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Doctor of Osteopathic Medicine or Doctor of Medicine: Which One?

Created September 25, 2007 by David Russo, DO, MPH, MS
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Osteopathic physicians (DO’s) are the legal and professional equivalents of MD’s. They practice in all areas of medicine and compete with MD’s for residencies and job opportunities. They are eligible for appointment in all federal programs and the military.

The medical training of DO’s mirrors that of MD’s; the major difference being that DO’s complete extra coursework in osteopathic manipulative medicine (OMM). OMM is a manual therapy that involves the use of hands-on treatment of painful muscles, tendons, and joints. It incorporates aspects of traditional physical therapy, massage therapy, and other body-based modalities to relieve pain and improve function. One other important educational difference is that DO schools typically require that students spend more time rotating in primary care specialties such as internal medicine, family medicine, pediatrics, and obstetrics/gynecology during the third and fourth years than do some MD schools. Thus, overall, DO schools emphasize generalist medical skills and training and seek to produce comprehensively trained primary care physicians over specialists.

However, this is not to say that one cannot specialize after earning the DO degree. There are thousands of DO’s specialized in every recognized medical specialty. DO’s take their own boards (called the COMLEX-USA), but have the option of sitting for the MD boards (called the USMLE). The COMLEX is recognized as the primary route of licensure for osteopathic physicians in all 50 states. It helps with career planning to know if the residency programs in the specialty of your interest recognize the COMLEX as USMLE equivalent or encourage DO’s take the USMLE too. Some particularly competitive MD residency programs (diagnostic radiology, for example) often strongly encourage osteopathic applicants to take the USMLE. From their perspective this helps “level the playing field” in the selection process and allows direct comparison of board scores between applicants.

If your heart is set on a surgical residency or subspecialty training, then in all likelihood you will end up pursuing an American Osteopathic Association (AOA) approved residency if you go the DO route. All specialty societies and professional organizations recognize osteopathic residencies and board certification. These surgical and sub-specialty residencies are mostly located in the mid-west and northeast United States — so if those areas are unappealing to you, then you’re out of luck.

Historically, DO schools and residency programs have been less research oriented and more service oriented than MD programs. In recent years, several osteopathic medical schools have established dual degree training programs in biomedical sciences, public health, healthcare administration, law, as well as other areas. If you are interested in DO/PhD Medical Scientist Training Programs (MSTP), then you should carefully scrutinize the resources and training opportunities available to you at osteopathic schools. DO/PhD candidates are offered a variety of tuition incentives and stipends through their sponsoring institutions, are eligible for (and have been awarded) research training grants through the NIH, and ultimately pursue the same academic careers as their MD/PhD counterparts. However, as of yet, there is no federally-funded osteopathic MSTP program.

Bottom Line:

No matter what kind of doctor you want to be, you should to talk to as many practicing physicians (MD and DO) as you can. If you’re looking for a DO, try contacting one out of the telephone book. Most osteopathic physicians understand that many people have a limited knowledge about osteopathic medicine and will be willing to talk to you. Ask candid questions about their professional relationships with other physicians in the community and their residency experiences.

Realize that you have a choice in what kind of physician you become and be a smart consumer of your medical education. Don’t rely solely upon any single person’s opinion, including my own. Instead, talk to as many different people as you can. Keep in mind that, ultimately, your own success in the residency match process, and your own future career in medicine, will depend more upon how much enthusiasm, ambition, and personal drive you have, than where you went to medical school. There are successful physicians in academia, private practice, and industry who have graduated from either private or public schools, from either research oriented or primary care focused schools, or from either DO or MD schools.

With respect to deciding if the osteopathic route is right for you, ask yourself these questions: Do you like the osteopathic approach to patient care? Are you the kind of person who is comfortable being a minority or different? (DOs comprise only 5% of all physicians in the US.) Will you feel frustrated or inadequate if you have to explain to a patient who has never been to an osteopathic physician before what the DO degree is and what osteopathic medicine is all about?

Finally, during your interviews pay attention to what students tell you about their school. Spend time on campus after your interview and ask students about their experiences. Is the school high stress and competitive or more laid back? Do students like the faculty and feel that the administration appreciates them or do they feel neglected?

Keep in mind that regardless of which path you choose, for most people medical school is long, tedious, and often an exhausting endeavor. No matter how good or prestigious other people think that a school is your experience is certain to be a terrible one if you wake up every day hating where you are or are not 100% invested in your education.

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