D.O.s Could Play Key Role in Bolstering Primary Care Workforce, Say Academy Leaders

Like many students graduating from the nation's colleges of osteopathic medicine, Richard Gray has chosen family medicine as his specialty. In fact, Gray, an AAFP student member from Fort Worth, Texas, and other soon-to-be doctors of osteopathic medicine, are an important part of the primary care workforce, says an Academy physician workforce expert.

"Traditionally, the osteopathic medical schools have attracted a larger proportion of young people interested in family medicine," Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, told AAFP News Now.

For the past several years, enrollment (7-page PDF; About PDFs) at the 25 member colleges of the American Association of Colleges of Osteopathic Medicine, or AACOM, has been growing steadily.

Last fall, first-time enrollment among osteopathic medical students reached 4,768, an increase of 360 students, or about 8 percent, compared with the enrolling class of fall 2007, according to Tom Levitan, AACOM's vice president for research and applicant services.

Most of the increase stemmed from the opening of two new osteopathic medical colleges in Yakima, Wash., and Parker, Colo. AACOM is expecting even more students to enroll this fall, with the opening of three new satellite campuses in Pennsylvania and Michigan.

The first-year enrollment growth in the osteopathic medical colleges parallels that in U.S. allopathic medical schools, which enrolled a historic high of 18,036 students last fall, according to the Association of American Medical Colleges (6-page PDF; About PDFs)

D.O.s have a long history of choosing primary care specialties, including family medicine, general internal medicine and general pediatrics, Levitan said. Even so, he noted, the results of annual AACOM surveys of graduating osteopathic medical students have shown a decline in self-reported interest in primary care from 40 percent of osteopathic graduates in 1999 to slightly less than 28 percent in 2007.

Interestingly, Levitan said, more osteopathic medical students opt for primary care specialties at the time they graduate than the number who said they planned to go into primary care when they entered school. For example, nearly 22 percent of students entering the nation's colleges of osteopathic medicine in 2004 said they were interested in primary care. When those students graduated in 2008, slightly more than 29 percent chose primary care specialties.

According to the National Resident Matching Program, 45.1 percent of overall Match participants in 2008 chose residencies in family medicine, internal medicine (categorical) or pediatrics (categorical). By comparison, 55.3 percent of osteopathic medical students who participated in the 2008 Match chose one of those primary care specialties.

Levitan said he believes that osteopathic medical schools may provide a model for ways to produce more students interested in primary care careers.

Pugno agreed. For one thing, faculty at the osteopathic medical colleges who serve on admissions committees seem to seek students with characteristics that make them more likely to choose family medicine and primary care, such as coming from a rural background, he said. He noted that admissions policies are one component of the Academy's overall strategy for attracting students interested in family medicine.

Gray became a newly minted D.O. when he graduated May 16 from the Texas College of Osteopathic Medicine, or TCOM. In a few weeks, he will start his training in the St. Louis University/Scott Air Force Base family medicine residency in Belleville, Ill.

Gray said he learned about osteopathic principles as a physical therapy student at East Carolina University in Greenville, N.C. He worked full time as a physical therapist for eight years before entering TCOM in 2005.

During his first two years at TCOM, Gray said he was exposed to primary care repeatedly in the classroom, the clinic and the hospital. He did a preceptorship with a family physician in Fort Worth who still delivers babies. He also did a rural rotation with a group of four family physicians -- three M.D.s and one D.O. -- in the town of Littlefield in West Texas where he observed them practicing the full spectrum of family medicine.

"Excellent experiences with good family medicine preceptors throughout my four years at TCOM sparked my interest in the specialty. I believe that a family medicine residency will help me become the kind of physician I have always wanted to be," Gray said. About 45 percent of the 128 students in his graduating class plan to go into primary care, he added.

Jason Dees, D.O., of New Albany, Miss., the new physician member of the AAFP Board of Directors, graduated from the West Virginia School of Osteopathic Medicine, or WVSOM, in Lewisburg and did his family medicine residency at The Medical Center in Columbus, Ga.

Dees said he considered becoming a surgeon, but chose family medicine as his career after his third year of medical school.

"WVSOM required every third-year student to do community-based family medicine as our first rotation," he said. "As I saw the relationships that developed between doctor and patient, I was hooked. The focus on whole-person care was also very appealing to me."

Pugno said both allopathic and osteopathic physicians are needed to meet the demand for more primary care health professionals in the coming years. ''We are partners with the American College of Osteopathic Family Physicians and other osteopathic physicians' groups in our endeavors to make a difference in American health care," he said.