Question:
What Do D.O.s Do?

Answer: Look down the list of participating providers in anyhealth plan directory — the letters after the names are changing. Along withthe familiar M.D., consumers increasingly can choose from N.P. (nursepractitioner), D.C. (doctor of chiropractic) and D.O. (doctor of osteopathicmedicine). Doctor of osteopathic medicine? Doesn't that have something to do withalternative medicine? While it may sound that way, D.O.s are fully qualified medical doctorswho can diagnose and treat disease, prescribe medications and perform surgery.As with M.D.s, physicians licensed as doctors of osteopathic medicine must passa national or state medical board examination in order to get a license topractice medicine. And while still heavily outnumbered by M.D.s — there areapproximately 43,555 D.O.s in the United States today compared with 756,710M.D.s — doctors of osteopathy are growing in visibility and popularity. There are a number of reasons for the change. The first is a matter ofsimple numbers: There are more qualified D.O.s now. In addition, legislatorsand health policy analysts are seeking to increase the number of primary-carephysicians, a traditional job choice for D.O.s. And, not least, health-careconsumers are looking for holistically oriented health-care providers who canoffer them a wide variety of treatment options but are still medically traineddoctors. "Recently, the American Osteopathic Association has hired a publicrelations firm to increase visibility and raise awareness about D.O.s andosteopathic medicine," says Dr. Tyler Cymet, an osteopathic physician ininternal medicine who practices at Sinai Hospital in Baltimore. "AOA will bespending close to $1 million per year on this campaign." While many members ofthe media and the public know about D.O.s and osteopathic medicine, heexplains, "there are still (some) with preconceived notions that D.O.s arealternative practitioners. Our challenge is to dispel this myth and then try toeducate the media about what D.O.s do and who they are." What D.O.s do closely parallels what M.D.s do. "The training and licensure requirements for an osteopathic physicianmirror the requirements that are expected for M.D.s," says Dr. Percy Wootton,past president of the American Medical Association. "Although the twoprofessions adhere to different medical philosophies, the public should expectno difference in the quality of care they receive." In fact, D.O.s work side by side on an equal basis with M.D.s in HMOs,in private practice and in the military. There is no hierarchical separation,and no medical pecking order. Training for D.O.s and M.D.s follows similar tracks. Before enteringosteopathic medical school, most applicants complete four years of college.They must take the Medical College Admissions Test, or MCAT — the same examrequired of applicants to allopathic medical school. Osteopathic medical schoolis a rigorous, four-year program, consisting of essentially the same courseworkthat students seeking M.D.s must tackle. After graduation, most D.O.s completea yearlong internship. Many also complete two- to six-year residencies inmedical specialties, then take board exams to become certified in theirspecialty areas. Many, but not all, choose family medicine, general internalmedicine or general pediatrics. But training for osteopathic physicians differs from training formedical doctors in a couple of major ways: D.O.s receive additional emphasis onpreventive, family and community medicine, and they receive training inosteopathic manipulative treatment, called OMT, a set of hands-on medicaltechniques osteopaths use to relieve pain, restore range of motion and enhancethe body's capacity to heal. “Consumers are seeing D.O.s because they want a physician who can treatthe whole body and not just each tiny orifice,” says Dr. Cymet. "D.O.s haveextra training and extra treatment modalities to offer their patients, andconsumers today tend to want more. They want to know more about nutrition,biomechanics, etc. And D.O.s are trained in these areas." Both D.O.s and chiropractors perform manipulation, but chiropractorsdon't have as much training in diagnosing medical problems, says Dr. KarenNichols, an osteopathic physician in Mesa, Ariz., who is president of theArizona Osteopathic Medical Association. "So," she says, "they are able totreat your symptoms, but unless it's a structural problem they cannot treat thecause of the pain. For example, a heart attack might result in low back pain.In addition, D.O.s are able to treat the whole body with OMT, not just thespine." What should consumers consider in deciding between a D.O. and an M.D.?Is there that much difference? When the rubber hits the road, not really. "Pre-doctoral training is now much the same, with more emphasis by theD.O.s on manipulation," said Dr. Lanny R. Copeland, President of the AmericanAcademy of Family Physicians in Kansas City, Mo., whose membership consists of45,888 M.D.s and 3,685 D.O.s. "As a health-care consumer," he says, "I'd be more interested in thingssuch as access, coverage, office hours and what hospital they used.