A DO program is a four-year medical school that trains students to become Doctors of Osteopathic Medicine. Graduates earn the DO degree, which grants the same full practice rights as an MD in the United States: DOs can prescribe medication, perform surgery, and specialize in any field of medicine. The key difference is that DO programs include additional training in osteopathic manipulative treatment (OMT), a hands-on approach to diagnosing and treating musculoskeletal problems and other conditions.
There are currently 38 colleges of osteopathic medicine in the U.S., accounting for about 22 percent of all accredited medical schools. The profession has grown rapidly, with the number of practicing DOs jumping from 30,000 in 1990 to 160,000 in 2025.
The Osteopathic Philosophy
DO programs are built around a specific medical philosophy that dates back to 1892, when Andrew Taylor Still founded the first osteopathic college in Kirksville, Missouri. Still believed that the body contained its own mechanisms for healing and that physicians should learn to support those mechanisms rather than rely solely on the drugs available at the time. That founding idea evolved into four core principles that still guide osteopathic education today.
The first is that the body functions as a single unit of body, mind, and spirit. The second is that the body is capable of self-regulation and self-healing. The third is that structure and function are directly related, meaning that problems in the musculoskeletal system can affect organ function and vice versa. The fourth is that effective treatment should be based on understanding all three of these ideas together. In practice, this means DO students are trained to think about the whole patient rather than isolating a single organ system or complaint.
What You Study in a DO Program
The core curriculum in a DO program mirrors what MD students learn: anatomy, physiology, biochemistry, pharmacology, pathology, and clinical rotations through internal medicine, surgery, pediatrics, psychiatry, obstetrics, and other specialties. The first two years focus heavily on classroom and lab-based science, while the third and fourth years shift to supervised clinical rotations in hospitals and clinics.
The distinguishing addition is training in osteopathic manipulative medicine (OMM). Students learn hands-on techniques for evaluating and treating the body’s structural framework. This training runs throughout the four years, with a minimum of 50 hours of dedicated instruction in osteopathic principles, at least 35 of which must be hands-on practice. Students also document performing these techniques on a minimum of 50 patients before graduating.
Osteopathic Manipulative Treatment
OMT is the hands-on skill set that sets DO training apart. Physicians use it to treat mechanical pain in muscles, joints, connective tissue, and bones caused by structural imbalance. It can also reduce swelling and ease symptoms of respiratory and digestive infections.
Several specific techniques are taught:
- Muscle energy: The physician guides you through specific movements that relax and lengthen muscles, increasing range of motion and improving circulation.
- Myofascial release: Gentle, sustained pressure on tight muscle and connective tissue to promote blood flow and relieve pain.
- Rib raising: A technique that gently lifts the ribs to stretch surrounding tissue, open the ribcage, and help the lungs expand more fully.
Not every DO uses OMT in daily practice. Some specialties like orthopedics or family medicine incorporate it regularly, while a DO working in cardiology or radiology may rarely use it. But the training shapes how DOs think about the relationship between the body’s structure and overall health, regardless of specialty.
Admissions and GPA Expectations
Getting into a DO program requires a bachelor’s degree, a competitive MCAT score, clinical experience, and strong grades. For the 2024 entering class, the average undergraduate GPA for students who actually enrolled (matriculants) was 3.59 overall and 3.49 in science courses. Non-science GPA averaged 3.71. These numbers are slightly lower than the averages at MD schools, though the gap has narrowed considerably as DO programs have grown more competitive.
Most programs also look for volunteer work, shadowing experience with a DO, and letters of recommendation. Demonstrating an understanding of the osteopathic philosophy is important during interviews, since programs want students who are genuinely interested in the whole-patient approach rather than simply looking for an alternative path into medicine.
Licensing Exams
DO students take the COMLEX-USA, a three-level licensing exam administered by the National Board of Osteopathic Medical Examiners. It’s structured differently from the USMLE that MD students take. COMLEX is designed to assess both general medical knowledge and osteopathic-specific skills, testing across two dimensions: patient presentation and physician tasks. Level 1 is scored as pass or fail, Level 2 reports a numerical score, and Level 3 (taken during residency) is also scored numerically.
Many DO students choose to take the USMLE in addition to COMLEX, particularly if they’re interested in competitive specialties or residency programs that are more familiar with USMLE scores. Taking both is optional but common.
Residency and Specialization
Since 2020, all residency programs in the United States have been accredited under a single system through the Accreditation Council for Graduate Medical Education. This means DO and MD graduates compete for the same residency positions. Before this merger, osteopathic and allopathic residencies operated under separate systems, which sometimes limited where DO graduates could train.
The transition was largely successful for primary care and most specialty programs. Nearly all osteopathic surgical subspecialty residencies and traditional rotating internships did not make the transition, but the overall effect has been to open more doors for DO graduates. Colleges of osteopathic medicine are particularly well known for producing graduates who go into primary care, rural medicine, and practice in underserved areas.
DOs can and do specialize in every field of medicine: surgery, dermatology, emergency medicine, psychiatry, anesthesiology, and beyond. The degree does not limit specialty options.
DO vs. MD: Practical Differences
Within the United States, a DO and an MD have identical practice rights. Both can prescribe medications, admit patients to hospitals, and perform surgeries. Patients often can’t tell the difference unless they look at the letters after their doctor’s name.
The practical differences come down to training emphasis and, to some degree, professional identity. DO programs instill a philosophy of treating the whole person and include OMT training. MD programs do not include this component. Once both doctors are practicing in the same specialty, their day-to-day work looks very similar.
One area where the distinction matters more is international practice. Practice rights for U.S.-trained DOs vary significantly by country. Many nations associate “osteopathy” with non-physician practitioners who only perform manual therapy, which can create confusion and licensing barriers. The American Osteopathic Association works to educate foreign health officials about the difference, but DOs planning to practice abroad should research the specific requirements of their destination country well in advance.