During my four years as an undergraduate attending the University of South Florida, I had the privilege of meeting doctors from a variety of backgrounds. I met medical doctors, osteopathic doctors, naturopathic physicians, Oriental medical doctors, acupuncture physicians, and chiropractors. All are technically physicians who practice some form of medicine. I am writing this article to explain what I learned about the differences and similarities of these physicians I met from various backgrounds. Topics including the explanation of the field, history, schooling, laws, cost of education, and salary will be discussed.
Medical doctors, MDs, are those we typically associate with being physicians. They usually practice allopathic, or Western, medicine. They wear white coats, stethoscopes, practice in rooms with bright, fluorescent lights, poke you with needles, prescribe medication, perform surgery, and so forth… Of course, not all MDs practice in this fashion, I just wanted to exemplify a, “typical MD.”
MDs undergo rigorous schooling. In the United States, they undertake 3-4 years of undergraduate coursework and complete the minimum basic science courses such as biology, chemistry, organic chemistry, and physics; many will take upper-level courses such as biochemistry, genetics, and physiology. To be accepted into medical school, an undergraduate student typically has to have a stellar GPA (e.g. 3.7 out of 4.0), a stellar MCAT score (I cannot comment because the test and scoring system was recently changed an I am not familiar with it), 3-5 letters of recommendation from professionals, hundreds of hours of meaningful shadowing, research and volunteering experience, and the ability to do a handstand on a narrow plank above a tank of live sharks… Basically, MDs are very dedicated students who can handle the pressures of rigorous coursework, little sleep, and tight schedules.
MD students have four years of basic medical education, typically the first two years cover the ins and outs of the human body, the last two years are rotations in various medical specializations. After completing medical school, the students begin residency; depending on the specialty, this training could last as little as three years to as many as ten plus.
MDs are allowed to practice in any state (as long as they are licensed in that state) and virtually anywhere in the world. The cost of their schooling may be over $200,000. The earning potential of MDs is tremendous, even the lowest paid typically earn $100,000+ after completing their residency training. Specialists typically earn hundreds of thousands per year. Residents typically earn $40,000 or more per year.
In conclusion, MD schools have the highest entry standards and typically attract the brightest and most well-rounded students. Their schooling is of the most rigorous and produces physicians well versed in even the most minute details of the human body; a strong emphasis is based on teaching healing modalities centered around drugs, radiation, and surgery. The cost of schooling is high, but the earning potential is also high, and guaranteed as long as the student gets through medical school, residency training, and continues learning as they practice. They may work 70 or more hours a week depending on the specialty.
Doctors of Osteopathic Medicine
Doctors of Osteopathic Medicine (DOs), earn a nearly equivalent education as medical doctors. In addition to the standard medical school curriculum, DOs learn osteopathic manipulative medicine (OMM). This approved medical modality is a hands-on approach. “It involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, your osteopathic physician will move your muscles and joints using techniques including stretching, gentle pressure and resistance (1).”
There are four main principles of osteopathic medicine (2):
- The body is a unit, and the person represents a combination of body, mind and spirit.
- The body is capable of self-regulation, self-healing and health maintenance.
- Structure and function are reciprocally interrelated.
- Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
Although all osteopaths are taught OMT, they do not all use it as a healing modality. DOs are licensed to prescribe drugs, radiation, and surgery as MDs; they may follow an allopathic approach to healthcare. DOs can be licensed to practice in any state and take board exams equivalent to MDs. There are fewer osteopathic schools than traditional medical schools (30 v. 141), but the entrance requirements for osteopathic schools are typically less rigorous than for MD schools. The GPA and MCAT requirements are slightly lower, say a 3.5 average GPA as opposed to 3.7, and a few points less on the MCAT. But, the education, volunteering, shadowing, and letter requirements are typically the same.
DOs are viewed as equivalent to MDs in the United States; the cost of tuition is about the same, as is the earning potential. DOs can also apply to the same residencies as MDs, although their primary education is tailored towards primary care specialties.
Naturopathic doctors (NDs) practice naturopathic medicine. The following principles are the foundation of naturopathic medical practice (6):
- The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic medicine recognizes an inherent self-healing process in people that is ordered and intelligent. Naturopathic physicians act to identify and remove obstacles to healing and recovery, and to facilitate and augment this inherent self-healing process.
- Identify and Treat the Causes (ToIle Causam): The naturopathic physician seeks to identify and remove the underlying causes of illness rather than to merely eliminate or suppress symptoms.
- First Do No Harm (Primum Non Nocere): Naturopathic physicians follow three guidelines to avoid harming the patient:
- Utilize methods and medicinal substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat;
- Avoid when possible the harmful suppression of symptoms; and
- Acknowledge, respect, and work with individuals’ self-healing process.
- Doctor as Teacher (Docere): Naturopathic physicians educate their patients and encourage self-responsibility for health. They also recognize and employ the therapeutic potential of the doctor-patient relationship.
- Treat the Whole Person: Naturopathic physicians treat each patient by taking into account individual physical, mental, emotional, genetic, environmental, social, and other factors. Since total health also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal spiritual development.
- Prevention: Naturopathic physicians emphasize the prevention of disease by assessing risk factors, heredity and susceptibility to disease, and by making appropriate interventions in partnership with their patients to prevent illness.
Naturopathic medical schools require typically the same basic science/humanities classes as MD and DO programs, but the entrance requirements are not as rigorous. The GPA must be high, but 3.4 would likely allow entrance; a 3.4 may not be considered high enough for many MD/DO schools (6). ND schools do not require the MCAT, nor any graduate standardized testing such as the GRE, for entrance. The volunteering, shadowing, and research experience required for entrance is likely equivalent, as well as the recommendation letters.
NDs learn the basic sciences as do MDs and DOs, and their schooling is typically four years, but the healing modalities taught can differ. An emphasis is based on natural healing as opposed to using drugs, surgery, and radiation as medicine. NDs are taught about pharmaceuticals, radiation, and surgery, but no so in-depth as MDs and DOs. Modalities including clinical nutrition, botanical medicine, homeopathic medicine, acupuncture, Oriental medicine, lifestyle counseling, massage, physical medicine, and hydrotherapy are emphasized. Oriental medicine, acupuncture, and massage are typically addressed in ND school, but further education is required to become proficient in these techniques. Most schools provide further training.
“Currently, 17 states, the District of Columbia, and the United States territories of Puerto Rico and the United States Virgin Islands have licensing or regulation laws for naturopathic doctors. In these states, naturopathic doctors are required to graduate from an accredited four-year residential naturopathic medical school and pass an extensive postdoctoral board examination (NPLEX) in order to receive a license (7).” Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Kansas, Maine, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Utah, Vermont, Washington, United States Territories: Puerto Rico and Virgin Islands currently have licensing laws for naturopathic physicians. Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan are provinces which offer regulation and registration for NDs.
From my understanding, NDs serve as primary care physicians in the aforementioned states and provinces; their services may or may not be covered by insurance.
The tuition for ND school may be as much as MD and DO school. Residency is not a requirement after completing ND school, although some graduates will train for an additional 1-2+ years as residents in a specialty field. From my understanding, not all graduates can attend a residency program, as spots are limited (8). ND residents may not earn as much as their MD & DO counterparts (9). Graduates are not guaranteed job placement either, and may have to start their own business or partner with other healthcare practitioners (10). NDs can earn salaries equivalent of more than their MD/DO counterparts, but in their first few years of practice, they may earn as little as $20,000 (10). ND students are eligible for educational loans to pay for tuition, but their repayment options may be more limited than MDs/DOs.
Oriental Medical Doctors & Acupuncture Physicians
Oriental Medicine is based in the practice of Traditional Chinese Medicine (TCM). “TCM has the power to unlock your true potential and help you develop and use your own unique gifts and talents. Its insightful wisdom and ability to understand and address individual health needs empowers each person with a way to unite body, mind, and spirit—the foundation for lasting, authentic health. TCM teaches you how to live a life of balance, wellness, and harmony (11).
Students of Oriental medicine study modalities including acupuncture, herbology, Taiji, and Qigong; they are provided with in-depth knowledge of the basic Western sciences as well as the energetic properties of the body such as meridians and acupuncture points. Students attend accredited masters program and get thousands of hours of training over 3-4 years. They can sit for national tests in acupuncture, Chinese herbology, Asian body work therapy, and Oriental medicine (12). Professional post-graduate doctoral programs in acupuncture and Oriental medicine (DAOM) are available to graduates of master’s Oriental medical programs (13).
Entrance into Oriental medical school is less rigorous than MD/DO; coursework must be taken in the basic sciences, but national tests such as the MCAT need not be taken. GPA requirements tend to be lower as well. Of course, extracurricular experiences and knowledge of Oriental medicine are expected, as well as strong letters of recommendation.
The cost of education is dependent on the school, although it is likely less than MD, DO, and ND. Licensing and laws vary greatly by state, as do salary earnings. I am honestly not sure how much DOMs and APs earn, although it appears to be dependent upon training and experience.
Doctors of Chiropractic Medicine
“Doctors of chiropractic — who are licensed to practice in all 50 states, the District of Columbia, and in many nations around the world — undergo a rigorous education in the healing sciences, similar to that of medical doctors. In some areas, such as anatomy, physiology, and rehabilitation, they receive more intensive education than most medical doctors or physical therapists (14). ” “Chiropractors care for patients with health problems of the neuromusculoskeletal system, which includes nerves, bones, muscles, ligaments, and tendons. They use spinal adjustments, manipulation, and other techniques to manage patients’ health concerns, such as back and neck pain (15).”
Students of chiropractic medicine have studied 3-4 years before entering school and must complete all requirements mentioned for MDs/DOs, besides the MCAT. No standardized testing is required for entrance. The entrance requirements are also less rigorous than MD/DO. After four years of training and licensure, chiropractors can begin practicing. The earning potential is lower initially than MDs/DOs, but can grow over time.
Info on other professions can be found by clicking here. The professions included in the link are highly regulated and provide healthcare to the public, such as physical therapists and podiatrists. There are less regulated “healers/physicians” practicing in the United States, such as Ayurvedic doctors, holistic healthcare practitioners, and so forth. To discuss each is beyond the scope of this article. There is much validity to the practice of ancient medical systems such as Ayurveda, but the practitioners are not necessarily bound by any laws, and their education may be spotty, so if patients seek treatments from such practitioners, it is definitely a good idea to check the laws for your state and the qualifications/experience of the practitioner. Serious harm may ensue from a practitioner which has a basic certificate and good intentions.
MDs and DOs undergo the most rigorous, scrutinized training of all the doctors. They are trained mainly in Western medical protocols, although DOs may utilize a technique which promotes the body’s innate healing capacity. NDs, DOMs, APs, and chiropractors use techniques which stimulate the body’s innate healing capacity, although their education and standards for practice may be less rigorous than MDs and DOs. There exist other “doctors” who may not be doctors at all, simply practitioners with good intentions and little understanding of the human frame.
All in all, it is up to the patient to discern who is the best doctor for them. MDs and DOs have the most rigorous education, and MDs, DOs, and NDs are eligible to learn advanced integrative medical healing modalities which are on the forefront of medical research today (16). Most allopathic and osteopathic medical schools fall short of providing adequate education in nutrition, and therefore cannot teach proper nutritional protocols to their patients (17). NDs may know a lot about nutrition, but are not as highly trained as their MD and DO counterparts. And so on…
I hope this article adequately explained the difference in the training and practice of a variety of healthcare providers. It is not comprehensive by any means, just a simple overview in case you were curious ;-). Hopefully it will help aspiring undergrads who are not sure about which path to choose, and patients who are not sure of the education and training of these “mysterious” osteopaths, naturopaths, TCM doctors, and chiropractors.
It is also important to mention that no matter the title of a doctor, their intention, enthusiasm, self-care protocol, and training is what really counts. An MD who had one course on nutrition in medical school may have studied nutrition for years as part of continuing education, and an ND who was taught basic nutrition in their 4 years at ND school may not have kept themselves completely updated on new research. And so forth…
I believe that some time in the not to distant future, the best medicine will prevail, and this integrative approach will be taught in medical schools. It has already begun with so many allopathic schools teaching integrative approaches such as acupuncture, meditation, nutrition, self-care, and the National Institute of Health throughly investigating these alternative healing modalities (18).
Hope you enjoyed; if I messed up any of the facts or should have added more please let me know in the comments 🙂
Other Healthcare Careers
1) Healthcare Careers
2) Consortium of Academic Health Centers for Integrative Medicine
3) American Holistic Medical Association
4) University of Arizona’s Integrative Medicine Distinction Track
5) National Center for Complementary and Alternative Medicine (NCCAM)
6) Integrative Medicine Fellowship in Residency
7) Integrative Medicine in Reisdency
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*Originally posted on my old website which no longer exists, riverbearfitness.com.