Quality, Costs of Care Similar Between DOs and MDs

A new study demonstrates that doctors of osteopathic medicine, or DOs, have similar patient outcomes and costs of care to doctors of medicine (MDs).

Patient mortality rates, hospital readmissions, and lengths of stay were nearly identical for hospitalized elderly patients treated by DOs compared to those treated by MDs, according to the study recently published in the Annals of Internal Medicine.

Of the over 329,000 Medicare admissions analyzed:

• Patient mortality was 9.4 percent for allopathic physicians versus 9.5 percent for osteopathic hospitalists
• Hospital readmission was 15.7 percent for allopathic physicians versus 15.6 percent for osteopathic hospitalists
• Length of stay was 4.5 days for both allopathic physicians and osteopathic hospitalists

Healthcare spending on hospitalized elderly patients was also similar, differing by just $1 in the study.

“These findings offer reassurance to patients by demonstrating that they can expect high-quality care regardless of whether their physicians received their training from allopathic or osteopathic medical schools,” senior author Yusuke Tsugawa, PhD, MPH, MD, said in a press release. Tsugawa is an associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and an associate professor of health policy and management at the UCLA Fielding School of Public Health.

The study’s other authors are Anupam B. Jena, MD, PhD, of Harvard University, Massachusetts General Hospital and the National Bureau of Economic Research; Nate Gross, MD, MBA, of Doximity; and Atsushi Miyawaki, MD, PhD, of UCLA and the University of Tokyo.

DOs and MDs do the same job after a similar rigorous educational journey. But osteopathic training has a more holistic or whole-person approach to care delivery, which includes more focus on musculoskeletal system manipulation — for instance, the use of stretching and massage to reduce pain or improve mobility.

Both types of doctors are licensed to practice medicine in every state. However, UCLA researchers say most practicing physicians hold MD degrees, while about 10 percent have DO degrees. Tides are starting to change, though, with the number of DOs rapidly increasing alongside the number of osteopathic medical schools and training programs.

The findings bring good news to older rural and underserved patients since osteopathic doctors are more likely to serve those types of patients, according to Tsugawa and colleagues.

The researchers attribute similar patient outcomes and costs of care to the rigorous, standardized medical education that both types of doctors receive. Both types of doctors must also comply with comparable accreditation standards, including four-year curriculums mixing science and clinical rotations, Tsugawa said.

However, the study has several limitations. Primarily, the study focused on a 20 percent sample of Medicare fee-for-service beneficiaries who were hospitalized, which means the findings are limited to an older population with medical conditions. Tsugawa et al. said the results may not translate to other patient populations.

Additionally, they limited outcomes to specific measures of care quality and resource use, so these findings may not generalize to other outcomes.

Despite the limitations, researchers wrote in the study that the 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.”