An osteopathic physician is a fully licensed medical doctor who holds a Doctor of Osteopathic Medicine (DO) degree instead of a Doctor of Medicine (MD) degree. DOs can prescribe medications, perform surgery, and practice in every medical specialty, with the same legal practice rights as MDs in all 50 U.S. states. The key difference is their additional training in the musculoskeletal system and a hands-on treatment method called osteopathic manipulative treatment (OMT). There are currently more than 167,000 practicing DOs in the United States, with roughly 40,000 osteopathic medical students enrolled for the 2025–26 academic year.
How DO Training Differs From MD Training
DO students complete four years of medical school covering the same core sciences as their MD counterparts: anatomy, physiology, pharmacology, pathology, and clinical rotations in hospitals and clinics. On top of that shared foundation, osteopathic programs add approximately 200 hours of musculoskeletal system training. This extra coursework focuses on how the body’s bones, muscles, and connective tissues relate to overall health, and it includes hands-on practice in OMT techniques.
After medical school, DOs enter residency training just like MDs. Since 2020, all residency programs in the U.S. operate under a single accreditation system run by the Accreditation Council for Graduate Medical Education (ACGME). This merger means DO and MD graduates train side by side in the same residency programs, meet the same competency standards, and are evaluated against the same milestones. Some ACGME-accredited residencies carry a designation called “Osteopathic Recognition,” meaning they formally integrate osteopathic principles into their curriculum for residents who want to continue developing those skills.
For licensing, DO graduates take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). Many also choose to take the United States Medical Licensing Examination (USMLE), which is the standard exam for MD graduates, though it’s not required.
The Philosophy Behind Osteopathic Medicine
Osteopathic medicine is built on four core principles adopted by the American Osteopathic Association. The first is that the body is a unit, meaning a person’s physical health, mental health, and overall well-being are interconnected rather than separate concerns. The second is that the body is capable of self-regulation and self-healing. The third holds that structure and function are linked: how a body part is built affects how it works, and vice versa. The fourth follows from the first three, stating that effective treatment should account for all of these relationships rather than targeting symptoms in isolation.
In practice, this philosophy shows up as a tendency to look beyond the immediate complaint. A DO treating chronic headaches, for example, might examine posture, neck alignment, and stress levels alongside more conventional diagnostic steps. This doesn’t replace standard medical care. It layers additional considerations on top of it.
Osteopathic Manipulative Treatment
OMT is the most visible distinction between DOs and MDs. It’s a set of hands-on techniques where a physician uses their hands to diagnose, treat, and prevent illness or injury by moving muscles, joints, and connective tissue. The goal is to restore normal motion, relieve tension, and support the body’s ability to heal.
There are 40 recognized OMT techniques in the official osteopathic glossary, ranging from gentle to more forceful. Some of the most commonly used include:
- Myofascial release: sustained pressure and stretching applied to the connective tissue surrounding muscles to relieve tightness and improve range of motion
- Muscle energy: the patient actively contracts specific muscles against the physician’s resistance, which helps reposition joints and lengthen tight muscles
- Counterstrain: the physician moves the patient into a position of comfort, holding it for about 90 seconds to reset overactive pain signals from tender points
- High velocity/low amplitude (HVLA): a quick, targeted thrust applied to a joint, similar to what you might associate with chiropractic adjustments, often producing an audible pop
- Soft tissue technique: rhythmic stretching, pressure, and kneading applied directly to muscles and surrounding tissue
- Lymphatic pump: gentle, rhythmic compressions designed to encourage the flow of lymph fluid, which plays a role in immune function and reducing swelling
Not every DO uses OMT regularly. Those in primary care and musculoskeletal specialties tend to incorporate it most often. A DO working as a cardiologist or psychiatrist may rarely use it in daily practice, though they received the same training in medical school.
What DOs Actually Practice
DOs practice in every specialty area of medicine. While osteopathic medicine has historically been associated with primary care fields like family medicine, internal medicine, and pediatrics, DOs today also work as surgeons, emergency physicians, dermatologists, anesthesiologists, and specialists in every other field. The distribution has broadened significantly as the profession has grown.
From a patient’s perspective, a visit to a DO often looks identical to a visit with an MD. They order the same lab tests, prescribe the same medications, refer to the same specialists, and perform the same procedures. The difference may surface if your DO incorporates OMT into your visit or spends more time evaluating how lifestyle, posture, or musculoskeletal issues might connect to your symptoms. But this depends entirely on the individual physician and their specialty.
Origins of Osteopathic Medicine
Osteopathic medicine traces back to Andrew Taylor Still, a physician and Civil War-era surgeon who grew disillusioned with conventional medicine after losing several family members to spinal meningitis despite the treatments available at the time. Still became convinced that the key to treating disease lay in understanding anatomy deeply, particularly how disruptions in the musculoskeletal system could interfere with blood flow and nerve function throughout the body. He founded the American School of Osteopathy in Kirksville, Missouri, in 1892.
The profession has evolved dramatically since then. Still’s original skepticism of pharmaceuticals has given way to a modern practice that fully embraces drugs, surgery, and evidence-based medicine. What remains from his founding vision is the emphasis on the musculoskeletal system, hands-on diagnosis and treatment, and the principle that the body’s systems are deeply interconnected.
DO vs. MD: What Matters for Patients
For most patients, the practical difference between seeing a DO and an MD is minimal. Both complete rigorous medical training, pass national licensing exams, and hold the same legal authority to practice medicine. Both can specialize in any field. The American Medical Association itself states that MDs and DOs have “equivalent training and practice rights.”
Where the difference becomes relevant is if you’re specifically interested in a physician who may take a more hands-on, musculoskeletal-oriented approach to your care, or if you’re curious about OMT as a complement to conventional treatment. If those things appeal to you, seeking out a DO, particularly one in primary care or physical medicine, increases the likelihood that those tools will be part of your visit. If you’re choosing a surgeon or a specialist for a specific condition, the physician’s training, experience, and board certification matter far more than whether the letters after their name are MD or DO.