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 philosophical: DO programs include additional training in the musculoskeletal system and a hands-on treatment approach called osteopathic manipulative treatment (OMT), while MD programs follow what’s called the allopathic tradition. In day-to-day practice, most patients won’t notice a difference. But the two paths diverge in meaningful ways during training, licensing exams, and competitiveness for certain specialties.
The Philosophical Split
MD programs train physicians in what’s known as allopathic medicine, which focuses on diagnosing disease and treating it with drugs, surgery, or other interventions. DO programs teach all of that too, but layer on a specific philosophical framework built around four tenets recognized by the American Osteopathic Association: the body functions as a single unit of body, mind, and spirit; it’s capable of self-healing; structure and function are deeply connected; and effective treatment requires understanding all three of those principles together.
In practical terms, this means DO students spend extra hours learning to use their hands to diagnose and treat problems in the muscles, joints, and connective tissues. This technique, OMT, is used most often for lower back pain, neck pain, and migraines, but it also has applications during pregnancy (improving sleep and relieving pain), in infants with colic or difficulty breastfeeding, and for conditions involving poor circulation or restricted range of motion. Not every DO uses OMT regularly in practice, but every DO is trained in it.
Medical School Training
Both MD and DO students complete four years of medical school. The first two years are heavily focused on basic sciences (anatomy, physiology, pharmacology, pathology), and the last two years are spent in clinical rotations at hospitals and clinics. The foundational science curriculum is essentially the same.
The key difference is that DO students take additional coursework in osteopathic principles and practice throughout all four years. This includes learning specific OMT techniques and applying the osteopathic philosophy to clinical decision-making. MD students don’t have this component, so their curriculum may allocate that time differently across other subjects, but neither degree requires meaningfully more or fewer total hours of training.
Different Licensing Exams
MD and DO graduates take separate national licensing exams, though both lead to the same result: a full medical license. MD graduates take the USMLE (United States Medical Licensing Examination), scored on a scale of 1 to 300. DO graduates are required to take the COMLEX-USA (Comprehensive Osteopathic Medical Licensing Examination), scored on a scale of 9 to 999.
The two exams cover similar biomedical and clinical science content, but COMLEX-USA also tests osteopathic principles, osteopathic manipulative treatment, and the application of osteopathic philosophy to patient care. Every US licensing jurisdiction accepts COMLEX-USA for DO licensure. Some DO students choose to take both COMLEX and the USMLE, particularly if they’re applying to residency programs that are more familiar with USMLE scoring.
Residency and the Single Accreditation System
Until recently, MD and DO graduates trained in separate residency systems. That changed in June 2020, when a five-year transition brought all US residency programs under a single accreditation system run by the ACGME (Accreditation Council for Graduate Medical Education). During the transition, 98% of previously osteopathic-only programs successfully earned ACGME accreditation, and filled positions in those programs grew 22% to over 10,400.
This means MD and DO graduates now compete for the same residency spots. In practice, both can match into any specialty, from family medicine to neurosurgery. But the playing field isn’t perfectly level yet, especially in competitive surgical subspecialties.
Match Rate Gaps in Competitive Specialties
DO applicants match into residency at significantly lower rates than MD applicants in several surgical subspecialties. From 2020 to 2023, the overall surgical subspecialty match rate was about 53% for DOs compared to 74% for MDs. The gap is especially stark in some fields:
- Plastic surgery: 4.2% of DO applicants matched versus 68.8% of MDs
- Thoracic surgery: 16.7% for DOs versus 46.5% for MDs
- Vascular surgery: 23.2% for DOs versus 74.2% for MDs
- Neurosurgery: 30.9% for DOs versus 74.9% for MDs
- Orthopedic surgery: 56.9% for DOs versus 72.5% for MDs
- General surgery: 57.6% for DOs versus 73.2% for MDs
These numbers reflect a mix of factors: residual bias in some program selection committees, differences in research opportunities at MD versus DO schools, and the fact that some programs are still less familiar with COMLEX scoring. The gap has been narrowing since the single accreditation system took effect, but it remains statistically significant. DO graduates who want to pursue highly competitive specialties often bolster their applications by also taking the USMLE and seeking research experience early.
In primary care fields like family medicine, internal medicine, and pediatrics, the match rate differences are much smaller, and DOs make up a growing share of the workforce. Historically, osteopathic medicine has emphasized primary care and whole-person health, so a disproportionate number of DOs practice in these areas by choice.
The Workforce Today
The 2024 FSMB census counted 1,082,187 actively licensed physicians in the United States. About 89% hold an MD degree and 11% hold a DO degree. That 11% figure has been climbing steadily as enrollment at osteopathic medical schools has grown faster than at allopathic schools over the past two decades. Once in practice, both MDs and DOs hold the same prescribing authority, hospital privileges, and scope of practice in all 50 states.
Practicing Internationally
Inside the US, there’s no legal distinction between what an MD and a DO can do. Internationally, the picture is more complicated. DOs have full practice rights in over 65 countries, but not everywhere. Some countries don’t recognize the DO degree as equivalent to an MD, or they may confuse American DOs (who are physicians) with non-physician osteopaths trained in manual therapy programs common in Europe and Australia. If you’re a DO considering international practice, checking the specific country’s recognition policies through the Osteopathic International Alliance or the AOA is worth doing before making plans.
What This Means for Patients
If you’re choosing a doctor, both MDs and DOs are fully qualified to diagnose, treat, prescribe, and operate. A DO may be more likely to incorporate hands-on musculoskeletal assessment into a routine visit and may approach treatment with a stronger emphasis on how your body’s structure affects its function. But individual practice style varies enormously within both groups. A board-certified DO cardiologist and a board-certified MD cardiologist have passed the same specialty boards and meet the same standards of care.
If you’re choosing a medical school path, the practical question is whether the osteopathic philosophy and OMT training resonate with how you want to practice, and whether you’re aware of the additional hurdles DO graduates can face when competing for the most selective surgical residencies. Both degrees lead to the same career, but the routes have different terrain.