Are Health Outcomes Any Different With MDs vs DOs?

Quality and cost of care were similar between allopathic (MD) and osteopathic (DO) physicians who care for older patients in hospital settings, according to a retrospective observational study.

Of over 300,000 Medicare admissions, the adjusted 30-day mortality rate was similar between MDs (9.4%) and DOs (9.5%), with an average marginal effect (AME) of -0.1 percentage point (95% CI, -0.4 to 0.1, P=0.36), reported Atsushi Miyawaki, MD, PhD, of the University of Tokyo in Japan, and co-authors.

In addition, 30-day readmission rates were also similar (15.7% vs 15.6%), with an AME of 0.1 percentage point (95% CI, -0.4 to 0.3, P=0.72), as were length of stay (4.5 vs 4.5 days, P=0.96), and healthcare spending ($1,004 vs $1,003, P=0.85), they reported in the Annals of Internal Medicine.

“The research suggests that whether a physician is trained in allopathic versus osteopathic medicine doesn’t matter for the quality of hospital care that a patient receives,” Miyawaki told MedPage Today.

“Any distinctions between allopathic and osteopathic medical schools, in terms of training or student demographics, aren’t associated with differences in costs or quality of hospital care,” he said. “We think that the findings of this study could contribute to the ongoing dialogue around the integral role of DO physicians in American healthcare. In fact, osteopathic schools are drastically increasing, raising the importance of the issue.”

The authors highlighted several potential explanations for the similarities in care between MD and DO physicians. They noted that both types of programs provide standardized medical education and have similarly rigorous standards for accreditation, including requiring 4-year curriculums of science courses and clinical rotations.

They emphasized that these similarities between academic rigor, accreditation standards, and clinical training standards all likely contributed to the similarities in outcomes seen in this study.

“These findings should be reassuring for policymakers, medical educators, and patients because they suggest that any differences between allopathic and osteopathic medical schools … are not associated with differences in quality or costs of care, at least in the inpatient setting,” the study authors concluded.

In an accompanying editorial, Charlie M. Wray, DO, MS, of the University of California San Francisco, and J. Bryan Carmody, MD, MPH, of Eastern Virginia Medical School in Norfolk, agreed that the two groups share remarkable similarities in education, training and, more recently, clinical practice.

“Historically, the distinguishing characteristic that has most obviously defined osteopathic physicians from their allopathic colleagues is the use of osteopathic manipulative treatment,” Wray and Carmody wrote. “However, recent surveys have shown that most osteopathic physicians do not use osteopathic manipulative treatment in their practice.”

The editorialists also noted that while DOs were initially trained to be suspicious of pharmacotherapy, modern DO providers practice evidence- and scientific-based clinical medicine just the same as MDs.

“Despite the quantitative and qualitative equivalence between allopathic and osteopathic physicians, medicine has often been reluctant to accept them into their highest ranks,” they wrote. “Yet, Miyawaki and colleagues’ work shows that in the most important ways, care from allopathic and osteopathic physicians does not differ.”

“As graduate medical programs push to create more diverse training environments, one might hope that the letters after an applicant’s name become just as inconsequential as the differences in the care that they provide,” they concluded.

For this study, Miyawaki and team used a 20% random sample of Medicare fee-for-service beneficiaries who were hospitalized from 2016 to 2019 and treated by an MD or DO hospitalist. They used CMS’s Medicare Data on Provider Practice and Specialty files for physician-level information and Doximity to determine a physician’s self-reported credentials. They also used the American Hospital Association’s annual survey to identify hospital characteristics.

Of 329,510 Medicare admissions, 77% received care from allopathic physicians, and 23% received care from osteopathic physicians. Mean patient age was 79.8, 59% were women, 83-86% were white, and 7-9% were Black.

Allopathic and osteopathic physicians had similar characteristics. MDs had a slightly older mean age compared with their DO counterparts (44.0 vs 40.1). A higher percentage of DOs were women (39.3% vs 36.6%), and the number of admissions per provider per year was higher among DOs (8.8 vs 7.0).

This article was developed in collaboration with ABC News.