Letters to the Editor  |   January 2007
Author Affiliations
  • Joseph P. McNerney, DO
    AOA Bureau on International Osteopathic Medical Education and Affairs, Director, Osteopathic Division of Medical Education, Detroit, Mich
Article Information
Medical Education / Osteopathic Manipulative Treatment / Practice Management / Being a DO / Graduate Medical Education
Letters to the Editor   |   January 2007
The Journal of the American Osteopathic Association, January 2007, Vol. 107, 7. doi:
The Journal of the American Osteopathic Association, January 2007, Vol. 107, 7. doi:
Training and equivalency in osteopathic medicine across nations is a complex topic that could take years to study. However, the basic questions about the international practice of osteopathic medicine and osteopathy are relatively more manageable. 
In the United States, DOs are “doctors of osteopathic medicine”—the only practitioners of osteopathic medicine who are trained from the beginning of their education to integrate the full spectrum of medicine, including osteopathic manipulative treatment. In France, Germany, and Switzerland, some osteopathic practitioners are MDs who take additional courses in osteopathy after completing their medical training. Others in these three countries are “osteopaths,” who are trained in osteopathic principles and osteopathic manipulative treatment but who are not physicians. This second model also applies to most other countries, including the United Kingdom, Canada, Australia, and New Zealand. 
In most countries outside the United States, DO stands for “diploma of osteopathy,” not “doctor of osteopathic medicine.” Osteopaths who are not trained in the full scope of medicine are not afforded certain medical practice rights, such as surgical and prescribing rights. Many, however, do act as primary care providers, coordinating treatment with fully licensed primary care physicians. 
Every country has different requirements and a different way of licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the US Department of Education recognizes as physicians are graduates of osteopathic medical colleges in the United States.1 Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. 
On the other hand, US-trained DOs are currently able to practice in 45 countries with full medical rights and in several others with restricted rights, according to the AOA International Licensure Summary (available to AOA members only at: The AOA works with foreign health ministers and other health authorities to gain licensure and registration for its members on a daily basis. According to the AOA International Licensure Summary, the United Kingdom and New Zealand granted practice rights to US-trained DOs in 2005. 
While each country's requirements for osteopathic practice are different, the United Kingdom's requirements for registration may provide readers with an understanding of the steps required by many other industrialized nations. After submitting the required paper-work to the General Medical Council of the United Kingdom (London, England), each applicant must pass the two-part examination of the Professional Linguistic Assessment Board.2 This examination consists of a written medical examination and a clinical assessment examination. After passing the examination, an applicant is required to work under supervision in the National Health Service on limited registration for 1 year, which is similar to a residency program.3 After that year, the applicant can apply for full, unlimited registration (unsupervised practice or private practice).4 For registration as a specialist, an osteopath must receive separate recognition of his or her graduate training from the Postgraduate Medical Education and Training Board. 
In addition, the terms DO and osteopath are protected by the Osteopaths Act of 1993.5 As a consequence, a US-trained osteopathic physician practicing in the United Kingdom must register with both the General Medical Council and the General Osteopathic Council (London, England). 
I have just touched the tip of the proverbial iceberg. There are large differences in osteopathic medicine from one country to the next. I hope that this information has helped JAOA readers better understand the international practice of osteopathic medicine. 
Federal Register / Vol. 70, No. 190 /October 3, 2005 / Notices. Available at: Accessed January 3, 2007.
General Medical Council. International Medical Graduates - important information. Available at: Accessed January 3, 2007.
General Medical Council. Types of registration. Available at: Accessed January 3, 2007.
Postgraduate Medical Education and Training Board. Available at: Accessed January 3, 2007.
General Osteopathic Council. The Osteopaths Act 1993. Available at: Accessed January 3, 2007.