Study: MDs and DOs offer similar quality, cost of care

Key takeaways:

• There were no major differences between MDs vs. DOs in terms of mortality, readmission, length of stay and health care spending.
• Given a rise in DOs, the results should reassure medical educators and patients.

Medicare patients who were treated by osteopathic and allopathic hospitalists received similar quality and costs of care, according to the results of research published in Annals of Internal Medicine.

There are two types of degree programs that educate physicians in the United States: allopathic and osteopathic medical schools, which produce MDs and DOs, respectively, Atsushi Miyawaki, MD, PhD, a visiting professor at the University of Tokyo, and colleagues wrote.

Both types of schools have similar educational requirements and both types of physicians are licensed to practice medicine in every state, the researchers wrote.

Although about 90% of practicing physicians in the United States have MD degrees, Miyawaki and colleagues noted that the number of osteopathic physicians has been on the rise in recent years. From 2010 to 2020, the percentage of allopathic physicians increased 16% while the percentage of osteopathic physicians increased 72% during the same period. That trend is only expected to continue given the fact that one in four medical students in the U.S. attend an osteopathic school.

However, “evidence is limited as to whether quality and costs of care differ between allopathic and osteopathic physicians,” the researchers wrote.

“Given the increasingly important role that osteopathic physicians play in patient care and an ongoing debate about differences between the medical education and training that allopathic and osteopathic physicians receive, national data on whether quality and costs of care differ between allopathic and osteopathic physicians is critically important,” Miyawaki and colleagues wrote.

The researchers conducted a retrospective observational study to assess whether the quality and cost of care differ between patients treated by osteopathic or allopathic physicians. They used nationally representative data for 329,510 Medicare patients admitted to hospitals with an urgent or emergency medical condition and treated by a hospitalist during 2016 to 2019 to estimate 30-day patient mortality, 30-day readmission, length of stay and health care spending.

Miyawaki and colleagues found that 77% of the participants received care from allopathic physicians and 23% received care from osteopathic physicians, but there were no major differences between the two groups.

Their results, they wrote, rule out important differences in costs and quality of care between osteopathic and allopathic physicians for:

• patient mortality (9.4% for allopathic physicians vs. 9.5% for osteopathic hospitalists; average marginal effect [AME] = -0.1 percentage point; 95% CI, -0.4 to 0.1 percentage point);
• readmission (15.7% vs. 15.6%; AME = 0.1 percentage point; 95% CI, -0.4 to 0.3),
• length of stay (4.5 vs. 4.5 days; adjusted difference = -0.001 day; 95% CI, -0.04 to 0.04), and
• health care spending ($1,004 vs. $1,003; adjusted difference = $1; 95% CI, -8 to 10).

“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,” Miyawaki and colleagues concluded.

In a related editorial, Charlie M. Wray, DO, MS, an associate professor of medicine at the University of California San Francisco, and J. Bryan Carmody, MD, MPH, an associate professor at Eastern Virginia Medical School, wrote the findings demonstrate 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,” Wray and Carmody wrote.

References:

• Miyawaki A, et al. Ann Intern Med. 2023;doi:10.7326/M22-3723.
• Wray CM, et al. Ann Intern Med. 2023;doi:10.7326/M23-1165.