Since 1984, a new set of realities has generated pressures that are transforming osteopathic graduate medical education (OGME) and forcing it to adapt to changing circumstances. Policy decisions were made that addressed these circumstances, and the impact of these choices moved OGME in new directions. Many of the changes were perceived as positive, but inherent weaknesses were exposed as well. While the appearance and structure of OGME have been significantly altered, nowhere are the changes more apparent than in the traditional osteopathic internship. Compared with 1990, today's osteopathic internship is markedly different in terms of its curriculum, its identity, and its place within residencies approved by the Accreditation Council for Graduate Medical Education. As a direct consequence of decisions made to expand internship opportunities, the traditional osteopathic internship appears destined to vanish as a distinct educational experience.