Osteopathic medicine is a distinct branch of American medical practice in which physicians earn a Doctor of Osteopathic Medicine (DO) degree instead of a Doctor of Medicine (MD) degree. DOs are fully licensed physicians who can prescribe medication, perform surgery, and specialize in any field of medicine. What sets them apart is additional training in the musculoskeletal system and a philosophy that emphasizes treating the whole person rather than isolated symptoms. Today, osteopathic physicians represent roughly 11% of all physicians in the United States, and more than 25% of all medical students are enrolled in DO programs.
The Philosophy Behind Osteopathic Medicine
Osteopathic medicine is built on four core principles, formally adopted by the American Osteopathic Association. The first is that the body is a unit: a person is an interconnected whole of body, mind, and spirit, not a collection of separate organ systems. The second is that the body is capable of self-regulation and self-healing. The third holds that structure and function are reciprocally related, meaning the way your body is physically arranged affects how well it works, and vice versa. The fourth principle ties the others together: effective treatment should be based on understanding all three of these ideas at once.
In practice, this philosophy shows up in how DOs approach patient care. Rather than focusing narrowly on the organ or system producing symptoms, osteopathic physicians are trained to consider how a patient’s lifestyle, mental health, diet, and physical structure all contribute to their condition. A DO treating chronic headaches, for instance, might evaluate posture, stress levels, and neck mobility alongside more conventional diagnostic steps.
How DO Training Compares to MD Training
DO and MD students follow very similar paths. Both complete four years of medical school covering anatomy, pharmacology, pathology, and clinical rotations. Both then enter residency training to specialize. Since 2020, DOs and MDs have competed in a single, unified residency match system, meaning they apply to the same programs and train side by side.
The key difference is that DO students receive additional coursework in osteopathic principles and hands-on musculoskeletal techniques (more on those below). DO-granting medical schools also require their graduates to pass the first two portions of the COMLEX-USA, a licensing exam specific to osteopathic physicians and the only exam accepted for osteopathic licensure in every U.S. jurisdiction. About 60% of osteopathic medical students also choose to take at least one portion of the USMLE, the licensing exam required for MDs. Interestingly, while DO students can take either exam, MD students are not permitted to take the COMLEX-USA.
Osteopathic Manipulative Treatment
The most distinctive clinical skill DOs learn is osteopathic manipulative treatment, or OMT. This is a set of hands-on techniques used to diagnose and treat musculoskeletal problems, improve circulation, and support the body’s ability to heal. Not every DO uses OMT regularly in practice, but all are trained in it.
Two of the most common techniques illustrate the range of OMT:
- Myofascial release is a slower, gentler approach in which the physician applies sustained pressure to the connective tissue (fascia) surrounding muscles. It is used for chronic low back pain, tendon and nerve disorders, and jaw problems like temporomandibular joint dysfunction.
- High-velocity, low-amplitude thrust is a quicker technique. The physician applies a rapid, short-distance force to a joint to release restrictions and restore range of motion. It is commonly used for acute low back pain, neck pain, shoulder problems, and cervicogenic headaches (headaches originating from the neck).
These are just two of several OMT methods. Others target lymphatic drainage, cranial movement, and soft tissue tension. A DO might use OMT as a standalone treatment or combine it with medication, physical therapy, or other conventional approaches.
What Specialties Do DOs Practice In?
DOs can specialize in any medical field, from neurosurgery to dermatology. That said, the profession has historically leaned toward primary care. About 57% of practicing osteopathic physicians work in primary care specialties: family medicine, internal medicine, pediatrics, or osteopathic manipulative medicine. The remaining 43% practice in areas like emergency medicine, anesthesiology, general surgery, and psychiatry.
This primary care emphasis traces back to the profession’s roots in whole-person medicine and community health. Many osteopathic medical schools are located in rural or underserved areas and actively recruit students interested in serving those communities. But the specialty distribution has been shifting over time as DO graduates increasingly enter surgical and subspecialty residencies through the unified match system.
Origins of the Profession
Osteopathic medicine was founded by Andrew Taylor Still, a physician who grew disillusioned with 19th-century medical practices after losing three of his children to spinal meningitis in 1864, despite the care of four physicians. He began developing a new approach that emphasized the body’s structural integrity and its natural capacity to heal. Still formally established osteopathy on June 22, 1874, and went on to open the American School of Osteopathy in Kirksville, Missouri in 1892, becoming the first Doctor of Osteopathy.
Originally, osteopathy was conceived as a comprehensive alternative to the medical standards of the time, which relied heavily on unproven remedies. Over the following century, osteopathic medicine evolved to incorporate the full scope of modern medical science, including pharmaceuticals and surgery, while retaining its emphasis on musculoskeletal health and whole-person care.
Practice Rights and Recognition
Within the United States, DOs hold the same practice rights as MDs in all 50 states. They can prescribe controlled substances, admit patients to hospitals, and lead surgical teams. Internationally, DOs have full practice rights in more than 65 countries. However, in some parts of the world, the title “osteopath” refers to a non-physician practitioner trained only in manual therapy, which can cause confusion. A U.S.-trained DO is a fully licensed physician; an osteopath in many European countries is not.
The profession has grown significantly. There are now over 207,000 osteopathic physicians and medical students in the United States, and new osteopathic medical schools have opened in recent years to meet rising demand. With more than a quarter of all U.S. medical students now pursuing the DO degree, osteopathic medicine has moved from a niche alternative into a major segment of the American healthcare system.