DOs (Doctors of Osteopathic Medicine) and MDs (Doctors of Medicine) are both fully licensed physicians who can practice in every medical specialty, prescribe medications, and perform surgery. The core difference is in their training: DO students receive approximately 200 additional hours of education in the musculoskeletal system and learn a hands-on treatment technique called osteopathic manipulative treatment (OMT), rooted in a philosophy that emphasizes the body’s interconnected systems. In day-to-day clinical practice, most patients would not notice a difference between the two.
Training Philosophy
MD programs follow what’s traditionally called an allopathic model, focused on diagnosing disease and treating it with medications, procedures, or surgery. DO programs teach all of the same science and clinical skills but layer on an osteopathic philosophy built around four core tenets: the body functions as a single unit of body, mind, and spirit; the body is capable of self-regulation and self-healing; structure and function are deeply interrelated; and effective treatment accounts for all of these principles together.
In practical terms, this means DO students are specifically trained to look beyond symptoms and consider lifestyle factors, biomechanics, and the patient’s broader physical and emotional context. That said, plenty of MD-trained physicians practice with a similarly holistic mindset. The difference is that osteopathic programs make this approach a formal, required part of the curriculum rather than leaving it to individual preference.
The Extra Training DOs Receive
The most tangible curricular difference is osteopathic manipulative medicine (OMM). DO students spend roughly 200 additional hours learning how the musculoskeletal system affects overall health and how to use hands-on techniques to diagnose and treat structural problems. This training produces a skill called osteopathic manipulative treatment, or OMT, where physicians apply manual pressure and stretching to muscles, joints, and connective tissue.
Research has shown OMT can help relieve low back pain, neck pain, sports injuries, repetitive stress injuries, and certain types of headaches. Cleveland Clinic physicians describe it as a whole system of evaluation and treatment designed to restore normal body function. Not every practicing DO uses OMT regularly, especially those in specialties like cardiology or psychiatry, but the training gives them an additional tool that MDs don’t have.
Medical School Admissions
MD programs are generally more competitive on paper. For the 2023-2024 academic year, students entering MD-granting schools had an average MCAT score of 511.7 and an average GPA of 3.77. DO programs typically admit students with slightly lower average scores, though the gap has narrowed considerably over the past decade as osteopathic medicine has grown in popularity. Both types of schools require a bachelor’s degree, prerequisite science courses, clinical experience, and a strong application.
The osteopathic profession now represents about 11% of all physicians in the U.S. and more than 25% of all medical students, a share that continues to climb. There are currently over 207,000 osteopathic physicians and medical students nationwide.
Licensing Exams
MD students take the United States Medical Licensing Examination (USMLE). DO students take a different series called COMLEX-USA, which is required for graduation from osteopathic programs and includes content on osteopathic principles. Here’s where it gets interesting: about 60% of DO students also choose to take at least one part of the USMLE, according to a 2022 study in the Journal of Graduate Medical Education. They do this primarily because some residency programs prefer or require USMLE scores when evaluating applicants.
Taking the USMLE is entirely optional for DO students, but it can broaden their residency options, particularly at highly competitive programs that historically trained only MD graduates.
Residency and Career Paths
Until recently, MDs and DOs trained in separate residency systems. That changed in 2015, when a five-year merger brought nearly all residency programs under a single accreditation body. By the end of that transition, 98% of previously osteopathic-only programs had earned accreditation under the unified system. This means DOs and MDs now compete for and train in the same residency programs across every specialty, from family medicine to neurosurgery.
The merger was a significant milestone. It effectively eliminated the structural barrier that had kept the two tracks separate for over a century. Since it began, the number of filled residency positions in previously osteopathic programs grew 22% to over 10,400 by 2020, reflecting broader integration.
In practice, both DOs and MDs can specialize in anything. DOs are somewhat more concentrated in primary care fields like family medicine, internal medicine, and pediatrics, partly because of osteopathic medicine’s historical emphasis on whole-person care. But you’ll find DOs in orthopedic surgery, emergency medicine, dermatology, and every other specialty.
Practicing Outside the U.S.
MDs face no credential recognition issues internationally. For DOs, the picture is more nuanced. In more than 65 countries, U.S.-trained DOs have full practice rights identical to MDs. However, in some countries the title “DO” refers to practitioners trained only in manual manipulation, not as full physicians. This can create confusion when a U.S.-trained DO seeks licensure abroad. If you’re a DO interested in international practice, it’s worth checking the specific country’s recognition policies in advance. For volunteer medical missions, both DOs and MDs are granted practice rights through the sponsoring organization, so this distinction doesn’t apply.
What This Means for Patients
If you’re choosing a doctor, the letters after their name matter far less than their training, experience, and communication style. A DO and an MD who both completed residency in the same specialty at the same hospital have virtually identical clinical capabilities. The DO may occasionally incorporate hands-on musculoskeletal techniques into your care, which some patients find beneficial for pain management, but this isn’t guaranteed.
If you’re deciding which type of medical school to attend, the choice comes down to whether osteopathic philosophy and OMT training resonate with you, your admissions profile, and your long-term career goals. Both paths lead to the same destination: a fully licensed physician who can practice any branch of medicine in the United States.