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Osteopathic medicine in the United States
Andrew Taylor Still (founder)
Doctor of Osteopathic Medicine (DO) Medicine US Medical education Schools Physicians Osteopathic Manipulative Medicine AOA AACOM AAO COMLEX MD & DO Comparison Specialty Colleges AOA BOS
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Doctor of Osteopathic Medicine (D.O. or DO) 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 (M.D.). 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 40 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.

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 was to ascertain the cause of pathological conditions." Still founded the American School of Osteopathy (now A.T. Still University of the Health Sciences) 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 profession has evolved into two branches, non-physician manual medicine osteopaths and full scope of medical practice osteopathic physicians holding the D.O. degree which have attained the same rights, privileges, and responsibilities as physicians with a Doctor of Medicine (M.D.) 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 (Doctor of Medicine). 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 (OMM). 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 "; 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 (OMT) 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 (MCAT). 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 (COMLEX-USA), which is sponsored by the National Board of Osteopathic Medical Examiners (NBOME). 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 (USMLE). 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 (this number may be misleading as only 46 D.O. students compared to 17,118 M.D. students were evaluated for Step 2 CS) Step 3: 100% and 95% (this number may be misleading, as only 16 D.O. students compared to 19,056 M.D. students, were evaluated for Step 3).

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 (COMLEX), 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 (USMLE) to apply for some Accreditation Council for Graduate Medical Education (ACGME) 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 (through the American Medical Association's American Board of Medical Specialties) or an osteopathic specialty board (through the American Osteopathic Association Bureau of Osteopathic Specialists certifying boards). 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 (D.O. and M.D.) 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

1. ^ MedLine Plus (2007). "Doctor of Osteopathic medicine (D.O.)". National Institute of Health. U.S. National Library of Medicine, National Institutes of Health. Retrieved June 28, 2012.
2. "DOs Around the World". American Osteopathic Association. Retrieved 12 June 2013.
3. ^ "Osteopathic Medical Profession Report 2013" (PDF). American Osteopathic Association.
4. "U.S. Colleges of Osteopathic Medicine". AACOM. Retrieved 6 October 2013.
5. Directory of Accredited Medical Education Programs, Liaison Committee on Medical Education
6. "AAMC Medical Schools". Association of American Medical Colleges. Retrieved 2006-12-13.
7. Ricardo Lopez (April 6, 2012). "Booming medical school brings life to downtown Pomona". Los Angeles Times. Retrieved May 15, 2012.
8. "What is Osteopathic Medicine". American Association of Colleges of Osteopathic Medicine. Retrieved May 15, 2012.
9. ^ Kasper, Dennis L.; Eugene Braunwald; Anthony S. Fauci; Stephen L. Hauser; Dan L. Longo; J. Larry Jameson; Kurt J. Isselbacher (2004). Chapter 10. Complementary and Alternative Medicine Harrison's principles of internal medicine (16th ed. ed.). New York: McGraw-Hill. ISBN 978-0071391405. {{cite book}}: |edition= has extra text (help)
10. ^ "Graduate Medical Education Data Resource Book: 2011-12" (PDF). Accreditation Council for Graduate Medical Education. pp. 5, 6, 59, 60. Retrieved 19 November 2012.
11. "Roadmap to Residency: From Application to the Match and Beyond" (PDF). Association of American Medical Colleges. 2007. Retrieved June 28, 2012.
12. ^ "AOA Approved Internships and Residencies". American Osteopathic Association. Retrieved 19 November 2012.
13. ^ "Opportunities, Directory of Osteopathic Postdoctoral Education Programs, Supplemental OPTI Affiliation List" (PDF). The DO. October 2010. Retrieved June 28, 2012. {{cite web}}: Italic or bold markup not allowed in: |publisher= (help)
14. ^ "AOA Specialty Certifying Boards". American Osteopathic Association. Retrieved 19 November 2012.
15. "''Medical Registration for Macon County, MO as of March 27, 1874,'' Missouri Digital Heritage, Secretary of State of Missouri". Retrieved 13 November 2011.
16. "Medical registration for Adair County, MO dated 28 July 1883". Missouri Digital Heritage, Secretary of State of Missouri.
17. "Early American Manual Therapy".
18. "Commission on Osteopathic College Accreditation" (PDF). State of New Jersey.
19. "Osteopathic Virtual Museum". Retrieved 13 November 2011.
20. "General Notices". Popular science monthly: 710. Mar 1898. Retrieved 14 May 2013.
21. Emmons Rutledge Booth (2006). History of Osteopathy. p. 80. ISBN 978-3-936679-04-5.
22. Eileen L. DiGiovanna; Stanley Schiowitz; Dennis J. Dowling (2005). An Osteopathic Approach to Diagnosis and Treatment. Lippincott Williams & Wilkins. p. 3. ISBN 978-0-7817-4293-1.
23. "Terminology for Reporting on Osteopathic Medicine". Retrieved 6 October 2013.
24. Allen, TW (1993). "'Osteopathic physician' defines our identity". The Journal of the American Osteopathic Association. 93 (9): 884. PMID 8244784.
25. Allen, TW (2010). "Osteopathic medical terminology--redux". The Journal of the American Osteopathic Association. 110 (12): 743–4. PMID 21178160.
26. ^ "Osteopathic Medical Profession Report 2012" (PDF). American Osteopathic Association.
27. "Overview of Osteopathic Medical Education/Accreditation/The Four-Year Curriculum (2012 Osteopathic Medical College Information Book)" (PDF). American Association of Colleges of Osteopathic Medicine. 2012.
28. Bryan E. Bledsoe (2004). "The Elephant in the Room: Does OMT Have Proved Benefit? (Letter to the editor)". J Am Osteopath Assoc. 104 (10): 407.
29. "Roadmap to Residency: From Application to the Match and Beyond" (PDF). Association of American Medical Colleges. 2007. Retrieved June 28, 2012.
30. "Dubious Aspects of Osteopathy". Quackwatch. August 2003. Retrieved September 2013. {{cite web}}: Check date values in: |accessdate= (help)
31. • Salzberg, Steven (27 October 2010). "Osteopaths Versus Doctors". Forbes. Retrieved 15 September 2013.
    • Salzberg, Steven (27 October 2010). "Second Thoughts On Osteopathic Medicine". Forbes. Retrieved 18 September 2013.
32. "Table 17: MCAT Scores and GPAs for Applicants and Matriculants to U.S. Medical Schools" (PDF). Association of American Medical Colleges. 2000–2011.
33. ^ "AACOMAS Matriculant Profile 2011 Entering Class" (PDF). American Association of Colleges of Osteopathic Medicine. Retrieved 14 July 2012.
34. "Osteopathic Medical College Information Book" (PDF). American Association of Colleges of Osteopathic Medicine. 2012.
35. Madison Park (June 13, 2011). "Never too late to be a doctor". CNN News. Retrieved December 17, 2011.
36. "United States Medical Licensing Examination | USMLE Bulletin | Eligibility". Usmle.org. Retrieved 2012-02-22.
37. Sarko, John (February 2010). "COMLEX-1 and USMLE-1 Are Not Interchangeable Examinations". Academic Emergency Medicine. 17 (2): 218–220. doi:10.1111/j.1553-2712.2009.00632.x. PMID 20070273. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
38. Chick, Davoren A.; Harley P. Friedman; Vincent B. Young; David Solomon (22 January 2010). "Relationship Between COMLEX and USMLE Scores Among Osteopathic Medical Students who Take Both Examinations". Teaching and Learning in Medicine. 22 (1): 3–7. doi:10.1080/10401330903445422. PMID 20391276.
39. "Physical Medicine & Rehabilitation Residency Program Director's Manual" (PDF). Association of Academic Physiatrists. Retrieved May 2011. {{cite web}}: Check date values in: |accessdate= (help)
40. "Program Directors FAQ". NBOME. Retrieved 2012-02-22.
41. "2012 Annual Report" (PDF). National Board of Medical Examiners. 2012. Retrieved 20 August 2013.
42. "Board Examinations and Licensure" (PDF). Medical College Information Book, 2012 edition. AACOM. Retrieved 19 November 2012.
43. "COMLEX-USA: Bulletin of Information" (PDF). National Board of Osteopathic Medical Examiners. Retrieved 19 November 2012.
44. "Allopathic and Osteopathic Medical Communities Commit to a Single Graduate Medical Education Accreditation System" (PDF). Accreditation Council for Graduate Medical Education. Retrieved 3 March 2014.
45. "Directory of State Medical and Osteopathic Boards". Federation of State Medical Boards. Retrieved 6 July 2012.
46. "Federation of State Medical Boards". Federation of State Medical Boards. Retrieved 18 November 2012.
47. "The Difference Between U.S.-Trained Osteopathic Physicians and Osteopaths Trained Abroad". American Association of Colleges of Osteopathic Medicine. 2012. Retrieved 17 December 2012.
48. Frequently Asked Questions regarding International Licensure, Council on International Osteopathic Medical Education & Affairs, American Osteopathic Association. Contact information listed.
49. ^ "AOA International Licensure Summary" (PDF). American Osteopathic Association. April 2013.
50. "FAQ and Fact Sheets". AHPRA. Medical Board of Australia.
51. "Norway: Osteopathic Medicine" (PDF). Osteopathic International Alliance.

External links

• One DO's description on "What Is A DO?"
• Doctor of Osteopathic Medicine (D.O.) - National Institutes of Health

v t e Osteopathic medical schools in the United States
Northeast	Lake Erie Pennsylvania Meritus New England New York Institute of Technology Philadelphia Rowan Touro NYC
South	Alabama Arkansas Baptist Campbell Edward Via Incarnate Word Lake Erie Florida Liberty Lincoln Memorial North Texas Nova Southeastern NYIT Jonesboro Oklahoma State Philadelphia Georgia Orlando Pikeville Sam Houston State West Virginia William Carey
Midwest	A.T. Still Kirksville Des Moines Kansas City Marian Michigan State Midwestern Chicago Ohio
West	A.T. Still Arizona Burrell California Health Sciences Idaho Midwestern Arizona Noorda Pacific Northwest Rocky Vista Touro California Touro Nevada WesternU California WesternU Oregon

• Osteopathic physicians
• Osteopathic medicine
• Doctoral degrees
• Medical degrees
• Academic degrees in healthcare