Letters to the Editor  |   August 2006
Author Affiliations
    Department of Anesthesiology University of Mississippi School of Medicine Jackson, Miss
    Vice Chairman and Professor of Anesthesiology, Surgery, Pediatrics, and Physiology/Biophysics
Article Information
Cardiovascular Disorders / Medical Education / Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment / Pediatrics / Graduate Medical Education
Letters to the Editor   |   August 2006
The Journal of the American Osteopathic Association, August 2006, Vol. 106, 441-442. doi:
The Journal of the American Osteopathic Association, August 2006, Vol. 106, 441-442. doi:
I very much appreciate Dr Reeves' thoughtful comments regarding my letter in the May 2006 issue of JAOA—The Journal of the American Osteopathic Association.1 I am pleased to know that his experience with the American Osteopathic Board of Neurology and Psychiatry has been favorably different from my experiences with the American Osteopathic Board of Anesthesiology. It is not unreasonable to expect that there will be substantial variation among the American Osteopathic Association (AOA) specialty boards, especially given the low numbers of physicians certified by these boards in some specialties.2 In this regard, the standards of the member boards of the American Board of Medical Specialties (ABMS), the organization that represents allopathic medical specialty boards,3 may be more consistent than those of the corresponding osteopathic boards—simply because of the large number of allopathic physicians in practice. 
Unfortunately, it is nearly impossible to definitively answer the question of osteopathic vs allopathic specialty board quality, because no systematic head-to-head comparison has ever been performed. Thus, we are left with anecdotal reports, including those illustrated by Dr Reeves and me. 
The large number of allopathic residency positions, coupled with a dwindling number of osteopathic hospitals and fewer filled osteopathic residency positions, makes the ABMS certification the de facto standard.46 Dr Reeves is quite correct that sole osteopathic board certification may be a hindrance in the allopathic academic world. Even more disturbingly (based on personal communications I've had with leaders in many allopathic medical schools), the DO degree—in and of itself—is a hindrance in an academic career. These attitudes are changing and not universal among allopathic institutions, but the tiny number of DOs who are department chairs or deans in allopathic medical schools testifies to the veracity of the generalizations. 
Following the publication of my letter in the May 2006 JAOA, I was gratified to receive numerous letters from DOs around the United States expressing solidarity with and support of my views. Most of these letters were from specialists and subspecialists in such areas as pediatric neurosurgery, histopathology, and neurology. To a one, they all expressed doubts about osteopathic graduate medical education (OGME) and certification, frustration with the AOA and the “official” osteopathic world, and a deep support for and belief in osteopathic medicine, despite the fact that few of them practice osteopathic manipulative treatment (OMT) in their practices. 
The strength and future of the osteopathic medical profession lie in the continued undergraduate education of competent, caring, and superior osteopathic physicians. A cadre of highly trained specialists and subspecialists is essential in this endeavor. We cannot, nor should we even try to, compete against the programs in massive allopathic medical centers that have large patient volumes, sophisticated and expensive technologies, and substantial research funding. Rather, I believe we should encourage graduates of colleges of osteopathic medicine to enter these allopathic programs. These student DOs could then go on to demonstrate the quality of osteopathic medical education, pass the ABMS boards, and return to the AOA and the osteopathic medical profession, making us all stronger in the process. In the specialties beyond primary care, it is difficult to make a case for the existence of separate osteopathic board examinations. 
I have corresponded with John A. Strosnider, DO, the current president of the AOA, about these matters. I am once again calling on the AOA to open a dialogue with osteopathic physicians who have trained in and function in the allopathic world. We support our profession and its philosophy—not for political reasons—but because it represents good patient care. But we need to do a better job in letting the general public know that we are not just family doctors, but also pediatric cardiac anesthesiologists, neurosurgeons, histopathologists, and cardiologists. 
The May 20, 2006, cover of Newsweek magazine featured a photograph of Richard Jadick, DO, with the huge, blaring title, “He Saved 30 Lives in One Battle—Hero M.D.—The Amazing Story of the [Iraq] War's Most Fearless Doctor.”7 Of course, the title should have read, “Hero D.O.” Although Newsweek got his medical degree wrong, Dr Jadick stands as an example of the strength and future of osteopathic medicine. When Dr Jadick conducts battlefield surgery in Iraq, he is not using OMT, but he is still practicing osteopathic medicine. Similarly, when I administer anesthesia to a neonate undergoing surgery for hypoplastic left heart syndrome or when my DO neurosurgical colleague is clipping an aneurysm, we are not using OMT but we are still practicing osteopathic medicine. Isn't it finally time for us to all come together? 
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Ramirez AF. Board certification of osteopathic physicians. J Am Osteopath Assoc. 2006;106:77–84. Available at: Accessed June 26, 2006.
Homepage. American Board of Medical Specialties Web site. Available at: Accessed June 26, 2006.
Obradovic JL, Beaudry SW, Winslow-Falbo P. Osteopathic graduate medical education. J Am Osteopath Assoc. 2006;106:59–68. Available at: Accessed June 26, 2006.
Sinay T. Cost structure of osteopathic hospitals and their local counterparts in the USA: are they any different? Soc Sci Med. 2005;60:1805 –1814.
Barr P. Final farewell. Osteopathic Medical Center of Texas closes its doors. Mod Healthc. 2004;34:10 .
Wingert P, Thomas E. On call in hell. Newsweek. 2006; March20 : 34–43.