Holders of a DO are known as osteopathic physicians, while holders of an MD are referred to as allopathic physicians, although this term is not universally accepted.
According to the Cecil Textbook of Medicine, 22 ed., "other than teaching manipulation, undergraduate medical training for an osteopathic medical degree (D.O.) is now virtually indistinguishable from that which leads to the M.D. degree. Osteopathic physicians complete conventional residencies in osteopathic or allopathic hospitals and training programs; are licensed in all states; and have rights and responsibilities, such as military service, that are identical to allopathic physicians and surgeons."
|Doctor of Medicine||Doctor of Osteopathic Medicine|
|Medical School Application Service||AMCAS (http://www.amcas.org/)||AACOMAS (https://aacomas.aacom.org/)|
|Years of medical school||4||4|
|Medical Licensing Exam (MLE) Step 1||USMLE required||COMLEX required, USMLE optional (DO students often take both exams)|
|MLE, Step 2||USMLE required||Varies by school. may require COMLEX, or choice of either USMLE or COMLEX|
|Residency||ACGME 1 year of internship + 2 to 5 years of residency depending on specialty at an ACGME approved residency or dually accredited program. May apply for fellowship after completion of residency.||1 year of internship + 2-5 years ACGME or AOA approved residency depending on specialty. May apply for fellowship after residency.|
|Board Certification||State medical specialty boards||Either D.O. or M.D. state medical specialty boards (or both)|
|Practice||Full scope of hospitals and clinics.||Full scope of hospitals and clinics.|
|Medication Prescribing Rights||Licensed MDs may prescribe medications to patients when appropriate.||Licensed DOs may prescribe medications to patients when appropriate.|
|ObGyn||Yes. MDs may deliver babies. Most who do are board certified in ObGyn or Family Medicine.||Yes. DOs may deliver babies. Most who do are board certified in ObGyn or Family Medicine.|
|Status||MDs are physicians and can provide all medical services.||DOs are physicians and can provide all medical services.|
|Surgery||Yes, MDs can provide full spectrum of surgical services after completion of a surgical residency and completion of board certification.||Yes, DOs can provide full spectrum of surgical services after completion of a surgical residency and completion of board certification.|
|Specialization||All medical specialties may be practiced by MDs and DOs.||All medical specialties may be practiced by DOs and MDs.|
The gender and racial distribution of MDs and DOs are similar. There are significantly more MDs than DOs. In 2004, 17,000 students matriculated as first-year students at MD programs, while 3,800 students matriculated at osteopathic programs, a ratio of 5 MD students for every 1 osteopathic student.
Between 1980 and 2005, the annual number of new MDs remained stable at around 16,000. During the same period, the number of new DOs increased by more than 250% (from about 1,150 to about 2,800). Osteopathic graduates are expected to increase to 3,300 by the year 2010 and as many as 4,000 by 2015. The number of new MDs per 100,000 people fell from 7.5 to 5.6, while the number of new DOs per 100,000 rose from 0.4 to 0.8.
One study compared the patient interactions of MDs and DOs. The study found that "osteopathic physicians were more likely to use patient's first names and to discuss the social, family and emotional impact of illnesses." For example, "66% of DOs discussed a patient's emotional state compared with about one-third of MDs." The same study found that "allopathic physicians scored higher in discussing literature or scientific basis of treatment."
However, a much larger study analyzed 341.4 million patient visits to general and family medicine specialists in the United States, including 64.9 million (19%) visits to osteopathic physicians and 276.5 million (81%) visits to MDs. It found that there was no significant difference between MDs and DOs "with regard to time spent with patients and preventive medicine services."
A Harvard study found significant differences in the attitudes of MDs and DOs. The study found that 40.1% of MD students and physicians described themselves as "socioemotionally" oriented over "technoscientific" orientation. 63.8% of their osteopathic counterparts self-identified as socioemotional.
One study of osteopathic physicians attempted to investigate their perceptions of differences in philosophy and practice between themselves and their MD counterparts. 88% of the respondents had a self-identification as osteopathic physicians, but less than half felt their patients identified them as such. Further, the study found that "not a single philosophic concept or resultant practice behavior had concurrence from more than a third of the respondents as distinguishing osteopathic from allopathic medicine."
As the training of DOs and MDs becomes less distinct, some have expressed concern that their unique characteristics will be lost. Others welcome the rapprochement and already consider "allopathic medicine" to be "the type of medicine practiced by M.D. and D.O. type doctors." One persistent difference is the respective acceptance of the terms "allopathic" and "osteopathic." Osteopathic medical organizations and medical schools all include the word osteopathic in their names, and such groups actively promote an "osteopathic approach" to medicine. This is in sharp contrast with the term allopathic. No major medical society or medical school includes the word allopathic in its title, nor do they adhere to an allopathic approach to medicine. However, as interest in alternative medical therapies increases, the term allopathic has been used to describe conventional medical practices - a usage which many have criticized.
Medical Education & Training
The LCME or Liaison Committee on Medical Education is the accrediting body for United States allopathic medical education. The LCME is sponsored by the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC). For years an independent board of the American Osteopathic Association (AOA), the Commission on Osteopathic College Accreditation (COCA), has accredited the U.S. medical schools that award the DO. (There are only two U.S. universities that have accredited allopathic and osteopathic medical schools - Michigan State University and the University of Medicine and Dentistry of New Jersey.)
Allopathic training is by far the most widely available and recognized type of medical training. The M.D. is universally recognized as a medical degree. In other nations osteopathy does not have the same relative equivalence in training as found in the United States. Only a few percentage points of United States trained physicians practice overseas and the M.D. degree may offer an easier route for approval to practice in some nations.
MD residency training programs are often considered more prestigious and competitive. The majority of U.S. osteopathic medical students are trained in allopathic residency programs. The most common reason given for choosing an allopathic residency is that allopathic programs offer superior training although fewer federal dollars support osteopathic training programs.
Many authors note the most obvious difference between the curricula of DO and MD schools, Osteopathic Manipulative Medicine (OMM), a type of manual therapy taught at only osteopathic schools. Osteopathic hands on training begins in the first days or weeks of training and continues throughout clinical training. Many graduates pursue osteopathic residency training to preserve their osteopathic difference.
The accreditation differences between the two will change in 2015, however, as D.O. residency programs and M.D. programs will both be accredited by the Accreditation Council of Graduate Medical Education, which will by then have osteopathic representatives on its board. By 2020, D.O. residency programs will have more in common with M.D. residency programs.
Applicant Aptitude Indicators
Some authors note the differences in the GPAs and MCAT scores of those who matriculate at osteopathic schools. In 2013, the average MCAT and GPA for students entering U.S.-based M.D. programs were 31 and 3.69, respectively, and 27 and 3.50 for D.O. matriculants. However, osteopathic MCAT scores have been increasing at a rate 30% greater than M.D. admission scores over the past seven years. The New York Times reported that in 2014, for example, the average MCAT score for students entering the Touro Osteopathic School of Medicine in Manhattan, New York, was a mere single point below the M.D. average.
Despite having students with slightly lower MCAT scores and GPAs, osteopathic schools are highly selective. In fall 2013, 144,000 people applied for 6,400 spots in 30 osteopathic schools across the country.
One study found that as many as one third of students at osteopathic schools had been rejected from schools awarding the Doctor of Medicine degree. Osteopathic schools also tend to reject medical school applicants that have failed to pursue greater understanding of osteopathic differences.
First-time USMLE pass rates for D.O. and M.D. students in 2011 are as follows: Step 1: 89% and 94%, Step 2 CK: 93% and 97%, and Step 2 CS: 93% and 97% respectively; Step 3: 94% and 100%--but this number may be misleading, as 18 D.O. students compared to 18,314 M.D. students, were evaluated for Step 3. M.D. students do not take the COMLEX so their failure rate for this examination is unknown.
Graduates of both osteopathic and allopathic medical schools are eligible to apply to residency programs through the National Residency Matching Program (NRMP). In 2004, 99% of new US MDs and 53% of new US DOs went on to train in ACGME-accredited residency programs.
Resident specialty choice
There are notable differences in the specialty choices of MDs and DOs. One study attributes this to a difference in the "cultures" of their medical schools. "In comparison with allopathic schools, the cultural practices and educational structures in osteopathic medical schools better support the production of primary care physicians." According to one survey, 54.6% of deans of conventional medical schools reported that training future primary care physicians was more important to their institutions than training future specialist physicians, compared with 100% of osteopathic medical school deans.
Recent trends show osteopathic graduates entering medical specialties historically dominated by MDs. A JAMA study found that "In 1996-1997, 624 DOs made up 2.9% of the total GY1 residents without prior Graduate Medical Education. By 2002-2003, their numbers had more than doubled to 1312, and DOs represented 6.0% of GY1s without prior GME."
Between 1997-01, the number of osteopathic graduates matching into anesthesiology almost doubled every year - from fewer than 10 to over 100 over the course of 4 years.
Reaction to trends
Some authors have described concerns within the osteopathic profession about the increasing number of DOs seeking allopathic GME. Not only are there more DOs training solely in ACGME-accredited programs and thus bypassing American Osteopathic Association (AOA)-accredited programs, but there are now more than 900 dually accredited programs, wherein the resident trains in the AOA-accredited internship and then transfers directly into an allopathic (MD) program.