The United States is the only country that has two fully accredited terminal medical degree pathways (MD and DO) leading to the unlimited practice of medicine. The Accreditation Council on Graduate Medical Education (ACGME) is responsible for the accreditation process for all postgraduate medical education programs (i.e., residency and fellowship programs) in the United States through a Single Accreditation System. The ACGME offers an Osteopathic Recognition option for residency programs that promote the education of residents in Osteopathic Principles and Practice (OPP) and Osteopathic Manipulative Treatment (OMT). To receive this recognition a residency program must meet established ACGME requirements. Each program applying for Osteopathic Recognition must have a Director of Osteopathic Education. Programs with Osteopathic Recognition must have a training environment conducive to education in the tenets of osteopathic medicine and enough qualified osteopathic faculty to adequately teach and supervise residents. Residency programs with Osteopathic Recognition must have a written policy that outlines the requirements for the appointment of a resident into the program. An explicit evaluation system, including an assessment of the resident’s ability to integrate OPP into clinical practice, must exist. Osteopathic Recognition Milestones must be incorporated into the evaluation process. Residents must have the opportunity to independently evaluate the residency program with Osteopathic Recognition. Residents may pursue board certification through the American Osteopathic Board of Family Physicians (AOBFP). Two primary certification pathways are available through the AOBFP: Family Medicine and Family Medicine with Osteopathic Manipulative Treatment.