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From the Division of Predoctoral Education, Department of Accreditation, American Osteopathic Association, Chicago, Ill.

Address correspondence to Andrea Williams, Director, Division of Predoctoral Education, Department of Accreditation, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: awilliams{at}osteopathic.org

This article details requests from the nation's 23 accredited colleges of osteopathic medicine (COMs) for class-size increases and the establishment of new COMs and branch campuses. Basic data on COM applicants and applications, matriculants, and graduates are also provided. Tuition, revenues, and expenditures at COMs are outlined.

The data presented in this article have been adapted from the results of a joint survey produced by the American Association of Colleges of Osteopathic Medicine (AACOM) and the American Osteopathic Association (AOA), the AACOM/AOA Annual Osteopathic Medical School Questionnaire: Academic Year 2005-06.³ In addition, AACOM's 2006-2007 Tuition Survey, as reported in that association's Annual Statistical Report on Osteopathic Medical Education, 2006, was also used.⁴ Finally, a draft of AACOM's Annual Statistical Report on Osteopathic Medical Education, 2004, and its historical database (SPSS 15.0 for Windows; SPSS Inc, Chicago, Ill) compiled from previous years' tuition surveys were used to prepare this article. As noted, the data reported are received mainly from AACOM. That association researches and updates its data regularly, providing corrected numbers on an annual basis in the AACOM Annual Statistical Report on Osteopathic Medical Education. Therefore, the data as reported in JAOA—The Journal of the American Osteopathic Association are to be considered incomplete, though this data will be corrected annually as AACOM makes its data available. All data is current as of publication. Readers are encouraged to contact AACOM directly for any subsequent updates to the data presented.

	Increases in Class Size and the Growth of New COMs

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
In partial response to a projected physician shortage in coming years,^5-7 many COMs have made requests to the AOA's Commission on Osteopathic College Accreditation (COCA) for permanent class-size increases. From 1999 to 2006, COCA has fielded such requests from 12 COMs. When combined with one new COM and three new branch campuses, approved requests have resulted in nearly 800 additional students being admitted into COMs during the 5-year period from the 2000-2001 academic year to the 2005-2006 academic year.⁸

In addition, COCA has received nine applications to establish new COMs since the 2000-2001 academic year. During the past 2 years alone, COCA has reviewed eight formal applications to open new COMs, with five receiving preaccreditation status and three receiving provisional accreditation status.

Currently, only one COM has preaccreditation status, Rocky Vista University College of Osteopathic Medicine in Parker, Colo.⁹ There are currently three COMs that have provisional accreditation status to begin instruction in 2007 (see appendix, pages 126-128):

• A.T. Still University-College of Osteopathic Medicine-Mesa in Arizona
  
• Lincoln Memorial University-DeBusk College of Osteopathic Medicine in Harrogate, Tenn
  
• Touro College of Osteopathic Medicine in New York, NY
  

It is likely that the growth of new COMs is related to the reported need for physicians in the United States,^5-7 an increased number of highly qualified applicants,² a need for primary care physicians to serve in certain underrepresented geographic regions,^9,10 and the potential in those areas for developing community-based primary care clinical opportunities.

	Applicants and Applications: Academic Year 2005-2006

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
Although most COMs showed an increase in the number of applications received for the 2005-2006 academic year, representing an overall increase in applications of 8.5% from the 2004-2005 academic year (Table 1), this number represents a reduction when compared with the 16.5% increase seen previously.² As reported in previous years,^2,8,11-13 the three colleges with the most applications received were Philadelphia (Pa) College of Osteopathic Medicine, New York College of Osteopathic Medicine of New York Institute of Technology in Old Westbury, and Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill. The fourth and fifth most popular COMs for applications were, respectively, A.T. Still University-Kirksville (Mo) College of Osteopathic Medicine and Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla.

As noted, there was a slight increase in the number of applications to COMs from most races and ethnic origins with traditional minority status: Asian/Pacific Islander, black/African American (non-Hispanic), Hispanic/Latino, and Native American/Alaskan Native (Table 2). The percentage of applications from minority groups that have been historically underrepresented in medical schools (ie, black/African American [non-Hispanic], Hispanic/Latino, and Native American/Alaskan Native) has remained steady at 11.8% [corrected from 11.7%] from 2005 to 2006, though the number of black applicants increased by 0.5% while the number of Hispanic applicants decreased by the same amount. Unfortunately, enrollment of underrepresented minority applicants has not shown an increase in recent years. First-year enrollment figures were 8.6% in 2001 and 2002, 8.3% in 2003, 8.9% in 2004, and 8.6% in 2005.⁴ This lack of growth perhaps demonstrates a need for COMs to develop diversity initiatives.

Although US Census Bureau documents ask survey respondents about race and Hispanic ethnicity in two separate questions because a person of Hispanic ethnicity can be of any race, AOA and AACOM data-collection methods have not yet conformed to this government standard.

	Tuition

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
For the 2006-2007 academic year, tuition averaged $20,276 for in-state residents in public COMs and $34,113 in private COMs. For out-of-state residents, tuition averaged $38,840 in public schools and $34,893 in private schools.

There is a nearly even split between COMs that have a higher percentage of out-of-state residents vs state residents matriculating in the 2005-2006 academic year (Table 3).

Many students benefit from government funding, which continues to play an important role in the fiscal health of osteopathic medical education. The US Armed Forces, through the US Armed Forces Health Professions Scholarship Program,^14-16 also continues to be an important source of funds for osteopathic medical students and schools.⁴ Accessibility to such scholarship programs and financial aid allows osteopathic medical education to be within reach for many individuals who would otherwise be unable to attend medical school.

	First-Year Student Enrollment: Academic Year 2005-2006

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
First-year student enrollment at COMs continues to increase. The first-year student enrollment in the 2005-2006 academic year was 3908, an increase of 262 (7.2%) students since the previous academic year.² The growing number of students enrolled during the past decade^{2,8,11-13,17,18} is consistent with the requests of COMs for class-size increases and the approvals of such requests by COCA.

As with the number of COM applications received from racial and ethnic minority students, the percentage of these students enrolled in COMs also increased in the 2005-2006 academic year. Students whose self-identified race or ethnic origin was Asian/Pacific Islander, black/African American [non-Hispanic], Hispanic/Latino, and Native American/Alaskan Native represented 24.4% of the total enrollment at COMs during the 2005-2006 academic year (Table 4). This ethnic minority enrollment represents a slight increase from the 23.7% [corrected from 23.9%] reported for the previous academic year.²

The number and percentage of women enrolled at COMs continues to increase. In the 2005-2006 academic year, nearly 50% of all enrolled students were women (Table 5).

First-year osteopathic medical students entering COMs in the 2005-2006 academic year had a mean grade point average of 3.44, representing virtually no change when compared with the 3.42 mean grade point average of students matriculating in the 2004-2005 academic year.² Mean scores of Medical College Admission Tests (MCAT) for these first-year students were as follows: biological sciences, 8.64; physical sciences, 8.04; and verbal reasoning, 8.31. The mean MCAT scores of osteopathic medical students entering the 2005-2006 academic year were higher than the scores of student in the preceding class: biological sciences, 8.53; physical sciences, 7.89; and verbal reasoning, 8.24.²

	COM Graduates: Class of 2006

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
During the past 5 years, there has been an increase in the number of COM graduates of approximately 12% from the 2001-2002 academic year to the 2005-2006 academic year. Such an increase is expected in light of the growth in the number of applicants and enrolled first-year students, in addition to the growth in COM requests for class-size increases. There has been a 3% average annual increase in the number of COM graduates each academic year (Table 6).

	Revenues and Expenditures at COMs

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
For fiscal year 2005, the 20 COMs reported revenues totaling approximately $899 million, which constitutes a 5.5% increase from reported revenues of $852 million in 2004.² As in the past years,² tuition contributes substantially more to total revenues in private schools than it does in public schools, which draw more heavily from state subsidies.

Total expenditures reported by COMs for fiscal year 2005 were approximately $795 million, an increase of 4.2% from the $759 million reported for fiscal year 2004.² Instruction continues to account for the largest portion of these expenditures, though this total does not include basic expenses paid by the home institution (eg, libraries, facilities, utilities) for which the COMs are responsible and must repay.² In other words, the expenditures cited do not capture all institutional support expenses for those COMs that are housed within another degree-granting institution.

	Conclusion

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
Since 2002, the number of applications received by COMs have increased, as have enrollment numbers—driven somewhat by applications from women. In fact, women now represent a little more than half of all COM applicants. However, the cost of medical education is on the rise. This increased cost may affect the number of applications COMs see in the future unless students are provided with adequate opportunities to lessen the heavy debt burden often associated with medical education (eg, scholarship funding).¹⁹

Although a causal relationship has not been established, it is clear that the increased interest in developing new COMs since 2000 has occurred in a time of increasing applications. The COMs will need to exercise continued diligence in their recruiting efforts if they wish to maintain high admission standards and further expand student diversity. The Commission will continue to exercise care in the scrutiny of new COM applications—as well as in COM recruitment plans and clerkship training opportunities—to ensure the success of future COM graduates. Finally, COCA will need to review all substantive changes in COM class-size requests to make sure that the quality of undergraduate osteopathic medical education is not compromised.

Submitted January 17, 2007; accepted January 17, 2007.

	References

Top Increases in Class Size... Applicants and Applications:... Tuition First-Year Student Enrollment:... COM Graduates: Class of... Revenues and Expenditures at... Conclusion References

 
1. Council on Graduate Medical Education. Physician Workforce Policy Guidelines for the United States, 2000-2020. US Department of Health and Human Services: Rockville, Md; 2005. Available at: http://www.cogme.gov/report16.htm. Accessed March 23, 2007.

2. Griffin AVO, Sweet S. Undergraduate osteopathic medical education: addressing the impact of college growth on the applicant pool and student enrollment. J Am Osteopath Assoc. 2006;106:51-56. Available at: http://www.jaoa.org/cgi/content/full/106/2/51. Accessed March 21, 2007.

3. American Association of Colleges of Osteopathic Medicine/American Osteopathic Association. AACOM/AOA Annual Osteopathic Medical School Questionnaire: Academic Year 2005-06. American Association of Colleges of Osteopathic Medicine: Chevy Chase, Md;2005 .

4. American Association of Colleges of Osteopathic Medicine. Tuition Survey. Annual Statistical Report on Osteopathic Medical Education, 2006. Available at: http://www.aacom.org/data/annualreport/slideshow/index.html. Accessed April 5, 2007.

5. "The work ahead," AAMC president's address 2005 [press release]. Washington, DC: Association of American Medical Colleges; November 6, 2005. Available at: http://www.aamc.org/newsroom/pressrel/2005/051106.htm. Accessed January 31, 2007.

6. Rosenthal MB, Zaslavsky A, Newhouse JP. The geographic distribution of physicians revisited. Health Serv Res.2005; 40:1931 -1952.[Medline]

7. Excess, shortage, or sufficient physician workforce: how could we know? Am Fam Physician.2005; 72:1670 .[Medline]

8. Singer A. Undergraduate osteopathic medical education. J Am Osteopath Assoc. 2001;101:646-652. Available at: http://www.jaoa.org/cgi/reprint/101/11/646. Accessed April 6, 2007.

9. New medical school breaks ground in Colorado: Rocky Vista University College of Osteopathic Medicine to expand access to quality healthcare to rural and underserved populations in state [press release]. London, United Kingdom: PR Newswire – United Business Media; March 23, 2007. Available at: http://sev.prnewswire.com/education/20070323/DCF01323032007-1.html#. Accessed April 12, 2007.

10. Welcome to Georgia Campus - PCOM page. Philadelphia College of Osteopathic Medicine Web site. Available at: http://www.pcom.edu/General_Information/georgia/georgia.html. Accessed April 16, 2007.

11. Sweet S. Undergraduate osteopathic medical education [published correction appears in J Am Osteopath Assoc. 2003;103:215]. J Am Osteopath Assoc. 2002;102:576-581. Available at: http://www.jaoa.org/cgi/reprint/102/11/576. Accessed April 10, 2007.

12. Sweet S. Undergraduate osteopathic medical education [published correction appears in J Am Osteopath Assoc. 2004;104:71]. J Am Osteopath Assoc. 2003;103:507-512. Available at: http://www.jaoa.org/cgi/reprint/103/11/507. Accessed April 10, 2007.

13. Sweet S. Undergraduate osteopathic medical education [published correction appears in J Am Osteopath Assoc. 2006;106:46]. J Am Osteopath Assoc. 2004;104:460-467. Available at: http://www.jaoa.org/cgi/content/full/104/11/460. Accessed March 23, 2007.

14. Healthcare education: money for school page. US Airforce Web site. Available at: http://www.airforce.com/education/healthcare/money-ForSchool.php. Accessed April 12, 2007.

15. US Army. Health Professions Scholarship Program [fact sheet]. August 2006. Available at: http://www.goarmy.com/amedd/docs/hpsp.pdf. Accessed April 12, 2007.

16. Careers & Jobs – Officers – Healthcare – Physicians page. Navy Web site. Available at: http://www.navy.com/careers/officer/healthcare/physicians/. Accessed April 12, 2007.

17. Rayman C. Undergraduate osteopathic medical education. J Am Osteopath Assoc. 1996;96:655 -660.[Medline]

18. Sweet S. Undergraduate osteopathic medical education. J Am Osteopath Assoc. 2000;100:671-674,677-679. Available at: http://www.jaoa.org/cgi/reprint/100/11/671. Accessed March 30, 2007.

19. Weinberg AM. Lessons in financial health and debt management for young physicians: loan consolidation programs, loan deferments, and tax savings. J Am Osteopath Assoc. 2002;102:545-548,551-554. Available at: http://www.jaoa.org/cgi/reprint/102/10/545. Accessed March 22, 2007.

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