Letters to the Editor  |   October 2005
The “Big DO”
Author Affiliations
  • Bradley H. Werrell, DO
    St John West Shore Hospital Westlake, Ohio
    Family Practice Resident
Article Information
Medical Education / Being a DO / Graduate Medical Education
Letters to the Editor   |   October 2005
The “Big DO”
The Journal of the American Osteopathic Association, October 2005, Vol. 105, 442-443. doi:
The Journal of the American Osteopathic Association, October 2005, Vol. 105, 442-443. doi:
To the Editor:
Andrew Taylor Still, MD, DO, established the osteopathic medical profession with an expanded understanding of human physiology and a unique vision of medical professionalism. The profession he created, and its subsequent growth and success, testify to the brilliance of that vision and to the dedication and labors of those many individuals who continue to develop the osteopathic medical profession. 
Today, however, there is some concern over the fact that more than 50% of osteopathic physicians are obtaining education in residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). 1 Our profession appears to be outsourcing its graduate medical education to the nonosteopathic medical establishment. Although the facts regarding osteopathic physicians in ACGME-accredited residency programs speak for themselves, a bit of perspective on this situation should ease the worried mind. 
The education that osteopathic physicians receive in medical school is necessary to their functioning as qualified physicians. If this were not the case, then the curriculum would be altered to more accurately reflect the needs of the practicing physician—or the osteopathic medical education establishment would be committing a grand hypocrisy on its patrons. This necessary education includes the teaching of osteopathic principles and practice. If we did not believe that such teachings are necessary for a qualified physician, then we would not need the distinct osteopathic medical profession whatsoever. 
Prior to the advent of near universal residency training, the osteopathic medical profession regarded the training that osteopathic medical students received in osteopathic principles and practice during their undergraduate experience to be fully adequate for a practicing physician. Since that time, however, much has changed. Undergraduate enrollment has expanded tremendously in our profession, 2 and residency training has become the norm. Concurrent with these changes has been the general acceptance of osteopathic physicians in ACGME-accredited training programs. 
Many osteopathic physicians are alarmed by this “desegregation” of hospitals and by the general amalgamation of the DO and MD professions. 1 Perhaps these physicians see an ominous harbinger of the demise of the osteopathic medical profession in the general acceptance by the ACGME programs of training osteopathic medical school graduates, and in the willingness of the graduates to be trained by these programs. Is the osteopathic medical profession at risk of losing its distinctiveness, and even its reason for existence? This question certainly suggests that we are approaching a crisis. 
In the 1960s, the California Medical Association—an MD organization— and the California Osteopathic Association agreed to a deal that led to DOs in the state being offered the opportunity to trade their professional titles for MD degrees (the so-called “Little MD”) for the price of $65. 3 This action led to the legal recognition of parity between DOs and MDs, as well as to the current state of affairs we find ourselves in professionally. 
Even as our osteopathic medical graduates flock toward the open arms of the ACGME residencies, we continue to disqualify MDs—regardless of their interests and aptitudes—from applying to our osteopathic residencies. Moreover, we don't even seem to be mildly aware of the irony of this situation! 
How would Dr Still advise us to proceed as a profession through these times? I think that he would advise us to stick to the fundamental understanding of our training and profession. I think he would also advise us to look within our own profession and training programs to seek to remove obstacles for training qualified personnel in the principles and practice of osteopathic medicine. 
I would like to offer the suggestion that our profession offer MDs some type of certificate of added qualification in osteopathic principles and practice by creating qualifying coursework. I call this proposal “the Big DO.” The goal of this proposal is to bring MDs who are so inclined up to the standards of osteopathic medicine. In my vision, these certificates would qualify MDs to participate in osteopathic residency programs. 
This plan offers the potential of increasing the number of applicants to osteopathic residency programs without significantly altering the osteopathic distinction of those programs. I believe the plan also has the potential advantage of reinvigorating osteopathic residency programs. 
I am confident that Dr Still would encourage us as representatives of the profession he founded to transmit the teachings of the osteopathic medical profession as widely as the winds will carry them and by such means as are at our disposal. Charting such a course will certainly lead to the betterment of our profession. 
  As the premier scholarly publication of the osteopathic medical profession, JAOA—The Journal of the American Osteopathic Association encourages osteopathic physicians, faculty members and students at osteopathic medical colleges, and others within the healthcare professions to submit comments related to articles published in JAOA and the mission of the osteopathic medical profession. The JAOA's editors are particularly interested in letters that discuss recently published original research.
  Letters to the editor are considered for publication in JAOA with the understanding that they have not been published elsewhere and that they are not simultaneously under consideration by any other publication.
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  Although JAOA welcomes letters to the editor, readers should be aware that these contributions have a lower publication priority than other submissions. As a consequence, letters are published only when space allows.
American Osteopathic Association's Commission on Osteopathic College Accreditation—Executive Committee and the Subcommittee on Osteopathic Educational Elements. Report of the AOA Commission on Osteopathic College Accreditation—Executive Committee and the Subcommittee on Osteopathic Educational Elements: Resolution 274 (A/2004) “Match participation and rotations with osteopathic physicians, proposed requirements for osteopathic.” Paper adopted at: Annual Meeting of the AOA House of Delegates; July 15–17, 2005; Chicago, Ill.
American Osteopathic Association Yearbook and Directory of Osteopathic Physicians 2000–2001. Chicago, Ill: American Osteopathic Association; 2000:669 .
The Historic Background of Osteopathic Medicine. The History of Osteopathic Medicine Virtual Museum Web site. Available at: Accessed September 9, 2005.