Compendium Osteopathic Workforce Studies

Compendium of Osteopathic Workforce
Studies
James E. Swartwout
June 2005
Table of Contents
Page
Introduction........................................................................................................................................ 3
Projection of Supply of Osteopathic Physicians (Hicks and Boles) .................................................. 7
Osteopathic Workforce Study 2004 (Megan, Ward and Corp).......................................................... 23
Estimated Number of DOs in 2020 using the BHPr Aggregate Physician Supply Model of
Physician Workforce Growth (Andes)............................................................................................... 99
2
Introduction
For decades, experts have attempted to forecast the supply of and demand for physician services in the
United States (US). The appropriate number of physicians distributed in the right specialties and
geography is necessary to optimize the provision of health care. Too few physicians and necessary
medical care will not be provided as needed; by contrast, too many physicians might lead to
underemployment or, some contend, might lead to the production of unnecessary physician services.
Making models to project physician workforce is an inexact science. Making credible physician
workforce projections requires an understanding of the complex interaction of economic factors, health
system characteristics, regulatory and legislative actions, technological factors, education system, vital
statistics and population dynamics. Seemingly minor changes in assumptions can lead to widely different
conclusions.
Studies in the early 1900s concluded that the US had sufficient number of physicians. 1 By the late 1940s,
however, reports began to suggest that the supply of physicians was not meeting the demand for physician
services. In 1959, the Bane’s report predicted a shortage of 40,000 physicians by the mid-1970s.2 In
response to the predicted shortage, federal programs were established to encourage the graduation of
more physicians through the development of new medical schools. The federal programs seemed to work
well and, by the mid-1970s, concern was being raised that the supply of physicians was increasing too
rapidly. A 1981 Graduate Medical Education National Advisory Committee (GMENAC) report predicted
a surplus of 70,000 physicians by 1990 and an excess supply of 145,000 physicians by 2000.3
In 2000, however, a surplus of physicians did not emerge and, since then, a growing number of experts
have begun to forecast an impending “shortage of physicians.” One study predicted a shortage of 85,000
physicians by 2020.4 Another study suggested a shortage of 200,000 physicians by 2020.5 While these
studies disagree on the magnitude of the physician shortfall, they agree that a shortage of physicians is
likely.
Osteopathic Workforce Studies

Historically, the osteopathic community has been largely overlooked when making physician supply
projections. This oversight was mainly due to limited information available on DOs.6 It may have also
been due to the fact that only 3.9 percent of US physicians were DOs in 1970. Ten years later that
percentage had not changed. Between 1980 and 2000, however, a number of new osteopathic schools
were established and the DO population began to grow at a faster pace than the MD population. By 2000,
osteopathic physicians comprised 5.7 percent of the total US physician population. Between 1995 and
2000, osteopathic medicine was the fastest growing health profession compared to MDs, dentists,
optometrists, pharmacists, veterinarians, chiropractors and registered nurses.
To provide information on trends in the supply of osteopathic physicians, this document is a compendium
of three studies on the supply of osteopathic physicians. The first is a 1998 study by Drs. Hicks and
Boles at the University of Missouri. The second is a 2004 study by Drs. Magen and Ward, and the third
1
Some conclude that the Flexner report of 1910 implied a surplus of physicians. A 1932 report by a commission on
medical education concluded that the supply of physicians was more than sufficient as compared with ratios of
physicians to populations in Europe.
2
The Surgeon General’s Consultant Group on Medical Education (Bane’s report) 1959.
3
SE Peterson and AE Rodin. GMENAC report on U.S. physician manpower policies: recommendations and
reactions. Health Policy Education, 3(4), April 1983, 337-49.
4
Council on Graduate Medical Education: Sixteenth Report: Physician Workforce Policy Guidelines for the United
States, 2000-2020. January 2005.
5
Cooper RA: Weighing the evidence for expanding physician supply. Ann Int Med Nov 2004, 141;9:705-714.
6
Kletke, PR, et al, The Demographics of Physician Supply: Trends and Projections, AMA, 1987, p. 32.
3
is a 2005 study by Dr. Andes. These reports examine the supply of osteopathic physicians. To date, there
have been no studies on the demand for osteopathic physician services.
Hicks and Boles Study

In 1998, Lanis Hicks, PhD, and Keith Boles, PhD, completed a study on the osteopathic physician
workforce for the American Osteopathic Association. The study examines three scenarios: no death of
DOs prior to age 99; the ratio of active-to-current supply is maintained into the future; and an annual
attrition rate of two percent occurs. The study is based on the 16 osteopathic medical schools and the
schools under development at the time. The study concludes that there will be between 82,628 and
87,961 osteopathic physicians in the year 2020.
Magen and Ward Study

In 2004, Myron S. Magen, DO, Douglas Ward, PhD, and Sarah Corp, MA, completed an “Osteopathic
Workforce Study.” The study examines five scenarios:
1) the ratio of DOs-to-population remains constant in each US state;

2) no additional increases in the number of osteopathic graduates;
3) an increase of 400 osteopathic graduates;
4) an increase of 600 osteopathic graduates; and
5) an increase of 1,000 osteopathic graduates.
The study concludes that the number of osteopathic physicians in the year 2020 would range between
54,659 (Table 31) and 61,928 (Table 37) osteopathic physicians. Drs. Magen and Ward conclude that,
“…Given the rate at which COM’s are currently enrolling and graduating students, it is likely that even
the more liberal of these estimates may prove to be conservative.”7
Andes Study
In 2005, Steve Andes, PhD, CPA, completed a workforce analysis based on the Aggregate Physician
Supply model developed by the National Center for Health Workforce Analysis of the Bureau of Health
Professions. This study examines three scenarios: a 1 percent increase in the annual graduation class; a 2
percent increase in the annual graduation size; and a class size increase of 500 in 2006. The model uses
an actuarially determined attrition rate adjusted for both age and gender. The study concludes that the
total number of osteopathic physicians would range between 106,944 and 111,851 and the number of
osteopathic physicians in active practice would range between 99,139 and 100,884. The Andes study
may overestimate the total number of physicians somewhat because it does not calculate death after
retirement.
7
See page 79 of this document.
4
Figure 1: Comparison of Osteopathic Workforce Projections
Projections of DOs in 2020

Thousands
112
110
107
90 88
83
70 62
50 55
Hicks and Boles, 1998 Magen and Ward, 2004 Andes, 2005
Conclusion
Figure 1 shows the estimates of the number of osteopathic physicians in the year 2020. Given the fact
that a number of new schools and branch campuses have opened in the last several years and additional
schools are being planned, the Hicks and Boles projections may be conservative. Given the recent growth
in new osteopathic schools and the fact that there were 54,000 DOs in 2004 and annual graduation classes
reaching ever closer to the 3,000 mark, the Magen and Ward projections also appear conservative. The
Andes study may offer the best estimate of approximately 110,000 osteopathic physicians in 2020, even
thought it may overestimate the total number of osteopathic physicians somewhat. Of these,
approximately 100,000 osteopathic physicians will be in active practice in 2020.
This paper serves as a starting point to begin discussions on the future supply of osteopathic physicians.
Many questions need to be studied, including: How many osteopathic physicians are needed in the
United States? Will there be too few or too many in 2020? What is the attrition rate of osteopathic
physicians? What factors affect attrition? Will osteopathic physicians be in the right specialties? Will
they be serving the entire nation or only selected regions of the country? Will they practice with the same
level of productivity as today? Will they separate from practice at the same age as today? As the national
debate regarding the “appropriate” number of physicians grows in intensity, these and other questions
about osteopathic physicians will need to be addressed.
5
Projection of Supply of Osteopathic Physicians
to 2020
Prepared for:
American Osteopathic Association
Prepared by:
Lanis L. Hicks, Ph.D.
Keith E. Boles, Ph.D.
Department of Health Management and Informatics

University of Missouri
May 21, 1998
6
Projection Of Supply Of Osteopathic Physicians To 2020
The health care environment has experienced substantial turbulence in recent years. This turbulence has
resulted in many changes in the organization and financing of health care services and these changes, often
unpredictable and chaotic, have produced uncertainty for everyone involved with the health work force. The
changes and uncertainty in the health care system are expected to continue, and perhaps intensify, as the
health care system is forced to adjust to cost-conscious competitive market forces. The changes resulting
from market forces receive all health. care providers to undertake a process of redefining themselves, and
their activities if they are to remain viable and survive in this rapidly changing health care environment.
Redefinition will involve many things, but a central component will be a comprehensive assessment of the
projected supply of personnel in the profession.
The only thing that is certain in today's environment is that the status quo is not a viable option for most
health professions. The uncertainty, however, makes determining the appropriate number, character, and
distribution of health professionals very difficult. While simple past trend extrapolation into the future is no
longer sufficient for projecting work force needs, these historical
patterns d o provide a foundation for estimating requirements organization and financing changes
must be incorporated into shaping the design of the future work force. The growth of integrated delivery
systems and managed care, with the resulting need for increased efficiency will force decision makers to be
very sensitive to the relative costs of different types of health professionals in determining future
staffing patterns. These changes must be included in efforts designed to ensure that the population's needs for
health care services can be met. A basic component of this assessment, therefore, is a comprehensive
assessment of the potential supply of health care professionals in the future.
This report provides the initial results of a study undertaken for The American Osteopathic Association (AOA)
by the Department of Health Management and Informatics of the University of Missouri - Columbia to
perform an evaluation of the supply of osteopathic physicians in the United States to the year 2020. The
following results reflect an assessment of the potential supply of osteopathic physicians to the year 2020.
The goal of this assessment was to provide the American Osteopathic Association with data that can be used
to develop a better understanding of the future supply of osteopathic physicians in the United States.
These data can then be used to assist the American Osteopathic Association in developing appropriate
policies and recommendations.
In performing the assessment of the potential supply of osteopathic physicians to 2020, three models were
developed, providing alternative projections of the supply. The foundation of all three models assumes that
the current supply of physicians will age between now and the year 2020 and that the new physicians
entering the work force will also age each year. The historical educational capacity and patterns of
osteopathic medical schools in terms of their enrollment, graduating class size, number of years in operation
and the increased capacity expected from the new osteopathic medical schools entering the field are
included in the projections of the future supply of physicians. In the first model, no attrition is included
prior to the physician reaching the age of 99, at which point they exit the system. In the second model, the
ratio of active-to-current supply is used to project future physicians in the market; and in the third model, an
annual attrition rate of two percent is assumed to apply to the supply of physicians.
7
Model 1: No Attrition In Physician Population Prior To Age 99
This first model used to project the supply of osteopathic physicians assumes no attrition in the current
osteopathic physician population prior to the age of 99, at which age, they exit from the data base. Consequently,
this model results in a very liberal estimate of the number of osteopathic physicians in the market by the year
2020. The following basic assumptions were used in projecting the supply of osteopathic physicians to
2020; assumptions 1 - 7 apply to all models:
1) The supply of osteopathic physicians available in 1997 will age each year between now and 2020; new
physicians entering the market each year will also age in subsequent years
2) New physicians entering the practice of osteopathic medicine will do so in the same age
distribution as those that graduated in 1997
3) Existing osteopathic medical schools will continue to graduate the same number of physicians as they
did in 1998
4) New osteopathic medical schools will reach expected capacity of graduates by 2011
5) One additional osteopathic medical school will open in 2002, graduating its first class in 2006;
the maximum class size in this school will be 84
6) All graduates of osteopathic medical schools will enter practice
7) The gender distribution of the supply of osteopathic physicians reflects changing admission patterns,
so that by 2011, the school mix will be 1:1 male:female
8) There will be no attrition of osteopathic physicians from the system prior to reaching the age of 99;
after age 99, the physician exits the system
OSTEOPATHIC PHYSICIANS BY AGE COHORT

ASSUMING NO ATTRITION PRIOR TO AGE 99
Age Cohort 1990 1995 2000 2005 2010 2015 2020
<35 7,613 7,507 9,334 12,018 14,043 14,776 14,803
35 - 44 10,555 13,836 14,739 15,303 18,103 21,753 23,967
45 - 54 4,271 7,278 11,380 15,331 16,422 17,166 19,997
55 - 64 2,995 3,096 4,269 7,404 11,982 15,501 16,596
65-69 1,177 1,400 1,449 1,616 2,655 4,752 7,233
70 > 1,181 1,251 1,585 1,709 1,950 2,987 5,365
Total 27,792 34,368 43,206 53,381 65,155 76,934 87,961
(For detailed annual breakdown by age and gender, see attached table.)
Model 2: Current Ratio Of Active To Total Physicians Will Be Maintained
8
This second model used to project the supply of osteopathic physicians assumes that the current
ratio between active physicians and total physicians will remain constant between now and 2020.
The assumption is also made that the ratio of males to females will reflect the percent in the total,
since gender of current active osteopathic physicians was not provided. This model results in a
more conservative estimate of the number of osteopathic physicians in the market by the year
2020. The following basic assumptions were used in projecting the supply of osteopathic
physicians to 2020:
1) The supply of osteopathic physicians available in 1997 will age each year between now and
2020; new physicians entering the market each year will also age in subsequent years
distribution as those graduated in 1997
3) Existing osteopathic medical schools will continue to graduate the same number of
physicians as they did in 1998
5) One additional osteopathic medical school will open in 2002, graduating its first class in
2006; the maximum class size in this school will be 84
7) The gender distribution of the supply of osteopathic physicians reflects the same changing
admission patterns as the total, so that by 2011, the school mix will be 1:1 male:female
8) The supply of active osteopathic physicians will maintain the average (1989 - 1997) ratio
of active physicians to total physicians

CURRENT RATIO OF ACTIVE TO TOTAL PHYSICIANS MAINTAINED
Age Cohort 1990 1995 2000 2005 2010 2015 2020
<35 7,607 7,501 9,327 12,009 14,032 14,765 14,792
35-44 10,524 13,795 14,694 15,257 18,050 21,688 23,895
45 - 54 4,232 7,214 11,722 15,179 16,251 16,991 19,801
55 - 64 2,798 2,894 4,016 6,980 11,269 14,508 15,485
65 - 69 884 1,047 1,084 1,207 1,996 3,576 5,429
70 > 1,251 1,399 1,782 2,209 2,612 3,495 5,369
Total 27,295 33,850 42,625 52,840 64,210 75,023 84,771
9
Model 3: Attrition Rate Will Be Two Percent Per Year
This third model used to project the supply of osteopathic physicians assumes that the attrition rate among
osteopathic physicians will mirror the national rate among all physicians at two percent per year. This model
results in the most conservative estimate of the number of osteopathic physicians in the market by the year
2020. The following basic assumptions were used in projecting the supply of osteopathic physicians to
2020:
1) The supply of osteopathic physicians available in 1997 will age each year between now and 2020;
new physicians entering the market each year will also age in subsequent years
distribution as those graduated in 1997
3) Existing osteopathic medical schools will continue to graduate the same number of physicians as
they did in 1998
5) One additional osteopathic medical school will open in 2002, graduating its first class in 2006;
the maximum class size in this school will be 84
7) The gender distribution of the supply of osteopathic physicians reflects the same changing
admission patterns as the total, so that by 2011, the school mix will be 1:1 male:female
8) The supply of physicians will reflect an attrition rate of two percent per year, and the age at
which the physicians leave is based on a version of the sum-of-the-years digits between the ages of
27 = 1 and 75> = 49 ; the corresponding value at each age is divided by 1,225 (the sum of all
values) to obtain the percent of the attrition accounted for by each age

ASSUMING TWO PERCENT ATTRITION RATE
Age Cohort 1990 1995 2000 2005 2010 2015 2020
<35 7,613 7,507 9,301 12,014 14,044 14,776 14,803
35 - 44 10,555 13,836 14,539 15,037 17,986 21,749 23,968
45 - 54 4,271 7,278 11,440 14,582 15,637 16,624 19,811
55 - 64 2,995 3,096 3,688 6,172 10,449 13,972 15,333
65 - 69 1,177 1,400 1,087 819 1,608 3,617 6,150
70 > 2,812 3,249 3,529 2,875 1,684 1,140 2,563
Total 29,423 36,366 43,585 51,500 61,409 71,876 82,628
In applying the two percent attrition rate across individual age cohorts, the numbers of females in current
10
practice in older age cohorts are small, resulting in negative projections in the older age cohorts in some
years. As the number of new female osteopathic physicians enter the market in increasing numbers, this
problem is minimized.
11
MODEL 1: OSTEOPATHIC PHYSICIANS BY AGE COHORT, UNDER ASSUMPTION OF NO ATTRITION PRIOR TO AGE 99
Total 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
DOs
Age
<35 7,613 7,510 7,469 7,402 7,390 7,507 7,652 7,889 8,343 8,835 9,334
35-44 10,555 11,387 12,021 12,739 13,310 13,836 14,257 14,484 14,633 14,712 14,739
45-54 4,271 4,711 5,302 5,796 6,515 7,278 8,088 8,974 9,878 10,877 11,830
55-64 2,995 3,025 3,050 3,078 3,055 3,096 3,216 3,420 3,730 3,989 4,269
65-69 1,177 1,222 1,267 1,327 1,381 1,400 1,432 1,434 1,415 1,375 1,449
70> 1,181 1,181 1,181 1,178 1,213 1,251 1,295 1,346 3,456 1,559 1,585
Total 27,792 29,036 30,290 31,520 32,864 34,368 35,940 37,547 39,455 41,347 43,206
Male 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
DO
Age
<35 5,756 5,583 5,461 5,308 5,200 5,174 5,204 5,279 5,463 5,728 5,970
35-44 8,999 9,539 9,911 10,328 10,598 10,849 10,985 10,988 10,920 10,820 10,697
45-54 4,018 4,401 4,890 5,298 5,900 6,501 7,110 7,768 8,442 9,153 9,809
55-64 2,913 2,943 2,973 2,993 2,961 2,980 3,083 3,250 3,515 3,735 3,970
65-69 1,126 7,173 1,218 1,280 1,332 1,357 1,393 1,402 1,383 1,346 1,415
70> 1,092 1,097 1,111 1,109 1,148 1,191 1,236 1,291 1,398 1,506 1,534
Total 23,904 24,736 25,564 26,316 27,139 28,052 29,011 29,978 31,140 32,288 33,395
Female 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
DOs
Age
<35 1,857 1,927 2,008 2,094 2,190 2,333 2,448 2,610 2,861 3,107 3,364
35-44 1,556 1,848 2,110 2,411 2,712 2,987 3,272 3,496 3,713 3,891 4,043
45-54 253 310 412 498 615 777 978 1,206 1,436 1,724 2,021
55-64 82 82 77 85 94 116 133 170 215 254 299
65-69 51 49 49 47 49 43 39 32 32 29 34
70> 89 84 70 69 65 60 59 55 58 53 51
Total 3,888 4,300 4,726 5,204 5,725 6,316 6,929 7,569 8,315 9,059 9,811
12
Total 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DOs
Age
<35 9,863 10,405 10,887 11,401 12,018 12,676 13,038 13,416 13,755 14,043 14,278
35-44 14,685 14,819 15,007 15,183 15,303 15,494 16,044 16,659 17,352 18,103 18,856
45-54 12,739 13,413 14,173 14,793 15,331 15,783 16,047 16,229 16,348 16,422 16,411
55-64 4,741 5,364 5,899 6,627 7,404 8,210 9,115 10,021 11,024 11,982 12,895
65-69 1,463 1,501 1,577 1,618 1,616 1,738 1,921 2,155 2,373 2,655 3,005
70 > 1,658 1,691 1,704 1,677 1,709 1,764 1,783 1,847 1,880 1,950 2,053
Total 45,149 47,194 49,247 51,299 53,381 55,664 57,948 60,327 62,732 65,155 67,498
Male 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DOs
Age
<35 6,288 6,591 6,877 7,167 7,547 7,937 8,161 8,401 8,620 8,809 8,953
35-44 10,463 10,406 10,379 10,403 10,373 10,421 10,677 10,987 11,367 11,779 12,248
45-54 10,390 10,781 11,225 11,503 11,748 11,905 11,924 11,876 11,801 11,705 11,497
55-64 4,384 4,896 5,343 5,960 6,581 7,188 7,868 8,543 9,257 9,917 10,501
65- 69 1,424 1,459 1,526 1,554 1,533 1,643 1,793 1,991 2,183 2,439 2,743
70> 1,610 1,651 1,661 1,640 1,671 1,718 1,739 1,785 1,811 1,858 1,946
Total 34,559 35,784 37,011 38,227 39,453 40,812 42,162 43,584 45,039 46,506 47,888
Female 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DOs
Age
<35 3,575 3,815 4,009 4,234 4,470 4,739 4,877 5,014 5,135 5,234 5,324
35-44 4,222 4,413 4,628 4,781 4,930 5,073 5,368 5,672 5,984 6,325 6,608
45-54 2,349 2,632 2,940 3,290 3,583 3,877 4,123 4,353 4,548 4,717 4,914
55-64 357 468 556 666 823 1,022 1,247 1,478 1,767 2,065 2,394
65 - 69 39 42 51 64 83 95 128 164 190 216 262
70> 48 40 43 37 38 46 44 62 69 92 107
Total 10,590 11,410 12,236 13,072 13,928 14,852 15,786 16,743 17,693 18,649 19,610
13
Total DOs 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
<35 14,477 14,630 14,727 14,776 14,797 14,802 14,802 14,802 14,803
35- 44 19,550 20,210 20,927 21,753 22,508 22,947 23,340 23,684 23,967
45-54 16,578 16,800 17,012 17,166 17,373 17,935 18,552 19,246 19,997
55-64 13,572 14,335 14,959 15,501 15,955 16,221 16,404 16,522 16,596
65-69 3,445 3,747 4,256 4,752 5,207 5,672 6,277 6,771 7,233
70> 2,241 2,501 2,676 2,987 3,442 3,948 4,327 4,777 5,365
Total 69,863 72,223 74,557 76,934 79,282 81,525 83,702 85,802 87,961
Male DOs 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
<35 9,074 9,165 9,221. 9,248 9,256 9,253 9,248 9,246 9,246
35-44 12,652 13,056 13,479 13,996 14,457 14,738 14,987 15,201 15,376
45-54 11,460 11,452 11,497 11,488 11,546 11,810 12,122 12,501 12,910
55-64 10,894 11,339 11,621 11,868 12,028 12,048 12,000 11,924 11,828
65-69 3,105 3,355 3,779 4,144 4,447 4,765 5,191 5,480 5,775
70 > 2,108 2,317 2,468 2,743 3,156 3,570 3,879 4,257 4,704
Total 49,292 50,684 52,065 53,487 54,890 56,184 57,426 58,609 59,839
Female 2012 2013 2014 2015 2016 2017 2018 2019 2020
DOs
Age
<35 5,404 5,466 5,506 5,528 5,542 5,549 5,554 5,557 5,557
35-44 6,898 7,154 7,448 7,757 8,051 8,209 8,354 8,463 8,592
45-54 5,118 5,348 5,515 5,678 5,827 6,125 6,431 6,744 7,086
55-64 2,678 2,996 3,339 3,633 3,927 4,173 4,403 4,598 4,768
65-69 340 392 476 608 760 907 1,086 1,29I 1,457
70> 133 184 208 244 286 378 448 520 662
Total 20,571 21,539 22,492 23,447 24,392 25,341 26,276 27,193 28,122
14
MODEL 2: OSTEOPATHIC PHYSICIANS BY AGE COHORT, UNDER ASSUMPTION OF RATIO OF ACTIVE TO TOTAL
Total 1990 1991 1992 1993 1994 1995 1996 1991 1998 1999 2000
Age
< 35 7,607 7,504 7,463 7,396 7,384 7,501 7,646 7,883 8,337 8,829 9,327
35-44 10,524 11,354 11,986 12,702 13,271 13,795 14,214 14,440 14,589 14,667 14,694
45-54 4,232 4,669 5,256 5,746 6,458 7,214 8,017 8,896 9,791 10,780 11,722
55-64 2,798 2,825 2,847 2,876 2,856 2,894 3,012 3,209 3,505 3,747 4,016
65-69 884 918 950 995 1,038 1,047 1,071 1,070 1,054 1,025 1,084
70 > 1,251 571 568 562 594 613 639 668 720 760 775
Total 27,295 704 718 742 763 786 804 810 868 940 1,006
Males 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Age
<35 6,551 6,462 6,427 6,369 6,359 6,459 6,584 6,788 7,179 7,603 8,032
35- 44 9,063 9,778 10,322 10,938 11,428 11,879 12,241 12,435 12,563 12,630 12,654
45-54 3,644 4,021 4,526 4,948 5,562 6,212 6,904 7,661 8,432 9,283 10,095
55-64 2,409 2,433 2,452 2,477 2,460 2,492 2,594 2,764 3,018 3,226 3,458
65-69 762 791 818 857 894 902 922 921 908 883 933
70 > 1,077 491 489 484 512 528 551 576 620 655 668
Total 23,506 606 619 639 657 677 692 698 748 810 867
Females 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Age
<35 1,056 1,042 1,036 1,027 1,025 1,041 1,062 1,094 1,157 1,226 1,295
35-44 1,461 1,576 1,664 1,763 1,842 1,915 1,973 2,005 2,025 2,036 2,040
45-54 588 648 730 798 897 1,002 1,113 1,235 1,359 1,497 1,628
55-64 388 392 395 399 397 402 418 446 487 520 558
65-69 123 127 132 138 144 145 149 149 146 142 150
70 > 174 79 79 78 82 85 89 93 100 106 108
Total 3,790 98 100 103 106 109 1 12 112 121 131 140
15
Total 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Age
< 35 9,856 10,398 10,879 11,393 12,009 12,666 13,029 13,406 13,745 14,032 14,267
35-44 14,640 14,774 14,961 15,137 15,257 15,447 15,996 16,609 17,300 18,050 18,800
15-54 12,622 13,289 14,039 14,650 15,179 15,623 15,883 16,062 16,179 16,251 16,241
55-64 4,468 5,063 5,570 6,253 6,980 7,739 8,594 9,450 10,383 11,269 12,122
65-69 1,097 1,126 1,183 1,206 1,207 1,307 1,452 1,637 1,791 1,996 2,268
70 > 804 817 806 783 827 837 860 902 922 922 996
Total 1,078 1,149 1,235 1,319 1,382 1,456 1,521 1,570 1,617 1,690 1,756
Males 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Age
<35 8,488 8,955 9,368 9,811 10,342 10,908 11,220 11,544 11,837 12,084 12,286
35-44 12,607 12,723 12,884 13,036 13,138 13,302 13,775 14,303 14,898 15,544 16,190
15-54 10,870 11,444 12,090 12,616 13,071 13,454 13,678 13,832 13,932 13,995 13,986
55-64 3,847 4,360 4,797 5,385 6,011 6,665 7,401 8,138 8,941 9,705 10,439
65-69 945 970 1,019 1,039 1,039 1,125 1,250 1,410 1,543 1,719 1,953
70 > 693 703 694 674 712 721 740 777 794 794 858
Total 929 989 1,064 1,136 1,190 1,254 1,310 1,352 1,393 1,456 1,512
Females 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Age
< 35 1,368 1,444 1,510 1,582 1,667 1,759 1,809 1,861 1,908 1,948 1,981
35-44 2,033 2,051 2,077 2,102 2,118 2,145 2,221 2,306 2,402 2,506 2,610
45-54 1,752 1,845 1,949 2,034 2,107 2,169 2,205 2,230 2,246 2,256 2,255
55-64 620 703 773 868 969 1,075 1,193 1,312 1,442 1,565 1,683
55-69 152 156 164 167 168 181 202 227 249 277 315
70 > 112 113 112 109 115 116 119 125 128 128 138
Total 150 159 171 183 192 202 211 218 225 235 244
16
Total 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
<35 14,466 14,619 14,716 14,765 14,786 14,791 14,791 14,791 14,792
35-44 19,492 20,150 20,865 21,688 22,441 22,878 23,270 23,613 23,895
45-54 16,406 16,627 16,837 16,991 17,196 17,756 18,369 19,056 19,801
55-64 12,753 13,451 14,020 14,508 14,917 15,156 15,321 15,423 15,485
65-69 2,612 2,837 3,212 3,576 3,920 4,284 4,733 5,095 5,429
70> 1,107 1,248 1,366 1,523 1,728 1,991 2,164 2,450 2,727
Total 1,813 1,881 1,923 1,972 2,073 2,201 2,358 2,479 2,643
Males 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
<35 12,458 12,589 12,673 12,715 12,733 12,737 12,738 12,738 12,738
35-44 16,786 17,353 17,968 18,677 19,325 19,702 20,039 20,335 20,577
45-54 14,128 14,318 14,500 14,632 14,809 15,291 15,819 16,411 17,052
55-64 10,983 11,583 12,073 12,494 12,846 13,052 13,194 13,282 13,335
65-69 2,249 2,443 2,766 3,080 3,376 3,689 4,076 4,388 4,675
70> 953 1,074 1,176 1,311 1,488 1,715 1,863 2,109 2,348
Total 1,561 1,620 1,656 1,699 1,785 1,896 2,031 2,135 2,276
Females 2012 2013 2014 2015 2016 2017 2018 2010 2020
Age
<35 2,008 2,030 2,043 2,050 2,053 2,054 2,054 2,054 2,054
35-44 2,706 2,798 2,897 3,011 3,116 3,176 3,231 3,278 3,317
45-54 2,278 2,308 2,338 2,359 2,387 2,465 2,550 2,646 2,749
55-64 1,771 1,867 1,946 2,014 2,071 2,104 2,127 2,141 2,150
65-69 363 394 446 497 544 595 657 707 754
70 > 154 173 190 211 240 276 300 340 379
Total 252 261 267 274 288 306 327 344 367
17
MODEL 3: OSTEOPATHIC PHYSICIANS BY AGE COHORT, UNDER ASSUMPTION OF TWO PERCENT ATTRITION RATE
Total 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
DOs
Age
<35 7,613 7,510 7,469 7,402 7,390 7,507 7,652 7,889 8,321 8,804 9,301
35-44 10,555 11,387 12,021 12,739 13,310 13,836 14,257 14,484 14,552 14,564 14,539
45-54 4,271 4,711 5,302 5,796 6,515 7,278 8,008 8,974 9,732 10,601 11,440
55-64 2,995 3,025 3,050 3,078 3,055 3,096 3,216 3,420 3,519 3,586 3,688
65- 9 1,177 1,222 1,267 1,327 1,381 1,400 1,432 1,434 1,286 1,125 1,087
70> 2,812 2,894 2,933 2,998 3,133 3,249 3,360 3,449 3,530 3,573 3,529
Total 29,423 30,749 32,042 33,340 34,784 36,366 38,005 39,650 40,940 42,254 43,585
Male 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
DOs
Age
<35 5,756 5,583 5,461 5,308 5,200 5,174 5,204 5,279 5,474 5,728 5,970
35-44 8,999 9,539 9,911 10,328 10,598 10,849 10,985 10,988 10,855 10,820 10,697
45-54 4,018 4,401 4,890 5,298 5,900 6,501 7,110 7,768 8,324 9,153 9,809
55-64 2,913 2,943 2,973 2,993 2,901 2,980 3,083 3,250 3,346 3,735 3,970
65-69 1,126 1,173 1,218 1,280 1,332 1,357 1,393 1,402 1,279 1,346 1,415
70> 2,526 2,609 2,656 2,719 2,853 2,970 3,087 3,182 3,292 3,606 3,719
Total 25,338 26,248 27,109 27,926 28,844 29,831 30,862 31,869 32,571 34,388 35,580
Female 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
DOs
Age
<35 1,857 1,927 2,008 2,094 2,190 2,333 2,448 2,610 2,847 3,076 3,331
35-44 1,556 1,848 2,110 2,411 2,712 2,987 3,272 3,496 3,697 3,744 3,843
45-54 253 310 412 498 615 777 978 1,206 1,408 1,449 1,631
55-64 82 82 77 85 94 116 133 170 174 (150) (282)
65-69 51 49 49 47 49 43 39 32 7 (221) (328)
70 > 286 285 277 279 280 279 273 267 237 (32) (190)
Total 4,085 4,501 4,933 5,414 5,910 6,535 7,143 7,781 8,369 7,866 8,005
18
Total 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DOs
Age
<35 9,834 10,383 10,871 11,392 12,014 12,675 13,038 13,416 13,755 14,044 14,278
35-44 14,446 14,555 14,729 14,906 15,037 15.249 15,827 16,475 17,201 17,986 18,772
45-54 12,249 12,838 13,527 14,089 14,582 15,003 15,248 15,423 15,547 15,637 15,654
55-64 4,000 4,478 4,883 5,496 6,172 6,892 7,724 8,570 9,526 10,449 11,340
65-69 998 941 930 892 810 877 1,003 1,187 1,363 1,608 1,929
70> 3,483 3,378 3,224 3,029 2,875 2,674 2,453 2,235 1,954 1,684 1,503
Total 45,010 46,573 48,166 49,805 51,500 53,369 55,293 57,306 59,346 61,409 63,476
Male 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DOs
Age
<35 6,288 6,591 6,877 7,167 7,547 7,937 8,161 8,401 8,620 8,809 8,953
35-44 10,463 10,406 10,379 10,403 10,373 10,421 10,6777 10,987 11,367 11,779 12,248
45-54 10,390 10,781 11,225 11,503 11,748 11,905 11,924 11,876 11,801 11,705 11,497
55-64 4,384 4,896 5,343 5,960 6,581 7,188 7,868 8,543 9,257 9,917 10,501
65-69 1,424 1,459 1,526 1,554 1,533 1,643 1,793 1,991 2,183 2,439 2,743
70> 3,829 3,887 3,887 3,851 3,852 3,803 3,739 3,662 3,523 3,382 3,332
Total 36,778 38,020 39,237 40,438 41,634 42,897 44,162 45,461 46,751 48,030 49,275
Female 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DOs
Age
<35 3,546 3,792 3,994 4,225 4,466 4,738 4,877 5,014 5,135 5,235 5,324
35-44 3,983 4,149 4,351 4,503 4,664 4,828 5,151 5,487 5,834 6,208 6,524
45-54 1,859 2,057 2,302 2,586 2,835 3,097 3,323 3,547 3,746 3,932 4,156
55-64 (384) (418) (460) (465) (408) (297) (144) 27 269 532 840
65-69 (426) (518) (596) (662) (714) (766) (790) (803) (820) (831) (814)
70 > (346) (509) (662) (822) (977) (1,129) (1,286) (1,428) (1,569) (1,698) (1,829)
Total 8,232 8,553 8,929 9,367 9,866 10,412 11,130 11,844 12,595 13,379 14,201
19
Total DOs 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
<35 14,477 14,630 14,727 14,776 14,797 14,802 14,802 14,802 14,803
35-44 19,495 20,179 20,914 21,749 22,507 22,947 23,340 23,684 23,968
45-54 15,858 16,129 16,400 16,624 16,905 17,544 18,235 18,998 19,811
55-64 12,006 12,771 13,407 13,972 14,459 14,768 15,005 15,187 15,333
65-69 2,346 2,630 3,127 3,617 4,072 4,542 5,158 5,667 6,150
70> 1,375 1,313 1,184 1,140 1,264 1,541 1,755 2,118 2,563
Total 65,558 67,653 69,759 71,876 74,005 76,145 78,296 80,457 82,628
Male DOs 2012 2013 2014 2015 2016 2017 2018 2019 2020
Age
<35 9,074 9,165 9,221 9,248 9,256 9,253 9,248 9,246 9,246
35-44 12,652 13,056 13,479 13,996 14,457 14,738 14,987 15,201 15,376
45-54 11,460 11,452 11,497 11,488 11,546 11,810 12,122 12,501 12,910
55-64 10,894 11,339 11,621 11,868 12,028 12,048 12,000 11,924 11,828
65-69 3,105 3,355 3,779 4,144 4,447 4,765 5,191 5,480 5,775
70> 3,319 3,350 3,323 3,368 3,561 3,857 4,093 4,453 4,832
Total 50,503 51,718 52,920 54,112 55,295 56,471 57,640 58,806 59,967
Female 2012 2013 2014 2015 2016 2017 2018 2019 2020
DOs
Age
<35 5,404 5,466 5,506 5,528 5,542 5,549 5,554 5,557 5,557
35-44 6,843 7,123 7,435 7,753 8,050 8,209 8,354 8,483 8,593
45-54 4,399 4,677 4,903 5,135 5,359 5,734 6,113 6,496 6,901
55-64 1,113 1,431 1,786 2,104 2,431 2,720 3,005 3,263 3,505
65-69 (760) (725) (652) (527) (375) (223) (33) 187 375
70> (1.944) (2,037) (2,139) (2,228) (2,297) (2,315) (2,338) (2,335) (2,269)
Total 15,055 15,935 16,839 17,764 18,710 19,674 20,655 21,651 22,661
20
21
22
OSTEOPATHIC WORKFORCE STUDY
2004
Myron S. Magen, DO
Douglas Ward, Ph.D.
Sarah Corp, M.A.
23
24
TABLE OF CONTENTS
LIST OF TABLES...................................................................................................................................... 26
LIST OF FIGURES .................................................................................................................................... 27
INTRODUCTION ...................................................................................................................................... 29
EXECUTIVE SUMMARY ........................................................................................................................ 31
PHYSICIAN WORKFORCE POLICIES & STUDIES ............................................................................. 33
UNITED STATES CENSUS BUREAU MATERIAL............................................................................... 35
1. US Census Projection Excerpts ......................................................................................................... 35
2. The Aging Of The Population Nationally & By Census Division..................................................... 35
3. US Population By States & Census Regions ..................................................................................... 37
OSTEOPATHIC PHYSICIAN POPULATION DATA............................................................................. 39
1. DO Population Distribution By State & Census Region ................................................................... 39
2. DO Population Relative to College of Medicine & Census Region .................................................. 47
3. Practicing DOs In US Census Regions, Divisions & States By COM .............................................. 59
Arizona ....................................................................................................................................................... 74
OSTEOPATHIC PHYSICIAN PROJECTIONS........................................................................................ 75
1. Population-Based DO Projections to 2025 by State & US Census Region/Division ........................ 75
2. Graduate-Based DO Projections (National) To 2040 ........................................................................ 79
CURRENT OSTEOPATHIC PHYSICIAN PRACTICE SPECIALTIES & TRAINING PROGRAM
TRENDS..................................................................................................................................................... 81
1. National Distribution of Osteopathic Practice Specialties, 2003....................................................... 81
2. National Distribution of DO Students by Program Types ................................................................. 83
OSTEOPATHIC PHYSICIAN DEMOGRAPHIC DATA: PRESENT & FUTURE .............................. 90
1. Age Information................................................................................................................................. 90
2. Gender Distribution of the Osteopathic Profession ........................................................................... 93
RECOMMENDATIONS............................................................................................................................ 97
APPENDIX A: Practice Specialty Groupings ........................................................................................... 98
25
LIST OF TABLES
Table 1 Projected Population Distribution by Practicing DOs by COM of Graduation in Southern
Age Group, 2000-2025 Census Divisions
Table 2 Ranking of Percent of Total US Table 23 Division 5 South Atlantic
Population by State, 2003 Table 24 Division 6 East South Central
Table 3 Total Number of Osteopathic Table 25 Division 7 West South Central
Physicians by US State, 2003
Table 4 Ranking of Percent of Total Practicing Practicing DOs by COM of Graduation in Western
DOs by US State, 2003 Census Divisions
Table 5 US Regional DO Totals Excluding Table 26 Division 8 Mountain
Largest DO States, 2003 Table 27 Division 9 Pacific
Table 6 US Divisional DO Totals Excluding
Largest DO States, 2003 Table 28 Distribution of DOs & Students by US
Table 7 DO Population by COM & Census Census Region, 2003
Region: Northeast Table 29 Distribution of Non-Practicing DOs by
Table 8 DO Population by COM & Census US Census Region, 2003
Region: Midwest Table 30 COM With Largest DO Graduate
Table 9 DO Population by COM & Census Representation by US States, 2003
Region: South Table 31 Practicing DO Projections by State
2003-2025
Table 10 DO Population by COM & Census
Table 32 Projected Distribution of Practicing
Region: West DOs by US Census Region, 2003-
Table 11 Percent of Practicing DOs by COM of
2025
Graduation in US Census Regions,
Table 33 Projected Distribution of Practicing
2003
DOs by US Census Division, 2003-
Table 12 Active DO Population Across States
2025
With a COM as Compared to Date of
Table 34 DO Projections 2000-2040 Based on
1st Graduating Class of COM in
2000 Graduation Rates
Given State
Table 13 Relationship Between # of COM’s &
Increase in 2000 Graduation Rates of
Proportion of DO Population, 2003
400
Table 14 US Census Regions & Divisions
Table 15 Practicing DOs by COM of Graduation
in Northeast Census Region
600
in Midwest Census Region
1000
in South Census Region
Table 38 Self-Reported Primary Practice
Specialties, 2003
in West Census Region
Table 39 Number of DOs Training in ACGME
Programs by State, 2003-2004
Practicing DOs by COM of Graduation in Northeast
Table 40 AOA Internship Programs by State,
Census Divisions
2003-2004
Table 19 Division 1 New England
Table 41 AOA Residency Programs by State,
Table 20 Division 2 Mid Atlantic
2003-2004
Table 42 Percentage of Practicing DOs by
Practicing DOs by COM of Graduation in Midwest
Graduation Decades, 2003
Census Divisions
Table 43 Distribution of Practicing DOs &
Table 21 Division 3 East North Central
Students by Age Category, 2003
Table 22 Division 4 West North Central
26
Table 44 Age Projections Based on DO Figure 18 Region of Practice: NSU-COM
Forecasts Using 2000 Graduation Graduates
Rates Figure 19 Region of Practice: NY-COM
Table 45 Age Projections Based on DO Graduates
Forecasts Using 2000 Graduation Figure 20 Region of Practice: OSU-COM
Rates + 400 Graduates
Table 46 Age Projections Based on DO Figure 21 Region of Practice: OU-COM
Forecasts Using 2000 Graduation Graduates
Rates + 600 Figure 22 Region of Practice: P-COM Graduates
Table 47 Gender Distribution of Inactive Figure 23 Region of Practice: PC-SOM Graduates
Osteopathic Physicians, 2003 Figure 24 Region of Practice: TU-COM
Table 48 Gender Distribution of Practicing Graduates
Osteopathic Physicians, 2003 Figure 25 Region of Practice: UHS-COM
Table 49 Gender Distribution of US Osteopathic Graduates
Students, 2003 Figure 26 Region of Practice: UMDNJ-COM
Table 50 Women in the Osteopathic Profession Graduates
by Graduation Class Figure 27 Region of Practice: UNE-COM
Table 51 DO Gender Graduation Percent Graduates
Projections 2005-2040 Figure 28 Region of Practice: UNT-COM
Graduates
LIST OF FIGURES Figure 29 Region of Practice: WV-SOM
Figure 1 Population Distribution by US States, Graduates
2003 Figure 30 Region of Practice: WU Graduates
Figure 2 Population Distribution by US Census Figure 31 Percent of DOs Practicing in States
Region, 2003 With COM’s
Figure 3 Distribution of Practicing DOs by Figure 32 Distribution of DO Practice Specialties
State, 2003 Figure 33 Distribution of Primary Practice Types
Figure 4 States With Greatest DO Share v. All Other Practice Types
Compared to Total Population Figure 34 Trends: DOs in AOA Primary Practice
Figure 5 States With Smallest DO Share Programs, 1987-2002
Compared to Total Population Figure 35 Trends: DOs in ACGME Primary
Figure 6 US Map by Census Region Practice Programs, 1987-2002
Figure 7 Population Distribution by US Census Figure 36 Trends: DOs in AOA & ACGME
Region, 2003 Family Practice Programs, 1987-
Figure 8 Practicing DO Distribution by US 2002
Census Region, 2003 Figure 37 Trends: DOs in AOA & ACGME
Figure 9 DO vs. Total Population by US Census Internal Medicine Programs, 1987-
Region 2002
Figure 10 Population Distribution by US Census Figure 38 Trends: DOs in AOA & ACGME
Division, 2003 OB/GYN Programs, 1987-2002
Figure 11 Practicing DO Distribution by US Figure 39 Trends: DOs in AOA & ACGME
Census Division, 2003 Pediatrics Programs, 1987-2002
Figure 12: Region of Practice: AZ-COM Graduates Figure 40 DO Enrollment in AOA & ACGME
Figure 13 Region of Practice: C-COM Graduates Primary Care Programs, 1987-2002
Figure 14 Region of Practice: Des Moines COM Figure 41 DO Enrollment in AOA & ACGME
Graduates Specialty Programs, 1987-2002
Figure 15 Region of Practice K-COM Graduates Figure 42 DOs in all AOA & ACGME Programs,
Figure 16 Region of Practice: LE-COM 1987-2002
Graduates Figure 43 Age Distribution of DO Population,
Figure 17 Region of Practice: MSU-COM 2003
Graduates
27
Figure 44 Percent of DO Population: Women, Figure 46 Projected Graduation Rates: Women as
2003 Percent of Total, 2005-2040
Figure 45 Women DOs by Graduating Class
28
INTRODUCTION
The policy issues related to the provision of and access to health care have been of increasing
interest and attention recently. As was noted in a previous study,8 the volatile nature of the
health care system in the United States requires its professionals to consider how the status quo
can be altered to meet changing care-provision needs. The following study seeks to shed light on
areas the Osteopathic profession can consider in determining how changing demands in the
health care system can best be addressed by its members.
Topics for consideration include: comparisons across distributions of total and DO populations,
as well as the relationship between geographic location of Colleges of Osteopathic Medicine
(COM) and national DO practice locations. Future considerations regarding the placement of
new COM’s could benefit from the use of such information by taking into account which areas
of the United States are geographically ‘underserved’ by the osteopathic profession. Findings
suggest that such considerations could lead to the national expansion of the Osteopathic
profession.
Additional subjects covered in this report include: the projected growth of the Osteopathic
profession to 2040, current distributions of Osteopathic care specialties, current and projected
age and gender distributions of the profession, and comparisons regarding trends in DO
participation in both ACGME and AOA programs.
About This Report

The Osteopathic Workforce Study started as a proposal from Doug Ward to John Crosby. Following
acceptance of the proposal and the appropriation of a small sum of money to start the project, data
collection began. It soon became obvious that the amount of data, all in various locations, was
staggering. Consequently, the services of So What Evaluation Resources, of Okemos Michigan were
contracted, and Sarah Corp was assigned to assist in project analysis and report writing. Most of the data
collection, analysis, and chart development is the work of Sarah. As always, John Crosby expedited and
assisted whenever necessary. The American Osteopathic Association Department of Membership,
particularly Steve Andes, provided data and invaluable advice. The AOA Department of Education,
primarily the Postgraduate Division, provided current residency and internship numbers. Diane Burkhart
was instrumental in this effort. Material on the American Association of Colleges of Osteopathic
Medicine, and individual college web sites were also of particular use. Mark Cummings, from Michigan
State University, was kind enough to allow the use of his aggregated data collection, and provided
interpretation when necessary. As always, publicly available US Census Bureau material provided the
basis for much of the study. Errors in data collection, misinterpretation of material, or errors in judgment
or addition are the sole responsibility of the authors.
Myron S. Magen, DO
Douglas Ward, Ph.D.
Sarah Corp, M.A.
8
Hicks, Lanis & Boles, Keith. 1998. “Projection of Supply of Osteopathic Physicians to 2020.”
29
30
EXECUTIVE SUMMARY
Population projections indicate that by 2025 all states will grow in total population. Alaska, California,
Utah, Texas, and Hawaii will have the highest average increases. California, Texas, and Florida are
expected to contain 45 percent of the total US population. By 2025 Alaska will be the youngest state and
Florida the oldest - with California, Texas, and Florida being the three oldest states.
In 2003, forty-four percent of the US population resided in seven states: Ohio, Illinois, Pennsylvania,
Florida, New York, Texas and California. There were 48,678 practicing DOs, and nearly sixty percent of
these resided in the eight states of: Pennsylvania, Michigan, Ohio, Florida, New York, Texas, California,
and New Jersey. However, only 47 percent of the total US population currently resides in these states.
In spite of the marked growth of the profession, geographic inequalities persist. As an example, while
only two tenths of one percent (0.2) of all practicing osteopathic physicians reside in Louisiana, 1.61
percent of the total US population is contained within this state. The largest inequalities relative to the
proportion of DO population occur in the South and West, with the greatest disparities persisting in the
South Atlantic and East South Central census divisions. In addition, when looking at census regions, it
becomes obvious that often an individual state contains the majority of DOs within that region. As an
example, removing Florida from the Southern region would decrease the total number of DOs by 26
percent in the South. Removing Pennsylvania from the Northeast region would result in a loss of 41.5
percent of osteopathic physicians in the Northeast.
DO practice location is strongly correlated with location of Colleges of Osteopathic Medicine of

graduation. In every instance, the region in which a college of osteopathic medicine is located is where
the overwhelming numbers of its graduates practice. Consequently, the placement of colleges of
osteopathic medicine is critical to the development of the osteopathic profession as a national profession.
While one would expect that the age of a college of osteopathic medicine (the date of the first graduating
class) would be a critical factor in determining the size of the DO population in its region, analysis reveals
that class size is a more important factor.
The majority of DO students come from census regions with high DO populations. Therefore, if the
profession wishes to address disparities in DO population across the nation, efforts must be made to
recruit students from regions of low DO populations.
Projections of DO population in relation to US population were made to the year 2025 using Census
Bureau (total) projections as a basis for analysis. These results indicated that the proportion of DOs to
total population will decline in the Northeast and Midwest and increase in the Southern and Western
regions. Because projections based on the location of total population are questionable, DO projections
to 2040 were made based on graduating class numbers in the year 2000 (2,400/year). Assuming a yearly
attrition rate of two percent, projections indicate a 40.5 percent increase in DO population over a four-
decade span. However, the number of graduates has not remained constant. In 2002 there were 2,534
graduates. Therefore, projections were made with assumptions of graduating class size increases of 400,
600, and 1000. These projections yield increases of up to 47.2 percent, with the possibility that even
these increases are too conservative.
The age of active osteopathic physicians continues to decrease, with the current average age resting at 44
years. Currently 51 percent of physicians fall within this age group, with 40 percent falling under the age
of 40.
31
The osteopathic profession continues to be a primary care profession, with 64 percent reporting a
practice-type in one of the primary care specialties. Family practice makes up 50 percent of this group,
with internal medicine comprising 8 percent, pediatrics 3 percent, and obstetrics/gynecology 3 percent.
Trends indicate that the number of DOs enrolling in ACGME programs has increased greatly, with the
largest numbers going into Family Practice and Internal Medicine. There have also been increases in the
number of DOs entering ACGME OB/GYN programs. DOs in ACGME Pediatrics programs have
always exceeded those in AOA programs, with the divergence continuing to grow. In addition, there is an
increasing interest in other ACGME specialty programs. There is every indication that these trends will
continue to grow.
While at the present time only 25 percent of practicing osteopathic physicians are female, the trend
towards gender equality is evident. In 2003, 45 percent of the DO student population was female. If the
rate of gender growth remains constant, women graduates will outnumber males by the year 2015.
In summary, the osteopathic profession is rapidly growing and will continue to do so. The gender
makeup of the profession will change. The growth is unplanned and opportunistic and does not
necessarily occur based on the needs of the profession.
32
PHYSICIAN WORKFORCE POLICIES & STUDIES9
During the 1950’s, and through the 1970’s concern was expressed with regards to physician shortages.
The number of active non-federal physicians was 126.6 per 100,000 in the total US population in the
1950’s, rising to 127.4 in 1960 and then to 137.4 in 1970. The two-decade span from 1970 through 1990
saw efforts to increase the supply of physicians. Consequently, during this time, graduation rates from
Medical Doctor schools rose from 9,000 to more than 15,000 in total, while graduates of Osteopathic
schools increased from 500 to 1,500. In addition, more International Medical Graduates were allowed to
enter the country. The result was an increase in the M.D. population of 60 percent – raising the ratio to
219.5 physicians per 100,000 persons in 1991. The ratio of Osteopathic physicians rose from 5.7 in 1970
to 7.5 per 100,000 persons in 1980. By 1990, there was one physician for every 398 people – up from 1
for every 584 individuals in 1970.
Attitudes changed with publication of the 1980 Graduate Medical Education National Advisory
Committee (GMENAC) report, which forecasted 536,000 physicians in 1990 and 643,000 by the year
2000. Physician-to-population ratios of 220 and 247 per 100,000 people were estimated for these years –
leading to the conclusion that the supply of physicians would grow from 70,000 in 1990 to 145,000 in
2000.
Attention then turned to the geographic and specialty distributions of physician practice, rather than
aggregate supply. Government policies in 1980 attempted to address these issues, but physician supply
continued to increase. The Kindig writings of the early 1990’s estimated the physician supply at more
than 628,000 physicians in 1992, or 235 per 100,000 in the total population. Of this supply, seventy-four
percent were actively participating in patient care, resulting in a ratio of 180.1 per 100,000 in the total
population. An additional 90,000 were residents and fellows providing care – which amounted to 38.7
per 100,000 of the total population. Of the active patient care physicians, more than 182,000 were in
primary care – amounting to 71 per 100,000 persons, or thirty-nine percent of physicians not in training.
At about the same time, Mullen et al. pointed out that twenty-three percent of active Medical Doctors in
the US were graduates of foreign medical schools. Fourteen percent (or 19,000) were United States
International Medical Graduates (native US citizens). The remaining 120,000 were foreign-born. Since
1975 approximately twenty-five percent of International Medical Graduates have come from India, with
large numbers also coming from Pakistan, the Philippines, the United Arab Republic, Israel, Italy, and the
United Kingdom.
Based on previous reports, and other analyses, some Institute of Medicine recommendations included:
• No new medical schools should be opened, and class sizes should remain the same
• Federal resources for research on physician supply and requirements should be made available
9
Note: the information in this section was compiled from the following sources:
1. Cooper, et al. Æ Published reports in 1995 & 1998 Journal of the American Medical Association, 2000
report to the Council on Graduate Medical Education, 1992 report to the Department of Health and Human
Services, 1994 published report in the New England Journal of Medicine, and 2002 published report in
Health Affairs.
2. Institute of Medicine. 1996. ‘The Nations Physician Workforce: Options for Balancing Supply &
Requirements.
3. Mullan, F. Æ Published reports in 2000 New England Journal of Medicine & 2002 Health Affairs
4. Salsberg, Ed Æ 2003 report to the Council on Graduate Medical Education.
5. Schwartz, W.B. & Mendelson D.N. 1990 published report in the Journal of the American Medical
Association
6. Weiner, J. Æ 2002 published report in Health Affairs
33
During this period of time, among the lone voices raised against the predictions of physician surplus were
those of Schwartz and Mendelson. In 1990, writing in the Journal of the American Medical Association,
they used changes in physician workload and economic indicators, among other things, to argue against
the surpluses suggested by GMENAC and the Council on Graduate Medical Education (COGME). Very
little attention was paid to these arguments until a series of articles by Cooper and associates were
published in journals such as the Journal of the American Medical Association, the New England Journal
of Medicine, Health Affairs and others. This group submitted similar reports to the Council on Graduate
Medical Education, and other federal committees and agencies. He and his associates used a model based
on the economic growth, factors related to productivity among physicians (i.e. non-physician clinicians
entering the workplace in greater numbers, playing an enlarged role in patient care). They projected a
deficit of 50,000 physicians by 2010. By 2020, they estimated that this deficit would exceed 200,000
physicians, representing more than twenty percent of the projected demand for physicians.
The year 2003 saw a dramatic about-face. COGME, which had previously projected physician surpluses
(since the mid 1980’s), began backing predictions of shortage. Ed Salsberg from the State University of
New York at Albany was then commissioned to look at the changing physician workforce environment.
His findings indicated a total physician population of 781,000 in 2000, one of 972,000 in 2020, and a
need for 1.06 million in 2020. COGME adopted this report, calling for: increases in the number of US
medical student graduates to 3,000 (per year) by 2015, the expansion of residency positions, and a change
in these positions to mirror market demands. The report anticipated a shortage of 85,000 physicians by
2020.
Cooper feels the COGME recommendations are conservative in light of the US Census Bureau
projections indicating that the US population will increase by eighteen percent (to 324 million) by 2020.
Medical school enrollment will only have increased by seven percent, while Cooper feels it must increase
by at least fifteen percent to reach a stable state. J. Weiner of Johns Hopkins, and Fitzhugh Mullan also
contend that there will not be an upcoming surplus of physicians. However, Mullan supports expanding
graduate medical education so that fewer International Medical Graduates would be needed to fill
expanded residency positions.
In Cooper’s report on a survey conducted of Medical School Deans and Medical Society Executive
Directors, he reports that approximately eighty-five percent perceived shortages of physicians in multiple
specialties, while only ten percent perceived surpluses. While some college Deans reported planned
increases in class size, others reported the capacity to train additional students. These increases would
yield an additional 7.6 percent matriculates.
Both the American Medical Association and the Association of American Medical Colleges (AAMC) are
in the process of reviewing previous policies indicating a physician surplus. The AAMC has just
appointed Edward Salsberg to a position in AAMC to head workforce studies.
In summary, we might say that the American Osteopathic Association and the American Association of
Medical Colleges non-policy of expansion or non-expansion of osteopathic medical school enrollment
may, in retrospect, have been a brilliant unconscious policy non-decision.
34
UNITED STATES CENSUS BUREAU MATERIAL10
1. US Census Projection Excerpts

Based on the most current population projection report published by the US Department of Commerce
Census Bureau, state populations will grow and shift over the next twenty years – with varying rates of
total and aging population figures. Summary information regarding state population projections are as
follows:
Population Growth
• Projections through 2025 indicate that all states will grow in total population, as well as in elderly
population, as ‘baby boomers’ continue to age. It is expected that the South and West will experience
the greatest population growth over this time period.
• The West is expected to be the fastest growing region in the United States.
o “Alaska, California, Utah, Texas, and Hawaii (in rank order) are expected to have the highest
average annual rate of natural increase from 1995 to 2025. West Virginia and Arkansas are
the only states expected to have either no gain or a loss from natural increase.”
Population Changes
• Population changes are expected to be most marked in California, Florida, and Texas. These three
states will account for approximately forty-five percent of net US population by 2025.
o By 2020 Florida is expected to replace New York as the third most populous state.
Population Age
• Projections indicate that over time the proportion of elderly will increase in the United States.
o The Southern region is expected to have the smallest proportion of individuals under the age
of 20.
o By 2025 Alaska is expected to be the ‘youngest’ state – with thirty-four percent of its
population being under age 20, and only ten percent being age 65 or older.
o By 2025 Florida is expected to be the ‘oldest’ state – with twenty-six percent of its population
being age 65 or older.
o By 2025 the oldest three states (in rank order) are expected to be: Florida, California, and
Texas.
Reviewing US Census projections provides a general impression of expected population changes in terms
of total numbers and shifts in residence, as well an idea of how and where the aging portion of the US
population is likely to reside in the future. This information combined with the following (current)
population figures can be used to guide discussion regarding the DO population as it changes and shifts
into the future.
2. The Aging Of The Population Nationally & By Census Division

The following table details the projected population distribution, by age, to 2025. It lists both age- group
totals and age group as a percent of census division population totals. As mentioned above US Census
projections of age distributions for the general population indicate the proportion of elderly will increase
in the United States over time.
10
Campbell, Paul R. “Current Population Reports, Population Projections for States 1995-2005.” US Department
of Commerce, Bureau of the Census, Population Division.
35
Table 1 Projected Population Distribution By Age Group, 2000-2025
Division 2000 2005 2015 2025
Age Group: 0-24
New England 4.6% (4,469) 4.6% (4,571) 3.4% (4,411) 4.2% (4,793)
Mid Atlantic 13.3% (12,923) 13.0% (13,081) 10.3% (13,204) 11.8% (13,626)
East North Central 16.1% 15.6% (15,642) 30.7% (39,591) 13.5% (15,551)
(15,622)
West North Central 6.9% (6,764)6.8% (6,811) 5.2% (6,738) 5.9% (6,800)
South Atlantic 17.3% (16,756) 17.4% (17,412) 13.9% (17,929) 16.0% (18,539)
East South Central 6.1% (5,876)5.9% (5,940) 4.6% (5,883) 5.1% (5,832)
West South Central 12.0% (11,629) 12.1% (12,129) 10.0% (12,903) 12.1% (14,015)
Mountain 6.9% (6,660)7.0% (7,030) 5.6% (7,261) 6.6% (7,668)
Pacific 16.8% (16,348) 17.6% (17,611) 16.2% (20,843) 24.8% (28,688)
97,047 100,227 128,793 115,512
Total 35% of total 35% of total 38% of total 34% of total
pop. pop. pop. pop.
Age Group: 25-64
New England 5.1% (7,273) 4.9% (7,448) 4.9% (7,749) 4.7% (7,677)
Mid Atlantic 14.2% (20,256) 13.7% (20,561) 13.2% (21,037) 12.9% (20,869)
East North Central 16.2% (23,124) 15.9% (23,726) 15.1% (24,103) 14.4% (23,304)
West North Central 6.8% (9,718) 6.8% (10,178) 6.6% 6.3% (10,226)
(10,595)
South Atlantic 18.6% (26,558) 18.9% (28,230) 19.1% (30,469) 19.0% (30,786)
East South Central 6.2% (8,901) 6.3% (9,379) 6.1% (9,783) 5.9% (9,557)
Mountain 6.3% (9,005) 6.6% (9,874) 6.7% (10,636) 6.6% (10,666)
Pacific 15.8% (22,600) 15.9% (23,800) 17.1% (27,359) 18.8% (30,372)
142,881 149,572 159,578 161,942
Total 52% of total 52% of total 48% of total 48% of total
pop. pop. pop. pop.
Age Group: 65+
New England 5.3% (1,839) 5.0% (1,824) 4.8% (2,167) 4.6% (2,852)
Mid Atlantic 15.4% (5,347) 14.6% (5,281) 13.2% (5,998) 12.2% (7,576)
East North Central 16.4% (5,674) 15.9% (5,783) 14.9% (6,819) 14.2% (8,820)
West North Central 7.5% (2,600) 7.7% (2,784) 7.2% (3,282) 7.1% (4,407)
South Atlantic 19.8% (6,839) 20.0% (7,279) 21.0% (9,568) 2.5% (13,349)
East South Central 6.2% (2,142) 6.3% (2,274) 6.4% (2,921) 6.4% (3,956)
Mountain 5.7% (1,961) 6.5% (2,344) 7.2% (3,270) 7.5% (4,627)
Pacific 13.7% (4,738) 13.6% (4,943) 14.4% (6,565) 15.2% (9,439)
34,613 36,270 45,571 61,954
Total 13% of total 13% of total 14 % of total 18% of total
pop. pop. pop. pop.
YEAR TOTALS 274,541 286,069 333,942 339,408
Source: US Department of Commerce, US Census Bureau
36
Note: above numbers are in thousands
3. US Population By States & Census Regions
Table 2: Ranking Of Percent Of Total US Population By State, 2003

2003 % of Total 2003 % of Total
STATE Population Population STATE Population Population
California 36,558,064 12.89 Kentucky 4,051,887 1.43
Texas 20,886,382 7.37 Oregon 3,551,052 1.25
New York 18,291,511 6.45 Oklahoma 3,461,538 1.22
Florida 15,936,547 5.62 Connecticut 3,292,664 1.16
Pennsylvania 12,353,533 4.36 Iowa 2,954,993 1.04
Illinois 12,323,085 4.35 Mississippi 2,799,141 .99
Ohio 11,545,698 4.07 Kansas 2,785,331 .98
Michigan 9,846,120 3.47 Arkansas 2,639,264 .93
New Jersey 8,254,643 2.91 Utah 2,254,563 .80
Georgia 7,926,882 2.80 New Mexico 1,904,492 .67
N. Carolina 7,856,890 2.77 W. Virginia 1,843,291 .65
Virginia 7,262,647 2.56 Nevada 1,784,850 .63
Washington 6,378,682 2.25 Nebraska 1,734,151 .61
Indiana 6,141,436 2.17 Hawaii 1,391,816 .49
Massachusetts 5,965,809 2.10 Idaho 1,351,583 .48
Tennessee 5,696,067 2.01 Maine 1,252,602 .44
Missouri 5,528,726 1.95 New Hampshire 1,193,105 .42
Maryland 5,458,091 1.93 Rhode Island 1,003,041 .35
Wisconsin 5,477,673 1.93 Montana 947,089 .33
Minnesota 4,925,567 1.74 S. Dakota 786,712 .28
Arizona 4,636,272 1.64 Delaware 778,322 .27
Alabama 4,600,665 1.62 Alaska 728,570 .26
Louisiana 4,563,163 1.61 N. Dakota 650,549 .23
Colorado 4,220,478 1.49 Vermont 600,650 .21
S. Carolina 4,046,468 1.43 Wyoming 544,081 .19
D.C. 539,803 .19
Total US Population 2003 = 283,506,239

The above table rank orders individual State populations in terms of percent share of total US population
for 2003. It is by examining these numbers that population distributions can be considered in relation to
the distribution of practicing Osteopathic physicians across the United States.
These population rates, as well as the following pie chart demonstrate that approximately 44 percent of
the total US population lies in seven states (Ohio, Illinois, Pennsylvania, Florida, New York, Texas, and
California).
37
Figure 1
Population Distribution by U.S. States, 2003
Pennsylvania
Ohio 4%
Illinois
4% 4% Florida
6%
New York
6%
All Other States Texas

56% 7%
California
13%
To explore further, the following pie chart shows the US population distribution on a regional level. In
this context, the US population appears to be more evenly dispersed. It can be implied that this result
appears because the seven states with the highest population totals are spread quite evenly across each of
the four regions of the country.
Figure 2
Population Distribution by U.S. Census Region, 2003
West Northeast
23% 18%
Midwest
23%
South
36%
38
OSTEOPATHIC PHYSICIAN POPULATION DATA
1. DO Population Distribution By State & Census Region

Based on current American Osteopathic Association data, there were 48,678 active/practicing osteopathic
physicians in the United States in 2003. The table below illustrates the distribution of DOs, both active
and inactive, across states. Unlike previous studies, these figures do not assume retirement/inactivity at
the age of 65.
Table 3: Total Number Of Osteopathic Physicians By US State, 2003

State Practicing* Inactive Total State Practicing* Inactive Total
Alaska 97 3 100 Mississippi 261 4 265
Alabama 319 5 324 Montana 95 8 103
Arkansas 188 14 202 N. Carolina 452 25 477
Arizona 1322 162 1484 N. Dakota 54 0 54
California 2866 75 2941 Nebraska 114 3 117
Colorado 772 64 836 N Hampsh. 159 4 163
Connecticut 306 3 309 New Jersey 2758 125 2883
D.C. 45 0 45 N Mexico 195 24 219
Delaware 214 9 223 Nevada 343 21 364
Florida 3295 436 3731 New York 3131 72 3203
Georgia 648 28 676 Ohio 3494 219 3713
Hawaii 145 3 148 Oklahoma 1393 66 1459
Iowa 1009 48 1057 Oregon 454 42 496
Idaho 152 3 155 Penn. 5396 277 5673
Illinois 2048 36 2084 Rh. Island 207 5 212
Indiana 718 35 753 S. Carolina 276 17 293
Kansas 560 38 598 S. Dakota 73 4 77
Kentucky 328 4 332 Tennessee 414 20 434
Louisiana 97 5 102 Texas 3033 177 3210
Mass. 450 26 476 Utah 180 3 183
Maryland 531 10 541 Virginia 593 20 613
Maine 565 25 590 Vermont 53 5 58
Michigan 4910 369 5279 Washington 642 47 689
Minnesota 308 8 316 Wisconsin 563 34 597
Missouri 1844 141 1985 W. Virginia 559 18 577
Wyoming 49 3 52
Source: American Osteopathic Association, Department of Membership
*Active/Practicing: DOs who have not informed the AOA that they have retired or become inactive.
The following table demonstrates that concentrations exist with regards to the practicing DO population
in the United States. Nearly sixty percent of practicing Osteopathic Physicians reside in eight states:
Pennsylvania, Michigan, Ohio, Florida, New York, Texas, California, and New Jersey. The remaining
forty percent are dispersed throughout the rest of the country. This table (Table 4) rank orders states in
terms of total number of practicing osteopathic physicians.
39
Table 4: Ranking of Percent of Total Practicing DOs By US State, 2003
% of Total % of Total US % of Total % of Total
Practicing Pop. Practicing US Pop.
State Total DOs State Total DOs
Penn. 5396 11.09 4.36 Mass. 450 .92 2.10
Michigan 4910 10.09 3.47 Tennessee 414 .85 2.01
Ohio 3494 7.18 4.07 Nevada 343 .70 .63
Florida 3295 6.77 5.62 Kentucky 328 .67 1.43
New York 3131 6.43 6.45 Alabama 319 .66 1.62
Texas 3033 6.23 7.37 Minnesota 308 .63 1.74
California 2866 5.89 12.89 Connecticut 306 .63 1.16
New Jersey 2758 5.67 2.91 S. Carolina 276 .57 1.43
Illinois 2048 4.21 4.35 Mississippi 261 .54 .99
Missouri 1844 3.79 1.95 Delaware 214 .44 .27
Oklahoma 1393 2.86 1.22 Rh. Island 207 .43 .35
Arizona 1322 2.72 1.64 N. Mexico 195 .40 .67
Iowa 1009 2.07 1.04 Arkansas 188 .39 .93
Colorado 772 1.59 1.49 Utah 180 .37 .80
Indiana 718 1.47 2.17 N. Hampsh. 159 .33 .42
Georgia 648 1.33 2.80 Idaho 152 .31 .48
Washington 642 1.32 2.25 Hawaii 145 .30 .49
Virginia 593 1.22 2.56 Nebraska 114 .23 .61
Maine 565 1.16 .44 Louisiana 97 .20 1.61
Wisconsin 563 1.16 1.93 Alaska 97 .20 .26
Kansas 560 1.15 .98 Montana 95 .20 .33
W. Virginia 559 1.15 .65 S. Dakota 73 .15 .28
Maryland 531 1.09 1.93 N. Dakota 54 .11 .23
Oregon 454 .93 1.25 Vermont 53 .11 .21
N. Carolina 452 .93 2.77 Wyoming 49 .10 .19
D.C. 45 .09 .19
TOTAL POPULATION OF PRACTICING DOs IN US = 48,678
Source: US Census Bureau & American Osteopathic Association Department of Membership
Table four (above) can be compared to the total US population distributions presented in Table two to get
an idea of how proportionately the DO population is spread across the United States. An easier to
understand demonstration of how practicing osteopathic physicians are distributed across the United
States is shown in the pie chart below. Clearly, a majority practice in the eight states mentioned above
(New Jersey, California, Texas, New York, Florida, Ohio, Michigan, and Pennsylvania) while a far lesser
amount practice in the remaining US states.
40
Figure 3
Distribution of Practicing DO's by State, 2003

California
New Jersey Texas
6%
6% 6%
All Other States New York
41% 6%
Florida
7%
Ohio
Pennsylvania Michigan 7%
11% 10%
Likewise, approximately forty-seven percent of the total US population resides in these eight states. This
indicates that there are likely states with a disproportionate amount of DOs to their total population size.
For example, as can be seen in the above table (Table 4), only two-tenths (0.2) of one percent of
practicing osteopathic physicians reside in Louisiana, while the total state population is 1.61 percent of
the US total. Arizona, a state with a similar share of the total population (1.64 percent), enjoys 2.72
percent of practicing DOs. Clearly there are discrepancies in the geographic distribution of osteopathic
physicians in the US
Further comparisons across state and DO population totals reveal that Pennsylvania, Michigan, Ohio,
New Jersey, and Missouri have the largest concentrations of Osteopathic Physicians, as compared to their
share of the total population. That is, they enjoy a larger proportion of osteopathic physicians than their
total state population suggests they should. Conversely, the states that most severely lack the benefit of
having a DO population proportionate to their total population are: California, North Carolina, Georgia,
Louisiana, and Virginia. This is further demonstrated in the following graphs.
Figure 4
States With Greatest DO Share

Compared to Total Population
Percent
12 11.09
10.09
10 % OF
PRACTICING
8 7.18
TOTAL
5.67
6 4.36 4.07 3.79
3.47
4 % OF TOTAL
2.91 1.95 U.S. POP.
2
0
Penn. Michigan Ohio New Jersey Missouri
State
41
Figure 5
States With Smallest DO Share
Compared to Total Population
14
12.89
12
10 % OF
PRACTICING
Percents
8 TOTAL
5.89
6
% OF TOTAL
4 U.S. POP.
2.77 2.8 2.56
1.33 1.61 1.22
2
0.93
0.2
0
California N. Carolina Georgia Louisiana Virginia
State
An alternative means of examining where the unevenness in DO distribution is occurring is to divide the
osteopathic physician population by census region and census division. Before such methods are
employed, the following graphic can be reviewed as a means of determining which states are contained
within each census region and division.
Figure 6: US Map by Census Region
42
When comparing the United States population by census region to the DO population by census region, as
demonstrated in the charts below, there are clear discrepancies. It appears that both the Western and
Southern regions have a less than proportionate share of practicing DOs, while the Midwest and Northeast
enjoy larger that their population’s proportion of DOs.
Figure 7
Population Distribution by
U.S. Census Region, 2003
West Northeast
23% 18%
Midwest
23%
South
36%
Figure 8
Practicing D.O. Distribution by

U.S. Census Region, 2003
West
15% Northeast
27%
South
26%
Midwest
32%
The following bar graph reiterates that DO and total populations are not evenly distributed. It clearly
demonstrates that the Northeast and Midwest enjoy larger than their population’s proportion of DOs. For
43
this reason, the South and West lack a share of the practicing DO population (even) equal to their share of
the total US population.
Figure 9
D.O. vs. Total Population by U.S. Census Region

Percent
40%
35%
30%
25% Total
20% Population
15% D.O.
10% Population
5%
0%
Northeast Midwest South West
Region
An even more comprehensible picture emerges when comparing the US population and practicing DO
population by census division (subcategories of regions). Again, refer to the above map graphic (Figure
6) detailing the states contained within particular census regions and/or divisions. Across the United
States, the total population is concentrated primarily within the Mid Atlantic, West South Central, East
North Central, and Pacific census divisions – accounting for approximately 65 percent of the total
population. As can be seen by comparing the two pie charts below, these same census divisions enjoy 74
percent of the total practicing DO population. Clearly, there is inequality in the distribution of the DO
population across the United States. The largest inequalities are currently centered in the South and West,
most drastically in the South Atlantic and East South Central states.
44
Figure 10
Population Distribution by U.S. Census Division, 2003
E.S. Central W.S. Central

S. Atlantic 6% 11%
Mountain
18%
6%
W.N. Central Pacific

7% 17%
E.N. Central New England

16% Mid Atlantic 5%
14%
Figure 11
Practicing D.O. Distribution by U.S. Census Division, 2003
Pacific New England

Mountain 9% 4%
7% Mid Atlantic
23%
W.S. Central
10%
E.S. Central
3%
S. Atlantic
14% E.N. Central
W.N. Central
24%
6%
A final way to explore discrepancies in the distributions of total population and DO population is to
consider how heavily Census regions and divisions rely on their largest DO states. For example, in the
North East region of the United States, the state with the largest share of the DO population is
Pennsylvania (N=5,396). If this State were pulled from the regional DO totals, the Northeast would be
left with only 58.5 percent of its original total of the osteopathic physician population. The table below
shows how each region would be affected if its ‘largest DO’ state were pulled. These numbers indicate
45
that regions are perhaps relying too heavily on the DO totals of these individual states to conclude the
sufficiency of their total regional and/or divisional supply of physicians.
Table 5: US Regional DO Totals Excluding Largest DO States, 2003

% of Total Nat. Largest DO % of Region DO Population Lost
REGION DO Population State in Region when Excluding Largest DO State
Northeast 27% Pennsylvania 41.5%
Midwest 32% Michigan 31.3%
South 26% Florida 26%
West 15% California 39%
By examining the phenomenon of DO outlier states on an even more specific level (Census division), it is
possible to see just how reliant each section of the US is on particular states in determining DO to patient
calculations. The table below shows how each census division would be affected if its largest DO state
were pulled. On a divisional level, it is clear that individual states account for a large proportion of stated
DO population totals. For example, both the Pacific and West South Central divisions would loose more
than 60 percent of their total Osteopathic physician population if their ‘largest DO states’ were pulled.
Table 6: US Divisional DO Totals Excluding Largest DO States, 2003

% of Division DO Population
% of Total Nat. Largest DO State Lost when Excluding Largest
DIVISION DO Population in Division DO State
Pacific 9% California 68.2%
West South Central 10% Texas 64.4%
South Atlantic 14% Florida 49.8%
Mid Atlantic 23% Pennsylvania 47.8%
West North Central 6% Missouri 46.5%
Mountain 7% Arizona 42.5%
East North Central 24% Michigan 41.8%
New England 4% Maine 32.5%
East South Central 3% Tennessee 31.3%
46
2. DO Population Relative to College of Medicine & Census Region
The following graphs give a general indication of where DOs from particular COM’s currently
practice medicine. They detail the regional distribution of practicing DOs based on COM of
graduation.
Figure 12
Region of Practice: AZ-COM Graduates
Nearly half (46%) of

46%
practicing DO graduates from
Percent
22.30% 19.40% AZ-COM practice medicine in

12.30% the Western region of the
United States.
U.S. Census Region
Figure 13
Region of Practice: C-COM Graduates
A majority (62.8%) of
62.80% practicing DO graduates from
Percent
C-COM practice medicine in

14.60% 14.90% the Midwest region of the
7.70%
United States.
U.S. Census Region
Figure 14
Region of Practice: Des Moines COM Graduates
48.90% Nearly half (48.9%) of
Percent
Des Moines COM practice

15.50% 18.70% 16.90%
medicine in the Midwest
region of the United States.
U.S. Census Region
47
Figure 15
Region of Practice: K-COM Graduates

Nearly half (47.3%) of
Percent
K-COM practice medicine in

22.80% 19% the Midwest region of the
10.90%
United States.

U.S. Census Region
Figure 16
Region of Practice: LE-COM Graduates
Percent
LE-COM practice medicine in

20.20% the Northeast region of the
14%
2.30%
United States.
U.S. Census Region
Figure 17
Region of Practice: MSU-COM Graduates
73.60% A large majority (73.6%) of

Percent
MSU-COM practice medicine

4.60% 11.20% 10.60% in the Midwest region of the
United States.
U.S. Census Region
Figure 18
Region of Practice: NSU-COM Graduates
66.60%
Percent
NSU-COM practice medicine

15.40% 11.80% 6.20% in the Southern region of the
United States.
U.S. Census Region
48
Figure 19
Region of Practice: NY-COM Graduates
A large majority (79.2%) of
Percent
NY-COM practice medicine

in the Northeast region of the
4.90% 11.50% 4.40% United States.
U.S. Census Region
Figure 20
Region of Practice: OSU-COM Graduates
Percent
OSU-COM practice medicine

16.20%
9.30%
in the Southern region of the
2.70% United States.
U.S. Census Region
Figure 21
Region of Practice: OU-COM Graduates
Percent
OU-COM practice medicine

6.90% 13.30% 7.10%
in the Midwest region of the
United States.

U.S. Census Region
Figure 22
Region of Practice: P-COM Graduates
Percent
28.10% P-COM practice medicine in

7.30% the Northeast region of the
U.S. Census Region
49
Figure 23
Region of Practice: PC-SOM Graduates
Percent
31.50% PC-SOM practice medicine in

6.30% the Southern region of the
0% United States.
U.S. Census Region
Figure 24
Region of Practice: TU-COM Graduates
Percent
TU-COM practice medicine in

the Western region of the
9.40% 5.50% 7% United States.
U.S. Census Region
Figure 25
Region of Practice: UHS-COM Graduates
Practicing DO graduates from
40.90% UHS-COM primarily (40.9%)
Percent
29.20%
practice medicine in the
12.30% 17.60% Midwest region of the United
States.

U.S. Census Region
Figure 26
Region of Practice: UMDNJ-COM Graduates
Percent
UMDNJ-COM practice
4.60% 15.30% 5.40% medicine in the Northeast
region of the United States.
U.S. Census Region
50
Figure 27
Region of Practice: UNE-COM Graduates
Percent
UNE-COM practice medicine

10.60% 14.40% 9.10%
in the Northeast region of the
United States.
U.S. Census Region
Figure 28
Region of Practice: UNT-HSC Graduates
75%
A large majority (75%) of
Percent

UNT-HSC practice medicine
9.80% 11.50% in the Southern region of the
3.70%
United States.
U.S. Census Region
Figure 29
Region of Practice: WV-SOM Graduates
69.30% A majority (69.3%) of
Percent
WV-SOM practice medicine

18.30%
8.90% in the Southern region of the
U.S. Census Region
Figure 30
Region of Practice: WU Graduates
75.10%
Percent
WU practice medicine in the

10.50% 9.50% Western region of the United
4.90% States.
U.S. Census Region
51
The numbers in the tables below also specify, by region, where the highest concentration of DOs
graduating from specified osteopathic medical schools currently practice. For example,
approximately six percent (7 of 111) of Pikeville College-School of Osteopathic Medicine
graduates currently practice medicine in the Northeast region of the United States, while nearly
sixty percent of practicing osteopathic physicians in the Northeast states attended Pennsylvania
College of Osteopathic Medicine. The following tables demonstrate that in every instance, the
region in which a College of Osteopathic Medicine is located is also where the overwhelming
number of its graduates practice medicine.
Table 7
DO Population by COM & Census Region: Northeast
COM of Graduation Region of Current Practice National Total
NORTHEAST
P-COM (Pennsylvania) 4819 8149
NY-COM (New York) 2562 3236
UNE-COM (Maine) 1040 1579
UMDNJ-COM (New Jersey) 880 1178
Des Moines (Iowa) 905 5822
UHS-COM (Missouri) 652 5318
K-COM (Missouri) 519 4749
LE-COM (Pennsylvania) 364 573
C-COM (Illinois) 300 3898
NSU-COM (Florida) 300 1954
MSU-COM (Michigan) 138 2981
OU-COM (Ohio) 126 1821
WV-SOM (W. Virginia) 122 1375
WU (California) 115 2367
UNT-HSC (Texas) 85 2311
OSU-COM (Oklahoma) 49 1782
AZ-COM (Arizona) 38 309
TU-COM (California) 12 128
PC-SOM (Kentucky) 7 111
Summary: The tally of practicing physicians in the Northeast region of the United
States, who also attended a College of Osteopathic Medicine in this region (P-COM,
LE-COM, UMDNJ-COM, UNE-COM, or NY-COM) amounts to just under sixty-
six percent (65.7%).
52
Table 8
DO Population by COM & Census Region: Midwest
MIDWEST
OU-COM (Ohio) 1323 1821
Summary: As in the Northeast, the tally of practicing physicians in the Midwest

region of the United States, who also attended a College of Osteopathic Medicine in
this region (Des Moines, UHS-COM, K-COM, C-COM, MSU-COM, or OU-COM)
amounts to a majority – with just over half (53.8%) remaining to practice in the
region of their training.
53
Table 9
DO Population by COM & Census Region: South
SOUTH
Summary: Though possessing a smaller share of graduates than the aforementioned

regions, COM’s from the Southern region appear to retain graduates for practice in
their region at a higher rate. The tally of practicing Osteopathic physicians in the
Southern region of the United States who also attended a College of Osteopathic
Medicine in this region (WV-SOM, OSU-COM, NSU-COM, or UNT-HSC) amounts
to over seventy percent (70.9%).
54
Table 10
DO Population by COM & Census Region: West
WEST
Summary: As in the South, the Western region of the United States does not enjoy a
large share of practicing Osteopathic physicians. Again though, it is evident that
those attending a COM in this region (AS-COM, WU, or TU-COM) are more likely
to stay to practice in one of the Western states. Over seventy percent (72.1%) of
those attending one of the COM’s in the Western states continue to practice
medicine in the Western region of the US
The above tables and graphs demonstrate that the region in which a College of Osteopathic
Medicine is located is also where the majority of its graduates remain to practice medicine. This
is further demonstrated in the table below. Clearly, the majority of osteopathic physicians
practice in the same state in which they attended medical school. For every College of
Osteopathic Medicine, the largest proportion of graduates practice in the region in which they
received their medical training.
55
Table 11 Percent of Practicing DOs by COM of Graduation in US Census Regions, 2003
College Region of Current Practice
NORTHEAST MIDWEST SOUTH WEST
AZ-COM 12.3 22.3 19.4 46.0
C-COM 7.7 62.8 14.6 14.9
Des Moines 15.5 48.9 18.7 16.9
K-COM 10.9 47.3 22.8 19.0
LE-COM 63.5 20.2 14.0 2.3
MSU-COM 4.6 73.6 11.2 10.6
NSU-COM 15.4 11.8 66.6 6.2
NY-COM 79.2 4.9 11.5 4.4
OSU-COM 2.7 16.2 71.8 9.3
OU-COM 6.9 72.7 13.3 7.1
P-COM 59.1 7.3 28.1 5.5
PC-SOM 6.3 31.5 62.2 0
TU-COM 9.4 5.5 7.0 78.1
UHS-COM 12.3 40.9 29.2 17.6
UMDNJ-COM 74.7 4.6 15.3 5.4
UNE-COM 65.9 10.6 14.4 9.1
UNT-HSC 3.7 9.8 75.0 11.5
WV-SOM 8.9 18.3 69.3 3.5
WU 4.9 10.5 9.5 75.1
Does it matter if a State and/or census division has an osteopathic medical school? The answer to this
question is clear. The evidence presented in the above tables and graphs indicate that the existence of a
College of Osteopathic Medicine is a good predictor of a high concentration of DOs within a State. The
above tables detailing DO population by COM and census region show that 78 percent (37,951 of 48,678)
of active Osteopathic physicians reside in the 16 States where a College of Osteopathic Medicine is
located.
The following table demonstrates that date of first graduating class is not as large a determining factor in
state DO population size as be might expected. This implies that class size is likely a larger determining
factor in state DO populations than is the age of any given College of Osteopathic Medicine.
This table, as well as the following pie chart demonstrates that over three-quarters of practicing
osteopathic physicians practice medicine in a State with a College of Osteopathic Medicine. This
reiterates the fact that osteopathic physicians tend to practice medicine in states/divisions with COM’s –
or more likely – in the general vicinity of where they received medical training.
56
Table 12: Active DO Population Across States with a COM as Compared to Date of 1ST
Graduating Class of COM in Given State Note: Items in Parentheses indicate Census Division of given COM
Date of 1st Current DO Current DO
College of State & Graduating Population in Population in
Medicine Census Division Class State of COM Division of COM
K-COM 1894
UHS-COM Missouri (West N. Central) 1917 1,844 2,952
Des Moines Iowa (West N. Central) 1902 1,009
C-COM Illinois (East N. Central) 1900 2,048
MSU-COM Michigan (East N. Central) 1973 4,910 11,726
OU-COM Ohio (East N. Central) 1980 3,494
P-COM 1900
LE-COM Pennsylvania (Mid Atlantic) 1996 5,396
UMDNJ-COM New Jersey (Mid Atlantic) 1980 2,758 11,283
NY-COM New York (Mid Atlantic) 1981 3,131
UNT-HSC Texas (West S. Central) 1974 3,033
OSU-COM Oklahoma (West S. Central) 1977 1,393 4,708
WV-SOM W. Virginia (S. Atlantic) 1978 559 6,610
UNE-COM Maine (New England) 1982 565 1,739
WU 1982
TU-COM California (Pacific) 1999 2,866 13,205
NSU-COM Florida (South Atlantic) 1985 3,295 6,610
AZ-COM Arizona (Mountain) 2000 1,322 3,103
PC-SOM Kentucky (East S. Central) 2001 328 1,322
Total DO population across states with a College of Osteopathic Medicine = 37,951

Note: the Edward Via Virginia College of Osteopathic Medicine will graduate its first class in 2007
57
Figure 31
Percent of DO's Practicing in States with COM's
23% D.O.'s practicing in a

state with a COM
D.O.'s practicing in a
state w/o a COM
77%
In broader terms, the below table also summarizes how the location of a COM relates to the DO
population in a given Census Region. Again, the presence of a College of Osteopathic Medicine
increases the number of DOs in a given geographic area. That is, the more COM’s in a given region, the
greater the proportion of practicing DOs in that region. Notice that approximately 41 percent of
osteopathic physicians reside in the Western and Southern regions. It was previously demonstrated that
approximately 59 percent of the total population lies in these states. Again, the disproportionality in
where physicians live and where the greater population lives is apparent.
Table 13 Relationship between Number of COMs & Proportion of DO Population, 2003

Census # of # of Osteopathic Percent of Total Percent of Total
Regions States in Region Medical Schools Active DO Population US Population
MIDWEST 12 6 32.2% 23%
NORTHEAST 9 5 26.8% 18%
SOUTH 17 5 26.0% 36%
WEST 13 3 15.0% 23%
Source: American Osteopathic Association, Department of Membership & US Census Bureau
58
3. Practicing DOs In US Census Regions, Divisions & States By COM
The subsequent sections present a more detailed examination of how the geographic location of a College
of Osteopathic Medicine determines where osteopathic physicians practice medicine. The following key
can be used as a reference to determine which states fall within the discussed Census regions and
divisions.
Table 14 US Census Regions & Divisions
NORTHEAST MIDWEST SOUTH WEST

Region 1 Region 2 Region 3 Region 4
New England East North Central South Atlantic Mountain
Connecticut Illinois Delaware Arizona
Maine Indiana Dist. of Columbia Colorado
Massachusetts Michigan Florida Idaho
New Hampshire Ohio Georgia Montana
Rhode Island Wisconsin Maryland New Mexico
Vermont North Carolina Utah
South Carolina Nevada
Mid Atlantic West North Central Virginia Wyoming
New Jersey Iowa West Virginia
New York Kansas
Pennsylvania Minnesota East South Central Pacific
Missouri Alabama Alaska
Nebraska Kentucky California
North Dakota Mississippi Hawaii
South Dakota Tennessee Oregon
Washington
West South Central
Arkansas
Louisiana
Oklahoma
Texas
Note: Divisions within the primary US Census Regions are divided by a highlighted heading.
59
Regional Figures
Connecticut, Maine, Massachusetts,

New Hampshire, Rhode Island,
Vermont, New Jersey, New York,
Pennsylvania
Table 15
Practicing DOs by COM of Graduation in Northeast Census Region*
College of Medicine # of DOs Percent

Philadelphia COM (Pennsylvania) 4819 37
New York COM (New York) 2552 20
University of Medicine and Dentistry of NJ, School of Osteopathic 1040 8
Medicine
(New Jersey)
University of New England COM (Maine) 905 8
Des Moines University – Osteopathic Medical Center (Iowa) 880 7
University of Health Sciences COM (Missouri) 652 5
Kirksville COM (Missouri) 519 4
Lake Erie COM (Pennsylvania) 364 3
Chicago COM (Illinois) 300 2
Nova Southeastern University COM (Florida) 300 2
Michigan State University COM (Michigan) 138 1
Ohio University COM (Ohio) 126 >1
West Virginia School of Osteopathic Medicine (West Virginia) 122 >1
Western University of Health Science COM of the Pacific (California) 115 >1
University of North Texas Health Science Center, Fort Worth (Texas) 85 >1
Oklahoma State University COM (Oklahoma) 49 >1
Arizona COM (Arizona) 38 >1
Touro University COM (California) 11 >1
Pikeville College School of Osteopathic Medicine (Kentucky) 7 >1
TOTAL N=
13,022
*NOTE: percents are rounded to the nearest whole number
Summary: A large majority of osteopathic physicians currently practicing in the

Northeast region of the United States attended a college of osteopathic medicine
(COM) within the same region. Seventy-six percent attended Philadelphia COM,
New York COM, University of Medicine and Dentistry of New Jersey School of
Medicine, University of New England COM, or Lake Erie COM.
60
Illinois, Indiana, Michigan, Ohio,
Wisconsin, Iowa, Kansas,
Minnesota, Missouri, Nebraska,
N. Dakota, S. Dakota
Table 16
Practicing DOs by COM of Graduation in Midwest Census Region *
College of Medicine # of DOs Percent

Ohio University COM (Ohio) 1323 8
Oklahoma State University COM (Oklahoma) 288 2
West Virginia School of Osteopathic Medicine (West Virginia) 252 2
Western University of Health Science COM of the Pacific (California) 248 2
University of North Texas Health Science Center, Fort Worth (Texas) 226 1
Lake Erie COM (Pennsylvania) 116 >1
University of Medicine and Dentistry of NJ, School of Osteopathic 54 >1
Medicine
(New Jersey)
TOTAL N = 15,695
Summary: Like the Northeast, a large majority of osteopathic physicians currently

practicing in the Midwest region of the United States attended a college of
osteopathic medicine (COM) within the same region. Eighty-four percent attended
Des Moines Osteopathic Medical Center, Chicago COM, Kirksville COM, Michigan
State University COM, University of Health Sciences COM, or Ohio University
COM.
61
Delaware, D.C., Florida, Georgia, Maryland,
N. Carolina, S. Carolina, Virginia, W. Virginia,
Alabama, Kentucky, Mississippi, Tennessee,
Arkansas, Louisiana, Oklahoma, Texas
Table 17
Practicing DOs by COM of Graduation in South Census Region*
College Of Medicine # of DOs Percent

West Virginia School of Osteopathic Medicine (West Virginia) 953 8
University of Medicine and Dentistry of NJ, School of Osteopathic Medicine 180 1
(New Jersey)
TOTAL N = 12,646
Summary: Unlike the Northeast and Midwestern regions, a minority of osteopathic

physicians currently practicing in the Southern region of the United States attended
a college of osteopathic medicine (COM) within the same region. Forty-three
percent attended University of North Texas Health Science Center, Nova
Southeastern University COM, Oklahoma State University COM, West Virginia
School of Osteopathic Medicine, or Pikeville College School of Osteopathic
Medicine. The remainder of DOs in this region attended COM’s in regions other
that that of their current practice.
62
Arizona, Colorado, Idaho, Montana,
New Mexico, Utah, Nevada,
Wyoming, Alaska, California,
Hawaii, Oregon, Washington
Table 18
Practicing DOs by COM of Graduation in West Census Region*

Arizona COM (Arizona) 142 2
Touro University COM (California) 102 1
University of Medicine and Dentistry of NJ, School of Osteopathic 64 >1
Medicine
(New Jersey)
West Virginia School of Osteopathic Medicine (West Virginia) 48 >1
TOTAL N = 7,312
Summary: Similar to the Southern region, a minority of osteopathic physicians

currently practicing in the Western region of the United States attended a college of
osteopathic medicine (COM) within the same region. Twenty-eight percent
attended Western University of Health Science COM, Arizona COM, or Touro
University COM. The remainder of DOs in this region attended COM’s in regions
other that that of their current practice.
63
Division Figures
I. Practicing DOs by COM of Graduation in Northeast Census Divisions
Connecticut, Maine, Massachusetts,

New Hampshire, Rhode Island,
Vermont
Table 19
Division 1: New England
University of New England COM (Maine) 709 40.7
Philadelphia COM (Pennsylvania) 208 12.0
New York COM (New York) 165 9.5
University of Health Sciences COM (Missouri) 125 7.2
Des Moines University – Osteopathic Medical Center (Iowa) 104 6.0
Kirksville COM (Missouri) 103 5.9
Chicago COM (Illinois) 63 3.6
Michigan State University COM (Michigan) 49 2.8
University of Medicine & Dentistry of NJ, School of Osteopathic 45 2.6
Medicine
(New Jersey)
Nova Southeastern University COM (Florida) 44 2.5
University of North Texas Health Science Center, Fort Worth (Texas) 28 1.6
Western University of Health Science COM of the Pacific (California) 25 1.4
Ohio University COM (Ohio) 23 1.3
Oklahoma State University COM (Oklahoma) 14 .8
West Virginia School of Osteopathic Medicine (West Virginia) 12 .7
Arizona COM (Arizona) 11 .6
Lake Erie COM (Pennsylvania) 9 .5
Touro University COM (California) 1 .1
Pikeville College School of Osteopathic Medicine (Kentucky) 1 .1
TOTAL N = 1,739
Summary: Nearly forty-one percent of osteopathic physicians currently practicing in the New England
division of the United States attended the only college of osteopathic medicine (COM) within this census
division – the University of New England College of Osteopathic Medicine.
64
New Jersey, New York, Pennsylvania
Table 20
Division 2: Mid Atlantic
University of Medicine and Dentistry of NJ, School of Osteopathic 835 7.4
Medicine
(New Jersey)
Lake Erie COM (Pennsylvania) 355 3.1
West Virginia School of Osteopathic Medicine (West Virginia) 110 1.0
Ohio University COM (Ohio) 103 .9
Western University of Health Science COM of the Pacific (California) 90 .8
Michigan State University COM (Michigan) 89 .8
University of North Texas Health Science Center, Fort Worth (Texas) 57 .5
Oklahoma State University COM (Oklahoma) 35 .3
TOTAL N = 11,283
Summary: An overwhelming majority of osteopathic physicians currently practicing

in the Mid Atlantic division of the United States attended a college of osteopathic
medicine (COM) within this census division. Approximately seventy-three percent
attended Philadelphia COM, New York COM, University of Medicine and Dentistry
of New Jersey SOM, or Lake Erie COM.
65
Practicing DOs by COM of Graduation in Midwest Census Divisions
Illinois, Indiana, Michigan,

Ohio, Wisconsin
Table 21
Division 3: East North Central
Oklahoma State University COM (Oklahoma) 116 1.0
University of Medicine and Dentistry of NJ, School of Osteopathic 47 .4
Medicine
(New Jersey)
TOTAL N = 11,726
Summary: Nearly half of the osteopathic physicians currently practicing in the East North Central
division of the United States attended a college of osteopathic medicine (COM) within this census
division. Approximately forty-nine percent attended Chicago COM, Michigan State University COM, or
Ohio University COM.
66
Iowa, Kansas, Minnesota, Missouri,
Nebraska, N. Dakota, S. Dakota
Table 22
Division 4: West North Central
Nova Southeastern University COM (Florida) 24 .8
University of New England COM (Maine) 22 .7
Ohio University COM (Ohio) 15 .5
New York COM (New York) 15 .5
Medicine
(New Jersey)
Pikeville College School of Osteopathic Medicine (Kentucky) 1 0
TOTAL N = 2,952
Summary: An overwhelming majority of osteopathic physicians currently practicing in the West North
Central division of the United States attended a college of osteopathic medicine (COM) within this census
division. Approximately eighty-one percent attended University of Health Sciences COM, Kirksville
COM, or Des Moines University Osteopathic Medical Center.
67
Practicing DOs by COM of Graduation in Southern Census Divisions
Delaware, D.C., Florida, Georgia,

Maryland, N. Carolina, S. Carolina,
Virginia, W. Virginia
Table 23
Division 5: South Atlantic
Medicine
(New Jersey)
TOTAL N = 6,610
Summary: Less than one-third of osteopathic physicians currently practicing in the

South Atlantic division of the United States attended a college of osteopathic
medicine (COM) within this census division. Approximately twenty-nine percent
attended either Nova Southeastern University COM or West Virginia SOM.
68
Alabama, Kentucky,
Mississippi, Tennessee
Table 24
Division 6: East South Central
West Virginia School of Osteopathic Medicine (West Virginia) 180
13.6
Pikeville College School of Osteopathic Medicine (Kentucky) 56 4.2
Medicine
(New Jersey)
TOTAL N = 1,322
Summary: An underwhelming minority of osteopathic physicians currently

practicing in the East South Central division of the United States attended the only
college of osteopathic medicine (COM) within this census division. Only about four
percent attended the Pikeville College SOM.
69
Arkansas, Louisiana,
Oklahoma, Texas
Table 25
Division 7: West South Central
New York COM (New York) 42 .9
University of New England COM (Maine) 32 .7
Medicine
(New Jersey)
TOTAL N = 4,708
Summary: Over half of the osteopathic physicians currently practicing in the West South Central division
of the United States attended a college of osteopathic medicine (COM) within this census division.
Approximately fifty-seven percent attended either the University of North Texas Health Science Center,
or Oklahoma State University COM.
70
IV. Practicing DOs by COM of Graduation in Western Census Divisions
Arizona, Colorado, Idaho,

Montana, New Mexico, Utah,
Nevada, Wyoming
Table 26
Division 8: Mountain
Arizona COM (Arizona) 95 3.1
Medicine
(New Jersey)
TOTAL N = 3,103
Summary: An underwhelming minority of osteopathic physicians currently

practicing in the Mountain division of the United States attended the only college of
osteopathic medicine (COM) within this census division. Only about three percent
attended the Arizona COM.
71
Alaska, California, Hawaii,
Oregon, Washington
Table 27
Division 9: Pacific
Touro University COM (California) 89 2.1
Arizona COM (Arizona) 47 1.1
Medicine
(New Jersey)
TOTAL N = 13,025
Summary: Approximately one-third of osteopathic physicians currently practicing

in the Pacific division of the United States attended the only college of osteopathic
medicine (COM) within this census division. Roughly thirty-four percent attended
the Western university of Health Science COM of the Pacific.
The distribution of DOs across census region is closely mirrored by the distribution of students by census
region, as is demonstrated in the table below. Both groups (DOs and students) are least concentrated in
the West, followed by the South and Northeast, with both emerging in highest volume in the Midwest. It
can be implied that students are clustered where there are concentrations of DOs (and Colleges of
Osteopathic Medicine).
72
More importantly, this implies that the distribution of Osteopathic Physicians is not going to change. If
students continue to remain in areas near COM's, as practicing DOs do, the distribution of osteopathic
physicians across the United States will remain disproportionate in nature.
Table 28: DISTRIBUTION OF DOs & STUDENTS by US CENSUS REGION, 2003

% of % of
Practicing Practicing Students Students
REGION
Northeast 13,025 26.8 3,571 31.3
Midwest 15,695 32.2 3,685 32.3
South 12,646 26.0 2,358 20.7
West 7,312 15.0 1,798 15.8
TOTAL 48,678 100 11,412 100
Interestingly, it appears from the table below that retired/inactive DOs shift where they reside, with the
majority being located in the Southern or Midwestern states.
Table 29: DISTRIBUTION of NON-PRACTICING DOS by US CENSUS REGION, 2003

Non- % of Non-
Practicing Practicing
REGION
Northeast 542 19.4
Midwest 935 33.5
South 858 30.7
West 458 16.4
TOTAL 2,793 100
STATE FIGURES
The following table shows which College of Osteopathic Medicine the majority of practicing osteopathic
physicians graduated from, on a state-by-state basis. For example, in Michigan, the majority of practicing
DOs graduated from Michigan State University COM.
73
Table 30: COM WITH LARGEST DO GRADUATE REPRESENTATION by US STATES, 200311
LARGEST COM LARGEST COM
STATE REPRESENTATION STATE REPRESENTATION
ACROSS ACROSS
PRACTICING DOs PRACTICING DOs
Alaska Des Moines Mississippi UHS-COM
Alabama UHS-COM Montana UHS-COM
Arkansas OSU-COM N. Carolina P-COM
Arizona K-COM N. Dakota Des Moines
California WU Nebraska Des Moines
Colorado UHS-COM New Hampshire UNE-COM
Connecticut NY-COM New Jersey P-COM
D.C. P-COM New Mexico UHS-COM
Delaware P-COM Nevada Des Moines
Florida NSU-COM New York NY-COM
Georgia UHS-COM Ohio OU-COM
Hawaii UHS-COM Oklahoma OSU-COM
Iowa Des Moines Oregon Des Moines
Idaho Des Moines Pennsylvania P-COM
Illinois C-COM Rhode Island UNE-COM
Indiana C-COM S. Carolina P-COM
Kansas UHS-COM S. Dakota Des Moines
Kentucky PC-SOM Tennessee UHS-COM
Louisiana UNT-HSC Texas UNT-HSC
Massachusetts UNE-COM Utah K-COM
Maryland P-COM Virginia P-COM
Maine UNE-COM Vermont UNE-COM
Michigan MSU-COM Washington Des Moines
Minnesota Des Moines Wisconsin Des Moines
Missouri UHS-COM W. Virginia WV-SOM
Wyoming UHS-COM
11
A more specific breakdown of COM graduation across practicing DOs by State, is provided in Appendix B. The exact number
of practicing DOs from each of the COM’s by state is detailed here. For example, Appendix B demonstrates that none of the
practicing DOs in North Dakota graduated from University of New England COM.
74
OSTEOPATHIC PHYSICIAN PROJECTIONS
1. Population-Based DO Projections to 2025 by State & US Census Region/Division

In order to determine the likely distribution of Osteopathic physicians into the future, US Census
Bureau population projections were used to project DO population by State, Region, and
Division – from present to 2025. The DO projections reported in the below tables use the
proportion of DOs by State (in 2003) as the base for calculations. For example, in 2003, .044
percent of Pennsylvania’s total population consisted of practicing DOs. Therefore, .044 percent
of Pennsylvania’s population (as projected by the US Census) was taken to project DO figures
over time. This method assumes that the proportion of DOs in the population will remain
constant based on 2003 national figures (.02% of total US population).
75
Table 31
PRACTICING DO PROJECTIONS by STATE 2003-2025
STATE YEAR
2003 2005 2010 2015 2020 2025
Alabama 319 327 340 353 366 366
Alaska 97 97 102 107 113 115
Arizona 1322 1381 1471 1564 1657 1859
Arkansas 188 188 195 202 210 214
California 2866 3022 3287 3561 3836 3943
Colorado 772 776 809 843 877 934
Connecticut 306 299 307 316 326 337
Delaware 214 213 220 227 235 232
District of Columbia 45 44 46 49 51 52
Florida 3295 3433 3648 3867 4084 4349
Georgia 648 649 684 720 754 790
Hawaii 145 144 155 168 182 181
Idaho 152 152 160 168 176 191
Illinois 2048 2111 2151 2197 2247 2285
Indiana 718 743 754 766 779 786
Iowa 1009 1008 1014 1022 1033 1034
Kansas 560 565 584 605 626 622
Kentucky 328 327 333 339 345 345
Louisiana 97 93 96 100 104 103
Maine 565 569 589 610 630 640
Maryland 531 555 578 603 629 627
Massachusetts 450 479 488 498 509 552
Michigan 4910 4949 5017 5098 5188 5039
Minnesota 308 299 308 317 326 331
Mississippi 261 255 263 271 279 283
Missouri 1844 1845 1901 1960 2021 2063
Montana 95 96 100 103 107 112
Nebraska 114 123 126 129 132 135
Nevada 343 349 368 388 408 439
New Hampshire 159 158 166 174 182 187
New Jersey 2758 2752 2825 2904 2989 3154
New Mexico 195 196 208 221 234 261
New York 3131 3119 3153 3197 3249 3371
North Carolina 452 480 500 521 541 561
North Dakota 54 53 54 56 58 58
Ohio 3494 3476 3498 3527 3561 3523
Oklahoma 1393 1408 1473 1541 1608 1623
Oregon 454 474 504 535 568 565
Pennsylvania 5396 5447 5473 5514 5569 5581
76
STATE YEAR
2003 2005 2010 2015 2020 2025
Rhode Island 207 212 217 223 229 240
South Carolina 276 289 302 315 328 325
South Dakota 73 72 73 75 78 78
Tennessee 414 405 420 436 450 467
Texas 3033 3217 3428 3637 3839 4077
Utah 180 185 197 209 220 231
Vermont 53 55 56 58 59 61
Virginia 593 592 618 645 671 677
Washington 642 657 702 749 796 781
W. Virginia 559 553 553 554 556 554
Wisconsin 563 553 563 574 585 587
Wyoming 49 50 54 57 59 62
TOTALS 48,678 49,494 51,131 52,873 54,659 55,983
Source: American Osteopathic Association data (2003) were used as a base for DO projections;
US Census projections were used to calculate State DO projections.
The above table projects that the DO population will continue to grow over time – reaching an
expansion in numbers of over 7,000 members by the year 2025. Because of the cumbersome
nature of reviewing the state-by-state DO projections presented in the above Table 31, this
information is further distilled in the tables below at both regional and division levels.
Table 32: Projected Distribution of Practicing DOs By US Census Region, 2003-2025

REGION Number and Percent of Practicing Osteopathic Physicians
2003 2005 2010 2015 2020 2025
Northeast 26.8% 26.4% 25.9% 25.5% 25.1% 25.2%
(N=13,025) (N=13,090) (N=13,274) (N=13,494) (N=13,742) (N=14,123)
Midwest 32.2% 31.9% 31.4% 30.9% 30.4% 29.5%
(N=15,695) (N=15,797) (N=16,043) (N=16,326) (N=16,634) (N=16,541)
South 26.0% 26.3% 26.8% 27.2% 27.5% 28.0%
(N=12,646) (N=13,028) (N=13,697) (N=14,380) (N=15,050) (N=15,645)
West 15.0% 15.3% 15.9% 16.4% 17.0% 17.3%
(N=7,312) (N=7,579) (N=8,117) (N=8,673) (N=9,233) (N=9,674)
US Census projections were used to calculate DO projections by region.
The previous table demonstrates that the projected proportion of DOs by regional population
continuously declines in the Northeast and Midwest from present to 2025 – while continuously
increasing in the Southern and Western regions of the US By examining the table below, it
becomes more evident where such shifts in the DO population should be expected to occur,
based on projections in overall population distribution.
77
Table 33: PROJECTED DISTRIBUTION of PRACTICING DOs by US CENSUS DIVISION,
2003-2025
DIVISION Number and Percent of Practicing Osteopathic Physicians
2003 2005 2010 2015 2020 2025
New England 3.6% 3.6% 3.6% 3.6% 3.5% 3.6%
(N=1,740) (N=1,772) (N=1,823) (N=1,879) (N=1,935) (N=2,017)
Mid Atlantic 23.2% 22.8% 22.4% 21.9% 21.6% 21.6%
(N=11,285) (N=11,318) (N=11,451) (N=11,615) (N=11,807) (N=12,106)
East North 24.1% 23.9% 23.4% 23.0% 22.6% 21.8%
Central (N=11,733) (N=11,832) (N=11,983) (N=12,162) (N=12,360) (N=12,220)
West North 8.1% 8.0% 7.9% 7.9% 7.8% 7.7%
Central (N=3,962) (N=3,965) (N=4,060) (N=4,164) (N=4,274) (N=4,321)
South Atlantic 13.6% 13.8% 13.9% 14.2% 14.4% 14.6%
(N=6,613) (N=6,808) (N=7,149) (N=7,501) (N=7,849) (N=8,167)
East South 2.7% 2.7% 2.7% 2.6% 2.6% 2.6%
Central (N=1,322) (N=1,314) (N=1,356) (N=1,399) (N=1,440) (N=1,461)
West South 9.7% 9.9% 10.2% 10.4% 10.5% 10.7%
Central (N=4,711) (N=4,906) (N=5,192) (N=5,480) (N=5,761) (N=6,017)
Mountain 6.4% 6.4% 6.6% 6.7% 6.8% 7.3%
(N=3,108) (N=3,185) (N=3,367) (N=3,553) (N=3,738) (N=4,089)
Pacific 8.6% 8.9% 9.3% 9.7% 10.1% 10.0%
(N=4,204) (N=4,394) (N=4,750) (N=5,120) (N=5,495) (N=5,585)
US Census projections were used to calculate DO projections by division.
As mentioned above, based on shifts in the overall population, it could be presumed that the
number of osteopathic physicians would decline in the Northeast and Midwest regions while
increasing in the Southern and Western regions of the US over time. By examining the above
table, more specific assertions can be made. Such shifts in the projected DO population can be
expected to occur primarily due to the loss of DOs in the Mid Atlantic, East North Central, and
West North Central census divisions – and the increase of such professionals in the South
Atlantic, West South Central, Mountain, and Pacific census divisions.
Important Note Regarding DO Projections Based on Census Data

The above projections of future DO distributions based on total population forecasts are likely
not the most accurate means of determining where osteopathic physicians will be in the future.
As was demonstrated in above sections, the distribution of the DO population does not mirror the
overall distribution of the total population. If the DO population did follow US population
distributions, the above projections could be presumed acceptable. Unfortunately, such an
assumption cannot be made, as previous analysis demonstrated that DOs primarily reside and
practice in states or regions where there are COM’s – not necessarily where total population
numbers are greatest. In addition, the assumption of a constant rate of osteopathic professionals
over time can easily be disputed based on a historical review of the growth of the profession.
Therefore, an alternative means of projecting future DO population totals was employed.
78
2. Graduate-Based DO Projections (National) To 2040
Because of the concerns related to projecting DO figures based on population estimates, an
alternative means of estimating the future DO population was employed. The first alternative
model used to project future DO population figures uses 2000 graduation rates to project the
future supply of DOs. It makes the assumption that 2000 graduation rates (2,400 DO graduates
per year) will remain constant over time from 2000-2040. Given that the AOA Department of
Membership has indicated that the total number of DOs for 2003 is 48,678, backwards
calculations can be made to estimate the DO population in 2000 for purposes of projection of the
DO supply to 2040. It should be noted that each of the following models displays DO
projections both with and without an attrition rate in the osteopathic profession of two percent
per year, as was done in previous studies.
The DO population projections shown in the below table, based on 2000 graduation rates and assuming a
yearly attrition rate of two percent, demonstrate a projected increase in the osteopathic profession of
19,129 members. This is an anticipated increase of 40.5 percent over a four-decade span.
Table 34: DO PROJECTIONS 2000-2040 BASED on 2000 GRADUATION RATES

YEAR 2000 2005 2010 2015 2020 2025 2030 2035 2040
Total
Graduates 2440 * * * * * * * *
Increase from
1999 +170 * * * * * * * *
# of DOs 45,728 48,168 50,608 53,048 55,488 57,928 60,368 62,808 65,248
+ Graduates 2440 * * * * * * * *
Total DOs 48,168 50,608 53,048 55,488 57,928 60,368 62,808 65,248 67,688
DO Total w/
2% Attrition 47,205 49,596 51,987 54,378 56,769 59,161 61,552 63,944 66,334
* Number remains constant – no increase
Osteopathic physician graduation rates will not likely remain constant at 2000 levels over the next several
decades. In fact, the number of DO graduates has continued to climb over time. The 2002 American
Association of Colleges of Osteopathic Medicine Annual Report on Osteopathic Medical Education12
reported that there were 2,534 DO graduates in 2002 (an all time high). This report also illustrated that
recent enrollment rates have grown by approximately 4.3 percent each year, while total numbers of active
osteopathic physicians have recently (since 1992) grown at an annual rate of 3.5 percent. This
information indicates that the above projections are too conservative. Hence, alternative DO projection
estimates are necessary. In the following table, size of DO graduating class is assumed to increase by 400
from 2000 levels, then remaining constant to 2040. Similarly, the third and fourth models below assume
increases in size of graduating DO classes of 600 and 1,000 individuals from 2000 levels, then remaining
constant to 2040.
The DO population projections shown in the below table, based on increased graduation rates of 400
individuals from the year 2000, and also assuming a yearly attrition rate of two percent, demonstrate a
projected increase in the osteopathic profession of 22,265 members. This is an anticipated increase of
47.2 percent over a four-decade span.
12
Singer, Allen M. June 2003.
79
Table 35: DO Projections 2000-2040 Based on Increase in 2000 Graduation Rates of 400
YEAR 2000 2005 2010 2015 2020 2025 2030 2035 2040
Total 2440 2840 * * * * * * *
Graduates
Increase +400 * * * * * * *
# of DOs 45,728 48,168 51,008 53,848 56,688 59,528 62,368 65,208 68,048
+ 2440 2840 * * * * * * *
Graduates
Total DOs 48,168 51,008 53,848 56,688 59,528 62,368 65,208 68,048 70,888
DO Total
w/ 2% 47,205 49,988 52,771 55,554 58,337 61,121 63,904 66,687 69,470
Attrition
The DO population projections shown in the below table, based on increased graduation rates of 600
Table 36: DO Projections 2000-2040 Based on Increase in 2000 Graduation Rates of 600
YEAR 2000 2005 2010 2015 2020 2025 2030 2035 2040
Total 2440 3040 * * * * * * *
Graduates
Increase +600 * * * * * * *
# of DOs 45,728 48,168 51,208 54,248 57,288 60,328 63,368 66,408 69,448
+ 2440 3040 * * * * * * *
Graduates
Total DOs 48,168 51,208 54,248 57,288 60,328 63,368 66,408 69,448 72,488
DO Total
w/ 2% 47,205 50,184 53,163 56,142 59,121 62,101 65,080 68,059 71,038
Attrition
The DO population projections shown in the below table, based on increased graduation rates of 1,00
80
Table 37: DO Projections 2000-2040 Based on Increase in 2000 Graduation Rates of 1,000
YEAR 2000 2005 2010 2015 2020 2025 2030 2035 2040
Total 2440 3440 * * * * * * *
Graduates
Increase +1000 * * * * * * *
# of DOs 45,728 48,168

+ 2440 3440 * * * * * * *
Graduates
Total DOs 48,168 51,608 55,048 58,488 61,928 65,368 68,808 72,248 75,688
DO Total
w/ 2% 47,205 50,576 53,947 57,318 60,689 64,061 67,432 70,803 74,174
Attrition
The above projections of future national DO population, beginning with 2000 as the
starting point, provide growth estimates in the osteopathic profession ranging from
40.5 percent to 57.1 percent. Given the rate at which COM’s are currently enrolling
and graduating students, it is likely that even the more liberal of these estimates
may prove to be conservative.
CURRENT OSTEOPATHIC PHYSICIAN PRACTICE SPECIALTIES & TRAINING

PROGRAM TRENDS
1. National Distribution of Osteopathic Practice Specialties, 2003

The data below from the AOA membership files reflect self-reported primary care specialties of
currently-practicing DOs.
Table 38: Self-Reported Primary Practice Specialties, 2003

Practice Specialty # of Practicing DOs Percent of Total*
Diagnostic Radiology* 524 1.2%
Cardiology* 649 1.5%
Orthopedic Surgery* 1,048 2.3%
Psychiatry* 1,173 2.6%
Pediatrics* 1,374 3.0%
Obstetrics & Gynecology* 1,510 3.4%
Anesthesiology* 1,613 3.6%
Surgery* 1,872 4.2%
Emergency Medicine* 2,995 6.7%
Internal Medicine* 3,578 8.0%
Family Practice* 22,432 50.3%
TOTAL 38,768 86.8%
N=44,602 reported practice specialties.
*See appendix A for a listing of specialties included under this heading.
81
It should be noted that additional specialties were not included in this table, due to extremely low rates of
occurrence (i.e. Hair Transplant equaled less than 0.2%). In addition, the above categories were expanded
to contain additional specialties due to the same low rates of occurrence (i.e. under Anesthesiology, Pain
Management was included as there are only 51, or .1% of practicing osteopathic physicians with this
specialty nationally). This practice was adopted to gain a broader perspective on the general distribution
of osteopathic practice specialties in the US
That being said, an overwhelming majority reported DO practice specialties falling into the Primary Care
area, with Family Practice containing the highest concentration, followed by those practicing Internal
Medicine and Emergency Medicine. No other category of practice was reported at a rate higher than five
percent. This is reiterated in the pie chart below.
Figure 32
Diagnostic Radiology*
Distribution of D.O. Practice Specialties
Cardiology*
Orthopedic Surgery*
13% 1%2% 2% 3% 3% Psychiatry*

3%
4% Pediatrics*
4%
Obstetrics & Gynecology*
Anesthesiology*
7%
8% Surgery*
50% Emergency Medicine*
Internal Medicine*
Family Practice*
The following graph shows how many reported a Primary Care field (Family Practice, Internal Medicine,
OB/GYN, Pediatrics) as their current practice specialty. Based on self-reports of practice specialties, a
majority (64 percent) work in one of the ‘Primary Care’ fields.
82
Figure 33
Distribution of Primary Practice Types v. All Other Practice Types
36%
Primary Practice
All Other Practice Types
64%
2. National Distribution of DO Students by Program Types

In order to determine current trends in primary care, the number of DOs in both AOA and ACGME
primary care programs are delineated in the graphs below. Primary Care is here defined as including:
Family Practice, Internal Medicine, OB/GYN, and Pediatrics. The following graph illustrates that the
majority of DOs in AOA primary care programs from 1987-2002 went into the Family Practice field.
With the exception of Family Practice, which has declined in popularity from 1999 onward, all other
AOA primary care programs have grown or remained at near constant levels over time.
Figure 34
Trends: DO's in AOA
Primary Practice Programs, 1987-2002
1200
1000
AOA Pediatrics
800
AOA OB/GYN
600
AOA Family Practice
400
AOA Internal Medicine
200
0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Source: Mark Cummings
Similar to AOA primary care programs, the following table illustrates that the majority of DOs in
ACGME primary care programs from 1987-2002 went into the field of Family Practice. It also shows
that all ACGME primary care fields have grown over time.
83
Figure 35
Trends: DO's in ACGME
Primary Pactice Programs, 1987-2002
3500
3000
2500 ACGME Internal Medicine
2000 ACGME Family Practice
1500 ACGME OB/GYN
1000
ACGME Pediatrics
500
0
7
2
8
0
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
Year
Because of the ease with which DOs may now access ACGME programs, enrollment trends across AOA
and ACGME programs were explored. The following graphs compare DOs across each Primary Care
specialty program, based on AOA and ACGME status. The following graph demonstrates that, in
general, DOs entering Family Practice programs over the last 15 years have been largely enrolled in
ACGME programs. Of note is that this discrepancy appears to be growing over time, with the number of
DOs recently enrolled in ACGME programs being of larger proportion than in previous years.
Figure 36
Trends: DO's in AOA & ACGME Family Practice Programs,
1987-2002
1400
1200
1000
800 ACGME Family Practice
600 AOA Family Practice
400
200
0
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
Year
Similar to the Family Practice specialty, DOs in Internal Medicine programs have been largely enrolled in
ACGME programs. The following graph also demonstrates that the proportion of DO students
participating in ACGME approved programs is increasing greatly - with fewer DOs participating in AOA
Internal Medicine programs.
84
Figure 37
Trends: DO's in AOA & ACGME Internal Medicine Programs,
1987-2002
1400
1200
1000
800 ACGME Internal Medicine
600 AOA Internal Medicine
400
200
0
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
Year
As was demonstrated above, DOs in Family Practice and Internal Medicine programs have largely been
enrolled in ACGME programs. The following graph reveals that DOs in AOA and ACGME OB/GYN
programs have been more similarly distributed. The graph below shows that DOs in ACGME approved
OB/GYN programs have recently increased, while those in AOA programs have decreased.
Figure 38
Trends: DO's in AOA & ACGME OB/GYN Programs, 1987-2002
300
250
200 ACGME OB/GYN
150 AOA OB/GYN
100
50
0
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
Year
Similar to the other Primary Care specialties (Family Practice, Internal Medicine, OB/GYN), the
following graph shows that DOs in ACGME Pediatrics Programs have always exceeded those in AOA
Pediatrics programs - with the divergence growing over time. Although DO increases in Pediatrics
Programs appear to be minimal, it should be noted that the numbers have steadily increased since 1991,
up from essentially zero prior to this time.
85
Figure 39
Trends: DO's in AOA & ACGME Pediatrics Programs, 1987-2002
450
400
350
300
250 ACGME Pediatrics
200 AOA Pediatrics
150
100
50
0
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
Year
In summary, the following graph demonstrates that ACGME programs have, in recent years, enjoyed a
greater margin of DOs entering Primary Care programs - with the gap appearing to widen over time.
Figure 40
D.O. Enrollment in AOA & ACGME

Primary Care Programs, 1987-2002
6000
5000
Enrolled in AOA
4000 primary care
programs
3000
2000 Enrolled in ACGME
primary care
1000
programs
0
1988 1990 1992 1994 1996 1998 2000 2002
Year
Also of interest is the over-time distribution of DOs entering specialty programs (those outside of
‘primary care’). The following graph demonstrates that, as with primary care types, ACGME specialty
programs are increasingly becoming the norm for DOs.
86
Figure 41
D.O. Enrollment in AOA & ACGME

Specialty Programs, 1987-2002
2500
2000 Enrolled in AOA
1500 specialty programs
1000
500 Enrolled in ACGME

specialty programs
0
1988 1990 1992 1994 1996 1998 2000 2002
Year
Finally, if DOs in all practice fields (primary care and specialty fields) are aggregated across both AOA
and ACGME programs, the indication is the same. The following graph demonstrates that DOs,
regardless of field-of-practice are, in recent years, participating in ACGME programs more frequently
than AOA programs. It appears that the disparity is not lessening.
Figure 42
DO's in all AOA & ACGME Programs, 1987-2002

8000
6000 DO's in
AOA
Programs
4000
DO's in
2000 ACGME
Programs
0
1987 1990 1993 1996 1999 2002
The above graphics demonstrate that in recent years (from 1987-2002) DOs have
been predominantly drawn to ACGME programs - for both primary and specialty
care types.
A final assessment of both the availability of, and positioning of osteopathic

physicians across both AOA and ACGME training programs is displayed in the
87
following tables. Table 39 details the most recent data on how many DO trainees
are in ACGME-approved programs, by state. This table demonstrates that there
are DO trainees in ACGME programs in each state of the US
Table 39
NUMBER OF DOs TRAINING in ACGME PROGRAMS by STATE, 2003-2004
Number of DO Number of
STATE Trainees STATE DO Trainees
Alaska 1 Mississippi 44
Alabama 40 Montana 1
Arkansas 22 N. Carolina 70
Arizona 116 N. Dakota 5
California 485 Nebraska 31
Colorado 62 New Hampshire 19
Connecticut 123 New Jersey 216
D.C. 56 New Mexico 17
Delaware 44 Nevada 19
Florida 147 New York 712
Georgia 100 Ohio 352
Hawaii 51 Oklahoma 78
Iowa 97 Oregon 30
Idaho 6 Pennsylvania 713
Illinois 405 Rhode Island 26
Indiana 54 S. Carolina 36
Kansas 70 S. Dakota 6
Kentucky 43 Tennessee 91
Louisiana 19 Texas 373
Massachusetts 145 Utah 25
Maryland 118 Virginia 137
Maine 54 Vermont 7
Michigan 240 Washington 84
Minnesota 65 Wisconsin 75
Missouri 152 W. Virginia 54
Wyoming 7
Total Number of DO Trainees in ACGME Programs = 5,943
Source: American Osteopathic Association
Tables 40 and 41 detail current American Osteopathic Association counts of DO

trainees in AOA approved internship and residency programs. These tables reveal
exactly which States and areas of the country lack approved and funded AOA
positions for DOs to choose from. These tables again demonstrate that the
opportunities for DOs to enter AOA programs lag behind the prospects for entering
ACGME programs. They also restate the above notion that trends towards
ACGME programs are likely to become the increasing norm for DOs.
88
Table 40: AOA Internship Programs by State, 2003-2004
Positions Positions
STATE Approved Funded Filled STATE Approved Funded Filled
Alaska NONE REPORTED Mississippi 6 0 1
Alabama 8 8 0 Montana NONE REPORTED
Arkansas 9 7 0 N. Carolina 4 0 2
Arizona 37 27 25 N. Dakota NONE REPORTED
California 80 65 47 Nebraska NONE REPORTED
Colorado 11 5 2 New Hamp 4 0 1
Connecticut 13 13 10 New Jersey 188 123 96
D.C. New Mexico 4 4 2
Delaware 19 8 12 Nevada 10 6 0
Florida 164 114 110 New York 388 243 158
Georgia 11 9 8 Ohio 248 199 136
Hawaii NONE REPORTED Oklahoma 79 59 52
Iowa 10 7 5 Oregon 7 7 1
Idaho NONE REPORTED Pennsylvania 436 373 267
Illinois 122 94 69 Rh. Island NONE REPORTED
Indiana 15 15 4 S. Carolina NONE REPORTED
Kansas 12 8 8 S. Dakota NONE REPORTED
Kentucky 44 25 10 Tennessee NONE REPORTED
Louisiana 2 0 0 Texas 71 51 42
Massachusett 22 22 8 Utah NONE REPORTED
s
Maryland NONE REPORTED Virginia 19 19 5
Maine 27 18 14 Vermont NONE REPORTED
Michigan 477 372 277 Washington NONE REPORTED
Minnesota 14 10 2 Wisconsin 23 6 4
Missouri 65 55 32 W. Virginia 71 49 32
Wyoming 4 4 2
Total Number Of DO Trainees In AOA Internship Programs = 1,444
Program Count = 220
Source: American Osteopathic Association, Education Department
89
Table 41 : AOA Residency Programs by State, 2003-2004
Pro- Positions Pro- Positions
STATE grams Approved Funded Filled STATE grams Approved Funded Filled
Alaska NONE REPORTED Mississippi NONE REPORTED
Alabama NONE REPORTED Montana NONE REPORTED
Arkansas 2 14 14 7 N. Carolina NONE REPORTED
Arizona 7 63 40 24 N. Dakota NONE REPORTED
California 13 136 76 68 Nebraska NONE REPORTED
Colorado 3 15 10 5 New Hamp NONE REPORTED
Connecticut NONE REPORTED New Jersey 40 446 317 193
D.C. NONE REPORTED New Mexico 1 4 2 0
Delaware 1 16 4 9 Nevada 1 12 0 0
Florida 28 269 194 145 New York 41 544 371 196
Georgia NONE REPORTED Ohio 76 601 454 332
Hawaii NONE REPORTED Oklahoma 20 168 131 110
Iowa 3 21 5 12 Oregon 1 16 12 4
Idaho NONE REPORTED Pennsylvania 68 624 422 303
Illinois 25 235 124 134 Rh. Island NONE REPORTED
Indiana 2 14 14 3 S. Carolina NONE REPORTED
Kansas 2 20 8 7 S. Dakota NONE REPORTED
Kentucky 4 56 0 9 Tennessee NONE REPORTED
Louisiana NONE REPORTED Texas 18 131 99 77
Massachusetts 2 10 10 5 Utah NONE REPORTED
Maryland NONE REPORTED Virginia 3 30 6 5
Maine 5 36 15 22 Vermont NONE REPORTED
Michigan 138 1,203 820 570 Washington NONE REPORTED
Minnesota NONE REPORTED Wisconsin 1 15 0 7
Missouri 27 163 94 81 W. Virginia 9 75 27 19
Wyoming NONE REPORTED
Source: American Osteopathic Association, Education Department
OSTEOPATHIC PHYSICIAN DEMOGRAPHIC DATA: PRESENT & FUTURE
1. Age Information
The following table reveals which decade (currently) practicing DOs originate from. It should be noted
that the last category displayed only covers the 2000 through 2003 time span, while all other groupings
encompass complete decades. Interestingly, over half (52%) of those in the DO profession have
graduated in the past 15 years, implying the profession is ‘young.’
90
Table 42: Percentage of Practicing DOs by Graduation Decades, 2003
Decade of Graduation Number of Practicing Percent of all Practicing DOs
DOs
1910-1919 1 >1%
1920-1929 1 >1%
1930-1939 36 >1%
1940-1949 167 >1%
1950-1959 1,018 2.1%
1960-1969 2,441 5.0%
1970-1979 6,459 13.3%
1980-1989 13,267 27.3%
1990-1999 17,861 36.7%
2000-2003 7,425 15.3%
TOTALS 48,676 100%
Analysis of recent American Osteopathic Association data revealed the average age of active osteopathic
physicians to be 44 years, with 51% of those currently practicing falling under this age. Likewise, the
average student age was found to be 28 years, with 57% falling under this age. This indicates a young
(’20-something) group of medical students.
That being said, the following table further supports the case that the DO profession is well on its way to
being ‘young’ in nature. This table shows that a large majority of DO students are in their 20’s. More
interestingly, it shows that nearly 40 percent (38.5%) of practicing physicians are under the age of 40,
while less than one-third are over the age of 50.
Table 43: Distribution of Practicing DOs & Students by Age Category, 2003
% of PRACTICING % of STUDENTS
Age
Group
20’s 5.5% 75%
30’s 33% 21.5%
40’s 32% 3.5%
50’s 20% 0%
60’s 6.5% 0%
70’s 3% 0%
Previously-detailed projections of future national DO population, along with current AOA figures
regarding the age distribution of the DO population were used to project the future numerical distribution
of the age of osteopathic profession. Similar to previous studies, the following age-projection models
assume that the current (2003) age ratio of active physicians will be maintained over time. This
distribution is shown in the graph below. Clearly, the majority of practicing osteopathic physicians are in
the ‘thirty’s’ and ‘forty’s’ groupings – with all other age categories representing only 35.3 percent of
currently-practicing DOs.
91
Figure 43
Age Distribution of D.O. Population, 2003

32.90% 31.80%
20’s
30’s
20% 40’s
50’s
60‘s
5.40% 6.40%
2.80% 70’s
0.70%
80’s+
% of Total D.O. Population 2003*
As was mentioned, the following DO age projections assume that future distributions, based on age, will
remain constant at current levels. The following tables simply demonstrate the raw number of osteopathic
physicians that are expected to be present in each age group – based on the above-calculated DO
projections to 2040.
Table 44: Age Projections Based on DO Forecasts Using 2000 Graduation Rates
Age % of Total
Cohort DO 2005 2010 2015 2020 2025 2030 2035 2040
Population
2003*
20’s 5.4% 2,678 2,807 2,936 3,066 3,195 3,324 3,453 3,582
30’s 32.9% 16,317 17,104 17,890 18,677 19,464 20,251 21,038 21,824
40’s 31.8% 15,772 16,532 17,292 18,053 18,813 19,574 20,334 21,095
50’s 20% 9,919 10,397 10,876 11,354 11,832 12,310 12,789 13,267
60‘s 6.4% 3,174 3,327 3,480 3,633 3,786 3,939 4,092 4,245
70’s 2.8% 1,389 1,456 1,523 1,589 1,657 1,723 1,790 1,857
80’s+ 0.7% 347 364 381 397 414 431 448 464
Total 100% 49,596t 51,987 t 54,378 t 56,769 t 59,161 t 61,552 t 63,944 t 66,334 t
*Source: American Osteopathic Association, Department of Membership, 2003
t
Source: Table 34
92
Table 45: Age Projections Based on DO Forecasts Using 2000 Graduation Rates + 400
% of Total
Age DO
Co- Population 2005 2010 2015 2020 2025 2030 2035 2040
hort 2003*
20’s 5.4% 2,700 2,850 3,000 3,150 3,301 3,451 3,601 3,751
30’s 32.9% 16,449 17,362 18,277 19,193 20,109 21,024 21,940 22,856
40’s 31.8% 15,899 16,781 17,666 18,551 19,436 20,322 21,207 22,092
50’s 20% 10,000 10,554 11,111 11,667 12,224 12,781 13,337 13,894
60‘s 6.4% 3,200 3,377 3,555 3,734 3,912 4,090 4,268 4,446
70’s 2.8% 1,400 1,478 1,556 1,633 1,711 1,789 1,867 1,945
80’s+ 0.7% 350 369 389 409 428 447 467 486
Total 100% 49,988 t 52,771 t 55,554 t 58,337 t 61,121 t 63,904 t 66,687 t 69,470 t
t
Source: Table 35
Table 46: Age Projections Based on DO Forecasts Using 2000 Graduation Rates + 600
Age % of Total
Cohort DO 2005 2010 2015 2020 2025 2030 2035 2040
Population
2003*
20’s 5.4% 2,710 2,870 3,032 3,193 3,354 3,514 3,675 3,836
30’s 32.9% 16,511 17,491 18,471 19,451 20,431 21,411 22,391 23,372
40’s 31.8% 15,959 16,906 17,853 18,800 19,748 20,695 21,643 22,590
50’s 20% 10,036 10,633 11,228 11,824 12,420 13,016 13,612 14,208
60‘s 6.4% 3,212 3,402 3,593 3,784 3,975 4,165 4,356 4,564
70’s 2.8% 1,405 1,489 1,572 1,655 1,739 1,822 1,906 1,989
80’s+ 0.7% 351 372 393 414 434 456 476 497
Total 100% 50,184 t 53,163 t 56,142 t 59,121 t 62,101 t 65,080 t 68,059 t 71,038 t
t
Source: Table 36
2. Gender Distribution of the Osteopathic Profession

Recent American Osteopathic Association data indicates an imbalance in the distribution of practicing
osteopathic physicians across gender lines. Women currently account for just over 25 percent of
practicing osteopathic physicians. The tables below demonstrate that this distribution is on its way
towards greater equality.
The following tables demonstrate that the gender distribution of inactive DOs, most of whom are retired,
is largely skewed towards the male gender (91%), as is the distribution of those currently practicing
(74%) – though to a lesser extent.
93
Table 47: Gender Distribution of Inactive Osteopathic Physicians, 2003
Frequency Percent
Male 2,557 91
Female 253 9
Total 2,810 100
Note: ‘Inactive’ DOs are those identified by the AOA as retired or not practicing due to disability, nursing
home residence, or some other (unspecified) reason. Of inactive male osteopathic physicians 93.7 percent
are retired, 2.7 percent report disabilities, and 3.6 percent report ‘other’ reasons for inactivity in the
profession. Of inactive female DOs 83.4 percent are retired, 4.8 percent report disability, and 11.9
identified ‘other’ reasons for inactivity in the profession.
Table 48: Gender Distribution of Practicing Osteopathic Physicians, 2003

Frequency Percent
Male 36,211 74
Female 12,646 26
Total Size of Active 48,867 100
Osteopathic Profession
As is demonstrated in the below table, the trend towards gender equality becomes evident when
examining the gender distribution of osteopathic students. Women account for 45 percent of the DO
student population. The ratio of women to men in the osteopathic profession is approaching parity, as is
demonstrated in the tables below.
Table 49: Gender Distribution of US Osteopathic Students, 2003

Frequency Percent
Male 6,350 55
Female 5,172 45
Total 11,522 100
The trend towards gender equality in the osteopathic profession is demonstrated in the graph below.
There are clearly a greater proportion of women students than active or inactive/retired DOs. There is
also a larger share of active/practicing DOs than those classified as inactive. These figures lead to the
conclusion that each successive cohort of women will enjoy a larger share of the total population of the
osteopathic profession.
94
Figure 44
Percent of D.O. Population: Women, 2003
50 45
40
Percent
30 26
20
9
10
0
Inactive Active Students
Current Status
A shift towards gender equality in the osteopathic profession is further demonstrated by appraising the
below table and corresponding graph that report the percent of total DO graduating class occupied by
women over time. It is evident that the number of women osteopathic physicians is coming to parity with
men by noting the growth of women in overall graduating class size over time. The percent of women
graduating in 1975 (6.5%) is projected to grow to nearly forty-seven percent by the year 2006. The
number of women (DO) graduates will multiply by more than seven times over the course of these three
decades. It is interesting that women did not reach even one-third of the total osteopathic population until
1993.
Table 50: Women in the Osteopathic Profession by Graduating Class

Year Frequency Percent of Total Year Frequency Percent of Total
1975 44 6.5 1991 454 29.6
1976 62 7.8 1992 496 32.4
1977 80 9.3 1993 533 33.3
1978 106 11.3 1994 608 34.7
1979 152 15.4 1995 627 33.9
1980 167 16.6 1996 665 34.9
1981 177 15.9 1997 716 35.5
1982 187 18.5 1998 782 37.2
1983 253 19.5 1999 828 37.4
1984 276 21.6 2000 878 38.1
1985 337 23.2 2001 996 39.1
1986 388 25.0 2002 1068 40.9
1987 394 25.0 2003 1120 41.8
1988 425 27.2 2004 1264 43.8
1989 477 29.8 2005 1340 46.5
1990 434 28.8 2006 1436 46.9
* These figures assume correct graduation dates, and no dropouts for students thru 2006
95
Figure 45
Women DO's by Graduating Class
1600
1400
1200
Frequency
1000
800
600
400
200
0
Years 1975-2006
Because the proportion of women DOs has continuously grown over time, it is of interest to project the
gender distribution of the osteopathic profession into the future. One telling way to do this is to examine
graduation rates based on gender. Based on above-presented American Osteopathic Association data
detailing percent of women DOs entering the osteopathic profession each graduation year, projections
were made regarding the future gender distribution of the osteopathic profession. Based on calculations
of AOA graduation figures by gender, it was determined that the average yearly increase of women into
the DO population over the past decade (from 1994-2003) was .85 percent each year. The following table
assumes that this rate of increase will remain constant over time. These results indicate that, given a
constant rate of growth, women graduates will outnumber male graduates by the year 2015. Projection
estimates anticipated a change of 31.5 percent in the ratio of men to women DO graduates over the next
(nearly) four-decade span.
Table 51: DO Gender Graduation Percent Projections 2005-2040

YEAR 2003 2005 2010 2015 2020 2025 2030 2035 2040
Average Yearly
Increase of Women
DO Graduates .85%*
Total % of DO
Graduates: 41.8% 43.5% 47.75% 52% 56.25% 60.5% 64.75% 69% 73.3%
Women
2003 Data Source: American Osteopathic Association, Department of Membership
*Yearly growth rate of .85% remains constant, each year, to 2040
96
The following graph reiterates that with the persistent growth of women DO graduates, there will
be a shift in the gender make up of the osteopathic profession in the coming decades.
Figure 46
Projected Graduation Rates:

Women as Percent of Total, 2005-2040
80.00% 73.30%
69%
70.00% 64.75%
60.50%
56.25%
60.00% 52%
47.75%
50.00% 41.80% 43.50%
40.00%
30.00%
20.00%
10.00%
0.00%
Year
RECOMMENDATIONS
Based on the results of the above-presented analyses, the authors recommend the following:
1. Development of a central database that contains membership, educational,

workforce and other data as may be pertinent to the current health care
environment.
• Appointment of an advisory committee (similar to the editorial
board of the JAOA)to recommend policies and procedures for the
operation of this database
• Subject to privacy or confidentiality restrictions, said database is
open and available to qualified researchers and others with
legitimate business with said database.
• Database should be updated and kept current, making the possibility
of longitudinal studies of interest to the profession
• In many instances data from various sources are not comparable due
to differences in definitions. Efforts should be made to bring these to
compatibility.
2. While recognizing the independence of the Colleges of Osteopathic

Medicine, efforts should me made wherever and whenever possible to
coordinate the placement of new colleges with the needs of the profession.
3. Appointment of a premedical counselor should be considered - to assist in

the recruitment of students from census regions with low DO populations.
97
4. Appointment of a membership recruiter/counselor should be considered – to
meet with students in ACGME residency programs to attract them back to
the profession.
APPENDIX A: Practice Specialty Groupings
Anesthesiology: Anesthesiology, Anesthesiology for Pain Management, Critical Care Anesthesiology,

Cardiothoracic Anesthesia, Obstetrical Anesthesia, Pediatric Anesthesiology
Cardiology: Cardiology, Cardiovascular Diseases, Pediatric Cardiology, Intervention Cardiology,

Cardiac Electrophysiology
Psychiatry: Psychiatry, Child Psychiatry, Pediatric Psychiatry, Forensic Psychiatry, Geriatric Psychiatry
Obstetrics & Gynecology: Obstetrics & Gynecology, Gynecology
Internal Medicine: General Practice, Internal Medicine
Emergency Medicine: Emergency Medicine, Emergency Medical Services, Pediatric Emergency

Medicine
Family Practice: Family Practice
Pediatrics: Pediatrics, Internal Medicine-Pediatrics
Surgery: General, Arthritis & Joint Implant Surgery, Critical Care Surgery, Cardiovascular Surgery,
Gynecological Surgery, General Vascular Surgery, Head & Neck Surgery, Head Surgery, Neurological
Surgery, Obstetrics & Gynecologic Surgery, Otolaryn & Facial Surgery, Facial Plastic Surgery, Pediatric
Surgery, Plastic & Reconstructive Surgery, Perpheral Vascular Surgery, Thoracic Cardiovascular
Surgery, Traumatic Surgery, Thoracic Surgery, Urological Surgery, Ophthalmology-Vitreous Surgery
Orthopedic Surgery: Orthopedic Surgery, Sports Medicine-Orthopedic Surgery, Orthopedic Surgery-

Spine, Hand Surgery-Orthopedic Surgery, Orthopedic Foot & Ankle Surgery
98
Estimated Number of DOs in 2020 using the BHPr
Aggregate Physician Supply Model of Physician
Workforce Growth
Steven Andes, PhD, CPA

May 2005
99
The AOA Committee on Membership reviewed a draft report on osteopathic physician workforce
projections at its January 2005 meeting. The Committee asked the AOA Department of Research to
conduct additional analyses of workforce projections, especially projections of the estimated number of
DOs in 2020. This report presents these analyses regarding the future number of DOs.
The AOA Department of Research used an adaptation of the federal Bureau of Health Professions (BHPr)
Aggregate Physician Supply Model to estimate the number of DOs in active practice and the total number
of DOs in 2020. This analysis describes the model and discusses its use with DO data rather than with
MD data. It then uses the model to estimate the future number of DOs.
The BHPr Aggregate Physician Supply Model

The National Center for Health Workforce Analysis (NCHWA) developed and maintains this model. The
NCHWA is part of the Bureau of Health Professions (BHPr), which is a division of the federal Health
Resources Services Administration (HRSA). Steven Andes, PhD, of the AOA Department of Research,
reconfigured this model with assistance from Jim Cultice, an NCHWA operations research analyst, to
meet AOA’s needs for a DO supply projection model.
To estimate the number of DOs in a future year, the model takes the number in the base year, which was
2004 for these analyses, and, for every year thereafter, adds the number of new graduates and then
subtracts the number of physicians estimated to leave active medical practice because of death, retirement
or other reasons. These estimates for the number leaving medicine are adjusted for both age and gender
and are based on data from the AMA Masterfile.
The model permits alternative assumptions to be made about the number of new graduates and the
percentage of women graduates. Assumptions about the number of new graduates are the major factor
driving increases in the number of physicians. The assumptions about the percentage of women are also
important because women live longer than men. Therefore, the greater the percentage of women, the
larger the total workforce. The model also can approximate the total number of physicians, rather than
only those in active practice, although it does not estimate deaths among physicians who die after they
leave medical practice.
While the BHPr model has not been tested completely, its projections have been reasonably accurate. It
has been used for numerous analytic studies including those conducted by the Council on Graduate
Medical Education, for professional journal articles, and for the BHPr biannual Reports to the President
and Congress on the Status of Health Personnel in the United States. The model's projections have
frequently been cited in health workforce studies, in government legislative background statements, and
in health policy papers.
Using the Model for DO Workforce Projections

As discussed above, the model depends heavily on three assumptions to estimate the number of
physicians in active medical practice: the number of new graduates, the mortality rate among active
physicians, and the rate of those leaving active practice prior to death. While the model uses AMA data
to estimate the separation rate and mortality rate by age and gender, it is reasonable to assume that DOs
and MDs of the same age and gender will have similar separation and mortality rates if in active practice.
It is preferable to make these assumptions because of the larger size of the AMA database rather than
making estimates of retirements and deaths from the AOA Masterfile.
The model’s use of retirement and mortality rates adjusted for both age and gender, rather than either an
overall mortality rate or an overall mortality rate for men and women, corrects for the facts that the
osteopathic profession is slightly younger than the MD profession and has a slightly larger percentage of
females (Table 1).
100
The model, however, assumes that the death rate for every age/gender group remains constant. While this
assumption is not completely accurate – people are living longer - we do not believe it will have a
significant effect on the estimated number of DOs in the next 15 years, especially when compared to other
factors such as the increase in the number of new graduates. In 2001, the average age of death was 69
years for men and 76 years for women (Statistical Abstract of the United States, 2004-05, Table 93).
Table 2 shows the number of male and female DOs expected to reach these average ages each year
between 2005-2020. While the number increases, it remains a small percentage of all DOs. The average
age of death increased an average of .2 of a year for men and an average of .1 of a year for women each
year between 1985 and 2001 (Statistical Abstract of the United States, 2004-05, Table 93). Even if this
trend continues, which may be unlikely, its effect on the total number of DOs still remains small.
The number of osteopathic graduates in future years is much more difficult to estimate. We estimate that
the number of graduates will increase every year between now and 2020 for at least three reasons: class
sizes at existing educational sites have been increasing, new sites (COMs and branches) have opened or
are being planned, and there appears to be a shortage rather than a surplus of physicians. Table 3 shows
the number of graduates for each year between 2000 and 2008. This table separates older educational
sites from new ones. While, as might be expected, between 2004 and 2008 newer COMs and campuses
enlarged their classes more than older ones, older ones also increased their class sizes. Older sites
increased their class sizes an average of 3.8% each year between 2004 and 2008, while newer sites
increased their class sizes an average of 6.9% over the same period. These increases occurred despite
difficult economic times, changes in reimbursements for graduate medical education, and the fact that
fewer students took the MCAT in 2003 than in 1993.
Even the older COMs located in states where the number of DOs is growing slowly
increased their class sizes, which suggests that older COMs are increasing their class
sizes regardless of how fast the number of DOs is growing in the state where they are
located. While newer COMs and campuses will probably not continue to increase their
class sizes at their current rates, they probably will continue to increase their class sizes at
a rate closer to that of the older COMs, especially after the newer sites reach their
“desired” class size.
Workforce studies now project a shortage of physicians. The Association of American Medical Colleges
called for an increase of 15% in the number of new allopathic graduates (or about 2,500 per year)
between now and 2015 (American Association of Medical Colleges, The Physician Workforce: Policy
Statement, February 22, 2005, http://www.aamc.org/workforce/12704workforce.pdf), reversing earlier
positions that there would be too many physicians. It is possible that if allopathic medical schools
expand, they may admit some of the students who otherwise may have selected a COM. However, we do
not believe that this possibility will make it difficult for COMs to increase their class sizes. We believe
that an increase in the demand for physicians will enable both allopathic and osteopathic colleges to
expand.
For these reasons, assuming a 1% annual increase in the COM class size each year between now and 2020
is reasonable, and may be conservative. This 1% annual increase is much lower than current rates. We
also explored the impact of assuming a 2% annual increase in COM class size, and assuming that the
number of students will increase by 500 in 2006 but will remain constant thereafter. Assuming that the
number of students will increase by 500 in 2006 has about the same effect as assuming only 100 more
students after LECOM-Brandenton and TUCOM-NV graduate their first classes in 2008.
101
Estimates of the Number of DOs in 2020
The model was applied using 2004 as the base year, including the class of 2004.
Table 4 shows the estimated number of DOs in active practice and the approximation of
the total DOs for each year between 2005 and 2020. The data for 2004 is the actual
number of DOs in 2004, including those graduating in 2004. In 2020, the BPHr model
predicts there will be approximately 104,000 DOs in active practice assuming a 2%
annual increase in class sizes, 101,000 DOs in active practice assuming a 1% annual
increase in the class sizes; and over 99,000 DOs assuming that class sizes increase by 500
students after 2005 and then remain constant. Each scenario shows substantial growth,
and even the most conservative estimate of the number of DOs in active practice exceeds
the earlier predictions of 87,921 total DOs in 2020 made by Hicks et al. in 1998.
The model predicts that in 2020 there will be approximately 112,000 total DOs if we assume a 2% annual
increase in class sizes, 109,000 total DOs if we assume a 1% annual increase in class sizes, and
approximately 107,000 total DOs if we assume that class sizes will not increase after 2006. These totals
are about 8% larger than the corresponding estimated number of DOs in active practice, but these
estimates of the totals are only approximate because they do not correct for deaths after retirement.
The DO profession grew 177% between 1982 and 2004 (Table 5) and the results of the BHPr model
predicts that we can expect this strong growth to continue.
102
List of Tables
1 Age structure and gender distribution of the osteopathic and allopathic physicians
2 Number of DOs reaching the average age of death, 2005 through 2020
3 Number of graduates, 2000-2008, all COMS and branches
4 Predicted number of active DOs and total DOs, 2005-2020
5 Total number of DOs and MDs, 1981-2004
103
Table 1. Age structure and gender distribution by age of osteopathic and allopathic physicians
Age Structure
Age DOs MDs Percent difference

Category Gender Gender Gender
(years) M F Total M F Total M F Total
<35 34.5 17.4 21.9 26.6 12.4 16.0 7.9 5.0 5.9
35-44 34.9 27.0 29.1 32.1 21.3 24.1 2.8 5.7 5.0
45-54 23.4 28.2 26.9 24.7 24.9 24.9 -1.2 3.2 2.0
55-64 5.3 15.2 12.5 9.9 18.6 16.3 -4.6 -3.4 -3.8
65+ 1.8 12.3 9.5 6.6 22.8 18.6 -4.8 -10.5 -9.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
Average (years) 48.1 40.3 46.0 NA NA 50.3
Median (years) 47.0 38.0 44.0 52.0 42.0 50.0
Gender distribution by age
Age DOs MDs Percent difference

Category Gender Gender Gender
(years) M F Total M F Total M F Total
<35 58.0 42.0 100.0 57.1 42.9 100.0 0.9 -0.9 0.0
35-44 68.0 32.0 100.0 65.6 34.4 100.0 2.4 -2.4 0.0
45-54 76.7 23.3 100.0 74.4 25.6 100.0 2.3 -2.3 0.0
55-64 88.8 11.2 100.0 84.4 15.6 100.0 4.4 -4.4 0.0
65+ 94.8 5.2 100.0 99.1 0.9 100.0 -4.3 4.3 0.0
Total 73.3 26.7 100.0 74.2 25.8 100.0 -0.9 0.9 0.0
Source:
Osteopathic data: AOA Masterfile as of June 1, 2004, which includes the graduating class of 2004.
Allopathic data: data provided by the AMA based on data contained in Physician Characteristics
and Distribution in the United States, 2005 Edition and is current as of December 2003. Medians are
estimated.
Both MD and DO data include interns, residents, and other postdoctoral physicians in training programs.
104
Table 2. Number of DOs reaching the average age of death, 2005 through 2020*
Year Female Male Total

2020 44 1,220 1,264
2019 61 1,083 1,144
2018 36 1,046 1,082
2017 21 845 866
2016 26 946 972
2015 20 761 781
2014 18 589 607
2013 6 515 521
2012 11 565 576
2011 10 512 522
2010 6 397 403
2009 8 315 323
2008 2 295 297
2007 7 334 341
2006 8 307 315
2005 8 304 312
* Average age of death in 2001 was 69 years for men and 76 years for women
(Statistical Abstract of the United States, 2004-05, Table 93)
Source: AOA Masterfile
105
Table 3. Number of graduates, 2000-2008, all educational sites (COMS and branches)
Average
Year Percent increase annual increase
COM Total Of ID 2000 2001 2002 2003 2004 2005 2006 2007 2008 2004-08 2000-08 2004-08 2000-08
MWU/CCOM 142 142 147 163 152 161 156 163 189 160 -0.6 12.7 -0.1 1.4
DMU-COM 183 183 208 190 200 192 205 211 195 229 19.3 25.1 3.9 2.8
KCUMB-COM 204 204 208 221 208 211 244 227 231 237 12.3 16.2 2.5 1.8
ATSU/KCOM 137 137 138 147 166 140 160 158 170 172 22.9 25.5 4.6 2.8
PCOM 244 244 239 250 235 241 270 258 246 252 4.6 3.3 0.9 0.4
MSUCOM 106 106 121 119 131 132 134 135 134 176 33.3 66.0 6.7 7.3
UNHSCFW/TCOM 107 107 108 108 109 118 126 123 124 135 14.4 26.2 2.9 2.9
WVSOM 64 64 65 65 72 72 79 82 100 117 62.5 82.8 12.5 9.2
OSU-COM 86 86 90 83 83 84 94 89 90 89 6.0 3.5 1.2 0.4
OU-COM 102 102 102 95 103 104 116 109 109 116 11.5 13.7 2.3 1.5
UMDNJ/SOM 74 74 68 81 70 78 87 90 94 97 24.4 31.1 4.9 3.5
NYCOM 222 222 267 267 261 298 269 314 267 306 2.7 37.8 0.5 4.2
WesternU/COMP 164 164 179 164 162 179 191 158 171 207 15.6 26.2 3.1 2.9
UNE/COM 111 111 111 117 103 108 124 124 123 122 13.0 9.9 2.6 1.1
NSU-COM 151 151 161 158 175 176 225 179 199 222 26.1 47.0 5.2 5.2
LECOM 110 110 120 133 133 174 200 213 222 231 32.8 110.0 6.6 12.2
MWU/AzCOM 96 96 96 117 122 126 145 146 138 154 22.2 60.4 4.4 6.7
Total existing sites 2303 2,303 2,428 2,478 2,485 2,594 2,825 2,779 2,802 3,022 16.5 31.2 3.3 3.5
Average existing sites 135.5 142.8 145.8 146.2 152.6 166.2 163.5 164.8 177.8 19.0 35.1 3.8 3.9
TUCOM 63 66 85 102 134 118 141 140 37.3 7.5
PCSOM 53 62 54 60 64 62 71 79 31.7 6.3
Total new sites group 1 2303 116 128 139 162 198 180 212 219 35.2 7.0
Average existing sites 2 58.0 64.0 69.5 81.0 99.0 90.0 106.0 109.5 34.5 6.9
VCOM 154 157

LECOM-Bradenton 170
TUCOM-NV 80
Total new sites group 2 407
Source: AOA Masterfile
The educational sites were divided into three groups: Group 1 are sites (campuses and COMs) that existed in 2000; group 2 are educational sites
that were opened in 2001 and group 3 are sites that were opened after 2003.
106
Table 4. Predicted number of active DOs and total DOs, 2005-2020
DOs in active practice Total DOs*

Assumption Assumption
Year 2% 1% Static 2% 1% Static
2004 56,285 56,285 56,285
2005 58,525 58,525 58,525 59,040 59,040 59,040
2006 60,705 60,705 60,705 61,716 61,717 61,716
2007 63,093 63,093 63,093 64,585 64,585 64,585
2008 65,953 65,953 65,953 67,915 67,914 67,915
2009 68,873 68,836 68,900 71,298 71,261 71,325
2010 71,848 71,736 71,828 74,733 74,621 74,712
2011 74,876 74,653 74,732 78,220 77,997 78,076
2012 77,952 77,577 77,608 81,758 81,383 81,415
2013 81,071 80,503 80,449 85,347 84,778 84,724
2014 84,236 83,432 83,254 88,987 88,183 88,005
2015 87,439 86,357 86,016 92,677 91,595 91,254
2016 90,681 89,276 88,735 96,414 95,010 94,468
2017 93,963 92,190 91,407 100,201 98,428 97,645
2018 97,283 95,096 94,032 104,036 101,849 100,785
2019 100,644 97,993 96,608 107,919 105,269 103,885
2020 104,047 100,884 99,139 111,851 108,688 106,944
% increase
over adjusted
2004 85 79 76 89 84 81
* Deaths of retired DOs are not considered.
Notes
• Adjusted 2004 refers to the number of DOs as of May 31, 2004 plus the graduating class of 2004.
• Predictions include the number of DOs graduating in that year. Excluding the graduates
for 2020, the predicted number of DOs are 95,398 (1% growth), 98,561 (2% growth) and 93,653
(static growth).
• Predictions based on the Bureau of Health Professions Aggregate Physician Supply Model.
Assumptions
• 2%: a 2% annual increase in the number of graduates each year.
• 1%: a 1% annual increase in the number of graduates each year.
• Static: 500 additional graduates over the number in 2005 and then no further increases, or,
equivalently, 100 new students after 2008.
Table 5. Total number of DOs and MDs, 1981-2004
Year # DOs #MDs

1981 18,717 485,123
1982 19,519 501,598
1983 20,338 519,546
1989 28,104 600,789
1990 29,461 615,421
1991 30,791 -
1992 32,064 653,062
1993 33,365 670,336
1994 34,810 684,414
1995 36,999 720,325
1996 38,043 737,794
1997 39,692 756,710
1998 41,572 777,859
1999 43,639 797,634
2000 44,918 813,770
2001 46,990 836,156
2002 49,210 853,187
2003 51,684 871,535
2004 54,087 -
% increase
Average 4.4 2.8
1990-2004 83.6 45.1
1982-2004 177.1 79.7
Source:
DO data: Annual Reports of the AOA Committee on Membership.
MD data: Physician Characteristics and Distribution in the United States, various years; data from
the AMA; data presented in the Statistical Abstracts of the United States, various years.
Notes
• DO data is as of May 31 and does not include the graduating class for that year.
• MD is as of December 31 except for 1989 - 96 when it is as of January 1 for that year.
• MD data for 2003 is compared to DO data for 2004 because the MD for 2004 includes the
class of 2003 whereas DO data for 2003 does not. MD data for 1981 is compared to DO data
for 1982 for the same reason.
108

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Compendium of Osteopathic Workforce

Projection of Supply of Osteopathic Physicians (Hicks and Boles) .................................................. 7

Osteopathic Workforce Study 2004 (Megan, Ward and Corp).......................................................... 23

Osteopathic Workforce Studies

Hicks and Boles Study

Magen and Ward Study

1) the ratio of DOs-to-population remains constant in each US state;

Projections of DOs in 2020

American Osteopathic Association

Department of Health Management and Informatics

May 21, 1998

6) All graduates of osteopathic medical schools will enter practice

OSTEOPATHIC PHYSICIANS BY AGE COHORT

Model 2: Current Ratio Of Active To Total Physicians Will Be Maintained

6) All graduates of osteopathic medical schools will enter practice

OSTEOPATHIC PHYSICIANS BY AGE COHORT

6) All graduates of osteopathic medical schools will enter practice

OSTEOPATHIC PHYSICIANS BY AGE COHORT

About This Report

DO practice location is strongly correlated with location of Colleges of Osteopathic Medicine of

1. US Census Projection Excerpts

2. The Aging Of The Population Nationally & By Census Division

3. US Population By States & Census Regions

Table 2: Ranking Of Percent Of Total US Population By State, 2003

Total US Population 2003 = 283,506,239

Population Distribution by U.S. States, 2003

All Other States Texas

Source: US Department of Commerce, US Census Bureau

Source: US Department of Commerce, US Census Bureau

1. DO Population Distribution By State & Census Region

Table 3: Total Number Of Osteopathic Physicians By US State, 2003

Distribution of Practicing DO's by State, 2003

Source: US Census Bureau & American Osteopathic Association Department of Membership

States With Greatest DO Share

Source: US Census Bureau & American Osteopathic Association Department of Membership

Source: US Census Bureau & American Osteopathic Association Department of Membership

Figure 6: US Map by Census Region

Source: US Department of Commerce, US Census Bureau

Practicing D.O. Distribution by

Source: US Census Bureau & American Osteopathic Association Department of Membership

D.O. vs. Total Population by U.S. Census Region

Source: US Census Bureau & American Osteopathic Association Department of Membership

Population Distribution by U.S. Census Division, 2003

E.S. Central W.S. Central

W.N. Central Pacific

E.N. Central New England

Source: US Department of Commerce, US Census Bureau

Practicing D.O. Distribution by U.S. Census Division, 2003

Pacific New England

Source: US Census Bureau & American Osteopathic Association Department of Membership

Table 5: US Regional DO Totals Excluding Largest DO States, 2003

Table 6: US Divisional DO Totals Excluding Largest DO States, 2003

Nearly half (46%) of

22.30% 19.40% AZ-COM practice medicine in

C-COM practice medicine in

Des Moines COM practice

Region of Practice: K-COM Graduates

K-COM practice medicine in

Northeast Midwest South West

LE-COM practice medicine in

73.60% A large majority (73.6%) of

MSU-COM practice medicine

NSU-COM practice medicine