Examinations are in multiple parts, and some cover distinct content. It is doubtful that those exams (COMLEX and USMLE) will merge anytime soon. Even if they do merge years down the road, a grandfather clause will be necessary to catch those who are part way through either examination process, and there will need to be at least an additional component for the DO students to test them on distinct osteopathic principles and practice. Conversely, if MDs seek a DO residency, an examination to test them on those distinctive principles will be necessary as well.

 DOs have had one unfair advantage over their MD counterparts: they could do either an AOA or ACGME residency, whereas the MDs could only train in an ACGME residency program. That will also change. DO and MD graduates will have access to ACGME-accredited training programs, including those with an osteopathic principles dimension. Prerequisite competencies (recommended by the new Osteopathic Principles Review Committee) and a recommended program of training for MD graduates may be required for entry into programs that have an osteopathic principles dimension, especially in primary care and physical medicine and rehabilitation. The same will apply to international medical graduates.

Osteopathic principles are becoming less foreign and are already being incorporated into many allopathic institutions. Most folks assume that manipulation is the hallmark difference between the two professions. This is a common misconception. Manipulation is something that DOs learn for sure, but the bulk of the differences are philosophical: that the body is a unit and the holistic approach to the patient, nutrition, and preventive medicine in addition to the manual medicine component. More and more of the allopathic schools and residencies are incorporating nutrition, holistic approaches, empathy training, and preventive medicine into their curriculums. In some respects, the entire approach to patient care, and the health care system itself, has begun to embrace and adopt many of the osteopathic principles.

Power in a United Front

The single system presents an opportunity to advocate, especially with members of Congress, for appropriate public support for funding the best-trained future physician workforce. As efforts are taken to cut GME funding, the single accreditation process is a clear reflection of the collaborative work being done by the AOA, AACOM, and ACGME to remove any perceived inefficiencies of maintaining two accreditation systems. Improving GME, with a focus on achieving demonstrated quality improvement, will produce the greatest benefit.