Osteopathic Medicine

It is important to be cognizant about the nature of osteopathic education and certification when considering a career in this branch of medicine.

Education. Basically, the same curriculum is in effect at both allopathic and osteopathic schools. Naturally, there are variations in emphasis among different osteopathic schools. Medical school curricula are discussed in Chapter 11. Initially courses are given in the basic sciences, which particularly stand out because of their depth. The clinical sciences at osteopathic schools are weaker, especially at schools whose teaching hospital affiliations are limited.

Naturally, a unique feature of osteopathic schools to a varying degree, are the courses in osteopathic manipulative medicine and treatment. Nevertheless, DO graduates can feel secure that by applying themselves conscientiously and securing meaningful postgraduate training, competency to practice medicine is assured.

Postgraduate training. Training as residents can be secured at osteopathic hospitals and at many, but not all, MD teaching centers. As the list of osteopathic specialty organizations (Appendix E) indicates, training can be secured in specialties ranging from anesthesiology to vascular surgery.

As indicated earlier, we can anticipate a dramatic increase in the number of osteopathic medical school graduates. The number of first-year or entry-level allopathic residency positions, both regular and transitional, is in excess of what can be filled. Thus, significant numbers of places are available to be filled by DO graduates. It is commonplace to find osteopathic graduates as physicians-in-training at many allopathic teaching hospitals. There, they secure higher salaries and quality training, and can specialize in areas not open at osteopathic hospitals. This is especially true for surgical specialties. There are, however, problems associated with certification for DOs who complete training in MD-approved positions (see discussion below).

Finally, it should be noted that an internship matching program for osteopathic graduates does exist. While increasing numbers of DOs are entering MD-approved specialties, some are still closed. These are general surgery and its subspecialties. However, one can get such training in some osteopathic programs and professional osteopathic organizations in these fields exist.

Certification. In recent years, a significant number of internal medicine and family practice residency programs (currently about 60), engaged in training MDs have been granted AOA accreditation. This provides assurance that all primary care DO physicians graduating from such programs are automatically eligible for AOA board certification and licensure.

Aside from jointly recognized programs, DO graduates planning to secure training at MD-accredited programs have dual hurdles to face, from both the program and the AOA. Completion of such a program makes you eligible to take the AMA's specialty board examination. However, to take the AOA's exam in the same field, you will need to pay this organization a high fee for a residency program site visit to evaluate its status. Moreover, arranging for such a visit does not necessarily guarantee approval of the program. Should a negative report result, some osteopathic hospitals will not grant these physicians a staff appointment, allowing them to practice there, in spite of AMA certification.

Another obstacle arises in cases where a DO is completing a PGY-1 at an MD-approved program. He or she cannot receive internship credit, allowing further postgraduate training at an osteopathic residency program.

Licensure. In a very few states, such as Florida and Michigan, DOs are still unable to secure a license to practice medicine, unless they complete an internship approved by the AOA. However, an AOA-approved PGY-1 internship, does not count as meeting the prerequisite for admission to an allopathic residency (but only has value at some osteopathic specialty programs). Thus completing a DO internship is fraught with problems. Those who want to enter an MD-approved residency program must repeat the PGY-1 year at an AMA-approved program in order to be eligible.

Bottom Line

When looking at a career as an osteopathic physician, consideration should be given to the following potential pitfalls:

• • There still exists on the part of some MDs an antiosteopathic hostility that under certain circumstances may induce discriminatory action.
• • There may be difficulties in securing a residency appointment in general and a surgical residency in particular. However, DOs frequently are welcomed in MD residency programs where vacancies exist.
• • There also are distinct hardships for DOs in securing appointments at those non-surgical allopathic programs that are highly competitive. In some specialties, residencies are unobtainable because positions for DOs are simply unavailable.
• • Many prospective patients lack an understanding of the status of DOs and what services they are capable of providing. Some people may be totally unaware that osteopaths are physicians who are fully qualified and entitled to practice medicine.
• • There are potential certification and licensure impediments for DOs.