Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine is a professional doctoral degree for physicians and surgeons offered by medical schools in the United States. A DO graduate may become licensed as an osteopathic physician, having equivalent rights, privileges, and responsibilities as a physician who has earned the Doctor of Medicine degree. Osteopathic physicians, or DOs, currently have unlimited practice rights in roughly 74 countries, with partial practice rights in many more; DOs have full practice rights in all 50 US states. They constitute 11% of all US physicians. As of 2018, there were more than 145,000 osteopathic physicians and osteopathic medical students in the United States.
DO degrees are offered in the United States at 36 medical schools, at 57 locations compared to MD degrees offered at 171 schools. Since 2007, total DO student enrollment has been increasing yearly. As of 2015, more than 20% of all medical school enrollment were DO students. The curricula at osteopathic medical schools are similar to those at MD-granting medical schools, which focus the first two years on the biomedical and clinical sciences, then two years on core clinical training in the clinical specialties.
Upon completing medical school, a DO graduate may enter an internship or residency training program, which may be followed by fellowship training. DO graduates attend the same graduate medical education programs as their MD counterparts.
One notable difference between DO and MD training is that DOs in training spend 300–500 hours studying 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, who named his new discipline 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 in Kirksville, Missouri, for the teaching of osteopathy on May 10, 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 US-trained osteopathic physicians, who conduct a full scope of medical practice. The regulation of non-physician manual medicine osteopaths varies greatly between jurisdictions. In the United States, osteopathic physicians holding the DO degree have the same rights, privileges, and responsibilities as physicians with a Doctor of Medicine degree. Osteopathic physicians and non-physician osteopaths 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". Since the late 20th century, the AOA has preferred that this title be used exclusively. Its members resolved at a 1960 conference:
A minority of DOs continue to use the old terms, and the American Academy of Osteopathy retains the old usage in its name.
Demographics
In 2018, there were 114,425 osteopathic medical doctors in the United States and 145,343 total DOs and osteopathic medical students. The proportion of females in the profession has steadily increased since the 1980s. In 1985, about 10 percent of DO physicians were female, compared with 41 percent in 2018. Between 2008 and 2012, 49 percent of new DO 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". The five-year change in osteopathic medical student enrollment by ethnicity has increased by 19 percent for white/non-Hispanic students, 36 percent for Asian-American students, 24 percent for Black/African American students and 60 percent for Hispanic/Latino students.
Education, training and distinctiveness
Osteopathic medical school curricula are virtually identical to those at schools granting the MD degree. Once admitted to an osteopathic medical school, students study for four years in order to graduate. 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 medicine, 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 MD qualifications, with 4 years of osteopathic medical school followed by specialty and subspecialty training and board certification".
DO 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. Osteopathic physicians use OMM predominantly to treat musculoskeletal conditions.
Examinations
Before entering osteopathic medical school, an applicant must complete a four-year undergraduate degree and take a national standardized exam called the Medical College Admissions Test. Some combined undergraduate/medical programs exist. Some authors note the differences in the average MCAT scores and grade point average of students who matriculate at DO schools compared to those who matriculate at MD schools within the United States. In 2019, the average MCAT and GPA for students entering US-based MD programs were 506 and 3.6, respectively, and 503 and 3.5 for DO matriculants, and 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.DO 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 four osteopathic medical licensing examinations. The first three exams of the COMLEX-USA are taken during medical school and are prerequisites for residency programs. Level 2 consists of a multiple-choice portion and a patient evaluation exam. COMLEX-Level 2PE, is available only in Chicago, IL and Philadelphia, PA. It is graded as a Pass/Fail exam. Finally, COMLEX Level 3 is taken during the first year of residency.
In addition to the COMLEX-USA, DO medical students may choose to sit for the MD licensure examinations, which are called the United States Medical Licensing Examination. This is typically done under specific circumstances, such as when the student desires to enter a residency that may have a historic preference for the USMLE, or if a higher USMLE score would help elevate the student’s application to be more competitive. USMLE pass rates for DO and MD 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, osteopathic 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 certain residency programs who may want USMLE scores in addition to COMLEX scores. Those that have received or are in the process of earning an MD or DO degree are both eligible to sit for the USMLE. Because of their additional training, only DO candidates are eligible to sit for the COMLEX.Upon completion of internship and residency requirements for their chosen medical specialty, holders of the DO may elect to be board certified by either a specialty board or an osteopathic specialty board or both. 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.