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Response to “Contribution of Osteopathic Training to the Primary Care Workforce”

To the Editor:

We are deeply grateful to Drs Malouin and Keenum for raising their concerns regarding the potential impact of the Single Accreditation System (SAS) for Graduate Medical Education (GME) and appropriate recognition of the significant proportion of osteopathic graduates matriculating into our family medicine residency programs. The Triple Aim of better health care experience, improved health of populations, and reduced per capita costs of health care will be extremely difficult to achieve without a workforce that is balanced between primary care and subspecialty physicians.1

The continued persistence of the osteopathic medical schools to prepare medical students for a career in family medicine is a key driver of the family medicine and primary care workforce production. We, and many others, recognize that the successful transition of as many of the GME positions in programs currently accredited only by the American Osteopathic Association (AOA) to accreditation by the Accreditation Council on Graduate Medical Education (ACGME) is critical for our family medicine workforce. To that end, the American Academy of Family Physicians (AAFP) is actively working with our sister family medicine organizations, including the American College of Osteopathic Family Physicians, to provide technical assistance, programs, and other tools to assist AOA-only accredited family medicine programs to successfully achieve ACGME accreditation before the deadline of June 30, 2020. Significant challenges lie ahead since, as of early February 2017, only a relatively small number of the total AOA-only accredited family medicine programs have entered the ACGME accreditation application process, given the deadline of December 31, 2017 by which AOA-only accredited programs must have achieved at least pre-accreditation status in order to participate in the 2018 AOA match.

Our two annual reports on the National Residency Matching Program (NRMP) Match and the Entry of US Medical Graduates into Family Medicine Residencies have served as barometers for the family medicine workforce for over three decades. We readily acknowledge that we can do more to increase the recognition of the contribution of the osteopathic graduates to the family medicine residency ranks. As noted in our companion article, the percentage of osteopathic graduates entering ACGME-accredited family medicine programs has grown steadily from 16% to 23% of the entering class from 2005 to 2015.2 The SAS is a shared opportunity to collaborate, aggregate and report data on the production, along with organizational and cultural influence of family medicine student choice in all medical schools.

As representatives of the AAFP, the authors are eager to host conversations, in partnership with our sister family medicine organizations, to discover those behaviors and strategies that enable some schools to achieve greater success in producing graduates entering into family medicine than their peer schools and to imagine new possibilities.

Stanley M. Kozakowski, MD; Alexandra Travis; Ashley Bentley, MBA; Gerald Fetter, MSHA

American Academy of Family Physicians, Medical Education Division


  1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff 2008;27(3):759-69.
  2. Kozakowski SM, Travis A, Bentley A, Jr GF. Entry of US Medical School Graduates Into Family Medicine Residencies: 2015–2016. Fam Med 2016;48(9):688-95.

Copyright 2018 by Society of Teachers of Family Medicine