the number of medical practitioners in the state of Indiana. They certainly have succeeded and have had also had success increasing the number of family physicians entering practice. The problem of maldistribution remains, however. If programs to correct that problem are successful, access to health care will be far more equal for all Americans. 

So the answer to the question in the title of this post is “maybe,” or “it’s a good possibility.” The other real possibility is that your new family doctor may be a nurse practitioner, and not a doctor of medicine or osteopathy! That’s a much greater and troublesome likelihood. 

Reference: Pristell C, Byun H, Huffstetler A. Osteopathic Medical Schools Produce an Zincreasing Proportion of Family Medicine Residents Am Fam Phys 2024 February;109(2):114-115.