Medical School: DO vs. MD and Other Deciding Factors

MD classmates huddling together on residency match day.

Medicine is a field filled with decisions – ones you’ll have to make before you even get to the part where you decide what you’re going to specialize in. There’s no point in rushing you through contemplating your entire medical career so quickly, however.

First you have to choose a school. Because of the cost, both in time and money, of applying to medical programs, you’ll want to get it right the first time.

Intro

Current medical students and admissions officers offer two pieces of advice to prospective med students: know what you’re looking for in a med school and know what the schools are looking for in a candidate. While numbers and scores play a big part in the admissions process, schools do look for students who are also well-rounded, that is, who don’t have stellar scores but do have an impressive story or background.

Types of Medical Program

Currently, there are 206 M.D.-granting (allopathic) medical schools in the U.S. and Canada, and 30 D.O.-granting (osteopathic) medical schools in the United States and its territories.

The first allopathic medical school was founded in 1791 at the University of Pennsylvania. Some 83 years later, Andrew Taylor Still, M.D. founded the first School of Osteopathic Medicine in 1874 in Missouri, with an emphasis on musculoskeletal training and manipulation to aid bodily function. Though chartered by state law to grant graduates an M.D., he chose rather to grant a D.O. or Diplomat in Osteopathy.

Over the next century, the two branches of medicine found themselves frequently in open conflict. But by 1974 federal and state governmental bodies, as well as the American Medical Association, recognized them as equals.

Today, allopathic and osteopathic medical schools share a great deal in common, including:

  • Applicant base chosen from students with four-year undergraduate degrees with science prerequisites
  • Four years of basic medical education, including two years didactic and two years clinical
  • The opportunity to pursue generalist and specialist tracks
  • The requirement to pass board exams for licensure
  • The opportunity to practice in fully-accredited hospitals

While they remain legally separate but equal branches of medicine, they are increasingly found working side by side in communities across America. D.O. training continues to possess additional emphasis on musculoskeletal function, but is also noted today for an emphasis on holistic care and success in producing a high percentage of primary care physicians.

Allopathic Medicine (MD)

Allopathic medicine is the most predominant and widely available type of medical education. The doctors that most people know about, like your dermatologist or orthopod, are usually allopathic or MDs.

If you choose allopathic medicine, your schooling will be divvied up into studying the medical sciences throughout the course of the first two years, then case-based training, more often than not with actual patients, in the last two years. This is when you’ll learn in small-sized, group collaboratives as opposed to in huge lecture auditoriums.

The last two years of medical school are mainly spent doing clinical rotations.

Regardless of whether you feel you were born to be an orthopedic surgeon, you’ll still have to go through family medicine, cardiology, emergency-room care and many other clinical rotations that you may not be too keen or enthusiastic about. Take on these duties thinking of them as “once in a lifetime” opportunities to explore the diverse range of specialties you may never enter. You may actually find it frustrating the fact you’re usually rotated out of an area just as you’re beginning to like it or learning enough to be useful.

Osteopathic Medicine (DO)

In the past, osteopathic medicine was based on preventive care, doctor-patient communication and a holistic approach to health. It was also at one time considered to be somewhat radical – the “other” medicine. Today much of what osteopathy has always advocated is rapidly becoming part of all medical training.

The major difference between osteopathic and allopathic training is that osteopaths are taught a type of treatment called osteopathic manipulative medicine, or OMM, (not to be confused with chiropractic manipulation, which has an entirely different system of education and is not recognized as a fully licensed medical degree). Osteopaths believe there exists a unity between a living organism’s anatomy and physiology. Osteopathic science includes behavioral, chemical, physical, spiritual and biological knowledge. It is based on health maintenance as well as disease prevention and alleviation.

According to the American Osteopathic Academy of Orthopedics (AOAO), osteopathic ideology underscores the following precepts:

  1. The human being is a dynamic unit of function;
  2. the body possesses self-regulatory mechanisms that are self-healing in nature;
  3. the body’s structure and function are interrelated at all levels;
  4. and rational treatment is based on these three principles.

What does this mean to an osteopathic student? You’ll have to learn all of the same science as allopathic students, as well as osteopathic diagnosis and treatment – in the same amount of time. The additional training gives practicing osteopaths a way of helping patients that allopaths don’t have.

Traditionally, most osteopaths go into family practice, internal medicine, pediatrics, ob-gyn and general surgery. They tend to be generalists first and specialists second. There are D.O.s (Doctors of Osteopathy), however, in just about every area of modern medical practice, from neurological surgery to psychiatry, oncology and emergency medicine.

Historically, certain surgical subspecialties did not accept D.O.s, in large numbers anyway. Osteopathic research used to be something of an oxymoron, but now the American Osteopathic Association is becoming much more active in encouraging research activities, particularly in primary care.

D.O. schools have a reputation for “looking past the numbers,” leading some in the medical field to look at osteopathic students as those who didn’t get accepted to allopathic schools. This shouldn’t deter you from practicing osteopathic medicine if that’s what you truly like. Also, if you have a few blemishes on your academic record but a life that suggests you’ll make a dedicated physician, you should strongly consider applying to osteopathic schools.

Most premeds trying to decide whether or not to apply to D.O. schools worry about what will happen to them after they graduate and try for a residency. Osteopathic graduates participate along with allopathic and foreign medical school graduates (both U.S. and non-resident) in the National Resident Matching Program (NRMP). Osteopaths can apply for either osteopathic or allopathic residencies.

In 2014 osteopathic candidates matched at a rate of 77.7%, vs. 94.4% for allopaths.

Reputation

Most applicants to medical school hope to get into the most prestigious institution possible. But a school’s reputation – often based on quantitative factors like the amount of research funding or the percentage of applicants accepted – doesn’t tell the whole story. For instance, if you’re interested in primary care, you won’t be happy at a med school that’s a leader in research but gives you little patient contact in the first two years. On the other hand, if you’re interested in becoming an academic physician or a biomedical researcher, a school whose mission is to educate family practitioners may leave you pining for the lab.

To find out which schools best match your interests, go directly to each program’s website, get in touch with med students, talk to physicians and pick the brains of your premed adviser and professors. There’s also online forums such as those found at The Student Doctor Network (SDN) where applicants can commiserate with each other, as well as med students, residents and physicians. While they can be tremendously useful, make sure not to get discouraged by hearsay and negative, at times paranoid, outlooks expressed in some posts.

Curriculum

Until relatively recently, med school curriculums were structured according to the formula adopted in the early part of the 20th century: the first two years were dominated by large, teacher-directed lectures that focused on the sciences basic to medicine, and the second two years were devoted to clinical experiences – exposure to patients, primarily in hospital settings. Criticism that traditional curriculums don’t adequately teach listening, interviewing and other interpersonal skills, and that lectures and other largely teacher-directed learning formats stress memorization over real understanding, forced med schools to change the way they train students.

Some schools now augment lectures with small discussion sections, while others offer pathways that are almost entirely student directed. A few schools require students to work in physicians’ offices or other clinical settings during the preclinical years. By now you know your learning style. If you’re comfortable guiding your own education and feel constricted by too much structure, a more modern, flexible curriculum is for you. If on the other hand you thrive on structure and work better in a less personalized environment, you may want to consider med schools with a more traditional curriculum. Overall, the trend is towards curricula that give students the opportunity to work in small groups and that expose students to patients early in their academic career.

Location

No matter how hard you intend to study, there is life outside the lab, and it’s not just in the classroom or the hospital. A school’s location can seriously affect the kind of lifestyle you’ll be able to have. Before you set your heart on a school because of an innovative curriculum or a top-notch research program, make sure you can live with your choice for at least four years, if not more. For example, if you’re leaning toward Columbia University but you have never lived in a big city, spend some time in New York before you make your final decision. On the other hand, if you’re a complete urbanite who doesn’t enjoy the great outdoors, a place like Dartmouth is probably not the place for you.

Size

Size can also play an important role in how you’ll feel about a school. Very small and very large schools have their advantages and disadvantages. Students from small schools are able to make personal contacts with their professors. They also tend to form a closer bond with their fellow students and professors than do students at larger institutions, though some students at small schools complain of the “cliquish atmosphere.” This is nothing different than the choices you faced in selecting an undergraduate school.

Students at large schools are usually enthusiastic about the number of opportunities they have to participate in academic and extracurricular activities. Some complain they sometimes feel like numbers in large lecture classes. Again, if you liked the choice you made for undergraduate school, a similar class size might work well for medical school. Or you may want to try what you haven’t already.

Diversity

Even though white males still represent the largest proportion of U.S. med students, times are changing. Most schools are committed to enrolling a student body that more accurately represents the makeup of society than did med school classes of the past. In recent years, most special recruiting efforts are directed at women and members of minorities traditionally underrepresented in medicine, specifically African Americans, mainland Puerto Ricans, Mexican Americans and Native Americans. Future legislative and judicial decisions may continue to encourage some schools to change admissions policies to foster more diversity.

Efforts to increase the number of female med students have been paying off. At several schools women are in the majority, and at many others the sexes are nearly balanced. Overall, the gender distribution of U.S. allopathic medical school matriculants in 2014 was 47.8% female and 52.2% male, respectively.

While perceptions of equal or unequal treatment are subjective, men and women clearly have different ideas of what is really going on in med school classrooms. Female students recommend that applicants look for evidence of support for women in medicine from a school’s faculty, administration and student body. For example: mentoring programs in which female students are paired with practicing female physicians, research efforts directed at women’s health issues, and a strong representation of women in senior faculty and administrative positions.

Additional Resources

For information on MD school locations, requirements and class sizes you can go to AAMC’s Medical School Admissions Requirements (MSAR) page. For DO schools, you can download the Osteopathic Medical College Information Book at the AACOM website.