Starting in the last decade of the 20th century, private colleges of osteopathic medicine (COMs) began to restructure themselves in ways that represent a distinct departure from the past. Their new organizational model de-emphasizes many of the characteristics that distinguish allopathic medical schools today. The new emphasis centers on high enrollment, diversity of health-related programs, formation of universities of health science, expansion, and a retreat from involvement in clinical and postdoctoral education. Such changes reflect an admixture of entrepreneurship, an ability to respond quickly to changing environments, and an insularity that draws them away from traditional forms of clinical and postdoctoral medical education. The private COMs carved out their own niche in medical education and created a new model compatible with their institutional strengths and weaknesses and related to their economic, educational, and human resources. As an evolving educational model, the private COMs have undergone a remarkable transformation in a brief period; they bear watching for future developments and to assess their long-term viability.