DOs go global: What to know about practicing osteopathic medicine abroad

As osteopathic medicine continues to grow, so too has osteopathic physician and student interest in practicing outside of the United States.

In light of the growth of the osteopathic medical profession around the world, we would like to share some important milestones in the AOA’s history of advocacy for DO practice rights abroad as well as an FAQ and practical information for DOs who are interested in practicing internationally.

Since the osteopathic medical model originated in the U.S. and accredited colleges of osteopathic medicine (COMs) only exist in the U.S., the AOA is uniquely positioned to advocate for DOs’ ability to gain unlimited medical licensure globally. In addition to advocating on behalf of individual members seeking licensure abroad (more on that below), the AOA has made significant strides in advancing recognition of the profession in recent years. Important milestones include:

• 2018: The International Labor Organization, an agency of the United Nations, issued a letter affirming that U.S.-trained DOs are fully licensed physicians who prescribe medication and perform surgery, and drew a clear distinction between U.S.-trained DOs and non-physician osteopaths who practice outside of the U.S.
• 2019: The Association of Medical Councils of Africa passed a resolution granting the AOA’s request to recognize U.S.-trained DOs as fully licensed physicians with practice rights equivalent to MDs in 20 African countries.
• 2022: The World Federation for Medical Education (WFME) awarded recognition status to the AOA’s Commission on Osteopathic College Accreditation (COCA) for 10 years, thereby acknowledging that COCA-accredited COMs meet standards that are equivalently rigorous to other top medical schools worldwide.
• 2023: The International Association of Medical Regulatory Authorities (IAMRA) passed a resolution supporting the equivalency of U.S.-trained DOs and MDs among its 47 member countries worldwide. During the meeting, AOA Past President Boyd Buser, DO, was also elected to the IAMRA Board of Directors, thereby strengthening our connections with other leading medical groups and licensing bodies around the world.

Next, the AOA, through its international partner, the Osteopathic International Alliance (OIA), a non-state actor in official relations with the World Health Organization (WHO), will pursue an update to the 2010 WHO Benchmarks in Training in Osteopathy to include osteopathic medicine, which will help governments and other global stakeholders understand and promote access to the safe, standardized practice of osteopathic medicine around the world.

For more information on the history of the OIA’s collaboration with the WHO and current projects, including the development of an international Glossary of Osteopathic Terms for worldwide use and a revised Global Review of the professions, please visit the OIA’s WHO webpage.

International licensure FAQs and examples

With many international students enrolled in U.S. COMs and growing interest in international license portability—which can help with opportunities for volunteering, rotations, research and thought leadership—we frequently receive questions about practicing abroad. Here are some commonly asked questions and answers:

1. Which countries currently license DOs?

Osteopathic medicine is relatively established in some countries, including Canada, the U.K., Australia and New Zealand. A map created by the AOA shows the countries where we are aware of DOs receiving medical practice rights, where they have been denied practice rights and where we lack data. The AOA has proactively reached out to individual medical regulatory authorities to inquire about whether they license DOs, but without a “test case,” it is often difficult to obtain confirmation. We encourage anyone who is interested in practicing abroad to contact us, and we will be happy to assist you however we can. For AOA members, this includes providing you with a personalized letter and packet of information that demonstrates the equivalency of U.S. DO and MD degrees to submit along with your application.

In some countries where DOs have unsuccessfully applied for licensure, there is often confusion about the difference between the U.S. osteopathic medical model vs the non-physician “osteopath” model. Milestones such as the IAMRA resolution and WFME recognition, as well as our upcoming work to add osteopathic medicine to the WHO Benchmarks, are important steps that help us in our continued efforts to educate international licensing authorities about the unique credentials of U.S.-trained DOs.

2. How do I apply for licensure abroad?

Each country’s medical council establishes its own requirements for international medical graduates. Requirements vary by country and can change at any time; therefore, the medical council website for the country of interest is the best source of information about current requirements.

3. If a country has licensed a DO in the past, does that mean that my application will be approved?

Not necessarily. While past acceptance of DO credentials is a positive sign, it depends on the requirements at the time you apply, as well as on your individual credentials. For example, some countries (such as Finland) require you to pass a (Finnish) language proficiency exam, and some (such as South Korea*) require you to pass their national medical exam. Unlike the U.S., many countries license physicians for practice only in their individual specialty, and some may only accept physicians who hold a U.S. specialty board certification in a high-need specialty.

Success stories

As you can see, international licensure is complex. Below, three DOs who have been licensed abroad share their stories:

Canada: “I am a 2017 Touro College of Osteopathic Medicine (Harlem) graduate, who subsequently completed a family medicine (FM) residency and sports medicine fellowship at Southern Illinois University, in a program that was dually accredited by the AOA and the Accreditation Council for Graduate Medical Education.

“After completing my training in 2021, I returned to British Columbia to start my practice. I obtained my full medical license without difficulty, and I am licensed to practice without restriction. My current practice includes primary care sports medicine, osteopathic manipulative treatment and FM. I also do occasional surgical assist for orthopedic surgeries.” —Jason Hui, DO ([email protected])

India: “I am an AOA board-certified, practicing OB-GYN physician in California. I initially applied for medical licensure with India’s National Medical Commission (NMC) in 2012. At that time, there were no licensed DOs in India, although there were several American MDs. After more than 10 years and intervention by the Delhi High Court, I finally became the first DO to be eligible for medical licensure in India in 2023.

“My application was initially denied on the grounds that ‘osteopathy’ was not recognized as a medical degree. Even with documentation from the AOA demonstrating that U.S.-trained DOs and MDs complete similar requirements, I was again denied, and in December 2015, I filed a petition in Delhi High Court challenging the decision.

“In September 2019, the NMC recognized the DO degree as equivalent to the Indian medical degree; however, further documentation regarding my residency training was requested in 2019, and again in 2022. The AOA provided significant assistance throughout this process, including, but not limited to, a letter from my certifying board outlining their requirements and the DO-MD equivalency laws in my state of licensure, per NMC’s request.

“In September 2023, NMC finally recognized my medical qualifications, enabling me to obtain a medical license and, hopefully, help pave the way for future DOs to practice in India.” —Sonali Shah, DO ([email protected])

South Korea: “I am a 2019 graduate of the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) and I completed my FM residency at the University of South Florida/Morton Plant Mease, where I served as a chief resident during my final year. Over the past three years, I have been working through barriers to osteopathic medical licensure in South Korea.

“Korean medical licensure is a complex and multi-step process that includes taking many medical and language examinations. One crucial step is for the applicant’s medical school to be approved by the Ministry of Health, which took many years since the Ministry had never previously reviewed a U.S. COM. The Ministry initially rejected my application on the grounds that COCA-accredited schools were not (at that time) recognized by the WFME.

“During this process, I submitted multiple appeals and letters from other Korean NYITCOM alumni and medical students, as well as from the AOA and NYITCOM. Thanks to these efforts, NYITCOM became the first U.S. osteopathic medical school ever to be approved by the Ministry of Health in 2023, joining 23 other approved U.S. MD schools.

“The final step in the application process is for me to sit for the Korean Medical Licensing Exam, which I plan to do in 2024.” —Joshua Son, DO ([email protected])

Where to find more information

For additional information on the AOA’s international work, please visit our website or email Raine Richards, JD, AOA vice president of state and international affairs, at [email protected].

Related reading:

US-trained DOs gain global recognition

What we can learn from international osteopaths