Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine (D.O. or DO) is a professional doctoral degree for physicians offered by medical schools in the United States. Holders of the D.O. degree are known as osteopathic physicians and have the same rights, privileges, and responsibilities as physicians with a Doctor of Medicine degree (M.D.). Both D.O.'s and M.D.'s are medical doctors and attend 4 years of medical school and now have a merged graduate medical training route acquired through an agreement between the ACGME and AOA. They are trained equally: as neurosurgeons to radiation oncologists to family practice and the entirety of medical specialties. D.O.'s as medical doctors hold the same knowledge as M.D.'s but also have been trained extensively (200+ hours) in manipulation medicine (musculoskeletal to be exact, not massage or chiropractic, and not bone doctors, as the osteo might imply), and is just another tool to add if conventional medicine isn't working or warranted. Many students apply to both D.O. and M.D. medical schools and get into both and simply pick based on where they feel they get the best training. The titles today are simply semantics. Whether you see a D.O. or an M.D., you are getting the same standard of care plus the added benefit of musculoskeletal treatment if needed. D.O. physicians are licensed to practice the full scope of medicine and surgery in all 50 states, and make up 7 percent of the total U.S. physician population. There are over 77,784 D.O. physicians in the United States, of which 69,429 are in active practice.
Currently, there are 29 medical schools with 37 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. One notable difference in the education at D.O.-granting medical schools is the inclusion of 300 – 500 additional hours in the study of hands-on manual medicine and the body's musculoskeletal system. This training, referred to as osteopathic manipulative medicine, is absent in the M.D. curricula.
Upon graduation from medical school, osteopathic physicians enter internship or residency training programs, which may be followed by fellowship training. Many D.O. physicians 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. However, as of June 2015, all post-graduate training for both D.O. and M.D. physicians will be accredited by the ACGME.
In the United States, there are over 77,784 osteopathic physicians; of which 69,429 are in active practice.
Education and Training
Osteopathic medical school curricula are virtually identical to those at schools granting the Doctor of Medicine 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 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. Because of the equivalency in training but the added OMT education, D.O. medical students are in school more hours of the day. Other than that there is no difference.
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.
Student Aptitude Indicators
Some authors note the differences in the average GPA and MCAT scores 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 26.51 and 3.50 for D.O. matriculants, although the gap has been getting smaller every year. Up to one third of students matriculating at a D.O. medical school were not accepted by M.D. programs; however, 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) that is sponsored by the National Board of Osteopathic Medical Examiners (NBOME). This exam is a prerequisite for osteopathic residency programs, which are available in almost every specialty of medicine and surgery. D.O. medical students may also choose to sit for the United States Medical Licensing Examination (USMLE) if they wish to take an M.D. residency; however, if they have taken COMLEX, it may or may not be needed, depending on the individual institution’s program requirements. First-time USMLE pass rates for D.O. and M.D. students in 2011 are as follows: Step 1: 89% and 94%, Step 2 CK: 93% and 97%, and Step 2 CS: 93% and 97% respectively; Step 3: 94% and 100%--but this number may be misleading, as 18 D.O. students compared to 18,314 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 COMLEX (Comprehensive Osteopathic Medical Licensing Exam), which is the exam given by the licensing board at the conclusion of their medical training. Students are given the option of taking the USMLE (United States Medical Licensing Exam) 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. 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).
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.
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
|Country||Year of Latest Policy||Medical Practice Rights||Requirements for Licensure|
|Argentina||2006||Unlimited||Foreign physicians must submit credentials to various agencies and then appear before any of the National Universities in order to have their diploma recognized.|
|Australia||2013||Unlimited||According to documents published online, the Medical Board of Australia has “agreed to accept the DO USA as a primary medical qualification for the purposes of medical registration provided that the DO USA was awarded by a medical school which has been accredited by the Commission on Osteopathic College Accreditation.”"|
|Austria||2009||Unlimited||Hospital must have position unable to be filled by Austrian physician.|
|Bahamas||2004||Unlimited||U.S. license recognized.|
|Bahrain||2010||Unlimited||U.S. license recognized.|
|Bermuda||1997||Unlimited||Required at least 2 years of GME and examination or interview by the Council’s Examination Committee. Non-Bermudans must have approval from the Ministry of Labour & Home Affairs to work on the island.|
|Brazil||2007||Unlimited||Completion of Brazilian board exam, establishing residency & some training in Brazilian hospital is required.|
|Canada||Alberta||Unlimited||Requires at least 2 years of GME accredited by the ACGME or AOA and must have passed the Universities Coordinating Council Exam, a basic sciences exam, and have passed all three parts of the LMCC.|
|British Columbia||Unlimited||Requires at least 1 year of GME approved by the AOA or the ACGME, completed at least 1 year of GME in Canada, passed all three parts of the LMCC.|
|Manitoba||Unlimited||U.S. license recognized.|
|New Brunswick||Unlimited||Requires at least 2 years of GME approved by the AOA or the ACGME and have passed all 3 parts of the LMCC. Reciprocity pathway for D.O. physicians with a Maine license.|
|Newfoundland||Unlimited||The Medical Act 2011 allows full licensure of osteopathic physicians, both for the country’s full registry & its educational registry.|
|NW Territories||Unlimited||U.S. license recognized.|
|Nova Scotia||Unlimited||Requires a Canadian or ACGME residency.|
|Ontario||Unlimited||Requires a Canadian or ACGME residency.|
|Prince Edward Island||Unlimited|
|Quebec||Unlimited||Requires 1 year of GME approved by the AOA or ACGME, 1 year of GME in Quebec passed the written, oral and clinical board examination of the College of Family Physicians of Canada and must speak French fluently.|
|Yukon Territory||Unlimited||U.S. license recognized.|
|Cayman Islands (UK)||1983||Unlimited||U.S. license recognized.|
|Central African Republic||1990||Unlimited||U.S. licensure and annual attendance at the National Congress for Physicians.|
|Chile||1993||Unlimited||A written exam in Spanish is required, besides a series of practical tests involving common procedures (CPR, intubation, lumbar puncture, etc.).|
|China||2009||Unlimited||U.S.-D.O. physicians are permitted to apply for "Short Term Medical Practice."|
|Colombia||1996||Unlimited||Same requirements as other foreign physicians.|
|Costa Rica||1993||Unlimited||Same requirements as other foreign physicians.|
|Dominican Republic||2000||Unlimited||U.S. license & board certification recognized.|
|Ecuador||1990||Unlimited||Same requirements as other foreign physicians. Reciprocity exists with most Latin American countries.|
|Finland||1996||Unlimited||Same requirements as other foreign physicians.|
|France||2009||Limited||OMM only. French government does not recognize full scope of practice osteopathic medicine.|
|Germany||2008||Unlimited||Same requirements as other foreign physicians. Depends on need. Decisions made on individual basis.|
|Greece||2009||Unlimited||Greek citizenship required, unless in rare instances, there exists a crucial need for certain types of specialist physicians. Further, a work permit must be obtained, a difficult task, and speaking Greek is an unwritten requirement. These are the same requirements as other foreign physicians.|
|Grenada||2007||Unlimited||U.S. license recognized.|
|Guyana||1996||Unlimited||Case-by case basis.|
|Honduras||2009||Unlimited||National Autonomous University must accredit all foreign titles. After accreditation is completed, the applicant must seek registration with the Medical College of Honduras (MCH).|
|Hong Kong||1998||Unlimited||Written examination. Personal interview. Training approval.|
|Indonesia||1992||Unlimited & Restricted||Foreign physicians affiliated with a university project or a mission have unlimited practice rights. No private practice allowed.|
|Israel||2007||Unlimited||Same requirements as other foreign physicians. Hebrew required.|
|Italy||2009||Unlimited||Physicians are discouraged from seeking employment in Italy without firm contracts and work permits. If there is a U.S. state law outlining reciprocity with Italy, a statement to this effect from the Italian Consulate will warrant better chances.|
|Jamaica||1994||Limited & Restricted||D.O. physicians were permitted to supply some services while participating in a specific mission project.|
|Lebanon||2004||Unlimited||AOA letter required. Examination required.|
|Lesotho||1990s||Unlimited||Applicants must appear before the Medical, Dental and Pharmacy Council to answer some medical questions and present their credentials. The Council will also make a recommendation about where the applicant’s skills would be most helpful in the country.|
|Liberia||1990s||Unlimited||Same requirements as other foreign physicians.|
|Luxembourg||1987||Unlimited||The practice of medicine in Luxembourg by a doctor who is not an EU national is very rare.|
|Malta||2010||Unlimited||Accepted on a case by case basis, if training meets the minimum educational requirements for physicians in the EU (Article 24 of Directive 2005/36/EC). Examination required.|
|Mexico||2011||Unlimited & Restricted||Health Secretary Quijano of the Yucatán State of Mexico signed a Proclamation recognizing U.S.-trained osteopathic physicians in that state; D.O. physicians can now obtain short-term & long-term licensure through the Health Secretary’s office. All other Mexican states require work permits - only available in conjunction with the association of a short-term medical mission project.|
|Micronesia||1993||Unlimited||Statutes specifically include DOs|
|Nepal||2008||Unlimited||Approval by the Nepal Medical Council & a visa from the Immigration Department.|
|Netherlands||2009||Unlimited||Same requirements as other foreign physicians.|
|New Zealand||2008||Unlimited||Hearing required. Case-by-case basis.|
|Nigeria||2010||Unlimited||U.S. Licensure and completion of specialty training required.|
|Pakistan||2011||Unlimited||U.S. osteopathic medical schools meet the Medical and Dental Council’s statutory regulations for international medical graduates. Scope is unlimited, but practice setting may be restricted|
|Panama||2009||Unlimited||Panamanian citizenship required.|
|Papua New Guinea||2010||Unlimited||Work permit required. Short-term or a long-term volunteer service license also available.|
|Poland||2009||Unlimited||Examination & Polish required.|
|Russia||2006||Unlimited||Foreign physicians make arrangements to practice through Russian sponsors, such as hospitals or businesses.|
|Saint Lucia||2000||Unlimited||U.S. credentials recognized.|
|Saudi Arabia||2009||Unlimited||Foreign physician must be recruited by a government agency, a corporation or a private health care entity, such as a hospital.|
|Sierra Leone||1993||Unlimited||Notarized U.S. credentials.|
|South Africa||2009||Limited||OMM only|
|Sweden||2005||Unlimited||U.S. license recognized.|
|Taiwan||2008||Unlimited||The ROC government recognizes U.S. D.O. degree. Applicants must take Taiwan Examination Yuan to obtain Taiwanese license.|
|Tanzania||1985||Unlimited||U.S. license & GME recognized. Temporary work permits are available|
|United Arab Emirates||2009||Unlimited||Examination required.|
|United Kingdom||2005||Unlimited||U.S.-trained D.O. physicians are eligible for full medical practice rights. Applicants must pass the PLAB examination and work for one year in the National Health Service. Following that year, the applicants will be able to apply for a license to practice privately. For GMC registration as a specialist, postgraduate training will need to be separately recognized by the Postgraduate Medical Education and Training Board (PMETB). GOsC registration is also required.|
|Venezuela||2007||Unlimited||Recognized legal status under the "law of the practice of medical."|
|Vietnam||1995||Unlimited||Foreign physicians can fill vacancies in hospitals that are in need of certain specialists.|
|Zambia||2009||Unlimited||U.S. licensure required.|
|Table data from AOA International Licensure Summary (updated February 2011).|
|OMM:Osteopathic Manipulative Medicine|
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