Anyone who dreams of becoming a doctor should understand that there are two types of med schools: allopathic and osteopathic schools. While allopathic schools offer a traditional medical curriculum, osteopathic schools supplement lessons in standard medical sciences and practices with instruction on how to provide touch-based diagnosis and treatment of various health problems, such as circulatory issues and musculoskeletal conditions.
While both allopathic and osteopathic med schools provide preparation for a career as a doctor, the academic credentials awarded are different. Graduates of allopathic schools receive Doctor of Medicine, or M.D., degrees. Osteopathic school alumni have Doctor of Osteopathic Medicine, or D.O., degrees. Someone holding either degree can call him or herself a physician.
Dr. Kenneth Steier, a pulmonologist with a D.O. degree who is also executive dean of the Touro College of Osteopathic Medicine in New York, warns that becoming a doctor is not easy, regardless of whether you take the M.D. or D.O. path. Steier suggests that, because of the extraordinary competitiveness of med school admissions, those determined to become a doctor should consider applying to both M.D. and D.O. programs to increase their chances of acceptance.
How M.D. and D.O. Classes Compare
Dr. Robert A. Cain, president and CEO of the American Association of Colleges of Osteopathic Medicine, says osteopathic medical education is designed to train physicians who treat each patient as a whole person.
Cain, a board-certified pulmonologist with a D.O. degree who previously saw patients for 14 years, notes that osteopathic medical principles "emphasize the mind-body-spirit connection and the body's ability to heal itself." He adds that the practice of osteopathic medicine began in the late 19th century during "a time of crisis and uncertainty in health care in the United States."
The origins of the M.D. curriculum can be traced back to the ancient Greeks, says Molly Johannessen, a Ph.D.-trained physiologist who has taught at both allopathic and osteopathic medical schools.
"This style of medicine is rooted back to Hippocrates and students who complete their MD degree adhere to the Hippocratic Oath to guide their practice," wrote Johannessen, a medical learning consultant for Kaplan Medical, a division of Kaplan Test Prep that helps people prepare for medical licensing exams.
The Hippocratic Oath is a vow to "do no harm" to health care patients that M.D. students sometimes recite, though the oath they take is often a modernized version rather than a verbatim translation of the original Greek oath.
The coursework in M.D. and D.O. programs is similar, experts say. Steier emphasizes that med school is extraordinarily difficult, regardless of whether it is taught using an M.D. or D.O curriculum.
Both M.D. and D.O. programs include science classes on topics like anatomy, biochemistry and physiology, Steier says, but one distinction is that about a tenth of the D.O. coursework focuses on hands-on therapies. "It's similar to chiropractic (care), but not as aggressive as chiropractic care," he says, noting that osteopathic manipulative techniques can be used as an alternative to prescribed medication.
D.O. and M.D. Career Trajectories
No matter which type of med school an aspiring doctor attends, he or she can expect to complete a residency after earning a medical degree, and that residency will supplement his or her general medical education with training in a specific specialty such as obstetrics and gynecology.
"M.D. and D.O. degrees afford graduates the same opportunity to apply for the same residencies," Dr. Samuel Sandowski, vice president of medical education and director of the residency program at Mount Sinai South Nassau hospital in New York, wrote in an email. "During residency and upon graduation, the scope of care and privileges permitted are the same."
Sandowski, who has an M.D. degree, says a med student's odds of obtaining a desirable residency match depend on many factors that have nothing to do with what type of med school he or she attended. Residency selection criteria include med school grades, research, leadership, community service and board scores.
While some residency program administrators might have a preference for M.D.-trained candidates, the prevalence of that sentiment could be dissipating, Sandowski says. "In my opinion, I think that bias is lessening," he says.
Cain notes that many residency programs and health care practices recruit D.O. doctors, and he says patients often look for physicians with D.O. degrees. "We are seeing residency programs and practices seek D.O. candidates for their distinct skill sets," he says. "Many patients are also choosing to see D.O.'s because they want to benefit from their training in whole person care and experience OMT (or osteopathic manipulative treatment)." Cain adds that a post-residency medical fellowship program where M.D. grads were historically in the majority will often grow more receptive to D.O. physicians in general once the program admits a single D.O. doctor. "While some programs may have a preference based on historical relationships and lack of familiarity with the D.O. degree, these preferences have been shown to evolve in many cases after the programs have accepted a D.O. and been exposed to their approach to patient care," he says.
According to a 2018 report from the American Osteopathic Association, nearly 57% of practicing D.O physicians in 2018 were primary care doctors who focused on either family medicine, internal medicine or pediatrics.
However, when you look at the overall proportion of active U.S. doctors who focus on primary care versus those who specialize in other fields -- including both allopathic and osteopathic physicians -- the split looks very different than if you focus solely on osteopathic doctors. According to March 2019 statistics from the Kaiser Family Foundation, a national nonprofit organization that addresses health care issues, about 52% of practicing U.S. physicians are specialist doctors.
Although D.O. grads historically have pursued primary care careers more often than their M.D. peers, those trends are shifting, experts say. Many D.O. physicians enter primary care fields like family medicine, internal medicine and pediatrics, Steier says, adding that a growing number of D.O. doctors are going into advanced specialties like anesthesiology, neurosurgery and invasive cardiology.
"D.O.s, at least for the last 20 or 30 years, have gone into all ranges of specialties," Steier says. "The emphasis on primary care is somewhat changing."
However, Dr. Mara Cvejic, a fellowship-trained pediatric neurologist and sleep medicine specialist who has a D.O. degree, cautions that it can be challenging for osteopathic med students to find mentors in medical specialties where allopathic medical degrees are the norm.
Cvejic's husband, Dr. Nitesh Paryani, a radiation oncologist with an M.D. degree, says an advantage of allopathic med schools is that they are typically affiliated with large research universities. "As a result, you have more robust research opportunities as an allopathic medical student," he says.
Paryani says one reason he chose an M.D. program was that he came from a family of allopathic physicians. "It seemed like a natural route," he says. "I also knew that I wanted to become a radiation oncologist, which is, you know, a very subspecialized field in medicine."
Paryani adds that he thought his odds of matching into a radiation oncology residency would be better if he earned an M.D. degree rather than a D.O.
Nevertheless, many D.O.-trained physicians say there are significant advantages to attending osteopathic med school.
Dr. Ross Kopelman, a first-year resident in ophthalmology who has a D.O. degree and plans to become an oculoplastic surgeon, chose to attend a D.O. school "because I strongly believe in its holistic philosophy of how we should approach and take care of patients. To always look at patients through their lens and to not look solely at their disease state to solve their medical problem," he wrote in an email.
Kopelman adds that patients are becoming increasingly receptive to doctors with D.O. degrees. "I think this is the golden age for D.O.s in terms of being respected by patients," he says. "Patients are more educated and aware of the fact that there are both D.O.s and M.D.s and refer to both of these as doctors on equal footing."
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