Osteopathic medicine is a fully legitimate branch of medicine in the United States. Doctors of Osteopathic Medicine (DOs) are licensed to practice the complete scope of medicine in all 50 states, prescribe medications, perform surgery, and specialize in every field from cardiology to neurosurgery. There are over 157,000 practicing DOs in the U.S., making up roughly 11% of all physicians and 28% of all medical students currently in training.
What DOs Study in Medical School
DO and MD programs have virtually the same admission requirements, weighing GPA and MCAT scores heavily. The curriculum follows the same general structure: roughly 12 to 24 months of classroom-based basic sciences (anatomy, physiology, pharmacology, pathology) followed by clinical rotations in hospitals and clinics. Both degrees take four years to complete, and both lead to residency training afterward.
The one curricular difference is that DO students also learn osteopathic manipulative treatment (OMT), a set of hands-on techniques involving stretching, gentle pressure, and resistance applied to muscles and joints. This adds extra training focused on the musculoskeletal system. Beyond that single addition, the medical education is the same.
Licensing and Board Exams
DO graduates must pass a national licensing exam called COMLEX-USA. It covers the same core medical knowledge as the USMLE (the exam MD graduates take), plus an additional section on osteopathic principles. Many DO students actually take both exams. Among those who do, their relative performance on COMLEX tends to be stronger: a score that lands around the 90th percentile on COMLEX typically corresponds to roughly the 67th percentile on the USMLE, suggesting the exams test overlapping but not identical material at slightly different scales.
Once licensed, a DO’s authority is identical to an MD’s. They can prescribe controlled substances, admit patients to hospitals, lead surgical teams, and practice in the military. This holds true across all 50 states, the District of Columbia, Puerto Rico, and U.S. territories.
DOs and MDs Train in the Same Residencies
Since 2020, there has been a single residency accreditation system in the United States. Before that, DO graduates could enter either osteopathic or allopathic residency programs, which were accredited separately. In 2014, the major governing bodies agreed to merge the two systems under one umbrella, the Accreditation Council for Graduate Medical Education (ACGME). The transition was completed by June 30, 2020, after which all residency programs, whether they originally trained MDs or DOs, operate under the same standards and milestones.
This means a DO and an MD completing an orthopedic surgery residency at the same hospital are held to identical competency benchmarks. They graduate with the same qualifications.
Patient Outcomes Are the Same
A 2024 study comparing surgical outcomes between MD and DO surgeons found no meaningful difference. The adjusted 30-day mortality rate was 1.61% for patients treated by DOs and 1.58% for those treated by MDs, a gap so small it was not statistically significant. There was also no difference in 30-day hospital readmissions or length of stay. In practical terms, patients do equally well regardless of which degree their surgeon holds.
The Osteopathic Philosophy
Osteopathic medicine is built on four principles: the body functions as a unit of body, mind, and spirit; the body has built-in mechanisms for self-healing; structure and function are deeply connected; and effective treatment should account for all of these ideas together. In practice, this translates to a reputation for taking a more holistic, whole-patient approach, though many MDs practice this way too, and plenty of DOs work in highly specialized, procedure-driven fields where the philosophical distinction matters little day to day.
The philosophy is most visible in OMT, the hands-on component unique to osteopathic training. Not every DO uses OMT regularly in practice. Many go into specialties like radiology, anesthesiology, or psychiatry where it rarely comes up. But the training shapes how they think about the relationship between the musculoskeletal system and overall health.
Does OMT Actually Work?
This is where healthy skepticism is most warranted, and where the evidence is worth examining closely. A large overview of systematic reviews published in BMJ Open found that OMT does show real benefits for certain conditions, particularly pain-related ones.
For chronic and acute low back pain (the condition with the most research), pooled data from 10 trials with over 1,100 participants showed a medium-sized effect on pain reduction and a small effect on functional improvement, with moderate-quality evidence. The results were stronger in specific populations: pregnant women with low back pain saw large reductions in pain across multiple trials, and postpartum women showed similar large effects.
For chronic neck pain, three trials with 123 participants found a medium-sized effect on pain reduction. For chronic non-cancer pain more broadly, OMT showed a small effect on pain severity compared to standard care but a large effect on reducing disability, both with moderate-quality evidence.
So OMT is not a cure-all, and the effects range from small to large depending on the condition. But for musculoskeletal pain, especially low back pain, the evidence supports it as a genuinely helpful treatment, not a placebo.
International Recognition
For decades, one legitimate criticism was that DOs faced barriers practicing abroad, since many countries didn’t recognize the degree. That changed substantially in November 2023, when the International Association of Medical Regulatory Authorities approved a resolution recognizing U.S.-trained DOs as fully equivalent to MDs in 47 additional member countries. Combined with countries that already recognized the degree, DOs now have practice rights in over 65 nations.
Why the Confusion Exists
Part of the skepticism around osteopathic medicine comes from confusion with non-physician osteopaths practiced in some other countries. In the U.K., Australia, and parts of Europe, “osteopath” refers to a manual therapist who is not a medical doctor and cannot prescribe medication or perform surgery. A U.S.-trained DO is a completely different credential: a fully licensed physician who happens to also have training in manual therapy techniques.
Another source of doubt is that OMT can sound similar to chiropractic care or massage therapy. While there is some overlap in hands-on techniques, the critical difference is that a DO completed full medical school and residency training. OMT is one tool in their medical toolkit, not the entirety of their practice. Most DOs spend the majority of their clinical time doing exactly what MDs do: diagnosing conditions, ordering imaging and labs, prescribing medications, and performing procedures.