FAQ

Osteopathic medicine is the best-kept secret in medicine! There are two types of licensed physicians in the United States—DOs (Doctor of Osteopathic Medicine) and MDs (Medical Doctor). To be an osteopathic physician, an individual must graduate from an American College of Osteopathic Medicine. The fact is that both DOs and MDs are fully qualified physicians licensed to prescribe medication and perform surgery. DOs have exactly the same practice rights as their MD counterparts in all scopes of medicine.

www.osteopathic.org
www.osteopathic.ca

Originally Posted by AACOM for the 2010-2011 cycle:
Potential medical students have submitted more than 100,000 applications to the nation’s 26 osteopathic medical colleges; on average, the colleges are receiving approximately 20 applications for every available seat. 19,426 students are currently enrolled in an osteopathic medical college, a number that has nearly doubled since the year 2000. More than 20 percent of new U.S. medical students are studying at osteopathic medical colleges. By 2015, more than 5,300 osteopathic physicians will graduate from the nation’s osteopathic medical schools each year.

That does not mean there are not important differences. While osteopathic physicians are trained in all areas of medicine as an allopathic physician, osteopathic training emphasizes a holistic perspective on patient health. Where an MD will see a disease and prescribe medication, a DO will try to understand an ailment in the context of the life of the patient, address sources of stress and unhealthy habits, and try to restore all aspects of health rather than treat a cluster of symptoms. Osteopathic physicians are also skilled in palpation and treating problems with function arising from physical alignment disorders using Osteopathic Manipulative Medicine.

They have the same exact practice rights! DOs and MDs take exactly the same classes, except DO’s are taught an additional skill- Osteopathic Manipulative Medicine (OMM) which stems from the idea that structure and function of the body are interrelated. Based on this theory, any misalignment of the spine or joints causing impingement on nerves or fascia can cause the body to function less than optimally. Osteopathic Manipulation is gentle, directed manipulation of the spine, limbs, and joints that aims to restore the body to its optimal structure so it can resume optimal function. Osteopathic physicians also learn manipulation involving high velocity and low amplitude, which is very different from the high amplitude manipulation used by chiropractors, as well as a variety of other techniques. OMM is applicable for a wide variety of other complaints. If you are interested in applying to a DO school, you should be familiar with OMM and the theory behind it, and be able to explain why it appeals to you.

Another important difference is that osteopathic training emphasizes a holistic perspective on patient health. Where an MD will see a disease and prescribe medication, a DO will try to understand an ailment in the context of the life of the patient, address sources of stress and unhealthy habits, and try to restore all aspects of health rather than treat a cluster of symptoms.

Only graduates from DO schools in the United States of America are considered physicians with equivalent practice rights to MDs. The Osteopathic Colleges in Canada, England, Scotland, etc. (ie. you have the Canadian college of Osteopathy http://www.osteopathiecollege.com/) also grant DO degrees, but graduates from these colleges are limited to Osteopathic Manipulative Medicine (which is a cornerstone of what makes Osteopathic medicine different from Allopathic medicine). These schools do not offer the full medical training of American Colleges of Osteopathic Medicine. Osteopaths are not physicians, and cannot register with the CPSO, or any medical specialty in Canada or the US; they fall in the same category as naturopaths and chiropractors. US-trained Doctors of Osteopathic Medicine are fully licensed physicians.

DO schools should not be compared on the same level to international Ireland/Australia/Carribean medical schools. Osteopathic medicine is an alternate North American medical degree that gives you the full practice rights as the North American MD degree in the US and in much of Canada. Going overseas places a candidate in the IMG pool, which means significant hurdles in the match. With a DO degree, a candidate is essentially guaranteed a US residency.

This is an issue of graduating as an American medical graduate, where you can get the full benefits of going to a US-accredited medical school, compared to the difficult path of going through the IMG route and facing much lower residency matching rate when the time comes.

See below for residency matching statistics

With all of the "out of Canada" medical degree routes (regardless of whether you chose IMG MD/ MBBS), one needs to be comfortable with the fact that you might never end up coming back to practice in Canada. You might have to match and practice in the US for a period of time - this is simply reality. However, in choosing a Carib MD/MBBS route, you should not expect to easily make it back into Canada for a residency. The chances are truly stacked against you.

From some first hand observation -

I see the struggles IMGs face (both Canadian-born who went abroad and newer Canadians who immigrated here) and it is not pretty. For Round 2 of CaRMs, my program (which is not even that competitive to get into in Round 1) got 122 applications for 1 spot. The vast majority were IMGs who went to Ireland, Australia, and the Caribbean who did not match first round.

Yes, you will hear of the one or two grads who went to SGU and got derm somewhere. But what you will not hear about are the countless others who make it through four-five years of med school, only to get rejected again in trying to secure a residency. Going overseas (non-LCME) is a HUGE risk and do not fool yourself into thinking that it is not.
- www.premed101.com/forums

Also the following quote speaks volumes -

I emailed 40 program directors for 40 different residency programs in CA (the state I want to do residency) and proposed a hypothetical situation. If I got into both RVU (DO granting program) and SGU (caribbean MD program) I asked which program I should attend to be most competitive for their residency program.
31/40 Said I should I should attend RVU
2/40 Said that IMG MDs and DOs are looked at equally
7/40 never responded.
0/40 Suggested SGU
- www.studentdoctor.net

An IMG is an IMG in Canada, it does not matter where one obtained their med education outside of North America. It is also a simple matter of fact that attending a US school (whether MD or DO) will give you a easier time during the residency match process (with first iteration putting you on the same footing as Canadian graduates). Also, it really is not that hard to get into a USDO school in terms of hard stats. But the benefits of attending one will pay for itself when residency application time rolls around. If you have the stats to be enrolled in a Caribbean, or Irish, or Aussie school, then you should not have a problem getting into a USDO school either.

Complete instructions for applying to a DO program in the US can be found on the website for the American Association of Colleges of Osteopathic Medicine (AACOM): www.aacom.org

Canadian prerequisites are acceptable. When the DO schools say they want their prereqs to be done in the US, what they really mean is that they accept course work done in the US or Canada (and if confusion lingers, email their adcom office to explain you are a Canadian). If someone was to have done their prereq in (say) Mexico, or anywhere else in the world, they would then have to have their credits looked over by an agency for equivalence to the US credit systems. Fortunately for Canadians, the American education system is nearly identical to the Canadian one, so we do not need to go through any of that. Just sent in your transcripts to AACOM, and it should be fine.

No, it is probably sufficient to have a your undergraduate university attach a copy of the OMSAS grade scale with your transcript, and send this to AACOMAS - but you should confirm this with AACOMAS.

Anything above the mid 20s. Any score in the 30s will really stand out.

A general arts course (e.g. sociology) can sometimes be sufficient - check with each school you are interested in applying to. Some may give you credit for courses you have already taken.

For AACOM (or AAMC) application purposes, full credit courses (1.0 credit) with labs are considered to have 8 semester hours. Full credit (1.0 credit) courses without lab are considered to have 6 hours. Half credit courses (0.5 credit) with lab are considered to have 4 credits, while half credit (0.5 credit) courses without lab are considered to have 3 credits . Basically, what this means is that Canadian schools do not give you 2 extra semester hours for labs in the courses. And yes, half credit courses (with OR without lab) are only "worth" 3 semester hours, while full credit courses (with or without lab) are only “worth” 6 hours. BUT the AACOM knows this Canadian difference, so they will adjust accordingly (and if not, your school will know of this difference so your school admission will adjust accordingly). On you AACOM application, you should write down the full name of the course followed by whether this course has a lab or not (e.g. BIO150Y1Y - Organisms in their environment (with lab)), vs. (ANT203Y1Y - Human Evolution (no lab)). The vast majority of problems can be avoided by doing this.

-Make sure you have a thorough understanding of how the American health care system works. It is very different from ours.
     - The Medical School Interview by Jeremiah Fleenor has some great tips. It is a very quick read.
     - Shadow a DO in Canada or in the US. A DO registry is located on this site under Resources.

You will need additional health insurance coverage on top of your provincial health plan. It is very important that you let the Ministry of Health in your province know that you are going to be out of the province for an extended period of time, to ensure that your provincial coverage does not lapse. They can issue you a special health card that is valid until your studies in the US are complete.

Once you have been accepted to a school in the US, you can have the school issue you an Enrollment letter which you can then use to apply for this special health card.

The Cooperators Travel Insurance-Basic plan- provides emergency hospital coverage, should you fall seriously ill or have an accident while out of the country. It should be sufficient to meet with your school health insurance requirements.

Alternatively, most schools offer health insurance to their students at relatively reasonable rates. This is a feasible back-up option for most. Make sure to look into what kind of health insurance plan your schools of interest are offering.

You will need an I-20 from the school once you are accepted.Start the process early after receiving your acceptance as it can take a while. A school official specific to dealing with international students will issue the I-20 once they have received proof of your ability to pay the tuition and associated living costs for the program.

You will need proof of funds from your bank/personal finances/line of credit approval, usually in the form of a signed letter from a bank employee; you will have to send proof of funds to your school for them to issue you an I-20.

Check the Canadian Consulate in Ottawa website to find out what documentation will be required to enter the US as a student.It is very important that you enter the US as a student, and not as a visitor.

Look into the "Big Five" Canadian Banks - TD, BMO, CIBC, Royal, and Scotia. Most are willing to extend a professional education line of credit for an accredited College of Osteopathic Medicine. For example, TD Canada trust will give you 200K, 50K per year on a Professional Student Line of Credit.

There is no issue getting loans as a DO Medical student (vs MD) because all DO schools are listed on Avicenna directory; an international directory of accredited medical schools compiled by the World Health Organization. This is the site that the bank will reference when deciding whether your school allows you to qualify for a loan.

Canadian students studying in Osteopathic medical programs in the United States may be eligible for Canadian student loans depending on their province of residence. Government student loans can be beneficial for several reasons; they generally do not require payments or accumulate interest until your studies have been completed, they may include grants which do not need to be repaid, and in some circumstances students can apply for loan forgiveness/debt reduction upon completion of their studies for a portion of what has been borrowed.

Information on provincial policies and applications can be found below. Application deadlines vary by province so it is important to verify when your application needs to be submitted. Many factors affect your eligibility and the award will vary between individuals, the lifetime maximum provided does not reflect your actual award but is meant to show the maximum amount of funding that may be available to you. The lifetime maximum includes any loans received during your undergraduate degree.

Additional information as well as an estimate loan calculator can be found at:

http://www.canlearn.ca/eng/postsec/index.shtml

A list of recognized international educational institutions can be found at the website below. If your school is not listed you may still be eligible for loans by requesting that it be added as a designated university.

http://tools.canlearn.ca/cslgs-scpse/cln-cln/50/reea-mdl/reea-mdl-1-eng.do?nom-name=inter

This information is intended as a guideline; information provided is not guaranteed and may vary.

Province	Lifetime max. available for medical degree (federal and provincial combined)	Accredited D.O. schools recognized?	Website
British Columbia	$50 000	YES	http://www.aved.gov.bc.ca/studentaidbc/ila/welcome.htm
Alberta	$150 000	YES	http://alis.alberta.ca/et/fo/studentsfinance/students-finance.html
Saskatchewan	Medical students qualify for a maximum of $575/week during medical school (up to 400 weeks of study including undergraduate degree)	YES	http://www.aeei.gov.sk.ca/applying-assistance-student-loans
Manitoba	$140 000 (up to 400 weeks of study including undergraduate degree)	YES*	http://www.gov.mb.ca/educate/sfa/pages/sfaFrontDoor_en.html
Ontario	$15 000 per academic year	YES	https://osap.gov.on.ca/OSAPPortal/en/PostsecondaryEducation/OSAP/GettingOSAP/index.htm
Quebec	$0	NO **	http://www.afe.gouv.qc.ca/en/pendantEtudes/etudesExterieurQuebec.asp?id=a1#a1
Nova Scotia	$140 000 (400 weeks of study including undergraduate degree)	YES	http://studentloans.ednet.ns.ca/
Newfoundland	$140 000 (400 weeks of study including undergraduate degree)	submit request***	http://www.ed.gov.nl.ca/studentaid/apply/fulltime.html
New Brunswick	$140 000 (400 weeks of study including undergraduate degree) ****		https://www.studentaid.gnb.ca/English/Default.asp?app=loans
PEI	$150 000 (400 weeks of study including undergraduate degree)	YES	http://www.gov.pe.ca/forms/pdf/1895.pdf
Yukon	400 weeks of study including undergraduate degree	YES	http://www.education.gov.yk.ca/advanceded/sfa/loans.html
Northwest Territories	20 semesters	YES	http://www.nwtsfa.gov.nt.ca/
Nunavut			http://www.edu.gov.nu.ca/apps/authoring/dspPage.aspx?page=4

Note: By completing the online application forms you are applying for both Federal and Provincial loans.

* School search allows you to determine if your school is currently recognized. Several Osteopathic medical schools in the United States appear on the list however some do not. By contacting Manitoba Student Aid it is likely that accredited Osteopathic medical schools not currently on the list will also be recognized. https://web4.gov.mb.ca/sao/app/en/camp

** Students studying medicine outside of Quebec except at the University of Ottawa do not qualify for student loans through Aide Financieres Aux Etudes

*** Osteopathic medical schools not currently recognized may become eligible following request by the student. Requests are submitted via email and are processed in 3-5 business days

**** A Request for Program Information form must be submitted along with your application if you are studying at an institution outside of the Atlantic Provinces

The answer is a resounding NO. The DO path is NOT one of no-return to Canada. In fact, in the province of British Columbia, the CaRMs website quite clearly states that DOs are granted the first iteration for residency matching as Canadian MDs. The same goes for the province of Ontario. One can try matching for residency in BC, or the easier method is to do a residency in the US, then return to Canada.

The vast majority of Canadian students doing DO in the US choose to pursue a US MD (ACGME) residency after medical school. It is also feasible (and probably easier) to complete a residency in the US, and then move back to Canada to practice medicine (while making sure to take all the Canadian licensing exams in the process). If all the licensing exams are done, and the Canadian USDO has successfully completed an ACGME residency with the equivalent length of training indicated by the Royal College of Physicians and Surgeons of Canada (RCPSC) - then the provinces have no basis to bar your entry back into Canada.

As for coming back to Canada eventually with a US trained DO medical degree, it is done all the time. In fact, the COA, Canadian Osteopathic Association recently stated the Michigan State University College of Osteopathic Medicine "has announced its intent to recruit 20-25 qualified Canadian students each year over the next 2-3 years to help promote osteopathic medicine in Canada. MSUCOM has taken the initiative to recruit qualified Canadian applicants and will be setting a special tuition rate for these students, the amount to soon be determined." See www.osteopathic.ca for more info.

The path to licensure in Canada as a DO is the same as that for a US trained MD. The only difference is the additional board exams we have to take - i.e., COMLEX series, and the MCCEE (in addition to the USMLEs, and MCCQEs).

Many Canadian educated DOs have returned within the last year or two. For instance, there is a US DO grad who became board certified in family med in BC recently. This US DO got licensed in BC "without a hitch". In 2008, a Canadian USDO matched into pathology at the University of Toronto. In 2010, another Canadian USDO matched at McMaster University (residency unknown).

Absolutely yes. A search on the CPSO website found a US trained Canadian DO doctor that became a specialized pediatrician that now works for Mount Sinai Hospital in Downtown Toronto. He completed his fellowship at the University of Toronto.

Osteopathic medical schools have their own set of board exams. These are the COMLEX exams. There are 3 COMLEX exams, parts 1,2,3. Taking the COMLEX series allow you to apply for AOA (American Osteopathic Association) residency spots. COMLEX exams are required by Osteopathic medical schools. However, if you want to return to Canada, you MUST match in ACGME (MD) residencies. In order to match for ACGME residencies, you MUST take the USMLEs (steps 1,2,3). Alternatively, there are dual accredited AOA/ACGME residencies, they take either the complete COMLEX or the complete USMLEs.

At the present time, COMSA and the COA strongly encourage Canadians to write both the COMLEX and USMLEs. This is because COMLEX is required for graduation from a DO medical school. USMLEs are required (the vast majority of the time) in order to apply for ACGME residencies. Lastly, Canada only recognizes ACGME residencies - so it is crucial for the Canadian trained DO to take the USMLEs.

Lastly, DOs can apply to BOTH ACGME and AOA accredited residencies, while MDs can only apply to ACGME residencies, and are barred from AOA residencies.

The MCCEEs are required for DOs if they plan on taking the MCCQEs (part 1 and 2). However, as of 2011, the MCC is reviewing their policy that USDOs have to take the MCCEE! This means there might come a day when USDOs no longer have to write it! Electives definitely can be done in Canada. The Canadian DO student must contact the medical school in Canada that they wish to do their elective rotations in, apply to that program, and then coordinate with their home school (as Canadian electives usually counts as “international rotations”). The details will vary with each school, so it is better to look at your school international rotations policy.

USDOs get first round in BC (all residencies), 2nd round in Alberta (but have to be a resident of Alberta), 1st round in Ontario, all residencies. Most important, DOs get none of the dreaded ROS that applies to IMGs.

Ensuring success when attending a "out of Canada" med school means to maximize your chances to MATCH IN A US ACGME RESIDENCY (obtaining a Canadian residency may be challenging). As to why being a DO is much more advantageous than IMGs, take a look at the match rates for US DOs and IMGs in the following 2 images:



It basically comes down to a ~70% success rate as a DO, vs. a ~40% success rate as an IMG. Also, keep in mind that American DOs also have their own AOA residencies (unfortunately at the present time, AOA residencies are NOT accepted by Canadian licensing authorities), so American DOs have their own residencies to fall back on if an ACGME residency is not obtained. Also, look at the trend - there has been a steady decline in match rates for IMGs for the past 4 years. It used to be almost 49% in 2006, now it is down to 39.8% in 2010.

USMLE Step 1: Written in the summer after the end of Med 2.
USMLE Step 2: Written at the end of Med 3, or sometime in Med 4 (usually in the Spring after interviews).
USMLE Step 3: Typically written at the end of PGY-1. Many states require you to have completed 6 months or a full year of internship/residency as a prerequisite, although if you register for this exam through certain states (ie. California, Connecticut), you may take it immediately after med school graduation before having started your PGY-1 year, even if your PGY-1 year is in a different state. www.fsmb.org/usmle_requirementschart

MCCEE: Exam taken by graduates of non-LCME accredited med schools. If you are attending an LCME accredited school (ie. a US allopathic MD school), you do not need to take this exam. DO (osteopathic) graduates do need to take this exam before being eligible for the MCCQE Parts 1 and 2.
MCCQE Part 1: Written by Canadian med students at the end of Med 4. US med students are eligible to write this exam. This would be the best time to do it as a US med student.
MCCQE Part 2: Written in the fall of your PGY-2 year. US med graduates now doing a Canadian or US residency are eligible to write this exam. This would be the best time to do it as well.

H1B visa: Best visa to be on as a Canadian for a US residency. Unfortunately, many US residency programs do not offer it, as it is significantly more paperwork than a J1 visa. The requirements for an H1B visa include having graduated medical school, and successful passage of USMLE Steps 1, 2 and 3.

OPT
If you are a US medical school graduate, you can do your PGY-1 year on something called an OPT, which is an extension of the F-1 visa that you used to attend the US medical school. OPT stands for Optional Practical Training, which gives you an entire year to get the USMLE Step 3 completed, as well as apply for, and receive your H1B visa. The H1B visa would then go into effect at the start of your PGY-2 year. This OPT year is key, because otherwise, you would need to graduate med school in May, send in USMLE Step 3 application (requires med school graduation as a prerequisite), take and pass USMLE Step 3 and receive said results, and apply for and receive your H1B visa, all before July 1 in order to start a US internship/residency on time (pretty much impossible).

If you can use the OPT year, then the H1B visa becomes a much more viable strategy. The strategy here is to contact each institution prior to applying there for residency, and see if they offer H1B visas. If not, do not apply there. Note that as the competitiveness of a specialty or its location increases, the likelihood of them offering the H1B visa decreases, since they will fill their spots regardless of whether you interview there or not. Conversely, if you are applying for something like Internal Medicine, Family Medicine, Pediatrics, Psychiatry, etc, all of whom are relatively less competitive and often fill their vacant spots with international medical graduates, you are much more likely to ask for, and receive H1B sponsorship. Intermediate difficulty specialties will be somewhere in the middle in their stance on offering H1B visas.

The H1B visa allows you to be employed in the US, allows you to moonlight during residency, and also is on the pathway to obtaining a green card, which lets you live and work permanently in the US.

J-1 visa
The second option for a Canadian training in a US residency. This visa is a student visa, which means you ca not moonlight on it. Additionally, once you finish your training, there is a home residency requirement, which means you need to return to Canada for 2 years before you can reenter the US on a different visa (such as an H1B visa).

Ways to get around that include working in a federally or state designated underserved area for 3 years, or working in a government institution (such as the VA hospital) for 3 years. Once you are signed up to a J-1 visa, you cannot convert over to an H1B visa without either fulfilling the home residency requirement, or obtaining a waiver through one of the above two mechanisms. Even marrying a US citizen at that point will not get you past the requirement. Of course, if you married that US citizen and got your green card before starting internship/residency, then you would be set and would not need a visa at all...

Alternatively, if you choose a US residency that is recognized as equivalent in Canada, you can take the Canadian Royal College exams, and if you pass them, come back to work in Canada or do a fellowship while simultaneously fulfilling the 2 year home residency requirement. After fulfilling that requirement, if you can find a hospital or private practice group willing to sponsor you for an H1B, then you can reenter the US to work. Otherwise, you can always stay in Canada to practice.

The major advantage of the J-1 visa is that the paperwork requirements are much less, and many more residency programs offer the J-1 versus the H1B visa. The J-1 visa requires Health Canada to issue a Statement of Need. You also need to make use of a US organization called the ECFMG, who will act as your J-1 visa sponsor. The ECFMG paperwork is relatively easy. The Statement of Need can be hit or miss, depending on the specialty you want, and the province from which you are applying.

The Health Canada administrator for issuing the Statement of Need is Judith Lewis, at:

613-952-1912.

That information is also mirrored on the CaRMS website at: www.carms.ca/eng/ERAS_intro_e.shtml It would be worth it to make a call to her relatively early on as you plan out your specialty choices to see if Health Canada will support you. If so, the J-1 visa may well be the difference between matching to a competitive specialty/location that does not offer H1B visas, or having to settle for a less competitive specialty/location that does offer H1B visas.

The J-1 visa is really not as bad as everyone makes it out to be, as long as Health Canada is willing to write that Statement of Need. Being willing to do a US residency on it could mean the difference between getting the spot or not.