M.D. versus D.O.?

Suppose you were in the middle of your typical, busy day, rustling papers, and you cut your finger. What do you grab? A Band–Aid? What about an adhesive bandage? What if your injury was more than just a paper cut? Who would you call? A D.O.? What about a physician? Just as a Band–Aid is a brand name for an adhesive bandage, a D.O. is one of two titles representing a physician. Most of society is familiar with M.D., which also implies a physician, but many patients may not even realize that their family doctor is a D.O. How important is it to know?

First of all, what is a D.O.? D.O. are the initials for a doctor of osteopathic medicine (formerly known as osteopathy in the United States). An osteopathic physician is the only other legal and professional equivalent of an M.D. and practices medicine based upon osteopathic philosophy. The philosophy emphasizes the inter–relationship between structure and function and has an appreciation of the body’s ability to heal itself. This viewpoint was initially founded by Andrew Taylor Still, M.D. (1828 – 1917) after losing several of his children to what he perceived as inadequate medical treatment of his time. He invented the name “osteopathy” by blending two Greek roots, osteon– for bone and –pathos for suffering, in order to communicate his theory that disease and physiologic dysfunction were because of a disordered musculoskeletal system. Although uunorthodox during the late 1800′s, Dr. Still believed that he could avoid the harsh medicines of his era by diagnosing and treating the musculoskeletal system with osteopathic manipulation. Osteopathic Manipulative Treatment (OMT) is defined as the application of a variety of techniques or manually guided forces by a physician to improve physiologic function and to support the body’s balance, which has endured an alteration of its muscles, joints, or other bodily elements.

In contrast, M.D. comes from the Latin words Medicinae Doctor meaning “teacher of medicine” and represents a doctor of allopathic medicine. “Allopathy” is a term coined by the founder of homeopathy, Samuel Hahnemann, from the two Greek roots, allos– for other, and –pathos for suffering. The true meaning behind allopathy has been controversial, but for the purpose of this article, allopathic medicine will be used to represent the conventional M.D. profession.

Since introduced in 1874, osteopathic medicine has evolved and incorporated the knowledge that is expected of an allopathic physician. In 1963, the U.S. Civil Service Commission announced that M.D. and D.O. degrees were equivalent. D.O.’s have always been members of their own American Osteopathic Association (AOA), but, as of 1969, were allowed full, active membership within the American Medical Association (AMA). Within the U.S., there are currently 26 D.O.–granting and 125 M.D.–granting medical schools. Hence, less than ten percent of physicians are D.O.’s. This is one of the reasons that patients are less likely to encounter a D.O. versus an M.D.

So, what does it take to become a physician? Prior to attending medical school, students typically earn an undergraduate degree, while fulfilling the medical course requirements and taking the Medical College Admissions Test (MCAT). Once admitted to an osteopathic (D.O.) or allopathic (M.D.) medical school, each student is expected to complete a pre–designed, four–year curriculum. The first two years are classroom–based, while the third and fourth years consist of clinical rotations through different medical specialties. In addition, the D.O. curriculum incorporates many hours of osteopathic manipulative medicine training. After graduation, M.D. and D.O. physicians alike can pursue residency training programs in any specialty, which requires an additional three to eight years. Sub–specialty fellowships may also be pursued after residency, which adds more years to a doctor’s training. Osteopathic physicians frequently pursue allopathic residency programs; however, M.D. physicians, at this time, are not currently accepted into osteopathic residencies. Just like allopathic physicians, D.O.’s may practice in any medical specialty including, but not limited to, internal medicine, anesthesiology, dermatology, surgery, radiology, and emergency medicine. Practicing physicians’ salaries are dependent upon experience, location, setting or specialty, but not based on whether he or she is a D.O. or an M.D.

Although D.O.’s may practice in any specialty, the primary care setting is of great interest to osteopathic physicians since more opportunities exist for patients to benefit from their OMT skills and philosophy. It is important to keep in mind that some D.O.’s do not continue to practice osteopathic manipulative medicine despite their prior training. On the other hand, some M.D.’s are incorporating a more holistic approach to healthcare. In essence, each M.D. and D.O. comes with his or her own set of experiences, skills, and preferences.

In this day and age, the paternalistic approach of medicine is long gone. It is now expected that patients take charge of their own health and participate in a partnership with their healthcare provider. Therefore, as a patient, it is vital to understand and get to know which services a physician can provide to maximize his or her healthcare experience. Whether M.D. or D.O., physicians possess a personalized approach to the care of each patient. It is in the patient’s best interest to discover the physician who suits his or her needs.

Do you have a favorite physician that suits you well?

(Copied from NSIDE magazine article in June 2007 by Dr. Cady & Dr. Michelle Craven.)