Doctor of Osteopathic Medicine is a professional doctoral degree for physicians and surgeons
offered by medical schools in the United States.
Holders of the D.O. degree have attained the ability to become licensed as osteopathic
physicians who have equivalent rights, privileges, and responsibilities as physicians with a
Doctor of Medicine degree.
D.O.
physicians are licensed to practice the full scope of medicine and surgery in 65 countries,
including all 50 states in the US, and make up 7 percent of the total U.S. physician population.
In 2013, there were 87,300 osteopathic physicians in the United States.
Currently, there are 30 medical schools with 42 locations throughout the United States
that offer the D.O. degree, and 141 medical schools that offer the M.D. degree.
As of 2011, 1 in 5 medical students in the United States were D.O.
students.
The curricula at osteopathic medical schools are very similar to those at M.D.-granting
medical schools.
Four years in total length, the first two years of medical school focus on the biomedical
and clinical sciences, followed by two years of core clinical training in the clinical
specialties.
Upon leaving medical school, D.O.
graduates may enter internship or residency training programs, which may be followed by
fellowship training.
Many D.O.
graduates attend the same graduate medical education programs as their M.D.
counterparts, and then take M.D.
specialty board exams, while other D.O.
graduates enter osteopathic programs and take D.O.
specialty board examinations.
One notable difference between D.O. and M.D.
training is that D.O.
training adds 300–500 hours studying philosophically-based techniques for hands-on manipulation of the
human musculoskeletal system.
These techniques, known as osteopathic manipulative medicine, have been criticized as "pseudoscientific".
History
The practice of osteopathy began in the United States in 1874.
The term "osteopathy" was coined by physician and surgeon Andrew Taylor Still, MD, DO..
Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the
starting point from which [he] was to ascertain the cause of pathological conditions."
Still founded the American School of Osteopathy in Kirksville, Missouri, for the teaching
of osteopathy on 10 May 1892.
While the state of Missouri granted the right to award the MD degree, he remained dissatisfied
with the limitations of conventional medicine and instead chose to retain the distinction
of the DO degree.
In 1898 the American Institute of Osteopathy started the Journal of Osteopathy and by that
time four states recognized the profession.
The osteopathic medical profession has evolved into two branches: non-physician manual medicine
osteopaths who were educated and trained outside the United States and U.S. trained full scope
of medical practice osteopathic physicians.
The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions.
In the United States, osteopathic physicians holding the D.O. degree have attained the
same rights, privileges, and responsibilities as physicians with a Doctor of Medicine degree.
These groups are so distinct that in practice they function as separate professions.
As originally conceived by Andrew Still, the letters "DO" stood for "Diplomate in Osteopathy"
and the title conferred by the degree was "Doctor of Osteopathy".
Subsequently the degree also came to be entitled "Doctor of Osteopathic Medicine", and in more
recent times the AOA has preferred that this title be used exclusively, resolving in a
1960 conference:
Be it resolved, that the American Osteopathic Association institute a policy, both officially
in our publications and individually on a conversational basis, to use the terms osteopathic
medicine in place of the word osteopathy and osteopathic physician and surgeon in place
of osteopath; the words osteopathy and osteopath being reserved for historical, sentimental,
and informal discussions only.
Nevertheless, some DOs continue to use the old terms and the American Academy of Osteopathy
retains the old usage in its name.
Demographics In 2013, there were 87,300 osteopathic physicians
in the United States, of which 73,074 were in active practice.
The proportion of females in the profession has steadily increased since the 1980s.
In 1985, about 10 percent of D.O.
physicians were female, compared with 34.6 percent in 2013.
Between 2008 and 2012, 49 percent of new D.O.
graduates were females.
During the 2011-12 academic year, the osteopathic medical student body consisted of: 69 percent
white/non-hispanic, 19 percent Asian or Pacific Islander, 3.5 percent hispanic, 3 percent
African American, and 0.5 percent Native American or Alaskan.
The remainder were listed as "other or not entered."
Education, training and distinctiveness
Osteopathic medical school curricula are virtually identical to those at schools granting the
M.D. degree.
Once admitted to an osteopathic medical school, it takes four years to graduate, and the schooling
is divided into the pre-clinical and clinical years.
The pre-clinical years, the first and second years, focus on the biomedical and clinical
sciences.
The clinical years, the third and fourth years, consist of core clinical training and sub-internships
in the clinical specialties.
Osteopathic medical school accreditation standards require training in internal medicine, obstetrics/gynecology,
pediatrics, family practice, surgery, psychiatry, emergency medicine, radiology, preventive
medicine and public health.
According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing,
licensure, and reimbursement of osteopathic physicians is virtually indistinguishable
from those of physicians with M.D.
qualifications, with 4 years of osteopathic medical school followed by specialty and subspecialty
training and board certification."
However, D.O.
schools provide an additional 300 – 500 hours in the study of hands-on manual medicine
and the body's musculoskeletal system, which is referred to as osteopathic manipulative
medicine.
The D.O.
physician Bryan E. Bledsoe, a professor of emergency medicine, has written disparagingly
of this element of D.O.
training.
He characterized its foundations as pseudoscientific and asked "why members of the osteopathic
medical profession continue to teach an outdated and ineffective system of healthcare to undergraduate
osteopathic medical students"?
After completing medical school, D.O.
physicians begin graduate medical training.
Many D.O.
physicians attend the same internship and residency training programs as their M.D.
counterparts, and then take M.D.
specialty board exams while other D.O.
graduates enter osteopathic internships and residencies and take D.O.
specialty board examinations.
In 2003 Quackwatch published an article which stated that "although most DOs offer competent
care, the percentage involved in dubious practices appears to be higher than that of [MDs]";
in particular, Quackwatch characterized some types of cranial therapy as "dubious".
In 2010, Steven Salzberg wrote that although he considered some D.Os. to be very good doctors,
osteopathic manipulative treatment was promoted as "the element that makes DOs 'special'"
and that it amounted to no more than "'extra' training in pseudoscientific practices".
Examinations To be considered for entry into a D.O.
program, an applicant must complete a national standardized exam called the Medical College
Admissions Test.
Some authors note the differences in the average MCAT scores and grade point average of students
who matriculate at D.O.
schools versus those who matriculate at M.D.
schools within the United States.
In 2011, the average MCAT and GPA for students entering U.S.-based M.D.
programs were 31.1 and 3.67, respectively, and 27.1 and 3.51 for D.O.
matriculants, although the gap has been getting smaller every year.
DO medical schools are more likely to accept non-traditional students who are older and
entering medicine as a second career, or coming from non-science majors.
D.O.
medical students are required to take the Comprehensive Osteopathic Medical Licensure
Examination, which is sponsored by the National Board of Osteopathic Medical Examiners.
The COMLEX-USA is series of three osteopathic medical licensing examinations.
The first two steps of the COMLEX-USA are taken during medical school, and are prerequisites
for osteopathic residency programs, which are available in almost every specialty of
medicine and surgery.
The step 3 portion of the COMLEX is taken during residency.
In addition to the COMLEX-USA, D.O.
medical students may choose to sit for the M.D.
board examinations, which are called the United States Medical Licensing Examination.
This is typically done if the student desires to enter an M.D.
residency.
However, this is not always required, as some M.D.
residency programs do not require the USMLE from D.O.
applicants.
USMLE pass rates for D.O. and M.D.
students in 2012 are as follows: Step 1: 91% and 94%, Step 2 CK: 96% and 97%, and Step
2 CS: 87% and 97%, respectively Step 3: 100% and 95%.
Licensing and board certification To obtain a license to practice medicine in
the United States, medical students must pass the Comprehensive Osteopathic Medical Licensing
Examination, the licensure exam administered by the National Board of Osteopathic Medical
Examiners throughout their medical training.
Students are given the option of also taking the United States Medical Licensing Examination
to apply for some Accreditation Council for Graduate Medical Education residency programs.
Those that have received or are in the process of earning an M.D. or D.O. degree are both
eligible to sit for the USMLE.
Because of their additional training, only holders of the D.O.
are eligible to sit for the COMLEX.
Upon completion of internship and residency requirements for their chosen medical specialty,
and depending on whether the program attended as ACGME or AOA accredited, holders of the
D.O.
may elect to be board certified by either a specialty board or an osteopathic specialty
board.
In February 2014, the American Osteopathic Association and the Accreditation Council
for Graduate Medical Education agreed to unify allopathic and osteopathic Graduate medical
education starting in 2020.
Depending on the state, medical licensure may be issued from a combined board or a separate
board of medical examiners.
All of the 70 state medical boards are members of the Federation of State Medical Boards.
International variations Currently, there are no osteopathic programs
located outside of the United States that would qualify an individual to practice as
an osteopathic physician in the United States.
Foreign osteopathic degrees are not recognized by any state in the U.S. as being equivalent
to American D.O. degrees.
International practice rights The following is an International Licensure
Summary for U.S.-trained Doctors of Osteopathic Medicine, as listed by the American Osteopathic
Association: See also
List of medical schools in the United States Notes and references
External links One DO's description on "What Is A DO?"
Doctor of Osteopathic Medicine - National Institutes of Health