Part 3: DO vs. MD: Residency and career questions
Are there any differences in DO vs. MD residency opportunities?
It used to be the case that MD students could only match to residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME), whereas DO students could match to residencies accredited by ACGME or the AOA. However, those accreditation councils merged in July 2020, allowing both MD and DO students to train at any residency site.
In the past, a number of ACGME-accredited residencies required that students pass USMLE to be considered for their program. Now USMLE and COMLEX are officially recognized as equivalents, meaning that DO students theoretically don’t have to pass USMLE in order to match into residencies.
Nevertheless, it’s still too early to say if residencies will recognize this equivalency in practice. As such, the safest way for current DO students to expand their residency options is to pass both COMLEX and USMLE.
Notably, as of May 2022, Step 1 of both COMLEX and USMLE are now administered Pass/Fail, and schools are likely to move toward using COMLEX Level 2 scores and Medical Student Performance Evaluation letters as some of the primary criteria in selecting DO students as candidates for medical residency interviews.
What are the differences in MD vs. DO residency match rates?
The 2023 NRMP Main Residency Match Results reflects just the fourth time that all MD and DO students participated in the same residency matching process. The PGY-1 match rate for U.S. MD seniors was 93.7 percent while the match rate for U.S. DO seniors was 91.6 percent.
While these match rates are fairly comparable, it’s worth also considering the match rates within individual specialties. While both MD and DO seniors matched into the primary care specialties—family medicine, internal medicine, and pediatrics—at high rates, DO seniors faced more difficulty matching into highly competitive specialties.
For example, when looking at students who matched into their preferred specialty, MD seniors matched into thoracic surgery residencies at a rate of 83.7 percent while DO seniors matched at a 2 percent rate. In neurological surgery, the difference was even greater: 86.8 percent for MD seniors vs. just 1.2 percent for DO seniors.
Competitive residencies (i.e., those in desirable urban areas and/or desirable specialties) are competitive for everyone. Nevertheless, DO students have an even harder time matching to them, mostly because of differences in prestige or reputation. However, DO students who are at or near the top of their class and who ace USMLE will be competitive for desirable residency programs.
One reason why DO physicians tend to practice primary care is because of the osteopathic medical philosophy. Another reason is that DO students have a more difficult time matching to residencies offering specialty training. In 2023, 52 percent of DO seniors ended up in primary care specialties vs. 35 percent of MD seniors.
(Suggested reading: The Most Competitive Medical Residencies)
Are there differences in DO vs. MD salary?
MD and DO physicians make comparable salaries when equivalent on factors like specialty, position, years of experience, and location. However, MD physicians earn higher incomes than DO physicians on average because they:
Are more likely to specialize, and specialists typically have higher salaries than generalists.
Tend to practice more in urban areas (salaries are usually higher for city dwellers, who have to deal with a higher cost of living; moreover, specialists tend to practice in urban areas).
However, it isn’t always the case that physicians who work in urban areas make more than their counterparts in rural areas. Because living in urban areas is more desirable for many people—plus the fact that many cities contain numerous medical schools and academic medical centers, leading to high concentrations of doctors—employers may offer lower compensation to urban physicians. On the other hand, some employers in rural areasmay offer higher compensation to attract talent.
(Suggested reading: How Much Do Doctors Make?)
Can U.S.-trained MD and DO physicians practice medicine internationally?
MD physicians have full practice rights worldwide, whereas DO physicians currently have them in roughly 50 countries and partial practice rights in many other countries. The AOA is working diligently to increase acceptance of DO degrees by more and more countries.
Working as Locum Tenens
If practicing internationally is a goal for you, you may want to consider an MD path and exploring your options for working as a locum doctor. Locum doctors take temporary assignments in locations where demand for physicians is high, and as such, travel will be a core part of the job.
One of the major benefits to working as a locum doctor is having more control over your work-life balance, as you’ll be free to choose your working hours and change locations or roles when you want.
Furthermore, locum doctors tend to be slightly better compensated than traditionally-employed doctors, as they fill roles in hospitals that are struggling to find qualified doctors. This means that the roles may be in rural areas, but with more free time on your hands, you can delve into hobbies such as learning a new language or exploring unique natural environments.
Part 4: DO vs. MD: Where to apply
So how should you decide whether to apply to DO programs, MD programs, or both? The answer to this question depends on the following factors:
Preferred training modality
Career goals
Stats (i.e., GPA and MCAT score)
Preferred training modality
Both MD and DO physicians are highly skilled practitioners who undergo years of intense medical training. However, the allopathic and osteopathic approaches to care appeal differently to different people. If you prefer to train via a more holistic medical approach and/or want to study osteopathic manipulative treatment, DO programs could be a great fit for you.
Career goals
While both MD and DO physicians can practice any medical specialty, this ability is contingent on matching into one’s desired specialty. Although interests change during medical school and beyond, you should prioritize MD programs if you anticipate wanting to pursue a medical specialty. On the other hand, if you’re strongly considering working as a primary care physician, your preferred training modality should play a heavier role in your decision-making process.
