What is osteopathic medicine and how do you become a DO?
Despite osteopathic medicine’s sometimes rocky reputation since its inception 130 years ago, osteopathic physicians (also called doctors of osteopathic medicine) are some of the most prestigious doctors in the world. In fact, the physicians of both President Biden and former President Trump are osteopathic doctors.
Furthermore, the accrediting body for osteopathic medical schools was accredited in August of 2021 by the World Federation of Medical Education, now allowing doctors of osteopathic medicine (DOs) to practice worldwide on the same level as medical doctors (MDs).
Thus it may be a great time to become an osteopath—but is that the right term?
A note from our experts on the word ‘osteopath’: Osteopathic physician (a.k.a. Doctor of Osteopathic Medicine or DO) is the correct term. The term osteopath could refer to anyone who practices osteopathy without actually having a medical degree.
For example, some naturopathic and other alternative medicine practitioners outside the US practice osteopathic manipulative treatment (OMT) and call themselves osteopaths, but that does not mean they are licensed doctors.
Steps to become an osteopathic doctor
“When people ask me, ‘What is a DO?’ my answer is that we are the original holistic integrated physicians that also use our hands,” said Dr. K. Scott Whitlow, Senior Associate Dean at Touro University California College of Osteopathic Medicine. Students at osteopathic medical colleges receive training in the same methods and procedures as allopathic doctors and in natural healing alternatives.
Most notably, they learn osteopathic manipulative treatment (OMT), a therapy that aims to improve the body’s balance and function, thereby promoting self-healing. If that sounds like a path you’re ready to follow, take the steps below to pursue a career as a DO.
Earn a bachelor’s degree in a health science-related field.
In order to get into osteopathic medical school, you’ll need to take a certain number of credits during your undergraduate degree in areas such as biology, physics, chemistry, and more. Majoring in biology, physics, health sciences or a related field may be a good option to get those prerequisite courses completed.
Take the Medical College Admissions Test (MCAT).
Osteopathic and allopathic students need to take the MCAT to measure their understanding of the natural, behavioral, social sciences, and more. You must achieve at least a passing score on the MCAT to be admitted to schools of osteopathic medicine.
Enroll in osteopathic medical school.
There are currently 37 schools of osteopathic medicine at 58 teaching locations accredited by the Commission on Osteopathic College Accreditation (COCA) in the United States. Medical school takes approximately four years of full-time study to complete and includes clinical experiences on top of regular coursework.
Take and pass the Comprehensive Osteopathic Medical Licensing Examination (COMLEX).
This three-part examination is the osteopathic equivalent to allopathic doctors’ United States Medical Licensing Examination (USMLE). You must pass parts one and two of the exam to graduate from osteopathic medical school. You’ll take part three during your residency. Passing the COMLEX in its entirety is required to apply for licensure.
Apply to residency and/or fellowship programs to complete your post-graduate training.
You must complete a certain amount of post-graduate training in order to apply for licensure. According to the American Osteopathy Association (AOA), this residency period can last anywhere from three to eight years.
Apply for licensure in your state.
Now that you’ve passed the COMLEX and completed your residency, you’re probably ready to apply for an osteopathic license in your state. Be sure to check your state’s individual requirements since they may vary. The AOA suggests checking out the Federation of State Medical Boards to view their directory of state licensing boards.
Start healing people.
You’ve finally got your license to practice as a Doctor of Osteopathic Medicine (DO). Now the work really begins! DOs can find jobs at hospitals, physician offices, community health clinics, and much more alongside their MD colleagues.
Get board certified.
DOs can advance their credentials by getting certified by the AOA or the American Board of Medical Specialties (ABMS) in a medical specialty. Certification demonstrates a particular level of competency in your area of specialty and may increase your earning potential.
What is osteopathic medicine?
Osteopathic medicine approaches health from the vantage point of the whole person—their lifestyle, diet, exercise routine, and even their stressors and personal life. To this end, osteopathic medicine attempts to treat a person’s entire condition, rather than individual symptoms—this is how osteopathic medicine is different.
Traditional medicine with a holistic approach
Akin to what holistic nurses do, DOs tend to emphasize tapping into the body’s self-healing processes to mitigate the use of traditional medical interventions. That being said, osteopathic medicine still encompasses traditional medical practices but adds a holistic approach coupled with osteopathic manipulative medicine (OMM), of which OMT is a part.
An expert’s take on how osteopathic manipulative medicine works
“Osteopathic manipulative medicine (OMM) is part of the greater field of osteopathic medicine. Looking at people as a unit as opposed to one piece,” said Dr. Alexandra Myers, Vice President of the San Diego Osteopathic Medical Association and executive board member of the Osteopathic Physicians & Surgeons of California.
“If somebody comes in with ankle pain then I’ll ask them questions about their ankle, but I’m really thinking, okay:
Why did they get ankle pain if they didn’t sprain their ankle or trip and fall?
Did something happen to that same side’s knee or hip?
Maybe it’s the bunion surgery they had on that foot three years ago and now their gait is abnormal.
It expands your potential for a diagnosis and expands your potential for treating people because you zoom out from the place where the problem is.”
Who started osteopathic medicine?
Osteopathic medicine traces its origins to Dr. Andrew Still, a medical doctor whose three children died of spinal meningitis in 1864. Disillusioned with the inefficacy of traditional medicine, Still was determined to find an alternative.
He devoted the next 30 years of his life to the study of how issues in our body’s structure affect us, especially the musculoskeletal system, and how manipulation of that system (and a body’s structure as a whole) can promote healing and improve the body’s ability to function.
This new holistic and preventative approach to medicine led to the first osteopathic medical school in 1892. DOs were not eligible for licensure in all 50 states until 1973, and the profession has grown since. Today, there are over 178,000 DOs and osteopathic medical students in the U.S.
What is an osteopathic doctor (DO)?
A doctor of osteopathic medicine (DO) is a fully licensed physician educated in an osteopathic medical school. They are trained by the osteopathic approach to medicine, where they view patients as partners in their medical treatment.
DOs interview patients about their conditions, lifestyle and other issues that can create imbalances in the body’s structure and function. Because they receive the same in-depth medical training as MDs, DOs can practice in any standard medical setting, prescribe medication and perform surgery.
DOs make up approximately 11% of all physicians in the United States. The majority of DOs are primary care physicians, but they can practice in any specialty such as pediatrics, emergency medicine, obstetrics-gynecology, and more.
Although DOs are sometimes referred to simply as osteopaths who practice osteopathy, these terms are not accurate since there are osteopaths in other countries that have not earned the DO designation because they did not attend a DO medical school.
What does an osteopathic doctor do?
DOs perform the same job duties as an allopathic doctor, with the addition of OMM, such as:
consult with patients to learn about their lifestyle and medical history
conduct examinations on patients
order, perform, and interpret diagnostic tests
make diagnoses and create treatment plans based on a patient’s condition and symptoms
prescribe medication and perform surgery, if necessary
DOs also perform OMM, one of the defining differences between DOs and MDs.
DOs perform osteopathic manipulative medicine (OMM)
OMM encompasses many different manual techniques used to treat issues in the neuromusculoskeletal system. DOs utilize these hands-on manipulative treatments, called osteopathic manipulative treatment (OMT), to restore balance to the body and optimize function.
There are dozens of different techniques, including:
Soft-tissue kneading, stretching, and massaging
Lymphatic pump
Balanced ligamentous tension
High velocity/low amplitude (HVLA)
Many of these techniques may appear like something a massage therapist or chiropractor might do. But what does this really look like in practice?
OMT and osteopathic duties according to a DO
As a doctor in the emergency department, Dr. Whitlow said that he utilizes OMT if it can be done quickly since he has a limited amount of time with patients. The reality is, some of these techniques simply take longer than he has time to give. However, he credits his OMM and OMT training for many other skills he utilizes on a daily basis.
His palpatory skills, most notably, were developed in the OMT lab in osteopathic medical school and allow him to have a better feel for what exactly he may be doing—realigning a dislocated joint or putting in a central line, for example—and he believes he gets better results because of it.
How OMM and OMT skills can transfer to other parts of medicine
“I think many DOs don’t give themselves credit because they don’t look at the palpatory skills that they learned in medical school as part of what they do,” Whitlow said.
“When I was delivering babies, for a whole year I never had a single perineal tear, which is super common. And the reason is I knew how to match the tissue tension, I knew how to release the pelvic diaphragm—I did all that stuff as I was delivering the baby so I prevented all those complications.
But I wasn’t using classic OMT, I was just using my palpatory skills and my knowledge of tissue and my knowledge of how the body responds to stress to counteract those things preemptively and during labor to make sure none of those things happened.”
DO vs MD—what’s the difference?
Similarities
Doctors of osteopathic medicine (DOs) and medical doctors (MDs) are both highly trained doctors that go through years of schooling and residency to learn their trade. DOs attend four years of osteopathic medical school and MDs attend four years of allopathic medical school, and both doctors complete residences following their graduation.
Both types of doctors do not work in isolation—DOs and MDs can attend the same residency programs and have worked alongside one another for decades. As of July 2020, residency programs transitioned to a single accrediting system for graduate medical education (GME), meaning DOs and MDs now train together at every level even more than before.
Differences
The biggest difference between these two doctors is their philosophies and medical techniques. DOs are educated in more holistic patient care and are trained in osteopathic manipulative medicine (OMM) and osteopathic manipulative treatment (OMT).
OMM is used to determine whether OMT could be beneficial to a patient, which can be used to address ailments in the musculoskeletal, circulatory, nervous, immune systems, and more. MDs do not receive this training in medical school, but many now look to the methods of DOs to inform their own approach to medicine and patient care.
Difference between MD vs DO—from a DOs perspective
“Osteopathic physicians for a long time were the underdogs and didn’t really want to call attention to their differences because they didn’t want people to see them as different. But now we realized that is the whole point—we should be celebrating and marketing that difference,” Whitlow said.
“We are trained to look at people holistically, in a 360-degree method. What is everything that is affecting this person’s life? It all affects one’s physical, emotional, and psychological health. As Andrew Taylor Still called it: mind, body, and spirit. And it’s all true. It’s all linked.”
Osteopathic physicians vs chiropractors
The biggest difference between osteopathic physicians and chiropractors is that DOs are fully licensed physicians and have a different degree than chiropractors.
DOs do this too, but they also do a lot of soft tissue manipulation through various stretching and massage methods. Chiropractors are not trained to practice medicine, prescribe medication or perform surgery.
Osteopathic medical schools and training
In order to be admitted to a school of osteopathic medicine, you must have at least a bachelor’s degree. Although every school’s admission requirements vary, a bachelor’s ensures that you have taken the prerequisite courses needed to be admitted to your osteopathic school of choice.
Prerequisites
Osteopathic prerequisite courses typically include subjects like biology, chemistry, physics, and more. Most schools are able to help you pick a major that is well suited for a pre-med student, such as:
Biology
Microbiology
Chemistry
Biochemistry
Physics
Psychology
Health Sciences
Note: You are not limited to these majors and most medical schools don’t care what you major in as long as you complete their prerequisite course requirements. Some students even choose to get a master’s or doctorate degree as well before moving on to medical school.
Prospective students of allopathic and osteopathic medical schools alike must take the Medical College Admission Test (MCAT). Your MCAT scores will be used in the admission process to your chosen school. It is a standardized, multiple-choice exam that measures your knowledge of natural, behavioral, and social science concepts, among other competencies.
Courses you’ll study in osteopathic schools
Osteopathic medical school will take about four years of full-time instruction to complete. You’ll take a variety of clinical and non-clinical classes, including:
Anatomy and physiology
Biochemistry
Behavioral science
Internal medicine
Medical ethics
Neurology
Osteopathic manual medicine (OMM)
Pathology
Pharmacology
Preventive medicine and nutrition
Clinical practice
“If you look at the curriculum for MD versus DO school, it’s exactly the same except for we add on time for OMT,” Myers said.
“The content of those lectures is delivered by different lecturers. So that faculty at an osteopathic medical school know about OMT, they incorporate OMT and osteopathic principles into their lectures. The nature of the way that you’re going to be taught is different, but if you’re learning about cardiology, for example, cardiology is cardiology, so the difference there is not huge.”
Residency and state licensure
After graduating from a school of osteopathic medicine, DOs must continue their education by applying to residencies and fellowships that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). This residency period can last anywhere from three to eight years.
You can apply for licensure once you have completed your osteopathic residency programs. Every state has different requirements for how many years of residency training are needed to apply for licensure. Check out your state’s requirements to determine if there is anything else needed to apply for licensure where you want to practice.
Osteopathic doctor salary & demand
The field of osteopathic medicine is growing rapidly—according to the American Osteopathic Association’s (AOA) 2021 report, there has been an 81% increase in DOs and osteopathic medical students in the last decade.
Continued expansion of the healthcare industry and the public’s ongoing interest in holistic health alternatives are two key factors that may contribute to this growth.
Although the Bureau of Labor Statistics (BLS) does not track data for osteopathic doctors specifically, we can derive a DO salary by looking at family medicine physicians, the most common type of DO.
Family Medicine Physicians
National data
Median Salary: $224,640
Projected job growth: 3.7%
10th Percentile: $68,890
25th Percentile: $152,810
75th Percentile: N/A
90th Percentile: N/A
Projected job growth: 3.7%
State data
State
Median Salary
Bottom 10%
Top 10%
Alabama
$217,170
$99,350
N/A
Alaska
N/A
$95,980
N/A
Arizona
N/A
$163,190
N/A
Arkansas
$59,980
$59,980
N/A
California
$228,970
$70,120
N/A
Colorado
$234,220
$71,260
N/A
Connecticut
$203,060
$77,470
N/A
Delaware
$226,840
$136,610
N/A
Florida
$229,990
$113,840
N/A
Georgia
$235,000
$145,170
N/A
Hawaii
N/A
$163,190
N/A
Idaho
$218,190
$86,740
N/A
Illinois
$128,350
$65,000
N/A
Indiana
$225,900
$140,180
N/A
Iowa
N/A
$132,880
N/A
Kansas
$228,040
$113,120
N/A
Kentucky
N/A
$108,880
N/A
Louisiana
N/A
$154,980
N/A
Maine
$224,340
$143,760
N/A
Maryland
N/A
$160,990
N/A
Massachusetts
$224,470
$110,110
N/A
Michigan
$162,940
$60,660
N/A
Minnesota
$232,760
$109,020
N/A
Mississippi
N/A
$137,690
N/A
Missouri
$217,890
$64,640
N/A
Montana
N/A
$81,300
N/A
Nebraska
N/A
$111,870
N/A
Nevada
N/A
N/A
N/A
New Hampshire
N/A
$163,070
N/A
New Jersey
$214,410
$65,740
N/A
New Mexico
$226,990
$112,580
N/A
New York
N/A
$80,830
N/A
North Carolina
$229,620
$110,000
N/A
North Dakota
N/A
N/A
N/A
Ohio
$74,410
$61,220
N/A
Oklahoma
$228,600
$79,420
N/A
Oregon
$220,620
$136,570
N/A
Pennsylvania
N/A
$107,640
N/A
Rhode Island
$199,990
$182,480
N/A
South Carolina
$225,260
$131,050
N/A
South Dakota
$216,160
$68,680
N/A
Tennessee
$222,090
$124,990
N/A
Texas
$180,440
$68,080
N/A
Utah
$233,170
$121,330
N/A
Vermont
$223,520
$140,400
N/A
Virginia
$228,570
$133,470
N/A
Washington
N/A
$63,970
N/A
West Virginia
$158,500
$62,300
N/A
Wisconsin
N/A
$166,900
N/A
Wyoming
N/A
$215,600
N/A
Source: U.S. Bureau of Labor Statistics (BLS) 2023 median salary; projected job growth through 2032. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.
The demographic makeup of the osteopathic profession has also evolved in recent years. According to the AOA’s report, over two-thirds of practicing DOs are under the age of 45.
Is osteopathic medicine right for me?
Anyone who wants to become a doctor will eventually have to make a choice: do you want to go to allopathic (MD) or osteopathic (DO) medical school?
Getting into med school
There are several things to consider when the time comes to answer that question for yourself. In her experience advising premedical students, Myers said that just getting into any medical school is the biggest hurdle before you can decide which to attend.
“Getting into medical school in and of itself is a miracle, from a numbers perspective it’s so hard to get in,” Myers said. “I think that ends up driving more of the choices. Did you get in and how much is it going to cost?”
Choosing between allopathic and osteopathic
If you have the option to go to either school, then it’s time to consider which philosophy you want to incorporate into your practice.
“When I’m advising medical students or pre-meds, I tell them if you want to go to a place where you’re going to look at the person as a unit from day one, and then you back up and you learn piece by piece how to put that back together, that’s the osteopathic mindset,” Myers said.
“These days it’s all a matter of personal preference,” Whitlow said. “What perspective do you want to be trained from? What foundation do you want to start from? And I think those are the only limiting things.”
MD and DO professional overlap
With the amount of integration there is today between DOs and MDs, Myers pointed out that regardless of which type of school you attend, there are opportunities to expand your skills and learn from other physicians throughout your career. “Even if you go to MD school, you can spend a bunch of time with DOs who do OMT and learn how to do OMT and practice OMT.”
