By Paul Levy

First Posted at Not Running a Hospital on 8/19/2013

Paul Levy, Host of (Not) Running a Hospital
Paul Levy, Host of (Not) Running a Hospital

I wrote to an associate, who is a DO (Doctor of Osteopathic Medicine), with the following question:

“I have a young friend who is trying to choose between a DO and an MD.  Would you have advice for her?”

The reply was immediate and strongly felt.  I copy it with permission and seek your responses:

This is really a philosophical choice. I applied to both and got in first to a DO school while wait-listed at a couple MD schools. I had no higher aspirations than to practice medicine and do good for people.
The sad reality is that there is a not so subtle and in many cases flagrant prejudice against DOs. Simply put, MDs and MD institutions discriminate against DOs. Hiring practices in many states or regions discriminate against DOs. I heard of a case recently where there was a sick patient on an airplane flying domestically, not foreign, and the responding doc was a DO. When the doc said we have to go down now in the best interest of the patient the pilot refused because the doc was “just” a DO.
It sounds cruel to say it but the question is similar in many ways to asking whether you want to be white or black, or whether you want to be male or female. As a DO you will be a discriminated against minority. Overall you will make less money, you will not have access to the best paying  or most prestigious jobs, you will unlikely be able to achieve an academic appointment at a prestigious MD led institution and you will constantly be asked to explain yourself. “Just what is a DO anyway, doc?” The good thing is that you will always do good work no matter where or for whom because the education is very good and all American. 
If her aspirations are simple then it really doesn’t matter. The philosophy of osteopathic medicine is very appealing and I think most human and appropriate. The education is at least as good as MD, especially in a university affiliated school. But the dark side is that the MD world will always look down on you as something less than adequate or someone significantly less than worthy or competent. If her aspirations are to function in a university setting, maybe do research, maybe aspire to lofty public health goals or something along these lines, forget DO school and go to an MD school even if it is an offshore school. Sadly, it is the letters after her name that will count, not the education. Sure there are a few token DO stars here and there, but the MDs rule and DOs are viewed as second rate, generally speaking, in the towers of medicine, especially in the ivory ones.
My advice? See if you can discern your long term goals. Then make your choice based on that discernment. We are all idealists at first. Try to see past that. It is not an easy task.

Best of luck to her.


  1. I would agree with the overall observations of your friend. The only exception I would state is in the specialty of Physical Medicine and Rehabilitation. I am an MD in that field and a previous residency program director. DO’s tend to outnumber MD’s with over 50% of applicants being DO’s. this is in part to the emphasis on MSK training. In my experience, the DO’s that I’ve trained and worked alongside as faculty are excellent colleagues and, within the field, well-respected.

    • Hi Linda:

      Thanks for the comment.

      Agreed! While we’ve come a long way towards curriculum, training and practice culture integration, there remains considerable specialty and regional variation. California faced the DO/MD issue many years ago. The former osteopathic ‘California College of Medicine’, now the University of California of Irvine, College of Medicine is now firmly in the ‘allopathic camp’. So one form of resolution is the let go of the profession’s central tenets and assimilate into the larger culture. No value judgement here, just an observation.


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