DO vs MD Match Rates by Specialty: What the Post-Merger Numbers Actually Show

In 2020, the American Osteopathic Association completed its merger with the Accreditation Council for Graduate Medical Education. One accreditation system. One match. A level playing field for DO and MD graduates.

That was the promise, anyway.

Five years later, the data tells a more complicated story. DO seniors are matching at record-high overall rates, but those headline numbers mask enormous specialty-level disparities that every pre-med and medical student considering a DO path needs to understand.

This post breaks down the actual NRMP match data, the peer-reviewed research on post-merger outcomes, and what it all means for the decision that keeps showing up on every pre-med forum: "Should I go DO if I want to do ortho/derm/neurosurgery?"

What the Single Accreditation Merger Actually Changed

Before 2020, there were two separate systems for residency training. The ACGME accredited residencies that primarily trained MD graduates. The AOA accredited a parallel set of osteopathic residency programs that were open exclusively to DO graduates. DO students could apply to both systems, but they had protected slots in AOA programs that MD graduates could not access.

The merger, formally called the Single Accreditation System, collapsed these two tracks into one. Every residency program would now be ACGME-accredited. DO students would compete in a single match alongside MD students and international medical graduates.

The intended benefit was clear: DO graduates would no longer be siloed into a separate, sometimes lower-profile training track. They could compete for any residency on equal footing.

But the merger came with a cost that gets less attention. More than one-quarter of eligible osteopathic surgical programs either did not apply for ACGME accreditation or voluntarily withdrew from the process, according to a study published in the Journal of the American Osteopathic Association. That translated to the loss of 41 surgical programs and a meaningful reduction in training positions during a period when DO enrollment was growing rapidly.

In other words, the merger eliminated the protected pipeline without guaranteeing that the newly unified system would absorb DO graduates at the same rate.

The Headline Numbers: Overall Match Rates Look Great

If you only look at the top-line statistics, the post-merger era has been a success story for DO graduates.

In the 2025 NRMP Main Residency Match, DO seniors achieved a 92.6% PGY-1 match rate, an all-time high. That was up from 92.3% in 2024, itself a record. For comparison, MD seniors matched at 93.5%. The gap between the two is less than one percentage point.

These numbers represent real progress. DO senior match rates have climbed 3.5 percentage points since 2021. Nearly 7,800 DO seniors matched to PGY-1 positions in 2025 out of roughly 8,400 who submitted rank lists.

But the overall match rate is doing a lot of heavy lifting here, and it is obscuring what happens when you zoom into specific specialties.

Where the Gap Disappears: Primary Care and Mid-Tier Specialties

In several large specialties, DO and MD students compete on essentially equal footing. The numbers reflect genuine parity.

Family Medicine is the clearest example. In 2025, MD seniors filled 1,501 positions and DO seniors filled 1,482. That is near-parity in absolute terms, and when you account for the fact that there are more MD graduates overall, DO students are actually overrepresented in family medicine relative to their share of the applicant pool.

Emergency Medicine shows a similar pattern. MD seniors claimed 1,377 spots and DO seniors took 1,078 in the 2025 match. DO graduates represent a substantial and growing share of the emergency medicine workforce.

Internal Medicine is the largest single specialty, and DO students claimed 1,882 of its categorical positions in 2025 compared to 3,782 for MD seniors. Given that DO graduates make up roughly 28% of all U.S. medical students, their share of internal medicine positions is proportional.

Pediatrics tells the same story: 1,476 MD seniors and 640 DO seniors matched in 2025.

Psychiatry has become increasingly popular across both degree types, with 1,433 MD and 542 DO seniors matching in 2025.

If you are headed toward primary care, emergency medicine, psychiatry, or general internal medicine, the DO vs MD distinction has minimal practical impact on your match chances. The data supports this clearly.

Where the Gap Is a Canyon: Competitive Surgical and Procedural Specialties

Now look at the other end of the spectrum.

Orthopedic Surgery is the specialty with the most data on this question, and the numbers are stark. In the 2025 match, all 929 orthopedic surgery positions were filled. MD seniors took 724 of those spots. DO seniors took 131. That means DO graduates filled roughly 14% of orthopedic positions despite representing 28% of all U.S. medical students.

But raw position counts only tell part of the story. The match rate -- the percentage of applicants who actually match -- reveals a deeper disparity. A 2024 study in Clinical Orthopaedics and Related Research found that from 2019 to 2023, 74.5% of allopathic students who applied to orthopedic surgery successfully matched, compared to just 59.9% of osteopathic students. More recent data from a PMC-published study covering 2020 to 2023 showed the gap widening further, with MD match rates around 73% and DO match rates dropping to approximately 50% in some years.

A finding from the 2022 NRMP Program Director Survey adds important context: 63% of orthopedic surgery program directors reported that they "seldom or never" interview osteopathic applicants. Only 16% said the same about allopathic applicants. That is not a subtle bias.

Plastic Surgery is even more extreme. All 221 integrated plastic surgery positions were filled in the 2025 match. MD seniors captured approximately 89% of those spots with 197 matches. DO seniors secured just 2 positions. Two.

Neurological Surgery follows the same pattern. Of 265 filled positions in 2025, MD seniors took 228. DO seniors matched into 5. That is less than 2% of the total.

Otolaryngology (ENT) shows a slightly better but still significant disparity. Of 35 DO senior applicants in 2025, 21 matched, for a 60% match rate. Compare that to the MD match rate in the same specialty, which consistently runs above 75%.

Dermatology may be the most studied example. Research published in the Journal of Osteopathic Medicine examined match data and found that from 2012 to 2016, DO graduates comprised just 0.9% of ACGME dermatology positions. Post-merger, from 2017 to 2019, that number appeared to rise to 4.4%, but the researchers demonstrated that this increase was almost entirely explained by formerly AOA-accredited dermatology programs transitioning to ACGME status. The true post-merger DO match rate to traditionally ACGME-accredited dermatology programs was just 0.4%.

A 2025 study analyzing dermatology match disparities from 2020 to 2024 confirmed that the pattern persists. DO applicants continue to match at significantly lower rates than MD applicants, and the majority of DO matches cluster in former AOA-accredited programs rather than legacy ACGME programs.

The Numbers in Context: A Specialty-Level Snapshot

Here is how the 2025 match data breaks down across key specialties, showing the approximate share of positions filled by DO seniors versus MD seniors.

The pattern is clear. In specialties where DO students make up 20-35% of matched residents, the playing field is roughly level or favors DO students relative to their share of graduates. In the most competitive surgical and procedural specialties, DO representation drops to single digits or lower.

The Paradox the Merger Created

Here is the uncomfortable truth that gets buried in forum debates. The single accreditation merger was supposed to help DO students by removing the stigma of a separate training track. In many specialties, it did exactly that. DO seniors are matching in record numbers overall.

But for competitive surgical and procedural specialties, the merger may have made things harder.

Before 2020, a DO student who wanted to do orthopedic surgery had a backup plan: AOA-accredited orthopedic residencies that were reserved for DO graduates. Those programs were not always as prestigious, but they existed. The merger eliminated those protected positions without fundamentally changing how legacy ACGME program directors evaluate applicants.

The result is a system where DO students compete in a single pool but face program directors who, according to survey data, often do not interview them. The protected slots are gone. The bias is not.

This is not speculation. It is published research. A 2024 study in PMC noted that many factors predicting a successful orthopedic surgery match -- AOA Honor Medical Society membership, attending a top-40 medical school, holding a USMLE score -- are either unavailable to or not required of DO students. The system measures applicants against benchmarks that structurally disadvantage one group.

The COMLEX vs USMLE Question

One of the most consequential decisions a DO student makes is whether to take the USMLE in addition to the required COMLEX exams.

The data is clear on this point. For competitive specialties, taking the USMLE is close to mandatory in practice, even if no official policy requires it. A 2022 study in the Journal of Graduate Medical Education found that roughly 60% of DO students sat for at least one USMLE section in addition to COMLEX.

The reason is straightforward. Program directors in competitive specialties know how to interpret USMLE scores. Many are less familiar with COMLEX scoring, and some residency screening software is built around USMLE cutoffs. A DO applicant with only COMLEX scores may not clear the initial filter at many programs, regardless of how strong their application is otherwise.

With USMLE Step 1 now pass/fail, Step 2 CK has become the differentiating exam. For DO students targeting competitive specialties, taking USMLE Step 2 CK and scoring well is one of the highest-leverage moves available. It does not erase the DO-MD gap, but it removes one barrier that programs use to screen applicants.

For primary care and mid-tier specialties like family medicine, internal medicine, psychiatry, and emergency medicine, COMLEX scores alone are widely accepted. The dual-exam burden is primarily a competitive specialty problem.

What Successful DO Applicants to Competitive Specialties Actually Do

The data on what differentiates DO students who match into competitive specialties is instructive.

Research output matters more for DO applicants. According to NRMP Charting Outcomes data, matched DO seniors in dermatology averaged 4.5 research experiences and 11.8 abstracts, presentations, and publications. In neurological surgery, the average was 11 research outputs. In orthopedic surgery, it was 5.1 research experiences. These numbers are high by any standard, and for DO applicants, they need to be because research is one of the few areas where a strong showing can partially offset institutional bias.

Away rotations are critical. Research has shown that completing an away rotation at a program is statistically associated with increased odds of matching, independent of board scores. For DO students, audition rotations serve a dual purpose: they demonstrate clinical competence directly to decision-makers and they build relationships that can lead to interview invitations from programs that might otherwise filter out osteopathic applicants.

Board scores remain the foundation. Research alone rarely compensates for below-average board scores in competitive fields. The reverse is more common: excellent scores with modest research can still lead to a match. For DO students, this means USMLE Step 2 CK performance is the single most important metric to optimize.

Mentorship and connections are disproportionately important. DO students at osteopathic medical schools often lack built-in mentorship networks in surgical subspecialties. The students who match into ortho, derm, or neurosurgery from DO programs typically sought out mentors at affiliated MD-granting institutions or academic medical centers early in their training.

The Pre-Med Decision: Should You Retake the MCAT or Go DO?

This is the question underneath all of this data, and it is worth addressing directly.

If you have a 505 MCAT and your dream is dermatology, orthopedic surgery, neurosurgery, or plastic surgery, the numbers suggest you should seriously weigh retaking the MCAT against attending a DO school. That is not a knock on osteopathic education. It is a reflection of what the match data shows about competitive specialty access.

The calculus looks something like this:

If your target specialty is primary care, emergency medicine, psychiatry, or PM&R, going DO is a perfectly sound decision. The match data shows near-parity, and the training quality across these fields is equivalent. Your degree type will not meaningfully limit your options.

If your target specialty is orthopedic surgery, going DO means you will need to significantly outperform the average applicant in research and board scores to overcome a structural disadvantage. It is possible -- 131 DO seniors matched in ortho in 2025 -- but the match rate is roughly 15 to 20 percentage points lower than for MD applicants.

If your target specialty is dermatology, neurosurgery, or plastic surgery, going DO makes the path dramatically harder. The absolute numbers are small enough that each match cycle, only a handful of DO students break through. You would be betting your career trajectory on being one of 2 to 5 people nationally in some specialties.

None of this means DO education is inferior. It means the residency selection system has not caught up to the promise of single accreditation. If you are a pre-med weighing this decision, your starting point should be honest data, not reassuring forum posts.

If you decide on the DO path, GradPilot can help you craft an AACOMAS personal statement that shows genuine engagement with osteopathic philosophy, not a copy of your AMCAS essay.

If you are navigating the DO vs MD application decision and wondering how it affects your personal statement strategy, we covered the AACOMAS vs AMCAS essay differences in depth here. The short version: your application essays need to reflect genuine engagement with osteopathic philosophy, not just a backup plan mentality.

Is the Gap Closing?

There are some encouraging signs, but "closing" is a strong word.

DO seniors increased their share of orthopedic surgery positions by 1.3 percentage points in 2025. In child neurology, DO representation jumped by nearly 5 percentage points. Medicine-Pediatrics saw a 2.9 percentage point increase in DO share.

At the overall level, the trajectory is positive. DO match rates have risen steadily since 2021, and the gap with MD seniors is the narrowest it has ever been.

But in the most competitive specialties, progress is glacial. The number of DO students matching into plastic surgery, neurosurgery, and dermatology has barely moved year over year. And the pool of DO applicants keeps growing -- roughly 28% of all U.S. medical students now attend osteopathic schools, up from around 25% just a few years ago. Enrollment at DO schools has grown 66% over the past decade, with nearly 9,000 new DO graduates entering the workforce each year.

More applicants competing for essentially the same number of competitive specialty slots means the per-applicant match rate may actually be getting worse, even as absolute numbers tick up slightly.

What Needs to Change

The published research points to several structural issues that headline match rates cannot fix.

Program director attitudes lag behind policy. The 2022 NRMP survey showing that 63% of orthopedic program directors seldom or never interview DO applicants is a systemic problem, not an individual one. Single accreditation changed the administrative structure. It did not change decades of institutional culture.

Osteopathic schools lack infrastructure for competitive specialties. Many DO schools do not have affiliated orthopedic, dermatology, or neurosurgery departments. Their students lack research mentors, clinical exposure, and the informal networks that drive competitive specialty matching. This is a resource problem that individual student effort cannot fully overcome.

The metrics favor MD-school infrastructure. USMLE scores, research productivity, AOA Honor Society membership, medical school prestige rankings -- these benchmarks were built for and around allopathic medical education. Evaluating DO students against them without adjustment creates a structural disadvantage independent of individual capability.

Several researchers have called for program-level interventions: holistic review processes, explicit policies against degree-type screening, and investment in research infrastructure at osteopathic institutions. Whether these changes happen at scale remains to be seen.

The Bottom Line

The single accreditation merger accomplished part of its mission. DO graduates now compete in one match and match at record overall rates. For most specialties, the DO path leads to the same outcome as the MD path.

But for competitive surgical and procedural specialties, the data is unambiguous: DO graduates face a significant and persistent disadvantage. That disadvantage is structural, not individual. It shows up in program director interview practices, in research access, in board exam interpretation, and in the loss of protected training positions that the merger eliminated.

If you are making the DO vs MD decision right now, base it on the specialty-level data for your target field, not on overall match rates. If you are a DO student targeting a competitive specialty, invest early and heavily in research, seek out USMLE Step 2 CK preparation, pursue away rotations aggressively, and find mentors outside your home institution.

The numbers are not destiny. But they are the clearest map we have.

From data to application

If the data points you toward the DO path, your AACOMAS personal statement needs to demonstrate genuine engagement with osteopathic medicine -- not read like a backup plan. GradPilot can help you write an application that reflects the deliberate choice the match data supports.