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What is a DO vs MD?

April 5, 2021
Part 1. IntroductionPart 2. DefinitionsPart 3. DO vs. MD: Philosophy‍Part 4. DO vs. MD: Application and Education Part 5. DO vs. MD: Practice, Residency, Lifestyle Part 6. DO vs. MD: Career Outlook and SalaryPart 7. Which is Better? Tips for Choosing Between the Two‍Part 8. FAQs

Introduction

What is a DO vs MD? You may have heard many opinions about which is better, but the two are quite similar, down to their match rates. Do away with everything you may have heard about what is a DO vs MD, and read the facts regarding these two highly capable physician varieties. 

Upon graduating from medical school, students receive credentials to signify their status as a physician. Medical school students can look forward to becoming a doctor of medicine (MD) or a doctor of osteopathic medicine (DO). There are many similarities between the two, but some significant differences may help you choose, which is the best path into your medical career. The fundamental difference is the philosophy behind each approach.

Definitions 

Before we determine what is a DO vs MD let’s take a moment to define each.

Doctor of Medicine (MD)

Physicians who earn the MD credential attend an allopathic school. An allopathic school is a conventional medical school and is what most people associate with becoming a physician. A doctor of medicine attends a 4-year medical school where they earn their MD. In addition to medical school, allopathic students match into a residency where they will train in their specialty of choice after completing their school's program. 

Doctor of Osteopathic Medicine (DO)

Medical students who attend an osteopathic school of medicine become physicians awarded a DO credential. Osteopathic medicine may not be familiar to some, but students who choose this path will end up working in the same places as those who attend conventional medical schools. Like allopathic students, DOs complete their medical school program and match into a residency program. They can choose from a variety of specialties and will attend residency alongside MD graduates.

Unique responsibilities and overlap tasks between a DO vs MD


DO vs. MD: Philosophy

As mentioned previously, the fundamental difference between DO vs MD is philosophy. MDs learn to use symptoms to develop a diagnosis and an appropriate treatment plan, using conventional methods. DOs also master the ability to diagnose and treat symptoms. However, they undergo additional training in manipulative techniques. DOs additionally take a more holistic approach to medicine. 

MD Philosophy

Allopathy is the foundation of the MD philosophy. Allopathy refers to science-based medicine. The treatments allopathic physicians implement include standard methods, such as prescribing drugs or administering x-rays. Physicians who follow these practices will focus on symptoms displayed by the body. They will rely on medicine and scientifically-based treatments to reverse the body's symptoms. 

DO Philosophy

The DO philosophy contemplates all aspects of a patient rather than symptoms alone. Physicians who study this philosophy learn to consider the body's ability to heal and regulate itself. While these physicians are knowledgeable regarding conventional medicine, they will also use hands-on, manipulative techniques learned in an osteopathic school of medicine to aid the body’s healing process.

DO vs. MD: Application and Education 

As stated, DOs and MDs will each learn about conventional medicine. Only DOs will learn the manipulative techniques to aid healing and the holistic conception of osteopathic medicine. This extra component means they will attend two different school types before uniting in residency. Osteopathic and allopathic schools have separate application systems. Once you have decided which philosophy you would like to base your education on, you will use the respective application method to apply.

DO Application

Future physicians seeking knowledge of osteopathic medicine will apply to medical school using a system provided by the American Association of Colleges of Osteopathic Medicine Application Service (AACOMAS). Students will need to fulfill the required prerequisite courses and extracurricular activities for their application. Prerequisites vary from school to school. Some schools require a certain number of upper-level biology courses rather than the traditionally required courses alone. Pre-med majors will typically fulfill the prerequisites needed for both DO and MD medical schools.

Letters of recommendation are required to accompany your application. Like prerequisites, the number of letters needed will vary from school to school. Also, some osteopathic schools will specifically require at least one letter from a doctor of osteopathic medicine. Be sure to connect with osteopathic physicians to fulfill this requirement before you begin your application process. Give them the courtesy of time and the ability to prepare a strong letter for you. Do not realize the need for a DO recommendation at the last minute. You want it to be written by someone who will vouch for your connection to the osteopathic medicine philosophy. Currently, you can submit up to 6 letters to AACOMAS. They recommend sending any additional letters directly to prospective programs.

The DO application has four sections made up of several smaller subsections. AACOMAS tracks your progress through each section. The categories are Personal Information, Academic History, Supporting Information, and Program Materials. 


                  

Four categories of the DO AACOMAS applicatioon


MD Application

Students choosing the allopathic route will apply using the American Medical College Application Service (AMCAS).  AMCAS differs from AACOMAS in its display, but it requires much of the same information. Again, prerequisite courses will vary from school to school. A notable difference here is that AACOMAS requires you to match prerequisites to schools one by one, in addition to verifying your transcripts before use. AMCAS system will also verify your transcripts. The difference here is you will need to do your due diligence to ensure you have satisfied the requirements at your school of choice. You can view school course requirements by visiting your school of choice's website or the MSAR system provided by the AAMC.

You may find the AMCAS application helpful when it comes to extracurricular experiences. The system gives you the ability to determine your “most meaningful” experiences, meaning clinical or volunteer experiences. Marking an experience as “most meaningful” allows you to write in more detail about the experience and why it was the most meaningful to you. You can declare multiple entries as “most meaningful.” An additional application difference to consider is that AMCAS encourages targeted letters. You will be able to upload up to 10 letters, and you must match them to each school. It is not a requirement to submit targeted letters. If there is a school you are determined to attend, a targeted letter could be a beneficial touch to add to your application. 

Application Fees

Both applications come with significant fees. AMCAS charges a processing fee, which includes submission to one school. Additional programs can be added, but after the first school, each program included on your application will incur a fee. AACOMAS uses a similar fee structure. The AACOM and AAMC each have fee assistance options in place. 

Education

Osteopathic and allopathic medical schools equally give students a thorough education in medicine's basic sciences. Because students will learn the same foundations for their medical training, general prerequisite courses to matriculate each school type are similar. Allopathic students do not receive training concerning the manipulative techniques used by osteopathic students. Although always based on conventional medicine, the allopathic curriculum content will vary slightly from school to school. Both allopathic and osteopathic students can look forward to a robust, challenging curriculum. 

According to AACOM, osteopathic students are to spend approximately 200 hours or more learning osteopathic manipulative medicine. Skills acquired during this training will allow students to treat and diagnose symptoms using their hands in addition to conventional means. Allopathic students study how to diagnose apparent symptoms and treat them using medicine rather than their hands. 

DO vs. MD: Practice, Residency, Lifestyle 

Practice

The practice and lifestyle of DO and MD physicians are similar. DOs may rely on their additional training when conventional medicine techniques do not completely resolve symptoms. MDs will practice depending on their allopathic studies and experiences. Osteopathic students train with great emphasis placed on analyzing the whole patient rather than the symptoms alone. They may take more time learning about their patient's lifestyle and health-impacting habits. Allopathic physicians also receive training that teaches them to consider multiple elements of their patients' health, but with different emphasis. Their focus will be on symptoms and narrowing down diagnoses based on symptoms present during a patient's visit. Allopathic and osteopathic physicians will enter the workforce with the same clinical medical knowledge. Both DOs and MDs will be able to practice medicine to the fullest extent as a licensed physician. Formerly, DOs and MDs applied to residency through two different systems. These systems were the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME). 

Residency 

The ACGME accepted MD and DO students but did not streamline the process for DO applicants. The AOA was specifically for osteopathic residencies. Using two different systems created challenges. First, osteopathic students had to submit two separate applications because they applied to the AOA and ACGME separately. Second, osteopathic students were previously presented differently from allopathic students in the ACGME applicant pool. Fortunately, the residency application has merged and is seamless for both DOs and MDs. Students are now able to be reviewed more uniformly. 

A third issue osteopathic students faced was the necessity of two different board exams. The COMLEX exam is part of the osteopathic graduation process. The USMLE is part of the allopathic graduation process. The ACGME previously did not officially recognize the COMLEX board exam as an equal alternative to the USMLE board exam. In recent years, the ACGME has acknowledged the COMLEX board exam as equivalent to the USMLE. This acknowledgment is good news for osteopathic students who previously had to take both exams if they wanted to enter an ACGME residency program. Many residency programs are now accepting of the COMLEX exam. Be mindful that there are programs that still require the USMLE, despite the merger and equality declaration. This preference for the USMLE found in some programs does not reflect on licensure. Like the USMLE, the COMLEX boards have validation in all states.

It may be necessary to take both board exams to be as competitive as possible for specific programs. You will have an advisor who can help you decide if taking both boards is appropriate to be competitive in your specialty of choice. Medical students in both school types will apply to residency through the ACGME. Students will be able to partake in the National Residency Match Program’s match process, “The Match." Exciting, yet frightening, Match Day is a rite of passage for many graduating medical students. Now, all medical students can partake in the fear and splendor of Match Day equally.

Lifestyle

DOs and MDs can choose from the same specialties. You will find them working as primary care physicians, dermatologists, surgeons, and more. They are equally qualified to administer medications, order follow-up tests, make diagnoses, and treat ailments. DOs and MDs have equal responsibilities and decision-making power. Each physician type obtains full licensure. No matter if you choose DO or MD, you will have the entire experience of the physician lifestyle. 

DO vs. MD: Career Outlook and Salary   

Career Outlook

According to the Bureau of Labor and Statistics, physicians' projected career outlook is the same as any other occupation. The demand for physicians is expected to grow  4 percent over the next several years. Physicians' employment opportunities may be more generous in certain areas, such as rural communities, that are medically underserved. As the population grows older and experiences the health effects of advanced age, many institutions expect the need for physicians to increase.  A difference in the employment rate between allopathic and osteopathic physicians is not distinguished. 

The main factor in career prospects for medical school graduates is matching into a residency program. In its introductory year, the residency merger's benefit for DO applicants was proven, with the highest DO match rate reported since 1992. The post-merge match rate for MD applicants remained within the average range. According to the NRMP, the match rate for PGY-1, postgraduate year or first year of residency,  positions was 90.7 percent for DO seniors and 93.7 percent for MD seniors. Those who do not fully match can undergo a process called SOAP. The SOAP process places unmatched students into unfilled programs. 

Salary

The salary for DO and MD physicians will not differ due to their credentials. Physician salaries will only vary based on specialty. Regardless, finances should not be the driving force when working in roles that are care-focused. Still, becoming a physician of any type takes a good portion of your life to achieve. It is natural to be curious about the financial soundness of your decision to spend years amassing debt rather than working. Pediatrics tends to earn less than other specialties, with a reported average annual income of $232k. Orthopedics is often paid a higher salary with an average of $511k annually. 

Average annual physician compensation bar graph

Keep in mind that specialties that come with a higher salary will be more challenging to enter and will often require an extended residency in addition to possible fellowships. For example, general pediatrics residencies are typically three years. Orthopedics residencies are, on average, five years. It is of the utmost importance that you carry out your medical responsibilities with patient care at the center of all you do. 

Which is Better? Tips for Choosing Between the Two

Picking your route to your career as a healthcare professional  is one of the most important decisions you will ever make in your life. Your medical school route will shape you as a physician in various ways. It is critical that you make your decision based on which path resonates with you most. Neither path is necessarily better than the other. Institutions have put effort into equalizing allopathic and osteopathic schools. Your decision comes down a few considerations.  

1. Decide which philosophy you identify with first.

If you view health as vastly interconnected with lifestyle and would like to get to the root of a problem, DO school may be right for you. Understanding the cause of symptoms is one of the goals of osteopathic medical training. If you believe you would like to use symptoms to chisel down to a diagnosis, then an MD school may be right for you. Allopathic medical training will teach you to offset exhibited symptoms using medicines and conventional therapies. You may ultimately discuss lifestyle changes, but you may not be trained to innately emphasize that aspect when speaking with patients. 

2. Determine if you are comfortable with the possibility of taking two board exams.

The ACGME residency merger is recent, and while most residency programs accept the COMLEX as equivalent, a few may still require you to take the USMLE to be competitive. If you choose the DO route, you will be obligated to take the COMLEX to graduate from your program.

3. There is a slight difference in match rates between DO and MD students.

This difference may continue to decrease each year. Still, the 3 percent match difference is something to be aware of, especially if you desire to enter a highly specialized residency program. These residencies will generally be challenging to enter. Allopathic students do have the marginally higher match rate. 

FAQs

1. Is it easier to become a DO than an MD? 

The average MCAT score for students accepted into an osteopathic medicine program is 503.83, based on the most recent matriculant profile reported by AACOM. The average MCAT is  511.5 for an allopathic medicine matriculant, according to the AAMC. If viewing the level of ease solely from an MCAT standpoint, attending a DO school may appear more manageable. Keep in mind many factors go into acceptance at both medical school styles.

2. Will COMLEX become a pass/fail like USMLE?

Current projections of Step 1 of the COMLEX determine it will go to a pass/fail structure, just as USMLE Step 1. This new structure means it may be beneficial to have a Step 2 COMLEX score to show competitiveness in the future. The same logic applies to those taking USMLE Step 1 who want to appear competitive among their peers, as it is now a pass or fail score. 

3. Is COMLEX harder than USMLE?

The material is similar for COMLEX and USMLE, except COMLEX incorporates topics related to OMM training. The COMLEX has more questions and has different timing for breaks. 

4. Can I learn osteopathic manipulative techniques (OMT) if I choose an MD school?

Yes. MDs interested in learning OMT may join an ACGME residency program awarded osteopathic recognition or visit the academyofosteopathy.org, which offers courses. Some osteopathic schools may also provide continuing medical education courses providing training in OMT. 

5. Can DOs become surgeons?

Yes, DOs can become surgeons of all types, including plastic surgeons and orthopedic surgeons. Remember, these positions will take hard work, extraordinary effort, and dedication to match into, no matter which credentials you obtain. 

6. Will people know if I am a DO instead of an MD?

Typically, your patients will not notice whether you are a DO or an MD. To most patients, you will be a physician. A difference is not likely to be perceived unless you make them aware or they see the DO credential printed on something that identifies you. You will be addressed by those you work with as "Doctor." A difference in care provided by DOs and MDs will be challenging to detect unless you are using OMM. 

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