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August 2003 ? Volume 42 ? Number 2
Education/Residents ' Perspective
Osteopathic physicians in emergency medicine
Joseph A Pollard, DO [MEDLINE LOOKUP]
Eric A Leveque, DO [MEDLINE LOOKUP]
Matthew R Lewin, MD, PhD [MEDLINE LOOKUP]
Fresno, CA
Although there is a diversity of osteopathic-based emergency medicine organizations, there appears to be little recognition or understanding of these groups by allopathic-trained emergency physicians or their organizations. Since 1978, when the American Osteopathic Association (AOA) established its first osteopathic emergency medicine residency, there has been an essentially parallel evolution between allopathic and osteopathic groups who share the same specialty. Whether this parallel development has been willful or a historical accident is not the subject of our discussion. In this article, we set out to introduce the history and development of osteopathic emergency medicine training and its relationship to the allopathic emergency medicine mainstream.
In 1874, Andrew Taylor Still, MD, presented his principles of osteopathic medicine as an alternative to the medical practices of the day. Paramount among these beliefs was the physician's role in facilitating the body's inherent ability to heal itself. In contrast to the allopathic medical tradition, the osteopathic tradition pays special attention to the musculoskeletal system and how it affects the function of all other body systems.
The first college, the American School of Osteopathy, was founded in 1892, in the state of Missouri.1 In 2001, there were 19 osteopathic colleges, which graduated 2,597 students with the doctor of osteopathic medicine (DO) medical degree. With the addition of a 20th school and increased enrollment, the number of osteopathic graduates is expected to increase to 2,926 in 2006. Although osteopathic physicians still only comprise approximately 5% of total physicians, the profession has seen a considerable population increase between 1992 and 2001 from 31,206 to 41,574 practicing physicians.2-4 In 1999, there were 2,559 osteopathic physicians practicing emergency medicine, comprising 8% of all emergency physicians.5,6
The AOA approved its first 3 osteopathic emergency medicine residencies in 1978.7 In 2002, there were 30 osteopathic emergency medicine programs with 302 residents.2 All but 4 of these programs are east of the Mississippi River (Figure).
Figure. Distribution of osteopathic emergency medicine residencies. There are 30 AOBEM-recognized residency programs for osteopathic medicine. Only 4 are located west of the Mississippi River.
Women make up approximately one quarter of osteopathic emergency medicine residents.8 Currently, all osteopathic emergency medicine residencies are 4 years long and fully funded by the Centers for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration) for all 4 years. By comparison, allopathic emergency medicine programs are funded for 3 years. In an effort to broaden their clinical experience before specializing, osteopathic residents are required to complete an initial ?traditional? internship year, which is included in the 4-year program. Additionally, osteopathic emergency medicine combined programs are available for internal medicine, pediatrics, and family medicine. All combined programs are 5 years in length. There is one combined allopathic-osteopathic emergency medicine program in Michigan, which matriculated its first mixed doctor of medicine-doctor of osteopathic medicine intern class in 1988.9 With the exception of the internship year, the usual osteopathic emergency medicine curricula closely mirrors that of their allopathic counterparts.10
Both the Accreditation Council for Graduate Medical Education (ACGME)-approved and the AOA-approved residency programs use a matching program. Allopathic residency programs use a centralized application service (the Electronic Residency Application Service) that allows students to send one application to multiple programs. In comparison, osteopathic programs require students to contact and apply to each program directly. For the 2001 to 2002 application period, 268 osteopathic students (comprising 10.9% of all applicants) applied to allopathic emergency medicine residencies. Doctor of osteopathic medicine applicants applied to fewer allopathic programs (17 applications) than their doctor of medicine counterparts (25 applications).11 Seventy-nine (7.5%) osteopathic applicants matched to allopathic residencies in March 2002, out of 1,052 positions that were filled.12,13
Although all allopathic residency programs allow osteopathic graduates to apply, the reverse is not true. Osteopathic residency programs do not accept applications from allopathic graduates because of the shortage of osteopathic residencies. In 2001, there were only 3,119 funded osteopathic residency positions. In the same year, 6,720 doctor of osteopathy residents were receiving postgraduate training (2,555 AOA-approved, 4,165 ACGME-approved).2 Before 2001, the osteopathic medical students were able to choose between their allopathic and osteopathic acceptances. In an effort to promote osteopathic residencies and prevent the chaos of broken internship contracts, the osteopathic match was moved to February and concludes before the National Residency Match Program. An osteopathic student who matches to any osteopathic residency is automatically dropped from the National Residency Match Program. With this change, senior osteopathic students are compelled to make risky educational decisions about their career paths at a very early stage in their medical careers if they gamble on the allopathic emergency medicine match, which is highly competitive. In the past, the AOA was facing the chaos of AOA-matched osteopathic residents breaking their contracts in favor of successful National Residency Match Program matches. This harmed their colleagues who might otherwise have matched more favorably in the osteopathic match. However, it is debatable whether the osteopathic educational system should be graduating more students than it can independently support, while punishing students seeking to match in the National Residency Match Program.
continued in next page...
Education/Residents ' Perspective
Osteopathic physicians in emergency medicine
Joseph A Pollard, DO [MEDLINE LOOKUP]
Eric A Leveque, DO [MEDLINE LOOKUP]
Matthew R Lewin, MD, PhD [MEDLINE LOOKUP]
Fresno, CA
Although there is a diversity of osteopathic-based emergency medicine organizations, there appears to be little recognition or understanding of these groups by allopathic-trained emergency physicians or their organizations. Since 1978, when the American Osteopathic Association (AOA) established its first osteopathic emergency medicine residency, there has been an essentially parallel evolution between allopathic and osteopathic groups who share the same specialty. Whether this parallel development has been willful or a historical accident is not the subject of our discussion. In this article, we set out to introduce the history and development of osteopathic emergency medicine training and its relationship to the allopathic emergency medicine mainstream.
In 1874, Andrew Taylor Still, MD, presented his principles of osteopathic medicine as an alternative to the medical practices of the day. Paramount among these beliefs was the physician's role in facilitating the body's inherent ability to heal itself. In contrast to the allopathic medical tradition, the osteopathic tradition pays special attention to the musculoskeletal system and how it affects the function of all other body systems.
The first college, the American School of Osteopathy, was founded in 1892, in the state of Missouri.1 In 2001, there were 19 osteopathic colleges, which graduated 2,597 students with the doctor of osteopathic medicine (DO) medical degree. With the addition of a 20th school and increased enrollment, the number of osteopathic graduates is expected to increase to 2,926 in 2006. Although osteopathic physicians still only comprise approximately 5% of total physicians, the profession has seen a considerable population increase between 1992 and 2001 from 31,206 to 41,574 practicing physicians.2-4 In 1999, there were 2,559 osteopathic physicians practicing emergency medicine, comprising 8% of all emergency physicians.5,6
The AOA approved its first 3 osteopathic emergency medicine residencies in 1978.7 In 2002, there were 30 osteopathic emergency medicine programs with 302 residents.2 All but 4 of these programs are east of the Mississippi River (Figure).
Figure. Distribution of osteopathic emergency medicine residencies. There are 30 AOBEM-recognized residency programs for osteopathic medicine. Only 4 are located west of the Mississippi River.
Women make up approximately one quarter of osteopathic emergency medicine residents.8 Currently, all osteopathic emergency medicine residencies are 4 years long and fully funded by the Centers for Medicare and Medicaid Services (CMS; formerly the Health Care Financing Administration) for all 4 years. By comparison, allopathic emergency medicine programs are funded for 3 years. In an effort to broaden their clinical experience before specializing, osteopathic residents are required to complete an initial ?traditional? internship year, which is included in the 4-year program. Additionally, osteopathic emergency medicine combined programs are available for internal medicine, pediatrics, and family medicine. All combined programs are 5 years in length. There is one combined allopathic-osteopathic emergency medicine program in Michigan, which matriculated its first mixed doctor of medicine-doctor of osteopathic medicine intern class in 1988.9 With the exception of the internship year, the usual osteopathic emergency medicine curricula closely mirrors that of their allopathic counterparts.10
Both the Accreditation Council for Graduate Medical Education (ACGME)-approved and the AOA-approved residency programs use a matching program. Allopathic residency programs use a centralized application service (the Electronic Residency Application Service) that allows students to send one application to multiple programs. In comparison, osteopathic programs require students to contact and apply to each program directly. For the 2001 to 2002 application period, 268 osteopathic students (comprising 10.9% of all applicants) applied to allopathic emergency medicine residencies. Doctor of osteopathic medicine applicants applied to fewer allopathic programs (17 applications) than their doctor of medicine counterparts (25 applications).11 Seventy-nine (7.5%) osteopathic applicants matched to allopathic residencies in March 2002, out of 1,052 positions that were filled.12,13
Although all allopathic residency programs allow osteopathic graduates to apply, the reverse is not true. Osteopathic residency programs do not accept applications from allopathic graduates because of the shortage of osteopathic residencies. In 2001, there were only 3,119 funded osteopathic residency positions. In the same year, 6,720 doctor of osteopathy residents were receiving postgraduate training (2,555 AOA-approved, 4,165 ACGME-approved).2 Before 2001, the osteopathic medical students were able to choose between their allopathic and osteopathic acceptances. In an effort to promote osteopathic residencies and prevent the chaos of broken internship contracts, the osteopathic match was moved to February and concludes before the National Residency Match Program. An osteopathic student who matches to any osteopathic residency is automatically dropped from the National Residency Match Program. With this change, senior osteopathic students are compelled to make risky educational decisions about their career paths at a very early stage in their medical careers if they gamble on the allopathic emergency medicine match, which is highly competitive. In the past, the AOA was facing the chaos of AOA-matched osteopathic residents breaking their contracts in favor of successful National Residency Match Program matches. This harmed their colleagues who might otherwise have matched more favorably in the osteopathic match. However, it is debatable whether the osteopathic educational system should be graduating more students than it can independently support, while punishing students seeking to match in the National Residency Match Program.
continued in next page...
