DOs = Doctor of Osteopathic Medicine. Let's take a few moments to learn what the heck those letters mean...
Very quick history lession:
Back in the 1860s, a MD named Andrew Taylor Still lost his three children to meningitis.
He began to question the efficacy of "modern medicine" at the time which was using mercury for constipation, opium for bronchitis, and chloroform for anesthesia.
Still proposed that the body could likely heal itself and that many maladies were often the result of physical misalignments. By realigning the body, he said he could optimize people to get better on their own.
This morphed into the tenets of osteopathic medicine:
The body is a unit, consisting of mind, body, and spirit.
The body is capable of self healing, self regulation, and health maintenance.
Structure and function are reciprocally related.
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function. from osteopathic.org
DO Schools
Wikipedia currently had 48 DO schools listed, compared to 170+ MD schools.
MCATs and GPAs are, on average, lower for DO matriculants.
(503.8 vs 511.5, 3.54 vs 3.73)
About 25% of med students are now DO students
The curriculum is also four years, though in addition to the basic sciences and standard med school classes, DO students put hundreds of hours into learning musculoskeletal manipulation, known as OMM or osteopathic manipulative medicine.
OMM
These modalities are based on in-depth knowledge of muscle origins, insertions, and actions, though their efficacy has certainly been called into question.
Counterstrain - a technique to reduce tender points in muscles by shortening the agonist muscle for 60-90 seconds
HVLA - rapid movements to mobilize joints through firmly restricted ranges of motion... this is when I crack José's neck in resus when no one's around
Muscle Energy - frankly, kind of a silly name for a similar technique called PNF that other practitioners use - this technique is to lengthen and relax constricted, tight, tender muscles
Soft tissue technique - similar to massage
And various other techniques
Does it work?
Because it isn't possible to blind practitioners, studying OMM is quite hard.
There is limited evidence outside of the American Osteopathic Association's own journal to support its use.
This excellent wikipedia section highlights some of the studies that show its controversy.
More Controversy
Craniosacral therapy is by far the most criticized modality of OMM. It is sometimes taught (and practiced) that providers can feel movement of the skull in full grown adults, and that this rhythmic movement may be altered or change to influence the health of the patient. (Yes, I was taught this in school.) It has been denounced as quackery for years.
Discrimation
DO students have certainly been discriminated against when competing for residency. I don't need a source for this, I can just tell you from personal experience that I've heard people say, "We don't take DOs."
As a result, DO students often have to put much more work into matching to competitive specialties than their MD counterparts, by completing two sets of boards, the COMLEX and the USMLE (yes, Step/Level 1 AND 2).
They also are encourage to perform more away rotations -- I did five EM-themed rotations during my last year of med school.
Until recently DOs had their own match day separate from MDs. This has just recently been merged in an effort to further equalize the degree and make the process more fair.
DO's in the Maimo ER
Have I used OMM in the ED? Once, on a wussy 17yo who couldn't move his arms after he lifted weights the day before. Yes, it worked.
As I'm sure you've seen by now, DOs in the ED are indistinguishable from their MD counterparts. In this clinical setting we are all just ER docs with the same job and same capabilities.
The whole MD vs DO thing has been re-sparked recently because some jerk decided to go and make a fool of himself on international television... and he happened to have a "DO" after his name. Anyway, I hoped this was mildly interesting. Feel free to ask me anything you want about the DO world, happy to chat about it and speak candidly.
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