74 New Challenges and Opportunities Osteopathic Graduates Entering Family Medicine Residencies Were a Decisive Factor in the Decision To Form a Single Accreditation System by Thomas N. Told, DO, FACOFP dist. For more than 105 years following the Flexner Report in 1910, allopathic and osteopathic medicine developed separate schools, hospitals, and postgraduate education programs using most of the same educational standards. Both organizations formed separate accrediting bodies, state licensure boards, and licensing examinations to support and validate that their graduates were qualified to be licensed for the unrestricted practice of medicine. Until 1969, nearly all osteopathic postgraduate training occurred in osteopathic hospitals, which were fully accredited by AOA. During that time, these hospitals were still relatively plentiful throughout the country. Then, as now, the number of physicians produced depends on the number of available postgraduate training spots open to MD and DO medical school graduates — not the number of graduates produced by those osteopathic or allopathic medical schools. There was rising concern, primarily among osteopathic leadership, that the profession was growing at a faster rate than the number of osteopathic residency slots available in osteopathic hospitals to train all the graduates of osteopathic colleges. The solution was to require colleges of osteopathic medicine to sponsor the development of more osteopathic training spots, but that meant opening more osteopathic hospitals, which was beyond the ability of the colleges to do, so the requirement was downgraded to a recommendation and little growth occurred. The growing lack of clinical training sites in osteopathic hospitals forced colleges to begin reaching out to nonosteopathic hospitals, such as community hospitals and private hospital networks, many of which were controlled by the Hospital Corporation of America (HCA). At that time, HCA was also in the process of buying many smaller osteopathic hospitals, including some with osteopathic residencies. Many in the profession called for a moratorium to be issued from the Commission on Osteopathic College Accreditation (COCA) to limit the number of new osteopathic colleges being proposed because of the growing loss of osteopathic residencies. They would learn that COCA could not limit anyone from starting a college of osteopathic medicine if they met all the requirements, which most did. This once again blocked a possible avenue of reaching any meaningful solutions on limiting growth of schools, and the problem continued to multiply in scope. By 2014, AOA and AACOM faced even more pressure to solve the two issues that had eluded the prior profession-wide attempts to mitigate them successfully. First, was the continued rapid growth of the osteopathic student population, driven by the development of new colleges of osteopathic medicine, which were much easier to start since they did not need a functioning academic medical center as a requirement for accreditation. This was a limiting factor for the establishment of new schools accredited by the Association of American Medical Colleges (AAMC). Many of those osteopathic colleges also were allowed to establish satellite campuses often of equal size to the home campus. Thomas N. Told
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