To the Editor:  

I read with much interest the June special communication article by Roy R. Reeves, DO, PhD, and Randy S. Burke, PhD.¹ In their article, Drs Reeves and Burke¹ analyzed survey results to reveal perceptions of osteopathic medicine among allopathic physicians in the deep central southern United States. The findings reported in the article should serve as a wake-up call to osteopathic physicians and osteopathic medical students across the country. 

It was frightening to read the perceptions that some allopathic physicians hold of the osteopathic medical community. Drs Reeves and Burke¹ reported that many allopathic physicians responding to their survey believed that osteopathic residency training is not equivalent to allopathic residency training; that research has not been conducted to gain understanding of the scientific basis of osteopathic medicine; and that osteopathic medicine is not as beneficial as traditional medicine for most medical problems. 

Although the authors were careful to point out limitations in the applicability of their data,¹ I believe that their findings can probably be broadly applied to any geographic region that is dominated by our allopathic colleagues. We cannot place all the blame for the misconceptions reported by Drs Reeves and Burke¹ on personal biases and discriminations among allopathic physicians in the South. Because of the limited number of osteopathic medical schools compared with allopathic medical schools, the strong regional ties of osteopathic graduate medical education, and the choices of many new osteopathic physicians to undertake training in residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), many DOs end up being an invisible force in US healthcare.² 

As an osteopathic medical student, I am encouraged by the focus that the American Osteopathic Association (AOA) has placed on the continuing development of high-quality graduate medical education in all specialties of osteopathic medicine.³ An example of this focus is the creation of new AOA-approved residencies in orthopedic surgery in both Michigan and Oregon.⁴ In Oregon, the opening of a residency program in a surgical subspecialty, with associations to major teaching hospitals, in a region heavily dominated by allopathic physicians is an especially positive step by the AOA. Working to ensure exceptional residency training in a wide spectrum of osteopathic medical disciplines throughout the United States should help to attract the interests of the most motivated students and serve as a solid strategy for promoting loyalty to the osteopathic medical profession. 

Unfortunately, based on my reading of professional literature and on my association with senior osteopathic medical students and practicing osteopathic physicians, it seems that the AOA has sometimes taken this loyalty for granted—or even rejected it.^5,6 For example, previous letter writers in JAOA—The Journal of the American Osteopathic Association have criticized the AOA for not having an adequate board-certification process and for not welcoming DOs who trained in ACGME-accredited programs.^3,4 The AOA seems to assume that osteopathic medical students who enter into ACGME-accredited programs are doing so with the intent of leaving behind their osteopathic identity. However, current data suggest that many DO residents in ACGME-accredited programs are unclear as to their place within the osteopathic medical community.⁷ 

This problematic issue can be avoided in two ways. First, the AOA should continue to add more high-quality AOA-approved residency programs in multiple specialties, thereby recognizing the desire of many osteopathic medical students to specialize. Second, the AOA should increase its efforts to reach out to DOs in ACGME-accredited residency programs with AOA-approved internships via Resolution 42 (A/2000, Approval of ACGME Training as an AOA-Approved Internship), ensuring that those DOs who wish to remain tied to their osteopathic medical heritage can do so. 

As medicine in the United States faces a crossroads, I hope that the AOA will remember that there are osteopathic medical students and osteopathic physicians—both new and highly experienced—who want to be driving forces in the growth and further recognition of the osteopathic medical profession.