President's Message, Career Planning

Osteopathic Medicine: What Exactly Is a DO?

MDs and DOs work side by side in the same residency programs and emergency departments all across the nation every day, providing quality care and strong teamwork.

A Brief History of Osteopathic Medicine
Osteopathic medicine was founded on the principle that all body systems are connected and interdependent on one another for good health. The philosophy was conceptualized and coined in 1874 by Dr. Andrew Taylor Still, MD. A Virginia-born man, Dr. Still studied medicine and completed an apprenticeship under his father Dr. Abraham Still.  He then moved to Missouri where he obtained his medical license in 1854. He completed additional coursework at the College of Physicians and Surgeons in Kansas City, MO. Dr. Still was a servant of the people, first as a member of the Kansas Legislature in 1857 and then as a surgeon within the 21st Kansas Militia of the Union Army during the Civil War, achieving the rank of Major.

After losing his three children to meningitis in 1864, Dr. Still pursued methods of treating disease outside of the realm of traditional medicine of the time. His research led him to believe all aspects of the human body are interconnected and the body itself has an inherent ability to heal. He developed a series of manual techniques which would come to be known as osteopathic manipulative medicine (OMM) that allowed him to both diagnose illness as well as restore the body back to a more relaxed state which serves to improve the body’s ability to heal itself. He opened the first school of osteopathic medicine (now known as A.T. Still University) in Kirksville, MO, in 1892 incorporating all aspects of modern medicine taught in allopathic medical schools while also integrating a more holistic philosophy of treating mind, body, and spirit rather than disease alone.1 

Health care in 19th century United States (U.S.) was fragmented by several competing approaches including naturopathy, chiropractic, osteopathy, and many others. The Flexner Report of 1910 helped define modern scientific medicine, and while osteopathy was often included in the realm of “nonconformist” approaches in medicine, osteopathic medicine, which included the current practice of medicine, surgery and obstetrics with its traditional principles, survived into the modern era of medicine.2 

A Brief History of Osteopathic EM
The American College of Osteopathic Emergency Physicians (ACOEP) was founded in 1975 and the American Osteopathic Association (AOA) approved the first osteopathic emergency medicine (EM) residency programs in 1978.3 Leading up to Single Accreditation, there were 62 osteopathic EM residency programs.4 Of the 2,488 EM positions available in the 2019 National Resident Matching Program (NRMP) Match, osteopathic students filled 648 (26%) of those positions.5 There have been two DO Past Presidents of ACEP: Robert E. Suter, DO, MHA, FACEP, and Alexander M. Rosenau, DO, CPE, FACEP.6 Dr. Suter is the current ACOEP President-elect as well.7 There are DOs on the current EMRA Board of Directors and MDs on the current ACOEP - Resident Student Organization (RSO) Board of Directors.8-9 On the surface, there are few differences between osteopathic and allopathic EM physicians. However, there are some important caveats to be aware of. 

Osteopath vs. Osteopathic Physician
Osteopathic medicine grew and perpetuated in the U.S. at the end of the 19th century when many medical therapies were more harmful than beneficial. When osteopathic medicine spread abroad, particularly to Europe, the principles remained the same but the training was very different. Osteopathic physicians in the U.S. earn a Doctor of Osteopathic Medicine (DO) degree, while European osteopaths earn a Diploma of Osteopathy (DO). They both call themselves DOs, though U.S.-trained osteopathic physicians are medical doctors who practice the entire scope of modern medicine, ie, prescribing medications and performing surgery. However, foreign-trained osteopaths are primarily trained to practice osteopathic manipulative techniques and are not medical doctors who prescribe medications and perform surgery.10 Similarly, osteopathy is sometimes used to refer to the limited practice of osteopathic diagnostic and manipulative techniques, whereas osteopathic medicine is the preferred term for the medical care delivered by U.S. osteopathic physicians that combines osteopathic philosophy with the current practice of medicine, surgery and obstetrics.11 Therefore, calling an osteopathic physician an osteopath discredits the years of medical school and residency that person has completed. 

The Differences Between DO and MD Physicians

Medical School
There are 35 accredited colleges of osteopathic medicine with more than 30,000 students.12-13 U.S. osteopathic students complete very similar curriculums to our allopathic counterparts. The biggest difference is the addition of Osteopathic Manipulative Medicine (OMM). OMM is a manual form of medicine which includes somatic, orthopedic, and visceral treatments to help reset the body to a neutral state in support of the body’s inherent ability to heal itself.11 

Board Exams
For medical students, osteopathic trainees are required to take the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX) board exams – our counterpart to the United States Medical Licensing Examination (USMLE) board exams. COMLEX has a different question style and often incorporates OMM physical findings into the question stems. Overall, the COMLEX and USMLE exams cover the same material just in slightly different ways. Osteopathic students can choose to take the USMLE in addition to the COMLEX and often many students do.

Pre-Single Accreditation Residency Training
Osteopathic EM residency programs were accredited by the AOA and participated in a separate match process from the Accreditation Council for Graduate Medical Education (ACGME) programs. These osteopathic EM programs were 4 years long to incorporate a traditional rotating internship and adequate OMM training at the residency level. Students could choose to apply through either the AOA or ACGME match. Those who applied to both, did so knowing the AOA match would be approximately one month prior to the ACGME match. If an osteopathic student chose to apply to both matches, and matched to an AOA residency, they would have to withdraw their application in the ACGME match.

Post-Single Accreditation Residency Training
However, with the completion of Single Accreditation set for 2020, much is changing. For osteopathic students, the merger means they only have to submit one application to apply to all of our potential residency programs. For osteopathic EM residents, major changes include the research paper is no longer required, the traditional rotating internship is no longer required except in a few states where they may need to apply for exemption through Resolution 42, and all emergency medicine residency graduates will be eligible to pursue board certification through the American Board of Emergency Medicine (ABEM). By 2020, all residency programs are expected to be solely accredited by the ACGME. Programs have the option to apply for Osteopathic Recognition which includes OMM training in the curriculum.14

Conclusion
Despite the nomenclature, MDs and DOs are both physicians. They work side by side in the same residency programs and emergency departments all across the nation every day. While there are some differences between the training philosophies and content, there are more similarities than differences. 


References
1. A Brief History of Osteopathic Medicine. Accessed May 30, 2019.
2. Stahnisch FW, Verhoef M. The Flexner Report of 1910 and Its Impact on Complementary and Alternative Medicine and Psychiatry in North America in the 20th Century. Evid Based Complement Alternat Med. 2012;2012:647896.
3. Pollard JA, Leveque EA, Lewin MR. Osteopathic physicians in emergency medicine. Ann Emerg Med. 2003;42(2):261-5.
4. Stobart-Gallagher M, Smith L, Giordano J, et al. Recommendations from the Council of Emergency Medicine Residency Directors: Osteopathic Applicants. West J Emerg Med. 2019;20(1):111-116.
5. National Resident Matching Program, Results and Data: 2019 Main Residency Match®. National Resident Matching Program, Washington, DC. 2019.
6. ACEP Past Presidents. Accessed May 30, 2019.
7. ACOEP Board of Directors. Accessed May 30, 2019.
8. EMRA Board of Directors. Accessed May 30, 2019.
9. RSO Board of Directors. Accessed May 30, 2019.
10. The Difference Between U.S.-Trained Osteopathic Physicians and Osteopaths Trained Abroad. Accessed May 30, 2019.
11. Glossary of Osteopathic Terminology. Revised November 2011. Accessed May 30, 2019.
12. 2019-2020 Student Guide to Osteopathic Medical Colleges. Accessed May 30, 2019.
13. Preliminary Enrollment Report Fall 2018. Accessed May 30, 2019.
14. Osteopathic Recognition. Accessed May 30, 2019.

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