The Quirks of being a DO

By: Ronke Olowojesiku

You are a premedical student fresh off the MCAT bandwagon. Now at that final stage when all your recommendations in order, your personal statement reviewed and re-reviewed, you click that daunting “Submit Application” button on the AMCAS site and send years of late nights, a couple hundred cups of coffee, dreams, and ambitions to the hands of some of the 141 medical school admission boards across the country. Set to begin your senior year, you notice some new contacts in your email account, such as schools you are not familiar with and a few that you are, encouraging you to look into their programs and consider applying, as well as information about scholarship opportunities through the various entities of the U.S. Armed Forces. You also see various emails from osteopathic schools about applying to their Doctor of Osteopathic Medicine programs, a degree program which, yes, you heard about in passing, but never really looked into. Soon, you continue to hear terms such as allopathic and osteopathic schools and osteopathic manipulative treatment (OMT) from various forums and become overwhelmed with curiosity. These internet searches inspire many questions: What exactly is a Doctor of Osteopathic Medicine? How did this field come about? How is a DO different from an MD?

Well, PreMed, your questions are valid and understanding given that osteopathic medicine is a field that we are often not exposed to prior to the medical school application process. These same questions perplexed me upon first receiving emails from DO schools, and as it is good to know all of the various options available in the medical field, I sought to explore them further.

What is a Doctor of Osteopathic Medicine?

A Doctor of Osteopathic Medicine (DO) is a doctoral degree conferred onto physicians and surgeons in the United States that emphasizes the use of osteopathic medicine. Osteopathic medicine ventures to treat disease in the body through the handling of the body’s musculoskeletal framework to improve its condition. This is known as osteopathic manipulative medicine or osteopathic manipulative treatment (OMM; OMT). The philosophy behind such a practice is that the structure of the body and its function are interconnected. The word osteopathy comes from two Greek roots, osteon meaning bone and pathos meaning suffering, thus conveying the idea of the bone or body structure as being the source of disease.

How did this field come about?

In 1865, frontier physician Andrew Taylor Still returned to an empty home after serving as a hospital steward in the Civil War, having lost his wife and children in a short span to disease. At the time, the medical practices that traditionally reigned often caused more harm than good, practices such as purging, bleeding, and using substances such as castor oil, arsenic, and opium as medication. Still, struck by the deficiencies of current-day techniques and gripped by the images of deaths he felt inadequately equipped to prevent, soon abandoned the medical methods of the day and developed osteopathic medicine.  Still was also one of the first physicians to emphasize preventive care and to argue for the treatment of the disease source and not just its symptoms. American School of Osteopathy, the first school of osteopathic medicine, was founded by Still in 1892 in Kirksville, Missouri and is known today as the A.T. Still University of Health Sciences. Recognition of the field over the years has been a work in progress. In 1966, DOs were allowed to serve as physicians and surgeons in the U.S. Armed Forces and in 1969 the American Medical Association began to allow qualified osteopaths to join the Association. In 1996, Dr. Ronald Blanck, became the first DO to serve as the Surgeon General of the United States Army.

MD vs. DO? Is there a difference?

With regards to the application process, training, licensing, and actual practice of allopathic versus osteopathic medicine, the differences between the two fields are becoming smaller and smaller as the years progress.

Both degrees require an MCAT score as part of the admissions process. The application systems are different; the majority of allopathic schools utilize AMCAS (American Medical College Application Service), and the 30 U.S. osteopathic schools utilize AACOMAS (American Association of Colleges of Osteopathic Medicine Application Service), but the process is essentially the same. There has been an observed slight difference in undergraduate GPAs and MCAT scores of students entering into allopathic schools and students entering into osteopathic schools, with 3.67 and 31.1 observed for allopathic matriculants, and 3.51 and 27.1 for osteopathic matriculants, as reported in 2011. These differences have been decreasing with each applicant pool.

The degree programs for both a MD and DO last four years and consist of two years of biomedical instruction followed by two years of clinical instruction. MDs become licensed through the United States Medical Licensing Examination (USMLE), whereas DOs become licensed through Comprehensive Osteopathic Medical Licensure Examination (COMLEX). Upon the completion of their degrees, MDs will enter allopathic residency training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), and DOs have the option of entering accredited  residency training in osteopathic programs or allopathic programs as they have the option of sitting for both the COMLEX and USMLE. In July 2015, however, all graduate training of physicians will be accredited by ACGME.

The major difference between a MD and DO is the practice of OMT. The training of a DO includes about 300-500 hours of instruction in OMT. OMT has long been criticized as pseudoscientific and research has mainly shown OMT to be ineffective in treating little beyond lower back pain.

However, just as not all MDs are the same, not all DOs are the same either. Some DOs utilize OMT heavily and others do not. What has been the driving appeal behind DO programs are their holistic approach, a growing trend in the medical field overall. The past couple of years show the MD and the DO converging, with MD programs becoming more and more holistic and some DOs receiving both osteopathic and allopathic training. As the differences between MDs and DOs continues to decrease, when all is said and done, perhaps the so-called quacks DOs are at times perceived to be may prove to be no more quirkier than your average doc.