Comparison of MD and DO in the United States

While MD schools have followed the development of society, osteopathic medicine is a more recent development. The first MD school in the United States opened in 1807 in New York.{{Citation needed|date=May 2020}} In 1845, the American Medical Association was formed, and standards were put into place, with a three-year program including lectures, dissection, and hospital experience.{{Citation needed|date=May 2020}} In 1892, frontier physician Andrew Taylor Still founded the American School of Osteopathy (now A.T. Still University) in Kirksville, Missouri, as a protest against the present medical system. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt, and treated effects rather than causes of disease.Still AT.[https://archive.org/stream/philosophymechan00stiliala/philosophymechan00stiliala_djvu.txt The Philosophy and Mechanical Principles of Osteopathy.] Kansas City, Mo: Hudson-Kimberly Pub Co; 1902:9–20,185,210,270. Version 2.0. Inter Linea Web site. Accessed January 23, 2006. Throughout the 1900s, DOs gained practice rights and government recognition. The first state to pass regulations allowing DOs medical practice rights was California in 1901, the last was Nebraska in 1989.{{cite book|last=Gevitz|first=Norman|title=The DO's: osteopathic medicine in America|year=2004|publisher=Johns Hopkins University Press|location=Baltimore, Maryland|isbn=978-0-8018-7833-6}} Up through the 1960s, osteopathic medicine was labeled a cult by the American Medical Association, and collaboration by physicians with osteopathic practitioners was considered to be unethical.{{cite book|url=http://accessmedicine.mhmedical.com/content.aspx?aid=1120786239|title=Harrison's Principles of Internal Medicine|first=Josephine P.|last=Briggs|editor-first1=Dennis|editor-last1=Kasper|editor-first2=Anthony|editor-last2=Fauci|editor-first3=Stephen|editor-last3=Hauser|editor-first4=Dan|editor-last4=Longo|editor-first5=J. Larry|editor-last5=Jameson|editor-first6=Joseph|editor-last6=Loscalzo|date=16 April 2018|publisher=McGraw-Hill Education|access-date=16 April 2018|via=Access Medicine}}

The American Medical Association's current definition of a physician is "an individual who has received a 'Doctor of Medicine' or a 'Doctor of Osteopathic Medicine' degree or an equivalent degree following successful completion of a prescribed course of study from a school of medicine or osteopathic medicine."{{cite web|title=H-405.969 Definition of a Physician|url=https://www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/resources/html/PolicyFinder/policyfiles/HnE/H-405.969.HTM|publisher=American Medical Association|access-date=27 September 2015}}

In a 2005 editorial about mitigating the impending shortage of physicians in the United States, Jordan Cohen, MD, then-president of the Association of American Medical Colleges (AAMC) stated:

{{blockquote|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.{{cite web|last=Cohen|first=Jordan|title=Following in Flexner's Footsteps|url=http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Footsteps2.aspx|publisher=American Medical Association|access-date=14 July 2012|archive-url=https://archive.today/20130223183610/http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Footsteps2.aspx|archive-date=23 February 2013|url-status=dead|df=dmy-all}}}}

Of the 989,320 physicians actively practicing in the United States as of December 31, 2022, 66% hold an MD degree granted in the U.S., 26% are international medical graduates (IMG), and 8% hold a DO degree.{{Cite web |title=2023 U.S. Physician Workforce Data Dashboard |url=https://www.aamc.org/data-reports/data/2023-us-physician-workforce-data-dashboard |access-date=2024-03-12 |website=AAMC |language=en}} The percentage of physicians that hold a DO degree varies by specialty, with the greatest representation in Family Medicine/General Practice (16.5% of general practitioners), Physical Medicine & Rehabilitation (13.8%), and Emergency Medicine (11.2%) [2016 data].{{cite web |title=2016 Physician Specialty Data Book |url=https://www.aamc.org/data/workforce/reports/457712/2016-specialty-databook.html |publisher=Association of American Medical Colleges}} IMG physicians are more likely to enter primary care specialties than US MD physicians. As of 2007, IMG physicians represented 36% of internal medicine physicians, 29% of anesthesiologists, 31.4% of psychiatrists, 28% of pediatricians, 17.8% of family physicians, 17.8% of OB/GYNs, 18.8% of radiologists and 20% of general surgeons.

As of 2015, 9.0% of residents and fellows in medical training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), which accredits all residency programs, hold a DO degree. 65.1% of the 19,302 DO graduates enrolled in post-doctoral training are in ACGME-accredited programs, with the remainder in AOA programs.{{cite web|title=2016 Osteopathic Medical Profession Report|url=http://osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf|publisher=American Osteopathic Association|access-date=2017-08-25|archive-url=https://web.archive.org/web/20170825143216/http://osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf|archive-date=2017-08-25|url-status=dead}} Since 2020, the ACGME accredits all residency programs in the United States for both MDs and DOs.{{cite web | url=https://www.acgme.org/What-We-Do/Accreditation/Single-GME-Accreditation-System/ | title=Single GME Accreditation System }}

There are significantly more MDs than DOs. However, the number of DOs is increasing at a rate faster than MDs. A 2012 survey of students applying to both U.S. MD and DO schools found that 9% of applicants were admitted only to an MD school, 46% were admitted only to a DO school, 26% were admitted to both, and 19% were not admitted to any medical schools.{{cite web|title=2012 Applicants to U.S. and Offshore Medical Schools|url=http://www.aacom.org/data/applicantsmatriculants/Documents/2012%20Applicants%20to%20U%20S%20%20and%20Offshore%20Medical%20Schools.pdf|publisher=American Association of Colleges of Osteopathic Medicine|access-date=2 November 2014|archive-url=https://web.archive.org/web/20140815225034/http://www.aacom.org/data/applicantsmatriculants/Documents/2012%20Applicants%20to%20U%20S%20%20and%20Offshore%20Medical%20Schools.pdf|archive-date=15 August 2014|url-status=dead|df=dmy-all}} Geographic location was the top reason given by both DO and MD students for choosing the school in which they enrolled.

Of first-year medical students matriculating in 2016, 25.9% (7,369 students) entered US-DO schools and 74.1% (21,030 students) entered US-MD schools.{{cite web|title=Results of the 2016 Medical School Enrollment Survey|url=https://members.aamc.org/iweb/upload/Results%20of%20the%202016%20Medical%20School%20Enrollment%20Survey.pdf|publisher=Association of American Medical Colleges|access-date=24 August 2017|archive-url=https://web.archive.org/web/20170825142837/https://members.aamc.org/iweb/upload/Results%20of%20the%202016%20Medical%20School%20Enrollment%20Survey.pdf|archive-date=25 August 2017|url-status=dead}} The Association of American Medical Colleges projects that from 2016 to 2021, first-year DO student enrollment will increase by 19.4% versus a 5.7% increase in MD students. 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 150% (from about 1,000 to about 2,800).{{cite journal |author=Salsberg E |author2=Grover A |title=Physician workforce shortages: implications and issues for academic health centers and policymakers |journal=Acad Med |volume=81 |issue=9 |pages=782–7 |year=2006 |pmid=16936479 |doi=10.1097/00001888-200609000-00003|doi-access=free }} 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.

The geographic distribution of MD and DO physicians is not uniform. As of 2012, the states with the greatest ratio of active physicians holding a DO degree versus active physicians holding an MD degree were Oklahoma (20.7% of physicians), Iowa, Michigan, Maine, and West Virginia. During that same year, the states with the greatest ratio of active physicians holding an MD degree versus a DO degree were Louisiana, D.C., Massachusetts, Maryland, and Connecticut.{{cite web|title=2013 State Physician Workforce Data Book|url=https://members.aamc.org/eweb/upload/State%20Physician%20Workforce%20Data%20Book%202013%20(PDF).pdf|page=19|publisher=Association of American Medical Colleges|access-date=1 September 2015|archive-url=https://web.archive.org/web/20160304053803/https://members.aamc.org/eweb/upload/State%20Physician%20Workforce%20Data%20Book%202013%20(PDF).pdf|archive-date=4 March 2016|url-status=dead}} The states with the greatest per capita number of MD physicians are Washington, D.C., Massachusetts, Maryland, New York, and Connecticut.

The sex and racial distribution of DOs and MDs are similar.{{cite journal |vauthors=Peters AS, Clark-Chiarelli N, Block SD |title=Comparison of Osteopathic and Allopathic Medical Schools' Support for Primary Care |journal=J Gen Intern Med |volume=14 |issue=12 |pages=730–9 |year=1999 |pmid=10632817 |doi=10.1046/j.1525-1497.1999.03179.x |pmc=1496864}}

While the number of MD students and MD schools is significantly greater than the number of DO students and DO schools, MD schools have applied for and received 800 times more funding for scientific and clinical research from the National Institutes of Health than DO schools. In 2011, DO schools ranked last out of 17 types of educational institutions, including veterinary medicine, optometry, social work, and dentistry.{{cite journal|title=Research in the Osteopathic Medical Profession: Roadmap to Recovery|first1=Brian C.|last1=Clark|first2=Jack|last2=Blazyk |date=1 August 2014|journal=The Journal of the American Osteopathic Association|volume=114|issue=8|pages=608–614|doi=10.7556/jaoa.2014.124 |pmid=25082966|doi-access=free}} In 2014, an article in the Journal of the American Osteopathic Association stated that research from osteopathic schools amounted to "fewer than 15 publications per year per school, and more than a quarter of these publications had never been cited."

About sixteen percent of IMG MD physicians hold academic positions, whereas eighty percent practice medicine in community settings.{{cite web |title=THE ROLE OF INTERNATIONAL MEDICAL GRADUATES IN THE U.S. PHYSICIAN WORKFORCE: A Policy Monograph of the American College of Physicians |url=https://www.acponline.org/acp_policy/policies/role_international_medical_graduates_2008.pdf |website=ACP |publisher=American College of Physicians |access-date=9 February 2020}}

Several studies have investigated whether there is a difference in the approach to patients by MDs and DOs. A study of patient visits to general and family medicine physicians in the U.S., including 277 million visits to MDs and 65 million visits to DOs, found that there was no significant difference between DOs and MDs with regard to time spent with patients and preventive medicine services.{{cite journal |author=Licciardone JC |title=A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004 |journal=Osteopath Med Prim Care |volume=1 |page=2 |year=2007 |pmid=17371578 |pmc=1805772 |doi=10.1186/1750-4732-1-2 |doi-access=free }}

The study of approximately 341 million healthcare visits founds that there was no difference on the rate that doctors provided to patients diet or nutrition counseling, weight-reduction counseling, exercise counseling, tobacco use or exposure counseling, and mental health or stress reduction counseling. Some authors{{who|date=November 2017}} describe subjective distinctions in patient interactions, but 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. The differences are there—subtle, but deep."{{cite journal |title=Inside osteopathic medicine's parallel world |author=Hurt, Avery |date=February 2007 |journal=The New Physician }}

A study published by the Journal of General Internal Medicine found significant differences in the attitudes of DOs and MDs. The study found that 40.1% of MD students and physicians described themselves as "socioemotionally" oriented over "technoscientific" orientation. In comparison, 63.8% of their DO counterparts self-identified as socioemotional.

One study of DOs attempted to investigate their perceptions of differences in philosophy and practice between themselves and their MD counterparts: "59 percent of the respondents believed they practiced differently from allopathic physicians, and 72 percent of the follow-up responses indicated that the osteopathic approach to treatment was a primary distinguishing feature, mainly incorporating the application of OMT, a caring doctor–patient relationship, and a hands-on style."{{cite journal |vauthors=Johnson SM, Kurtz ME |title=Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts |journal=Soc Sci Med |volume=55 |issue=12 |pages=2141–8 |date=December 2002|pmid=12409127 |doi=10.1016/S0277-9536(01)00357-4}}

As the training of DOs and MDs became less distinct, some expressed concern that the unique characteristics of osteopathic medicine would be lost. Others welcomed the rapprochement and already considered modern medicine to be the type of medicine practiced by both "MD and DO type doctors".{{cite web |url=http://www.neurosurgical.com/neurgosurgery_glossary/a.htm |title=Medical/Neurosurgical Glossary |website=Northern California Neurosurgery Medical Group |access-date=27 September 2015}} One persistent difference is the respective acceptance of the terms "allopathic" and "osteopathic." DO medical schools and organizations all include the word osteopathic in their names, and such groups actively promote an "osteopathic approach" to medicine. While "osteopathy" was a term used by its founder AT Still in the 19th century to describe his new philosophy of medicine, "allopathic medicine" was originally a derogatory term coined by Samuel Hahnemann to contrast the conventional medicine of his day with his alternative system of homeopathic medicine.{{cite journal|author=Berkenwald A|title=In the Name of Medicine|journal=Ann Intern Med|date=1 February 1998|volume=128|issue=3 |pages=246–250|doi=10.7326/0003-4819-128-3-199802010-00023|s2cid=53089206}}{{Citation|title=Nature Cures: The History of Alternative Medicine in America|author=Whorton JC|year=2004|isbn=978-0-19-517162-4|pages=18, 52|url=https://books.google.com/books?id=RU0DndWVSPoC&pg=PA18|publisher=Oxford University Press|location=New York}} Some authors argue that the terms "osteopathic" and "allopathic" should be dropped altogether, since their original meanings bear little relevance to the current practice of modern medicine.{{cite journal|author=Gundling K|title=When Did I Become an "Allopath"?|journal=Arch Intern Med|date=9 November 1998|volume=158|issue=20|pages=2185–2186|doi=10.1001/archinte.158.20.2185|pmid=9818797}}{{cite web |url=http://www.ncahf.org/articles/a-b/allopathy.html |title=Misuse of the Term "Allopathy" |author=Jarvis WT |access-date=27 September 2015 |publisher=National Council Against Health Fraud |date=1 December 2000}}

The Liaison Committee on Medical Education (LCME) accredits the 144 U.S. medical schools that award the MD degree,{{cite web |url=https://www.aamc.org/about/membership/378788/medicalschools.html |title=Medical Schools |publisher=Association of American Medical Colleges |access-date=27 September 2015}}{{cite web|url=http://www.lcme.org/directory.htm |archive-url=https://archive.today/20131114000754/http://www.lcme.org/directory.htm |url-status=dead |archive-date=14 November 2013 |title=Medical School Directory |publisher=Liaison Committee on Medical Education |access-date=27 September 2015 }} while the American Osteopathic Association (AOA)'s Commission on Osteopathic College Accreditation (COCA) accredits the 38 osteopathic medical schools that award the DO degree.{{cite web|url=https://osteopathic.org/about/affiliated-organizations/osteopathic-medical-schools/ |title=Osteopathic Medical Schools |publisher=American Osteopathic Association |access-date=31 August 2019}} Osteopathic medical schools tend to be affiliated with smaller universities.{{cite web|url=https://www.forbes.com/sites/sciencebiz/2010/10/27/osteopaths-versus-doctors/#204d2a9d1033|title=Osteopathic Physicians Versus Doctors|first=Steven|last=Salzberg|website=forbes.com|access-date=16 April 2018}}

Michigan State University, Rowan University, and Nova Southeastern University offer both MD and DO accredited programs.{{cite news|last=Hedger|first=Brian|title=Texas university explores offering an MD degree in addition to its DO program|url=http://www.ama-assn.org/amednews/2009/04/27/prsc0427.htm|access-date=5 July 2012|newspaper=American Medical News|date=April 27, 2009}} In 2009, Kansas City University proposed starting a dual MD/DO program in addition to the existing DO program,{{cite news|title=Fired medical school president had been pushing big changes|url=http://www.joplinglobe.com/joplin_metro/x546223676/Fired-medical-school-president-had-been-pushing-big-changes|access-date=30 June 2012|newspaper=Joplin Metro|date=December 25, 2009}} and the University of North Texas explored the possibility of starting an MD program that would be offered alongside the DO program. Both proposals were met with controversy. Proponents argued that adding an MD program would lead to the creation of more local residency programs and improve the university's ability to acquire research funding and state funding, while opponents wanted to protect the discipline of osteopathy.

61% of graduating seniors at osteopathic medical schools evaluated that over half of their required in-hospital training was delivered by MD physicians.{{Cite web|url=http://www.aacom.org/docs/default-source/data-and-trends/2014-15-GSSSR.pdf|title=AACOM 2014-15 Academic Year Survey of Graduating Seniors Summary|date=2015|website=AACOM|access-date=June 5, 2016}} Overall, osteopathic medical schools have more modest research programs compared to MD schools, and fewer DO schools are part of universities that own a hospital.{{cite journal|author=Chen C|author2=Mullan F|title=The separate osteopathic medical education pathway: uniquely addressing national needs. Point.|journal=Acad Med|date=June 2009|volume=84|issue=6|pages=695|pmid=19474535|doi=10.1097/ACM.0b013e3181a3dd28|doi-access=free}} Osteopathic medical schools tend to have a stronger focus on primary care medicine than MD schools. DO schools have developed various strategies to encourage their graduates to pursue primary care, such as offering accelerated three-year programs for primary care, focusing clinical education in community health centers, and selecting rural or under-served urban areas for the location of new campuses.

{{see also|List of medical schools in the United States|Medical school in the United States}}

Many authors note the most obvious difference between the curricula of DO and MD schools is osteopathic manipulative medicine (OMM), a form of hands-on care used to diagnose, treat and prevent illness or injury and is taught only at DO schools. As of 2006, the average osteopathic medical student spent almost eight weeks on clerkships for OMM during their third and fourth years.{{cite journal|author=Krueger PM|author2=Dane P |author3=Slocum P |author4= Kimmelman M |title=Osteopathic clinical training in three universities|journal=Acad Med|date=June 2009|volume=84|issue=6|pages=712–7|doi=10.1097/ACM.0b013e3181a409b1|pmid=19474543|doi-access=free}} The National Institute of Health's National Center for Complementary and Integrative Health states that overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments.{{cite web|url=http://nccih.nih.gov/health/pain/spinemanipulation.htm |title=Spinal Manipulation for Low-Back Pain | NCCIH |publisher=National Institutes of Health National Center for Complementary and Integrative Health |date=26 January 2015 |access-date=27 September 2015}} In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when pain does not improve with self-care.{{cite journal|author=Chou R|author2=Qaseem A |author3=Snow V |author4=Casey D |author5=Cross T |author6=Shekelle P |author7=Owens DK |title=Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society|journal=Ann Intern Med|date=2 October 2007|volume=147|issue=7|pages=478–491|pmid=17909209|doi=10.7326/0003-4819-147-7-200710020-00006|doi-access=free}}{{cite journal|last=Chou|first=R|author2=Huffman, LH|title=Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.|journal=Ann Intern Med|date=2 October 2007|volume=147|issue=7|pages=492–504|pmid=17909210|doi=10.7326/0003-4819-147-7-200710020-00007|doi-access=}} Spinal manipulation is generally a safe treatment for low-back pain. Serious complications are very rare. A 2001 survey of DOs found that more than 50% of the respondents used OMT (osteopathic manipulative treatment) on less than 5% of their patients. The survey was the latest indication that DOs have become more like MD physicians in all respects: fewer perform OMT, more prescribe drugs, and many perform surgery as a first option.{{cite journal |vauthors=Johnson SM, Kurtz ME |title=Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession |journal=Acad Med |volume=76 |issue=8 |pages=821–8 |year=2001 |pmid=11500286 |doi=10.1097/00001888-200108000-00016|doi-access=free }} One area which has been implicated, but not been formally studied regarding the decline in OMT usage among DOs in practice, is the role of reimbursement changes.{{cite journal|author=Snider KT |author2=Jorgensen DJ |title=Billing and coding for osteopathic manipulative treatment |journal=J Am Osteopath Assoc |date=August 2009 |volume=109 |issue=8 |pages=409–13 |pmid=19706830 |doi=10.7556/jaoa.2009.109.8.409 |doi-access=free }} Only in the last several years could a DO charge for both an office visit (Evaluation & Management services) and use a procedure (CPT) code when performing OMT; previously, it was bundled.

{{further-text|Status of OMM within the Osteopathic profession}}

The use of standardized exams as indicators of performance or aptitude has been debated.{{Citation needed|date=November 2021}} However, while less than the difference between other factors such as race (which may affect MCAT scores by 9 points or more{{Cite web|url=https://www.aamc.org/system/files/2019-10/2019_FACTS_Table_A-18.pdf|title=Table A-18: MCAT Scores and GPAs for Applicants and Matriculants to U.S. Medical Schools by Race/Ethnicity, 2019-2020|date=October 16, 2019|website=aamc.org|access-date=March 12, 2020}}), there is a statistical difference of about 5 points on average MCAT scores of those who matriculate at DO schools versus those who matriculate at MD schools. There is also a difference of 0.16 GPA between MD and DO matriculants. In 2016, the average MCAT and GPA for students entering U.S.-based MD programs were 508.7 and 3.70,{{cite web|title=Table A-16: MCAT Scores and GPAs for Applicants and Matriculants to U.S. Medical Schools, 2016-2017|url=https://www.aamc.org/download/321494/data/factstablea16.pdf|publisher=Association of American Medical Colleges|access-date=24 August 2017}} respectively, and 503.8 and 3.54 for DO matriculants.{{cite web|title=2016 AACOMAS Profile: Applicant and Matriculant Report|url=http://www.aacom.org/docs/default-source/data-and-trends/2016-aacomas-applicant-amp-matriculant-profile-summary-report.pdf?sfvrsn=10|publisher=American Association of Colleges of Osteopathic Medicine|access-date=24 August 2017}} DO medical schools are more likely to accept non-traditional students, who are older, coming to medicine as a second career, etc.{{cite web|title=Osteopathic Medical College Information Book|url=http://www.aacom.org/docs/default-source/cib/2016_cib.pdf|publisher=American Association of Colleges of Osteopathic Medicine|page=19|year=2016|access-date=27 September 2015}}{{cite news|author=Madison Park |url=http://www.cnn.com/2011/HEALTH/06/13/mid.life.doctors/index.html?hpt=hp_t2/ |title=Never too late to be a doctor |publisher=CNN News |date=June 13, 2011 |access-date=December 17, 2011}}

MD students take United States Medical Licensing Examination (USMLE)'s series of three licensing exams during and after medical school.

DO students are required to take the Comprehensive Osteopathic Medical Licensure Examination (COMLEX-USA) that is administered by the National Board of Osteopathic Medical Examiners (NBOME). This exam is a prerequisite for DO-associated residency programs, which are available in almost every specialty of medicine and surgery. DO medical students may also choose to sit for the USMLE if they wish to increase their competitiveness for residency{{cite web|url=http://www.usmle.org/bulletin/eligibility/ |title=Eligibility for the USMLE Examinations |publisher=United States Medical Licensing Examination |access-date=27 September 2015}} and about 48% take USMLE Step 1. However, if they have taken COMLEX, it may or may not be needed, depending on the individual institution's program requirements.{{cite journal |author=Sarko J |author2=Svoren E |author3=Katz E |title=COMLEX-1 and USMLE-1 are not interchangeable examinations |journal=Acad Emerg Med |pmid=20070273 |doi=10.1111/j.1553-2712.2009.00632.x |date=February 2010 |volume=17 |issue=2 |pages=218–20 |doi-access=free }}{{cite journal|author=Chick DA |author2=Friedman HP |author3=Young VB |author4=Solomon D |title=Relationship between COMLEX and USMLE scores among osteopathic medical students who take both examinations|journal=Teach Learn Med|date=January 2010|volume=22|issue=1|pages=3–7|pmid=20391276|doi=10.1080/10401330903445422|s2cid=1517521 }}{{cite web |url=http://www.nbome.org/directors-faq.asp |title=Information for Program Directors |publisher=National Board of Osteopathic Medical Examiners |access-date=27 September 2015 |archive-url=https://web.archive.org/web/20110807005745/http://www.nbome.org/directors-faq.asp |archive-date=7 August 2011 |url-status=dead |df=dmy-all }}

Currently, the ACGME accredits all MD and DO residency programs, while previously the American Osteopathic Association (AOA) accredited all DO residency programs. Now all DO students apply to ACGME-accredited residency programs through the National Resident Matching Program (NRMP) rather than completing a DO residency. As of 2014, 54% of DOs in post-doctoral training are enrolled in an ACGME-accredited residency program and 46% are enrolled in an AOA-accredited residency program.

Since 1981, a single residency training program can be dual-accredited by both the ACGME and the AOA.{{cite journal |author=Hayes OW |title=Dual approval of a residency program: ten years' experience and implications for postdoctoral training |journal=J Am Osteopath Assoc |volume=98 |issue=11 |pages=647–52 |date=November 1998|pmid=9846049}}

The number of dually accredited programs increased from 11% of all AOA approved residencies in 2006 to 14% in 2008, and then to 22% in 2010.{{cite journal|last=Burkhart|first=DN|author2=Lischka, TA|title=Dual and parallel postdoctoral training programs: implications for the osteopathic medical profession.|journal=J Am Osteopath Assoc|date=April 2011|volume=111|issue=4|pages=247–56|pmid=21562295}} In 2000, the AOA adopted a provision making it possible for a DO resident in any MD program to apply for osteopathic approval of their training.{{cite journal |author=Bulger JB |url=http://jaoa.org/article.aspx?articleid=2093263 |title=Approval of ACGME Training as an AOA-approved internship: history and review of current data |journal=J Am Osteopath Assoc |pmid=17242416 |date=December 2006 |volume=106 |issue=12 |pages=708–13}} The topic of dual-accreditation is controversial. Opponents claim that by merging DO students into the "MD world", the unique quality of osteopathic philosophy will be lost.{{cite journal |author=Zeigler, Jennifer |title=Osteopathic residencies struggle to keep up with the growing number of DO grads |journal=The New Physician |date=April 2004 |volume=53 |issue=3}} Supporters claim the programs are popular because of the higher prestige and higher resident reimbursement salaries associated with MD programs.{{cite journal |author=Terry RR |title=Dually accredited family practice residencies: wave of the future |journal=J Am Osteopath Assoc |volume=103 |issue=8 |pages=367–70 |date=August 2003|pmid=12956249}}

Over five years starting in July 2015, the AOA, AACOM, and the ACGME will create a single, unified accreditation system for graduate medical education programs in the United States.{{cite web|title=Single GME Accreditation System|url=https://www.acgme.org/acgmeweb/tabid/445/GraduateMedicalEducation/SingleAccreditationSystemforAOA-ApprovedPrograms.aspx|publisher=Accreditation Council for Graduate Medical Education|access-date=31 August 2015|archive-url=https://web.archive.org/web/20150829115535/http://www.acgme.org/acgmeweb/tabid/445/GraduateMedicalEducation/SingleAccreditationSystemforAOA-ApprovedPrograms.aspx|archive-date=29 August 2015|url-status=dead}}{{cite web|title=The Single GME Accreditation System|url=http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/default.aspx|publisher=American Osteopathic Association|access-date=31 August 2015|archive-url=https://web.archive.org/web/20150905205518/http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/default.aspx|archive-date=5 September 2015|url-status=dead|df=dmy-all}} This will ensure that all physicians trained in the U.S. will have the same graduate medical education accreditation, and as of June 30, 2020, the AOA will cease its accreditation functions.

There are notable differences in the specialty choices of DOs and MDs. 60% of DOs work in primary care specialties,{{cite web|url=https://medicalschoolhq.net/md-vs-do-what-are-the-differences-and-similarities/#2|title=MD vs DO - What are the Differences (and similarities)?|date=3 March 2012|website=medicalschoolhq.net|access-date=16 April 2018}} compared to 35% of MDs.{{cite web|url=http://www.philly.com/philly/blogs/health-cents/Does-osteopathic-medicine-have-a-future.html|title=Does osteopathic medicine have a future? - Philly|website=philly.com|access-date=16 April 2018}}

For IMG graduates applying for residency training in the US, the Educational Commission for Foreign Medical Graduates assesses the applicants' preparedness for entering these US training programs. IMG physicians tend to enter primary care at higher rates than US MD physicians.

|-

! Residency
(Prior to June 30, 2020)

| MD (ACGME)|| One must be selected:

|-

! Residency
(Current)

| colspan="2" style="text-align:center" | ACGME

|-

! Board certification

|MD medical specialty boards || Either DO or MD medical specialty boards

|}

{{main|Continuing medical education}}

To maintain a professional license to practice medicine, U.S. physicians are required to complete ongoing additional training, known as continuing medical education (CME). CME requirements differ from state to state and between the American Osteopathic Medical Association (DO) and the American Medical Association (MD/DO) governing bodies.

An MD degree is accepted in most countries worldwide, while the DO degree is currently accepted in 85 countries abroad; this does not indicate that the DO degree is rejected in the rest of the countries but showcases a history of graduates approaching the medical boards of the accepting countries.{{Cite web|title=International Licensure|url=https://osteopathic.org/life-career/medical-licensure/international-licensure/|access-date=2021-09-03|website=American Osteopathic Association|language=en-US}} DO graduates may apply to countries outside of the 85 countries for recognition or practicing rights. Accredited DO and MD medical schools are both included in the World Health Organization's World Directory of Medical Schools.{{cite web|title=World Directory of Medical Schools|url=http://avicenna.ku.dk/database/medicine|publisher=University of Copenhagen|access-date=5 July 2012|archive-url=https://web.archive.org/web/20100220160231/http://avicenna.ku.dk/database/medicine|archive-date=20 February 2010|url-status=dead}}

• Physicians in the United States

{{Reflist|30em}}

• [https://osteopathic.org/what-is-osteopathic-medicine/what-is-a-do/ American Osteopathic Association: What is a DO?]

{{Medical education in the United States}}

{{DEFAULTSORT:Comparison Of Md And Do In The United States}}

Category:Osteopathic medicine

Category:Health care occupations

Category:Medical education in the United States

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