Is a Doctor With an M.D. Better Than One With a D.O.?
Record numbers of doctors now have the latter.
Of the approximately 1 million licensed physicians in the United States, the vast majority—nine in 10—are MDs, or medical doctors.
But if you pay attention to the two little initials after your doc's name, you might have noticed something less familiar. An increasing number of doctors now have DO degrees, which stands for doctor of osteopathic medicine, instead. In January, the American Osteopathic Association announced that the number of DOs passed 100,000 for the first time, nearly triple the total three decades ago.
Doctors of both types say there are more similarities than differences between the two, at least in the United States. They're all legit physicians, trained and licensed to do everything from prescribe your Xanax to deliver your babies to answer your embarrassing questions about hygiene habits and STIs.
Students considering a career in medicine are far more likely to end up in an MD, or allopathic, program—there are 147 medical schools in the United States and 17 in Canada that offer them, compared to 33 American DO programs. The main difference is that osteopathic physicians receive bonus training in musculoskeletal health, which may result in a more touchy-feely type of medical visit.
"Osteopathic physicians have been trained in a very holistic model of care—thinking about all the things that may be going into the symptoms the patient is having beyond just obvious physical abnormalities," says William Burke, DO, a family physician and dean of the Ohio University Heritage College of Osteopathic Medicine at Dublin.
Philosophical and logistical changes to medical training and practice are erasing some of the subtle distinctions that remain. And a shortage of both post-graduate residency positions and practicing physicians in the United States have brought the two types of doctors—and the people who train them—together like never before, according to Lisa Howley, senior director of educational affairs at the Association of American Medical Colleges.
Still, when it comes to the person protecting your heart or prodding at your insides, it's probably worth understanding how they earned that white coat.
Those who go for a DO degree tend to look a little bit different from the get-go, Burke says. They are more likely than MD students to be women, and to grow up in rural communities or inner cities. They may be more strongly driven by caring for others than the intellectual and technical challenges of medicine. In a Harvard study, about 63 percent described themselves as more "socioemotionally" than "technoscientifically" oriented, compared with 40 percent of those pursuing MD degrees.
From their first day of freshman year, both MDs and DOs follow a similar nine-plus-year path. They earn bachelor's degrees, followed by four years of medical school. There, they learn the same basic facts about anatomy, physiology, and pharmacology, Burke says.
DOs, however, spend an additional 200 hours or so learning more about nerves, muscles, bones, and how the connection between them impacts your overall health. This includes learning a hands-on technique called osteopathic manipulation, in which the doctor diagnoses and treats patients with touch, Burke says.
Some in the allopathic medical community have raised questions about the evidence underlying this technique. And in some other countries, practitioners called osteopaths who are not medical doctors provide it, potentially creating confusion.
However, recent studies have shown a benefit for osteopathic manipulation in treating low back pain and also balance problems in older adults, among other conditions. What's more, Burke says, the mere act of touching a patient can encourage trust and break down barriers.
After graduation, both types of doctors must pass a licensing examination to practice in their states. MDs take the USMLE, while DOs can opt either for that exam or a similar one that's specific to osteopathic medicine, called COMLEX. From there, newly minted physicians go on to training programs called residencies and fellowships, which typically last two to six years depending on their specialty.
Though there were once two different systems for accrediting these programs, by 2020 both osteopathic and allopathic post-graduate medical opportunities will fall under one agency, the Accreditation Council for Graduate Medical Education. That means some MDs might receive training in osteopathic manipulation, while some DOs might pursue positions that don't include that element, Burke says.
So what does all that mean to you, the patient? For one thing, it affects where you might encounter a DO in the first place. Geographically speaking, there are far more DOs in states that have osteopathic medical programs, including Michigan, Ohio, Indiana, and Florida, according to the January report from the AOA. And they more often practice in underserved urban or rural areas, Burke points out.
More than half of osteopathic physicians choose to go into primary care, which includes family medicine, pediatrics, and internal medicine. "In some cases, patients may notice a more holistic approach to wellness and prevention during a visit with a DO. This is because during their additional training hours, they are taught to put emphasis on a patient's environment, nutrition, and body system as a whole when treating medical conditions," says Keri Peterson, an New York City-based internist who works with digital health platform Zocdoc. "But it's important to note that many MDs also make this a part of their practice."
In fact, in a study published in the journal Osteopathic Medicine and Primary Care, University of North Texas researchers found essentially no difference between MD and DO primary care docs in terms of how long they spent with patients, how much they focused on prevention, or how often they brought up lifestyle issues like exercising, stress, and nutrition.
The musculoskeletal focus of a DO's training also means you'll find many in sports medicine, along with physical medicine and rehabilitation, a specialty that treats physical impairments and disabilities. About one-third of all residency slots in this field are filled with DOs, Burke says.
But a doctor's degree is just one of many factors to consider when choosing either a primary care physician or a specialist, and it's unlikely to be the most crucial one. "There are a multitude of factors and preferences that can impact why one doctor may be a better fit over another for any given patient," Peterson says. "Ultimately, choosing a doctor, whether allopathic or osteopathic, is a very personal choice."
So how can you be sure that you're getting a high-quality health care professional? First, make sure they're board-certified. After their residencies and fellowships, doctors sit for exams administered by specialty organizations. You can check to see if your doc's certified in the area he or she practices here. The task of giving doctors the OK to practice—and weeding out bad seeds—falls to the state, so you could follow up with the medical board (here's a directory) to see if your doc's license is current and contains any black marks.
Most health care providers also have online bios—give yours a quick search. These profiles can tell you where he or she went to school and did residencies and fellowships. You want to look for accredited programs, Hawley says; cross-reference with the Liaison Committee on Medical Education or American Association of Colleges of Osteopathic Medicine for schools and the ACGME for post-grad positions. That'll help you get a sense of their philosophy, Peterson says, and whether or not it's a good fit for your needs.
Written by Cindy Kurzma on https://tonic.vice.com/en_us/article/is-a-doctor-with-an-md-better-than-one-with-a-do