Some residency training programs, such as in neurology and ophthalmology, do not include an internship year and begin after completion of an internship or transitional year. Some use it to re-apply to programs into which they were not accepted, while others use it as a year to decide upon a specialty. In addition, osteopathic physicians "are required to have completed an American Osteopathic Association (AOA)-approved first year of training in order to be licensed in Florida, Michigan, Oklahoma and Pennsylvania."[3]