Applying to Both Allopathic and Osteopathic Medical Programs? Here’s What You Need to Know.

If you’re a prospective medical student, particularly one interested in primary care, it’s a good idea to consider osteopathic medical programs in addition to allopathic ones. While many students grow up dreaming of an MD behind their name, osteopathic medicine continues to grow in popularity. One in four medical students in the United States attends an osteopathic program, according to the American Osteopathic Association (AOA). 

The program requirements for MD and DO programs are similar, although osteopathic students are required to take an additional 200 hours of osteopathic manipulative medicine (OMM) training, which focuses on the spine, bones, and muscles. “Osteopathic physicians use all of the tools and technology available to modern medicine with the added benefits of a holistic philosophy and a system of hands-on diagnosis and treatment known as osteopathic manipulative medicine. Doctors of osteopathic medicine emphasize helping each person achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention,” the AACOM says.

Additionally, while osteopathic programs are highly competitive, entrants typically have slightly lower GPAs and MCAT scores than their allopathic counterparts.

Mean GPA and MCAT scores for Entering 2022 Osteopathic Students:

• Overall GPA: 3.61

• Science: 3.53

• Non-Science: 3.70

• Overall MCAT: 504.8

• Psychological, Social, and Bio: 125.3

• Bio and Biochemical: 127.2

• Chemical and Physical: 126.4

• Critical Analysis and Reasoning: 126.0

Mean GPA and MCAT scores for Entering 2022 Allopathic Students:

• Overall GPA: 3.75

• Science: 3.68

• Non-Science: 3.84

• Overall MCAT: 511.9

• Psychological, Social, and Bio: 128.9

• Bio and Biochemical: 128.2

• Chemical and Physical: 127.9

• Critical Analysis and Reasoning: 127.0

Recipients of both degrees have similarly high residency match rates (over 90 percent for both in 2023), though DOs tend to specialize in primary care at higher rates. In May 2021, the AOA’s Physician Masterfile reported that 56.5% of osteopathic doctors (DOs) practiced primary care (including specialties like obstetrics and gynecology and pediatrics). And in 2022, nine colleges of osteopathic medicine were in U.S. News & World Report’s list of the top 10 schools with the most graduates practicing primary care. 

Among the more competitive specialties, MDs continue to outnumber DOs in residency placement. But DOs can increase their competitiveness by taking the USMLE (MD accreditation) in addition to the COMLEX (DO accreditation). 

Sounds appealing? Here’s what to keep in mind for your DO application:

• Submit your AMCAS and secondary applications first. Then, turn to your osteopathic applications (AACOMAS), which you’ll want to submit by October. 

• Spend at least 20 hours working alongside a DO and ensure your application demonstrates your understanding of and motivation to pursue a career in osteopathic medicine.

• Request a recommendation letter from a DO. 

• Review the guidelines for any program where you would be considered in-state, as some schools must admit a certain percentage of in-state students.

• Review the residency placements for the DO programs you are considering to ensure the school’s placements align with your goals. 

Osteopathic Medicine Continues to Grow in Popularity

Osteopathic medicine is one of the fastest growing segments in healthcare, according to the American Osteopathic Association’s (AOA) Osteopathic Medical Profession Report. The number of osteopathic medical students has grown by 77 percent in the last ten years, which has led to an 81 percent increase in the total number of DOs (including practicing physicians, residents, and medical students). Today, there are an estimated 122,236 in the physician workforce, just over one in four medical students are currently pursuing a Doctor of Osteopathic Medicine (DO) degree, and an estimated 36,500 medical students are expected to matriculate into a DO program this school year (up 2,700 from last year). 

Demographic highlights:

• Practicing DOs predominantly fall within a younger cohort. Just over two-thirds of practicing physicians are under 45 (35 percent are under 35, and 32 percent are between 35 and 44). 

• In 2022, 43 percent of the practicing DOs were female, an upward trend that has continued over time (40 percent in 2015, and 32 percent in 2010). Almost half of practicing physicians (47 percent) are female and under 45. 

• Most DOs tend to practice near where they completed their education, and DO programs are typically located in medically underserved regions. The states with the largest number of DOs include: California (8.3 percent), Pennsylvania (8.1 percent), Florida (7.9 percent), Michigan (6.6 percent), New York (6.4 percent), and Texas (6.1 percent).

• Since 2020, the Accreditation Council on Graduate Medical Education (ACGME) has overseen the accreditation of all graduate medical education (allopathic and osteopathic). DO graduates also participate in the National Resident Matching Program (NRMP). The report notes that 2022 brought a new record level of placement for participating DOs, with 7,049 graduates placing into residency programs in 41 specialties. This is up 7 percent from the previous year. 

• DOs predominantly work in primary care specialties. The top fields include family medicine, internal medicine, and pediatrics. Among the remaining 43 percent who opt into other specialties, the top fields include: Emergency medicine, Anesthesiology, Obstetrics and Gynecology, General surgery, and psychiatry. 

Related: Alternatives to Allopathic Medical Programs in the United States

Medical Student Calls for Greater Transparency in Residency Match Data

National Match Day took place on Friday, March 18, 2022. According to the National Resident Matching Program, NRMP, it was a successful day, which “realized many significant milestones” including: 

• Consistent or increased match rates across applicant types: 

--US MD Seniors PGY-1 matched at 92.9 percent (+0.1 percentage points from 2021)

--US DO Seniors matched at 91.3 percent (+2.2)

--US citizen international medical graduates matched at 61.4 percent (+1.9)

--Non-US citizen international medical graduates matched at 58.1 percent (+3.3)

--And it was the highest match rate on record for previous year graduates, with US MD graduates matching at a rate of 50.5 percent (+2.3), and DO graduates matching at a rate of 53.6 percent (+9.3).

However, a recent article written by Nicole Mott, a student at the University of Michigan Medical School, and published in the New England Journal of Medicine, with a follow-up interview on MedPage Today contends that most current match reporting only tells part of the story. Mott is calling for the NRMP to reconsider how the match rate is calculated and to provide additional transparency into the match data. 

She starts by pointing out aspects of the current reporting that can be misleading or confusing. 

• The published NRMP “match rate” doesn’t include all specialties and programs; it excludes ophthalmology, urology, and military training programs. 

• The variation in match rates by applicant type should always be called out explicitly (as seen above) in recognition of the significant variation in match rates between applicant types: MD Senior, DO Senior, IMG (citizen or non-citizen), and graduates (MD, DO). The media often just reports one overall (or applicant type) match rate, which can be misleading and create inaccurate expectations among applicants regarding the likelihood of receiving a match. 

Next, she calls for a reconsideration of how the current match rate is calculated. Currently, the match rate is the proportion of “active applicants” who match into a participating residency program. However, an “active applicant” is someone who registers for the NRMP match and submits a rank order list. Mott points out that approximately eight percent of NRMP registrants withdraw or do not submit a rank order list and are thus excluded from the calculation. This includes participants who apply to programs but are not invited to interview and therefore do not submit a rank order list. This definition of active applicant likely inflates the match rate and underestimates the number of physicians who are unable to find a residency placement. 

She also provides suggestions for data that, if made publicly available, would help inform medical students as they make plans for the future.

• The number of applicants who register for NRMP match and don’t submit a rank order list, as well as the characteristics of this group. This would provide insight into potential inequities in the process, as well as applicant competitiveness for specialties. 

• The number and characteristics of unmatched physicians including those who only match into a preliminary first-year position. It would also be helpful to include information on the careers these physicians pursue and where they ended up, which could inform physician workforce planning. 

• Detailed match outcomes relevant to students going through the process, which could inform students pursuing a match, and also drive systemic improvements. This may include the specialty-specific matching positions on rank order lists, which could also inform decisions such as application or interview caps. 

Mott notes that the proportion of MD and DO seniors matched to their top-ranked programs has “subtly declined” over the past 15 years and, during the same period, the number matched to their fourth-ranked choice or lower has increased. Additionally, she calls out the “over-congestion” in the residency application process. Applicants are now applying to more programs than ever, just as programs are receiving more applicants. She recommends a review of the data to determine if caps should be placed on the number of applications and interviews. Similarly, she calls for more transparency from residency programs in their selection criteria. Programs should be explicit in the criteria they seek in an applicant, and applicants should be more specific about their goals and geographic preferences. 

Ultimately, better data, and more visibility into the match process will benefit students and residency programs, and allow each to make the best possible decisions.