Prior to 2000, allopathic and osteopathic physicians were required to pass all three parts of the United States Medical Licensing Examination (USMLE) to obtain a license to practice medicine in Louisiana. There was no other pathway for osteopathic physicians to be licensed in this state, as the Comprehensive Osteopathic Medical Licensing Examination–USA (COMLEX-USA) was not accepted.

In 1999, the Louisiana State Board of Medical Examiners (LSBME) began the process of modifying its rules for osteopathic licensure; and in early 2000, osteopathic resident physicians were granted training permits to participate in residency programs in Louisiana accredited by the Accreditation Council for Graduate Medical Education (ACGME). Upon completion of this residency, again in Louisiana only, these D.O.s could apply for licenses. However, these medical licenses could only be renewed if applicants had successfully taken and passed a certifying examination offered by a board within the American Board of Medical Specialties (ABMS) on their first attempt or, in specialties for which certification is not possible within a year following training, the physician was progressing towards certification. This meant osteopaths who completed an American Osteopathic Association (AOA) approved residency were not eligible unless they were allowed to sit for and pass a certifying examination approved by an ABMS-affiliated board. For a reciprocity license, the D.O. applicant was required to hold a license in another state and possess ABMS certification. If board certification was obtained more than 10 years before the application date, the applicant had to pass the Special Purpose Examination (SPEX) administered by the Federation of State Medical Boards. Although these changes were a step in the right direction, they obviously had their shortcomings.

In 2003, I began to gather data on the licensing of osteopaths in this country and how it compared to their allopathic colleagues. My research took in me in many directions, as I wanted to cover many aspects of osteopathic education, training and licensure. The data gathered included osteopathic medical-school educational experiences, postgraduate training, examination experiences (such as that of the National Board of Osteopathic Medical Examiners (NBOME) and AOA specialty boards), onsite inspection of the NBOME clinical-skills-testing center in Conshohocken, Pa., and disciplinary actions involving doctors of osteopathy. This data was compiled and presented to the LSBME. It was quite clear from this information, although there were some differences in educational experiences and training between osteopaths and allopathic physicians, there were no significant comparative differences when judging competency and disciplinary actions. However, from a licensing agency’s perspective, what is most pertinent is competency and subsequent actions taken on a physician’s license. From that vantage point, my research showed it really doesn’t matter whether training is in the allopathic or osteopathic pathway; there was no difference in disciplinary action between the two groups.

This was certainly reassuring to the LSBME and, as a result, the board unanimously approved full acceptance of COMLEX–USA for licensure of osteopathic physicians in Louisiana in January 2004. Thus, decades of debate in Louisiana were over and osteopaths could be licensed in the state on par with allopathic physicians. COMLEX–USA and USMLE are now equally accepted, similar to all other states.

Not surprisingly, as a consequence of the previous obstacles, Louisiana has never had a large osteopathic presence within the state. Nonetheless, I decided to undertake a retrospective review and evaluate the impact of full acceptance of COMLEX–USA as it relates to physician numbers. Although some of the statistical accuracy has been difficult to determine as a result of Hurricane Katrina and the rapid migration of physicians into and out of Louisiana, some interesting and encouraging trends are emerging.

According to statistical data obtained from the LSBME, a total of 359 osteopaths have been licensed in the state of Louisiana. Currently, 174 are still licensed to practice medicine. Of the total osteopaths licensed, 309 of them, or 86 percent, were licensed before COMLEX–USA was accepted, indicating all of them had taken the USMLE or its predecessor to meet licensure requirements. Of this 309, 124 are still licensed. Seventeen of these did not renew their licenses after September 2005, which is basically since the passage of Hurricane Katrina. Since 2004, 50 new osteopaths have been licensed in Louisiana, a substantial increase. Prior to 2004, there was less than one newly licensed doctor of osteopathy in Louisiana each year. Since 2004, the number of initially licensed osteopaths has grown. In 2004, there were eight new licensed D.O.s. That number dramatically increased to 27 in 2005. There was a slightly lesser increase in 2006, with 23 newly licensed osteopaths. It appears the number in 2006 was affected by Hurricane Katrina, as it may have dissuaded some physicians from coming to the state.

Although doctors of osteopathy represent less than six percent of all physicians, they account for approximately 15 percent of all physicians practicing in rural areas, according to the AOA. Of the 102 licensed osteopaths in Louisiana, 47 practice in rural areas. This represents 46 percent of the total number of osteopaths in this state. As a percentage, this is higher than that of allopathic physicians, although the specific number has been difficult to determine since Hurricane Katrina, making an exact comparison impossible. In addition, it appears approximately two-thirds of the newly licensed osteopaths are entering postgraduate training programs in Louisiana. Nearly all of these are entering ACGME-accredited residency programs, as currently there is only one osteopathic postgraduate training program (OPTI) in the state: a Family Medicine training program (also an ACGME program) affiliated with the Louisiana State University School of Medicine in New Orleans located in Lake Charles.

There is still a great need for physicians in Louisiana, particularly in rural areas. Geographically, Louisiana is mostly a rural state, which results in an intensification of this need. It appears more osteopaths are coming to Louisiana for training and, hopefully, future practice. Historically, most physicians practice within 100 miles of their training programs. This trend bodes well for the citizens of the state and the future availability of medical care. As more osteopaths enter postgraduate training in Louisiana, it is assumed there will be more acceptance within academic medical centers and perhaps the establishment of more OPTIs in the future.

The acceptance of COMLEX–USA for licensing osteopathic physicians has had a beneficial affect for everyone concerned. The previous impediment for D.O.s has been removed. The “welcome mat” is now out for osteopaths to train and practice in Louisiana. Academic medical centers have a broader pool of physicians to train. The citizens of Louisiana, particularly in rural areas, will be well served by the potentially increasing numbers of available physicians to treat them. Time will tell if these positive trends continue. We look to the future with anticipation.

This material was presented in part at the American Association of Osteopathic Examiners Summit Meeting in New Orleans in January 2007.