Allopathic and Osteopathic Physicians May Provide Equivalent Quality of Care

Atsushi Miyawaki, MD, PhD

Credit: ResearchGate

Elderly patients with Medicare experience similar hospital outcomes, including in quality and cost of care, when receiving treatment from an allopathic or osteopathic physician, according to new research.¹

The analysis showed no clinically important differences between allopathic and osteopathic-trained physicians serving as the principal physician in a care team regarding 30-day patient mortality after hospital admission, or for readmissions, length of stay, and healthcare spending.

“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,” wrote the investigative team, led by Atsushi Miyawaki, MD, PhD, from the department of public health in the graduate school of medicine at the University of Tokyo.

Medical education in the United States consists of two types of programs: allopathic medical schools awarding a Doctor of Medicine (MD) degree and osteopathic schools awarding a Doctor of Osteopathic Medicine (DO) degree. Reports suggest approximately 90% and 10% of practicing physicians in the US have MD and DO degrees, respectively. Educational requirements are broadly similar with both degrees licensed to practice medicine in every state; however, osteopathic schooling focuses on holistic care and body manipulation training.

The percentage of osteopathic physicians is expected to increase further, with 1 in 4 medical students in the US attending an osteopathic school. Osteopathic physicians are additionally more likely to practice in rural and underserved areas and may help attenuate disparities in access to health care. However, there is limited evidence regarding differences in hospital outcomes between allopathic and osteopathic physicians, with most data centered around processes of care and patient experience.

As a result, investigators cited the critical need for national data on the outcomes of patients treated by allopathic and osteopathic physicians. The current analysis used nationally representative data on Medicare fee-for-service beneficiaries admitted to hospitals with an urgent or emergency medical condition and treated by a hospitalist between 2016 - 2019 to compare the quality and cost of care between allopathic and osteopathic physicians.

To minimize the potential for unobserved differences in clinical severity that may affect patient outcomes, the analysis focused on patients admitted to hospitals with an urgent or emergency medical condition and treated by a hospitalist. The primary outcome was 30-day patient mortality, with secondary outcomes consisting of 30-day readmissions, length of stay, and health care spending. Analyses were adjusted for patient and physician characteristics, and hospital-level averages to presume differences within hospitals were estimated by investigators.

Of a total of 329,510 hospitalizations, 253,670 (77.0%) and 75.840 (23.0%) received care from allopathic and osteopathic physicians, respectively, with an overall unadjusted 30-day mortality rate was 9.4% (30,945 of 329,510). Upon analysis, investigators ruled out important differences in quality and costs of care between allopathic and osteopathic physicians.

Data showed the difference in 30-day mortality between allopathic and osteopathic physicians was clinically small (adjusted mortality rate, 9.4% for allopathic hospitalists vs. 9.5% for osteopathic hospitalists; average marginal effect [AME], 0.1 percentage point [95% CI, 0.4 - 0.1]; P = .36). In addition, the findings suggested no important differences between allopathic and osteopathic hospitalists in 30-day readmissions (15.7% vs. 15.6%), length of stay (4.5 vs. 4.5 days), or total Medicare Part B spending per admission ($1004 vs. $1003).

Investigators noted the results were consistent across a range of examined medical conditions, and the difference in 30-day mortality between allopathic and osteopathic hospitalists was clinically small across the severity of illness.

An accompanying editorial from Charlie M. Wray, DO, MS, from the division of hospital medicine at the San Francisco VA medical center, University of California San Francisco, further described the commonalities between osteopathic and allopathic medicine.²

Wray suggests that although the distinguishing characteristic that once separated osteopathic physicians was their use of osteopathic manipulative treatment, most physicians today do not use it in their practice. Moreover, although historically slower to adopt pharmacotherapy and modern scientific principles, osteopathic physicians today practice evidence- and science-based clinical medicine.

“Similarly, although osteopathic training focuses on providing holistic, patient-centered care, osteopathic medicine can hardly claim a monopoly on these terms and ideas as they now permeate the modern health care milieu,” Wray wrote. “Altogether, the functional distinction between allopathic and osteopathic physicians has become almost indistinguishable.”

However, the field of medicine may be reluctant to accept osteopathic physicians, with data from the National Resident Matching Program showing applicants from osteopathic medical schools are less likely to match into their preferred specialty compared with their allopathic counterparts.

“Disparities grow more pronounced with more competitive medical specialties, and many of the most famous and storied institutions in medicine list many fewer osteopathic physicians on their residency roster or faculty list than may be expected based on the prevalence of osteopathic physicians,” Wray wrote. “Yet, Miyawaki and colleagues’ work shows that in the most important ways, care from allopathic and osteopathic physicians does not differ.”

References

1. Miyawaki A, Jena AB, Gross N, Tsugawa Y. Comparison of Hospital Outcomes for Patients Treated by Allopathic Versus Osteopathic Hospitalists : An Observational Study [published online ahead of print, 2023 May 30]. Ann Intern Med. 2023;10.7326/M22-3723. doi:10.7326/M22-3723
2. Wray CM, Carmody JB. Equal and No Longer Separate: Examining Quality of Care Provided by Osteopathic and Allopathic Physicians [published online ahead of print, 2023 May 30]. Ann Intern Med. 2023;10.7326/M23-1165. doi:10.7326/M23-1165