Both D.O.’s and M.D’s complete four years of medical education. After medical school, both D.O.’s and M.D.’s can choose to do a residency in any specialty area. After completing a residency program, both D.O.’s and M.D.’s must pass state licensing examinations. Both can further certify through board certification in their area of specialty and fellowship training. They both practice together in fully accredited and licensed health care facilities. Osteopathic training differs primarily during medical school where functional anatomy as well as therapeutic touch and manipulation is incorporated into understanding disease, diagnosis and treatment. Although relatively few Osteopaths maintain manual treatment as a part of their treatment mode, we still do.