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Letters to the Editor  |   April 2013
Osteopathic Training of MDs
Author Affiliations
  • Stephen J. Noone, MS, CAE
    Retired Executive Director (1992-2008), American Academy of Osteopathy
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   April 2013
Osteopathic Training of MDs
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 270-271. doi:10.7556/jaoa.2013.113.4.270
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 270-271. doi:10.7556/jaoa.2013.113.4.270
To the Editor: 
I read with interest the September 2012 discussion1,2 in The Journal of the American Osteopathic Association about the Accreditation Council of Continuing Medical Education common program requirements, including opening osteopathic graduate medical education (GME) programs to allopathic physicians (ie, MDs). In their response to Dr Zeichner's letter,1 Dr Buser and colleagues2 correctly stated that “allowing MDs into DO training programs” is not a new initiative for the osteopathic medical profession. My recollection of prior actions related to osteopathic training of MDs is as follows. 
In April 1993, the Council on Osteopathic Postdoctoral Training (COPT) of the American Osteopathic Association (AOA) adopted a resolution (Resolution 4—Acceptance of Allopathic Graduates Into Osteopathic Medical Education Programs) by a vote of 12-7 to enroll allopathic medical school graduates from Liaison Committee on Medical Education institutions into AOA-approved internship and residency programs. However, as documented in AOA records, after negative reaction on the part of some AOA practice affiliates, the COPT reversed its decision by a vote of 12-9 at its November 1993 meeting, thereby denying enrollment of MDs in AOA-approved GME programs. This COPT proposal dealt with the matter as it applied to all AOA-approved internships and residencies. 
Also in the 1990s, the American Academy of Osteopathy (AAO) proposed changes in the basic standards for residency training in osteopathic manipulative medicine (OMM) that would permit MDs to enroll in those programs only. The AAO leadership was nearly successful in shepherding these changes through the various required levels of approval within the AOA. 
A brief history of this AAO initiative follows:
  •  
    At the July 1993 AOA House of Delegates meeting, the assembly adopted Resolution 241 (Allopathic Postdoctoral Training in Osteopathic Manipulative Medicine), which directed the AAO's Postdoctoral Standards and Evaluation Committee to return in 1994 with a proposal that would accommodate enrollment of MDs in OMM residency programs.
  •  
    In March 1994, the AAO's Board of Governors approved a proposal from its Postdoctoral Standards and Evaluation Committee that would permit the enrollment of MDs in OMM residency programs.3
  •  
    The July 1994 AOA House of Delegates considered Resolution 200, which directed the AOA Bureau of Education and the COPT to revise the Basic Standards for Residency Training in Osteopathic Manipulative Medicine for enrollment of MDs. The House referred Resolution 200 to the Committee on Basic Documents of Affiliated Organizations and the Bureau of Professional Education.
  •  
    At its November 1995 meeting, the COPT approved amendments to the Basic Standards for Residency Training in Osteopathic Manipulative Medicine for enrollment of MDs.
  •  
    The AOA Board of Trustees subsequently approved the Bureau of Professional Education and COPT's recommendation (Resolution 18) to these changes to its Basic Standards for Residency Training in Osteopathic Manipulative Medicine for enrollment of MDs.
  •  
    The American Osteopathic Board of Special Proficiency in Osteopathic Manipulative Medicine (AOBSPOMM) then drafted changes in its bylaws to accommodate MDs who would complete OMM residencies, take examinations, and ultimately receive a credential in this discipline.
  •  
    In the 1997-1998 academic year, the AAO's and the AOBSPOMM's efforts to guide the issue of credentialing MDs in OMM became a growing controversy within the osteopathic medical profession. While the COPT had approved the revision to the basic standards for residency training, and while the AOBSPOMM revised its bylaws to provide for examination of MDs who completed residency training in OMM, several member boards of the AOA Bureau of Osteopathic Specialists strongly objected to the initiative out of fear that allopathic physicians would force themselves into other AOA specialty disciplines.4
  •  
    At its February 1998 meeting, the AOA Board of Trustees created a special task force on OMM certification and credentials (Resolution 40—Osteopathic Manipulative Medicine Credentialing for Allopathic Physicians) to study the challenge by some in the profession that OMM was not a specialty, and therefore graduating residents were not eligible for certification in special proficiency in OMM. The AAO was able to persuade the task force and AOA leadership that OMM was indeed a specialty and that osteopathic physician (ie, DO) residents should continue to sit for examinations to earn a primary, general certification. However, the downside to this recognition was that the AOA suspended existing OMM residencies pending revision of the basic documents for residency training in the specialty. This action effectively ended the AAO's efforts to provide OMM training for MDs and recognize their expertise by means of a credential in OMM.
  •  
    Ultimately, the AOA Board of Trustees dissolved the AOBSPOMM and directed the creation of a new certifying board with a revised constitution and bylaws to reflect the changes in the basic standards for residency training in neuromusculoskeletal medicine and OMM. The new certifying board became the American Osteopathic Board of Neuromusculoskeletal Medicine (Resolution 70 [A/1998]—Proposed Amendments to the Constitution and Bylaws of the American Osteopathic Board of Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine).
Notwithstanding the facts above, the reality is that DOs and osteopathic medical institutions have for many decades provided instruction to MDs on osteopathic philosophy and OMM. In my humble opinion, our profession should not fear that opening osteopathic GME programs to MDs will have a deleterious effect on these programs. Rather, I believe it would strengthen the osteopathic medical profession as a whole and would benefit all patients being served by osteopathically trained physicians, be they DOs or MDs.
References
Zeichner SB. Need to oppose proposed ACGME common program requirements [letter]. J Am Osteopath Assoc. 2012;112(9):586-587. [PubMed]
Buser BR, Bulger J, Watson DK, Crosby JB, Swartwout JE. Response [letter]. J Am Osteopath Assoc. 2012;112(9):587-588.
Osteopathic Graduate Medical Education (OGME) by Allopathic Physicians: A Position Paper of the American Academy of Osteopathy. Indianapolis, IN: American Academy of Osteopathy; 1994.
White Paper [to the AOA's Special Task Force on OMT Certification and Credentials]. Indianapolis, IN: American Academy of Osteopathy; 1998.