Both a DO (Doctor of Osteopathic Medicine) and an MD (Doctor of Medicine) are fully licensed physicians who can prescribe medication, perform surgery, and practice in any medical specialty. The core difference is philosophical and curricular: DO programs include additional training in osteopathic manipulative treatment, a hands-on diagnostic and therapeutic approach rooted in the idea that the body’s structure and function are deeply interconnected. In day-to-day clinical practice, though, the two degrees lead to largely overlapping careers, and research comparing patient outcomes finds no measurable difference in the quality of care.
Where the Two Degrees Come From
The MD degree traces back centuries through the European tradition of allopathic medicine. The DO degree is newer and distinctly American. Andrew Taylor Still, a frontier physician working in Kansas in the mid-nineteenth century, developed what he called osteopathy after growing disillusioned with the medical practices of his era. Still emphasized the body’s capacity for self-healing and the importance of the musculoskeletal system in overall health.1PubMed. Andrew Taylor Still and the birth of osteopathy (Baldwin, Kansas, USA, 1855) He founded the first school of osteopathic medicine in 1892 in Kirksville, Missouri.
For decades, osteopathic and allopathic medical education followed very different paths, and quality varied widely across all types of medical schools. It was not until the early twentieth century, following sweeping reforms prompted by the Flexner Report, that medical training in the United States became standardized and consistently rigorous.2JAMA. The Flexner Report and the Standardization of American Medical Education Over the following century, osteopathic medical schools adopted the same scientific curriculum as allopathic schools while preserving their additional focus on osteopathic principles. Today, DO students take anatomy, physiology, pharmacology, and pathology courses that mirror what MD students learn, plus several hundred additional hours of training in osteopathic manipulative medicine.
How the Training Actually Differs
If you sat in on lectures at an MD program and a DO program, most of what you’d hear would be identical. Both require four years of medical school following an undergraduate degree, both include two years of classroom-based science and two years of clinical rotations in hospitals and clinics, and both prepare students for residency training afterward. The licensing exams are different in name: MD students take the USMLE (United States Medical Licensing Examination), while DO students take the COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination). Many DO students also take the USMLE, particularly if they plan to apply to residency programs at institutions that historically trained only MDs.
The distinctive element in DO training is osteopathic manipulative treatment, or OMT. This is a set of hands-on techniques used to diagnose and treat musculoskeletal problems and, according to osteopathic philosophy, to support the body’s broader functioning. Students learn to use their hands to stretch muscles, apply pressure to joints, and guide tissues into alignment. The training also emphasizes a holistic framework: DOs are taught to consider how the musculoskeletal system interacts with other organ systems, and to think about preventive care and lifestyle factors alongside standard medical treatment.
Whether individual DOs actually use OMT in practice varies enormously. A survey of osteopathic physicians found that exposure matters: among those who incorporate OMT into their practice, the vast majority had the opportunity to see it work during their first two years of medical school, whereas very few physicians who don’t use OMT had that early positive exposure.3Journal of Osteopathic Medicine. Why do physicians practice osteopathic manipulative treatment? In reality, many DOs go on to practice in ways that are indistinguishable from their MD colleagues, particularly those who enter hospital-based specialties like cardiology or emergency medicine where hands-on manipulation isn’t part of the standard workflow.
Does OMT Actually Work?
The strongest evidence for osteopathic manipulative treatment centers on low back pain, one of the most common reasons people see a doctor. A meta-analysis of randomized controlled trials found that OMT produced statistically significant reductions in low back pain compared to both active treatments and no-treatment controls, with benefits holding up over short-, intermediate-, and long-term follow-up periods.4PubMed Central. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials A randomized controlled trial comparing OMT to no intervention found that patients receiving treatment reported less pain, greater satisfaction with their care, better physical functioning and mental health at one month, and fewer additional treatments at six months.5PubMed. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial
More recent research has reinforced these findings. A scoping review and meta-analysis of patient-reported outcomes found that OMT for adult mechanical low back pain led to significant improvements in pain perception, ability to perform daily tasks, and functional status.6PubMed. The efficacy of osteopathic manipulative medicine in the treatment of low back pain: a scoping review and meta-analysis of patient-reported outcomes The effect sizes are modest, not dramatic, and OMT is best understood as one tool in a larger toolkit rather than a standalone cure. For conditions beyond low back pain, the evidence thins considerably. Claims that OMT can treat asthma, digestive disorders, or other systemic conditions remain largely unproven by rigorous trials, though individual patients and practitioners sometimes report benefits.
Do Patients Get Different Quality of Care?
This is the question that matters most to anyone choosing a doctor, and the answer is reassuring. A large study published in JAMA Surgery directly compared outcomes for patients treated by DO surgeons versus MD surgeons. There was no evidence of any difference in 30-day mortality (the adjusted mortality rate was about 1.6% for both groups), and no difference in 30-day readmission rates or length of hospital stay.7PubMed Central. Comparison of Outcomes for Patients Treated by Allopathic vs Osteopathic Surgeons When you are lying on an operating table, the letters after your surgeon’s name do not predict how well you’ll do.
This finding shouldn’t be surprising. By the time any physician is practicing independently, they have completed the same residency training regardless of whether they entered with an MD or DO. A DO orthopedic surgeon and an MD orthopedic surgeon go through the same residency program, pass the same board examinations, and operate under the same hospital credentialing standards. The degree determines the path into medicine, not the endpoint.
The Single Accreditation Merger and What It Changed
Until recently, DOs and MDs trained in separate residency systems. MD graduates went through programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), while DO graduates could choose between ACGME programs and those accredited by the American Osteopathic Association (AOA). In 2020, the two systems formally merged into a single accreditation system under the ACGME. The idea was to eliminate a two-track system and put all physicians on equal footing.
The merger’s effects have been mixed. On one hand, it opened every ACGME-accredited program to DO applicants, theoretically expanding their options. On the other hand, it eliminated AOA-accredited programs that had historically served as a pipeline for osteopathic graduates. In surgical specialties, more than a quarter of eligible osteopathic programs either didn’t apply for ACGME accreditation or withdrew from the process, and nearly half of the osteopathic programs that did transition listed an MD as program director.8PubMed. The Impact of the ACGME/AOA Single Accreditation System on Osteopathic Surgical Specialties, Residents, and DO Students The loss of those protected training slots hit DO applicants in competitive fields particularly hard.
Following the merger, osteopathic application proportions increased across specialties, but the gains in actual match rates for DO applicants slowed.9PubMed. Impact of the ACGME/AOA Single Accreditation System Merger on PM&R Applications and Match Rates In ophthalmology, researchers found that the transition primarily harmed DO applicants, likely because of the loss of protected residency positions and the closure of osteopathic ophthalmology programs.10PubMed Central. Characterizing the initial effects of the single accreditation system merge on the ophthalmology residency match The merger removed structural barriers on paper while leaving cultural and institutional preferences largely intact.
The Match Rate Gap in Competitive Specialties
The starkest remaining difference between DO and MD isn’t in training quality or patient outcomes. It’s in how easily graduates can enter highly competitive residency programs. Across selected surgical subspecialties from 2020 to 2023, DO applicants matched at roughly 53% compared to about 74% for MDs.11PubMed Central. Comparison of Osteopathic (DO) and Allopathic (MD) Candidates Matching Into Selected Surgical Subspecialties The gap varied by specialty. In general surgery, the difference was relatively modest. In plastic surgery and thoracic surgery, it was enormous: DO match rates in those fields were in the single digits and teens, while MD rates were far higher.
Orthopedic surgery illustrates the problem in detail. Even after single accreditation, the unadjusted match rate for DO applicants in orthopedics dropped from about 63% to 50% between 2020 and 2023, compared to a drop from 79% to 73% for MDs. After adjusting for the number of applicants who actually submitted rank lists, the gap persisted: adjusted match rates were roughly 37-39% for DOs versus 57-59% for MDs.12PubMed Central. The Real Match Rate? US DO Students Match Into Orthopaedic Surgery at Significantly Lower Rates than US MD Students Despite Single Accreditation A separate analysis of orthopedic applicants found that while the number of DO applicants grew significantly over time, the proportion matching into residency remained lower than for MDs.13PubMed Central. Residency Match Rates in Orthopaedic Surgery Based on Sex, Under-Represented in Medicine Status, and Degree Type
The reasons are multiple and entangled. Some residency programs have longstanding institutional ties to allopathic schools. Program directors at many established surgical programs have historically favored MD applicants, a bias that persists even in a unified system. DO students may also have fewer research opportunities and clinical connections at the major academic medical centers where competitive residency programs are based. The gap isn’t about ability: once DOs complete the same residency, their patient outcomes are equivalent. But getting into that residency in the first place remains harder.
How Physicians and the Public Perceive the Degrees
Within the medical profession, awareness of what a DO degree means is generally high, but perceptions vary. A survey of both MDs and DOs found that DO respondents were far more likely to report that their degree type had altered their medical careers, and far more likely to say they had been advised not to pursue a radiology residency based on their degree. A large majority of both MDs and DOs felt that residency selection is biased toward the allopathic degree.14Elsevier / Current Problems in Diagnostic Radiology. MD and DO: Differing Medical Degrees and the Associated Perceptions In other words, even MDs recognize the structural disadvantage their DO colleagues face.
Among the general public, confusion is common. Many patients don’t know what “DO” stands for or assume it’s a lesser degree. Others confuse DOs with chiropractors or physical therapists, partly because the word “osteopathic” sounds like it refers only to bones and joints. In practice, a DO working as your cardiologist, pediatrician, or emergency physician has the same legal authority and clinical capabilities as an MD in that role. Both can prescribe controlled substances, admit patients to hospitals, and perform procedures within their specialty scope.
The confusion sometimes runs in the other direction, too. Outside the United States, “osteopath” typically refers to a manual therapist who is not a physician, someone more comparable to a chiropractor or physiotherapist. An American DO traveling abroad may need to explain that their training includes full medical school and residency, not just manipulation therapy. This international discrepancy is a source of ongoing frustration for osteopathic physicians who practice the full scope of medicine.
DOs and Primary Care
One of the most consistent patterns in American medicine is the disproportionate contribution of DOs to primary care. Osteopathic physicians have long been recognized as major contributors to primary care in the United States, alongside international medical graduates and physicians from underrepresented minority backgrounds.15PubMed Central. Addressing the primary care physician shortage in an evolving medical workforce A substantial share of DO graduates enter family medicine, internal medicine, and pediatrics, the fields facing the most acute shortages.
This pattern reflects both philosophical orientation and practical reality. Osteopathic training emphasizes whole-person care, prevention, and the kind of longitudinal doctor-patient relationships that define primary care. But it also reflects the match rate disparities described above: when competitive subspecialties are harder to access, primary care becomes a more natural and achievable path. Whether this concentration in primary care is a feature of osteopathic philosophy or a byproduct of structural barriers is a question the profession continues to debate internally. Probably both forces play a role.
Choosing Between DO and MD Schools
For prospective medical students deciding where to apply, the practical differences between DO and MD schools are worth understanding clearly. Both paths lead to the same destination: a licensed, practicing physician. But the road to get there has some different features.
DO schools generally have slightly lower average admissions statistics (GPA and standardized test scores) than MD schools, which makes them an important access point for students who are strong candidates but may not have the numbers for the most competitive allopathic programs. This does not mean the education is easier. The curriculum is equally demanding, and the additional OMT training adds to the workload.
If you already know you want to pursue a highly competitive surgical subspecialty, attending an MD school statistically gives you a smoother path to matching. If you’re drawn to primary care, rural medicine, or a holistic approach to patient care, a DO program may align particularly well with your goals. If you’re open to multiple specialties and just want to become the best physician you can, either degree will serve you well. The most important factor for any medical student’s career trajectory is what they do during medical school: their clinical performance, research involvement, board scores, and the strength of their letters of recommendation. The degree letters matter less than the work behind them.
What Happens Outside the United States
The American DO degree is unique globally. In the United Kingdom, Australia, and most of Europe, osteopaths are trained as manual therapists, not as full-scope physicians. They treat musculoskeletal complaints using manipulation techniques, but they cannot prescribe medications, order imaging studies, or perform surgery. This creates a confusing landscape for American DOs who want to practice internationally, because their credentials may be misunderstood or not recognized as equivalent to a local medical degree.
Some countries have worked out reciprocity agreements or recognition pathways for American DOs, but the process is neither universal nor simple. An American DO who has completed residency training and is board-certified in a specialty has, functionally, the same training as any MD specialist. Conveying that to a foreign licensing board that associates “osteopath” with manual therapy can be an uphill climb. This issue doesn’t affect the vast majority of DOs who practice domestically, but it’s worth knowing about if international work is part of your plans.
Within the U.S. military and Veterans Affairs systems, DOs serve in every specialty and hold equivalent rank and responsibilities to MDs. Federal employment treats the degrees as identical for credentialing purposes, which reflects the legal and practical reality: both degrees confer the same scope of practice, the same prescribing authority, and the same professional obligations.