Every year, tens of thousands of students prepare for medical school. In addition to the choice of major, MCAT prep, or any other number of factors, one that faces practically every medical student is the choice between allopathic medicine, or an MD, and osteopathic medicine, or a DO. While both are full medical degrees, there are a number of differences between the two. One isn’t necessarily better than the other, but depending on the type of medicine that you wish to practice, one may be better suited to you.
Before going any further, it is worth understanding the differences between an MD and a DO. While both degrees lead to the same outcome, there are still a number of differences between the two. Think about it like this: You can go to pick up dinner, or you can have it delivered. Either way, you have the same end result of eating dinner at home (and one that you didn’t have to cook!).
For most people, going to medical school means getting an MD. The majority of doctors in the United States are MDs, and the vast majority of medical schools produce graduates who carry the title of MD. At the risk of making a very general overstatement, MDs focus on the treatment of disease.
This is a stark philosophical difference from a DO. Instead, DOs focus on holistic health. They are interested in how the entire body functions as a single entity, rather than individual systems. One way this manifests itself is that DO students have to spend 200 hours learning how to perform Osteopathic Manipulative Treatment, or OMT. These techniques involve moving tissues and joints, and have been clinically proven to help relieve some forms of pain. MDs receive no such training.
This difference in philosophy can best be explained using an example. Let’s say that a patient presents with high blood pressure. Both an MD and a DO are going to encourage the patient to pursue a healthier diet and a more active lifestyle, as well as consider some prescription medications. However, look for the DO to be more hesitant with the medication, instead wanting to focus on healthier foods and more exercise.
It is not only in philosophy that the MD and DO programs differ. The application process can be somewhat different. First, it’s worth establishing that there are a lot of similarities. Every DO and MD program requires students to complete an undergraduate degree, and they all require at least a year of basic biology, a year of physics, and a year each of general and organic chemistry (some schools). Most also require some combination of calculus, statistics, biochemistry, or English. Note that there are no specific major requirements; Classics majors are just as prepared to be doctors as chemistry majors, as long as they fulfill the minimum requirements. Also, everyone has to take the MCAT.
However, that’s where the similarities start to end. There are more spots in MD programs, so one might think that they are easier to apply to. However, there’s a lot more competition for MD spots. Additionally, DO students tend to be non-traditional; older applicants can often find some success as DO applicants, especially if they are coming to medicine from another career.
Don’t make the mistake of thinking that DO programs are easier to get into, though. DO programs like to have people who see medicine like they do, so if you’re simply applying to a DO program because you think it will be easier, you’re going to have a rough time getting through the application process.
Despite all this, there are a lot of similarities. Both DOs and MDs can practice medicine anywhere in the United States. They can apply to each others’ residency programs, and we’ll talk more about that in a minute. Also, they take the same science classes in medical school. No matter which route you take, you’ll be qualified as a doctor by the end of it.
Is One Better?
Some people mistakenly believe that an MD is more prestigious than a DO. They point to the fact that the MD is a more established degree and that MDs tend to make more money and hold more specialized roles. However, a lot of this has to do with the fact that there are simply more MDs out there; 90% of doctors are MDs. Instead, potential doctors should approach the question as a reflection of how they view medicine. If they are concerned with the treatment of disease, then an MD route may make more sense. If, on the other hand, they want to play a more preventative role, then the DO option could well be better.
MD vs. DO Residencies
One reason that MDs and DOs have such differences between specialities is that it has been a relatively recent move to allow DOs to pursue the same residencies as MDs. That has shifted in recent years, and now MDs and DOs can be admitted into one another’s residencies.
In 2020, MD students were finally allowed to apply to DO residencies. This has gone a long way in leveling the playing ground, but there are still some differences. MDs have to pass the United States Medical Licensing Exam (USMLE), while DOs have to pass the Comprehensive Medical Licensing Examination (COMLEX). However, some MD residencies require students to pass the USMLE regardless of their background, so plenty of DOs take the USMLE as well. Both routes provide plenty of preparation for each.
Trends Among Residents
Generally speaking, MDs tend to make more money and have better placements because they tend to come from more prestigious programs and they tend to have a mindset that is already driven towards specializing. On the other hand, a DO’s practice mindset is more about holistic programs, so it lends to be pursued more by those who want to practice a more general type of medicine. Also, those specialized residencies (and eventual practices) tend to be in larger, more expensive cities; more general residencies take place in smaller environments.
However, DOs who do choose to specialize and who excel on their COMLEX and USMLE exams can find themselves in the most prestigious MD residencies. In that case, there is no difference in earnings.
One last note is worth mentioning. An MD is universally recognized around the world. A DO, on the other hand, is accepted in dozens of countries, but it is not always seen as a ‘real’ medical degree. If you’re looking to practice in the US, that won’t matter, but if you’re thinking about pursuing practice outside of the US, it is worth bearing in mind.
Compared to Foreign Degrees
It’s worth stepping back to point out that we’re only talking about medical programs in the US. A number of students consider getting foreign degrees. As a general rule, students who complete an MD or a DO in the US will have a higher match rate for residencies that are based in the US. Close behind them are programs in the UK and Ireland, while those based in the Caribbean can lag behind.
This really does depend on the residency, however. Ultra competitive residencies, like dermatology, will be dominated by MDs; of the ~70 Irish med school grads to apply for residencies in the US in a given year, only one will end up with a dermatology placement. However, for those looking to practice general medicine, any route can work.
Which Is Right for You?
Ultimately, the choice of whether to pursue an MD or a DO comes down to the career goals of the individual student. Generally speaking, those interested in a more holistic, prevention-centered form of medicine, in which a practitioner takes an active role in all aspects of a patient’s medical life will find more fulfillment as a DO, while those wanting specialization, especially with regards to treating diseases of specific systems, will prefer being MDs.
The best way to figure this out is through spending considerable time pursuing healthcare internships and physician shadowing opporuntities. Luckily, we have just the internships to help you find out whether you are more of an MD, DO, or even another healthcare professional like a PA.