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Comparison of MD and DO in the United States

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This article discusses similarities and differences between doctors of osteopathic medicine (DOs) and doctors of medicine (MDs) in the United States.

Holders of a DO are known as osteopathic physicians, while holders of an MD are referred to as allopathic physicians.[1] There is disagreement on the extent of the difference between osteopathic and allopathic medicine.[2][3] According to the Cecil Textbook of Medicine, 22 ed., other than teaching manipulation, medical training for an osteopathic degree (DO) is now virtually indistinguishable from that which leads to the MD degree. Osteopathic physicians complete conventional residencies in hospitals and training programs; are licensed in all states; and have rights and responsibilities, such as military service, that are identical to MD qualified physicians and surgeons.[4]

History

There is a history of territorialism between the MD and DO qualified physicians worlds, though animosity between the groups has subsided in recent years. In 2005, Jordan Cohen, the president of the Association of American Medical Colleges wrote,

after more than a century of often bitterly contentious relationships between the osteopathic and allopathic medical professions, we now find ourselves living at a time when osteopathic and allopathic graduates are both sought after by many of the same residency programs; are in most instances both licensed by the same licensing boards; are both privileged by many of the same hospitals; and are found in appreciable numbers on the faculties of each other's medical schools.[5]

Further information: [[:Osteopathic medicine in North America]]

Demographics

First year medical school enrollment, 1975-2007.
  MD
  DO

The gender and racial distribution of MDs and DOs are similar.[6] There are significantly more MDs than DOs. [7] In 2004, 17,000 students matriculated as first-year students at MD programs, while 3,800 students matriculated at osteopathic programs, a ratio of 5 MD students for every 1 osteopathic student.[8]

Changing numbers

Between 1980 and 2005, the annual number of new MDs remained stable at around 16,000. During the same period, the number of new DOs increased by more than 140% (from about 1,150 to about 2,800).[9] Osteopathic graduates are expected to increase to 3,300 by the year 2010 and as many as 4,000 by 2015.[5] The number of new MDs per 100,000 people fell from 7.5 to 5.6, while the number of new DOs per 100,000 rose from 0.4 to 0.8.[9]

Cultural differences

Some authors describe less quantifiable distinctions between the two. Avery Hurt writes, "In actual practice, the variations between the two types of physicians are often so slight as to be unnoticeable to patients, and a day in the life of each can appear indistinguishable. But the differences are there, subtle but deep."[10] Several studies have investigated these differences. One compared the patient interactions of MDs and DOs. The study found that "osteopathic physicians were more likely to use patient's first names and to discuss the social, family and emotional impact of illnesses." For example, "66% of DOs discussed a patient's emotional state compared with about one-third of MDs." The same study found that MD qualified "physicians scored higher in discussing literature or scientific basis of treatment."[11] However, a much larger study analyzed 341.4 million patient visits to general and family medicine specialists in the United States, including 64.9 million (19%) visits to osteopathic physicians and 276.5 million (81%) visits to MDs. It found that there was no significant difference between MDs and DOs "with regard to time spent with patients and preventive medicine services."[12]

Self-characterization

A Harvard study found significant differences in the attitudes of MDs and DOs. The study found that 40.1% of MD students and physicians described themselves as "socioemotionally" oriented over "technoscientific" orientation. 63.8% of their osteopathic counterparts self-identified as socioemotional. (p < .0001)[13]

Perceptions

One study of osteopathic physicians attempted to investigate their perceptions of differences in philosophy and practice between themselves and their MD counterparts. 88% of the respondents had a self-identification as osteopathic physicians, but less than half felt their patients identified them as such. The study asked respondents to identify points of philosophical and practical difference between MDs and DOs; no more than 1/3 of respondents could agree on any single such point of difference.[14]

Further information: [[:Principles of Osteopathic philosophy]]

Self-identification

As the training of DOs and MDs becomes less distinct, some have expressed concern that their unique characteristics will be lost.[15] Others welcome the rapprochement and already consider modern medicine to be the type of medicine practiced by both "MD and DO type doctors."[16] One persistent difference is the respective acceptance of the terms "allopathic" and "osteopathic." Osteopathic medical organizations and medical schools all include the word osteopathic in their names, and such groups actively promote an "osteopathic approach" to medicine. This is in sharp contrast with the term allopathic. No major medical society or medical school includes the word allopathic in its title, nor do they adhere to an allopathic approach to medicine.[17] However, as interest in alternative medical therapies increases, the term allopathic has been used to describe conventional medical practices - a usage which many have criticized.[18] Indeed, many reject the term allopath as derogatory.

Medical education and training

MDs and DOs in Texas by practice type.[19]

Medical schools

The Association of American Medical Colleges (AAMC) accredits the 130 US medical schools that award the MD, while the American Osteopathic Association (AOA) Commission on Osteopathic College Accreditation (COCA) accredits the 25 colleges of osteopathic medicine in 28 locations in the United States that award the DO degree.[20][21] There are only two US universities that have accredited programs that give both MD and DO qualifications: Michigan State University, and the University of Medicine and Dentistry of New Jersey.

See also: List of medical schools in the United States and Medical school in the United States

Osteopathic manipulative medicine

Many authors note the most obvious difference between the curricula of DO and MD schools, Osteopathic Manipulative Medicine (OMM), a type of manual therapy taught at only osteopathic schools. Natural Standard, a complementary and alternative medicine group, lists several types of injuries and illnesses in which evidence-based studies suggest OMM may provide some benefit.[22] A 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey was the latest indication that osteopathic physicians have become more like MD qualified physicians in all respects: fewer perform OMT, more prescribe drugs, and many perform surgery as a first option.[23]

Further information: [[:Status of OMM within the Osteopathic profession]]

Applicant aptitude indicators

Some authors note the differences in the GPA's and MCAT scores of those who matriculate at Osteopathic schools versus those who qualify as MDs within the United States. In 2007, the average MCAT score and GPA was 31 and 3.7 for students entering US-based MD programs, and 25 and 3.5 for osteopathic matriculants.[24] One study found that as many as one third of students at osteopathic schools had been rejected from US schools awarding the Doctor of Medicine degree. In addition, osteopathic students have a failure rate three time greater than their MD counterparts on the United States Medical Licensing Exam (USMLE)--though osteopathic students are not required to take the USMLE and instead take their own National Board of Osteopathic Medical Examiners (NBOME) exam series. Furthermore, the same study notes that "despite correlations between MCATs and Step 1 licensing exams, correlations between the latter and clinical performance are weak. Performance as a physician correlates better with proficiency in the humanities and with personal characteristics such as motivation, conscientiousness, integrity, empathy, and a robust psychological constitution."[25] The author notes that the "better performance [of Osteopathic students] on their own National Board of Osteopathic Medical Examiners (NBOME) exam has been attributed to its greater emphasis on clinical context."[25]

Residency

Applicants in the 2007 Main NRMP Residency Match [26]

Graduates of both osteopathic and MD certified medical schools are eligible to apply to these programs through the National Residency Matching Program (NRMP). In 2003, 99% of new US MDs and 43% of new US osteopaths went on to train in ACGME-accredited residency programs.[15]

The American Osteopathic Association accredits osteopathic residency programs. There have been calls to end the remaining barriers between the two types of programs.[27][28][29] Since 1985, a single residency training program can be dual-accredited by both the ACGME and the AOA.[30][31][15]

In 2001, the AOA adopted a provision making it possible for a resident (who is a DO) in any MD program to apply for osteopathic approval of their training.[32] The topic of dual-accreditation is controversial. Opponents claim that by merging osteopathic students into the "MD world", the unique quality of osteopathic philosophy will be lost.[15] Supporters claim the programs are popular because of the higher prestige and higher resident reimbursement salaries associated with MD programs.[33] MDs are generally not permitted to train in osteopathic (AOA-accredited) residencies, though this has become a subject of debate within the osteopathic profession. The American Osteopathic Association has agreed to study the issue of permitting MDs to train in DO (AOA-accredited) residencies.[34][35]

See also: Residency (medicine)

Resident specialty choice

Primary Care

There are notable differences in the specialty choices of MDs and DOs. One study attributes this to a difference in the 'cultures' of their medical schools. "In comparison with allopathic schools [MD], the cultural practices and educational structures in osteopathic medical schools better support the production of primary care physicians."[36] According to one survey, 54.6% of deans of conventional medical schools reported that training future primary care physicians was more important to their institutions than training future specialist physicians, compared with 100% of osteopathic medical school deans. (F = 893.11,95, p < .0001).[37]

Licensure

Steps to licensure
MD DO
Medical School Application service AMCAS AACOMAS
Years of medical school 4 4
Medical Licensing Exam (MLE) Step 1 USMLE required
USMLE optional (~50%)
COMLEX required
MLE, Step 2 USMLE required varies by school; may require COMLEX, or choice of either USMLE or COMLEX
residency MD (ACGME) one must be selected:
MD (ACGME)
osteopathic (AOA)
combined MD/DO
AOA approval of an ACGME program[32]
Board Certification State medical specialty boards Either MD or DO medical specialty boards

Continuing medical education

Main article: Continuing medical education

To maintain a license to practice medicine, US physicians are required to complete additional training every few years, so called continuing medical education, CME. There are subtle differences in the CME requirements for MD and DO qualified physicians, and in how these CME credits are approved. The requirements for maintaining a physician license for MD or DO qualified physicians are almost identical in most states, though there are small differences. For example, in the case of Pennsylvania, MD licenses begin on December 31, whereas DO ones begin on October 31.[38]

Professional advantages for MD qualified physicians

MD qualification training is the most widely available and recognized type of medical training. Like the DO, it gives the option to practice in any of the medical specialties, but unlike the DO, the MD is internationally recognized as a medical degree. Thus, when practicing overseas, the MD is easier to negotiate with than is the DO, where the DO degree isn't always understood or recognized. Because they are a minority in American medicine, DOs are more likely than their MD counterparts to have to explain or even defend their training. [39] In the United States, ACGME-accredited residency training programs are generally considered more prestigious and offer higher reimbursement salaries.[40] The majority of US osteopathic medical students attend ACGME-accredited residency programs. Surveys show that the most common reason given by osteopathic medical students choosing an ACGME residency is the perception among osteopathic graduates that ACGME programs offer superior training.[41]

References

  1. ^ Gundling, Katherine E. (1998). "When did I become an "allopath"? (Commentary)". Archives of Internal Medicine. 158: 2185–6. PMID 9818797. Allopathy artificially delimits the practice of medicine […]. It embodies an unnatural, inflexible philosophy of care and implies that our system of care is merely one of many from which a discerning health care consumer may choose. […] The practice of medicine deserves so much more than the parsimonious title allopathy. {{cite journal}}: |access-date= requires |url= (help)
  2. ^ Jung, Paul, MD That Thing that You DO American Medical Student Association.
  3. ^ Phil Galewitz. MD or DO—does it matter to you? Palm Beach Post. 6 Nov 2007.
  4. ^ Chapter 34: Complementary and Alternative Medicine. Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders. 2004.
  5. ^ a b Cohen, Jordan. A Word from the President: "Filling the Workforce Gap." AAMC Reporter: April 2005.
  6. ^ Peters AS, Clark-Chiarelli N, Block SD (1999). "Comparison of MD and DO medical Schools' support for primary care". J Gen Intern Med. 14 (12): 730–9. PMID 10632817.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ Medical School Expansion Plans: Results of the 2006 AAMC Survey Center for Workforce Studies. American Association of Medical Colleges. February 2007.
  8. ^ Fact Sheet 2006 American Osteopathic Association. August 2006.
  9. ^ a b Salsberg, Edward and Grover, Atul. Physician Workforce Shortages: Implications and Issues for Academic Health Centers and Policymakers. Academic Medicine, Vol. 81, No. 9 / September 2006.
  10. ^ Hurt, Avery. Inside osteopathic medicine’s parallel world. The New Physician. Feb 2007.
  11. ^ Adams, Damon Adams D (23 Aug 2003). "Small study compares styles: Osteopathic physicians talk more about feelings". Amednews.com.
  12. ^ Licciardone JC (2007). "A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003-2004". Osteopath Med Prim Care. 1: 2. doi:10.1186/1750-4732-1-2. PMC 1805772. PMID 17371578.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ^ Peters AS, Clark-Chiarelli N, Block SD (1999). "Comparison of osteopathic and allopathic medical Schools' support for primary care". J Gen Intern Med. 14 (12): 730–9. PMID 10632817.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Johnson SM, Kurtz ME (2002). "Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts". Soc Sci Med. 55 (12): 2141–8. PMID 12409127. {{cite journal}}: Unknown parameter |month= ignored (help)
  15. ^ a b c d Ziegler, Jennifer. Osteopathic residencies struggle to keep up with the growing number of DO grads. The New Physician. April 2004.
  16. ^ Allopathic medicine. Medical/Neurosurgical Glossary. Northern California Neurosurgery. accessed 5 Nov 2007.
  17. ^ Gevitz N (2006). "Center or periphery? The future of osteopathic principles and practices". J Am Osteopath Assoc. 106 (3): 121–9. PMID 16585378. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ^ Gundling KE (1998). "When did I become an "allopath"?". Arch Intern Med. 158 (20): 2185–6. PMID 9818797.
  19. ^ Miller T, Hooker RS, Mains DA (2006). "Characteristics of osteopathic physicians choosing to practice rural primary care". J Am Osteopath Assoc. 106 (5): 274–9. PMID 16717369.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ Yale Career Counseling Center.
  21. ^ Osteopathic Medical Profession Report American Osteopathic Association. August 2008.
  22. ^ Osteopathic medicine. Intelihealth.com
  23. ^ Johnson SM, Kurtz ME (2001). "Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession". Acad Med. 76 (8): 821–8. PMID 11500286.
  24. ^ Croasdale, Myrle. Record number vied for 2007-08 medical school slots American Medical News. 5 Nov 2007.
  25. ^ a b Cooper RA (2003). "Medical schools and their applicants: an analysis". Health Aff (Millwood). 22 (4): 71–84. PMID 12889752.
  26. ^ Charting Outcomes in the Match Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2007 NRMP Main Residency Match, 2nd Ed. National Resident Matching Program and Association of American Medical Colleges August 2007.
  27. ^ Mychaskiw G (2006). "Will the last DO turn off the lights?". J Am Osteopath Assoc. 106 (5): 252–3, 302, discussion 302–3. PMID 16717365.
  28. ^ Steier KJ (2006). "Time to accept allopathic physicians into AOA-approved residencies?". J Am Osteopath Assoc. 106 (5): 250–2. PMID 16717364.
  29. ^ Forte TE (2007). "Repatriating DOs with MD-affiliated residencies". J Am Osteopath Assoc. 107 (5): 174, 197. PMID 17596585.
  30. ^ Osteopathic Residency FAQ. University of Wisconsin.[1]
  31. ^ Hayes OW (1998). "Dual approval of a residency program: ten years' experience and implications for postdoctoral training". J Am Osteopath Assoc. 98 (11): 647–52. PMID 9846049.
  32. ^ a b Resolution 42: Approval of ACGME Training as an AOA-Approved Internship. American Osteopathic Association. accessed October 2007.
  33. ^ Terry RR (2003). "Dually accredited family practice residencies: wave of the future". J Am Osteopath Assoc. 103 (8): 367–70. PMID 12956249.
  34. ^ Schierhorn C. "Educators at summit frame future of Osteopathic Graduate Medical Education" The DO magazine. American Osteopathic Association. June 2008. p.22-27
  35. ^ Schierhorn C. "Slumping Osteopathic Graduate Medical Education piques educators at summit". The D.O. magazine. American Osteopathic Association. Feb 2008. p.22-28
  36. ^ Peters AS, Clark-Chiarelli N, Block SD (1999). "Comparison of osteopathic and allopathic medical Schools' support for primary care". J Gen Intern Med. 14 (12): 730–9. PMID 10632817.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  37. ^ Peters AS, Clark-Chiarelli N, Block SD (1999). "Comparison of osteopathic and allopathic medical Schools' support for primary care". J Gen Intern Med. 14 (12): 730–9. PMID 10632817.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ Requirements for license renewal. Pennsylvania Medical Society.
  39. ^ Allopathic medicine. Princeton Review
  40. ^ Terry RR (2003). "Dually accredited family practice residencies: wave of the future". J Am Osteopath Assoc. 103 (8): 367–70. PMID 12956249.
  41. ^ "Table 16" Debts, Plans and Opinions of Osteopathic Medical Students in 2004. American Association of Colleges of Osteopathic Medicine. p40
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