By the time a patient arrives in an emergency room with chest pain, nobody asks whether the physician caring for them trained in an allopathic (M.D.) or osteopathic (D.O.) medical school. Both physicians prescribe medications, perform procedures, lead hospital teams, and practice under the same state licenses.

The credential on the wall does not change the care provided at the bedside.

The available outcomes data bear this out. A national cohort study published in JAMA Surgery found no significant differences in mortality, readmissions, or length of stay between patients treated by allopathic versus osteopathic surgeons. A separate large-scale analysis in Annals of Internal Medicine found the same for hospitalist physicians caring for Medicare patients.

Yet the training pipeline that produces these physicians still runs on two separate tracks. America maintains two accreditation bodies and two licensing examination pathways for physicians who will ultimately perform identical work. D.O. students are required to take their own licensing exam series. Many now feel pressured to sit for the M.D. licensing exams as well, paying twice the fees and preparing for two exam series, all to be considered competitive for the same residency positions as their M.D. counterparts.

The two-track divide does more than create an administrative and financial burden. It follows D.O. students into their careers, letting a degree rather than clinical ability decide which specialties they can enter, where they practice, and who they serve. It’s time to change that.

Established in 1874 by Andrew Taylor Still, osteopathic medicine emerged as a distinct approach to health care, emphasizing the musculoskeletal system’s role in health. In 1892, Still founded the American School of Osteopathy. At the time, allopathic medicine in the U.S. was based on Hippocrates’ belief that humoral imbalances led to disease. The phrase “allopathic medicine” was coined in 1810 by Samuel Hahnemann to distinguish it from his new branch of medicine, homeopathy.

The historical development of accreditation for undergraduate medical education in the U.S. began around 1847 with the establishment of the American Medical Association (AMA). Several decades later, the Liaison on Committee Medical Education (LCME) was founded at a 1942 meeting between leaders of the Association of American Medical Colleges and the AMA.

Now, medical schools in the U.S. are accredited through either the LCME or the Commission on Osteopathic College Accreditation.

D.O. seniors match into all specialties at lower rates than their M.D. peers, and the 2024 NRMP Program Director Survey helps explain why. Across all specialties, nearly 1 in 10 programs said they never consider a U.S. D.O. applicant. In the most competitive specialties, that statistic rises sharply: In vascular surgery, 30% of programs reported never considering D.O. students, and another 40% said they seldom did. Not a single program said the same about M.D. students. That is bias, and it operates on a credential rather than on a candidate.

It is fair to ask whether D.O. students match at lower rates simply because they were weaker applicants to begin with. M.D. programs do admit students with higher average test scores and grades. But residency programs are not trying to recruit the best test takers. They are trying to produce the best physicians. The question is really a prediction: that students who enter with lower numbers will leave as weaker physicians. Across hundreds of thousands of patients, the studies above found no difference in outcomes between physicians holding the two degrees.

What persists, then, is not a clinical judgment but an institutional habit, and the burden of proof has been sitting on the wrong side of it all along. D.O. students spend four years and thousands of dollars proving they are equivalent, sitting for two exam series and applying more broadly to hedge against a bias they cannot control. The system that draws the distinction has never had to show it means anything.

The answer is structural. Merge the two medical education systems into one. This is not as radical as it sounds. The same reform has already happened at the graduate level.

In 2020, graduate medical education successfully transitioned into a single accreditation system under the Accreditation Council for Graduate Medical Education (ACGME). Before that merger, M.D. and D.O. residency programs operated in entirely separate worlds. Critics warned the new system would fail. Instead, the transition succeeded and standardized postgraduate training nationwide.

The same model can work at the medical school level, and it need not erase what is distinctive about osteopathic medicine. Following the residency merger, more than 250 residency programs voluntarily sought osteopathic recognition, an ACGME designation certifying that a program teaches osteopathic philosophy and manipulative medicine to its residents, with faculty credentialed to do so.

A unified medical school framework could offer a similar pathway. Interested students could pursue an optional curriculum track or elective concentration in osteopathic principles, available at any accredited school rather than confined to a parallel one.

What is needed now is a joint commission on physician education modernization. The two accrediting bodies that currently govern allopathic and osteopathic medical education cannot act alone. A joint body should set a unification timeline, consolidate the two licensing pathways into a single national exam, and protect the schools serving rural and underserved communities through the transition.

America faces a worsening physician shortage and rising student debt. Maintaining two parallel education systems for functionally equivalent degrees has outgrown its rationale. It is historical inertia dressed as educational diversity. A joint commission to merge the two systems is the obvious place to start.

That patient in the emergency room never asked about accreditation. The only thing that mattered was competency. American physician education should answer to the same standard. It is past time we built a system that does.

Abigail MacKenzie, M.D., is an internal medicine resident physician and a graduate of Nova Southeastern University’s Dr. Kiran C. Patel College of Allopathic Medicine, with an interest in medical education. Vijay Rajput, M.D., has more than 25 years of experience in undergraduate and graduate medical education, including service as a residency program director, assistant dean, and medical school educational leader at Nova Southeastern University’s Dr. Kiran C. Patel College of Allopathic Medicine. The views expressed here are the authors’ own and do not represent the positions of their employers or affiliated institutions.