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What is a Doctor of Osteopathic Medicine (D.O.)

The landscape of healthcare delivery has changed so drastically over the past three decades with the proliferation of allied health professions, increased in medical specialization, managed health care, and technology advancement.

The direct doctor-patient relations have been relegated to the relations between healthcare providers and patients, in which doctors are only participants among other healthcare givers. A patient can be easily further confused when visiting medical offices or hospitals as there is no dress code, i.e., any employee can wear any scrubs or white coats. Moreover, allied health professions have upgraded their degrees to doctorate levels such as Doctor of Pharmacy, Doctor of Physical Therapy, Doctor of Audiology, and Doctor of Nursing Practice, which can further confuse patients from distinguishing these doctors with their physicians, whom they normally used to know as doctors.

How to become a practicing physician in the US?


There are two types of complete physicians, M.D.s and D.O.s, who are fully-licensed to prescribe medication and practice in all specialties of medicine and surgery. In 2008, there were about 780,000 practicing physicians in the United States, of which 68% were graduates from a US M.D. school, 25% were graduates from a foreign medical school, and 7% were graduates from a D.O. school. All these graduates must pass the medical licensing board examinations and complete internships and residencies before being licensed to practice medicine.

D.O.s are fully licensed physicians and are recognized as equals to M.D.s at every level of government in all 50 states. There are more similarities than differences between M.D.s and D.O.s. The medical education and training of D.O.s follow the exact rigorous curriculum of M.D.s training. The main difference lies in the osteopathic philosophy of the preventive and holistic approach of these tenets:

• The body is a unit, and the person represents a combination of body, mind and spirit.

• The body is capable of self-regulation, self-healing and health maintenance.

• Structure and function are reciprocally interrelated.

• Rational treatment is based on understanding the body unity, self-regulation and the interrelationship of structure and function.

With the concept that diseases of internal organs can manifest externally as referred pain to different musculoskeletal regions and vice versa, D.O.s are trained at least 200 hours extra in osteopathic manual medicine (OMM), a hands-on technique for diagnosis and treatment. OMM incorporates aspects of traditional manual therapy, soft-tissue massage therapy, and other body-based modalities to relieve pain from strained muscles, tendons, and joints and improve motion and function of blood circulation, lymphatic and respiratory systems.

Another important educational difference in the D.O. schools is the emphasis placed on primary care specialties such as internal medicine, family medicine, pediatrics, and obstetrics/ gynecology during the clinical years. Therefore, approximately 60% D.O.s practice in the primary care specialties in contrast with 35% of M.D.s. Furthermore, osteopathic schools focus on providing care to rural and urban underserved areas by recruiting students from these areas, promoting rural medicine, and even establishing new schools in the underserved areas. While D.O.s constitute 7 percent of all U.S. physicians, they are responsible for 16 percent of patient visits in communities with populations of fewer than 2,500.

Recently, the Annals of Internal Medicine released a new national study that ranks medical schools based on their contributions to meeting the nation's health care needs, "social mission" scale, based on an analysis of graduates who practice primary care, work in medically underserved communities or are themselves minorities. The discussion section of the study praises osteopathic medical schools' achievements in their "social mission." Six osteopathic schools ranked in the top 50 overall. In contrast, some prestigious institutions such as Columbia, Johns Hopkins, Northwestern, Duke, University of Pennsylvania and Stanford all ranked in the bottom twenty.

Growth of osteopathic medicine: An answer to physician shortage

Osteopathic medicine has enjoyed the exponential growth over the past three decades while M.D. schools decided to remain stagnant. In 1980, there were 17,620 practicing D.O.s and 1,059 D.O. graduates. In 2010, there are 63,000 practicing D.O.s and 3,845 D.O. graduates. The number of colleges of osteopathic medicine has increased from 15 to 26 colleges and 5 branch campuses. At least three schools and two branch campuses are being planned. Marian University in Indianapolis, IN, Campbell University at Buies Creek, NC, and Southeast Alabama Medical Center in Dothan are applying for accreditation. Interestingly, because of the continuous growth, one in five medical students in the United States is currently enrolled in an osteopathic medical school. 32% of the D.O. student body is made up by minority groups. By 2020, there will be 100,000 D.O.s practicing in the U.S., more than 6,000 D.O.s will graduate yearly, and one in four medical students will be D.O. students. The looming forecast of physician shortage in 2030 estimated to be from 160-250,000 physicians as the population will grow to 350 million, the number of people over 65 will double, a third of current physician work force will retire, and the new healthcare law providing more coverage to 32 million persons. In 2006, Association of American Medical Colleges called for increased of 30% M.D. student enrollment by 2020, i.e., additional 5,000 students. Despite this expansion, shortage of physicians cannot be prevented. The continuous growth of osteopathic medicine will somewhat alleviate the future physician shortage, and its unique blending characteristic of holistic and conventional medicine makes it a special and leading force responding to the healthcare needs of the nation

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