Doctor of Osteopathic Medicine

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Osteopathic medicine
in the United States


Andrew Taylor Still (founder)

Doctor of Osteopathic Medicine (DO)

Medicine · US Medical education

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Schools · Physicians

Osteopathic Manipulative Medicine

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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.).[1] 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.[2]

Currently, there are 29 medical schools with 37 locations throughout the United States that offer the D.O. degree,[3] and 141 medical schools that offer the M.D. degree.[4][5] As of 2011, 1 in 5 medical students in the United States were D.O. students.[6][7] The curricula at osteopathic medical schools are very similar to those at M.D.-granting medical schools.[8] Four years in total length,[8] 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,[1] 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.[8] Many D.O. physicians attend the same graduate medical education programs as their M.D. counterparts,[9] and then take M.D. specialty board exams,[10] while other D.O. graduates enter osteopathic programs[11][12] and take D.O. specialty board examinations.[13] However, as of June 2015, all post-graduate training for both D.O. and M.D. physicians will be accredited by the ACGME.[14][15]

Further information: Osteopathic medicine in the United States

Contents

Demographics [edit]

In the United States, there are over 77,784 osteopathic physicians; of which 69,429 are in active practice.[2]

Education and Training [edit]

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 about four years to graduate, and the schooling is roughly 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.[16] 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."[8] 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.[1]

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,[9] and then take M.D. specialty board exams[17] while other D.O. graduates enter osteopathic internships and residencies[11][12] and take D.O. specialty board examinations.[13]

Further information: Osteopathic medicine in the United States

Student Aptitude Indicators [edit]

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,[18] respectively, and 26.51 and 3.50 for D.O. matriculants,[19] although the gap has been getting smaller every year.[19] Up to one third of students matriculating at a D.O. medical school were not accepted by M.D. programs;[20] however, DO medical schools are more likely to accept non-traditional students[21][22] 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)[23] 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.[24][25][26][27] 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.[28]

Further information: Comparison of MD and DO in the United States

Licensing and board certification [edit]

To obtain a license to practice medicine in the United States, medical students must pass the COMLEX (Comprehensive Osteopathic Medical Licensing Exam),[29] 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.[30]

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.[31] All of the 70 state medical boards are members of the Federation of State Medical Boards.[32]

International variations [edit]

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.[33] Foreign osteopathic degrees are not recognized by any state in the U.S. as being equivalent to American D.O. degrees.

International practice rights [edit]

The following is an International Licensure Summary for U.S.-trained Doctors of Osteopathic Medicine, as listed by the American Osteopathic Association:[34][35]

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.”"[36]
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.
Barbados 1995 Limited OMM only.
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.
Saskatchewan Unlimited
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.
The Gambia 2011 Unlimited
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.
Kenya 2007 Unlimited
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.
Malawi 1991 Unlimited
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.
Norway 2009 Limited OMM only.
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
Uganda 2008 Unlimited
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.
Zimbabwe 2009 Limited OMM only.
Table data from AOA International Licensure Summary (updated February 2011).[35]
OMM:Osteopathic Manipulative Medicine

See also [edit]

References [edit]

  1. ^ a b c 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. ^ a b "Osteopathic Medical Profession Report 2012". American Osteopathic Association. 
  3. ^ "U.S. Colleges of Osteopathic Medicine". AACOM. Retrieved 5 July 2012. 
  4. ^ Directory of Accredited Medical Education Programs, Liaison Committee on Medical Education
  5. ^ "AAMC Medical Schools". Association of American Medical Colleges. Retrieved 2006-12-13. 
  6. ^ Ricardo Lopez (April 6, 2012). "Booming medical school brings life to downtown Pomona". Los Angeles Times. Retrieved May 15, 2012. 
  7. ^ "What is Osteopathic Medicine". American Association of Colleges of Osteopathic Medicine. Retrieved May 15, 2012. 
  8. ^ a b c d Kasper, Dennis L.; Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and 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. 
  9. ^ a b "Graduate Medical Education Data Resource Book: 2011-12". Accreditation Council for Graduate Medical Education. pp. 5, 6, 59, 60. Retrieved 19 November 2012. 
  10. ^ "Roadmap to Residency: From Application to the Match and Beyond". Association of American Medical Colleges. 2007. Retrieved June 28, 2012. 
  11. ^ a b "AOA Approved Internships and Residencies". American Osteopathic Association. Retrieved 19 November 2012. 
  12. ^ a b "Opportunities, Directory of Osteopathic Postdoctoral Education Programs, Supplemental OPTI Affiliation List". The DO. October 2010. Retrieved June 28, 2012. 
  13. ^ a b "AOA Specialty Certifying Boards". American Osteopathic Association. Retrieved 19 November 2012. 
  14. ^ "M.D.s and D.O.s Moving toward a Single, Unified Accreditation System for Graduate Medical Education". ACGME. Retrieved 3 November 2012. 
  15. ^ "AOA, ACGME Move Toward Unified Accreditation for Graduate Medical Education Programs". AOA. Retrieved 3 November 2012. 
  16. ^ "Overview of Osteopathic Medical Education/Accreditation/The Four-Year Curriculum (2012 Osteopathic Medical College Information Book)". American Association of Colleges of Osteopathic Medicine. 2012. 
  17. ^ "Roadmap to Residency: From Application to the Match and Beyond". Association of American Medical Colleges. 2007. Retrieved June 28, 2012. 
  18. ^ "Table 17: MCAT Scores and GPAs for Applicants and Matriculants to U.S. Medical Schools". Association of American Medical Colleges. 2000-2011. 
  19. ^ a b "AACOMAS Matriculant Profile 2011 Entering Class". American Association of Colleges of Osteopathic Medicine. Retrieved 14 July 2012. 
  20. ^ Cooper RA (2003). "Medical schools and their applicants: an analysis". Health Aff (Millwood) 22 (4): 71–84. PMID 12889752. 
  21. ^ "Osteopathic Medical College Information Book". American Association of Colleges of Osteopathic Medicine. 2012. 
  22. ^ Madison Park (June 13, 2011). "Never too late to be a doctor". CNN News. Retrieved December 17, 2011. 
  23. ^ "United States Medical Licensing Examination | USMLE Bulletin | Eligibility". Usmle.org. Retrieved 2012-02-22. 
  24. ^ Sarko, John; Svoren, Elena; Katz, Eric (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. Retrieved 19 November 2012. 
  25. ^ Chick, Davoren A.; Harley P. Friedman, Vincent B. Young, and David Solomon (22). "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. 
  26. ^ "Physical Medicine & Rehabilitation Residency Program Director’s Manual". Association of Academic Physiatrists. Retrieved May 2011. 
  27. ^ "Program Directors FAQ". NBOME. Retrieved 2012-02-22. 
  28. ^ "2011 Performance Data". United States Medical Licensing Examination. 2012. Retrieved 18 July 2012. 
  29. ^ "Board Examinations and Licensure". Medical College Information Book, 2012 edition. AACOM. Retrieved 19 November 2012. 
  30. ^ "COMLEX-USA: Bulletin of Information". National Board of Osteopathic Medical Examiners. Retrieved 19 November 2012. 
  31. ^ "Directory of State Medical and Osteopathic Boards". Federation of State Medical Boards. Retrieved 6 July 2012. 
  32. ^ "Federation of State Medical Boards". Federation of State Medical Boards. Retrieved 18 November 2012. 
  33. ^ "The Difference Between U.S.-Trained Osteopathic Physicians and Osteopaths Trained Abroad". American Association of Colleges of Osteopathic Medicine. 2012. Retrieved 17 December 2012. 
  34. ^ Frequently Asked Questions regarding International Licensure, Council on International Osteopathic Medical Education & Affairs, American Osteopathic Association. Contact information listed.
  35. ^ a b AOA International License Summary, Council on International Osteopathic Medical Education & Affairs, American Osteopathic Association (February 2011).
  36. ^ "FAQ and Fact Sheets". AHPRA. Medical Board of Australia. 

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