View source for Comparison of allopathic and osteopathic physicians in the United States



{{Template:Physician education and training in the United States}}
This article discusses similarities and differences between [[allopathic]] and [[Osteopathic medicine in the United States|osteopathic]] physicians in the United States.  For the sake of comparison, holders of an [[Doctor of Medicine|M.D.]] are sometimes referred to as [[allopathic]] [[physicians]], while those with a D.O. are known as [[Doctor of Osteopathic Medicine|osteopathic physicians]].

=={{-}}Differences in the United States==
There is disagreement on the differences between osteopathic and allopathic medicine.<ref name = "Jung">Jung, Paul, M.D. [http://www.amsa.org/premed/rx/rx1101.cfm ''That Thing that You D.O.''] American Medical Student Association.</ref><ref>Phil Galewitz. [http://www.palmbeachpost.com/blogs/content/shared-blogs/palmbeach/healthblog/entries/2007/11/06/md_or_dodoes_it_matter_to_you.html M.D. or D.O—does it matter to you?] Palm Beach Post. 6 Nov 2007.</ref> According to the ''Cecil Textbook of Medicine, 22 ed.'', "other than teaching manipulation, undergraduate medical training for an osteopathic degree ([[Doctor of osteopathic medicine|D.O.]]) is now virtually indistinguishable from that which leads to the M.D. degree. Osteopathic physicians complete conventional residencies in osteopathic or allopathic hospitals and training programs; are licensed in all states; and have rights and responsibilities, such as military service, that are identical to allopathic physicians and surgeons."<ref name = "Cecil">''Chapter 34: Complementary and Alternative Medicine.'' Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders.  2004.</ref>

''[[Harrison's Principles of Internal Medicine]]'', 16th ed., makes a similar comparison. 
{{cquote|[T]he training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and certification by organizations such as the American Board of Internal Medicine.<ref>Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. ''Chapter 10. Complementary and Alternative Medicine'' Harrison's Principles of Internal Medicine, 16th Edition. 2005.  McGraw Hill.</ref>|30px|30px}}
===History===
There is a history of hostility between the allopathic and osteopathic worlds, though animosity between the groups has subsided in recent years.  In 2005, the president of the [[Association of American Medical Colleges]] wrote, {{cquote|after more than a century of often bitterly contentious relationships between the osteopathic and allopathic medical professions, we now find ourselves living at a time when osteopathic and allopathic graduates are both sought after by many of the same residency programs; are in most instances both licensed by the same licensing boards; are both privileged by many of the same hospitals; and are found in appreciable numbers on the faculties of each other's medical schools.<ref name ="Cohen">Cohen, Jordan. [http://www.aamc.org/newsroom/reporter/april05/word.htm ''A Word from the President: "Filling the Workforce Gap."''] [[Association of American Medical Colleges|AAMC]] Reporter: April 2005.</ref>|30px|30px}}  {{further|[[Osteopathic Medicine#History|History of Osteopathic Medicine]]}}

===Demographics===
[[Image:MD DO first year.PNG|thumb|right|120px|First year medical school enrollment, 1975-2007.
{{legend|#BE5B5B|allopathic}}
{{legend|#5B8CBE|osteopathic}}]]
The gender and racial distribution of allopathic and osteopathic practitioners are similar.<ref name="pmid10632817">{{cite journal |author=Peters AS, Clark-Chiarelli N, Block SD |title=Comparison of osteopathic and allopathic medical Schools' support for primary care |journal=J Gen Intern Med |volume=14 |issue=12 |pages=730–9 |year=1999 |pmid=10632817 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=1999&volume=14&issue=12&spage=730}}</ref>
There are significantly more allopathic physicians than osteopathic physicians. <ref>[http://www.aamc.org/workforce/2006medschoolexpansion.pdf Medical School Expansion Plans: Results of the 2006 AAMC Survey] Center for Workforce Studies. American Association of Medical Colleges. February 2007.</ref>  In 2004, 17,000 students matriculated as first-year students at allopathic medical students while 3,800 students matriculated at Osteopathic schools, a ratio of 5 allopathic students for every osteopathic one.<ref>[http://www.osteopathic.org/pdf/ost_factsheet.pdf Fact Sheet 2006] American Osteopathic Association. August 2006.</ref>
====Changing numbers====
[[Image:Allopathic Graduates per capita.PNG|thumb|left|200px|Enrollment of first-year students at U.S. [[allopathic]] medical schools per 100,000 population, 1980–2020.<ref name ="per capita">Salsberg, Edward and Grover, Atul.   [http://im.org/AAIM/Pubs/Docs/articlesofinterest/Salsberg.Sept.pdf ''Physician Workforce Shortages: Implications and Issues for Academic Health Centers and Policymakers.''] Academic Medicine, Vol. 81, No. 9 / September 2006.</ref>]]
Between 1980 and 2005, the number of yearly allopathic graduates remained virtually constant at around 16,000.  During the same period, the number of osteopathic graduates increased by more than 250% (from about 1,150 to about 2,800).<ref name ="per capita">Salsberg, Edward and Grover, Atul.   [http://im.org/AAIM/Pubs/Docs/articlesofinterest/Salsberg.Sept.pdf ''Physician Workforce Shortages: Implications and Issues for Academic Health Centers and Policymakers.''] Academic Medicine, Vol. 81, No. 9 / September 2006.</ref>  Osteopathic graduates are expected to increase to 3,300 by the year 2010 and as many as 4,000 by 2015.<ref name ="Cohen">Cohen, Jordan. [http://www.aamc.org/newsroom/reporter/april05/word.htm ''A Word from the President: "Filling the Workforce Gap."''] [[Association of American Medical Colleges|AAMC]] Reporter: April 2005.</ref> The number of allopathic graduates per 100,000 fell from 7.5 to 5.6, while the number of osteopathic graduates per 100,000 rose from 0.4 to 0.8.<ref name ="per capita">Salsberg, Edward and Grover, Atul.   [http://im.org/AAIM/Pubs/Docs/articlesofinterest/Salsberg.Sept.pdf ''Physician Workforce Shortages: Implications and Issues for Academic Health Centers and Policymakers.''] Academic Medicine, Vol. 81, No. 9 / September 2006.</ref>

===Cultural differences===
Some authors describe less quantifiable distinctions between the two.  Avery Hurt writes, "In actual practice, the variations between the two types of physicians are often so slight as to be unnoticeable to patients, and a day in the life of each can appear indistinguishable. But the differences are there, subtle but deep."<ref name = "Hurt">Hurt, Avery. [http://www.amsa.org/tnp/articles/article.cfx?id=342 ''Inside osteopathic medicine’s parallel world.'']  The New Physician.  Feb 2007.</ref> Several studies have investigated these differences.  One compared the patient interactions of allopathic and osteopathic physicians.  The study found that "osteopathic physicians were more likely to use patient's first names and to discuss the social, family and emotional impact of illnesses." For example, "66% of DOs discussed a patient's emotional state compared with about one-third of MDs."  The same study found that "allopathic physicians scored higher in discussing literature or scientific basis of treatment."<ref>Adams, Damon [[http://www.ama-assn.org/amednews/2003/08/25/prsb0825.htm ''Small study compares styles: Osteopathic physicians talk more about feelings.''] Amednews.com. 23 Aug 2003.</ref>  However, a much larger study analyzed 341.4 million patient visits to general and [[family medicine]] specialists in the United States, including 64.9 million (19%) visits to osteopathic physicians and 276.5 million (81%) visits to allopathic physicians.  It found that there was no significant difference between allopathic and osteopathic physicians "with regard to time spent with patients and preventive medicine services."<ref>Licciardone, JC. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1805772 ''A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004''] Osteopath Med Prim Care. 2007 Jan 12;1:2. PMID: [http://www.om-pc.com/pubmed/17371578 17371578]</ref>
=====Self-characterization=====
A Harvard study found significant differences in the attitudes of members of the osteopathic and allopathic communities.  The study found that 40.1% of allopathic students and physicians described themselves as "socioemotionally" oriented over "technoscientific" orientation. 63.8% in the osteopathic community self-identified as socioemotional. (p < .0001)<ref name="pmid10632817">{{cite journal |author=Peters AS, Clark-Chiarelli N, Block SD |title=Comparison of osteopathic and allopathic medical Schools' support for primary care |journal=J Gen Intern Med |volume=14 |issue=12 |pages=730–9 |year=1999 |pmid=10632817 |doi= |url=http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1525-1497.1999.03179.x}}</ref>

=====Perceptions=====
One study of osteopathic physicians attempted to investigate their perceptions of differences in philosophy and practice between themselves and their allopathic counterparts.  88% of the respondents had a self-identification as osteopathic physicians, but less than half felt their patients identified them as such.  Further, the study found that "not a single philosophic concept or resultant practice behavior had concurrence from more than a third of the respondents as distinguishing osteopathic from allopathic medicine."<ref>Johnson SM, Kurtz ME.  ''Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts.'' Soc Sci Med. 2002 Dec;55(12):2141-8. PMID [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12409127&dopt=Citation 12409127]</ref>
{{further|[[Osteopathic_Medicine#Osteopathic_principles|Principles of Osteopathic philosophy]]}}

=====Self-identification=====
As the training of osteopathic and allopathic physicians become less distinct, some have expressed concern that their unique characteristics will be lost.<ref name = "Ziegler" />  Others welcome the merger and already label "allopathic medicine" as "the type of medicine practiced by M.D. and D.O. type doctors."<ref>[http://www.lieberson.com/en/neurgosurgery_glossary/a.htm Allopathic medicine.] Medical/Neurosurgical Glossary. Northern California Neurosurgery. accessed 5 Nov 2007.</ref>   One persistent difference is the respective acceptance of the terms "allopathic" and "osteopathic."  Osteopathic medical organizations and medical schools all include the word ''osteopathic'' in their names, and such groups actively promote an "osteopathic approach" to medicine.  This is in sharp contrast with the term ''allopathic''.  No major medical society or medical school includes the word ''allopathic'' in its title, nor do they promote an ''allopathic'' approach to medicine.<ref name = "Gevitz">[[Norman Gevitz|Gevitz, Norman.]] [http://www.jaoa.org/cgi/reprint/106/3/121.pdf ''Center or Periphery? The Future of Osteopathic Principles and Practices.''] [[J Am Osteopath Assoc]]. 2006 Mar;106(3):121-9. [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=16585378&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum  PMID 16585378]</ref>  However, as interest in alternative medical therapies increases, the term ''allopathic'' has been used by the medical profession<ref name="pmid9818797">{{cite journal |author=Gundling KE |title=When did I become an "allopath"? |journal=Arch. Intern. Med. |volume=158 |issue=20 |pages=2185–6 |year=1998 |pmid=9818797 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=9818797}}</ref> to describe conventional medical practices - an acceptance which many have criticized.<ref name="pmid9818797" />
[[Image:MD and DO inTexas.PNG|thumb|350px|Allopathic & osteopathic physicians in [[Texas]] by practice type.<ref name="pmid16717369">{{cite journal |author=Miller T, Hooker RS, Mains DA |title=Characteristics of osteopathic physicians choosing to practice rural primary care |journal=J Am Osteopath Assoc |volume=106 |issue=5 |pages=274–9 |year=2006 |pmid=16717369 |url=http://www.jaoa.org/cgi/content/full/106/5/274 |doi= |issn=}}</ref>]]

===Medical education and training===
====Medical schools====
An independent board of the AMA, the [[Association of American Medical Colleges]] (AAMC) accredits the 125 U.S. allopathic medical schools, while an independent board of the [[American Osteopathic Association|American Osteopathic Association (AOA)]] (COCA) accredits the 26 U.S. osteopathic medical schools.<ref>Yale Career Counseling Center.[http://www.yale.edu/career/students/gradprof/addhealth/index.html]</ref>  There are only two U.S. universities that have accredited programs in both allopathic and osteopathic medicine - [[Michigan State University]] and the [[University of Medicine and Dentistry of New Jersey]].
{{see also|List of medical schools in the United States|Medical school in the United States}}

=====Osteopathic manipulative medicine=====
Many authors note the most obvious difference between the curricula of osteopathic and allopathic medical schools, [[Osteopathic Manipulative Medicine|Osteopathic Manipulative Medicine (OMM)]], a type of [[manual therapy]] taught at only osteopathic schools.  A Harvard medical school faculty reviewed report lists several types of injuries and illnesses in which evidence-based studies suggest OMM may provide some benefit.<ref>[http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358839.html?d=dmtContent ''Osteopathic medicine.''] Intelihealth.com</ref>  A 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey was the latest indication that osteopathic physicians have become more like allopathic physicians in all respects—fewer perform OMT, more prescribe drugs, and many perform surgery as a first option.<ref name="pmid11500286">{{cite journal |author=Johnson SM, Kurtz ME |title=Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession |journal=Acad Med |volume=76 |issue=8 |pages=821–8 |year=2001 |pmid=11500286 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1040-2446&volume=76&issue=8&spage=821}}</ref>
{{further|[[Osteopathic_Medicine#Manipulative therapy|Status of OMM within the Osteopathic profession]]}}

=====Applicant aptitude indicators=====
Some authors note the differences in the GPA's and MCAT scores of those who matriculate at Osteopathic schools.  In 2007, the average [[MCAT]] score and GPA was 28 and 3.5 for allopathic applicants and 25.3 and 3.5 for osteopathic applicants.<ref>Croasdale, Myrle. [http://www.ama-assn.org/amednews/2007/11/05/prl21105.htm Record number vied for 2007-08 medical school slots] American Medical News. 5 Nov 2007.</ref> One study found that as many as one third of students at osteopathic schools had been rejected by an allopathic school.  In addition, osteopathic students have a failure rate three time greater than allopathic students on the United States Medical Licensing Exam (USMLE). (It should be noted that osteopathic students are required to take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) and  that the USMLE  can be taken in addition to the COMLEX.  Allopathic students however are not allowed to take the COMLEX)  However, the same study notes that "despite correlations between [[MCAT]]s and [[USMLE|Step 1]] licensing exams, correlations between the latter and clinical performance are weak. Performance as a physician correlates better with proficiency in the humanities and with personal characteristics such as motivation, conscientiousness,
integrity, empathy, and a robust psychological constitution."<ref name ="Cooper">Cooper RA. [http://content.healthaffairs.org/cgi/reprint/22/4/71 ''Medical schools and their applicants: an analysis.''] Health Affairs (Millwood). 2003 Jul-Aug;22(4):71-84. PMID [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=12889752&dopt=AbstractPlus 12889752]</ref>  The author notes that the "better performance [of Osteopathic students] on their own [[COMLEX-USA|National Board of Osteopathic Medical Examiners (NBOME)]] exam has been attributed to its greater emphasis on clinical context."<ref name ="Cooper">Cooper RA. [http://content.healthaffairs.org/cgi/reprint/22/4/71 ''Medical schools and their applicants: an analysis.''] Health Affairs (Millwood). 2003 Jul-Aug;22(4):71-84. PMID [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=12889752&dopt=AbstractPlus 12889752]</ref>

====Residency====
[[Image:2007 NRMP applicants.PNG|thumb|right|350px|Applicants in the 2007 Main NRMP Residency Match <ref>[http://www.nrmp.org/data/chartingoutcomes2007.pdf ''Charting Outcomes in the Match Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2007 NRMP Main Residency Match, 2nd Ed.] [[National Resident Matching Program]] and [[Association of American Medical Colleges]] August 2007.</ref>]]
[[Image:Osteopathic matches NRMP.PNG|thumb|225px|Osteopathic graduates in the [[National Residency Matching Program]], by year.<ref>Table 2: Applicants in the Matching Program, 2001-2007. [http://www.nrmp.org/data/resultsanddata2007.pdf ''Results and Data, 2007 Main Residency Match.''] [[National Residency Matching Program]].</ref>]]
In contrast to medical school accreditation, the boundaries between allopathic and osteopathic residency programs are more flexible.  The [[ACGME|Accreditation Council for Graduate Medical Education (ACGME)]] describes the residency programs it oversees as training in allopathic medicine.<ref>ACGME "Glossary of Terms." 1 July 2005.[http://www.acgme.org/acWebsite/about/ab_ACGMEglossary07_05.pdf]</ref><ref>''Duty Hours for Resident Physicians — Tough Choices for Teaching Hospitals.'' New England Journal of Medicine. 17 Oct 2002.[http://content.nejm.org/cgi/content/full/347/16/1275]</ref> Graduates of both osteopathic and allopathic medical schools are eligible to apply to these programs through the [[National Residency Matching Program]] (NRMP).  In 2003, 99% of US allopathic and 43% of osteopathic graduates went on to train in allopathic residency programs.<ref name = "Ziegler" />

The American Osteopathic Association accredits osteopathic residency programs.  There have been calls to end the remaining barriers between the two types of programs.<ref name="pmid16717365">{{cite journal |author=Mychaskiw G |title=Will the last DO turn off the lights? |journal=J Am Osteopath Assoc |volume=106 |issue=5 |pages=252–3, 302; discussion 302–3 |year=2006 |pmid=16717365 |doi= |url=http://www.jaoa.org/cgi/content/full/106/5/252 }}</ref><ref name="pmid16717364">{{cite journal |author=Steier KJ |title=Time to accept allopathic physicians into AOA-approved residencies? |journal=J Am Osteopath Assoc |volume=106 |issue=5 |pages=250–2 |year=2006 |pmid=16717364 |doi= |url=http://www.jaoa.org/cgi/content/full/106/5/250}}</ref><ref name="pmid17596585">{{cite journal |author=Forte TE |title=Repatriating DOs with MD-affiliated residencies |journal=J Am Osteopath Assoc |volume=107 |issue=5 |pages=174, 197 |year=2007 |pmid=17596585 |doi= |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=17596585}}</ref> Since 1985, a single residency training program can be dual-accredited by both the ACGME and the AOA, and such programs are called combined allopathic/osteopathic residencies.<ref>''Osteopathic Residency FAQ.'' University of Wisconsin.[http://www.fammed.wisc.edu/residency/osteopathic/faq.html]</ref><ref name="pmid9846049">{{cite journal |author=Hayes OW |title=Dual approval of a residency program: ten years' experience and implications for postdoctoral training |journal=J Am Osteopath Assoc |volume=98 |issue=11 |pages=647–52 |year=1998 |pmid=9846049 |doi= |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=9846049}}</ref><ref name = "Ziegler">Ziegler, Jennifer.  [http://www.amsa.org/tnp/articles/article.cfx?id=103 ''Osteopathic residencies struggle to keep up with the growing number of D.O. grads'']. The New Physician.  April 2004.</ref>

In 2001, the AOA adopted a provision making it possible for a resident in any allopathic program to apply for osteopathic approval of their training.<ref name = "res 42">[http://www.osteopathic.org/index.cfm?PageID=sir_postdocres42 ''Resolution 42: Approval of ACGME Training as an AOA-Approved Internship'']. [[American Osteopathic Association]]. accessed October 2007.</ref> The topic of dual-accreditation is controversial.  Opponents claim that by merging osteopathic students into the "allopathic world," the unique quality of osteopathic philosophy will be lost.<ref name = "Ziegler" />  Supporters claim the programs are popular because of the higher prestige and higher resident reimbursement salaries associated with allopathic programs.<ref name="pmid12956249">{{cite journal |author=Terry RR |title=Dually accredited family practice residencies: wave of the future |journal=J Am Osteopath Assoc |volume=103 |issue=8 |pages=367–70 |year=2003 |pmid=12956249 |doi= |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=12956249}}</ref> Allopathic graduates are generally not permitted to training in osteopathic residencies, except under special circumstances. The two largest traditionally allopathic organizations, the American Medical Association and the [[American Medical Student Association]], both support further integration and non-discrimination in residency programs.<ref name = "AMA">AMA policy H-295.876. [http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-295.876.HTM]</ref><ref name = "AMSA">[http://www.amsa.org/about/ppp/osteo.cfm ''Osteopathic Principles.''] [[American Medical Student Association]].</ref>
{{see also|Residency (medicine)}}

=====Resident statistics=====
[[Image:DO residents in ACGME total.jpg|thumb|right|375px|Total number of DOs in ACGME (allopathic) residency programs, by year.<ref name="pmid16145028">{{cite journal |author=Brotherton SE, Rockey PH, Etzel SI |title=US graduate medical education, 2004-2005: trends in primary care specialties |journal=JAMA |volume=294 |issue=9 |pages=1075–82 |year=2005 |pmid=16145028 |doi=10.1001/jama.294.9.1075 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16145028}}</ref>]] The number of osteopathic students entering ACGME residencies increased every year from 1999-2004, while the number in AOA-accredited programs fell.  In 2000, 4175 osteopathic graduates were training in ACGME programs, versus 2781 in AOA programs.<ref name="pmid15040420">{{cite journal |author=Hayes OW |title=AOA membership and board certification of residency graduates: comparison of three programs accepting osteopathic physicians--implications for graduate medical education |journal=J Am Osteopath Assoc |volume=104 |issue=2 |pages=82–6 |year=2004 |pmid=15040420 |doi= |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=15040420}}</ref>
=====Resident specialty choice=====
======Primary Care======
There are notable differences in the specialty choices of allopathic and osteopathic medical graduates.  One study attributes this to a difference in the 'cultures' of allopathic and osteopathic school. "In comparison with allopathic schools, the cultural practices and educational structures in osteopathic medical schools better support the production of primary care physicians."<ref name="pmid10632817">{{cite journal |author=Peters AS, Clark-Chiarelli N, Block SD |title=Comparison of osteopathic and allopathic medical Schools' support for primary care |journal=J Gen Intern Med |volume=14 |issue=12 |pages=730–9 |year=1999 |pmid=10632817 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=1999&volume=14&issue=12&spage=730}}</ref> According to one survey, 54.6% of deans of allopathic medical schools reported that training future primary care physicians was more important to their institutions than training future specialist physicians, compared with 100% of osteopathic medical school deans. (F = 893.11,95, p < .0001).<ref name="pmid10632817">{{cite journal |author=Peters AS, Clark-Chiarelli N, Block SD |title=Comparison of osteopathic and allopathic medical Schools' support for primary care |journal=J Gen Intern Med |volume=14 |issue=12 |pages=730–9 |year=1999 |pmid=10632817 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=1999&volume=14&issue=12&spage=730}}</ref>
======Specialist training======
[[Image:DOs in ACGME residencies.jpg|thumb|right|375px|The number of PGY1 DOs training in ACGME residencies, by year, for selected specialties.<ref name="pmid12953003">{{cite journal |author=Brotherton SE, Rockey PH, Etzel SI |title=US graduate medical education, 2002-2003 |journal=JAMA |volume=290 |issue=9 |pages=1197–202 |year=2003 |pmid=12953003 |doi=10.1001/jama.290.9.1197 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12953003}}</ref>]]Recent trends show osteopathic graduates entering specialty historically dominated by allopathic graduates. A [[JAMA]] study found that "In 1996-1997, 624 DOs made up 2.9% of the total GY1 residents without prior [Graduate Medical Education]. By 2002-2003, their numbers had more than doubled to 1312, and DOs represented 6.0% of GY1s without prior GME."<ref name="pmid12953003">{{cite journal |author=Brotherton SE, Rockey PH, Etzel SI |title=US graduate medical education, 2002-2003 |journal=JAMA |volume=290 |issue=9 |pages=1197–202 |year=2003 |pmid=12953003 |doi=10.1001/jama.290.9.1197 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12953003}}</ref>
======Anesthesiology======
Between 1997-01, the number of osteopathic graduates matching into anesthesiology almost doubled every year - from fewer than 10 to over 100 over the course of 4 years.<ref>Grogono, Alan M.D. ''National Resident Matching Program Results for 2003: Continuing Strong Recruitment, Few Surprises.'' American Society of Anesthesiology Newsletter. May 2003. [http://www.asahq.org/Newsletters/2003/05_03/grog.html]</ref>
=====Reaction to trends=====
Some authors have described concerns within the osteopathic profession about the increasing number of DOs seeking allopathic GME. Not only are there more DOs training solely in ACGME-accredited programs and thus bypassing American Osteopathic Association (AOA)-accredited programs, but there are now more than 900 dually accredited programs, wherein the resident trains in the AOA-accredited internship and then transfers directly into an allopathic program.<ref name="pmid12525405">{{cite journal |author=Cummings M |title=Does the osteopathic internship have a future? |journal=Acad Med |volume=78 |issue=1 |pages=22–5 |year=2003 |pmid=12525405 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1040-2446&volume=78&issue=1&spage=22 |issn=}}</ref>{{-}}

====Licensure====
{| class="wikitable" style="font-style:italic; font-size:120%; border:3px solid red;"
|+Steps to licensure
|-
! !! [[Allopathic]] !! [[Osteopathic]] !!
|-
! Medical School Application service
| [[AMCAS]] || [[AACOM]]AS
|-
! Years of medical school
| 4 || 4
|-
! Medical Licensing Exam (MLE)  Step 1
| [[USMLE]] required || 
{|
|USMLE optional (~50%)
|-
|[[COMLEX]] required 
|} 
|-
! MLE, Step 2
| USMLE required || varies by school.  may require COMLEX, or choice of ''either'' USMLE or COMLEX 
|-
! residency
| allopathic ([[ACGME]])|| one must be selected:
{| 
| allopathic (ACGME)
|-
| osteopathic ([[American Osteopathic Association|AOA]])
|-
| combined allopathic/osteopathic
|-
|AOA approval of an ACGME program<ref name = "res 42">[http://www.osteopathic.org/index.cfm?PageID=sir_postdocres42 ''Resolution 42: Approval of ACGME Training as an AOA-Approved Internship'']. [[American Osteopathic Association]]. accessed October 2007.</ref>
|} 
|-
! Board Certification
|[[List of medical speciality colleges in the United States|State medical specialty boards]] || Either allopathic or osteopathic [[List of medical speciality colleges in the United States|medical specialty boards]]
|}

====Continuing medical education====
{{main|Continuing medical education}}
To maintain a license to practice medicine, U.S. physicians are required to complete addition training every few years, so called [[continuing medical education]], CME.  There are subtle differences in the CME requirements for allopathic and osteopathic physicians, and in how these CME credits are approved.  The requirements for maintaining a physician license for allopathic or osteopathic physicians are almost identical in most states, though there are small differences. For example, in the case of Pennsylvania, allopathic licenses begin on December 31, whereas osteopathic ones begin on October 31.<ref>[http://www.pamedsoc.org/Template.cfm?Section=CME&Template=/ContentManagement/ContentDisplay.cfm&ContentID=6751 ''Requirements for license renewal'']. Pennsylvania Medical Society.</ref>

===Symbols===
[[Image:Rod of asclepius.png|thumb|left|Rod of Asclepius]]
Some osteopathic organizations use the [[Rod of Asclepius|rod of Ascelpius]], a symbol of healing through medicine consisting of a single serpent entwined around a staff.  Allopathic organization also use the rod of Asclepius, and another symbol, the [[caduceus]], consisting of two intertwining snakes.{{Fact|date=August 2007}} [[Image:Caduceus.svg|thumb|120px|right|Caduceus]]{{-}}

==References==
{{Reflist|2}}
==External links==
*[http://gradschool.about.com/od/medicalschool/f/osteoallo.htm What's the difference between osteopathic and allopathic medicine?]
*[http://www.amsa.org/osteo/ American Medical Student Association forum on osteopathic and allopathic medicine]

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[[Category:Osteopathic medicine]]
[[Category:Allopathic medicine]]
[[Category:Medical education in the United States]]
[[Category:Comparisons|Medicine]]

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