The Future of DO and MD Licensing

Across the United States, the approach to licensing doctors—whether osteopathic (DO) or allopathic (MD)—varies significantly. While 37 states, including populous ones like New York and Texas, have unified licensing boards overseeing both DOs and MDs, 13 states maintain distinct boards for each. This edition of "Credentialing Insider" delves into the impact of these different approaches and explores the ongoing debate on whether to merge licensing boards.

A Look Back at Osteopathic Medicine's Roots

Recent studies, including a 2023 report in the Annals of Internal Medicine, show that DOs and MDs provide equally effective care. The osteopathic field is expanding, with one in four medical students enrolled at osteopathic schools, and projections suggesting that by 2030, one in five physicians will be a DO.

The integration of osteopathic and allopathic training was solidified in 2020 when DOs joined MDs in competing for the same residency slots, achieving nearly identical match rates.

Historically, separate licensing boards for DOs were created to protect them from allopathic bias. While remnants of this bias exist—some still view DO programs as less rigorous—the overall acceptance of osteopathic medicine has grown significantly, showcasing its established role in the healthcare system.

West Virginia's Licensing Debate: A Closer Look

Since 2017, a question has loomed in West Virginia's legislative halls, posed by a member of the West Virginia State Senate Takubo: Why does the state maintain separate licensing and disciplinary boards for osteopathic (DO) and allopathic (MD) physicians? These boards operate under markedly different rules and standards, creating a puzzling disparity.

In an attempt to streamline and unify these bodies, Takubo, who is also an osteopathic physician and pulmonary critical care specialist, proposed legislation in February to merge the two boards. His vision was a single board overseeing both the 9,067 MDs and 1,800 DOs practicing in the state. Despite securing strong bipartisan support and backing from both existing boards, the initiative stumbled at the governor’s desk. In March, Governor Jim Justice vetoed the bill, siding with organized osteopathic groups who feared such a merger would erode the autonomy of DOs.

The proposed legislation was designed to equalize the representation and influence of DOs and MDs by appointing five members from each discipline to the new board. It also sought to eliminate outdated biases, epitomized by disparate standards that imply inferiority of DOs compared to MDs. For instance:

• The West Virginia Board of Medicine requires "clear and convincing evidence" of wrongdoing to discipline an MD, whereas the Board of Osteopathic Medicine only needs a "preponderance of evidence" to take action against a DO.
• MDs are required to complete 50 hours of continuing medical education (CME) every two years for re-licensure, while DOs are required only 32 hours.
• The MD board can issue temporary licenses quickly for physicians needing to start work immediately and also grants special administrative licenses for non-practicing clinicians, privileges not extended by the DO board.
• Unlike the MD board, which restricts academic MDs from membership, academic DOs are eligible to serve on the DO board.

New Mexico's Unified Medical Board

New Mexico recently saw a significant shift in how it regulates medical practitioners by merging its osteopathic and allopathic boards into a single entity as well. This move was driven by a consensus among state officials and osteopathic physicians that the previous structure did not adequately support the state’s 1,000 DOs. Previously, the osteopathic board was grouped with regulatory bodies for professions distinctly different from medicine, such as chiropractors, tattoo artists, and barbers.

The push for this merger began several years ago, spurred by the small number of osteopathic physicians in the state and frustrations over the inefficiency of the DO board in processing licenses. However, efforts to consolidate were initially stalled due to strong opposition from the dean of the state's sole osteopathic medical school.

Brad Scoggins, DO, a former president of the New Mexico Osteopathic Medical Association, highlighted the benefits of the merger, noting that it was crucial for complaints against DOs to be handled by the same board that oversees MDs, ensuring fair and equal treatment.

He pointed out that while there might be a case for maintaining separate boards in states with larger numbers of osteopathic physicians, New Mexico’s reality was different. In this state, DOs often hold significant leadership positions in healthcare, such as chiefs of staff, heads of surgery, and medicine, demonstrating that parity between DOs and MDs has largely been achieved. This integration, according to Scoggins, reflects a modern understanding that the distinction in regulatory oversight between the two types of physicians was no longer necessary.

Join the Discussion

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