Osteopathic Medical School Graduates' Perceptions of Bias in the Transition to Residency in the United States: a national cross-sectional survey
A national cross-sectional survey of 2,435 graduating US DO students reveals that a majority (62%) perceived bias based on their degree during the residency selection process, with significantly higher reports among female applicants and those applying to procedural specialties.
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In the United States, two distinct paths lead to the same destination: becoming a licensed physician. One path trains students to earn a Doctor of Medicine, or MD, degree, while the other leads to a Doctor of Osteopathic Medicine, or DO, degree. Though their training differs slightly in philosophy and technique, with osteopathic students receiving extra instruction in the body's musculoskeletal system and manual manipulation, both groups enter the same rigorous residency programs to specialize in fields like surgery, pediatrics, or internal medicine. For decades, these two groups have competed for spots in these training programs through a centralized matching system. However, as the number of osteopathic students has grown significantly in recent years, a quiet tension has emerged. Many in the field suspect that despite having similar skills and qualifications, osteopathic graduates face an invisible barrier, a subtle but persistent preference for their allopathic counterparts that shapes who gets hired and where.
A new national survey seeks to measure the weight of this feeling. Researchers from the American Association of Colleges of Osteopathic Medicine asked nearly four thousand graduating osteopathic students about their experiences during the residency selection process. The goal was not to prove that discrimination occurred in a legal sense, but to understand what the students themselves perceived as they navigated interviews, applications, and rotations. The findings reveal a landscape where a majority of these future doctors feel their degree is a disadvantage, a sentiment that varies sharply depending on the specialty they seek and their gender.
The survey, conducted after the 2023 residency matching season, asked students a direct question: did you experience bias because you are a DO? Nearly two-thirds of the respondents said yes. This perception was not evenly distributed across the board. Students applying for procedural specialties, such as surgery or orthopedics, reported feeling this bias far more often than those applying for non-procedural fields like family medicine or pediatrics. The disparity was even more pronounced when looking at gender. Female osteopathic students applying for procedural specialties reported the highest rates of perceived bias, with more than eight out of ten feeling that their degree worked against them. In contrast, students who matched into military residency programs reported much lower rates of this feeling, suggesting that the environment of the selection process plays a critical role in how bias is experienced.
The students described specific moments where this bias felt tangible. During visiting rotations, where students train at hospitals outside their home school to audition for residency spots, many reported being told they were not welcome or were asked to take an additional, expensive licensing exam that their allopathic peers did not need to take. In interviews, a significant number of students recounted being asked why they chose an osteopathic school instead of a medical school, or being made to feel that their training was inferior. One student described being told by a program director after a long day of interviews, "We usually don't take DOs, but thanks for coming." Another shared that they gave up on their dream of becoming a cardiothoracic surgeon because mentors told them no osteopathic doctor had ever matched at the programs they wanted, leading them to abandon the path before they even tried.
The researchers were careful to note that these are perceptions, not necessarily proof of discriminatory intent by every program director. The study design relied on self-reports, meaning it captures the students' lived experiences and how they interpreted the events around them. However, the authors argue that these perceptions are consequential regardless of their objective accuracy. When students feel unwelcome or undervalued, it influences their career choices, their mental well-being, and their sense of belonging in the medical profession. The data suggests that the current system may be pushing osteopathic graduates away from the most competitive specialties, potentially limiting the diversity of physicians in those fields.
This exclusion has broader implications for patient care. Osteopathic physicians are statistically more likely to practice in rural and underserved areas, providing essential primary care to communities that often lack access to medical services. If bias in the selection process prevents these doctors from entering certain specialties or programs, it could reduce the availability of care for the very populations that need it most. The study concludes that while the clinical performance of osteopathic and allopathic physicians is comparable, the atmosphere of the selection process often fails to reflect this equality. The authors suggest that medical training organizations need to take these reports seriously, investigating whether the feelings of bias reflect actual unfair treatment and working to ensure that the path to becoming a specialist is open to all qualified candidates, regardless of the letters after their name.
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