Doctor of Osteopathic Medicine

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Osteopathic medicine in the United States
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Doctor of Osteopathic Medicine (D.O. or DO) is a professional doctoral degree for physicians in the United States. Holders of the DO degree are known as osteopathic physicians and have the same rights, privileges and responsibilities as MDs.

DOs are licensed to practice the full scope of medicine and surgery in all 50 states, equivalent to their MD counterparts. Depending on state, licensure may be issued from a combined board (DO & MD) or a separate board of medical examiners;[1] regardless, all of the 70 state boards are members of the Federation of State Medical Boards.[2]

Currently, there are 26 medical schools in 34 locations across the US that offer the DO degree,[3] compared with 134 medical schools that offer the MD degree.[4] Osteopathic physicians comprise 7% of the total US physician population; there are over 70,480 DOs in the country, of which 63,121 are in active practice.[5]


[edit] Education and training

Osteopathic medical school curricula closely mirrors those of allopathic (MD) medical schools. The first two years focus on the biomedical and clinical sciences, followed by 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.[6] According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification."[7] However, osteopathic physicians also receive an additional 300 – 500 hours in the study of hands-on manual medicine and the body's musculoskeletal system integrated into the medical curriculum.[8]

Upon graduation from medical school, many DOs attend the same internship and residency training programs as their MD counterparts[9] and then take MD specialty board exams.[10] In addition, the osteopathic medical profession has its own specialty training programs[11][12] and specialty board examinations[13] for DO graduates.

[edit] Licensing and board certification

To obtain a license to practice medicine in the United States, medical students must pass one of two licensing boards at the conclusion of their medical training: USMLE (United States Medical Licensing Exam) or COMLEX (Comprehensive Osteopathic Medical Licensing Exam).[14] Those that have received or in the process of earning a MD or DO are both eligible to sit for the USMLE. Because of their additional training, only holders of the DO are eligible to sit for the COMLEX.[15]

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 DO may elect to be board certified by either an allopathic 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).

[edit] Osteopathic Manipulative Medicine (OMM)

Osteopathy is based on the belief that most diseases are related to problems in the musculoskeletal system and that structure and function of the body are inseparable.

The musculoskeletal system comprises the muscles, bones, and soft-tissues like cartilage, tendons, and ligaments. All of these structures are interconnected and form the body's framework. Nerves originating in the spinal cord create an important network throughout the body and are highly connected to the musculoskeletal framework.

Doctors of osteopathy (D.O.s) receive the same basic training as medical doctors (M.D.s). D.O.s also learn manipulation therapies (hands-on adjustments of muscles, bones, and ligaments), using these in addition to more conventional medical treatments. Most D.O.s are primary care practitioners, specializing in family medicine, internal medicine, obstetrics/gynecology, or pediatrics. A few can be found in other medical specialties as well. D.O.s have full practice rights in all 50 states.

Although osteopathic manipulations were originally intended and used to treat all forms of disease, now they are mainly considered useful for musculoskeletal conditions.

How does osteopathy work?

Long nerves connect the spine to various organs in the body. According to Andrew Taylor Still, the founder of osteopathy, when problems arise in the spine the nerves send abnormal signals to the body's organs. Still called these spinal problems "osteopathic lesions" ("osteo" for bone and "pathic" for diseased), and devised osteopathic manipulation techniques (OMTs) to treat them. Such lesions are detected by the osteopathic doctor from abnormal texture of the skin and other soft tissues of the body as well as from restricted range of motion in the joints.

OMTs range from light pressure on the soft tissues to high-velocity thrusts on the joints. These treatments, he believed, would return the nerves to their normal function and allow the blood to flow freely throughout the circulatory system. Mr. Still theorized that with structure restored, the body's own natural healing powers are then able to restore the entire body to full health.

What happens during a visit to the osteopath?

A visit to a D.O. is much like a visit to your family doctor. The D.O. will ask you questions about your medical history, physical condition, and lifestyle. However, because D.O.s have particular expertise in musculoskeletal systems (namely, bones, joints, and soft tissues like ligaments and tendons), the physical exam of that bodily system will likely be more extensive.

During the physical, the D.O. will assess your posture, spine, and balance; check your joints, muscles, tendons, and ligaments; and may use their hands to manipulate your back, legs, or arms. Variations in your skin temperature and sweat gland activity will also be measured. If needed, the D.O. will order x-rays and laboratory tests.

When the results are in, the D.O. will make a diagnosis and establish a treatment plan for you that may even include prescriptions for medications.

For problems involving the bones, muscles, tendons, tissues, or spine, many (but not all) D.O.s use OMTs. There are two categories of OMT procedures: direct and indirect. In direct OMT, "problem" or "tight" tissues are moved (by the D.O., the person being treated, or both) toward the areas of tightness or restricted movement. In indirect OMT, the D.O. pushes the "tight" tissues away from the area of restricted movement, in the opposite direction of the muscle's resistance. The D.O. holds the tissues in this position until the tight muscle relaxes.

What illnesses and conditions respond well to osteopathy?

OMTs can be applied to a variety of health problems, both musculoskeletal and non-musculoskeletal. According to the US Department of Health and Human Services, OMTs are most effective for back and neck pain. In fact, if you have back pain, you may be able to reduce the amount of pain medication you are taking if you receive OMT as part of your therapy.

Examples of other conditions for which OMT may be helpful include:

   Stress-related problems (such as tension headaches, muscle spasm)
   Strains and sprains (especially of the neck and back)
   Shoulder pain
   High blood pressure
   Injuries (such as whiplash or carpal tunnel syndrome)
   Sinus congestion

Who should not be treated with osteopathy?

You should avoid osteopathic manipulation if you have a broken bone or dislocation, bone cancer, a bone or joint infection, damaged ligaments, rheumatoid arthritis of the neck, or osteoporosis. Osteopathic manipulation is also not recommended for people who recently underwent joint surgery or for people taking an anticoagulant (blood thinning) medication.

Are there risks associated with osteopathy?

Shortly after an OMT treatment you might feel an increase in pain, slight headache, or fatigue. These symptoms are temporary, and generally disappear within a day. More serious adverse events of stroke and spinal injury have been reported following manipulation of the neck; this complication is extremely rare.

(Ref- Penn Medicine

[edit] International variations

Osteopathic medicine
in the United States

Andrew Taylor Still (founder)

Doctor of Osteopathic Medicine (DO)

Medicine · US Medical education

Asclepius staff.svg

Schools · Physicians

Osteopathic Manipulative Medicine


MD & DO Comparison

Specialty Colleges · AOA BOS

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There are currently no osteopathic programs located outside of the United States that 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.

[edit] International practice rights

Every country has different requirements and a different way of licensing or registering osteopathic physicians and osteopaths. Osteopaths who have trained outside the United States are not eligible for medical licensure in the United States, however, U.S.-trained DOs are currently able to practice in over 50 countries with full medical rights and in several others with limited rights.[16]

The following is an International Licensure Summary for US-trained Doctors of Osteopathic Medicine, as listed by the American Osteopathic Association:[17][18]

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 2009 Varies by state A US educated DO was recruited to head up an ER in Sydney. Through the hospital’s efforts and the endorsement of the Australian College of Emergency Medicine, he secured an unlimited medical license through the New South Wales Medical Board.
Austria 2009 Unlimited Hospital must have position unable to be filled by Austrian physician.
Bahamas 2004 Unlimited US license recognized.
Bahrain 2010 Unlimited US 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 (varies by province) 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 US 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 DOs with a Maine license.
Newfoundland Pending Currently under review.
NW Territories Unlimited US license recognized.
Nova Scotia Unlimited Requires a Canadian or ACGME residency.
Ontario Unlimited Requires a Canadian or ACGME residency.
Prince Edward Island Restricted No provision for licensing US-trained DOs.
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 Limited OMM only.
Yukon Territory Unlimited US license recognized.
Cayman Islands (UK) 1983 Unlimited US license recognized.
Central African Republic 1990 Unlimited US licensure and annual attendance at the National Congress for Physicians.
Chile 1993 Unlimited A written exam, in Spanish, is required.
China 2009 Unlimited US-DOs are permitted to apply for "Short Term Medical Practice."
Columbia 1996 Unlimited Same requirements as other foreign physicians.
Costa Rica 1993 Unlimited Same requirements as other foreign physicians.
Dominican Republic 2000 Unlimited US 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 US 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 DOs 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 US-trained osteopathic physicians in that state; DOs 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 US Licensure and completion of specialty training required.
Norway 2009 Limited OMM only.
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 US 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 US credentials.
South Africa 2009 Limited OMM only
Sweden 2005 Unlimited US license recognized.
Taiwan 2008 Unlimited The ROC government recognizes US DO degree. Applicants must take Taiwan Examination Yuan to obtain Taiwanese license.
United Kingdom 2005 Unlimited. US-trained DOs 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.
Tanzania 1985 Unlimited US license & GME recognized. Temporary work permits are available
Uganda 2008 Unlimited
United Arab Emirates 2009 Unlimited Examination required.
United Kingdom 2005 Unlimited 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 US licensure required.
Zimbabwe 2009 Limited OMM only.
Table data from AOA International Licensure Summary (updated February 2011).[18]
OMM:Osteopathic Manipulative Medicine

[edit] See also

[edit] References

  1. ^ Directory of State Medical and Osteopathic Boards, Federation of State Medical Boards
  2. ^ Federation of State Medical Boards
  3. ^ 2012 Osteopathic Medical College Information Book, American Association of Colleges of Osteopathic Medicine, 2011
  4. ^ Directory of Accredited Medical Education Programs, Liason Committee on Medical Education
  5. ^ Osteopathic Medical Profession Report 2010 - page 2&3, American Osteopathic Association
  6. ^ Overview of Osteopathic Medical Education/Accreditation/The Four-Year Curriculum, 2012 Osteopathic Medical College Information Book (CIB), American Association of Colleges of Osteopathic Medicine
  7. ^ Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. Chapter 10. Complementary and Alternative Medicine Harrison's Principles of Internal Medicine, 16th Ed. 2005. McGraw Hill.
  8. ^ Doctor of Osteopathy (D.O.), MedLine Plus, National Library of Medicine, National Institutes of Health
  9. ^ ACGME Data Resource Book, Academic Year 2009-2010, Accreditation Council on Graduate Medical Education (2010), page 6, 58-61.
  10. ^ Roadmap to Residency: From Application to the Match and Beyond, Association of American Medical Colleges, (2007), pages 1-18.
  11. ^ AOA Approved Internship & Residency Programs
  12. ^ Opportunities, Directory of Osteopathic Postdoctoral Education Programs, Supplemental OPTI Affiliation List,’’ Updated: October 2010.
  13. ^ AOA Specialty Certifying Boards
  14. ^ Board Examinations and Licensure, 2012 Osteopathic Medical College Information Book (CIB), American Association of Colleges of Osteopathic Medicine, page 11.
  15. ^ COMLEX-USA Bulletin of Information 2010-2011, National Osteopathic Board of Medical Examiners, Updated January 14, 2011.
  16. ^ International Practice Rights Map
  17. ^ Frequently Asked Questions regarding International Licensure, Council on International Osteopathic Medical Education & Affairs, American Osteopathic Association. Contact information listed.
  18. ^ a b AOA International License Summary, Council on International Osteopathic Medical Education & Affairs, American Osteopathic Association (February 2011).

[edit] External links


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