Compendium Osteopathic Workforce Studies

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Compendium of Osteopathic WorkforceStudies

James E. Swartwout

June 2005


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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


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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 Banes 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 toorapidly. 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 alsobeen 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 onmedical education concluded that the supply of physicians was more than sufficient as compared with ratios of

physicians to populations in Europe.2 The Surgeon Generals Consultant Group on Medical Education (Banes 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 MedNov 2004, 141;9:705-714.6 Kletke, PR, et al, The Demographics of Physician Supply: Trends and Projections,AMA, 1987, p. 32.


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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 annualattrition 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; and5) 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 COMs 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 usesan 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.


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Figure 1: Comparison of Osteopathic Workforce Projections

Projections of DOs in 2020

112

62

88

107

55

83

50

70

90

110

Hicks and Boles, 1998 Magen and Ward, 2004 Andes, 2005

Thousands

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 theUnited 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.


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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


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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 changesmust 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 usedto 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, theratio 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.


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Model 1: NoAttrition 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 to2020; 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

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


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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

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



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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 to2020:

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 allvalues) 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

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


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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.


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MODEL 1: OSTEOPATHIC PHYSICIANS BY AGE COHORT, UNDER ASSUMPTION OF NO ATTRITION

Total

DOs

1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

1,181 1,181 1,181 1,178 1,213 1,251 1,295 1,346 3,456

Total 27,792 29,036 30,290 31,520 32,864 34,368 35,940 37,547 39,455

Male

DO

1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

1,092 1,097 1,111 1,109 1,148 1,191 1,236 1,291 1,398

Total 23,904 24,736 25,564 26,316 27,139 28,052 29,011 29,978 31,140

Female

DOs

1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

89 84 70 69 65 60 59 55 58

Total 3,888 4,300 4,726 5,204 5,725 6,316 6,929 7,569 8,315


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Total

DOs

2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

1,658 1,691 1,704 1,677 1,709 1,764 1,783 1,847 1,880

Total 45,149 47,194 49,247 51,299 53,381 55,664 57,948 60,327 62,732

Male

DOs

2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

1,610 1,651 1,661 1,640 1,671 1,718 1,739 1,785 1,811

Total 34,559 35,784 37,011 38,227 39,453 40,812 42,162 43,584 45,039

Female

DOs

2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

48 40 43 37 38 46 44 62 69

Total 10,590 11,410 12,236 13,072 13,928 14,852 15,786 16,743 17,693


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Total DOs 2012 2013 2014 2015 2016 2017 2018

Age

2,241 2,501 2,676 2,987 3,442 3,948 4,327

Total 69,863 72,223 74,557 76,934 79,282 81,525 83,702

Male DOs 2012 2013 2014 2015 2016 2017 2018 20

Age

2,108 2,317 2,468 2,743 3,156 3,570 3,879

Total 49,292 50,684 52,065 53,487 54,890 56,184 57,426 5

Female

DOs

2012 2013 2014 2015 2016 2017 2018 20

Age

133 184 208 244 286 378 448

Total 20,571 21,539 22,492 23,447 24,392 25,341 26,276 2


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MODEL 2: OSTEOPATHIC PHYSICIANS BY AGE COHORT, UNDER ASSUMPTION OF RATIO OF ACTIV

Total 1990 1991 1992 1993 1994 1995 1996 1991 1998

Age

< 35 7,607 7,504 7,463 7,396 7,384 7,501 7,646 7,883 8,337

35-44 10,524 11,354 11,986 12,702 13,271 13,795 14,214 14,440 14,589

45-54 4,232 4,669 5,256 5,746 6,458 7,214 8,017 8,896 9,79155-64 2,798 2,825 2,847 2,876 2,856 2,894 3,012 3,209 3,505

65-69 884 918 950 995 1,038 1,047 1,071 1,070 1,054

70 > 1,251 571 568 562 594 613 639 668 720

Total 27,295 704 718 742 763 786 804 810 868

Males 1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

1,077 491 489 484 512 528 551 576 620

Total 23,506 606 619 639 657 677 692 698 748

Females 1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

174 79 79 78 82 85 89 93 100

Total 3,790 98 100 103 106 109 1 12 112 121


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Total 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

< 35 9,856 10,398 10,879 11,393 12,009 12,666 13,029 13,406 13,745

35-44 14,640 14,774 14,961 15,137 15,257 15,447 15,996 16,609 17,300

15-54 12,622 13,289 14,039 14,650 15,179 15,623 15,883 16,062 16,17955-64 4,468 5,063 5,570 6,253 6,980 7,739 8,594 9,450 10,383

65-69 1,097 1,126 1,183 1,206 1,207 1,307 1,452 1,637 1,791

70 > 804 817 806 783 827 837 860 902 922

Total 1,078 1,149 1,235 1,319 1,382 1,456 1,521 1,570 1,617

Males 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

693 703 694 674 712 721 740 777 794

Total 929 989 1,064 1,136 1,190 1,254 1,310 1,352 1,393

Females 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

< 35 1,368 1,444 1,510 1,582 1,667 1,759 1,809 1,861 1,908

35-44 2,033 2,051 2,077 2,102 2,118 2,145 2,221 2,306 2,402

45-54 1,752 1,845 1,949 2,034 2,107 2,169 2,205 2,230 2,246

55-64 620 703 773 868 969 1,075 1,193 1,312 1,442

55-69 152 156 164 167 168 181 202 227 249

70 > 112 113 112 109 115 116 119 125 128Total 150 159 171 183 192 202 211 218 225


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Total 2012 2013 2014 2015 2016 2017 2018 20

Age

1,107 1,248 1,366 1,523 1,728 1,991 2,164

Total 1,813 1,881 1,923 1,972 2,073 2,201 2,358

Males 2012 2013 2014 2015 2016 2017 2018 20

Age

953 1,074 1,176 1,311 1,488 1,715 1,863

Total 1,561 1,620 1,656 1,699 1,785 1,896 2,031

Females 2012 2013 2014 2015 2016 2017 2018 20

Age

154 173 190 211 240 276 300

Total 252 261 267 274 288 306 327


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MODEL 3: OSTEOPATHIC PHYSICIANS BY AGE COHORT, UNDER ASSUMPTION OF TWO PERCENT

Total

DOs

1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

2,812 2,894 2,933 2,998 3,133 3,249 3,360 3,449 3,530

Total 29,423 30,749 32,042 33,340 34,784 36,366 38,005 39,650 40,940

Male

DOs

1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

2,526 2,609 2,656 2,719 2,853 2,970 3,087 3,182 3,292

Total 25,338 26,248 27,109 27,926 28,844 29,831 30,862 31,869 32,571

Female

DOs

1990 1991 1992 1993 1994 1995 1996 1997 1998

Age

286 285 277 279 280 279 273 267 237

Total 4,085 4,501 4,933 5,414 5,910 6,535 7,143 7,781 8,369


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Total

DOs

2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

3,483 3,378 3,224 3,029 2,875 2,674 2,453 2,235 1,954

Total 45,010 46,573 48,166 49,805 51,500 53,369 55,293 57,306 59,346

Male

DOs

2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

3,829 3,887 3,887 3,851 3,852 3,803 3,739 3,662 3,523

Total 36,778 38,020 39,237 40,438 41,634 42,897 44,162 45,461 46,751

Female

DOs

2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

(346) (509) (662) (822) (977) (1,129) (1,286) (1,428) (1,569)

Total 8,232 8,553 8,929 9,367 9,866 10,412 11,130 11,844 12,595


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Total DOs 2012 2013 2014 2015 2016 2017 2018 201

Age

1,375 1,313 1,184 1,140 1,264 1,541 1,755 2,11

Total 65,558 67,653 69,759 71,876 74,005 76,145 78,296 80,45

Male DOs 2012 2013 2014 2015 2016 2017 2018 20

Age

3,319 3,350 3,323 3,368 3,561 3,857 4,093

Total 50,503 51,718 52,920 54,112 55,295 56,471 57,640 5

Female

DOs

2012 2013 2014 2015 2016 2017 2018 20

Age

(1.944) (2,037) (2,139) (2,228) (2,297) (2,315) (2,338) (

Total 15,055 15,935 16,839 17,764 18,710 19,674 20,655 2


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OSTEOPATHIC WORKFORCE STUDY

2004

Myron S. Magen, DO

Douglas Ward, Ph.D.

Sarah Corp, M.A.


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TABLE OF CONTENTS

LIST OF TABLES...................................................................................................................................... 26LIST OF FIGURES .................................................................................................................................... 27INTRODUCTION...................................................................................................................................... 29

EXECUTIVE SUMMARY ........................................................................................................................ 31PHYSICIAN WORKFORCE POLICIES & STUDIES............................................................................. 33UNITED STATES CENSUS BUREAU MATERIAL............................................................................... 35

1. US Census Projection Excerpts ......................................................................................................... 352. The Aging Of The Population Nationally & By Census Division..................................................... 353. US Population By States & Census Regions ..................................................................................... 37

OSTEOPATHIC PHYSICIAN POPULATION DATA............................................................................. 391. DO Population Distribution By State & Census Region ................................................................... 392. DO Population Relative to College of Medicine & Census Region .................................................. 473. Practicing DOs In US Census Regions, Divisions & States By COM .............................................. 59

Arizona ....................................................................................................................................................... 74OSTEOPATHIC PHYSICIAN PROJECTIONS........................................................................................ 75

1. Population-Based DO Projections to 2025 by State & US Census Region/Division........................ 752. Graduate-Based DO Projections (National) To 2040 ........................................................................ 79

CURRENT OSTEOPATHIC PHYSICIAN PRACTICE SPECIALTIES & TRAINING PROGRAM

TRENDS..................................................................................................................................................... 811. National Distribution of Osteopathic Practice Specialties, 2003....................................................... 812. National Distribution of DO Students by Program Types ................................................................. 83

OSTEOPATHIC PHYSICIAN DEMOGRAPHIC DATA: PRESENT & FUTURE .............................. 901. Age Information................................................................................................................................. 902. Gender Distribution of the Osteopathic Profession ........................................................................... 93

RECOMMENDATIONS............................................................................................................................ 97APPENDIX A: Practice Specialty Groupings........................................................................................... 98


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LIST OF TABLESTable 1 Projected Population Distribution by

Age Group, 2000-2025

Table 2 Ranking of Percent of Total US

Population by State, 2003

Table 3 Total Number of OsteopathicPhysicians by US State, 2003

Table 4 Ranking of Percent of Total Practicing

DOs by US State, 2003

Table 5 US Regional DO Totals ExcludingLargest DO States, 2003

Table 6 US Divisional DO Totals Excluding

Largest DO States, 2003

Table 7 DO Population by COM & Census

Region: Northeast


Region: MidwestTable 9 DO Population by COM & Census

Region: South


Region: WestTable 11 Percent of Practicing DOs by COM of

Graduation in US Census Regions,

2003

Table 12 Active DO Population Across States

With a COM as Compared to Date of

1st Graduating Class of COM in

Given State

Table 13 Relationship Between # of COMs &Proportion of DO Population, 2003

Table 14 US Census Regions & Divisions

Table 15 Practicing DOs by COM of Graduation

in Northeast Census Region


in Midwest Census Region


in South Census Region


in West Census Region

Practicing DOs by COM of Graduation in Northeast

Census Divisions

Table 19 Division 1 New England

Table 20 Division 2 Mid Atlantic

Practicing DOs by COM of Graduation in Midwest

Census Divisions

Table 21 Division 3 East North Central

Table 22 Division 4 West North Central

Practicing DOs by COM of Graduation in Southern

Census Divisions

Table 23 Division 5 South Atlantic

Table 24 Division 6 East South Central

Table 25 Division 7 West South Central

Practicing DOs by COM of Graduation in Western

Census DivisionsTable 26 Division 8 Mountain

Table 27 Division 9 Pacific

Table 28 Distribution of DOs & Students by US

Census Region, 2003Table 29 Distribution of Non-Practicing DOs by

US Census Region, 2003

Table 30 COM With Largest DO Graduate

Representation by US States, 2003Table 31 Practicing DO Projections by State

2003-2025

Table 32 Projected Distribution of Practicing

DOs by US Census Region, 2003-

2025

Table 33 Projected Distribution of Practicing

DOs by US Census Division, 2003-

2025

Table 34 DO Projections 2000-2040 Based on

2000 Graduation Rates


Increase in 2000 Graduation Rates of400


Increase in 2000 Graduation Rates of

600


Increase in 2000 Graduation Rates of

1000

Table 38 Self-Reported Primary Practice

Specialties, 2003

Table 39 Number of DOs Training in ACGME

Programs by State, 2003-2004

Table 40 AOA Internship Programs by State,2003-2004

Table 41 AOA Residency Programs by State,

2003-2004

Table 42 Percentage of Practicing DOs by

Graduation Decades, 2003

Table 43 Distribution of Practicing DOs &

Students by Age Category, 2003


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Table 44 Age Projections Based on DO

Forecasts Using 2000 Graduation

Rates

Table 45 Age Projections Based on DO

Forecasts Using 2000 Graduation

Rates + 400

Table 46 Age Projections Based on DOForecasts Using 2000 Graduation

Rates + 600

Table 47 Gender Distribution of Inactive

Osteopathic Physicians, 2003

Table 48 Gender Distribution of Practicing

Osteopathic Physicians, 2003

Table 49 Gender Distribution of US Osteopathic

Students, 2003

Table 50 Women in the Osteopathic Profession

by Graduation Class

Table 51 DO Gender Graduation Percent

Projections 2005-2040

LIST OF FIGURESFigure 1 Population Distribution by US States,

2003

Figure 2 Population Distribution by US Census

Region, 2003

Figure 3 Distribution of Practicing DOs by

State, 2003

Figure 4 States With Greatest DO Share

Compared to Total Population

Figure 5 States With Smallest DO Share

Compared to Total PopulationFigure 6 US Map by Census Region


Region, 2003

Figure 8 Practicing DO Distribution by US

Census Region, 2003

Figure 9 DO vs. Total Population by US CensusRegion


Division, 2003

Figure 11 Practicing DO Distribution by US

Census Division, 2003

Figure 12: Region of Practice: AZ-COM GraduatesFigure 13 Region of Practice: C-COM Graduates

Figure 14 Region of Practice: Des Moines COM

Graduates

Figure 15 Region of Practice K-COM GraduatesFigure 16 Region of Practice: LE-COM

Graduates

Figure 17 Region of Practice: MSU-COM

Graduates

Figure 18 Region of Practice: NSU-COM

Graduates

Figure 19 Region of Practice: NY-COM

Graduates

Figure 20 Region of Practice: OSU-COM

Graduates

Figure 21 Region of Practice: OU-COMGraduates

Figure 22 Region of Practice: P-COM Graduates

Figure 23 Region of Practice: PC-SOM Graduates

Figure 24 Region of Practice: TU-COM

Graduates

Figure 25 Region of Practice: UHS-COM

Graduates

Figure 26 Region of Practice: UMDNJ-COM

Graduates

Figure 27 Region of Practice: UNE-COM

Graduates

Figure 28 Region of Practice: UNT-COMGraduates

Figure 29 Region of Practice: WV-SOM

Graduates

Figure 30 Region of Practice: WU Graduates

Figure 31 Percent of DOs Practicing in States

With COMs

Figure 32 Distribution of DO Practice Specialties

Figure 33 Distribution of Primary Practice Types

v. All Other Practice Types

Figure 34 Trends: DOs in AOA Primary Practice

Programs, 1987-2002

Figure 35 Trends: DOs in ACGME PrimaryPractice Programs, 1987-2002

Figure 36 Trends: DOs in AOA & ACGME

Family Practice Programs, 1987-

2002


Internal Medicine Programs, 1987-

2002


OB/GYN Programs, 1987-2002


Pediatrics Programs, 1987-2002

Figure 40 DO Enrollment in AOA & ACGMEPrimary Care Programs, 1987-2002

Figure 41 DO Enrollment in AOA & ACGME

Specialty Programs, 1987-2002

Figure 42 DOs in all AOA & ACGME Programs,

1987-2002

Figure 43 Age Distribution of DO Population,

2003


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Figure 44 Percent of DO Population: Women,

2003

Figure 45 Women DOs by Graduating Class

Figure 46 Projected Graduation Rates: Women as

Percent of Total, 2005-2040


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INTRODUCTIONThe 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 quocan 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 thehealth 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 ofnew COMs 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 Osteopathicprofession.

Additional subjects covered in this report include: the projected growth of the Osteopathicprofession 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.


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EXECUTIVE SUMMARYPopulation 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 41.5percent 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 theprofession 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 eventhese 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 ageof 40.


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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 havealways 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.


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PHYSICIAN WORKFORCE POLICIES & STUDIES9

During the 1950s, and through the 1970s 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

1950s, 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 toenter 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 thanaggregate supply. Government policies in 1980 attempted to address these issues, but physician supply

continued to increase. The Kindig writings of the early 1990s 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, withlarge 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

9Note: the information in this section was compiled from the following sources:

1. Cooper, et al. Published reports in 1995 & 1998Journal 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 theNew England Journal of Medicine, and 2002 published report inHealth Affairs.

2. Institute of Medicine. 1996. The Nations Physician Workforce: Options for Balancing Supply &

Requirements.

3. Mullan, F. Published reports in 2000New England Journal of Medicine & 2002Health Affairs

4. Salsberg, Ed 2003 report to the Council on Graduate Medical Education.

5. Schwartz, W.B. & Mendelson D.N. 1990 published report in theJournal of the American Medical

Association

6. Weiner, J. 2002 published report inHealth Affairs


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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 GraduateMedical 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 1980s), 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 changein 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 Coopers report on a survey conducted of Medical School Deans and Medical Society ExecutiveDirectors, 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.


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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.


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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 Central16.1%(15,622)

15.6% (15,642) 30.7% (39,591) 13.5% (15,551)

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)

Total

97,047

35% of total

pop.

100,227

35% of total

pop.

128,793

38% of total

pop.

115,512

34% of total

pop.

Age Group: 25-64New 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%(10,595)

6.3% (10,226)

South Atlantic 18.6% (26,558) 18.9% (28,230) 19.1% (30,469) 19.0% (30,786)



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)

Total

142,881

52% of total

pop.

149,572

52% of total

pop.

159,578

48% of total

pop.

161,942

48% of total

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)



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)

Total

34,613

13% of total

pop.

36,270

13% of total

pop.

45,571

14 % of total

pop.

61,954

18% of total

pop.

YEAR TOTALS 274,541 286,069 333,942 339,408Source: US Department of Commerce, US Census Bureau


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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

STATE2003Population

% of TotalPopulation

STATE

2003Population

% of TotalPopulation

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 = 283,506,239Source: US Department of Commerce, US Census Bureau

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).


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Figure 1

Population Distribution by U.S. States, 2003

Ohio

4%Illinois

4%

New York

6%

Texas

7%

California

13%

All Other States

56%

Florida

6%

Pennsylvania

4%

Source: US Department of Commerce, US Census Bureau

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

Northeast

18%

Midwest

23%

South

36%

West

23%



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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 293Kansas 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 52Source: 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.


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Table 4: Ranking of Percent of Total Practicing DOs By US State, 2003

State Total

% of Total

Practicing

DOs

% of Total US

Pop.

State Total

% of Total

Practicing

DOs

% of Total

US Pop.

Penn. 5396 11.09 4.36 Mass. 450 .92 2.10

Michigan 4910 10.09 3.47 Tennessee 414 .85 2.01Ohio 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 .93Colorado 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 .21N. Carolina 452 .93 2.77 Wyoming 49 .10 .19

D.C. 45 .09 .19

TOTAL POPULATION OF PRACTICING DOs IN US = 48,678Source: 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.


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Figure 3

Distribution of Practicing DO's by State, 2003

New Jersey

6%

New York

6%

Florida

7%Ohio

7%Michigan

10%Pennsylvania

11%

All Other States41%

Texas

6%

California

6%

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

Likewise, approximately forty-seven percent of the total US population resides in these eight states. Thisindicates 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 osteopathicphysicians 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 theirtotal 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

10.09

7.18

5.67

3.794.36 3.474.07

1.95

11.09

2.91

0

2

46

8

10

12

Penn. Michigan Ohio New Jersey Missouri

State

Percent

% OF

PRACTICING

TOTAL

% OF TOTAL

U.S. POP.



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Figure 5

States With Smallest DO ShareCompared to Total Population

1.33 1.221.61

0.20.93

5.89

2.82.77

12.89

2.56

0

2

4

6

8

10

12

14

California N. Carolina Georgia Louisiana Virginia

State

Percents

% OF

PRACTICING

TOTAL

% OF TOTAL

U.S. POP.


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


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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 populations proportion of DOs.

Figure 7

Population Distribution by

U.S. Census Region, 2003

Northeast

18%

Midwest23%

South

36%

West

23%


Figure 8

Practicing D.O. Distribution by

U.S. Census Region, 2003

Northeast

27%

Midwest

32%

South

26%

West

15%


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 populations proportion of DOs. For


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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

0%

5%

10%

15%

20%

25%

30%

35%

40%

Northeast Midwest South West

Percent

Region

Total

Population

D.O.Population


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 DOpopulation 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.


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Figure 10

Population Distribution by U.S. Census Division, 2003

New England

5%Mid Atlantic

14%

E.N. Central

16%

W.N. Central

7%

S. Atlantic

18%

E.S. Central

6%W.S. Central

11% Mountain6%

Pacific

17%


Figure 11

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

New England

4%Mid Atlantic

23%

E.N. Central

24%W.N. Central

6%

S. Atlantic

14%

E.S. Central

3%

W.S. Central10%

Mountain

7%

Pacific

9%


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


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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

REGION

% of Total Nat.

DO Population

Largest DO

State in Region

% of Region DO Population Lost

when Excluding Largest DO State

Northeast 27% Pennsylvania 41.5%

Midwest 32% Michigan 31.3%

South 26% Florida 26%

West 15% California 39%Source: American Osteopathic Association, Department of Membership

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

DIVISION

% of Total Nat.

DO Population

Largest DO State

in Division

% of Division DO Population

Lost when Excluding Largest

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%Source: American Osteopathic Association, Department of Membership


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2. DO Population Relative to College of Medicine & Census Region

The following graphs give a general indication ofwhere DOs from particular COMs currently

practice medicine. They detail the regional distribution of practicing DOs based on COM ofgraduation.

Figure 12

Region of Practice: AZ-COM Graduates

46%

19.40%22.30%

12.30%


U.S. Census Region

Percent

Figure 13

Figure 14

Region of Practice: Des Moines COM Graduates

48.90%

16.90%18.70%15.50%


U.S. Census Region

Percent

Region of Practice: C-COM Graduates

14.90%14.60%

62.80%

7.70%


U.S. Census Region

Percent

Nearly half (46%) of

practicing DO graduates from

AZ-COM practice medicine in

the Western region of the

United States.

A majority (62.8%) of


C-COM practice medicine in

the Midwest region of the

United States.

Nearly half (48.9%) of


Des Moines COM practice

medicine in the Midwest

region of the United States.


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Figure 15

Region of Practice: K-COM Graduates

19%22.80%

47.30%

10.90%


U.S. Census Region

Per

cent

Figure 16

Region of Practice: LE-COM Graduates

2.30%

14%20.20%

63.50%


U.S. Census Region

Percent

Figure 17

Region of Practice: MSU-COM Graduates

10.60%11.20%

73.60%

4.60%


U.S. Census Region

Percent

Figure 18

Region of Practice: NSU-COM Graduates

15.40% 11.80% 6.20%

66.60%


U.S. Census Region

Percent

Nearly half (47.3%) of


K-COM practice medicine in

the Midwest region of theUnited States.



LE-COM practice medicine inthe Northeast region of the

United States.

A large majority (73.6%) of

practicing DO graduates fromMSU-COM practice medicine

in the Midwest region of the

United States.

A majority (66.6%) ofpracticing DO graduates from

NSU-COM practice medicine

in the Southern region of the

United States.


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Figure 19

Region of Practice: NY-COM Graduates

4.40%11.50%4.90%

79.20%


U.S. Census Region

Pe

rcent

Figure 20

Region of Practice: OSU-COM Graduates

16.20%

71.80%

9.30%2.70%


U.S. Census Region

Perc

ent

Figure 21

Region of Practice: OU-COM Graduates

72.70%

13.30%6.90% 7.10%


U.S. Census Region

Percen

t

Figure 22

Region of Practice: P-COM Graduates

5.50%

28.10%

7.30%

59.10%


U.S. Census Region

Percent



NY-COM practice medicine

in the Northeast region of theUnited States.



OSU-COM practice medicine


United States.

A large majority (72.7%) ofpracticing DO graduates from

OU-COM practice medicinein the Midwest region of the

United States.


practicing DO graduates fromP-COM practice medicine in

the Northeast region of the

United States.


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Figure 23

Region of Practice: PC-SOM Graduates

31.50%

0%6.30%

62.20%


U.S. Census Region

Pe

rcent

Figure 24

Region of Practice: TU-COM Graduates

9.40% 5.50% 7%

78.10%


U.S. Census Region

Perc

ent

Figure 25

Region of Practice: UHS-COM Graduates

40.90%

17.60%29.20%

12.30%


U.S. Census Region

Percen

t

Figure 26

Region of Practice: UMDNJ-COM Graduates

4.60% 5.40%15.30%

74.70%


U.S. Census Region

Percent


practicing DO graduates fromUMDNJ-COM practice

medicine in the Northeast

region of the United States.

Practicing DO graduates fromUHS-COM primarily (40.9%)

practice medicine in theMidwest region of the United

States.



TU-COM practice medicine in

the Western region of the

United States.



PC-SOM practice medicine in

the Southern region of theUnited States.


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Figure 27

Region of Practice: UNE-COM Graduates

10.60% 14.40% 9.10%

65.90%


U.S. Census Region

Pe

rcent

Figure 28

Region of Practice: UNT-HSC Graduates

9.80%

75%

11.50%

3.70%


U.S. Census Region

Perc

ent

Figure 29

Region of Practice: WV-SOM Graduates

8.90%

69.30%

3.50%

18.30%


U.S. Census Region

Percen

t

Figure 30

Region of Practice: WU Graduates

10.50% 9.50%

75.10%

4.90%


U.S. Census Region

Percent


practicing DO graduates fromWU practice medicine in the

Western region of the United

States.


practicing DO graduates fromWV-SOM practice medicine


United States.



UNE-COM practice medicine

in the Northeast region of theUnited States.

A large majority (75%) of


UNT-HSC practice medicinein the Southern region of the

United States.


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The numbers in the tables below also specify, by region, where the highest concentration of DOsgraduating 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 nearlysixty percent of practicing osteopathic physicians in the Northeast states attended Pennsylvania

College of Osteopathic Medicine. The following tables demonstrate that in every instance, theregion in which a College of Osteopathic Medicine is located is also where the overwhelmingnumber of its graduates practice medicine.

Table 7

Compendium Osteopathic Workforce Studies

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