“Are you sure you want to be an MD? Your interest in holistic medicine makes me think a D.O. might be a good fit for you,” said a Career Center advisor, as we discussed my passion for nutrition and hopes for attending medical school. I wasn’t sure of how to respond except that I had originally thought D.O. programs were for students who “couldn’t get into med school.” Retrospectively, this comment may seem a bit judgmental, but it does highlight something about D.O. programs: the lack of understanding many people have about them.
For starters, what does D.O. even mean? A D.O. is a Doctor of Osteopathy. According to the American Association of Colleges of Osteopathic Medicine, osteopathic medicine is a form of medical care based on the philosophy that “all body systems are interrelated.” The MedTerms dictionary explains osteopathy as being based on the concept that “the body can formulate its own remedies against diseases when its parts are in a normal structural relationship, it has a normal environment, and it enjoys good nutrition.”
This is in contrast with mainstream allopathic medicine, that which is typically associated with an M.D. degree. Allopathic medicine, also known as “western medicine,” “conventional medicine,” and “evidence-based medicine,” is what we may typically think about when we hear “medicine,” and it is more associated with specific treatments.
These two types of medicine are founded on different philosophies, but in practice, D.O.’s and M.D.’s are very similar. Osteopathic physicians use all of the tools of conventional medicine such as prescription medications and surgery. Osteopathic physicians serve in primary care areas, but they also work in a wide range of specialties, often alongside M.D.’s. Both types of medical schools have four-year programs, and all students take the same medical licensing exam (MLE). After this exam, D.O.’s qualify and apply to the same residency programs as M.D.’s.
The American Osteopathic Association says that the distinction between the two degrees lies in the foundation of osteopathic medicine. D.O. programs emphasize preventive care and comprehensive patient care. This holistic approach to medicine also entails special training in the musculoskeletal system. Osteopathic school requires up to 200 hours of manipulation training, which consists of learning how to move patients’ muscles and joints using stretching, gentle pressure, and resistance. Manipulative treatment is used to diagnose, treat, and prevent illness.
Although the American Osteopathic Association website does highlight this distinction, Dr. Keith Byler, a D.O. in Illinois, said the difference is mostly a “historic anomaly.” Andrew Taylor Still, a surgeon in the 1800’s, came up with a thought that sparked the eventual development of osteopathic medicine. After the Civil War, his wife died due to childbirth complications, three of his children died of spinal meningitis, and his daughter born to his second wife died of pneumonia. This intense personal tragedy led him to search for a better system of medicine. This D.O. system was more mechanically based since he viewed the body as a machine in which all the parts needed to function properly.
Still’s research and clinical findings caused him to believe that the musculoskeletal system played a vital role in health and disease. These findings led him to test mechanical skills on the body, which were focused on improving the natural functions of the body. Still continued to use drugs at first, but when patients remained satisfied without the use of drugs, he eventually condemned the use of all drugs.
In 1892, Still founded A.T. Still University, the first college of osteopathic medicine, in Kirksville, Missouri. Once the practice of osteopathic medicine was more established, a new art of treating people as a whole emerged. But in 1910, the Flexner Report implemented strict guidelines for all medical schools. A majority of the D.O. schools that survived these guidelines tended to practice more allopathic-like medicine similar to M.D. programs of the time because the report’s guidelines tended to be more in accordance with the treatment strategies found in M.D. schools. At this point, the two fields of medicine became somewhat merged because the D.O. schools that strictly followed the osteopathic and holistic approach to medicine were forced to close due to the report’s guidelines.
Despite this merge, many patients today seek out osteopathic physicians. Gillian Parrish, a Washington University Career Center advisor, chose a D.O. as her primary care physician in St. Louis. Parrish said she began to seek out D.O.’s after her chronic wrist pain was successfully treated with a movement-based modality instead of surgery. Since then, she said she wanted “a doctor who is more savvy about ways of healing that don’t involve invasive procedures…There’s no difference in the office setting or in what she does. If I have an infection, she prescribes antibiotics; if I need an MRI, she orders an MRI.”
It is sometimes difficult for pre-medical students to decide which of the two degrees to pursue. Dr. Byler said there is not too much of a difference between the two. He did suggest that students interested in primary care pursue a D.O. program, as osteopathic education is tailored for primary care, while those interested in pursuing research, might have an easier time doing an M.D. “But the distinctions are so small now,” he said.
However, Dr. Byler said that from his experience “physical manipulation has real advantages.” He said he has been able to use it in order to help his patients with conditions such as migraines. With respect to manipulation, Dr. Byler said he is not sure what “percentage of [it] is actually science and what percentage of it is just the warmth of physical touch”.
Students often dismiss the D.O. degree as the easier route of the two degrees. It is true that osteopathic colleges have less stringent admissions requirements, and the admitted classes tend to have lower average GPA’s and MCAT scores than admitted M.D. classes. Nonetheless, D.O. schools remain competitive in an effort to maintain the integrity of the D.O. profession. The admissions committees hope to find those students particularly passionate about how osteopathic medicine differs from allopathic medicine. This being said, be cautious of assuming a D.O. program to be ‘plan B’.