Phil WestBy Phil West, WCI Contributor

Is it worth it to become a doctor of osteopathic medicine— aka a DO— instead of becoming a doctor with the more commonly known MD (aka Medical Doctor) designation? The DO vs. MD question largely boils down to the type of medicine that a doctor wants to practice. It’s also important to consider that becoming a DO entails much of the same kind of training that it takes to become an MD but, on average, pays a little less. Yes, there is a difference in salary between an MD and a DO.

The pay differential is, in part, due to many MDs choosing higher-paying specialties, according to an Indeed article comparing the two types of degrees. The main difference between the two tracks, according to the Cleveland Clinic, is that a DO is trained in osteopathic medicine, which “emphasizes the relationship between the mind, body, and spirit. It focuses on treating the person and improving wellness through education and prevention.” That’s different than what MDs focus on—allopathic medicine, which “uses medication, surgery and other interventions to treat illnesses.” 

 

How Do You Become a DO? 

Becoming a DO is a lot like becoming an MD. The journey begins with an undergraduate degree and the MCAT exam, and while the standards for traditional medical schools might be slightly more rigorous than a DO program, there’s not that much difference. 

There is a broader selection of schools if you’re going the MD route; the International Medical Aid site notes there are 37 DO-granting institutions compared to 155 that take the allopathic, MD-granting approach. Resources like the American Association of Colleges of Osteopathic Medicine (AACOM) and the American Osteopathic Association (AOA) websites include info on colleges and universities with DO programs. 

The four-year curriculum of both programs includes two years in the classroom followed by third and fourth years in clinical rotations. Students then complete three or more years in a residency program, depending on the specialty chosen. DO candidates also take on one extra step compared to their MD counterparts: 200 hours of training in what’s called osteopathic manipulative medicine, which is done in a one-year program coming after a residency. 

DOs can take the standard US Medical Licensing Exam (USMLE) that MDs take, but they also must take the three-part Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA), starting after the second and third years of school and finishing after graduation. 

More information here:

Choosing Your Physician Board Certification Organization (ABMS, AOA, ABPS)

 

What Do You Do Once You’ve Got Your DO Degree? 

According to the AACOM, more than one in four US medical students goes the DO route, set to join the growing number of doctors with DO degrees. In 2023, according to the AOA, the total number of osteopathic physicians in the US reached almost 149,000—a 30% increase over the past five years. 

Upon graduation and completing osteopathic manipulative medicine training, 57 % of DOs go into one of three primary care fields: family medicine, internal medicine, and pediatrics. 

The White Coat Investor has noted that though annual salaries for various types of practices can be hard to pin down, the three fields most common to DOs are toward the lower end of the spectrum for physician pay. The AOA does offer board certification in 27 specialties and 48 subspecialties for DOs who want to pursue those avenues of patient care. 

 

Salary for Osteopathic Doctor

Here's a chart from the 2024 Medscape Physician Compensation Report that shows the average salaries of several specialties (though these numbers are not separated by the MD or DO designations).

 

doctors average annual earnings

 

Preventive medicine can boost an annual family medicine salary by a significant amount, and seeing that DOs already have focus and training in that approach, that’s one avenue to investigate. 

It’s also noteworthy that some DOs gravitate toward emergency medicine, OB/GYN, and surgery practices, all of which average more toward the middle of the pay spectrum. For DOs looking to sell that point of difference in their practices, it’s less common to have a DO-trained surgeon or OB/GYN than a family practice doctor. So, if the osteopathic approach is important to people looking for a particular specialist, it’s possible that the DO designation makes you even more appealing. 

As more and more people learn about the differences between MDs and DOs, it’s always possible that more people will seek out DOs if a more holistic approach aligns more with the kind of care they desire. 

More information here:

Do For-Profit Medical Schools Provide an Inferior Education for Higher Costs?

 

You Have to Look at the Numbers — All the Numbers

do vs md salary

Through various surveys and reports, it's clear that in the comparison of DO vs. MD salary levels, DOs tend to make less money. One source says DOs make an average of about $312,000 per year, while Medscape says the average doctor makes $363,000.

It's important to remember that a lot of factors go into determining the purchasing power of a doctor’s salary. There’s also the idea we’ve espoused before that intraspecialty pay variation is higher than interspecialty pay variation, and unless you know that, you don’t have a good sense of how much you could make if you stick with a specific field over time. Geography can also play an important role in a physician's purchasing power as living in a lower-cost-of-living area can be highly beneficial when the need for physicians is so great.

Ultimately, it comes down to how you want to practice medicine and how you want to prioritize financial independence. While it might make more sense to pursue an MD in favor of a DO just on the base salary numbers and on the extra year that a DO requires—a year in which you could be practicing rather than training—it also hinges on the type of doctor you want to be and where you might want to live. As a DO, you could certainly make more money and be happier than you might as an MD. 

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