MD and DO Physicians Provide Similar Quality and Cost of Care, Study Finds

Researchers compared the performance of doctor of medicine (MD) and doctor of osteopathic medicine (DO) hospitalists in the care of Medicare beneficiaries.

Physicians who are doctors of medicine (MDs) and doctors of osteopathic medicine (DOs) generate similar results on key indicators of quality and cost of care, a new research article says.

Among practicing physicians, about 90% hold MD degrees and about 10% hold DO degrees. Medical education for MDs and DOs is similar, although DOs have a more holistic focus and inclusion of manipulation training in osteopathic schools. MDs and DOs are licensed to practice medicine in all 50 states.

The research article, which was published by Annals of Internal Medicine, features data collected from more than 329,000 Medicare admissions at acute care hospitals from January 2016 to December 2019. Among the Medicare admissions of patients over age 65, 77.0% received care from an MD hospitalist and 23% received care from a DO hospitalist. The inpatients in the study had been admitted to hospitals with urgent or emergency conditions.

The research article features four key findings:

• 30-day patient mortality was similar for MD and DO hospitalists, with a 9.4% rate for MDs and a 9.5% rate for DOs
   
• 30-day readmissions were similar for MD and DO hospitalists, with a 15.7% rate for MDs and a 15.6% rate for DOs
   
• Hospital length of stay (LOS) for MDs and DOs was identical at 4.5 days
   
• Medicare Part B spending for MDs and DOs was nearly identical at $1,004 and $1,003, respectively

"We found that allopathic and osteopathic physicians performed similarly in terms of patient mortality after hospital admission, readmissions, LOS, or health care spending when they cared for elderly patients and worked as the principal physician in a team of health care professionals that often included other allopathic and osteopathic physicians. These findings should be reassuring for policymakers, medical educators, and patients because they suggest that any differences between allopathic and osteopathic medical schools, either in terms of educational approach or students who enroll, are not associated with differences in quality or costs of care, at least in the inpatient setting," the research article's co-authors wrote.

Interpreting the data

There are four potential explanations for why quality and cost of care were found to be similar for MD and DO hospitalists, according to the research article.

• MD and DO medical schools are both required to provide standardized medical education based on accreditation systems. MD and DO medical schools have similar accreditation standards such as a four-year curriculum that features science courses and clinical rotations. Standardized tests required for all physicians "may function as a safeguard toward excluding nonqualified medical students from either type of school."
   
• Residency and fellowship training that physicians receive after medical school may help standardize how MDs and DOs practice medicine.
   
• Lack of time, institutional support, and reimbursement are structural barriers that result in most DOs not using osteopathic manipulative treatment. So, there may be only minor differences in how MDs and DOs practice medicine.
   
• This study compared MDs and DOs practicing within the same hospitals. So, hospital efforts to ensure care quality may limit the variation between the ways individual MDs and DOs practice medicine.