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That Thing You D.O.

Diversifying your pool of potential medical schools


Paul Jung, M.D. What is an osteopathic physician? This is an excellent, but unfortunately infrequently asked, question. Many medical students and applicants have never heard the term "osteopathy." Even within organized medicine there are disagreements about the similarities and differences between osteopathic and allopathic physicians. With this column, I hope to make clear the distinction between physicians who hold a Doctor of Osteopathy (D.O.) degree and those with a Doctor of Medicine (M.D.). And as you become more informed, you'll find that your list of potential medical schools will expand. Don't worry, though. This column also offers some tips for choosing among medical schools. Similarities and differences First and foremost, D.O.s are physicians who can practice medicine just like M.D.s. Osteopathic physicians hold all of the required state medical licenses and are eligible to practice in every medical specialty. The admission requirements to D.O. and M.D. schools are identical. The D.O. and M.D. curricula are also quite similar, and both degrees require four years of study. Both osteopathic and allopathic students have to pass background courses such as anatomy, physiology and pathology as well as all of the clinical clerkships. The scientific training in both types of medical school is equally rigorous. And as there are for M.D. students, there are combined degree programs for osteopathic students-D.O.-Ph.D., D.O.-M.P.H. and others. The D.O. boards cover the same material as the M.D. boards and ask the same types of questions. Like M.D.s, D.O.s must complete a residency-and may do so at the same program to which M.D.s apply and match. However, some state boards require D.O.s to complete a specific osteopathic internship before they can obtain a license. This internship would have to be done before either an osteopathic-specific residency or an allopathic residency. As another example of how similar the two degrees are, take a look at the 1961 allopathic conversion of a California osteopathic medical school. The state medical board decided to offer all of the school's alumni an M.D. degree for a $65 fee and a few required seminars. Osteopathic and allopathic physicians use the same medical reference books, learn about the same bodies, diagnose and treat the same diseases in the same patients, order the same diagnostic tests, dispense the same prescriptions and get paid the same money. The federal government recognizes no differences between D.O.s and M.D.s for the purposes of treatment and reimbursement under government-run health-care programs.

Yet despite all of these similarities, there are significant philosophical, if not practical, differences between osteopaths and allopaths. Let's look at how osteopathy began. Dr. Andrew Taylor Still formally launched osteopathic medicine in 1892 with the founding of the first osteopathic medical school in Kirksville, Missouri. An allopathic physician dissatisfied with contemporary medical practices, Still wanted to create a more comprehensive, holistic approach to medicine. With the belief that the human body can heal itself and that all disease has a basic musculoskeletal component, Still created the osteopathic manipulative treatment (OMT)-the manual manipulation of the body designed to stimulate the body's ability to combat disease and restore health. OMT is the cornerstone of the osteopathic medical curriculum. Many people believe the OMT philosophy and treatment to be the true distinction between osteopaths and allopaths. Many D.O.s use OMT in their daily practice, sometimes on its own or in combination with other therapies such as prescribing medicine or performing surgeries. Conversely, many D.O.s do not use OMT in their practices, further blurring the line between allopathic and osteopathic medicine. There are 19 osteopathic medical schools and 125 allopathic medical schools in the United States. D.O. graduates comprise 6 percent of the physician population and 15 percent of physicians practicing in our underserved communities. In contrast to M.D.s, D.O.s have historically chosen to practice in primary care fields. D.O.s and M.D.s have virtually the same professional opportunities. Every premed should consider both osteopathic and allopathic medical schools. For more information about osteopathic medicine and osteopathic medical schools, you can contact: the American Association of Colleges of Osteopathic Medicine (http://www.aacom.org ); the Student Osteopathic Medical Association (http://www.studentdo.com ); and the American Osteopathic Association (http://www.aoa-net.org ). So many schools, so little time and money With 19 osteopathic and 125 allopathic medical schools on your list of possibilities, exactly how many medical schools should you apply to? This is a perennial question for many premeds. Surely you shouldn't apply to all of them. Nor should you apply only to two or three prestigious institutions. What is the appropriate number? To determine this, take a look at your odds of acceptance. Of course, there are numerous variables to consider, so here are some handy guidelines: Apply to your state school(s). State-affiliated medical schools typically give preferential consideration to in-state applicants. So unless you have extreme reservations about attending a particular institution, you should stack the deck in your favor by applying to all of your state medical schools. Some schools may not be state-supported, yet still may provide preferential consideration for state residents. For example, for Pennsylvania residents, the University of Pittsburgh charges a lower tuition and the University of Pennsylvania offers preferential admissions. So if this is true in your state, apply to these schools as well.

If your state doesn't have an affiliated medical school, check to see if surrounding states' medical schools would offer you preferential consideration. Pennsylvania's Thomas Jefferson University gives preference to Delaware applicants, and Washington's medical school gives preference to applicants from Idaho, Wyoming, Alaska and Montana. The bottom line is to investigate which schools would offer you preferential consideration and apply to those. Location, location, location. Many students would prefer to live in a particular region or city. If this is the case for you, you should apply to several medical schools in your desired areas. Don't hesitate to cluster your applications and frankly admit to admissions committees that you prefer that region of the country. But, don't necessarily expect your personal preference to carry any weight with a school's admissions staff. Money talks. Applying to medical school costs money. So the number of schools you apply to may be limited by the amount of money you have to spend on applications. If this is the case, financial restraints behoove you to choose carefully. Unfortunately, medical school tuition is also pricey. Your state school probably charges the least expensive tuition, but you must also consider living expenses and other costs when evaluating schools. If certain institutions are prohibitively expensive for you, don't bother applying to them. Of course, as a medical student you will have absolutely no problem finding an adequate number of loans to cover all your expenses. But keep in mind there's no guarantee these loans will carry a reasonable interest rate. Don't bury yourself in debt. And never assume that a higher tuition implies a higher quality of education. In fact, when comparing schools with radically different tuitions, you should always ask yourself, "What am I getting in return for paying the additional tens of thousands of dollars per year?" You should research the financial aid, grant and scholarship options at each school. Some institutions have special programs significantly reducing tuition. These deserve investigating. Matching interests. Some schools have truly unique and innovative curricula designed to encourage and develop particular interests or medical careers. For example, Mercer University School of Medicine and the University of MinnesotaDuluth School of Medicine were both founded to provide physicians for rural underserved areas. You should investigate several schools matching your career interests and apply to them. Obviously, your application to these schools should promote your interest in their special programs. And it makes no sense to apply to schools with strong primary care programs if you're interested in a subspecialty and vice versa. Remember to diversify your list. If your entire application list consists of similar schools and you suspect you lack the qualifications for one of them, chances are you won't be admitted to the rest either. You should strive for a balanced list-one that includes several different schools, varying by location, state affiliation, unique programs and special interests. In other words, don't apply only to the Ivy League

schools or only to M.D.-Ph.D. or D.O.-Ph.D. programs. Nor should you apply only to "safety schools." Diversify your list of medical school choices, take a few chances, but always be reasonable. There are many options available to you, and with a little research and analysis, you should be able to select the medical institutions that are the best fit for you.

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