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Little White Coats: The Failed Promise of Osteopathic Medicine

Pescatore, Rick DO

doi: 10.1097/01.EEM.0000464084.74109.40
Little White Coats

Dr. Pescatoreis a first-year emergency medicine resident at Cooper University Hospital in Camden, NJ. He is a 2014 graduate of the Philadelphia College of Osteopathic Medicine, and an EMS medical director in Pennsylvania. He has been writing a blog, Little White Coats, for EMN since 2012. Follow his career as he starts his residency in emergency medicine at



When I graduate from residency and pass the ABEM qualifying exam, I'll be ready to start my own career as a board certified emergency physician. After four years of medical school and three more of residency, the powers that be will have deemed me ready to care for the ill and injured across the country — but not in my home state. I'll be permitted to infuse inotropes and lead resuscitations in New Jersey, but it will be unlawful for me to prescribe laxatives in Pennsylvania. I can strive to save lives in Alabama, but I am barred from doing the same in Florida. The problem, you see, is that I'm a DO.

I should start off by saying how proud I am to have graduated from an osteopathic medical school. An institution that had no compelling reason to accept me readily brought me into their academic fold, and I thrived on every moment of their tutelage. The mornings of manipulative medicine instruction shaped my role as a physician just as the long nights of anatomy lab did. Osteopathic principles infused into every patient-centered lesson helped mold me in the vision of Andrew T. Still, MD, DO, and I truly believe that my daily patient interactions are influenced by my osteopathic education. Nonetheless, I opted to enter an ACGME-accredited program for my residency training. Many reasons led me to forgo the AOA match and enter an MD program — the same arguments that are played out daily on Internet message boards and in the minds of the thousands of emergency medicine applicants each year — but the only reason that matters, of course, is that it was the right program for me, the place where I could best learn the art and science of emergency medicine.

To maintain some measure of osteopathic distinctiveness, the osteopathic licensing boards of four states (Pennsylvania, Michigan, Oklahoma, and Florida) typically require completion of an AOA-approved internship prior to granting a permanent medical license. The remaining 46 states make no distinction between the medical degrees, but these four stand fast in their requirement. The AOA instituted Resolution 42, or the “hardship resolution,” in 2000, which grants credit for internship to ACGME trainees, allowing them to apply for licensure in the four states. Resolution 42 provides a mechanism for DO graduates to remain part of the osteopathic family, but it places perhaps onerous requirements on emergency medicine trainees, sometimes requiring replacement of elective time — designed to help residents pursue a niche interest or sharpen a relevant skill — with a rotation of questionable benefit to the emergency medicine curriculum.

My co-residents, the residency faculty, and the hospital staff treat me no differently as a DO in an MD program. Most patients are unaware of the difference or at worst simply ask what the letters behind my name mean. By and large, the only entities that force a distinction are the four state boards that would deem me unfit to treat their citizens. Graduate medical education is undergoing a long-awaited evolution toward a combined certifying organization, so it is peculiar indeed that such restrictions and requirements still exist in these states.

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