Gray zone: why a delayed acceptance of osteopathic medicine persists in the international community.

Barriers to International Recognition Although DOs practice in all 50 states and in every medical specialty,6 the osteopathic medical profession is officially separate from the allopathic medical (ie, MD) profession. The distinction is based on the additional 200 hours of osteopathic coursework required of osteopathic medical students7 with an otherwise complete overlap in the biomedical science and clinical curriculum shared by DO and MD programs. In fighting to convey osteopathic medicine as separate from allopathic medicine, DOs have not fully assimilated into the MD community. Parallel systems of domestic licensure reinforce this individualism. Whereas MD schools are accredited by the Liaison Committee on Medical Education and their graduates are represented by the American Medical Association, osteopathic institutions are recognized by the AOA Commission on Osteopathic College Accreditation and the AOA is the central decision-making body for the osteopathic medical profession. However, both the osteopathic and allopathic professions agreed to a single accreditation system under the Accreditation Council for Graduate Medical Education.8 The global spread of osteopathic medicine is promoted by several advocacy groups. Since 1986, the AOA Division of International Affairs (formerly combined into the Division of State Government and International Affairs) has been the established authority on negotiating international licensure. The AOA also charged the Bureau of International Osteopathic Medicine to “promote the highest standards of osteopathic medical education and practice throughout the world.”9 In 2004, the Osteopathic International Alliance was formed to represent the global osteopathic profession including DOs and foreign-trained osteopaths.10 The AOA works to maximize the scope of practice for DOs in other countries while recognizing the sovereignty of health care delivery systems in other nations.9 Gray Zone: Why a Delayed Acceptance of Osteopathic Medicine Persists in the International Community