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What’s the Difference Between an M.D. and a D.O.?

If someone wants to be a doctor, they go to medical school to get a medical degree to practice medicine. It seems like a pretty simple concept, but–as you may already have figured out if you’ve done a little research–there are two kinds of medical degrees. A Doctor of Medicine (M.D.) comes from something called an Allopathic school of medicine, while a Doctor of Osteopathic Medicine (D.O.) comes from an Osteopathic school of medicine.

So, the biggest questions most people have is whether or not there is a real difference between the two and if one is “better” than the other. Both of those questions have complicated answers, so I’ll try and break it down.

The very first thing you should know is that Osteopathic physicians (D.O.) have all of the same professional rights and privileges that Allopathic physicians (M.D.) do. They are eligible to enter all of the same specialties and are basically indistinguishable in every way other than the two letters after their names.

Osteopathic medical schools are also almost identical in the scope of their curriculum to Allopathic medical schools, with one major difference. An Osteopathic curriculum covers all of the same material as its Allopathic counterparts, but places a greater emphasis on holistic approaches to patient care. They tend to consider things like lifestyle changes, environmental factors, and non-medical options in addition to standard medical treatments. In addition to the medical curriculum, Osteopathic schools require 300-500 additional hours that cover something called “osteopathic manipulative treatment” (OMT). OMT is a specialized system of manipulating the musculoskeletal system through stretching, applying gentle pressure, and applying resistance–very similar to techniques used in physical therapy and massage therapy.

While attending an Osteopathic program, you’ll take the Comprehensive Osteopathic Medical Licensure Exam (COMLEX-USA) parts 1 and 2. Part 3 of the COMLEX is taken during the first year of residency. These exams are analogous to the USMLE Step 1, Step 2, and Step 3. Osteopathic students also have the option to take the USMLE exams in addition to the COMLEX exams if they want to apply for Allopathic residencies.

Osteopathic students also participate in The Match program when applying for residencies in their desired specialty. They are eligible to apply for both Osteopathic AND Allopathic residency programs, which is why many Allopathic residency programs have a mix of M.D. and D.O. graduates. D.O.s are also able to apply for both Osteopathic and Allopathic fellowships after residency if they wish. Residencies and fellowships may be dual accredited by the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA), though it is important to note that after 2020, there will be a single, unified accreditation system for residency and fellowship training.

After completing residency and/or fellowship, a D.O. may be board certified by either Allopathic or Osteopathic specialty boards. As a practicing physician, both an M.D. and a D.O. must complete a certain number of hours (differing by state) of continuing education per year to maintain their medical license. While an M.D. from a US medical school is accepted worldwide, a US D.O. degree is recognized in 44 countries.

The application process to get into an Osteopathic medical school is very similar to their Allopathic counterparts. You’ll take all of the same pre-requisites and take the MCAT. Rather than the American Medical College Application Service (AMCAS), however, you’ll send your applications through another common application system, the American Association of Colleges of Osteopathic Medicine (AACOM). (I’ll also note that, like Allopathic application, Osteopathic applications to Texas schools are submitted through the Texas Medical and Dental Schools Application Service (TMDAS)).

The number of Allopathic medical schools in the US vastly outnumber Osteopathic schools, and the number of practicing D.O.s reflects that–only 11% of US physicians are D.O.s rather than M.D.s. Students at Osteopathic schools tend to have slightly lower test scores and GPA’s on entry than those at Allopathic schools, and for this reason Osteopathic school tend to have a higher proportion of more non-traditional and older students. Osteopathic schools are also less likely to be part of a large university system and have generally less robust research programs. Because of these reasons, Osteopathic schools have gained a reputation for being “easier to get into” than Allopathic schools. However, keep in mind that the degree requirements are the same at both kinds of institutions and many Osteopathic students do extremely well on all of their licensure exams while and are very competitive for spots in Allopathic or dual-accredited residency and fellowship programs.

Ok, that was a lot, but it all comes down to this: Osteopathic and Allopathic medical education is extremely similar and the end result is basically the same. Now, the real question is whether or not you should consider applying to Osteopathic medical schools. To this I, personally, say absolutely if the program appeals to you. If something about the school just calls to you, it shouldn’t matter whether or not it’s Osteopathic or Allopathic, but there are a few more considerations to make when deciding whether or not in include certain DO programs:

Geography is really important to you. I bring up to issue of geography a lot, because it’s extremely important to a lot of people (it certainly was to me). If you’re single and 100% willing to move wherever you need to so you can attend medical school, more power to you. But if you have any ties to a particular area at all, definitely make sure you consider Osteopathic and Allopathic options in the area–it’ll potentially expand your pool of viable options.

You want to practice Primary Care. Many Osteopathic schools place particular emphasis on primary care and strive to specifically produce primary care physicians. Nearly half of Osteopathic physicians practice primary care compared to a third of Allopathic physicians. Additionally, many Osteopathic schools place greater emphasis than some of their Allopathic analogs on rural and underserved populations. If this is of particular interest to you, you would be well served to look into these programs.

You want to practice Holistic Care. Given the founding philosophy of Osteopathic medicine, education at DO schools goes beyond the vast majority of Allopathic schools in their incorporation of holistic and integrative medicine in their curriculum. While many Allopathic schools are including holistic practice into their curriculum, if you’re someone who genuinely believes in that philosophy and wants to incorporate holistic approaches in their future practice, you should absolutely look into Osteopathic schools as a potential route to your medical degree.

You need to hedge your bets. Some people are just fighting against longer odds trying to get into medical school, especially us more non-traditional candidates or folks whose grades and test scores may not be the best. It’s not warm and fuzzy, but it’s reality. For reasons I addressed above Osteopathic schools do tend to be somewhat easier to get into, and if you really want to be a doctor but don’t feel like you’re as competitive as you’d like to be, you should apply to a broad spectrum of programs to increase your chances of admission. Again, the education and professional outcome is the same, so why wouldn’t you?

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