Osteopathic Physicians

What is a DO?

For more than a century, Doctor of Osteopathic Medicine (DO) physicians have practiced a holistic approach to health care. They know that the mind plays a crucial role in the body’s capacity to heal, that treating the whole person rather than just the symptoms is essential, that treatments such as osteopathic manipulative medicine (OMM) aid the body’s natural healing process, and that physicians should work in partnership with patients for the best outcomes.

http://www.pcom.edu/Philadelphia College of Osteopathic Medicine

A premier osteopathic medical school, Philadelphia College of Osteopathic Medicine boasts a history that spans more than 110 years and a rich tradition of training and placing DOs in primary and specialty care. Among its alumni that number more than 12,000, are board-certified specialists, academic leaders and educators, and recognized researchers and practitioners. These osteopathic physicians contribute to the health and health policy of communities throughout the nation-including those in disadvantaged rural areas and in regions especially impacted by primary care physician shortages.
As an academic institution, the College was among the earliest to adopt innovative high-fidelity patient simulators as well as standardized patient actors, providing students with experiential learning and proficiency modalities reflective of actual clinical procedure and practice. Sponsored research projects promote opportunities for collaborative research. And a commitment to community service is evident in College- and student-sponsored outreach programs as well as training at the College’s five Healthcare Centers that primarily benefit urban Philadelphia locales.
All instruction-didactic and clinical-is delivered by expert and accomplished faculty. Program curriculum includes clerkship participation at over 30 of the finest teaching hospitals in the greater Philadelphia area.

If you’re like most people, you’ve been going to physicians ever since you were born and perhaps were not aware whether some or all of them were osteopathic physicians, also known as DOs. You may not even be aware that there are two types of complete physicians in the United States—DOs and MDs.

The fact is that both DOs and MDs are fully qualified physicians licensed to prescribe medication and perform surgery.

DOs and MDs are Alike in Many Ways

• Students entering both DO and MD medical colleges typically have already completed four-year bachelor’s degrees with an emphasis on scientific courses.
• Both DOs and MDs complete four years of basic medical education.
• After medical school, both DOs and MDs obtain graduate medical education through internships, residencies and fellowships. This training lasts three to eight years and prepares DOs and MDs to practice a specialty.
• Both DOs and MDs can choose to practice in any specialty of medicine—such as pediatrics, family medicine, psychiatry, surgery or ophthalmology.
• DOs and MDs must pass comparable examinations to obtain state licenses.
• DOs and MDs both practice in accredited and licensed health care facilities.
• Together, DOs and MDs enhance the state of health care available in the U.S.

DOs, however, belong to a separate yet equal branch of American medical care. It is the ways that DOs and MDs are different that can bring an extra dimension to your health care.

AOA Rules and Guidelines on Physicians’ Professional Conduct
Professionalism and Physician Responsibilities
Professionalism is a core competency expected of all physicians. Physicians are among the most highly educated and trained professionals in our society and should enjoy the respect of their peers and the community. Society expects them to perform various roles. As health care providers, they diagnose and treat patients; as advisors, they provide patients with an understanding of their health status and the potential consequences of decisions regarding treatment and lifestyles; as advocates, physicians communicate with patients, their patients’ caregivers, and their patients’ health insurers the needs of the patient; and as counselors, they listen to their patients and discuss their condition with family members and others involved in health care decision-making. Physicians are entrusted by their patients and their patients’ families with private and confidential information, much of which is related to health care, but frequently includes other personal details.
Osteopathic physicians, in order to enjoy the continued respect and trust of society, recognize the responsibilities and obligations they bear and in order to maintain their status as professionals, must act accordingly. Medical ethics includes many tenets that should guide osteopathic physicians in their professional and personal activities. Although ethics and professionalism encompass broad concepts, some of the recognized elements are:
• Non-maleficence – first, do no harm
• Acting as a positive role model
• Displaying respect in interactions with others
• Legal and ethical behavior
• Appropriate management of potential conflicts of interest
• Beneficence – a physician should act in the best interest of the patient/altruism/placing the needs of the patient first
• Autonomy – the patient has the right to refuse or choose their treatment
• Dignity – the patient (and the medical professional involved with their care) has the right to dignity, truthfulness and honesty
• Participation in self-evaluation programs and acceptance of constructive criticism from others.
The AOA’s Code of Ethics offers rules to guide physicians in their interactions as physicians with their patients, with society, and with the AOA. This document is intended to supplement the Code of Ethics by providing rules and guidance for physicians’ conduct as professionals in the broader context beyond the traditional role in the delivery of care. Some of the Rules and Guidelines are mandatory (i.e., “shall” or “shall not”), while others are permissive (i.e., “may,” “should,” “should not” or “may not”) and recognize a physician’s discretion to assess the specific context and situation and exercise professional judgment.
Finally, the Rules and Guidelines are designed by the AOA to provide guidance to physicians in appropriate professional behavior and to provide a structure for regulating conduct. Any assessment of a physician’s conduct must be made with due consideration to the facts and circumstances that existed at the time of the conduct in question and recognize that a physician may have had to act based upon uncertain or incomplete information. The Rules and Guidelines are not intended to be a basis for civil liability. Rather, perceived failure of a physician to comply with an obligation or prohibition imposed by the Code of Ethics or these Rules and Guidelines is a basis for invoking the AOA’s disciplinary process through the Bureau of Membership’s Subcommittee on Ethics.
1. A physician’s conduct shall be consistent with the requirements of the law, whether providing medical/professional service to patients or in conducting business and personal affairs.
2. Physicians should use their status as professionals only for legitimate purposes and not to take advantage of economic or social opportunities or to harass or intimidate others.
3. A physician has an obligation to pursue a patient’s best interests and to be an advocate for the patient. In so doing, physicians shall conduct themselves in a civil manner. When appropriate, physicians should disclose and resolve any conflict of interest that might influence decisions regarding care.
4. Patients may come from any of a broad spectrum of cultures and beliefs. Physicians should conduct themselves with appropriate respect for their patients’ social and cultural needs and provide necessary care without regard to gender, race, color, religion, creed, age, marital status, national origin, mental or physical disability, political belief or affiliation, veteran status, gender identity or sexual orientation.
5. Physicians are allowed limited autonomy to govern conduct within their own profession through participation on state licensing boards, hospital credentialing committees and in peer review processes. Physicians should fully participate in self-regulation by setting, maintaining, and enforcing appropriate practice standards. Regulations and rules with respect to healthcare delivery shall be developed with the best interests of patient care in mind rather than advancing private interests or protecting friends or colleagues from adverse action.
6. Physicians are responsible for observance of the Code of Ethics and these Rules and Guidelines on Professional Conduct. While compliance depends primarily upon understanding of and voluntary compliance with these obligations, physicians should also make efforts to secure their observance by other physicians through expression of formal or informal peer opinion or, when necessary, invocation of disciplinary proceedings. Where a protected peer review process is available, adverse events and medical errors should be fully disclosed.
7. Physicians should be aware of disparities in medical care within the United States and internationally. Where possible, physicians should assist those less fortunate in securing access to appropriate medical care.

Licensing of Osteopathic Physicians

Osteopathic Physicians (DOs) are licensed to practice medicine in the United States by licensing boards in each state. Requirements for licensure vary by state, but there are generally three ways a DO can become licensed to practice medicine:

1. Successful completion of a medical licensing examination administered by the state licensing board. State boards may prepare their own examination or administer an examination that has been prepared and purchased from a specialized agency.

Today, the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) and the United States Medical Licensing Examination (USMLE) are the most widely used tests. The COMLEX-USA is the most widely used and the only licensure examination series accepted in all 50 states for the licensure of DOs.

2. Acceptance of the certificate issued by the National Board of Osteopathic Medical Examiners (NBOME), awarded after an applicant has satisfied the requirements, including the successful passage of a rigorous series of tests.

3. Reciprocity or endorsement of a license previously received from another state. The license presented for reciprocity or endorsement usually must have been issued on the basis of a written examination.

Although a physician may satisfy the basic licensing requirements for a state, this does not guarantee licensure. State licensing boards look at each applicant on an individual basis. They verify the information given and look into the moral character of the applicant.

AOA Code of Ethics
The American Osteopathic Association has formulated this Code to guide its member physicians in their professional lives. The standards presented are designed to address the osteopathic physician’s ethical and professional responsibilities to patients, to society, to the AOA, to others involved in health care and to self.
Further, the American Osteopathic Association has adopted the position that physicians should play a major role in the development and instruction of medical ethics.
Section 1. The physician shall keep in confidence whatever she/he may learn about a patient in the discharge of professional duties. Information shall be divulged by the physician when required by law or when authorized by the patient.
Section 2. The physician shall give a candid account of the patient’s condition to the patient or to those responsible for the patient’s care.
Section 3. A physician-patient relationship must be founded on mutual trust, cooperation, and respect. The patient, therefore, must have complete freedom to choose her/his physician. The physician must have complete freedom to choose patients whom she/he will serve. However, the physician should not refuse to accept patients for reasons of discrimination, including, but not limited to, the patient’s race, creed, color, sex, national origin, sexual orientation, gender identity or handicap. In emergencies, a physician should make her/his services available.
INTERPRETATION OF SECTION 3
THIS SECTION NOTES THAT A PHYSICIAN-PATIENT RELATIONSHIP MUST BE FOUNDED ON MUTUAL TRUST, COOPERATION AND RESPECT—A PATIENT MUST HAVE COMPLETE FREEDOM TO CHOOSE HIS OR HER PHYSICIAN, AND A PHYSICIAN MUST HAVE COMPLETE FREEDOM TO CHOOSE PATIENTS WHOM HE OR SHE WILL SERVE.
SECTION 3 DOES NOT ADDRESS A PATIENT’S DISCRIMINATING AGAINST A PHYSICIAN BASED ON THE PHYSICIAN’S RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, GENDER IDENTITY OR DISABILITY; AND A PATIENT MAY EXPRESS A DESIRE TO NOT BE TREATED BY A PARTICULAR PHYSICIAN OR BY A PHYSICIAN WITH CERTAIN CHARACTERISTICS.
THEREFORE, THE AOA INTERPRETS SECTION 3 OF ITS CODE OF ETHICS TO PERMIT BUT NOT REQUIRE AN OSTEOPATHIC PHYSICIAN TO TREAT A PATIENT WHEN THE PHYSICIAN REASONABLY BELIEVES THE PATIENT IS EXPERIENCING A LIFE- OR LIMB-THREATENING EVENT, EVEN THOUGH THE PATIENT MAY HAVE PREVIOUSLY EXPRESSED A DESIRE TO NOT BE TREATED BY A PHYSICIAN BASED ON THE PHYSICIAN’S RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, GENDER IDENTITY OR DISABILITY. (July 2014)

Section 4. A physician is never justified in abandoning a patient. The physician shall give due notice to a patient or to those responsible for the patient’s care when she/he withdraws from the case so that another physician may be engaged.
Section 5. A physician shall practice in accordance with the body of systematized and scientific knowledge related to the healing arts. A physician shall maintain competence in such systematized and scientific knowledge through study and clinical applications.
Section 6. The osteopathic medical profession has an obligation to society to maintain its high standards and, therefore, to continuously regulate itself. A substantial part of such regulation is due to the efforts and influence of the recognized local, state and national associations representing the osteopathic medical profession. A physician should maintain membership in and actively support such associations and abide by their rules and regulations.
Section 7. Under the law a physician may advertise, but no physician shall advertise or solicit patients directly or indirectly through the use of matters or activities which are false or misleading.
Interpretation of Section 7
This section is designed to discourage practices, which would lead to false, misleading or deceptive information being promulgated.
Section 7 does not prohibit advertising, so long as advertising is designed as making proper factual information available to the public. People seeking health care are entitled to know the names of osteopathic physicians, the types of practices in which they engage, their office hours, place of their offices, and other pertinent factual information. On the other hand, the public should be protected from subjective advertising material designed to solicit patients, which is essentially misleading. Such material would include attempts to obtain patients by influence or persuasion, employing statements that are self-laudatory and deceptive; the result of which is likely to lead a patient to a misinformed choice and unjustified expectations. (July 1985)

Section 8. A physician shall not hold forth or indicate possession of any degree recognized as the basis for licensure to practice the healing arts unless he is actually licensed on the basis of that degree in the state in which she/he practices. A physician shall designate her/his osteopathic school of practice in all professional uses of her/his name. Indications of specialty practice, membership in professional societies, and related matters shall be governed by rules promulgated by the American Osteopathic Association.
Guide to Section 8
This guide applies to AOA members’ professional (as opposed to organizational) stationery, office signs, telephone directories, and to other listings referred to by the general public. (July 1985)
Part I – Indications of Specialty Practice
1. Osteopathic physicians who are not certified by the AOA or who do not devote their time exclusively to a specialty should not indicate any area of practice specialization. They may designate the nature of their practice in one of the following ways:
• General Practice
• General Practice of Osteopathic Medicine
• Surgery
Osteopathic physicians who are certified by the AOA or who devote themselves exclusively to a specialty may designate such specialty in one of the following ways:
• Practice Limited to Internal Medicine (or other practice area)
• Internal Medicine
The listing of terms in each of the two categories is illustrative and should act as a guideline.
Part II – Membership in Professional Organizations
The public has little or no knowledge of what membership in various professional organizations entails. Accordingly, use of the names or initials of such organizations tends to indicate unusual professional competence, which is usually not justified. Professional stationery should contain no indication whatever of membership in professional organizations or of any present or past office held in any professional organization.
Designation of membership in various professional organizations is permissible on organizational stationery (AOA, divisional and district society, practice organizations, etc.) provided the organizational stationery is not used in practice correspondence.
The above guidelines apply with respect to written signatures of physicians. For example, a physician should not use FACOI or other appropriate fellowship designation in signing a letter or other communications that will go to a patient. The physician may use such designation in correspondence with other physicians or third parties.
Part III – Osteopathic Identification
The following, in order of preference, are considered proper on practice stationery and office signs:
• John Doe, DO
• John Doe, Osteopathic Physician & Surgeon
• John Doe, Doctor of Osteopathy
The following are not considered proper on practice stationery or office signs:
• Dr. John Doe (this is considered improper even if the doctor signs his name John Doe, DO). The osteopathic identification should be printed.
• Dr. John Doe, Specialist in Osteopathic Medicine. The term specialist should be avoided in this circumstance.
Part IV – Degrees (other than DO)
It is strongly recommended that only the degree DO appear on professional stationery. However, the following additional guides are offered: No undergraduate degree (BA, BS, etc.) should be used.
Graduate degrees (MA, MS, PhD, etc.) should not be used unless the degree recognizes work in a scientific field directly related to the healing arts. Therefore, advanced degrees in scientific fields such as public health, physiology, anatomy, and chemistry may be used but their use is not recommended.
Honorary degrees relating to scientific achievement in the healing arts or other achievements within the osteopathic profession (such as administrative excellence or educational achievement) may be used if the honorary nature of the degree is indicated by use after the degree of the abbreviation “Hon.”
Law degrees may be used if the physician carries on medical-legal activities.
Part V – Telephone Directory Listings
1. It is desirable for divisional societies to have an established program to implement these guidelines and, where necessary, to meet with representatives of the telephone companies in furtherance of that objective.
2. In classified directories, it is recommended that DOs be listed under the heading “Physicians and Surgeons-(DO)” and that there be a cross-reference to that heading from the heading “Physicians and Surgeons-Osteopathic.” This letter heading is also acceptable as the main listing if it has long been the heading customarily used in the community.
3. In telephone directory listings of doctors, it is recommended that the doctor’s name be followed by the abbreviation DO.
4. The abbreviation “Dr” is not recommended because it is misleading. “Dr” can refer to dentists, doctors of medicine, etc. “Phys” is also misleading because it can refer to MDs.
5. In telephone directories, no indication of certification or membership in any osteopathic professional organization should appear by initials or abbreviations, because such would generally be confusing.
6. In classified telephone directories it is not improper to indicate “Practice limited to” or simply to name the field of specialty.
Only specialties or practice interests recognized as such by the American Osteopathic Association should be indicated.
Only physicians who are certified in or who limit their practice exclusively to a specialty should list themselves in a particular field.
Section 9. A physician should not hesitate to seek consultation whenever she/he believes it advisable for the care of the patient.
Section 10. In any dispute between or among physicians involving ethical or organizational matters, the matter in controversy should first be referred to the appropriate arbitrating bodies of the profession.
Section 11. In any dispute between or among physicians regarding the diagnosis and treatment of a patient, the attending physician has the responsibility for final decisions, consistent with any applicable hospital rules or regulations.
Section 12. Any fee charged by a physician shall compensate the physician for services actually rendered. There shall be no division of professional fees for referrals of patients.
Section 13. A physician shall respect the law. When necessary a physician shall attempt to help to formulate the law by all proper means in order to improve patient care and public health.
Section 14. In addition to adhering to the foregoing ethical standards, a physician shall recognize a responsibility to participate in community activities and services.
Section 15. It is considered sexual misconduct for a physician to have sexual contact with any current patient whom the physician has interviewed and/or upon whom a medical or surgical procedure has been performed.
Section 16. Sexual harassment by a physician is considered unethical. Sexual harassment is defined as physical or verbal intimation of a sexual nature involving a colleague or subordinate in the workplace or academic setting, when such conduct creates an unreasonable, intimidating, hostile or offensive workplace or academic setting.
Section 17. From time to time, industry may provide some AOA members with gifts as an inducement to use their products or services. Members who use these products and services as a result of these gifts, rather than simply for the betterment of their patients and the improvement of the care rendered in their practices, shall be considered to have acted in an unethical manner.
Interpretation of Section 17
Section 17 relates to the interaction of physicians with pharmaceutical companies.
1. Physicians’ responsibility is to provide appropriate care to patients. This includes determining the best pharmaceuticals to treat their condition. This requires that physicians educate themselves as to the available alternatives and their appropriateness so they can determine the most appropriate treatment for an individual patient. Appropriate sources of information may include journal articles, continuing medical education programs, and interactions with pharmaceutical representatives.
2. It is ethical and in the best interest of their patients for osteopathic physicians to meet with pharmaceutical companies and their representatives for the purpose of product education, such as, side effects, clinical effectiveness and ongoing pharmaceutical research.
3. Pharmaceutical companies may offer gifts to physicians from time to time. These gifts should be of limited value and the appropriate to patient care or the practice of medicine. Gifts unrelated to patient care are generally inappropriate. The use of a product or service based solely on the receipt of a gift shall be deemed unethical.
4. When a physician provides services to a pharmaceutical company, it is appropriate to receive compensation. However, it is important that compensation be in proportion to the services rendered. Compensation should not have the substance or appearance of a relationship to the physician’s use of the employer’s products in patient care.
SECTION 18. A physician shall not intentionally misrepresent himself/herself or his/her research work in any way.
SECTION 19. When participating in research, a physician shall follow the current laws, regulations and standards of the United States or, if the research is conducted outside the United States, the laws, regulations and standards applicable to research in the nation where the research is conducted. This standard shall apply for physician involvement in research at any level and degree of responsibility, including, but not limited to, research, design, funding, participation either as examining and/or treating provider, supervision of other staff in their research, analysis of data and publication of results in any form for any purpose.