Letters to the Editor  |   May 2007
Repatriating DOs With MD-Affiliated Residencies
Author Affiliations
  • Thomas E. Forte, DO
    Cincinnati, Ohio
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   May 2007
Repatriating DOs With MD-Affiliated Residencies
The Journal of the American Osteopathic Association, May 2007, Vol. 107, 174-197. doi:
The Journal of the American Osteopathic Association, May 2007, Vol. 107, 174-197. doi:
To the Editor: I am writing in regard to the letter about osteopathic graduate medical education by George Mychaskiw II, DO,1 that appeared in the May 2006 issue of JAOA—The Journal of the American Osteopathic Association, as well as the multiple responses to Dr Mychaskiw's communication.2-6 I am an osteopathic physician who completed a rotating internship at an osteopathic medical institution and then, like Dr Mychaskiw, I chose to pursue avenues for advanced residency training at an institution that was not osteopathically affiliated. Although some people in the osteopathic medical profession refer to such institutions as “MD” or “allopathic” hospitals, I have found in more than 30 years of practice that a medical institution that is not an osteopathic hospital is usually referred to simply as “a hospital.” 
I considered attempting to obtain approval from the American Osteopathic Association (AOA) for both my anesthesiology residency and my occupational medicine residency, but I concluded that these paths were too time consuming and would lead to substantial additional expenses that would never be recouped. Although I have paid AOA dues for most of the years since graduating from my osteopathic medical school, there were a few years when I chose not to do so. My withholding of dues was prompted by the AOA's refusal to recognize my board certifications and list me as a certified physician in the AOA Directory of Osteopathic Physicians, which I find rather insulting. There are many trained osteopathic physicians, like me, who would prefer to be more closely aligned with the AOA. 
I believe that the main issue influencing decisions on where to pursue residencies is not about an osteopathic residency versus an “allopathic/MD” residency, but rather about “location, location, location”: smaller community private hospitals versus larger public institutions. Frankly, osteopathic hospitals tend to be smaller and have fewer beds than “allopathic” hospitals, and having an adequate number of beds is of vital importance in advanced specialty training. Furthermore, osteopathic hospitals may not offer training in certain important procedures. The institution in which I completed my rotating internship—despite being one of the largest osteopathic medical institutions in the United States—did not, 30 years ago, perform cardiac surgical procedures, major pediatric surgeries, radical cancer surgeries, or total joint procedures, and it rarely performed neurologic, thoracic, or vascular procedures or invasive monitoring. 
I am not complaining about my internship. In fact, I was very satisfied with it and felt it prepared me well for my residency training. I remain extremely grateful for the interest and time that the osteopathic physicians provided me in my education. However, for many, there may come a time when one must pursue the opportunities afforded by a more demanding and challenging clinical setting. I believed that the needs of my anesthesiology residency could not be fulfilled at an osteopathic medical institution because these institutions lacked firm, didactic, mandatory, and ongoing formal educational programs in this area. I find this problem to be characteristic of many smaller private training programs in many residencies—not just residencies at osteopathic medical institutions. 
During the time I considered having my anesthesiology residency approved by the AOA in the late 1970s, the AOA exhibited very punishing tactics toward residents like me, including invoking excessive costs and forcing physicians to wait years for approval. As I watched residents in other programs at my residency institution fall prey to these tactics, I decided this was something that I did not want my family, myself, or my pocketbook to endure. In addition, the university through which I performed my residency training had previously had other residents in my specialties proceed through the same “allopathic” programs. The occupational medicine program had even included several osteopathic residents in the past. That particular program happened to be the oldest occupational medicine residency in the world. Yet the AOA required each resident marching through that program who was an osteopathic physician to “jump through the same hoops,” including obtaining multiple additional credentials and continuing medical education credits. 
In this day and age, it is cost prohibitive to invoke such demands on residents. I speak from a great deal of experience in this regard. 
It is time for the AOA to revisit the issue of graduate medical education for many reasons—but primarily to repatriate many of the physicians who have completed osteopathic internship training but then proceeded to perform residencies at institutions that were not osteopathically affiliated. I hope the AOA will find the common sense and resolve to repatriate osteopathic physicians who have trained outside of osteopathic institutions, instead of treating us as lesser citizens and refusing to list us as board-certified physicians in the Find a D.O. search utility on the Association's home page ( The AOA should recognize that many of us continue to be very committed to the osteopathic medical philosophy. 
Why punish us any more than we have already been punished by the AOA over these many years? 
Mychaskiw G II. Will the last DO turn off the lights [letter]? J Am Osteopath Assoc. 2006;106:252-253,302. Available at: Accessed May 8, 2007.
Opipari MI. Response [letter]. J Am Osteopath Assoc. 2006;106:302-303. Available at: Accessed May 8, 2007.
Yacavone DW. Hey AOA, give us a break [letter]! JAm Osteopath Assoc. 2006;106:377-378. Available at: Accessed May 8, 2007.
Reeves RR. AOA certifying boards are credible and capable [letter]. J Am Osteopath Assoc. 2006;106:441. Available at: Accessed May 8, 2007.
Mychaskiw G II. Response [letter]. J Am Osteopath Assoc. 2006;106:441-442. Available at: Accessed May 8, 2007.
Tatum WO IV. AOA needs to reach out more [letter]. J Am Osteopath Assoc. 2006;106:442-443. Available at: Accessed May 8, 2007.