The Vulnerabilities of Osteopathic Medicine

Recently, I was asked to give a talk to a group of osteopathic medical school deans. In particular, they wanted me to provide an outsider’s perspective on the vulnerabilities of osteopathic medical education to generate discussion for their own strategic planning.

Here’s my talk.

From the Sheriff of Sodium YouTube channel.



This version is slightly longer than the one that the deans heard, which had to fit within a one hour time slot. Some of the discussion at the end (about the NBA-ABA merger) gets more fleshed out more leisurely here.


The lecture received a mixed response.

Many deans, I think, appreciated hearing the viewpoints of an outsider. Others disagreed with some of my points and the way that I framed them. And at least a few were displeased that I’d been given airtime to discuss certain issues.

In particular, my comments about the National Board of Osteopathic Medical Examiners (NBOME) were not favorably received by at least some of the audience. Certainly, everyone is entitled to their opinion on this issue… but I stand by mine.

Unless you’re a first time visitor to this site, you know I’ve questioned whether the NBOME is an organization that’s outlived its usefulness, and whether maintaining a “separate but equal” licensing examination really serves the interests of DOs, or just the interests of the NBOME.

I’ve made the same points in the academic literature in an interesting series of correspondence that includes a reply from the CEO of the NBOME himself. (If you’re interested, the full sequence is here: our original article; first letter to the editor in reply; our reply to the first letter to the editor; NBOME CEO’s reply to that; then our reply to the NBOME CEO.)


I gave the lecture by Zoom, so I couldn’t clearly hear most of the extemporaneous audience discussion… but I’m told that there was some grumbling that certain slides used incorrect data.

In the Q&A after the talk, I invited anyone who believed I have the wrong numbers to please reach out to me. I want to reiterate that point here, because although we may disagree about the inference to be drawn, the data should be good. It’s important to me that I get it right.

(So far, I haven’t heard from anyone.)


Since this post went up, I’ve heard from quite a few members of the osteopathic medicine community about various points I made in the talk. I’ve also received a formal communication from one school requesting that I change or remove at least certain portions of the talk.

They pointed out that my figures on the number of osteopathic medical school applicants and matriculants from Idaho and Montana are incorrect. These data come from AACOM – but I mistakenly used figures from 2021 rather than preceding years. Of course, the 2021 data are preliminary: most students haven’t yet chosen to which school they’ll matriculate, which makes the matriculant numbers appear low.

This slide is incorrect (38:47). The actual figures for DO applicants and matriculants from Idaho in 2020 should have been 143 and 64.

I should have used the figures from 2020, in which there were 143 osteopathic medical school applicants and 64 matriculants from Idaho. In Montana, there were 48 applicants and 18 matriculants. The erroneous data appear at 38:47 and 40:27, respectively.

I apologize for this mistake. However, I’m not going to take down the video because of it. Whether there’s 1 or 64 DO students from Idaho is really irrelevant to my central point, which is that if you add medical school positions faster than you add qualified applicants, you put the perceived quality of your degree at risk.

The school also claimed that my statement about how their business plan called for a doubling of the class size was inaccurate. In their letter to me, they asserted that the school “does not currently have any plans to increase its class size.”

On first pass, this statement seems to contradict the school’s business plan as it was presented to potential investors – which is where I got my statistics in the first place.

Materials from an osteopathic medical school’s bond presale demonstrate clear intent to expand (and highlight potential financial risks should expansion be delayed due to accreditation issues).

I asked the school representative to clarify this. So far, they have not responded.

My impression is that the word currently is doing a lot of work in the section of their letter I quoted above, and that I am fundamentally correct in my assertion that expansion is called for in their business plan. I do not intend to make any change at this point. However, if I am incorrect on this issue – or anything else – I will post additional corrections or clarifications as needed.


The NBOME, Part 2: Osteopathic Medicine’s Vestigial Organ

Mailbag: Second Looks, the USMLE “Curve,” and Residency Placement Rates for DOs

Journal Club: COMLEX-USA and Physician Discipline