MD vs. DO: What Applicants Should Know Before Choosing

Two Degrees, One Profession

MDs and DOs are both fully licensed physicians. They prescribe the same medications, perform the same surgeries, complete the same residencies, and practice in the same hospitals. Patients rarely know — or care — which degree their physician holds. Yet the distinction continues to matter in admissions strategy, residency competitiveness, and career planning in ways that applicants need to understand clearly.

The Historical Divide

Osteopathic medicine was founded in 1874 by Andrew Taylor Still, who emphasized the musculoskeletal system's role in health and disease. DO training includes everything MD training includes, plus osteopathic manipulative medicine (OMM) — a set of hands-on diagnostic and treatment techniques. In practice, most DOs do not use OMM regularly after residency, but it remains a required part of osteopathic medical education.

The practical differences have narrowed considerably. The single accreditation system (implemented 2020) means DO and MD students now train in the same residency programs under the same accreditation body (ACGME). Before 2020, DO students often matched into AOA-accredited residencies that were separate from the ACGME system. That separation is gone.

The Numbers

As of 2024, there are 38 osteopathic medical schools in the US (with many operating multiple campuses) compared to 158 MD-granting schools. DO schools collectively enroll about 35% of all US medical students — a share that has grown significantly over the past decade.

Average MCAT scores at DO schools are typically 502-510, compared to 510-520 at MD schools. Average GPAs follow a similar pattern. This is not a commentary on quality — it reflects different applicant pools and admissions thresholds. A 507 MCAT that is below median at most MD schools is competitive at many DO programs.

Residency Match: Where It Matters

The single most important question for MD-vs-DO decision-making is: what specialty do you want to practice?

For primary care specialties — family medicine, internal medicine, pediatrics, psychiatry — DO graduates match at rates comparable to MD graduates. The training is equivalent, the clinical exposure is equivalent, and residency directors in these fields evaluate DO and MD applicants on substantially similar criteria.

For competitive specialties — dermatology, orthopedic surgery, plastic surgery, neurosurgery, radiation oncology — DO graduates face a measurably harder path. Match rates for DO applicants in these fields, while improving, remain lower than for MD applicants with comparable board scores. This is partly statistical (fewer DO applicants in these fields), partly institutional (some program directors retain a preference for MD applicants), and partly practical (DO students historically had less access to away rotations and research networks at academic medical centers).

If you are certain you want to pursue a highly competitive specialty, the MD degree provides a structural advantage that is worth factoring into your decision. If you are open to a range of specialties, or if primary care is your goal, the distinction matters far less.

COMLEX vs. USMLE

DO students take COMLEX (the osteopathic licensing exam) and may additionally take USMLE (the allopathic licensing exam). Many DO students take both, because some residency programs — particularly competitive ones — prefer or require USMLE scores for comparison purposes.

Taking both exams is additional work and expense, but it removes one variable from the residency application. If you attend a DO school and have any interest in competitive specialties or non-primary-care fields, plan to take USMLE Step 1 and Step 2 in addition to COMLEX.

When DO Makes Strategic Sense

Choosing a DO school is strategically sound in several scenarios:

• Your MCAT is 500-509. This range is below median at most MD schools but competitive at many strong DO programs. Attending a well-regarded DO school with a 506 is a better outcome than reapplying for a year to raise your MCAT to 512.
• You are drawn to primary care or general specialties. The training is equivalent, the match rates are comparable, and many DO schools have excellent primary care and community medicine curricula.
• A specific DO school offers something you value. Geographic location, curriculum structure, clinical rotation sites, cost — these factors matter more day-to-day than the letters after your name.
• You want to be a physician this cycle, not next cycle. If the choice is between a DO acceptance now and reapplying to MD programs next year, the gap year has real costs (financial, emotional, temporal) that must be weighed against the marginal benefit of the MD degree.

When to Prioritize MD

• Highly competitive specialty aspirations — dermatology, ortho, plastics, neurosurgery.
• Academic medicine career goals — while DO faculty exist at academic medical centers, MD graduates currently hold the vast majority of academic and leadership positions.
• International practice — some countries do not recognize the DO degree, or recognition is more complex than for MD.

The Honest Bottom Line

If you can get into both an MD and a DO program and all other factors are roughly equal, the MD degree provides marginally more flexibility — particularly for competitive specialties and academic careers. But "all other factors equal" is rare. Tuition, location, clinical sites, match data, and the specific programs available at each school are often more consequential than the degree type.

Do not attend a poorly ranked, expensive MD program over a well-established, affordable DO program solely for the letters. The degree opens the door; everything after that is you.