Undeserved Hate? D.O.s vs M.D.s

The scrubs are the same whether worn by an M.D. or a D.O. Most patients don’t even realize whether their primary care provider graduated from a traditional medical school or a D.O. school. Yet as I see users on social media dismiss osteopathic medical schools as “backup options,” I wonder about the history and validity of this invisible medical hierarchy. Why does a two-letter suffix carry so much weight?

The story begins with Andrew Taylor Still in 1874. Three of his children died in an epidemic. Traditional medicine had failed. Crude interventions such as bloodletting and mercury often harmed more than helped. So Still created osteopathic medicine, built on a radical idea – the body could heal itself if you understood how everything was connected.

Meanwhile, M.D. schools had been well-established and were rapidly churning out doctors. Formed in 1845, the American Medical Association had cemented its institutional power. As the new kid on the block, D.O. schools tended to and still do accept slightly lower MCAT scores on average. Their schools also cluster in rural areas. As a result of their “lesser” preconception, early D.O.s faced discrimination as they were excluded from hospitals and banned from medical societies. The irony cuts deep. Everything supposedly “lesser” about D.O. education (focus on primary care, holistic treatment, serving the underserved) is exactly what modern medicine needs. Although these factors don’t necessarily show up on standardized tests, I think anyone could agree that they absolutely matter for physician effectiveness.

Fast-forward to today. The practical differences have nearly vanished. D.O. students get 200 extra hours of hands-on manipulation training. Same MCAT requirements. Same Board Exam. Same residency programs through a unified match system as of 2020. In fact, a comprehensive study found mortality rates of 9.4% for M.D.-treated patients versus 9.5% for D.O.-treated patients. Readmission rates: 15.7% versus 15.6%. Medicare spending differed by one dollar—$1,004 versus $1,003 (Miyawaki et al.). That’s about as similar as you can get.

Given the similarities and benefits of a D.O. education, I was still left wondering why the bias against D.O.s persists. I think it must be a self-fulfilling prophecy. If pre-med students are told that D.O. schools are less academic and prestigious, it only makes sense that the less competitive students will apply. Furthermore, those students might believe that they cannot pursue higher opportunities because their education is “not as rigorous.” If they stay in their bubble serving their communities, they might not get the chance to dismantle this preconception. In the past three decades, the number of D.O.s in the U.S. has quadrupled, merging into the healthcare workforce. I think this is the best way to approach healthcare – integrate multiple backgrounds and educations, remove any bias against certain groups.

So is the animosity toward D.O.s undeserved? Largely, yes. When training and outcomes are nearly identical, the hierarchy seems built on tradition rather than substance. That is to say, I’m hesitant to declare the distinction meaningless. The skepticism of over-medicalization, emphasis on prevention, attention to the whole person are vital osteopathic values. In a healthcare system in need of compassionate physicians willing to serve diverse communities, maybe the question isn’t whether D.O.s measure up to some imaginary M.D. standard. Maybe it’s whether our definition of medical excellence is broad enough to value different paths toward the same goal of healing.