Doctor of Osteopathic Medicine

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 (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 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 (M.D.) 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", 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 2015, there were 96,954 osteopathic medical doctors in the United States and 123,075 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 D.O. physicians were female, compared with 40 percent in 2015. 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." 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 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."

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). Historically, osteopaths subscribed to the view that such body manipulation can bring about systemic healing – a belief which is a form of pseudomedicine – but today American osteopathic physicians have largely evolved away from such pre-scientific ideas. Osteopathic physicians who use OMM predominantly use it to treat musculoskeletal conditions, for which there is conflicting evidence. Particular criticism has been targeted at craniosacral therapy, a component of OMM taught at many D.O. schools that has limited scientific support.

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 2015, the average MCAT and GPA for students entering U.S.-based M.D. programs were 31.4 and 3.70, respectively, and 27.33 and 3.55 for D.O. matriculants, although the gap has been getting smaller every year. D.O. 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 four 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 second step exam consists of a written portion and a physical exam evaluation. The physical exam evaluation (COMLEX- PE), is only available in select regions in the country and graded as a PASS/FAIL exam. 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. licensure 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, osteopathic 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 D.O candidates 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: