A DO (Doctor of Osteopathic Medicine) degree is not inherently harder than an MD (Doctor of Medicine) degree in terms of academic rigor. Both require four years of medical school, cover the same core sciences, and produce fully licensed physicians with identical practice rights in all 50 states. Where the paths diverge is in admissions competitiveness, additional coursework, a double-testing burden many DO students take on voluntarily, and real disparities in residency match outcomes that can make the DO pathway feel harder in practice.
What DO Students Learn That MD Students Don’t
DO programs include everything MD programs do: anatomy, physiology, pharmacology, pathology, clinical rotations, and board exams. On top of that, DO students take several hundred additional hours of training in osteopathic manipulative medicine (OMM), a hands-on approach to diagnosing and treating musculoskeletal issues. This is extra material layered onto an already demanding curriculum, not a replacement for anything.
Some students find OMM training valuable, especially those heading into primary care, sports medicine, or physical medicine. Others view it as an added burden with limited relevance to their intended specialty. Either way, it means DO students are covering more ground in the same four-year window.
Admissions Are Easier for DO Programs
Getting into a DO school is generally less competitive than getting into an MD school. Average MCAT scores and GPAs for DO matriculants run lower than their MD counterparts. Median MCAT scores for students entering DO programs typically fall 4 to 8 points below those at MD schools, and average GPAs tend to be a few tenths of a point lower.
This doesn’t mean DO schools are easy to get into. Acceptance rates are still low, and applicants need strong academic records. But for students whose numbers fall below the MD threshold, DO programs offer a viable path into medicine that wouldn’t otherwise exist. Many applicants apply to both MD and DO schools simultaneously.
The Double-Testing Problem
DO students must take the COMLEX-USA board exams, which are specific to osteopathic medicine. MD students take the USMLE. Both exam series have multiple levels spanning preclinical knowledge through clinical skills, and both are grueling multi-hour tests.
Here’s where things get complicated: many residency programs, particularly competitive ones, prefer or require USMLE scores. This means a significant number of DO students choose to sit for both the COMLEX and the USMLE, essentially doubling their testing burden. They’re studying for and taking two parallel sets of high-stakes board exams while their MD peers only take one. That’s a real and measurable increase in difficulty during the clinical years.
USMLE Step 1 shifted to pass/fail scoring in 2022, which has reduced some of the pressure. But Step 2 CK remains scored, and many programs still use it as a screening tool.
Residency Matching Is Harder for DOs
This is where the DO path becomes objectively more difficult. While DOs and MDs now participate in a single residency match system (the merger happened in 2020), outcomes are not equal across specialties.
In primary care fields like family medicine, internal medicine, and pediatrics, DOs match at healthy rates and face minimal disadvantage. These specialties have long welcomed osteopathic graduates, and the numbers reflect that.
In the most competitive specialties, the picture is starkly different. In 2024, DO graduates made up roughly 3% of matched U.S. seniors in orthopedic surgery and just 2% in dermatology. In ENT, neurosurgery, plastic surgery, and urology, DO representation remains in the low single digits. At top academic programs in these fields, a DO match is a rare event. According to a decade-long analysis of match data, a DO applicant with the same research output, same board scores, and same clinical performance as an MD applicant still faces a significantly lower probability of matching in orthopedics.
The reasons are systemic. Many competitive programs don’t routinely interview DO applicants or rank them as highly as MDs. There are fewer DO faculty members in these departments to serve as advocates, and program directors at prestigious institutions often have less familiarity with osteopathic training. These specialties function as what match analysts describe as “MD-first ecosystems.”
For a DO student who enters medical school dreaming of dermatology or neurosurgery, the climb is steeper. They’ll need stronger research portfolios, more strategic networking, and often higher board scores than MD peers competing for the same slots.
Once You’re Practicing, the Degrees Are Equal
DOs hold identical practice rights and prescribing authority to MDs in every U.S. state. They practice in the same hospitals, perform the same surgeries, and manage the same patients. A patient seeing a DO-credentialed cardiologist or surgeon is receiving the same standard of care as one seeing an MD.
Thirteen states still maintain separate licensing boards for DOs and MDs, but this is an administrative distinction, not a practical one. The scope of what you can do as a physician is the same regardless of which degree you hold.
So Which Path Is Actually Harder?
The answer depends on what phase of training you’re talking about. Getting admitted to a DO program is less competitive. The curriculum itself is slightly more demanding due to the added OMM training. Board exams are harder in the sense that many DO students take two full sets of them. And the residency match is meaningfully harder for DOs pursuing competitive specialties.
If you’re aiming for family medicine or emergency medicine, the DO and MD paths are roughly equivalent in difficulty once you’re in. If you’re targeting dermatology, orthopedic surgery, or another ultra-competitive field, the DO path carries real disadvantages that require more effort to overcome. The degree itself isn’t harder. The system around it is.