An MD (Doctor of Medicine) and a DO (Doctor of Osteopathic Medicine) are both fully licensed physicians who can practice in every medical specialty, prescribe medications, and perform surgery. The core difference is that DO programs include additional training in osteopathic principles and hands-on musculoskeletal techniques, while MD programs follow a strictly allopathic model. In practice, the two degrees have converged significantly over the past decade.
Training and Curriculum
MD and DO students take the same prerequisite courses before medical school and complete four years of medical education covering anatomy, pharmacology, pathology, and clinical rotations. The major curriculum difference is that DO students receive extra coursework in osteopathic manipulative treatment (OMT), a set of hands-on techniques for diagnosing and treating musculoskeletal problems. This training adds roughly 200 additional hours to the DO curriculum over four years.
After medical school, both MDs and DOs enter residency programs. Since a five-year transition that began in 2015, all residency programs now fall under a single accreditation system run by the ACGME. Before that merger, DO graduates trained in separately accredited programs. The transition was remarkably successful: 98% of previously osteopathic-only programs that applied gained ACGME accreditation, and filled residency positions in those programs grew 22% by 2020. Some residency programs now carry “Osteopathic Recognition,” meaning they formally integrate osteopathic principles into training for residents who want to maintain that focus.
The Osteopathic Philosophy
Osteopathic medicine is built on four tenets adopted by the American Osteopathic Association. The first is that the body is a unit of body, mind, and spirit. The second holds that the body is capable of self-regulation and self-healing. The third states that structure and function are reciprocally interrelated, meaning a problem in one part of the musculoskeletal system can affect other organs and systems. The fourth is that rational treatment should be based on all three of those principles working together.
In practical terms, this means DO training emphasizes looking at the whole patient rather than isolating a single organ system. DOs are trained to consider how posture, musculoskeletal alignment, and lifestyle contribute to a patient’s condition. MD programs also teach patient-centered care, but they don’t formalize it as a core philosophical framework the way osteopathic schools do.
Osteopathic Manipulative Treatment
OMT is the most visible, tangible difference between the two degrees. It’s a collection of hands-on techniques that DOs can use alongside conventional treatments. Common techniques include muscle energy (using gentle resistance to relax and lengthen muscles), myofascial release (working tight muscle and connective tissue to improve blood flow), and lymphatic pump (rhythmic pressure on the chest, abdomen, or feet to clear fluid blockages and reduce swelling).
Doctors most commonly use OMT for back, neck, and head pain. But it’s also applied to a surprisingly broad range of conditions: asthma and sinus infections, irritable bowel syndrome and constipation, chronic pain from fibromyalgia or arthritis, carpal tunnel syndrome, pregnancy-related swelling and sciatica, and sports injuries. Not every DO uses OMT regularly in practice. Those in surgical specialties or hospital-based medicine may rarely perform it, while DOs in primary care or musculoskeletal medicine incorporate it more often.
Board Exams
MD students take the United States Medical Licensing Examination (USMLE). DO students are required to take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), which covers standard medical content plus osteopathic principles. COMLEX is necessary for DO students to graduate.
Here’s where it gets interesting: a 2022 study in the Journal of Graduate Medical Education found that 60% of DO students also took at least one part of the USMLE. Taking the USMLE is entirely optional for DO students, but many choose to do so because USMLE scores are more commonly used as a metric in residency selection. The American Medical Association has advocated for COMLEX and USMLE scores to be viewed equally, but in competitive specialties, some program directors still favor USMLE scores simply because they’re more familiar with the scoring scale.
Primary Care vs. Specialty Distribution
The biggest statistical difference between MDs and DOs shows up in career choices. According to 2024 figures from the AOA, 57% of DOs practice in primary care specialties. Among MD graduates, historically about a quarter work in primary care. That gap reflects both the osteopathic emphasis on whole-patient, preventive care and the fact that many osteopathic medical schools were founded specifically to address primary care shortages in underserved areas.
Both MDs and DOs can and do enter every specialty, from neurosurgery to dermatology to cardiology. The degree on your diploma does not limit which residencies you can apply to. That said, some of the most competitive subspecialties still draw disproportionately from MD-granting schools, partly because of historical networking effects and partly because top-ranked research institutions have traditionally been MD programs.
Licensing and Practice Rights
Within the United States, MDs and DOs have identical practice rights. Both hold unrestricted medical licenses, can prescribe controlled substances, admit patients to hospitals, and practice in any state. From a patient’s perspective, your DO cardiologist and your MD cardiologist went through equivalent residency training and passed equivalent licensing standards.
Internationally, the picture is more complicated. Practice rights for U.S.-trained DOs vary by country and sometimes by province. A major source of confusion is that many countries associate the American DO degree with foreign-trained “osteopaths,” who are non-physician practitioners that only perform manipulation. In those countries, a U.S.-trained DO may need to go through additional credentialing to demonstrate that they hold a full medical degree. If you’re a DO considering practicing abroad, expect to research each country’s requirements individually, because there is no universal standard.
Which Degree Should You Choose?
If you’re a pre-med student deciding between MD and DO programs, the clinical training you’ll receive is functionally equivalent. The choice comes down to a few practical factors. DO programs appeal to students drawn to the osteopathic philosophy, those interested in hands-on treatment techniques, and those leaning toward primary care. MD programs tend to have stronger research infrastructure and may offer a slight edge in the most competitive specialty matches, though this gap is narrowing.
Acceptance statistics also matter. DO programs generally have slightly lower average MCAT scores and GPAs for admitted students compared to MD programs, making them a realistic path for strong applicants who might not match the profile of top-tier MD schools. The total number of osteopathic medical schools has grown rapidly, with more than 40 colleges of osteopathic medicine now operating across the country.
If you’re a patient wondering whether to see an MD or a DO, the short answer is that the letters after your doctor’s name matter far less than their training, experience, and communication style. Both degrees produce fully qualified physicians. The only practical difference you might notice is that a DO may occasionally offer hands-on musculoskeletal treatment as part of your visit, something an MD typically would not.