Doctor of osteopathic medicine degree still faces recognition challenges in the United States: Suggested ways to improve awareness

Abstract

Approximately one-quarter of United States medical students train at osteopathic medical schools, which confer the Doctor of Osteopathic Medicine (DO) degree upon graduation. That number has risen exponentially over the past several years, with the American Association of Colleges of Osteopathic Medicine reporting a 65.7% increase in total enrollment since 2013. This increase is at least partly due to the opening of more DO-granting medical schools. However, despite the growing number of osteopathic physicians entering the United States workforce, the degree remains under recognized by patients, nurses, and ancillary staff within hospital systems across the country. Surprisingly, a portion of DO physicians themselves contribute to this under recognition through degree misrepresentation with the Doctor of Medicine label. These physicians have also been historically marginalized from certain competitive specialties and leadership positions, which play a role in under recognition. We suggest proper degree identification and the promotion of more DOs into leadership roles to ultimately improve awareness. Some perceptual challenges and specific barriers to career advancement persist, particularly in competitive specialties, and the continued under recognition despite more osteopathic physicians than ever in the workforce may further perpetuate biases that limit opportunities for prominent leadership roles.

Key Words: Doctor of osteopathic medicine; Association of colleges of osteopathic medicine; Doctor of medicine; Professional identity; Medical leadership; Program director; Health systems

Core Tip: Despite the growing number of osteopathic physicians within the United States workforce, the degree remains under recognized compared to the Doctor of Medicine (MD) degree. This is partly due to degree misrepresentation and the lack of osteopathic physicians in prominent leadership positions within the United States healthcare system compared to their MD counterparts. Addressing these factors may ultimately improve awareness.

INTRODUCTION

The osteopathic medical profession in the United States is thriving due to its continuous expansion and the growing demand for medical care. According to the latest Osteopathic Medical Profession Report and data from the Federation of State Medical Boards, the number of Doctor of Osteopathic Medicine (DO) physicians has risen exponentially since the 1870s, with that number exceeding 160000, an astonishing 1.721% increase since the American Osteopathic Association began keeping records in 1935 (Figure 1)[1-6]. This significant increase is partially due to the opening of more DO-granting medical schools (Table 1)[6,7]. An excess of 38000 students is pursuing osteopathic medical education at more than 40 osteopathic colleges across 71 campuses[1,7]. There are now 207158 DO physicians and medical students, with the osteopathic profession representing more than 25% of all United States medical students[1,8]. Approximately 11% of all physicians in the United States are DOs who now practice across a broad range of medical specialties[1,7,8]. However, despite the tremendous growth of osteopathic physicians, the degree remains under recognized, particularly among nurses, patients, and ancillary hospital staff. There are several reasons for this, including frequent misrepresentation of the DO degree with the Doctor of Medicine (MD) label in the clinical setting and limited representation in certain specialties and leadership roles. This article addresses each of these points in detail and outlines actions physicians within the medical community can take to ultimately improve awareness of the DO degree.

Figure 1 A clustered column chart showing the trend in licensed osteopathic physicians in the United States from 2010 to 2024, based on data from the Federation of State Medical Boards. DO: Doctor of Osteopathic Medicine.

Table 1 List of new Doctor of Osteopathic Medicine-granting medical schools in the United States between 2014-2020.

School	Location	Year established
Edward via College of Osteopathic Medicine Auburn	Auburn, AL, United States	2014
Arkansas College of Osteopathic Medicine	Fort Smith, AR, United States	2014
University of the Incarnate Word School of Osteopathic Medicine	San Antonio, TX, United States	2015
California Health Sciences University College of Osteopathic Medicine	Clovis, CA, United States	2016
Idaho College of Osteopathic Medicine	Meridian, ID, United States	2016
Edward via College of Osteopathic Medicine Louisiana	Monroe, LA, United States	2019
Sam Houston State University College of Osteopathic Medicine	Conroe, TX, United States	2019
Noorda College of Osteopathic Medicine	Provo, UT, United States	2019
Kansas Health Science Center–Kansas College of Osteopathic Medicine	Wichita, KS, United States	2021
Baptist Health Sciences University College of Osteopathic Medicine	Memphis, TN, United States	2021
Meritus School of Osteopathic Medicine	Hagerstown, MD, United States	2022
Orlando College of Osteopathic Medicine	Winter Garden, FL, United States	2023
Duquesne University College of Osteopathic Medicine	Pittsburgh, PA, United States	2024
Lake Erie College of Osteopathic Medicine Jacksonville	Jacksonville, FL, United States	2026

DEGREE MISREPRESENTATION

One of the major reasons the DO degree is still under recognized to patients and the medical community is due to misrepresentation that comes in various forms. DO physicians sometimes mislabel themselves as MDs in both the clinic and the hospital setting. The reason for this remains unknown, though some speculate it stems from challenges with professional identity[9]. Many DOs and students struggle to articulate clear distinctions between allopathic and osteopathic practice, and patients frequently do not recognize or understand the DO designation. It can sometimes be difficult to explain what the DO degree truly means to patients, as the MD degree is far more common and thus requires little to no explanation. Some DO physicians may use the MD degree in these scenarios to avoid the cumbersome conversation with patients. Another form of misrepresentation lies within the electronic medical records (EMRs). Whether intentional or unintentional, EMRs across the United States in various hospital systems are filled with mislabeled physician titles by degree. Sometimes DO physicians are labeled as MDs in the EMRs, and often, it is DOs who are mislabeled as MDs rather than the other way around.

These instances of misrepresentation all contribute to the continued under recognition of the degree. The MD title is far more common historically and, as a result, more familiar to the public[10]. This familiarity and number are further enhanced by the fact that international medical graduates who obtain alternative medical degrees such as the Bachelor of Medicine and Bachelor of Surgery degree from various countries, including India, Australia, Ghana, and Pakistan, among others, convert their degree to MD once they start practicing within the United States, whether as a resident, fellow, or an attending physician[11,12]. This makes it more important for DOs to use the correct degree label whenever possible to increase awareness and ultimately normalize it.

LIMITED REPRESENTATION IN CERTAIN SPECIALITIES AND LEADERSHIP POSITIONS

DOs are highly underrepresented in competitive medical specialties despite the growing number of osteopathic physicians. Competitive specialties such as dermatology and orthopedic surgery consistently attract a disproportionately higher number of United States MD applicants than DOs, despite the increasing number of osteopathic applicants to these positions. A study by Wood et al[13] examined trends in the orthopedic surgery match for allopathic and osteopathic medical graduates after the transition to a single accrediting body found that MD applicants consistently had higher match rates than their DO counterparts. MD applicants had statistically significantly higher numbers of publications (P = 0.0091), research experiences (P = 0.0216), and applications (P = 0.0010) over the years experienced, which accounted for the difference in results. Another study by Craig et al[14] examined match rates for DOs in competitive specialties, including dermatology, otolaryngology, neurosurgery, orthopedic surgery, and plastic surgery, between 2017 and 2019, after the unification of the Accreditation Council for Graduate Medical Education and the former American Osteopathic Association programs. The results were astonishing, with match rates for DOs at 0.6% across all competitive specialties and 0.4% in dermatology. The lack of representation in these specialties is another factor that greatly contributes to the continued under recognition of the DO degree as patients and ancillary staff in these fields are less exposed to the title.

Although the exact numbers are unknown, we theorize that there is a lack of DO physicians in leadership positions such as chief medical officers and medical directors who oversee the medical and clinical operations of a healthcare organization. This to a lesser extent, also plays a role in degree under recognition compared to their MD counterparts. The literature indicates that DOs have experienced decreased representation in educational leadership positions following the transition to the Single Accreditation System, with sharp reductions in DO leadership roles after the merger of allopathic and osteopathic graduate medical education accreditation systems[15]. This suggests that DO representation in program director positions may be limited, though the precise percentages for larger specialties such as internal medicine are not available in the literature. DOs in program director roles could potentially match more DO applicants within their medical residencies, especially if they oversee larger programs, which could ultimately increase visibility.

SUGGESTED WAYS TO IMPROVE AWARENESS

Improving awareness of the DO degree requires addressing professional and public misconceptions while highlighting the equivalence and distinctive contributions of osteopathic physicians, which can be achieved in several ways. First, there needs to be more strengthening of professional identity within the osteopathic community, as surveys reveal that rank-and-file osteopathic practitioners struggle with professional identification[9]. Many DOs identify holistic medicine and osteopathic manipulative treatment as distinguishing features, though professional identity remains complex, as not all DOs emphasize these elements of practice, which may ultimately manifest in behaviors such as degree misrepresentation. We suggest that DO physicians always display their degree label on their badges in the clinical setting. DO physicians should also take the possible steps to correct EMR chart misrepresentation whenever they are incorrectly labeled as MDs, and physicians in general should correct staffing whenever incorrect terminologies are used. For example, “Who is the MD on call tonight?” Sentences like these are frequently used within the hospital setting, even when a DO physician, in this instance, is on call. Surprisingly, there is a portion of nurses in the United States healthcare system who do not know that people with the DO degree are physicians, despite their frequent interactions. This trickles down to the hospital ancillary staff and patients, both in the hospital and clinics. Correcting chart misrepresentation and incorrect terminology may ultimately facilitate good practices that could result in increased degree recognition, which aligns with strengthening of professional identity.

Secondly, we suggest integrating DO into mainstream medical education discussions to help normalize the DO degree. The rapid growth of osteopathic medical education- with DOs comprising more than 25% of all United States medical school graduates- warrants their inclusion in standard medical education histories and policy discussions, from which they have been historically marginalized. We suggest more implicit bias training to reduce individual and systemic biases to facilitate more inclusive environments. This could potentially change hiring practices to include more DOs in prominent leadership positions. More DOs in program director roles could potentially match more DO applicants within their medical residencies, especially if they oversee larger programs, which could ultimately increase visibility. Lastly, educational outreach to the public and patients is essential, as less than 50% of patients identify their physicians as DOs even when treated by them. This suggests a need for clearer communication about DO credentials in clinical settings and in public health campaigns that explain that DOs are fully licensed physicians with training equivalent to that of MDs. With these steps and the continued expansion of DO medical schools, we can ultimately move toward normalization. These are all factors that can be addressed to ultimately improve awareness of the DO degree.

CONCLUSION

In summary, despite the gradual rise in the number of osteopathic physicians in the US healthcare workforce over the past several years, the DO degree remains underrecognized compared to the MD degree. This is partly due to degree misrepresentation by DO physicians themselves, professional identity issues, and limited representation in leadership positions and certain specialties, among others. Limiting degree misrepresentation, encouraging educational outreach to patients and the public, and increasing DO physicians in more prominent leadership roles are ways to improve osteopathic degree recognition. Future research in areas such as qualitative studies of patient perceptions, institutional audits of EMR labeling practices, and longitudinal analyses of leadership representation trends are needed to guide additional steps that can be taken to improve degree awareness.