Osteopathic medicine emerged in the U.S. in 1874 under the vision of Andrew Taylor Still, who sought to reform medical practice by emphasizing the body’s inherent capacity for self-healing and the importance of treating disease holistically. Over the past 150 years, osteopathic medicine has evolved into a robust, evidence-based system of medical training that parallels allopathic medicine in curriculum, clinical exposure, and licensure outcomes. With approximately 30% of medical students in the U.S. pursuing a Doctor of Osteopathic Medicine (DO) degree, the field has grown rapidly and become a significant force in American health care.
Despite this progress, many DOs are not given a fair chance.
A persistent belief, often echoed by medical schools and residency programs, is that osteopathic students are inherently more likely to choose a career in primary care. At first glance, the statistics appear to support this claim, as a greater proportion of DO graduates enter family medicine, internal medicine, and pediatrics compared to MD students. However, this framing raises an important question: How much of this trend reflects genuine choice, and how much results from structural barriers within the residency system?
Residency placement data suggest that the disparity is not explained by preference alone. Osteopathic students continue to face challenges when applying to historically competitive specialties such as dermatology, orthopaedic surgery, and certain subspecialties of internal medicine. Bias, whether overt or subtle, persists in many residency programs, limiting opportunities for DO students despite equivalent training, board scores, and clinical experience. The merger of the American Osteopathic Association and the ACGME residency accreditation systems was intended to unify pathways and reduce inequities. While this was an important step forward, discrepancies in Match outcomes reveal that the work is far from complete.
Even within so-called “DO-friendly” specialties, the playing field is not always level. I am fortunate that the specialty to which I am applying is regarded as relatively welcoming to osteopathic applicants. However, this is not the case for many of my peers. Each year, thousands of osteopathic students face uncertainty, as even top programs in historically DO-friendly fields may limit or exclude osteopathic applicants. This leaves students with fewer viable options, forcing them to apply to an excessive number of programs or even to dual-apply across multiple specialties, often at considerable financial and emotional cost. Practices like these place unnecessary strain on students while simultaneously inflating the residency application pool and overwhelming program directors. What appears inclusive on paper often turns out to be a false sense of opportunity in practice.
The narrative that DOs are “more primary care oriented” also deserves scrutiny. While many osteopathic students are passionate about primary care (and rightly so, as it is the backbone of the health care system), this framing can be misleading. To assume that primary care is the universal preference of most DO students ignores the fact that many choose these fields not solely out of interest, but because other doors have been closed. Reducing osteopathic medicine to a primary care pipeline diminishes the individuality, ambition, and diverse interests of its students. At the same time, primary care deserves residents who are genuinely passionate about serving in these essential roles, not those who feel constrained by systemic barriers. Ensuring that DOs can pursue their preferred specialties allows primary care to remain staffed by physicians motivated by true interest and commitment, while also allowing osteopathic physicians to flourish across the full spectrum of medicine.
The osteopathic philosophy was founded on the principle of expanding, not limiting, opportunities for patient care. True recognition of osteopathic physicians requires dismantling structural biases, increasing transparency in program selection criteria, and ensuring that DO applicants are evaluated fairly alongside their allopathic peers. Whether in primary care or in the most competitive subspecialties, DOs bring a unique perspective grounded in holistic, patient-centered care. By removing artificial barriers and allowing osteopathic physicians to follow their interests and passions, the medical community can honor the founding principles of osteopathy while strengthening health care for all patients.
Sophia Valerino is a fourth-year medical student at Lake Erie College of Osteopathic Medicine.
Illustration by Diana Connolly
