Choosing Between MD & DO
Updated October 20, 2020
If you are hoping to practice medicine as a physician in the US, you have degrees to choose from: the MD (Doctor of Medicine) and the DO (Doctor of Osteopathy). For this post, we will discuss the main differences between both degrees and how to choose between the two.
First, let’s talk about the similarities. Both MDs and DOs are afforded the same privileges and rights to practice. In essence, MDs and DOs of a given specialty will assume the same set of responsibilities regardless of degree. If an MD and DO both match into the same general surgery program, the residency program will train them the same way into competent surgeons.
Philosophy
MD:
The MD is the classical medical doctor degree focusing on diagnosing and treating human disease. Each school has its own distinct mission and vision but the MD degree itself does not have a distinct ideology.
DO:
DOs prides itself on a philosophy of care that revolves around four tenets:
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The body is a unit; the person is a unit of body, mind, and spirit.
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The body is capable of self-regulation, self-healing, and health maintenance.
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Structure and function are reciprocally interrelated.
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Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
DOs learn the same physiology, pharmacology, and pathophysiology material as their counterparts, but the difference lies in their interpretation. This interpretation yields itself onto a physician who places a strong emphasis on patient-focused, preventative, and holistic care.
Main Point: In practice, you may not see a difference in philosophy because a good physician regardless of degree will treat a patient holistically. My experience at a DO school has placed great emphasis in teaching and maintaining the osteopathic philosophy throughout my first year of training.
Education
MD:
Among different medical schools, education models will vary. Some schools will have problem-based learning, team-based learning, and systems-based learning just to name a few. In general, most medical schools will have the first two years as “preclinical years” in which the focus is on learning the fundamentals of medicine which include biochemistry, microbiology, physiology, pathology, anatomy, and pharmacology. The last two years of medical school are considered the “clinical” or clerkship years. At this point, the medical students will be rotating throughout different fields of medicine, ranging from emergency medicine, surgery, family medicine etc. and applying the knowledge they learned from the first two years.
DO:
Everything I stated above for MDs also applies to DOs as well. I like to think of DO education as MD education plus more. What makes a DO different is their knowledge of Osteopathic Manipulative Medicine (OMM). When I try to describe it to people, I like to say it’s a mixture of evidence-based physical therapy and chiropractic techniques. This would insult most of my OMM professors but it gets the point across in an understandable way. DOs take pride in using their hands and their sense of palpation to evaluate the body for “somatic dysfunction.” It is believed that abnormalities in physiological functioning will rear itself in palpable ways. To rid the body of somatic dysfunction, we use manipulative techniques that will give the patients an immediate sense of relief.
Main Point: Curriculum is truly the biggest difference between MD vs. DO. DOs have another curriculum to learn compared to their MD counterparts. This yields itself in board exam preparation as DOs must take the COMLEX* and the USMLE in order to graduate and match into a competitive residency.
*Note: The COMLEX is the licensing board exam in which all osteopathic medical students must take. The USMLE is the licensing board exam for allopathic medical students. Almost all residencies primarily use USMLE scores to screen applicants so DO students must take both exams.
Difference In Application
MD:
There are 154 MD schools in the US. In order to apply, one must complete the AMCAS application. The mean cumulative GPA (cGPA) for matriculants to MD programs in the 2019-2020 application cycle was 3.73, whereas the mean science GPA (sGPA) was 3.66. The mean MCAT score for matriculants was 511.5.
DO:
There are 38 DO schools in the US. The application program used is known as the AACOMAS. The mean cGPA for matriculants to DO programs in the 2019-2020 application cycle was 3.54, while the mean sGPA was 3.43. The mean MCAT score for matriculants was 503.8.
In terms of metrics, MDs historically have had higher average GPAs and MCAT scores. Because of this, DO programs have been viewed to be kinder to those with lower metrics. This may change as DO programs are starting to trend upwards with their average metrics along with the fact that the number of applicants has been increasing as well.
Main Point: From my personal experience and from other medical students, MD schools tend to prefer applicants who have a strong research background. This does not mean research is mandatory to be accepted, but it can definitely open doors for you. If research is not your passion, you must show your passions in other ways via your commitment to service, community, and so forth.
Prospect
MD:
In 2020, 93.7% of MDs matched into a residency position. MDs tend to spread out in their choice of specialty. 37% matched in primary care specialties.
DO:
Before 2020, DO and MD residencies were separated into their own respective programs which were accredited by the ACGME and AOA. Historically, it was more difficult for DOs to match into university, research-oriented institutions because they mostly accepted MD applicants. After the 2020 match this past fall, it seems that DOs have better chances of matching into these formerly MD-dominated programs. In 2020, 90.7% of DOs matched into a residency program. 55% matched into primary care specialties.
Main Point: Statistics apply to populations, not individuals. That being said, it is difficult to make the conclusion that DOs have a harder time matching into more competitive specialties or that since the education and philosophy line up with primary care specialties. Nonetheless, my advice is to choose the school that you feel you will be most comfortable and happy at the most affordable price.
Note: There is no difference in earning potential. Specialty and location are the main effectors of salary.
My Final Perspective
As someone who has completed their first year of osteopathic medical school, I am giving my perspective based on my own experience and those of my classmates.
I will start with what I wish could improve in DO education. DO education tends to be more expensive due to having the added curriculum of OMM. This results in a higher indebtedness and burden once you begin to practice as a physician. This effect is further multiplied by the fact that most DOs match into primary care, which tends to have lower salaries.
At my school, most of the physiology and basic sciences are taught by Ph.Ds who specialize in those areas rather than clinicians (MD or DOs). This could be due to the fact that most DO schools do not have their own university hospital and are also private schools. These factors altogether make it harder to facilitate clinician-student relationships because they are simply not present as faculty.
Research is typically not a focus at DO schools and knowing that competitive specialties lean towards applicants with an extensive publication history, I would say this could be the reason as to why DOs have a harder time matching into those programs. I had to find research at a different medical school (MD) nearby because my school does not have an anesthesia department (the field that I am interested in).
In short, I would recommend that all applicants apply to DO programs. If your end goal is to become a physician, regardless of what kind, you should apply. As a DO or MD you will have the great privilege of committing to serve and treat patients. If you have an interest in primary care, physical therapy, wellness, rural/community medicine, and preventative medicine, you should especially apply to DO programs. The OMM curriculum goes into great detail about the musculoskeletal system and offers you with the unique skills of using your bare hands to diagnose and treat. Unfortunately for musculoskeletal complaints such as back pain or flank pain, MDs typically will prescribe medication, refer to physical therapy, or recommend procedures. The advantages of OMM is that it is non-pharmacological, requires no equipment, and can offer instant relief.
In the end, I recommend that all who aspire to be physicians apply to both MD and DO schools. Regardless of the school you choose, your patients will refer to you as “Dr.______” and all that matters is your ability to be compassionate, knowledgeable, and your commitment to improve the livelihoods of those you serve.
Jovy Rex-Al Orbon
Hometown: Stockton, CA
Medical School: Western University of Health Sciences - College of Osteopathic Medicine
Year: M2